吸煙對膀胱癌患者總體和特定死亡率的相關風險分析：台灣健保資料庫研究

Association risk of Smoking on Overall and Specific Mortality of Patients with Bladder Cancer: A Population-based Study

Wen-Hsin Tseng¹、Chung-Han Ho²、Steven K. Huang^1,、Chien-Liang Liu¹、Allen W.Chiu ^3,4

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

²Medical Research, Chi Mei Medical Center, Tainan, Taiwan

³Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan

⁴School of medicine, National Yang-Ming University, Taipei, Taiwan

曾文歆¹、何宗翰²、黃冠華¹、劉建良¹、邱文祥^3,4

¹奇美醫學中心 外科部 泌尿外科  ²奇美醫學中心 醫學研究部

³馬偕紀念醫院 泌尿外科部  ⁴陽明醫學大學 醫學系

Purpose:

The involvement of smoking in the role of bladder cancer prognosis could have a significant impact on the clinical management of the patients and it also represents a considerable burden to the country’s health and economy. In this study, we searched Taiwan’s National Health Insurance Research Database to determine whether or not smoking affects the overall mortality and cancer-specific mortality of patients with bladder cancer.

Materials and Methods:

This analysis was a retrospective cohort study using 7 years (2011–2017) of claims data from Taiwan’s National Health Insurance Research Database (NHIRD). A total of 21,135 patients who had bladder cancer and we excluded the missing data of smoking and clinical stage then we used 1:1 propensity score matching by gender and age. The Cox proportional hazard regression model was used to estimate the hazard ratio of overall and specific mortality adjusted with the potential confounding factors.

Results:

This study enrolled never-smoke and ever-smoke groups that included 4728 patients after matching. The overall and specific mortality rates of the ever-smoke patients were 1.15-fold compared with those of the never-smoke patients.

Our study displays the risk factors for overall and specific mortality associated with bladder cancer patients who ever smoked. Patients with bladder cancer who smoke have a significantly higher overall and specific mortality rates, especially males with Charlson Comorbidity Index (CCI) ≥ 3, comorbidity of diabetes mellitus (DM), and non-muscle invasive bladder cancer (NMIBC).

Conclusions:

The overall mortality and specific mortality rates were significantly higher in ever-smoke patients with bladder cancer than in never-smoke patients. Male, CCI ≥ 3, comorbidity of DM, and NMIBC were the risk factors for overall and specific mortality in ever-smoke patients with bladder cancer.