Influence of Body Mass Index on Clinical Outcome Parameters, Complication Rate and Survival after Radical Cystectomy: Evidence from a Prospective European Multicentre Study

Gierth, Michael; Zeman, Florian; Denzinger, Stefan; Vetterlein, Malte W.; Bastian, Patrick J.; Syring, Isabella; Ellinger, Jörg; Müller, Stephan; Herrmann, Edwin; Gilfrich, Christian; May, Matthias; Pycha, Armin; Wagenlehner, Florian M. E.; Vallo, Stefan; Bartsch, Georg; Haferkamp, Axel; Grimm, Marc‐Oliver; Roigas, Jan; Protzel, Chris; Hakenberg, Oliver W.; Fritsche, Hans‐Martin; Burger, Maximilian; Aziz, Atiqullah; Mayr, Roman

doi:10.1159/000488466

Cited by 30 publications

(34 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: 86%

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: 86%

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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“…The morbidity and mortality are among the highest in oncological surgery [3][4][5][6][7]. Influential factors are the high level of invasiveness combined with patient-derived factors such as the elevated mean patient's age and greater comorbidity [4,6,8,9].…”

Section: Introductionmentioning

confidence: 99%

In-Hospital Outcomes after Radical Cystectomy for Bladder Cancer: Comparing National Trends in the United States and Germany from 2006 to 2014

et al. 2019

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Background: Radical cystectomy (RC) still poses a significant risk for mortality and morbidity. Objectives: We compared in-hospital outcomes after RC in the United States and Germany using population-based data. Methods: We compared data from the US Nationwide Inpatient Sample to the German hospital billing database. Mortality and transfusion during hospital stay and length of stay (LOS) were evaluated. Results: In all, 17,711 (the United States) and 60,447 (Germany) cases were included. The share of robot-assisted RC increased to 20.5% in the United States vs. 2.3% in Germany (p < 0.001). In-hospital mortality was 1.9% (the United States) vs. 4.6% (Germany), transfusion rates were 34.2% (the United States) vs. 58.7% (Germany), and LOS was 10.7 (the United States) vs. 25.1 days (Germany; all p < 0.001). On multivariate analysis, higher patient age and lower annual hospital caseload were associated with increased mortality and longer LOS. Minimal-invasive surgery was associated with less blood transfusion and shorter LOS in the United States vs. hospital caseload and choice of urinary diversion in Germany. Conclusions: Healthcare systems might exert a relevant impact on outcomes of oncologic surgery. Increased in-hospital mortality rates in Germany seem to be partly explained by much longer LOS compared to those in the United States. Annual caseload seems to be influential on in-hospital outcomes raising the question of centralization of RC.

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“…Eighteen studies have assessed the association between body mass index (BMI) and prognosis [7,24,25,30,34,39,59,[65][66][67][68][69][70][71][72][73][74][75]. One study assessed BMI at diagnosis, [24] 13 studies assessed BMI at time of treatment (e.g., transurethral resection of bladder tumor (TURBT), radical cystectomy), [25,30,34,39,59,[65][66][67][68][69][70][71][72] and three studies did not report timing of BMI measurement [73][74][75].…”

Section: Body Mass Indexmentioning

confidence: 99%

Lifestyle and Non-muscle Invasive Bladder Cancer Recurrence, Progression, and Mortality: Available Research and Future Directions

Zuniga

Graff

Feiger

et al. 2020

BLC

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BACKGROUND: A broad, comprehensive review of studies exploring associations between lifestyle factors and non-muscle invasive bladder cancer (NMIBC) outcomes is warranted to consolidate recommendations and identify gaps in research. OBJECTIVE: To summarize the literature on associations between lifestyle factors and clinical outcomes among patients with NMIBC. METHODS: PubMed was systematically queried for articles published through March 2019 regarding lifestyle factors and recurrence, progression, cancer-specific mortality, and all-cause mortality among patients with NMIBC. RESULTS: Notwithstanding many ambiguities, there is good-quality evidence suggesting a benefit of smoking avoidance/cessation, healthy body mass index (BMI), and type II diabetes mellitus prevention and treatment. Lactobacillus casei probiotic supplementation may reduce recurrence. There have been individual studies suggesting a benefit for uncooked broccoli and supplemental vitamin E as well as avoidance of supplemental vitamin B9, areca nut chewing, and a "Western diet" pattern high in fried foods and red meat. Additional studies do not suggest associations between NMIBC outcomes and use of fibrin clot inhibitors; insulin and other oral hypoglycemics; statins; supplemental selenium, vitamin A, vitamin C, and vitamin B6; fluid intake and intake of specific beverages (e.g., alcohol, coffee, green tea, cola); various dietary patterns (e.g., Tex-Mex, high fruit and vegetable, low-fat); and occupational and chemical exposures. CONCLUSIONS: Despite a myriad of publications on lifestyle factors and NMIBC, a need remains for research on unexplored associations (e.g., physical activity) and further studies that can elucidate causal effects. This would inform future implementation strategies for healthy lifestyle change in NMIBC patients.

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Influence of Body Mass Index on Clinical Outcome Parameters, Complication Rate and Survival after Radical Cystectomy: Evidence from a Prospective European Multicentre Study

Cited by 30 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

In-Hospital Outcomes after Radical Cystectomy for Bladder Cancer: Comparing National Trends in the United States and Germany from 2006 to 2014

Lifestyle and Non-muscle Invasive Bladder Cancer Recurrence, Progression, and Mortality: Available Research and Future Directions

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