Sex differences in bladder cancer outcomes among smokers with advanced bladder cancer

摘要

Objective: ? To study the effect of smoking on bladder cancer presentation and outcome in a large cystectomy population. Patients and Methods: ? A database including 546 patients from the University Health Network (Toronto, Canada) and Turku University Hospital (Turku, Finland) was studied. ? In addition to the association of smoking with clinicopathological parameters, the effect of smoking on survival was analyzed. ? Categorical data were analyzed by the chi-squared test and numerical data were analyzed by Student's t-test. ? The Kaplan-Meier method, log-rank test and a proportional hazards model were used to estimate the effect of smoking on survival. Results: ? In total, 352 patients (64%) were smokers and 194 (36%) were non-smokers. ? Smokers had more frequently advanced tumours and nodal metastasis. ? The 10-year disease-specific survival (DSS) was 52% vs 66% for smokers and non-smokers, respectively (P= 0.039). ? Smokers also had significantly worse overall survival (10-year overall survival 37% vs 62%; P= 0.015). ? Smoking affected significant DSS among men (P= 0.012), although no effect was observed among women. ? In a univariate model smoking was associated with a hazard ratio (HR) of 1.4 (95% confidence interval, CI, 1.0-1.9) for bladder cancer specific mortality and 1.4 (95% CI, 1.1-1.8) for overall mortality. ? In a multivariate model, smoking did not impact on DSS (HR, 1.1; 95% CI, 0.8-1.6; P= 0.41). ? In addition to advanced stage and nodal metastasis, female sex was an independent risk factor for DSS (HR, 1.6; 95% CI, 1.1-2.3; P= 0.007). Conclusions: ? Smokers appear to have worse outcomes after radical cystectomy for bladder cancer; however, it does not appear to be an independent prognostic factor for survival. ? Smoking affected survival only among men. ? Women had poorer survival but smoking was not a contributing factor to this.