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Interethnic differences in the impact of body mass index on upper tract urothelial carcinoma following radical nephroureterectomy

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Abstract

Purpose

Inconsistent prognostic implications of body mass index (BMI) in upper tract urothelial carcinoma (UTUC) have been reported across different ethnicities. In this study, we aimed to analyze the oncologic role of BMI in Asian and Caucasian patients with UTUC.

Methods

We retrospectively collected data from 648 Asian Taiwanese and 213 Caucasian American patients who underwent radical nephroureterectomy for UTUC. We compared clinicopathologic features among groups categorized by different BMI. Kaplan–Meier method and Cox regression model were used to examine the impact of BMI on recurrence and survival by ethnicity.

Results

According to ethnicity-specific criteria, overweight and obesity were found in 151 (23.2%) and 215 (33.2%) Asians, and 79 (37.1%) and 78 (36.6%) Caucasians, respectively. No significant association between BMI and disease characteristics was detected in both ethnicities. On multivariate analysis, overweight and obese Asians had significantly lower recurrence than those with normal weight (HR 0.631, 95% CI 0.413–0.966; HR 0.695, 95% CI 0.493–0.981, respectively), and obesity was an independent prognostic factor for favorable cancer-specific and overall survival (HR 0.521, 95% CI 0.342–0.794; HR 0.545, 95% CI 0.386–0.769, respectively). There was no significant difference in outcomes among normal, overweight and obese Caucasians, but obese patients had a relatively poorer 5-year RFS, CSS, and OS rates of 52.8%, 60.5%, and 47.2%, compared to 54.9%, 69.1%, and 54.9% for normal weight patients.

Conclusion

Higher BMI was associated with improved outcomes in Asian patients with UTUC. Interethnic differences could influence preoperative counseling or prediction modeling in patients with UTUC.

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Funding

This study was supported by grants from the Ministry of Science and Technology (MOST 105-2628-B-037-004-MY2), Kaohsiung Medical University Hospital (KMUH105-5R45) and Kaohsiung Municipal Ta-Tung Hospital (kmtth-103-054).

Author information

Authors and Affiliations

  1. Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

    Hsin-Chih Yeh, Chun-Nung Huang & Hsiang-Ying Lee

  2. Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Hsin-Chih Yeh, Ching-Chia Li, Tsu-Ming Chien, Chun-Nung Huang, Hung-Lung Ke, Wei-Ming Li, Hsiang-Ying Lee, Bi-Wen Yeh & Wen-Jeng Wu

  3. Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Hsin-Chih Yeh, Ching-Chia Li, Chun-Nung Huang, Hung-Lung Ke, Wei-Ming Li, Hsiang-Ying Lee, Bi-Wen Yeh & Wen-Jeng Wu

  4. Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA

    Hsin-Chih Yeh, Solomon L. Woldu, Arthur I. Sagalowsky, Nirmish Singla, Vitaly Margulis, Yair Lotan & Jer-Tsong Hsieh

  5. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan

    Chia-Yang Li, Hsiang-Ying Lee, Sheau-Fang Yang & Wen-Jeng Wu

  6. Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan

    Yen-Chen Cheng

  7. Division of Urology, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    Haley Robyak & Jay D. Raman

  8. Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Sheau-Fang Yang

  9. Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Hung-Pin Tu

  10. Department of Biotechnology, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan

    Jer-Tsong Hsieh

Authors
  1. Hsin-Chih Yeh
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  2. Ching-Chia Li
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  3. Tsu-Ming Chien
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  4. Chia-Yang Li
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  5. Yen-Chen Cheng
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  6. Solomon L. Woldu
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  7. Haley Robyak
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  8. Chun-Nung Huang
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  9. Hung-Lung Ke
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  10. Wei-Ming Li
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  11. Hsiang-Ying Lee
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  12. Bi-Wen Yeh
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  13. Sheau-Fang Yang
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  14. Hung-Pin Tu
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  15. Arthur I. Sagalowsky
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  16. Jay D. Raman
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  17. Nirmish Singla
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  18. Vitaly Margulis
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  19. Yair Lotan
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  20. Jer-Tsong Hsieh
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  21. Wen-Jeng Wu
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Contributions

HCY: project development, data management, data analysis, and manuscript writing. CCL: data collection. TMC: data collection. CYL: data collection. YCC: project development and data collection. SW: data collection. HR: data collection. CNH: data collection. HLK: data collection. WML: data collection. HYL: data collection. BWY: data collection. SFY: data collection. HPT: data analysis. AS: data collection. JR: manuscript editing. NS: data management and manuscript writing. VM: manuscript editing. YL: manuscript editing. JTH: manuscript editing. WJW: manuscript editing.

Corresponding authors

Correspondence to Nirmish Singla, Jer-Tsong Hsieh or Wen-Jeng Wu.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The institutional review board of Kaohsiung Medical University Hospital approved this study (No. KMUHIRB-E(I)-20180214).

Informed consent

A general exemption from the rule of informed consent was given by the institutional ethics committee because this research is at the lowest risk, the possible risk to the research subject is not more than that of the non-participants, and the waiver of prior consent does not affect the rights of the research subject.

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Yeh, HC., Li, CC., Chien, TM. et al. Interethnic differences in the impact of body mass index on upper tract urothelial carcinoma following radical nephroureterectomy. World J Urol 39, 491–500 (2021). https://doi.org/10.1007/s00345-020-03204-0

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  • DOI: https://doi.org/10.1007/s00345-020-03204-0

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