SMOKING STATUS, RECURRENCE RISK ANDINTRAVESICAL CHEMOTHERAPY IN NONMUSCLE-INVASIVE BLADDER CANCER

Risultato della ricerca: Otherpeer review

Abstract

Background and Aim: The influence of smoking status onthe diagnosis of carcinoma of the bladder, on recurrence riskAbstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italyand response to intravesical treatment has been scarcelystudied. Available studies suggest a reduction in recurrencerisk with cessation of smoking, however, most studies lacksufficient statistical power. The aim of the present analysiswas to study the recurrence risk and the response tointravesical chemotherapy in terms of recurrence-free rate(RFR) and recurrence-free survival (RFS) in relation tosmoking status at diagnosis in patients affected byintermediate-risk non-muscle invasive carcinoma of thebladder (NMI-BC). Patients and Methods: Tumorcharacteristics and smoking status were recorded forpatients affected by NMI-BC treated by transurethralresection (TUR) and adjuvant intravesical therapy. Allpatients received intravesical epirubicin within six hours ofTUR at a dose of 80 mg diluted in 50 ml of saline solution.Further adjuvant treatment in low- and high-risk patientswas given according to physicians’ choice. Two differentschemes of intravesical chemotherapy with epirubicin wereadopted at a dose of 80 mg in 50 ml for patients atintermediate risk. All patients were submitted to cytologyand cystoscopy at three-monthly intervals for two years andthen at six-monthly intervals for three more years.Multivariate statistical analysis was conducted to study therecurrence risk and the response to intravesicalchemotherapy in terms of RFR and RFS in relation tosmoking status at diagnosis. Results: Out of 577 consecutivepatients, 241 (42%), 188 (33%) and 148 (25%) werecurrent, former and never smokers, respectively. The meannumber of cigarettes smoked per day was 20 for a medianperiod of 30 years. Recurrent tumors were statistically morefrequent in smokers that in never smokers. The percentageof recurrence increased from 20% to 42% (p<0.0001) forthese who smoked less than 30 years compared to those whohad smoked for longer. No significant difference betweencurrent and former smokers emerged in terms of RFR andRFS at a median follow-up of four years. On the other hand,a significant difference in terms of RFS between never andformer smokers was evident (p=0.019). The 3-year RFS innever and former smokers was 71.3% and 57.6%,respectively. The above mentioned difference wascompletely removed 20 years after smoking cessation. Anadvantage in terms of RFR at 12 months emerged in favorof prolonged intravesical chemotherapy only in currentsmokers. Conclusion: Recurrent tumors are more frequentin smokers than in never smokers. Duration of smoking hasa relevant impact on RFR. A significant difference in termsof RFS between never and former smokers was evident butthe difference was completely removed 20 years aftercessation of smoking. No statistically significant differencebetween current and former smokers emerged in ouranalysis. A statistically significant benefit from prolongedintravesical chemotherapy in terms of RFR emerged incurrent smokers only.
Lingua originaleEnglish
Pagine1817-1818
Numero di pagine2
Stato di pubblicazionePublished - 2011

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