Optimal body mass index cut‑point for predicting recurrence‑free survival in patients with non‑muscle‑invasive urothelial carcinoma of bladder

Abstract

In Japanese patients with non-muscle-invasive urothelial carcinoma of the bladder, the impact of body mass index (BMI) on recurrence following transurethral resection of bladder tumor (TURBT) is unclear. The present study retrospectively examined data collected from 50 patients diagnosed with primary urothelial carcinoma of the bladder (pTa, pTis, and pT1) who had previously undergone TURBT surgery. Two BMI cut-off points for predicting disease recurrence were evaluated: i) A threshold generated through receiver operating characteristic (ROC) curve analysis; ii) the World Health Organization BMI index (24 kg/m) for overweight status in Japanese populations. Univariate and multivariate analyses were applied to assess individual variables (BMI included) and the effect they had on recurrence-free survival (RFS). Median RFS and BMI values of 19.72 months (range, 3.13-72.13 months) and 23.37 kg/m2 (range, 14.72-36.84 kg/m2), respectively, were recorded. In multivariate analyses, higher continuous BMI was significantly associated with shorter RFS (P=0.019). Based on a ROC-generated BMI cut-off point (23.4 kg/m2), patients were ranked with either a high (≥23.4 kg/m2) or low (<23.4 kg/m2) BMI status. Multivariate analysis indicated that BMI values >23.4 kg/m2 were significantly associated with shorter RFS (P=0.028). Intravesical Bacillus Calmette-Guérin treatment and history of upper-tract urothelial carcinoma were also independently associated (P=0.044 and P=0.010, respectively). However, BMI values >24 kg/m2 (customary cut-off point) had no significant impact on RFS (P=0.066). Thus, a higher BMI status was revealed to be independently predictive of shorter RFS in Japanese patients undergoing TURBT for urothelial carcinoma of the bladder. A greater number of samples are required in order to determine optimal BMI cut-off points in Japanese patients and to investigate whether weight reduction intervention may improve prognosis.

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

“…Among NMIBC patients, the majority of studies suggest that elevated BMI is associated with increased risks of recurrence [ 7 , 24 , 34 , 65 , 66 , 73 , 74 ] and progression [ 65 , 66 , 73 , 74 ]. The association between BMI and recurrence is more conflicting in studies with both NMIBC and MIBC patients [ 7 , 25 , 30 , 68 , 70 ].…”

“…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].…”

Prognostic value of preoperative neutrophil-to-lymphocyte ratio in histological variants of non-muscle-invasive bladder cancer

“…Several studies indicated that PNLR was associated with an increased risk of disease recurrence, progression and survival in patients with NMIBC [ 17 18 22 ]. However, none of these studies focused on the effectiveness of PNLR in VH-NMIBC.…”

“…Many studies indicated that the appearance of VH in NMIBC usually meant advent disease and poor prognosis, prompting surgeons to perform early RC [ 22 ]. Urologists sought to determine what patient subset has aggressive properties and discover the useful biomarkers for identifying a higher risk population, especially in patients with VH-NMIBC.…”

Body mass index and waist circumference in relation to risk of recurrence and progression after non‐muscle invasive bladder cancer

“…There is limited and inconsistent evidence regarding the association between obesity and risk of NMIBC recurrence and progression. Seven cohort studies showed that higher body mass index (BMI) was associated with higher risk of recurrence, 7–13 of which five studies showed statistically significant associations 7–11 . In contrast, two studies reported no associations 14,15 .…”