Obesity is associated with worse outcomes in patients with T1 high grade urothelial carcinoma of the bladder

TY - JOUR

T1 - Obesity is associated with worse outcomes in patients with T1 high grade urothelial carcinoma of the bladder

AU - Kluth, Luis A

AU - Xylinas, Evanguelos

AU - Crivelli, Joseph J

AU - Passoni, Niccolo

AU - Comploj, Evi

AU - Pycha, Armin

AU - Chrystal, James

AU - Sun, Maxine

AU - Karakiewicz, Pierre I

AU - Gontero, Paolo

AU - Lotan, Yair

AU - Chun, Felix K-H

AU - Fisch, Margit

AU - Scherr, Douglas S

AU - Shariat, Shahrokh F

N1 - Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

PY - 2013/8/1

Y1 - 2013/8/1

N2 - PURPOSE: To our knowledge the impact of body mass index on oncologic outcomes in nonmuscle invasive bladder cancer has not been evaluated. We hypothesized that higher body mass index is associated with worse outcomes in patients with clinical primary T1 high grade urothelial carcinoma of the bladder.MATERIALS AND METHODS: We retrospectively analyzed data from 892 patients with primary nonmuscle invasive bladder cancer from 7 centers. Patients were treated with transurethral resection of the bladder with or without intravesical therapy. Body mass index was analyzed as a continuous and a categorical variable (nonobese-body mass index less than 30 kg/m(2) vs obese-body mass index 30 kg/m(2) or greater). Disease progression was defined as the development of T2 or higher tumor stage.RESULTS: Median followup was 42.8 months (IQR 56). Of the patients 44.3% were obese and median body mass index was 29.2 kg/m(2) (IQR 8). On univariable analyses higher body mass index and age were associated with an increased risk of disease recurrence, progression, cancer specific mortality and any cause mortality (all p ≤ 0.001). On multivariable analyses that adjusted for the effects of gender, concomitant carcinoma in situ, tumor size, number of tumors and intravesical therapy, higher body mass index and age remained independent predictors of disease recurrence, progression, cancer specific mortality and any cause mortality (all p <0.05). This study was limited by its design (ie lack of data on repeat transurethral resection of the bladder and intravesical therapy protocol).CONCLUSIONS: Patients diagnosed with clinical T1 high grade urothelial carcinoma of the bladder who are obese have worse cancer specific outcomes compared to their nonobese counterparts. Further work is needed to improve our understanding of clinical T1 high grade outcomes in the growing population of obese patients.

AB - PURPOSE: To our knowledge the impact of body mass index on oncologic outcomes in nonmuscle invasive bladder cancer has not been evaluated. We hypothesized that higher body mass index is associated with worse outcomes in patients with clinical primary T1 high grade urothelial carcinoma of the bladder.MATERIALS AND METHODS: We retrospectively analyzed data from 892 patients with primary nonmuscle invasive bladder cancer from 7 centers. Patients were treated with transurethral resection of the bladder with or without intravesical therapy. Body mass index was analyzed as a continuous and a categorical variable (nonobese-body mass index less than 30 kg/m(2) vs obese-body mass index 30 kg/m(2) or greater). Disease progression was defined as the development of T2 or higher tumor stage.RESULTS: Median followup was 42.8 months (IQR 56). Of the patients 44.3% were obese and median body mass index was 29.2 kg/m(2) (IQR 8). On univariable analyses higher body mass index and age were associated with an increased risk of disease recurrence, progression, cancer specific mortality and any cause mortality (all p ≤ 0.001). On multivariable analyses that adjusted for the effects of gender, concomitant carcinoma in situ, tumor size, number of tumors and intravesical therapy, higher body mass index and age remained independent predictors of disease recurrence, progression, cancer specific mortality and any cause mortality (all p <0.05). This study was limited by its design (ie lack of data on repeat transurethral resection of the bladder and intravesical therapy protocol).CONCLUSIONS: Patients diagnosed with clinical T1 high grade urothelial carcinoma of the bladder who are obese have worse cancer specific outcomes compared to their nonobese counterparts. Further work is needed to improve our understanding of clinical T1 high grade outcomes in the growing population of obese patients.

KW - Age Factors

KW - Aged

KW - Carcinoma, Transitional Cell

KW - Disease Progression

KW - Female

KW - Humans

KW - Male

KW - Neoplasm Invasiveness

KW - Neoplasm Staging

KW - Obesity

KW - Proportional Hazards Models

KW - Retrospective Studies

KW - Risk Factors

KW - Statistics, Nonparametric

KW - Treatment Outcome

KW - Urinary Bladder Neoplasms

U2 - 10.1016/j.juro.2013.01.089

DO - 10.1016/j.juro.2013.01.089

M3 - SCORING: Journal article

C2 - 23376707

VL - 190

SP - 480

EP - 486

JO - J UROLOGY

JF - J UROLOGY

SN - 0022-5347

IS - 2

ER -