Can body mass index predict survival outcomes in patients treated with radical nephroureterectomy for upper-tract urothelial carcinoma?

Kim, Hyung Suk; Jeong, Chang Wook; Kwak, Cheol; Kim, Hyeon Hoe; Ku, Ja Hyeon

doi:10.1007/s11255-015-1039-4

Cited by 17 publications

(6 citation statements)

References 29 publications

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“…Similarly, other retrospective studies confirmed the prognostic value of higher BMI in patients with both BC or UTUC [23,24] while another series suggested that also lowest value of BMI was associated to worst oncological outcomes [25]. On the contrary, other retrospective studies failed to find an association between BMI and oncological outcomes after surgery [26,27] while other confirmed a prognostic role only after RC without significant association after RNU [28,29]. Due to the absence of external and perspective validation of the results observed in retrospective series, the role of BMI in oncological outcomes prediction after surgery still remains unclear.…”

Section: Obesity and Risk Of Urothelial Cancermentioning

confidence: 85%

Key Role of Obesity in Genitourinary Tumors with Emphasis on Urothelial and Prostate Cancers

Santoni

Cimadamore

Massari

et al. 2019

Cancers

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Background: In human populations, a certain amount of data correlate obesity/body mass index (BMI) with urothelial cancer (UC) and prostate cancer (PCa) occurrence, however this is not fully elucidated at all stages of disease. In an attempt to shed light on uncertain areas in such field, in the present review we illustrate the main molecular mechanisms linking obesity and cancer, focusing on the correlation between obesity and tumor risk, disease progression and response to chemo- and immunotherapy in patients with UC and the predictive/prognostic role of obesity in PCa patients treated with the currently available therapeutic approaches. Methods: We did a large-scale literature search on existing scientific websites focusing on keywords “obesity”, “body mass index (BMI)”, “urothelial cancer”, “prostate cancer”, “docetaxel”, “cabazitaxel”, “abiraterone acetate”, “enzalutamide”, and “radium223”. Results: Many adipocytes-induced molecules support tumor proliferation through activation of various cellular pathways. The available evidence in the postoperative setting do the role of BMI in oncological outcomes prediction still not completely clear. Likewise, in metastatic UC patients controversial results link the role of obesity/BMI with clinical outcomes of tumor response to chemotherapy. Adipose stromal cells recruitment, induced by PCa cells, from white adipose tissue to the tumor sites inducing cell invasiveness was associated with poor survival. Conflicting data, although more oriented towards a better survival outcome, resulted in obese patients treated with docetaxel. In PCa cell-lines a certain cabazitaxel chemo resistance adipose stromal cells (ASC)-mediated was demonstrated. In metastatic castration-resistant PCa patients with high BMI (>25 kg/m2) receiving abiraterone acetate there were significant worse survival outcomes, while in enzalutamide patients BMI did not affect survival outcome. In radium 223 patients higher BMI significantly correlated with favorable overall survival. Conclusions: The main focus of this review was to understand the interplay between obesity/BMI and UC/PCa. Several pathogenic cellular pathways exploring the issue are discussed, opening the way to challenging tailored treatments on the basis of BMI. Improving the knowledge of molecular connections between obesity and UC and PCa could favor the development of new therapies likely reducing chemo- and immunotherapy drug resistance.

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Section: Obesity and Risk Of Urothelial Cancermentioning

confidence: 85%

Key Role of Obesity in Genitourinary Tumors with Emphasis on Urothelial and Prostate Cancers

Santoni

Cimadamore

Massari

et al. 2019

Cancers

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“…In this study, BMI was not significantly associated with CSS and OS. Similarly, the prognostic roles of decreased BMI in UTUC patients have been inconclusive in previous studies . This may partly be because BMI does not reflect body composition, including the proportion of fat to muscle tissue and the degree of fluid accumulation such as ascites and edema .…”

