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

  • Urology - Original Paper
  • Published:
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Abstract

Purpose

To assess the relationship between body mass index (BMI) and survival outcomes in Korean patients with upper-tract urothelial carcinoma (UTUC).

Methods

A single-institutional retrospective analysis was conducted using clinical and pathological data of 445 UTUC patients who had undergone radical nephroureterectomy with bladder cuff excision from 1997 to 2012. Enrolled patients were classified into normal weight (BMI < 23 kg/m2), overweight (BMI 23–24.9 kg/m2), and obese (BMI ≥ 25 kg/m2) in accordance with BMI cutoffs for Asian populations. The impact of BMI on intravesical recurrence (IVR)-free survival, overall survival (OS), and cancer-specific survival (CSS) was evaluated using Kaplan–Meier analysis with the log-rank test and the Cox proportional hazard model.

Results

The median BMI of all patients was 24.2 kg/m2 (interquartile range 22.2–25.8). There were no significant differences in the IVR-free survival rates according to BMI classification (p = 0.488). The 5-year OS and CSS rates were 58.8, 66.3, and 76.3 % (p = 0.057) and 67.4, 69.3, and 81.5 % (p = 0.021) in the normal, overweight, and obese groups, respectively. In the univariate analysis, obesity (BMI ≥ 25 kg/m2) was a significant predictor of better OS [hazard ratio (HR) 0.63; 95 % confidence interval (CI) 0.43–0.92, p = 0.017] and CSS (HR 0.53; 95 % CI 0.33–0.84, p = 0.007) than normal weight. However, these associations could not be confirmed in the multivariable analysis after adjusting for other clinicopathological factors, such as tumor stage, tumor grade, lymphovascular invasion, and surgical margin.

Conclusions

Our study results are inconclusive, in that, the multivariate analysis did not identify the influence of BMI on survival, although higher BMI appears clinically associated with favorable survival outcomes in Korean patients with UTUC.

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Acknowledgments

This study design and the use of patients’ information stored in the hospital database were approved by the Institutional Review Board (IRB) at the Seoul National University Hospital. The approval number is H-1503-099-657. We were given exemption from obtaining informed consent by the IRB because the present study is a retrospective study and personal identifiers were completely removed and the data were analyzed anonymously. Our study was conducted according to the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. There were no grants or other external funding sources for this study.

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Authors and Affiliations

  1. Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Hyung Suk Kim, Chang Wook Jeong, Cheol Kwak, Hyeon Hoe Kim & Ja Hyeon Ku

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  1. Hyung Suk Kim
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  2. Chang Wook Jeong
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  3. Cheol Kwak
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Correspondence to Ja Hyeon Ku.

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All the authors declare no conflicts of interest.

Electronic supplementary material

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11255_2015_1039_MOESM2_ESM.docx

Fig. 1. Kaplan–Meier plots for intravesical recurrence free survival in accordance with BMI classification of the entire study cohort. (DOCX 34 kb)

11255_2015_1039_MOESM1_ESM.tif

Table 1. Univariable and multivariable Cox regression analyses predicting intravesical recurrence free survival in the entire study cohort. (TIFF 1737 kb)

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Kim, H.S., Jeong, C.W., Kwak, C. et al. Can body mass index predict survival outcomes in patients treated with radical nephroureterectomy for upper-tract urothelial carcinoma?. Int Urol Nephrol 47, 1311–1320 (2015). https://doi.org/10.1007/s11255-015-1039-4

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  • DOI: https://doi.org/10.1007/s11255-015-1039-4

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