An increased body mass index is associated with a worse prognosis in patients administered BCG immunotherapy for T1 bladder cancer: World Journal of Urology

M. Ferro, M.D. Vartolomei, G.I. Russo, F. Cantiello, A.R.A. Farhan, D. Terracciano, A. Cimmino, S. Di Stasi, G. Musi, R. Hurle, V. Serretta, G.M. Busetto, E. De Berardinis, A. Cioffi, S. Perdonà, M. Borghesi, R. Schiavina, G. Cozzi, G.L. Almeida, P. BoveE. Lima, G. Grimaldi, D.V. Matei, N. Crisan, M. Muto, P. Verze, M. Battaglia, G. Guazzoni, R. Autorino, G. Morgia, R. Damiano, O. de Cobelli, S. Shariat, V. Mirone, G. Lucarelli

Research output: Contribution to journalArticle

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–Guérin (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. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.
Original languageEnglish
Pages (from-to)507-514
Number of pages8
JournalWorld J. Urol.
Volume37
Issue number3
DOIs
Publication statusPublished - 2019

    Fingerprint

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

Cite this

Ferro, M., Vartolomei, M. D., Russo, G. I., Cantiello, F., Farhan, A. R. A., Terracciano, D., Cimmino, A., Di Stasi, S., Musi, G., Hurle, R., Serretta, V., Busetto, G. M., De Berardinis, E., Cioffi, A., Perdonà, S., Borghesi, M., Schiavina, R., Cozzi, G., Almeida, G. L., ... Lucarelli, G. (2019). An increased body mass index is associated with a worse prognosis in patients administered BCG immunotherapy for T1 bladder cancer: World Journal of Urology. World J. Urol., 37(3), 507-514. https://doi.org/10.1007/s00345-018-2397-1