No clear associations of adult BMI and diabetes mellitus with non-muscle invasive bladder cancer recurrence and progression

Abstract

Background Non-muscle invasive bladder cancer patients are at high risk for tumour recurrence and progression, hence an intensive follow-up procedure is recommended which is costly. Identification of factors that are associated with the risk of recurrence and progression may enable personalized follow-up schedules. Obesity and diabetes mellitus may be associated with a worse prognosis, but the evidence is limited and inconsistent. Our objective was to determine the associations of BMI and diabetes mellitus with risks of recurrence and progression among non-muscle invasive bladder cancer patients. Methods A population-based cohort of patients diagnosed with non-muscle invasive bladder cancer between 1995 and 2010 was retrospectively identified from the Netherlands Cancer Registry and invited to participate in the Nijmegen Bladder Cancer Study (n = 1,433). Average weight during adult life, height, and diabetes mellitus diagnosis were self-reported by use of a questionnaire. Clinical follow-up data were retrieved from medical files. Associations were quantified using proportional hazard analyses. For all analyses, minimal adjustment sets were selected using a Directed Acyclic Graph. Results Fourteen percent of the patients indicated to be diagnosed with diabetes mellitus, and more than half was overweight (45%) or obese (9%). Compared to healthy weight, overweight and obesity were not associated with risk of recurrence (adjusted hazard ratio (HR) = 1.02; 95%

The obesity paradox: defining the impact of body mass index and diabetes mellitus for patients with non‐muscle‐invasive bladder cancer treated with bacillus Calmette–Guérin

“…Evers et al . [22] evaluated the association of both BMI and DM on recurrence and progression for a population‐based cohort of 1433 patients with NMIBC in the Netherlands. Patients were invited to participate years after therapy, which might have led to recall bias, as BMI and DM were self‐reported.…”

“…In keeping with these findings, the use of intravesical immunotherapy in our present study resulted in a positive association between obesity and improved in outcomes of NMIBC treated with BCG, while in studies with limited or no immunotherapy use, obesity was associated with worse outcomes. Thus, obesity might be associated with worse outcomes for patients with NMIBC not treated with BCG [22,23], but improved outcomes for those receiving intravesical immunotherapy. Several potential mechanisms for this phenomenon include increased circulating inflammatory cytokines associated with obesity, increased activation of mitogenic pathways by insulin produced in response to insulin resistance, and decreased inhibition of mitogenic pathways [26].…”

Preoperative Prognostic Nutritional Index and Systemic Immune-Inflammation Index for Predicting the Long-Term Recurrence-Free Survival of Patients with High-Risk Non-Muscle-Invasive Bladder Cancer After Transurethral Resection of a Bladder Tumour: A Cohort Study

“…However, in this study, BMI was not an effective predictor of RFS. Contradictory results have been reported as to whether BMI can predict clinical outcomes for BC [40,41]. These results may be due to biases related to the limited patient pool, varying clinicopathological stages of patients and risk strati cation.…”

Incidence of Bladder Cancer in Type 2 Diabetes Mellitus Patients: A Population-Based Cohort Study

“…Fifth, the ethnicity in this study was all Taiwanese, but Asians are a major population in the world, so this study still has external validity. Another population-based cohort study also revealed that diabetes mellitus is not clearly associated with the risk of recurrence or progression in non-muscle-invasive bladder cancer [ 43 ]. Finally, we used insurance claims data rather than actual medical records; thus, we did not analyze the different stages of BC and CKD.…”

“…Finally, we used insurance claims data rather than actual medical records; thus, we did not analyze the different stages of BC and CKD. However, because all stages of BC and CKD share similar features, this may not have significantly influenced our results [ 43 ].…”