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van Zutphen M, Beeren I, Aben KKH, van der Heijden AG, Witjes JA, Kiemeney LALM, Vrieling A. Body mass index and waist circumference in relation to risk of recurrence and progression after non-muscle invasive bladder cancer. Cancer Med 2023; 12:20459-20469. [PMID: 37800635 PMCID: PMC10652337 DOI: 10.1002/cam4.6620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/25/2023] [Accepted: 09/23/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Obesity may be associated with increased risk of recurrence and progression in patients with non-muscle invasive bladder cancer (NMIBC), but evidence is limited and inconsistent. We examined the associations of body mass index (BMI), waist circumference, and waist-to-hip ratio (WHR) with risk of recurrence and progression among patients with NMIBC. METHODS This prospective study included 1029 patients diagnosed with primary NMIBC between 2014 and 2017. Patients reported weight 2 years before diagnosis at baseline, and weight, waist and hip circumference at 3 months postdiagnosis. Associations were quantified using Cox proportional hazard analyses, adjusted for clinical and lifestyle characteristics. RESULTS More than half of patients were overweight (49%) or obese (19%) after diagnosis. During a median follow-up time of 3.6 years, 371 patients developed ≥1 recurrence and 53 experienced progression. No associations with recurrence were observed for BMI (HRper 5 kg/m2 0.94; 95% CI 0.82, 1.07), waist circumference (HRper 10 cm 0.95; 95% CI 0.86, 1.05), or WHR (HRper 0.1 unit 0.90; 95% CI 0.76, 1.06). In contrast, higher BMI was associated with a 40% increased risk of progression, with only the 2-year prediagnosis association reaching statistical significance (HRper 5 kg/m2 1.42; 95% CI 1.09, 1.84). No associations for pre-to-postdiagnosis weight change were found. CONCLUSION General and abdominal obesity were not associated with recurrence risk among patients with NMIBC, but might be associated with increased risk of progression. Studies with sufficient sample size to stratify by tumor stage and treatment are needed to better understand whether and how obesity could influence prognosis.
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Affiliation(s)
- Moniek van Zutphen
- Department for Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
| | - Ivy Beeren
- Department for Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
| | - Katja K. H. Aben
- Department for Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
- Netherlands Comprehensive Cancer OrganisationUtrechtThe Netherlands
| | | | - J. Alfred Witjes
- Department of UrologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Lambertus A. L. M. Kiemeney
- Department for Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
- Department of UrologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Alina Vrieling
- Department for Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
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Huang LK, Lin YC, Chuang HH, Chuang CK, Pang ST, Wu CT, Chang YH, Yu KJ, Lin PH, Kan HC, Chu YC, Hung WK, Hsieh ML, Shao IH. Body composition as a predictor of oncological outcome in patients with non-muscle-invasive bladder cancer receiving intravesical instillation after transurethral resection of bladder tumor. Front Oncol 2023; 13:1180888. [PMID: 37637042 PMCID: PMC10448957 DOI: 10.3389/fonc.2023.1180888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/07/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Body status, categorized as sarcopenia or obesity and assessed using body mass index and body composition, affects the outcome of bladder cancer patients. However, studies comparing disease progression, recurrence, or overall survival in patients with non-muscle-invasive bladder cancer (NMIBC) with different body compositions are lacking. Therefore, we conducted a retrospective study to identify the impact of body composition, sarcopenia, and obesity on the oncological prognosis of patients with NMIBC who underwent transurethral resection of bladder tumor (TURBT) with Bacillus Calmette-Guerin (BCG) intravesical instillation (IVI). Methods Patients with NMIBC who had undergone TURBT with adjuvant IVI with BCG from March 2005 to April 2021 were included. Body composition parameters were evaluated using computed tomography images of the third lumbar vertebrae and further categorized by sarcopenia and obesity. Oncological outcomes including recurrence-free survival (RFS), progression-free survival, and overall survival (OS) after treatment were analyzed. Results A total of 269 patients were enrolled. Subcutaneous adipose tissue (SAT) density was a significant predictor of RFS, whereas psoas muscle density was a significant predictor of OS in the multivariate analysis. Patients with sarcopenia but without obesity tolerated significantly fewer BCG IVIs than patients without sarcopenia or obesity. Patients with sarcopenia had poorer RFS and OS than those without sarcopenia. In contrast, patients with obesity had better OS than those without obesity. Discussion Body composition parameters, including SAT density and psoas muscle density, emerged as significant predictors of OS and RFS, respectively. Hence, our findings indicate that body composition is a helpful measurement to assess the oncological outcomes of patients with NMIBC.
