Smoke load prognostic impact on bacillus Calmette-Guérin (BCG) treated non-muscle invasive bladder cancer.

Smoking habit is the major risk factor for bladder cancer (BC), related to about 50% of these tumors; however, the tobacco dose-effect impact on BC immune treatment is underexplored. This study evaluates the impact of smoke load on non-muscle invasive bladder cancer (NMIBC) prognosis after intravesical BCG.

Smoke load, recurrence, progression and disease-specific survival were evaluated in a retrospective study including NMIBC patients treated with intravesical BCG between 2006 and 2015. Multivariate Cox regression, ROC and Kaplan-Meier curves were utilized.

132 pT1 NMIBC patients were included: 95 (72%) males, mean age 69.6 ± 10.5 years and mean smoking pack-years 22.0 ± 20.8. Recurrence, progression and disease-specific death occurred in 69 (52.3%, mean 20.55 ± 20.44 months), 22 (16.7%, mean 31.39 ± 20.19 months) and 11 (8.3%, mean 37.23 ± 18.34 months), respectively. Smoke load significantly impacted recurrence, HR = 1.019 (95% CI 1.008-1.030, p = 0.0004), and progression, HR = 1.034 (95% CI 1.016-1.052, p = 0.0002), but not survival. For every 1-year increment in pack-years, the risk of relapse and progression increases by 1.9% and 3.4%, respectively. Over 20 pack-year showed the best predictive prognostic power.

The smoke load has a potential prognostic role in terms of recurrence and progression in the BCG treated NMIBC. Future studies should explore the smoking impact on the immune system, mainly beyond 20 pack-year.

International urology and nephrology. 2020 Mar 10 [Epub ahead of print]

Danilo Leite Andrade, Tomas Bernardo Costa Moretti, Wilmar Azal Neto, Júlia Benedetti, Leonardo Oliveira Reis

Department of Urology, UroScience, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop-Jardim Ipaussurama, Campinas, SP, CEP: 13034-685, Brazil., Department of Urology, UroScience, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop-Jardim Ipaussurama, Campinas, SP, CEP: 13034-685, Brazil. .