An increased body mass index is associated with a worse prognosis in patients administered BCG immunotherapy for T1 bladder cancer.
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Ferro Matteo, Vartolomei Mihai Dorin, Russo Giorgio Ivan, Cantiello Francesco, Farhan Abdal Rahman Abu, Terracciano Daniela, Cimmino Amelia, Di Stasi Savino, Musi Gennaro, Hurle Rodolfo, Serretta Vincenzo, Busetto Gian Maria, De Berardinis Ettore, Cioffi Antonio, Perdonà Sisto, Borghesi Marco, Schiavina Riccardo, Cozzi Gabriele, Almeida Gilberto L, Bove Pierluigi, Lima Estevao, Grimaldi Giovanni, Matei Deliu Victor, Crisan Nicolae, Muto Matteo, Verze Paolo, Battaglia Michele, Guazzoni Giorgio, Autorino Riccardo, Morgia Giuseppe, Damiano Rocco, de Cobelli Ottavio, Shariat Shahrokh, Mirone Vincenzo, Lucarelli Giuseppe
Аннотация
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.