Section: Discussionmentioning

confidence: 96%

Prognostic significance of sarcopenia in upper tract urothelial carcinoma patients treated with radical nephroureterectomy

et al. 2016

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We investigated the prognostic significance of sarcopenia in upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy (RNU). The skeletal muscle index (SMI) was calculated from computed tomography images. Sarcopenia was defined as SMI <43 cm2/m2 for males with body mass index <25 kg/m2, <53 cm2/m2 for males with BMI ≥25 kg/m2, and <41 cm2/m2 for females. Associations of sarcopenia with cancer‐specific survival (CSS) and overall survival (OS) were evaluated in 81 consecutive UTUC patients who underwent RNU. Forty‐seven (58%) out of 81 patients had sarcopenia. Multivariate analyses identified sarcopenia as a significant and independent poor prognostic factor for both CSS (hazard ratio [HR] 8.58, 95% confidence interval [CI]: 1.63–158.1, P = 0.008) and OS (HR 6.05, 95%CI 2.00–26.21, P < 0.001). In patients with locally advanced disease (pT3/4 or pN+), those with sarcopenia showed significantly worse CSS and OS than those without (5‐year CSS rate 55% vs. 100%, P = 0.014; 5‐year OS rate 40% vs. 86%, P = 0.007). In contrast, no prognostic difference was observed between patients with and without sarcopenia in those with organ‐confined disease (pTa‐2pN0/x). Sarcopenia is an independent poor prognostic factor for UTUC patients treated with RNU, particularly for those with locally advanced disease.

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“…When UI was defined as a tumour located only in the ureter (subgroup 1) or as a tumour located only in the ureter and as a dominant lesion in that location (subgroup 2), no differences in OS were found. Sensiti vi ty analysis indicated that the study of Kim et al affected the summary result in the first subgroup [24]. Heterogeneity: τ 2 = 0.00; χ 2 = 1.30, df = 2 (p = 0.52); I 2 = 0% Test for overall effect: Z = 6.10 (p = 0.00001) Total (95% Cl) 100.0% 1.39 [1.11, 1.74] Heterogeneity: τ 2 = 0.07; χ 2 = 31.20, df = 7 (p < 0.0001); I 2 = 78% Test for overall effect: Z = 2.86 (p = 0.004) Test for subgroup differences: χ 2 = 9.13, df = 2 (p = 0.01 ), I 2 = 78.1%…”

Section: Resultsmentioning

confidence: 98%

“…The 14 studies in this meta-analysis included 14,895 participants [13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The baseline characteristics of the included studies are summarised in Table I study ranged from 133 to 3387 (mean 1064, median 623).…”

Section: Resultsmentioning

confidence: 99%

Survival differences of patients with ureteral versus pelvicalyceal tumours: a systematic review and meta-analysis

et al. 2021

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Introduction: Worse survival in upper tract urothelial carcinoma (UTUC) in the presence of a tumour in the ureter vs. pelvicalyceal tumours is reported in some studies; however, the definition of ureteral involvement (UI) varies across studies. We systematically evaluated evidence regarding the prognostic role of UI in overall and cancer-specific survival of patients with UTUC. Material and methods: A systematic search of PubMed, Scopus and Web of Knowledge was performed in March 2018. Results: The results were presented as a comparison between ureteral vs. pelvicalyceal tumours. A total of 14,895 patients were identified. Cumulative analyses indicated that UI worsens cancer-specific survival (CSS) and overall survival (OS), with a pooled HR of 1.52 (p < 0.001) and 1.39 (p = 0.004), respectively. Conclusion: Our meta-analysis identified UI in UTUC as an adverse prognostic factor.

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Can body mass index predict survival outcomes in patients treated with radical nephroureterectomy for upper-tract urothelial carcinoma?

Abstract: Our study results are inconclusive, in that, the multivariate analysis did not identify the influence of BMI on survival, although higher BMI appears clinically associated with favorable survival outcomes in Korean patients with UTUC.

Cited by 17 publications

References 29 publications

Key Role of Obesity in Genitourinary Tumors with Emphasis on Urothelial and Prostate Cancers

Key Role of Obesity in Genitourinary Tumors with Emphasis on Urothelial and Prostate Cancers

Prognostic significance of sarcopenia in upper tract urothelial carcinoma patients treated with radical nephroureterectomy

Survival differences of patients with ureteral versus pelvicalyceal tumours: a systematic review and meta-analysis

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