Obesity is associated with worse oncological outcomes in patients treated with radical cystectomy.
OBJECTIVE
To investigate the association between body mass index (BMI) and oncological outcomes in patients after radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) in a large multi-institutional series.


METHODS
Data were collected from 4118 patients treated with RC and pelvic lymphadenectomy for UCB. Patients receiving preoperative chemotherapy or radiotherapy were excluded. Univariable and multivariable models tested the effect of BMI on disease recurrence, cancer-specific mortality and overall mortality. BMI was analysed as a continuous and categorical variable (<25 vs 25-29 vs ≥30 kg/m(2)).


RESULTS
Median BMI was 28.8 kg/m(2) (interquartile range 7.9); 25.3% had a BMI <25 kg/m(2), 32.5% had a BMI between 25 and 29.9 kg/m(2), and 42.2% had a BMI ≥30 kg/m(2). Patients with a higher BMI were older (P < 0.001), had higher tumour grade (P < 0.001), and were more likely to have positive soft tissue surgical margins (P = 0.006) compared with patients with lower BMI. In multivariable analyses that adjusted for the effects of standard clinicopathological features, BMI >30 was associated with higher risk of disease recurrence (hazard ratio (HR) 1.67, 95% confidence interval (CI) 1.46-1.91, P < 0.001), cancer-specific mortality (HR 1.43, 95% CI 1.24-1.66, P < 0.001), and overall mortality (HR 1.81, CI 1.60-2.05, P < 0.001). Themain limitation is the retrospective design of the study.


CONCLUSIONS
Obesity is associated with worse cancer-specific outcomes in patients treated with RC for UCB. Focusing on patient-modifiable factors such as BMI may have significant individual and public health implications in patients with invasive UCB.
Weill Medical College of Cornell University, New York, NY, USA.
Thomas F
TF
Chromecki
Eugene K
EK
Cha
Harun
H
Fajkovic
Michael
M
Rink
Behfar
B
Ehdaie
Robert S
RS
Svatek
Pierre I
PI
Karakiewicz
Yair
Y
Lotan
Derya
D
Tilki
Patrick J
PJ
Bastian
Siamak
S
Daneshmand
Wassim
W
Kassouf
Matthieu
M
Durand
Giacomo
G
Novara
Hans-Martin
HM
Fritsche
Maximilian
M
Burger
Jonathan I
JI
Izawa
Antonin
A
Brisuda
Marek
M
Babjuk
Karl
K
Pummer
Shahrokh F
SF
Shariat
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015653:Cystectomy / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000401:mortality / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality; D009765:Obesity / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*