The impact of smoking and polymorphic enzymes of xenobiotic metabolism on the stage of bladder tumors: a generalized ordered logistic regression analysis

Cigarette smoking is the predominant risk factor for bladder cancer in males and females. The tobacco carcinogens are metabolized by various xenobiotic metabolizing enzymes such as N-acetyltransferases (NAT) and glutathione S-transferases (GST). Polymorphisms in NAT and GST genes alter the ability of these enzymes to metabolize carcinogens. In this paper, we conduct a statistical analysis based on logistic regressions to assess the impact of smoking and metabolizing enzyme genotypes on the risk to develop bladder cancer using a case-control study from Tunisia. We also use the generalized ordered logistic model to investigate whether these factors do have an impact on the progression of bladder tumors.