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

• DOI: 10.1007/s00345-018-2397-1
• Publication Date: 2018-07-10T15:07:20Z
• Authors: Matteo Ferro; Mihai Dorin Varto...; Giorgio Ivan Russo; Francesco Cantiello; Abdal Rahman Abu ...; Daniela Terracciano; Amelia Cimmino; Savino Di Stasi; Gennaro Musi; Rodolfo Hurle; Vincenzo Serretta; Gian Maria Busetto; Ettore De Berardinis; Antonio Cioffi; Sisto Perdonà; Marco Borghesi; Riccardo Schiavina; Gabriele Cozzi; Gilberto L. Almeida; Pierluigi Bove; Estevao Lima; Giovanni Grimaldi; Deliu Victor Matei; Nicolae Crisan; Matteo Muto; Paolo Verze; Michele Battaglia; Giorgio Guazzoni; Riccardo Autorino; Giuseppe Morgia; Rocco Damiano; Ottavio de Cobelli; Shahrokh Shariat; Vincenzo Mirone; Giuseppe Lucarelli
• Keywords: Male; Prognosi; Urology; Comorbidity; Cystectomy; Disease-Free Survival; Body Mass Index; Adjuvants, Immunologic; Bladder cancer; Body mass index; Obesity; Prognosis; Humans; Obesity; Mortality; Body mass index; Aged; Neoplasm Staging; Aged, 80 and over; 2. Zero hunger; Carcinoma, Transitional Cell; Bladder cancer; Body mass index; Obesity; Prognosis; Urology; Settore MED/24 - UROLOGIA; Bladder cancer; Cystoscopy; Middle Aged; Prognosis; 3. Good health; Administration, Intravesical; Chemotherapy, Adjuvant; Multivariate Analysis; Bladder cancer; Body mass index; Obesity; Prognosis.; Bladder cancer; body mass index; obesity; prognosis; urology; BCG Vaccine; Disease Progression; Female

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).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.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.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.