The nonmuscle invasive bladder cancer treated with BCG instillations in patients who smoke could potentially lead to poorer oncological results in the light of the new EAU risk groups classification for NMIBC that did not include BCG treated patients or smoking status.
Outcomes from 1313 patients with nonmuscle invasive bladder cancer treated with TURBT, re-TURBT and BCG instillations at 13 academic hospital centers, since 2002, has been included in this retrospective study. The study variables, including cumulative smoking exposure have been analyzed. A multivariable Cox proportional hazard model was used to assess associations between smoking variables and disease progression and repeated in the EAU high risk and very high-risk group. The statistical significance threshold was set at 0.05, and the statistical analysis was performed using Stata/SE version 17 (StataCorp, College Station, TX, USA).
Cox regression analysis revealed in 1313 patients diagnosed with T1G3 NMIBC that patients with a history of heavy and long-term smoking faced a more than twofold increased risk of disease progression compared to nonsmoker patients (HR 2.35; 95% CI: 1.7-3.2; P < 0.01) and a significantly poorer PFS for patients with a history of heavy long-term smoke exposure (P < 0.01). Patients with heavy long-term smoking exposure according to the EAU21 high-risk group had a PFS comparable to very high-risk patients and high-risk patients with heavy long-term smoking exposure showed a higher risk of progression when compared to the high-risk group (HR 1.4; 95% CI: 1.3-1.6; P < 0.01).
This study adds valuable information on the relationship between smoking and the progression of NMIBC and BCG therapy. The findings emphasize the need for healthcare providers to consider a patient's smoking history when managing NMIBC and express the need for individualized smoking cessation counseling and individualized treatment approach.
Urologic oncology. 2024 Dec 12 [Epub ahead of print]
Roberto Contieri, Francesco Claps, Rodolfo Hurle, Nicolò Maria Buffi, Giovanni Lughezzani, Massimo Lazzeri, Achille Aveta, Savio Pandolfo, Francesco Porpiglia, Cristian Fiori, Biagio Barone, Felice Crocetto, Pasquale Ditonno, Giuseppe Lucarelli, Francesco Lasorsa, Gian Maria Busetto, Ugo Falagario, Francesco Del Giudice, Martina Maggi, Francesco Cantiello, Marco Borghesi, Carlo Terrone, Pierluigi Bove, Alessandro Antonelli, Alessandro Veccia, Andrea Mari, Stefano Luzzago, Ciprian Todea-Moga, Andrea Minervini, Gennaro Musi, Giuseppe Fallara, Francesco Alessandro Mistretta, Roberto Bianchi, Marco Tozzi, Francesco Soria, Paolo Gontero, Michele Marchioni, Letizia M I Janello, Daniela Terracciano, Giorgio I Russo, Luigi Schips, Sisto Perdonà, Octavian S Tataru, Mihai D Vartolomei, Riccardo Autorino, Michele Catellani, Chiara Sighinolfi, Emanuele Montanari, Savino M Di Stasi, Bernardo Rocco, Ottavio de Cobelli, Matteo Ferro
Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy., Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56127 Pisa, Italy., Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy., Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy., Department of Urology, University of Turin, AOU San Luigi Gonzaga Hospital, 10043 Orbassano, Turin, Italy., Division of Urology, Department of Surgical Sciences, AORN Sant'Anna e San Sebastiano, 81100 Caserta, Italy., Unit of Urology, Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy., Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy., Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden., Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy., Department of Urology, Magna Graecia University, Catanzaro, Italy., Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, 16126 Genoa, Italy., Unit of Urology, Department of Surgery, Tor Vergata University, Rome, Italy; Department of Urology, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy, 00165 Rome, Italy., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy., Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy., Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan 20142, Italy., Department of Urology, George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, 540142 Târgu Mureș, Romania., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, Chieti, Italy., Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy., Department of Surgery, Urology Section, University of Catania, 95124 Catania, Italy., G. Pascale IRCCS Foundation, 80131 Naples, Italy., I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, 540142 Târgu Mureș, Romania., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA., Department of Urology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy. Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy., U.O.C. Clinica Urologica, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Universitá Cattolica del Sacro Cuore, Milam, Italy., Department of Experimental Medicine and Surgery, Tor Vegata University, 00133 Rome, Italy., U.O.C. Clinica Urologica, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Universitá Cattolica del Sacro Cuore, Milam, Italy. Electronic address: ., Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan 20142, Italy. Electronic address: .