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Effect of Smoking-Related Lung Disease on Bladder Urothelial Carcinoma Survival

By: Celeste L. Dixon
Posted: Wednesday, January 12, 2022

For patients with unmetastasized muscle-invasive bladder urothelial carcinoma receiving concurrent chemoradiotherapy for bladder preservation, co-occurring smoking-related chronic obstructive pulmonary disease (COPD)—and, even more so, chronic obstructive pulmonary disease with acute exacerbation—may have a detrimental effect on survival, research results indicate. In the Journal of Personalized Medicine, Szu-Yuan Wu, MD, MPH, PhD, of Lo-Hsu Medical Foundation in Taiwan, and colleagues reported that the prevention of progression of COPD to COPD with acute exacerbation was associated with better overall survival of those who received bladder preservation through concurrent chemoradiotherapy.

The study focused on 708 propensity score–matched patients with muscle-invasive bladder urothelial carcinoma, clinical stage IIA to IVB, who were undergoing maximal transurethral resection of a bladder tumor followed by concurrent chemoradiotherapy for bladder preservation. Those who were current smokers with smoking-related COPD (n = 232) had significantly worse survival outcomes (all-cause mortality) than did never-smokers without COPD (n = 472; P = .017). In each group, about 75% of patients were male, and about 87% were older than age 65.

Hospitalization for COPD with acute exacerbation within 1 year before concurrent chemoradiotherapy was found to be an independent risk factor for all-cause and bladder cancer–related mortality in the patients with COPD. For patients with muscle-invasive bladder urothelial carcinoma undergoing concurrent chemoradiotherapy for bladder preservation, “the adjusted hazard ratios of all-cause mortality for ≥ 1 and ≥ 2 hospitalizations for chronic obstructive pulmonary disease with acute exacerbation within 1 year before concurrent chemoradiotherapy for bladder preservation were 3.26 and 6.33 [respectively] (P < .0001 for both), compared with patients [who did not have] COPD with acute exacerbation,” wrote the team.

The association between COPD and worse overall survival in these patients with bladder cancer is multifactorial, Dr. Wu and co-investigators stated. However, they added, “emerging evidence [indicates] that cigarette smoking might induce a mechanism of resistance to cisplatin-based chemotherapy in bladder cancer.”

Disclosure: The study authors reported no conflicts of interest.



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