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Affiliation(s)
- Liang-Kang Huang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Ching Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung and Chang Gung University, Taoyuan, Taiwan
| | - Hai-Hua Chuang
- Department of Family Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Keng Chuang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - See-Tong Pang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Te Wu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ying-Hsu Chang
- Department of Urology, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei, Taiwan
| | - Kai-Jie Yu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Hung Lin
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hung-Cheng Kan
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yuan-Cheng Chu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Kang Hung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Li Hsieh
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Lu Y, Tao J. Diabetes Mellitus and Obesity as Risk Factors for Bladder Cancer Prognosis: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:699732. [PMID: 34690923 PMCID: PMC8529220 DOI: 10.3389/fendo.2021.699732] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/14/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Urinary bladder carcinoma is common in developed settings, and prognosis may be impacted by lifestyle factors such as excess body weight and diabetes mellitus. The present meta-analysis aimed to systematically collate and analyze evidence on the impact of diabetes and excess BMI on bladder cancer outcomes. METHODS PubMed, Scopus, and Google Scholar databases were screened for relevant studies that examined the association between bladder cancer outcomes and diabetes and/or excess body weight. The primary outcomes for this study were mortality (both all-cause and cancer-specific), risk of cancer progression, and recurrence. Strength of association was presented in the form of pooled adjusted hazard ratios (HR). Statistical analysis was performed using STATA version 16.0. RESULTS Twenty-five articles met inclusion criteria. Nine of these examined diabetes mellitus while 16 studied body mass index. All studies were retrospective. Diabetic patients had significantly higher risk for all-cause mortality (HR 1.24, 95% CI: 1.07, 1.44, n=3), cancer specific mortality (HR 1.67, 95% CI: 1.29, 2.16, n=7), disease progression (HR 1.54, 95% CI: 1.15, 2.06, n=8), and recurrence (HR 1.40, 95% CI: 1.32, 1.48, n=8) compared to non-diabetics. No statistically significant risk change for all-cause mortality, cancer specific mortality, disease progression, and recurrence was found for overweight patients. However, obese individuals were at higher risk for disease progression (HR 1.88, 95% CI: 1.41, 2.50, n=3) and recurrence (HR 1.60, 95% CI: 1.06, 2.40, n=7) compared to normal BMI patients. CONCLUSIONS These findings suggest that diabetes and excess body weight negatively influences bladder cancer prognosis and outcome. The increased risk of mortality due to diabetes was similar to that in the general population. Since retrospective studies are potentially susceptible to bias, future prospective studies on this subject are required.
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Brooks NA, Kokorovic A, Xiao L, Matulay JT, Li R, Ranasinghe WK, Nagaraju S, Shen Y, Gao J, Navai N, Dinney CP, Grossman HB, Kamat AM. The obesity paradox: defining the impact of body mass index and diabetes mellitus for patients with non‐muscle‐invasive bladder cancer treated with bacillus Calmette–Guérin. BJU Int 2020; 128:65-71. [DOI: 10.1111/bju.15296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Nathan A. Brooks
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Andrea Kokorovic
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Lianchen Xiao
- Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Justin T. Matulay
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Roger Li
- Department of Genitourinary Oncology Moffitt Cancer Center Tampa FLUSA
| | | | - Supriya Nagaraju
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Yu Shen
- Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Jianjun Gao
- Department of Genitourinary Medical Oncology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Neema Navai
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Colin P.N. Dinney
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - H. Barton Grossman
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Ashish M. Kamat
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TXUSA
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5
