@article{4d99b17f03be46759b81acb0a5dbd5e4,
title = "An increased body mass index is associated with a worse prognosis in patients administered BCG immunotherapy for T1 bladder cancer: World Journal of Urology",
abstract = "Purpose: The body mass index (BMI) may be associated with an increased incidence and aggressiveness of urological cancers. In this study, we aimed to evaluate the impact of the BMI on survival in patients with T1G3 non-muscle-invasive bladder cancer (NMIBC). Methods: A total of 1155 T1G3 NMIBC patients from 13 academic institutions were retrospectively reviewed and patients administered adjuvant intravesical Bacillus Calmette–Gu{\'e}rin (BCG) immunotherapy with maintenance were included. Multivariable Cox regression analysis was performed to identify factors predictive of recurrence and progression. Results: After re-TURBT, 288 patients (27.53%) showed residual high-grade NMIBC, while 867 (82.89%) were negative. During follow-up, 678 (64.82%) suffered recurrence, and 303 (30%) progression, 150 (14.34%) died of all causes, and 77 (7.36%) died of bladder cancer. At multivariate analysis, tumor size (hazard ratio [HR]:1.3; p = 0.001), and multifocality (HR:1.24; p = 0.004) were significantly associated with recurrence (c-index for the model:55.98). Overweight (HR: 4; p <0.001) and obesity (HR:5.33 p <0.001) were significantly associated with an increased risk of recurrence. Addition of the BMI to a model that included standard clinicopathological factors increased the C-index by 9.9. For progression, we found that tumor size (HR:1.63; p <0.001), multifocality (HR:1.31; p = 0.01) and concomitant CIS (HR: 2.07; p <0.001) were significant prognostic factors at multivariate analysis (C-index 63.8). Overweight (HR: 2.52; p <0.001) and obesity (HR: 2.521 p <0.001) were significantly associated with an increased risk of progression. Addition of the BMI to a model that included standard clinicopathological factors increased the C-index by 1.9. Conclusions: The BMI could have a relevant role in the clinical management of T1G3 NMIBC, if associated with bladder cancer recurrence and progression. In particular, this anthropometric factor should be taken into account at initial diagnosis and in therapeutic strategy decision making. {\textcopyright} 2018, Springer-Verlag GmbH Germany, part of Springer Nature.",
keywords = "Bladder cancer, Body mass index, Obesity, Prognosis, BCG vaccine, immunological adjuvant, adjuvant chemotherapy, aged, bladder tumor, body mass, cancer staging, comorbidity, cystectomy, cystoscopy, disease exacerbation, disease free survival, female, human, intravesical drug administration, male, middle aged, mortality, multivariate analysis, obesity, pathology, prognosis, proportional hazards model, retrospective study, transitional cell carcinoma, tumor volume, very elderly, Adjuvants, Immunologic, Administration, Intravesical, Aged, Aged, 80 and over, BCG Vaccine, Body Mass Index, Carcinoma, Transitional Cell, Chemotherapy, Adjuvant, Comorbidity, Cystectomy, Cystoscopy, Disease Progression, Disease-Free Survival, Female, Humans, Male, Middle Aged, Mortality, Multivariate Analysis, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, Tumor Burden, Urinary Bladder Neoplasms",
author = "M. Ferro and M.D. Vartolomei and G.I. Russo and F. Cantiello and A.R.A. Farhan and D. Terracciano and A. Cimmino and {Di Stasi}, S. and G. Musi and R. Hurle and V. Serretta and G.M. Busetto and {De Berardinis}, E. and A. Cioffi and S. Perdon{\`a} and M. Borghesi and R. Schiavina and G. Cozzi and G.L. Almeida and P. Bove and E. Lima and G. Grimaldi and D.V. Matei and N. Crisan and M. Muto and P. Verze and M. Battaglia and G. Guazzoni and R. Autorino and G. Morgia and R. Damiano and {de Cobelli}, O. and S. Shariat and V. Mirone and G. Lucarelli",
note = "Cited By :10 Export Date: 26 February 2020 Correspondence Address: Ferro, M.; Division of Urology, European Institute of OncologyItaly; email: matteo.ferro@ieo.it Chemicals/CAS: Adjuvants, Immunologic; BCG Vaccine Funding details: Atsumi International Scholarship Foundation Funding text 1: Aknowledgements M.D.V is supported by the Scholarship Foundation References: Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., Mullany, E.C., Alfonso, R., Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013 (2014) Lancet, 384 (9945), pp. 766-781; Colditz, G.A., Peterson, L.L., Obesity and Cancer: evidence, Impact, and future directions (2018) Clin Chem, 64 (1), pp. 154-162; Chromecki, T.F., Cha, E.K., Fajkovic, H., Rink, M., Ehdaie, B., Svatek, R.S., Karakiewicz, P.I., Burger, M., Obesity is associated with worse oncological outcomes in patients treated with radical cystectomy (2013) BJU Int, 111 (2), pp. 249-255; 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year = "2019",
doi = "10.1007/s00345-018-2397-1",
language = "English",
volume = "37",
pages = "507--514",
journal = "World J. Urol.",
issn = "0724-4983",
publisher = "Springer Verlag",
number = "3",
}