Matteo Ferro1, Mihai Dorin Vartolomei2,3,4, Giorgio Ivan Russo5, Francesco Cantiello6, Abdal Rahman Abu Farhan6, Daniela Terracciano7, Amelia Cimmino8, Savino Di Stasi9, Gennaro Musi2, Rodolfo Hurle10, Vincenzo Serretta11, Gian Maria Busetto12, Ettore De Berardinis12, Antonio Cioffi2, Sisto Perdonà13, Marco Borghesi14, Riccardo Schiavina14, Gabriele Cozzi2, Gilberto L Almeida15, Pierluigi Bove16, Estevao Lima17, Giovanni Grimaldi17, Deliu Victor Matei2,18, Nicolae Crisan18, Matteo Muto19, Paolo Verze20, Michele Battaglia21, Giorgio Guazzoni10, Riccardo Autorino22, Giuseppe Morgia5, Rocco Damiano6, Ottavio de Cobelli2,23, Shahrokh Shariat3,24,25,26, Vincenzo Mirone20, Giuseppe Lucarelli21. 1. Division of Urology, European Institute of Oncology, Milan, Italy. matteo.ferro@ieo.it. 2. Division of Urology, European Institute of Oncology, Milan, Italy. 3. Department of Urology, Medical University of Vienna, Vienna, Austria. 4. Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania. 5. Department of Urology, University of Catania, Catania, Italy. 6. Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy. 7. Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy. 8. Institute of Genetics and Biophysics "A. Buzzati Traverso", National Research Council (CNR), Naples, Italy. 9. Urology Unit, Policlinico Tor Vergata, University of Rome, Rome, Italy. 10. Department of Urology, Istituto Clinico Humanitas, Clinical and Research Hospital, Milan, Italy. 11. Division of Urology, University of Palermo, Palermo, Italy. 12. Department of Urology, Sapienza University of Rome, Rome, Italy. 13. Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale"-IRCCS, Naples, Italy. 14. Department of Urology, University of Bologna, Bologna, Italy. 15. Department of Urology, University of Vale do Itajaí, Itajaí, Brazil. 16. Department of Experimental Medicine and Surgery, Urology Unit, Azienda Policlinico Tor Vergata, Rome, Italy. 17. Department of CUF Urology and Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal. 18. Department of Urology, University of Medicine and Pharmacy, "Iuliu Hațieganu", Cluj-Napoca, Romania. 19. Department of Clinical Medicine and Surgery, Federico II University Medical School of Naples, Naples, Italy. 20. Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy. 21. Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy. 22. Division of Urology, Virginia Commonwealth University, Richmond, VA, USA. 23. Università degli Studi di Milano, Milan, Italy. 24. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. 25. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 26. Department of Urology, Weill Cornell Medical College, New York, NY, USA.
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.
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.
Entities:
Keywords:
Bladder cancer; Body mass index; Obesity; Prognosis
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