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Fernández MI, Valdebenito P, Delgado I, Segebre J, Chaparro E, Fuentealba D, Castillo M, Vial C, Barroso JP, Ziegler A, Bustamante A. Impact of arsenic exposure on clinicopathological characteristics of bladder cancer: A comparative study between patients from an arsenic-exposed region and nonexposed reference sites. Urol Oncol 2019; 38:40.e1-40.e7. [PMID: 31630994 DOI: 10.1016/j.urolonc.2019.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/15/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Beyond exposure to arsenic in drinking-water, there is few information about demographic and clinicopathological features of patients with bladder cancer living in arsenic-exposed regions. The aim of the study was to assess the impact of arsenic exposure on clinicopathological characteristics in patients with bladder cancer from a contaminated region compared to those of 2 reference areas. METHODS Data of 285 patients with bladder cancer (83 with arsenic exposure from Antofagasta and 202 controls from 2 different sites in Santiago) were obtained through personal interviews and from review of medical records. Demographic, clinicopathological parameters, and information on relevant environmental risk factors were compared with parametric and nonparametric tests as needed. Multivariable analysis was performed to identify independent predictors for high grade and muscle-invasive disease (T2-4). RESULTS We found no significant differences between groups regarding age at presentation (66.4 vs. 66.5 and 67.2 years; P = 0.69, for exposed vs. the 2 nonexposed groups, respectively) and female gender (28.9% vs. 29.8% and 26.2%; P = 0.84). Proportion of current smokers was significantly lower in the exposed population (10.7% vs. 38.6% and 26.9%; P < 0.001). There was a significantly higher proportion of locally advanced (10.8 vs. 1.8 and 0.7% T3/4; P = 0.002) and high-grade tumors (79.5% vs. 63.2% and 64.1%; P = 0.001) within arsenic-exposed patients. Arsenic exposure was the only significant predictor for the presence of high-grade tumors (adjusted OR: 5.10; 95%CI: 2.03-12.77) on multivariable analysis. CONCLUSIONS Our study revealed relevant clinical differences in bladder cancer patients with a history of arsenic exposure as compared to nonexposed cases. The more aggressive phenotype associated to arsenic-related bladder cancer should be considered when designing efficient screening strategies for this high-risk population.
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Affiliation(s)
- Mario I Fernández
- Department of Urology, Clínica Alemana de Santiago, Vitacura, Santiago, Chile; Center for Genetics and Genomics, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Lo Barnechea, Santiago, Chile.
| | | | - Iris Delgado
- Center for Public Policies, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Lo Barnechea, Santiago, Chile
| | - Jorge Segebre
- Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Lo Barnechea, Santiago, Chile
| | - Eduardo Chaparro
- Department of Urology, Hospital Regional de Antofagasta, Antofagasta, Chile
| | - David Fuentealba
- Department of Urology, Hospital Regional de Antofagasta, Antofagasta, Chile
| | - Martín Castillo
- Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Lo Barnechea, Santiago, Chile
| | - Cecilia Vial
- Center for Genetics and Genomics, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Lo Barnechea, Santiago, Chile
| | - Juan P Barroso
- Department of Urology, Clínica Alemana de Santiago, Vitacura, Santiago, Chile; Department of Urology, Hospital Padre Hurtado, Santiago, Chile; Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Lo Barnechea, Santiago, Chile
| | - Annemarie Ziegler
- Center for Genetics and Genomics, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Lo Barnechea, Santiago, Chile
| | - Alberto Bustamante
- Department of Urology, Clínica Alemana de Santiago, Vitacura, Santiago, Chile; Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Lo Barnechea, Santiago, Chile
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