An increased body mass index is associated with a worse prognosis in patients administered BCG immunotherapy for T1 bladder cancer
An increased body mass index is associated with a worse prognosis in patients administered BCG immunotherapy for T1 bladder cancer
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DOI：
10.1007/s00345-018-2397-1
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发表时间：
2019-03-01
影响因子：
3.4
通讯作者：
Lucarelli, Giuseppe
中科院分区：
文献类型：
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作者：
Ferro, Matteo;Vartolomei, Mihai Dorin;Lucarelli, Giuseppe
体重指数(BMI)可能与泌尿系癌症的发病率和侵袭性增加有关。本研究旨在探讨体重指数(BMI)对T1G3型非肌肉浸润性膀胱癌(NMIBC)患者生存的影响。对13个学术机构的1155例T1G3型非肌肉浸润性膀胱癌患者进行了回顾性研究，其中包括接受卡介苗(BCG)膀胱内免疫治疗的患者。多因素COX回归分析显示，再次TURBT后，288例(27.53%)患者残留高级别NMIBC，867例(82.89%)阴性。随访期间复发678例(64.82%)，进展303例(30%)，全因死亡150例(14.34%)，死于膀胱癌77例(7.36%)。在多变量分析中，肿瘤大小(风险比：1.3；p=0.001)和多灶性(风险比：1.24；p=0.004)与复发显著相关(模型中的c指数：55.98)。超重(HR：4；P<；0.001)和肥胖(HR：5.33 P<；0.001)与复发风险显著相关。将体重指数添加到包括标准临床病理因素的模型中，使C指数增加了9.9。对于进展，我们发现在多因素分析(C指数63.8)中，肿瘤大小(HR：1.63；p<；0.001)、多灶性(HR：1.31；p=0.01)和伴发的CIS(HR：2.07；p<；0.001)是显著的预后因素。超重(HR：2.52；P<；0.001)和肥胖(HR：2.521；P<；0.001)与疾病进展的风险显著相关。在包括标准临床病理因素的模型中加入BMI后，C指数增加了1.9。如果BMI与膀胱癌的复发和进展有关，那么BMI可能在T1G3NMIBC的临床治疗中起到相关作用。特别是，这种人体测量因素应该在初始诊断和治疗策略决策中考虑在内。
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).A total of 1155 T1G3 NMIBC patients from 13 academic institutions were retrospectively reviewed and patients administered adjuvant intravesical Bacillus Calmette-Gu,rin (BCG) immunotherapy with maintenance were included. Multivariable Cox regression analysis was performed to identify factors predictive of recurrence and progression.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.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.