Obesity and prognosis in muscle‐invasive bladder cancer: The continuing controversy

Abstract

Abbreviations & AcronymsObjectives: To investigate the association between body mass index and clinicopathological features of bladder cancer, and to assess the prognostic value of body mass index in patients undergoing radical cystectomy for bladder cancer. Methods: The medical records of 714 patients who underwent radical cystectomy for bladder cancer were reviewed. The association of body mass index at surgery with clinicopathological features was examined, and the prognostic value of body mass index for recurrence-free survival and cancer-specific survival was analyzed using the Kaplan-Meier method and Cox regression models. Additional survival analyses were carried out in a subgroup of 534 patients with N0M0 disease. Results: Of 714 patients, 304 (42.6%), 184 (25.8%) and 226 (31.7%) had a body mass index of <23 (normal), 23-25 (overweight), and ≥25 (obese) kg/m 2 , respectively. Patients with high body mass index had a lower pathological T stage, fewer lymph node metastases and a lower frequency of lymphovascular invasion than those with low body mass index (P < 0.05). Multivariable analysis showed that obese status was an independent predictor of recurrencefree survival (obese vs normal: P < 0.001; overweight vs normal: P = 0.008) and cancerspecific survival (obese vs normal: P < 0.001; overweight vs normal: P = 0.019), along with pathological T stage, lymph node metastasis, and lymphovascular invasion. In addition, obesity was significantly associated with recurrence-free survival (P = 0.018) and cancerspecific survival (P = 0.019) in patients with N0M0 status. Conclusions: The present findings suggest that overweight and obesity are associated with favorable pathological features and prognosis in patients with bladder cancer undergoing radical cystectomy.

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

“…Kwon et al [15] recently reported that overweight patients who underwent RC had more favourable pathological features and a better prognosis than those with normal BMI values. Quite the contrary, low BMI was a predictor for increased mortality and poor OS.…”

“…However these findings stand in strong contrast to other studies’ results. As preoperative nutritional deficiency is a risk factor for increased mortality and poor overall survival (OS) after RC Kwon et al [15] found favorable pathological features and prognosis in obese patients after RC. Hafron et al [16] reported no significant association between higher BMI and disease-specific survival.…”

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

“…Although obesity is considered as an established risk factor for the development of renal cell carcinoma (RCC), it has been consistently reported that obesity is related to better pathological features and survival outcome in RCC [10,11]. However, in cases of prostate and bladder cancer, conflicting results have been reported between studies [12,13,15,16]. Interestingly, for prostate and bladder cancer, the influence of obesity on cancer-related outcomes was different depending on patients' ethnicities.…”

“…Generally, 15-20 % of all cancer deaths in the USA were probably because of excess body weight [6]. The relationship between obesity and mortality from cancer has also been investigated in urologic cancers, including kidney, prostate, and bladder [10][11][12][13][14][15][16].…”

“…Obesity has also been suggested as a potential prognostic factor of UTUC, but research on this area is still insufficient, and the studies assessing the impact of obesity on survival in UTUC have reported inconsistent results [20][21][22][23]. In addition, the prognostic role of obesity has shown conflicting results between studies regarding UC of the bladder [14][15][16].…”