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No clear associations of adult BMI and diabetes mellitus with non-muscle invasive bladder cancer recurrence and progression. PLoS One 2020; 15:e0229384. [PMID: 32210471 PMCID: PMC7094867 DOI: 10.1371/journal.pone.0229384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/05/2020] [Indexed: 01/16/2023] Open
Abstract
Background Non-muscle invasive bladder cancer patients are at high risk for tumour recurrence and progression, hence an intensive follow-up procedure is recommended which is costly. Identification of factors that are associated with the risk of recurrence and progression may enable personalized follow-up schedules. Obesity and diabetes mellitus may be associated with a worse prognosis, but the evidence is limited and inconsistent. Our objective was to determine the associations of BMI and diabetes mellitus with risks of recurrence and progression among non-muscle invasive bladder cancer patients. Methods A population-based cohort of patients diagnosed with non-muscle invasive bladder cancer between 1995 and 2010 was retrospectively identified from the Netherlands Cancer Registry and invited to participate in the Nijmegen Bladder Cancer Study (n = 1,433). Average weight during adult life, height, and diabetes mellitus diagnosis were self-reported by use of a questionnaire. Clinical follow-up data were retrieved from medical files. Associations were quantified using proportional hazard analyses. For all analyses, minimal adjustment sets were selected using a Directed Acyclic Graph. Results Fourteen percent of the patients indicated to be diagnosed with diabetes mellitus, and more than half was overweight (45%) or obese (9%). Compared to healthy weight, overweight and obesity were not associated with risk of recurrence (adjusted hazard ratio (HR) = 1.02; 95% confidence interval (CI): 0.86–1.22, and HR = 1.02; 95% CI: 0.76–1.38, respectively) and overall progression (HR = 1.04; 95% CI: 0.74–1.44, and HR = 1.20; 95% CI: 0.69–2.09, respectively). Also, no clear associations of diabetes mellitus with risk of recurrence (HR = 1.22; 95% CI: 0.98–1.54) and overall progression (HR = 1.16; 95% CI: 0.76–1.76) were found. Conclusion Average BMI during adult life and diabetes mellitus were not clearly associated with risk of recurrence or progression in non-muscle invasive bladder cancer. Prospective cohort studies with detailed information on BMI and diabetes mellitus before and after diagnosis are needed to confirm these findings.
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6
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Zuniga KB, Graff RE, Feiger DB, Meng MV, Porten SP, Kenfield SA. Lifestyle and Non-muscle Invasive Bladder Cancer Recurrence, Progression, and Mortality: Available Research and Future Directions. Bladder Cancer 2020; 6:9-23. [PMID: 34095407 PMCID: PMC8174672 DOI: 10.3233/blc-190249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND: A broad, comprehensive review of studies exploring associations between lifestyle factors and non-muscle invasive bladder cancer (NMIBC) outcomes is warranted to consolidate recommendations and identify gaps in research. OBJECTIVE: To summarize the literature on associations between lifestyle factors and clinical outcomes among patients with NMIBC. METHODS: PubMed was systematically queried for articles published through March 2019 regarding lifestyle factors and recurrence, progression, cancer-specific mortality, and all-cause mortality among patients with NMIBC. RESULTS: Notwithstanding many ambiguities, there is good-quality evidence suggesting a benefit of smoking avoidance/cessation, healthy body mass index (BMI), and type II diabetes mellitus prevention and treatment. Lactobacillus casei probiotic supplementation may reduce recurrence. There have been individual studies suggesting a benefit for uncooked broccoli and supplemental vitamin E as well as avoidance of supplemental vitamin B9, areca nut chewing, and a “Western diet” pattern high in fried foods and red meat. Additional studies do not suggest associations between NMIBC outcomes and use of fibrin clot inhibitors; insulin and other oral hypoglycemics; statins; supplemental selenium, vitamin A, vitamin C, and vitamin B6; fluid intake and intake of specific beverages (e.g., alcohol, coffee, green tea, cola); various dietary patterns (e.g., Tex-Mex, high fruit and vegetable, low-fat); and occupational and chemical exposures. CONCLUSIONS: Despite a myriad of publications on lifestyle factors and NMIBC, a need remains for research on unexplored associations (e.g., physical activity) and further studies that can elucidate causal effects. This would inform future implementation strategies for healthy lifestyle change in NMIBC patients.
