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

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

Abstract

Purpose

The body mass index (BMI) may be associated with an increased incidence and aggressiveness of urological cancers. In this study, we aimed to evaluate the impact of the BMI on survival in patients with T1G3 non-muscle-invasive bladder cancer (NMIBC).

Methods

A total of 1155 T1G3 NMIBC patients from 13 academic institutions were retrospectively reviewed and patients administered adjuvant intravesical Bacillus Calmette–Guérin (BCG) immunotherapy with maintenance were included. Multivariable Cox regression analysis was performed to identify factors predictive of recurrence and progression.

Results

After re-TURBT, 288 patients (27.53%) showed residual high-grade NMIBC, while 867 (82.89%) were negative. During follow-up, 678 (64.82%) suffered recurrence, and 303 (30%) progression, 150 (14.34%) died of all causes, and 77 (7.36%) died of bladder cancer. At multivariate analysis, tumor size (hazard ratio [HR]:1.3; p = 0.001), and multifocality (HR:1.24; p = 0.004) were significantly associated with recurrence (c-index for the model:55.98). Overweight (HR: 4; p < 0.001) and obesity (HR:5.33 p < 0.001) were significantly associated with an increased risk of recurrence. Addition of the BMI to a model that included standard clinicopathological factors increased the C-index by 9.9. For progression, we found that tumor size (HR:1.63; p < 0.001), multifocality (HR:1.31; p = 0.01) and concomitant CIS (HR: 2.07; p < 0.001) were significant prognostic factors at multivariate analysis (C-index 63.8). Overweight (HR: 2.52; p < 0.001) and obesity (HR: 2.521 p < 0.001) were significantly associated with an increased risk of progression. Addition of the BMI to a model that included standard clinicopathological factors increased the C-index by 1.9.

Conclusions

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.

Keywords

Bladder cancer Body mass index Obesity Prognosis 

Notes

Aknowledgements

M.D.V is supported by the Scholarship Foundation of the Republic of Austria—OeAD and by the EUSP Scholarship—European Association of Urology.

Author contributions

MF, MDV, GIR, ARAF, VM, GL: protocol/project development. All authors: data collection or management. All authors: data analysis. MF,GIR, MDV, FC, GL: manuscript writing/editing

Compliance with ethical standards

conflict of interest

The authors declare that they have no conflict of interest, nothing to declare.

Research involving human participants and/or animals

This is a retrospective study. Institutional review board approval was granted by means of a general waiver for studies with retrospective data analysis in each center. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent to take part was given by all participants.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Matteo Ferro
    • 1
  • Mihai Dorin Vartolomei
    • 1
    • 2
    • 3
  • Giorgio Ivan Russo
    • 4
  • Francesco Cantiello
    • 5
  • Abdal Rahman Abu Farhan
    • 5
  • Daniela Terracciano
    • 6
  • Amelia Cimmino
    • 7
  • Savino Di Stasi
    • 8
  • Gennaro Musi
    • 1
  • Rodolfo Hurle
    • 9
  • Vincenzo Serretta
    • 10
  • Gian Maria Busetto
    • 11
  • Ettore De Berardinis
    • 11
  • Antonio Cioffi
    • 1
  • Sisto Perdonà
    • 12
  • Marco Borghesi
    • 13
  • Riccardo Schiavina
    • 13
  • Gabriele Cozzi
    • 1
  • Gilberto L. Almeida
    • 14
  • Pierluigi Bove
    • 15
  • Estevao Lima
    • 16
  • Giovanni Grimaldi
    • 16
  • Deliu Victor Matei
    • 1
    • 17
  • Nicolae Crisan
    • 17
  • Matteo Muto
    • 18
  • Paolo Verze
    • 19
  • Michele Battaglia
    • 20
  • Giorgio Guazzoni
    • 9
  • Riccardo Autorino
    • 21
  • Giuseppe Morgia
    • 4
  • Rocco Damiano
    • 5
  • Ottavio de Cobelli
    • 1
    • 22
  • Shahrokh Shariat
    • 2
    • 23
    • 24
    • 25
  • Vincenzo Mirone
    • 19
  • Giuseppe Lucarelli
    • 20
  1. 1.Division of UrologyEuropean Institute of OncologyMilanItaly
  2. 2.Department of UrologyMedical University of ViennaViennaAustria
  3. 3.Department of Cell and Molecular BiologyUniversity of Medicine and PharmacyTirgu MuresRomania
  4. 4.Department of UrologyUniversity of CataniaCataniaItaly
  5. 5.Department of UrologyMagna Graecia University of CatanzaroCatanzaroItaly
  6. 6.Department of Translational Medical SciencesUniversity of Naples “Federico II”NaplesItaly
  7. 7.Institute of Genetics and Biophysics “A. Buzzati Traverso”National Research Council (CNR)NaplesItaly
  8. 8.Urology Unit, Policlinico Tor VergataUniversity of RomeRomeItaly
  9. 9.Department of UrologyIstituto Clinico Humanitas, Clinical and Research HospitalMilanItaly
  10. 10.Division of UrologyUniversity of PalermoPalermoItaly
  11. 11.Department of UrologySapienza University of RomeRomeItaly
  12. 12.Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei TumoriFondazione “G. Pascale”-IRCCSNaplesItaly
  13. 13.Department of UrologyUniversity of BolognaBolognaItaly
  14. 14.Department of UrologyUniversity of Vale do ItajaíItajaíBrazil
  15. 15.Department of Experimental Medicine and Surgery, Urology UnitAzienda Policlinico Tor VergataRomeItaly
  16. 16.Department of CUF Urology and Life and Health Sciences Research Institute, School of MedicineUniversity of MinhoBragaPortugal
  17. 17.Department of UrologyUniversity of Medicine and Pharmacy, “Iuliu Hațieganu”Cluj-NapocaRomania
  18. 18.Department of Clinical Medicine and SurgeryFederico II University Medical School of NaplesNaplesItaly
  19. 19.Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology UnitUniversity of Naples “Federico II”NaplesItaly
  20. 20.Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation UnitUniversity of BariBariItaly
  21. 21.Division of UrologyVirginia Commonwealth UniversityRichmondUSA
  22. 22.Università degli Studi di MilanoMilanItaly
  23. 23.Karl Landsteiner Institute of Urology and AndrologyViennaAustria
  24. 24.Department of UrologyUniversity of Texas Southwestern Medical CenterDallasUSA
  25. 25.Department of UrologyWeill Cornell Medical CollegeNew YorkUSA

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