Diabetes Mellitus and Obesity as Risk Factors for Bladder Cancer Prognosis: A Systematic Review and Meta-Analysis

Abstract

BackgroundUrinary bladder carcinoma is common in developed settings, and prognosis may be impacted by lifestyle factors such as excess body weight and diabetes mellitus. The present meta-analysis aimed to systematically collate and analyze evidence on the impact of diabetes and excess BMI on bladder cancer outcomes.MethodsPubMed, Scopus, and Google Scholar databases were screened for relevant studies that examined the association between bladder cancer outcomes and diabetes and/or excess body weight. The primary outcomes for this study were mortality (both all-cause and cancer-specific), risk of cancer progression, and recurrence. Strength of association was presented in the form of pooled adjusted hazard ratios (HR). Statistical analysis was performed using STATA version 16.0.ResultsTwenty-five articles met inclusion criteria. Nine of these examined diabetes mellitus while 16 studied body mass index. All studies were retrospective. Diabetic patients had significantly higher risk for all-cause mortality (HR 1.24, 95% CI: 1.07, 1.44, n=3), cancer specific mortality (HR 1.67, 95% CI: 1.29, 2.16, n=7), disease progression (HR 1.54, 95% CI: 1.15, 2.06, n=8), and recurrence (HR 1.40, 95% CI: 1.32, 1.48, n=8) compared to non-diabetics. No statistically significant risk change for all-cause mortality, cancer specific mortality, disease progression, and recurrence was found for overweight patients. However, obese individuals were at higher risk for disease progression (HR 1.88, 95% CI: 1.41, 2.50, n=3) and recurrence (HR 1.60, 95% CI: 1.06, 2.40, n=7) compared to normal BMI patients.ConclusionsThese findings suggest that diabetes and excess body weight negatively influences bladder cancer prognosis and outcome. The increased risk of mortality due to diabetes was similar to that in the general population. Since retrospective studies are potentially susceptible to bias, future prospective studies on this subject are required.

Impact of Age on Outcomes of Patients With Pure Carcinoma In Situ of the Bladder: Multi-Institutional Cohort Analysis

“…Furthermore, BMI and multifocality were also independent predictive factors for worse outcomes in patients with pure CIS. BMI was investigated in many studies [32]and in the most recent metaanalysis was demonstrated that obese individuals were at higher risk for disease progression (HR 1.88, 95% CI: 1.41, 2.50, n=3) and recurrence (HR 1.60, 95% CI: 1.06, 2.40, n=7) compared to normal BMI patients [33]. Multifocality is a well known predictive factor for NMIBC [34], and its role is even more important in case of CIS.…”

Rac1 as a Target to Treat Dysfunctions and Cancer of the Bladder

“…These pathologies can be interconnected. As mentioned above, diabetes mellitus is a risk factor for bladder cancer prognosis [ 64 ], and urinary incontinence is a common complication of bladder cancer [ 133 ].…”

“…Diabetes causes bladder remodeling leading to uropathy in a mulitfactorial way, with neurogenic and myogenic detrusor overactivity and changes in transmitter regulation leading to a hyper-excitability of the detrusor [ 63 ]. DM is also a risk factor for bladder cancer prognosis and outcome [ 64 ]. Diabetic cystopathy (urinary disturbances) is one of the most common complications of diabetes mellitus [ 65 ].…”

Metformin, Statin Use, and Female Colorectal Cancer: A Population-Based Cohort Study in Taiwan

“…Type 2 diabetes mellitus (T2DM) is a risk factor for solid malignancies such as liver, pancreatic, colon, breast, bladder, and endometrial cancer [ 8 , 9 , 10 , 11 ]. The cancer-causing mechanisms in diabetes are complex, including excessive reactive oxygen species (ROS) formation, chronic inflammation, and impaired healing phenomena, collectively leading to carcinogenesis under diabetic conditions [ 12 , 13 ].…”