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Affiliation(s)
- Kyle B Zuniga
- Department of Urology, University of California, San Francisco, CA, USA.,Osher Center for Integrative Medicine, University of California, San Francisco, CA, USA.,College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Rebecca E Graff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - David B Feiger
- Department of Urology, University of California, San Francisco, CA, USA.,School of Medicine, Duke University Medical Center, Durham, NC, USA.,Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maxwell V Meng
- Department of Urology, University of California, San Francisco, CA, USA
| | - Sima P Porten
- Department of Urology, University of California, San Francisco, CA, USA
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, CA, USA
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7
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de Goeij L, Westhoff E, Witjes JA, Aben KK, Kampman E, Kiemeney LA, Vrieling A. The UroLife study: protocol for a Dutch prospective cohort on lifestyle habits in relation to non-muscle-invasive bladder cancer prognosis and health-related quality of life. BMJ Open 2019; 9:e030396. [PMID: 31619424 PMCID: PMC6797314 DOI: 10.1136/bmjopen-2019-030396] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Patients with non-muscle-invasive bladder cancer (NMIBC) have a good survival but are at high risk for tumour recurrence and disease progression. It is important to identify lifestyle habits that may reduce the risk of recurrence and progression and improve health-related quality of life (HRQOL). This paper describes the rationale and design of the UroLife study. The main aim of this study is to evaluate whether lifestyle habits are related to prognosis and HRQOL in patients with NMIBC. METHODS AND ANALYSIS The UroLife study is a multicentre prospective cohort study among more than 1100 newly diagnosed patients with NMIBC recruited from 22 hospitals in the Netherlands. At 6 weeks and 3, 15 and 51 months after diagnosis, participants fill out a general questionnaire, and questionnaires about their lifestyle habits and HRQOL. At 3, 15 and 51 months after diagnosis, information about fluid intake and micturition is collected with a 4-day diary. At 3 and 15 months after diagnosis, patients donate blood samples for DNA extraction and (dietary) biomarker analysis. Tumour samples are collected from all patients with T1 disease to assess molecular subtypes. Information about disease characteristics and therapy for the primary tumour and subsequent recurrences is collected from the medical records by the Netherlands Cancer Registry. Statistical analyses will be adjusted for age, gender, tumour characteristics and other known confounders. ETHICS AND DISSEMINATION The study protocol has been approved by the Committee for Human Research region Arnhem-Nijmegen (CMO 2013-494). Patients who agree to participate in the study provide written informed consent. The findings from our study will be disseminated through peer-reviewed scientific journals and presentations at (inter)national scientific meetings. Patients will be informed about the progress and results of this study through biannual newsletters and through the website of the study and of the bladder cancer patient association.
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Affiliation(s)
- Liesbeth de Goeij
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Ellen Westhoff
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud university medical center, Nijmegen, The Netherlands
| | - Katja Kh Aben
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Lambertus Alm Kiemeney
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- Department of Urology, Radboud university medical center, Nijmegen, The Netherlands
| | - Alina Vrieling
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
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8
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Therapeutic benefit of second-look transurethral resection of bladder tumors for newly diagnosed T1 bladder cancer: a single-center experience. Int Urol Nephrol 2019; 51:1335-1342. [PMID: 31129781 DOI: 10.1007/s11255-019-02172-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/13/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE In recent years, second-look transurethral resection of bladder tumors (TURBT) has been recommended for patients with stage T1 bladder cancer after the initial TURBT for restaging and deciding the subsequent treatment. However, we believe that second-look TURBT has therapeutic benefits, such as low incidence of recurrence and progression. Therefore, we compare the differences in long-term outcome between patients who did and did not accept second-look TURBT for stage T1 bladder cancer. METHODS We assessed 504 patients diagnosed with urothelial carcinoma who underwent initial TURBT between January 2012 and December 2016 at a single medical center; of these patients, 177 were diagnosed with T1 bladder cancer during the initial TURBT, and we excluded no muscle from the specimen in the initial TURBT. The patients were categorized into groups 1 and 2 based on the acceptance of second-look TURBT, which was performed within 4-14 weeks after the initial TURBT. Group 1 underwent second-look TURBT, but group 2 did not. Both groups were followed-up for recurrence-free survival (RFS) and progression-free survival (PFS), and the risk factors for recurrence and progression were analyzed. RESULTS In total, 93 (52.5%) patients in group 1 underwent second-look TURBT, and 84 (47.5%) in group 2 did not. The 2-year RFS rates were 74.6% and 60.0% and the PFS rates were 91.2% and 87.5% in groups 1 and 2, respectively. CONCLUSION This study demonstrated higher recurrence-free and progression-free survival rates for patients who underwent second-look TURBT. This result emphasizes the importance of second-look TURBT in stage T1 bladder cancer not only for restaging but also for therapeutic benefit.
