An increased body mass index is associated with a worse prognosis in patients administered BCG immunotherapy for T1 bladder cancer

Ferro, Matteo; Vartolomei, Mihai Dorin; Russo, Giorgio Ivan; Cantiello, Francesco; Farhan, Abdal Rahman Abu; Terracciano, Daniela; Cimmino, Amelia; Stasi, S. Di; Musi, Gennaro; Hurle, Rodolfo; Serretta, Vincenzo; Busetto, Gian Maria; Berardinis, Ettore De; Cioffi, Antonio; Perdonà, Sisto; Borghesi, Marco; Schiavina, Riccardo; Cozzi, Guido; Almeida, Gilberto Laurino; Bove, Pierluigi; Lima, Estêvão; Grimaldi, Giovanni; Matei, Deliu Victor; Crişan, Nicolae; Muto, Matteo; Verze, Paolo; Battaglia, Michele; Guazzoni, Giorgio; Autorino, Riccardo; Morgia, Giuseppe; Damiano, Rocco; Cobelli, Ottavio De; Shariat, Shahrokh F.; Mirone, Vincenzo; Lucarelli, Giuseppe

doi:10.1007/s00345-018-2397-1

Cited by 81 publications

(92 citation statements)

References 26 publications

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“…This was confirmed by the fact that a sensitivity analysis with additional adjustment for smoking status did not change our risk estimates (data not shown). Also, no associations were found in the subgroup of patients initially treated with adjuvant immunotherapy (S5 Table), in contrast to results of Kluth et al [19] and Ferro et al [39]. Our results are in line with those of Wyszynski et al [20], who also found that associations for BMI did not differ by immunotherapy treatment status.…”

Section: Discussionsupporting

confidence: 87%

“…Here, statistically significant associations with recurrence (HR; 2.66, 95% CI: 2.13-3.32) and progression (HR: 1.49, 95% CI: 1.00-2.21) were shown when comparing obesity with no obesity [19]. In a recent study by Ferro et al in 1155 T1G3 NMIBC patients treated with maintenance Bacillus Calmette-Guerin (BCG), obesity versus normal weight at diagnosis was associated with an increased risk of recurrence (HR: 5.33; 95% CI: 4.16-6.83) and progression (HR:2.51, 95% CI: 1.76-3.57) as well, with similar but slightly lower risk estimates for overweight [39]. None of these three studies adjusted for smoking status.…”

Section: Discussionmentioning

confidence: 91%

“…Four historical cohort studies investigated the association of overweight and/or obesity with the risk of recurrence and progression in NMIBC patients [19][20][21]39]. In a study of 469 NMIBC patients, Xu et al (2015) compared overweight and obesity to healthy weight at the time of transurethral resection of the bladder tumour.…”

Section: Discussionmentioning

confidence: 99%

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

Evers¹,

Grotenhuis²,

Aben

et al. 2020

PLoS ONE

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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%

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 91%

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

Evers¹,

Grotenhuis²,

Aben

et al. 2020

PLoS ONE

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“…However, Koebnick et al 12 claimed that obesity increased the risk of bladder cancer and Ferro et al 27 revealed that BMI plays a role in the recurrence and progression of non-muscle-invasive bladder cancer. In the Asian population, a recent study 28 showed that the incidence of bladder cancer was higher in the overweight and obese population.…”

Section: Discussionmentioning

confidence: 99%

Increased incidence of bladder cancer with metabolically unhealthy status: analysis from the National Health Checkup database in Korea

Kim

Ahn

et al. 2020

Sci Rep

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We assessed the association between metabolic health status and the incidence of bladder cancer using nationally representative data from the national Health insurance System and national Health Checkups (NHC) databases in South Korea. Data for 11,781,768 men who participated in the NHC between 2009 and 2012 were analysed. The normal-weight and physically obese categories were defined as body mass indexes (BMI) < 25 and ≥25 kg/m 2 , respectively. Metabolically obese was defined as the presence of ≥3 components of metabolic syndrome. The participants were stratified into metabolically healthy, normal-weight (MHNW); metabolically obese, normal-weight (MONW); metabolically healthy, obese (MHO); metabolically obese, obese (MOO). Multivariate-adjusted Cox regression analysis was conducted to examine the association between metabolic health status and the incidence of bladder cancer. The study participants included 17,777 men newly registered with bladder cancer. Analysis according to metabolic health status classification revealed a higher multivariableadjusted hazard ratio in the MOO, MONW group than in the MHO group (1.307 [95% CI: 1.258-1.358], 1.183 [95% CI: 1.137-1.231] and 1.066 [95% CI: 1.017-1.119], respectively; hazard ratios given relative to MHnW group) We found an association between metabolic health status and the incidence of bladder cancer, with an increasing risk according to the number of metabolic health status components. Data source and study population. InSouth Korea, the National Health Insurance System (NHIS) established in 2000 covers about 98% of the citizens (about 50 million in 2014) 15 . All insurance members and dependents are asked to undergo a free biannual health check-up as part of the NHIS. In 2013, about 68% of members received a full health check-up 16 , making it possible to obtain information on population-wide disease status 17 .In the present study, sex, birth date, past history, medication history, socioeconomic data, body size phenotypes, and diagnostic codes based on the International Statistical Classification of Diseases and related health problems 10th revision, Clinical Modification (ICD-10-CM) were retrieved.Data from a total of 11,781,768 men who participated in the National Health Checkups (NHC) program between January 2009 and December 2012 were analysed. Body size phenotypes were classified according to BMI, which was calculated from measured height and weight, and the presence or absence of metabolic syndrome according to the results of the NHC 17 .Since patients that are diagnosed with cancer, cardiovascular disease, cerebrovascular disease, and rare disease are entitled to economic benefits from the Korean government 18 , almost all physician-diagnosed cancer patients are registered in the central database 19 . Bladder cancer was coded as C67 in the ICD-10-CM. A flowchart for the selection of the study participants is shown in Fig. 1. Definition of metabolic health status. 'Physically obese' was categorized according to the World HealthOrganization's (WHO) definit...

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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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An increased body mass index is associated with a worse prognosis in patients administered BCG immunotherapy for T1 bladder cancer

Abstract: 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.

Cited by 81 publications

References 26 publications

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

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

Increased incidence of bladder cancer with metabolically unhealthy status: analysis from the National Health Checkup database in Korea

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

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