Survival Impact of Current-Smoking-Related COPD or COPD with Acute Exacerbation on Bladder Preservation through Concurrent Chemoradiotherapy for Muscle-Invasive Bladder Urothelial Carcinoma.

Jiaqiang Zhang,Kuo-Chin Chiu,Shyh-Chyi Chang,Szu-Yuan Wu,Ming-Feng Chiang

doi:10.3390/jpm11100958

Abstract

PURPOSE: The survival effect of smoking-related chronic obstructive pulmonary disease (COPD) and COPD with acute exacerbation (COPDAE) on patients with muscle-invasive bladder urothelial carcinoma (MIBUC) receiving concurrent chemoradiotherapy (CCRT) for bladder preservation is unclear. METHODS: We recruited patients with MIBUC, clinical stages IIA–IVB, who had received maximal transurethral resection of bladder tumor (TURBT) followed by CCRT from the Taiwan Cancer Registry Database. The Cox proportional hazards model was used to analyze all-cause mortality. We categorized the patients into two groups by using propensity score matching based on the preexisting COPD status (within 1 year before CCRT) to compare overall survival outcomes: Group 1 (never smokers without COPD) and Group 2 (current smokers with COPD). RESULTS: In multivariate Cox regression analyses, the adjusted hazard ratio (aHR; 95% confidence interval (CI)) of all-cause mortality in Group 2 compared with Group 1 was 1.89 (1.12–3.18), p = 0.017. The aHRs (95% CIs) of all-cause mortality for ≥1 and ≥2 hospitalizations for COPDAE within 1 year before CCRT for bladder preservation were 3.26 (1.95–5.46) and 6.33 (3.55–11.281) compared with non-COPDAE patients with MIBUC undergoing CCRT for bladder preservation. CONCLUSIONS: Among patients with MIBUC undergoing TURBT followed by CCRT for bladder preservation, current smokers with smoking-related COPD had worse survival outcomes than did nonsmokers without COPD. CONDENSED ABSTRACT: This was the first study to estimate the survival impact of smoking-related chronic obstructive pulmonary disease (COPD) on patients with muscle-invasive bladder urothelial carcinoma (MIBUC) receiving maximal transurethral resection of bladder tumor (TURBT) followed by concurrent chemoradiotherapy (CCRT) for bladder preservation. Smoking-related COPD was a significant independent risk factor for all-cause mortality in patients with clinical stages IIA–IVB receiving TURBT followed by CCRT. Hospitalization frequency for COPD with at least one acute exacerbation within 1 year before CCRT was highly associated with high mortality for patients with MIBUC receiving CCRT for bladder preservation. Not only all-cause death but also bladder cancer death and COPD death were significantly higher in the current-smoking COPD group than in the never-smoking non-COPD group.

Highlights

Bladder cancer is the most common malignancy of the urinary system, with approximately 84,000 new cases and 17,000 deaths in the United States annually [1]
Sex, diabetes, hyperlipidemia, hypertension, acute myocardial infarction (AMI), cardiovascular diseases, ischemic stroke, kidney/bladder stones, Charlson comorbidity index (CCI) scores, American Joint Committee on Cancer (AJCC) clinical tumor stage, AJCC clinical nodal stage, surgical consolidation after concurrent chemoradiotherapy (CCRT), bladder preservation rate, cisplatin-based regimen dosage, and radiotherapy dosage were similar between the two groups due to propensity score matching (PSM)
Multivariate Cox regression analysis indicated that chronic obstructive pulmonary disease (COPD) and ≥1 or ≥2 hospitalizations for COPD with acute exacerbation (COPDAE) within 1 year before CCRT for bladder preservation were associated with poor overall survival (OS) (Table 2)

Summary

Introduction

Bladder cancer is the most common malignancy of the urinary system, with approximately 84,000 new cases and 17,000 deaths in the United States annually [1]. Bladder cancer accounts for approximately 600,000 new cases and >200,000 deaths per year [2]. In developed areas, such as North America, Western Europe, and Taiwan, bladder cancers are predominantly urothelial [1,3]. In Taiwan, bladder cancer is the most common urinary malignancy [3], with approximately 2200 new cases and 1000 deaths annually [3]. Radical cystectomy with neoadjuvant cisplatin-based chemotherapy is the standard approach for the treatment of muscle-invasive urothelial bladder cancer [4]. In the extended follow-up, CCRT for bladder preservation in MIBUC was associated with improved disease-specific survival and decreased rates of salvage radical cystectomy [7,8]

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Conclusion