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9
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Vrieling A. The association of BMI with risk of recurrence and progression in patients with non-muscle-invasive bladder cancer. Transl Androl Urol 2019; 7:S702-S705. [PMID: 30687600 PMCID: PMC6323281 DOI: 10.21037/tau.2018.10.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Alina Vrieling
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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10
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Peng XF, Meng XY, Wei C, Xing ZH, Huang JB, Fang ZF, Hu XQ, Liu QM, Zhu ZW, Zhou SH. The association between metabolic syndrome and bladder cancer susceptibility and prognosis: an updated comprehensive evidence synthesis of 95 observational studies involving 97,795,299 subjects. Cancer Manag Res 2018; 10:6263-6274. [PMID: 30568489 PMCID: PMC6267767 DOI: 10.2147/cmar.s181178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The association between metabolic syndrome (MS) and bladder cancer (BC) was not fully investigated, and most primary studies and pooled analyses were only focused on certain specific components. Objective To further investigate this issue and obtain more precise findings, we conducted this updated evidence synthesis of published studies, which involved not only MS components but also the MS in its entirety. Materials and methods We searched the PubMed, EMBASE, and Web of Science databases for observational studies on the association between BC susceptibility and/or mortality, and MS and its components. We extracted data from included studies, evaluated heterogeneity, and performed meta-analytic quantitative syntheses. Results A total of 95 studies with 97,795,299 subjects were included in the present study. According to the results, MS significantly increased the risk of BC (risk ratio [RR]=1.11, 95% CI=1.00–1.23); diabetes significantly increased the risk of BC (RR=1.29, 95% CI=1.19–1.39) and associated with poor survival (RR=1.24, 95% CI=1.08–1.43). Excessive body weight was associated with increased susceptibility (RR=1.07, 95% CI=1.02–1.12), recurrence (RR=1.46, 95% CI=1.18–1.81), and mortality (RR=1.17, 95% CI=1.00–1.37). As indicated by cumulative meta-analysis, sample size was inadequate for the association between BC susceptibility and MS, the association between BC recurrence and excessive body weight, and the association between BC survival and diabetes. The sample size of the meta-analysis was enough to reach a stable pooled effect for other associations. Conclusion Diabetes and excessive body weight as components of MS are associated with increased susceptibility and poor prognosis of BC. Uncertainty remains concerning the impact of overall MS, hypertension, and dyslipidemia on BC susceptibility and prognosis, for which further investigations are needed.
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Affiliation(s)
- Xiao-Fan Peng
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha 410000, China,
| | - Xiang-Yu Meng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Cheng Wei
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha 410000, China,
| | - Zhen-Hua Xing
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha 410000, China,
| | - Jia-Bin Huang
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha 410000, China,
| | - Zhen-Fei Fang
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha 410000, China,
| | - Xin-Qun Hu
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha 410000, China,
| | - Qi-Ming Liu
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha 410000, China,
| | - Zhao-Wei Zhu
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha 410000, China,
| | - Sheng-Hua Zhou
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha 410000, China,
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Yonekura S, Terauchi F, Hoshi K, Yamaguchi T, Kawai S. Optimal body mass index cut-point for predicting recurrence-free survival in patients with non-muscle-invasive urothelial carcinoma of bladder. Oncol Lett 2018; 16:4049-4056. [PMID: 30128027 DOI: 10.3892/ol.2018.9068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 06/28/2018] [Indexed: 12/12/2022] Open
Abstract
In Japanese patients with non-muscle-invasive urothelial carcinoma of the bladder, the impact of body mass index (BMI) on recurrence following transurethral resection of bladder tumor (TURBT) is unclear. The present study retrospectively examined data collected from 50 patients diagnosed with primary urothelial carcinoma of the bladder (pTa, pTis, and pT1) who had previously undergone TURBT surgery. Two BMI cut-off points for predicting disease recurrence were evaluated: i) A threshold generated through receiver operating characteristic (ROC) curve analysis; ii) the World Health Organization BMI index (24 kg/m2) for overweight status in Japanese populations. Univariate and multivariate analyses were applied to assess individual variables (BMI included) and the effect they had on recurrence-free survival (RFS). Median RFS and BMI values of 19.72 months (range, 3.13-72.13 months) and 23.37 kg/m2 (range, 14.72-36.84 kg/m2), respectively, were recorded. In multivariate analyses, higher continuous BMI was significantly associated with shorter RFS (P=0.019). Based on a ROC-generated BMI cut-off point (23.4 kg/m2), patients were ranked with either a high (≥23.4 kg/m2) or low (<23.4 kg/m2) BMI status. Multivariate analysis indicated that BMI values >23.4 kg/m2 were significantly associated with shorter RFS (P=0.028). Intravesical Bacillus Calmette-Guérin treatment and history of upper-tract urothelial carcinoma were also independently associated (P=0.044 and P=0.010, respectively). However, BMI values >24 kg/m2 (customary cut-off point) had no significant impact on RFS (P=0.066). Thus, a higher BMI status was revealed to be independently predictive of shorter RFS in Japanese patients undergoing TURBT for urothelial carcinoma of the bladder. A greater number of samples are required in order to determine optimal BMI cut-off points in Japanese patients and to investigate whether weight reduction intervention may improve prognosis.
