Approximately 70% of bladder cancer is diagnosed as non-muscle invasive (NMIBC) and inflammation is known to impact the oncological outcomes. Adjuvant intravesical BCG in intermediate/high risk can lower recurrence and progression.
The efficacy of intravesical BCG can be impacted by smoking effects on systemic inflammation.
Our retrospective, multicenter study with data from 1.313 NMIBC patients aimed to assess the impact of smoking and the systemic inflammatory status on BCG response in T1G3 bladder cancer, using a machine-learning CART based algorithm.
In a median of 50-month follow-up (IQR 41-75), 344 patients experienced progression to muscle invasive or metastatic disease and 65 died due to bladder cancer. A CART algorithm has been employed to stratify patients in three prognostic clusters using smoking status, LMR (lymphocytes to monocytes ratio), NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio) as variables. Cox regression models revealed a 1.5-fold (HR 1.66, 95%, CI 1.20-2.29, P=0.002) and three-fold (HR 2.99, 95% CI 2.08-4.30, P<0.001) risk of progression, in intermediate and high risk NMIBC respectively, compared to the low-risk group. The model's concordance index was 0.66.
Our study provides an insight into the influence of smoking on inflammatory markers and BCG response in NMIBC patients. Our machine-learning approach provides clinicians a valuable tool for risk stratification, treatment, and decision-making. Future research in larger prospective cohorts is required for validating these findings.
Minerva urology and nephrology. 2024 Dec 03 [Epub ahead of print]
Matteo Ferro, Octavian S Tataru, Giuseppe Fallara, Cristian Fiori, Matteo Manfredi, Francesco Claps, Rodolfo Hurle, Nicolò M Buffi, Giovanni Lughezzani, Massimo Lazzeri, Achille Aveta, Savio D Pandolfo, Biagio Barone, Felice Crocetto, Pasquale Ditonno, Giuseppe Lucarelli, Francesco Lasorsa, Giuseppe Carrieri, Gian M Busetto, Ugo G Falagario, Francesco Del Giudice, Martina Maggi, Francesco Cantiello, Marco Borghesi, Carlo Terrone, Pierluigi Bove, Alessandro Antonelli, Alessandro Veccia, Andrea Mari, Stefano Luzzago, Raul Gherasim, Ciprian Todea-Moga, Andrea Minervini, Gennaro Musi, Francesco A Mistretta, Roberto Bianchi, Marco Tozzi, Francesco Soria, Paolo Gontero, Michele Marchioni, Letizia M Janello, Daniela Terracciano, Giorgio I Russo, Luigi Schips, Sisto Perdonà, Riccardo Autorino, Michele Catellani, Chiara Sighinolfi, Emanuele Montanari, Savino M DI Stasi, Francesco Porpiglia, Bernardo Rocco, Ottavio de Cobelli, Roberto Contieri
Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy - ., I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Targu Mures, Targu Mures, Romania., Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy., Department of Urology, University of Turin, AOU San Luigi Gonzaga Hospital, Orbassano, Turin, Italy., Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy., Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy., Department of Urology, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy., Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy., Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy., Division of Urology, Department of Surgical Sciences, AORN Sant'Anna e San Sebastiano, Caserta, Italy., Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy., Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy., Department of Urology, La Sapienza University, Rome, Italy., Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy., Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy., Department of Urology, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy., Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy., Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy., Department of Urology, George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, Târgu Mureș, Romania., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Turin, Turin, Italy., Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio, University of Chieti, Chieti, Italy., Department of Translational Medical Sciences, University Federico II, Naples, Italy., Department of Urology, University of Catania, Catania, Italy., G. Pascale IRCCS Foundation, Naples, Italy., Department of Urology, Rush University Medical Center, Chicago, IL, USA., Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy., Division of Urology, Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy., Unit of Urology, Department of Medicine and Translational Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/39625636