RESUMO
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , Vacina BCG/uso terapêutico , Nicotiana , Fumaça/efeitos adversos , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/mortalidade , Idoso , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/patologiaRESUMO
A terapia reabilitadora com implantes de titânio osseointegráveis, em forma de raiz dentária, vem sendo utilizada de maneira segura desde 1965. No entanto, não há um protocolo estabelecido para manutenção bucal desses pacientes, a exemplo da terapia periodontal de suporte (TPS) empregada em pacientes com periodontite. O objetivo desse trabalho foi testar a hipótese de que pacientes tabagistas e em tratamento da periodontite, quando submetidos a um protocolo de TPS bimestral teriam benefícos em relação à incidência de complicações biológicas perimplantares. Pacientes edêntulos parciais, tabagistas e com periodontite receberam terapia periodontal e, em seguida, foram submetidos à inserção cirúrgica de um ou dois implantes dentários. Antes mesmo da fase pós-cirúrgica de TPS, bimestral ou semestral, 71,4 % desses pacientes apresentaram complicações biológicas perimplantares. Um grupo controle não-tabagista e sem periodontite foi incorporado ao estudo original. Análises dos parâmetros clínicos pelo teste de Kruskal-Wallis e quiquadrado de Pearson demonstraram que a carga tabágica está diretamente relacionada com a ocorrência e a gravidade dos acidentes biológicos perimplantares. Conclui-se que pacientes com história de periodontite e consumo diário superior a 20 cigarros apresentam risco aumentado de desenvolver complicações biológicas perimplantares que inclui a perda precoce de implantes. (AU)
Rehabilitation therapy with osseointegrated titanium implants in the form of tooth root has been used safely since 1965. However, there is no established protocol for oral maintenance of these patients, such as periodontal supportive therapy (TPS) employed in patients with periodontitis. The aim of this study was to test the hypothesis that smokers and those undergoing treatment of periodontitis, when submitted to a bimonthly TPS protocol, would have benefits in relation to the incidence of perimplant biological complications. Partial edentulous, smoking and periodontitis patients received periodontal therapy and then underwent surgical insertion of one or two dental implants. Even before the postoperative phase of TPS, bimonthly or semi-annually, 71.4% of these patients had perimplant biological complications. A non-smoking control group with no periodontitis was incorporated into the original study. Analysis of the clinical parameters by the Kruskal-Wallis test and Pearson's chi-square test showed that the smoking load is directly related to the occurrence and severity of perimplantal biological accidents. It is concluded that patients with a history of periodontitis and daily consumption of more than 20 cigarettes are at increased risk of developing perimplant biological complications including early implant loss. (AU)