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Affiliation(s)
- Satoru Yonekura
- Department of Pathology, Tochigi Medical Center Shimotsuga, Tochigi 329-4498, Japan
| | - Fumihito Terauchi
- Department of Urology, Tochigi Medical Center Shimotsuga, Tochigi 329-4498, Japan
| | - Kenji Hoshi
- Department of Pathology, Tochigi Medical Center Shimotsuga, Tochigi 329-4498, Japan
| | - Takehiko Yamaguchi
- Department of Pathology, Dokkyo Medical University, Koshigaya Hospital, Koshigaya, Saitama 343-8555, Japan
| | - Shigeo Kawai
- Department of Pathology, Tochigi Medical Center Shimotsuga, Tochigi 329-4498, Japan
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12
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An increased body mass index is associated with a worse prognosis in patients administered BCG immunotherapy for T1 bladder cancer. World J Urol 2018; 37:507-514. [PMID: 29992381 DOI: 10.1007/s00345-018-2397-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022] Open
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.
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Lin Y, Wang Y, Wu Q, Jin H, Ma G, Liu H, Wang M, Zhang Z, Chu H. Association between obesity and bladder cancer recurrence: A meta-analysis. Clin Chim Acta 2018; 480:41-46. [DOI: 10.1016/j.cca.2018.01.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/18/2018] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
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Westhoff E, Witjes JA, Fleshner NE, Lerner SP, Shariat SF, Steineck G, Kampman E, Kiemeney LA, Vrieling A. Body Mass Index, Diet-Related Factors, and Bladder Cancer Prognosis: A Systematic Review and Meta-Analysis. Bladder Cancer 2018; 4:91-112. [PMID: 29430510 PMCID: PMC5798521 DOI: 10.3233/blc-170147] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Urologists are frequently confronted with questions of urinary bladder cancer (UBC) patients about what they can do to improve their prognosis. Unfortunately, it is largely unknown which lifestyle factors can influence prognosis. Objective To systematically review the available evidence on the association between body mass index (BMI), diet, dietary supplements, and physical activity and UBC prognosis. Methods We searched PubMed and Embase up to May 2017. We included thirty-one articles reporting on observational and randomized controlled trials investigating BMI, diet and dietary supplements in relation to recurrence, progression, cancer-specific or all-cause mortality in UBC patients. Results In non-muscle invasive bladder cancer (NMIBC) patients, both overweight (3 studies, pooled hazard ratio (HR) 1.29, 95% CI 1.05-1.58, I2 = 0%) as well as obesity (3 studies, pooled HR 1.82, 95% CI 1.12-2.95, I2 = 79%) were associated with increased risk of recurrence when compared to normal weight. No association of BMI with risk of progression was found. Results for BMI and prognosis in muscle-invasive or in all stages series were inconsistent. Observational studies on diet and randomized controlled trials with dietary supplements showed inconsistent results. No studies on physical activity and UBC prognosis have been published to date. Conclusions Evidence for an association of lifestyle factors with UBC prognosis is limited, with some evidence for an association of BMI with risk of recurrence in NMIBC. Well-designed, prospective studies are needed to develop evidence-based guidelines on this topic.
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Affiliation(s)
- Ellen Westhoff
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Neil E Fleshner
- Department of Surgery, Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Karl Landsteiner University, Krems an der Donau, Austria
| | - Gunnar Steineck
- Department of Oncology, Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Oncology and Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Ellen Kampman
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Lambertus A Kiemeney
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alina Vrieling
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Baselga J, Bhardwaj N, Cantley LC, DeMatteo R, DuBois RN, Foti M, Gapstur SM, Hahn WC, Helman LJ, Jensen RA, Paskett ED, Lawrence TS, Lutzker SG, Szabo E. AACR Cancer Progress Report 2015. Clin Cancer Res 2015; 21:S1-128. [PMID: 26429991 PMCID: PMC5001568 DOI: 10.1158/1078-0432.ccr-15-1846] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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