title: Effect of body mass index on the outcomes of patients with upper and lower urinary tract cancers treated by radical surgery: results from a Canadian multicenter collaboration.
abstract: OBJECTIVE
  To evaluate the effect of body mass index (BMI) on the outcomes of patients with urinary tract carcinoma treated with radical surgery.
  
  
  METHODS
  Data were collected from 10 Canadian centers on patients who underwent radical cystectomy (RC) (1998-2008) or radical nephroureterectomy (RNU) (1990-2010). Various parameters among subsets of patients (BMI < 25, 25 ≤ BMI < 30, and BMI ≥ 30 kg/m(2)) were analyzed. Kaplan-Meier and multivariate analyses were performed to assess the effect of BMI on overall survival, disease-specific survival, and recurrence-free survival (RFS).
  
  
  RESULTS
  Among the 847 RC and 664 RNU patients, there was no difference in histology, stage, grade, and margin status among the 3 patient subsets undergoing either surgery. However, RC patients with lower BMIs (< 25 kg/m(2)) were significantly older (P = 0.004), had more nodal metastasis (P = 0.03), and trended toward higher stage (P = 0.052). RNU patients with lower BMIs (< 25 kg/m(2)) were significantly older (P = 0.0004) and fewer received adjuvant chemotherapy (P = 0.04) compared with those with BMI ≥ 30 kg/m(2); however, there was no difference in tumor location (P = 0.20), stage (P = 0.48), and management of distal ureter among the groups (P = 0.30). On multivariate analysis, BMI was not prognostic for overall survival, disease-specific survival, and RFS in the RC group. However, BMI ≥ 30 kg/m(2) was associated with more bladder cancer recurrences and worse RFS in the RNU group (HR = 1.588; 95% CI: 1.148-2.196; P = 0.0052).
  
  
  CONCLUSIONS
  Increased BMI did not influence survival among RC patients. BMI ≥ 30 kg/m(2) is associated with worse bladder cancer recurrences among RNU patients; whether this is related to difficulty in obtaining adequate bladder cuff in patients with obesity requires further evaluation.
authors.affiliation: Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada.
authors.forename: Bassel G
authors.initials: BG
authors.lastname: Bachir
authors.affiliation: Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada.
authors.forename: Armen G
authors.initials: AG
authors.lastname: Aprikian
authors.affiliation: Department of Surgery (Urology), Western University, London, Ontario, Canada.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Izawa
authors.affiliation: Department of Surgery (Urology), Western University, London, Ontario, Canada.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Chin
authors.affiliation: Department of Surgery (Urology), Laval University, Quebec City, Quebec, Canada.
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.affiliation: Department of Surgery (Urology), University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Adrian
authors.initials: A
authors.lastname: Fairey
authors.affiliation: Department of Surgery (Urology), University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Estey
authors.affiliation: Department of Surgery (Urology), University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Niels
authors.initials: N
authors.lastname: Jacobsen
authors.affiliation: Department of Surgery (Urology), Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rendon
authors.affiliation: Department of Surgery (Urology), University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Ilias
authors.initials: I
authors.lastname: Cagiannos
authors.affiliation: Department of Surgery (Urology), Laval University, Quebec City, Quebec, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
authors.affiliation: Department of Surgery (Urology), University of Montreal, Montreal, Quebec, Canada.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Lattouf
authors.affiliation: Department of Surgery (Urology), McMaster University, Hamilton, Ontario, Canada.
authors.forename: Anil
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Department of Surgery (Urology), McMaster University, Hamilton, Ontario, Canada.
authors.forename: Edward
authors.initials: E
authors.lastname: Matsumoto
authors.affiliation: Department of Surgery (Urology), University of Montreal, Montreal, Quebec, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.affiliation: Department of Surgery (Urology), Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Bell
authors.affiliation: Department of Surgery (Urology), University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Black
authors.affiliation: Department of Surgery (Urology), University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Alan I
authors.initials: AI
authors.lastname: So
authors.affiliation: Department of Surgery (Urology), University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Darrel
authors.initials: D
authors.lastname: Drachenberg
authors.affiliation: Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada. Electronic address: wassim.kassouf@muhc.mcgill.ca.
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015653:Cystectomy / Q000401:mortality*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014571:Urologic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery
keywords: Body mass index; Radical cystectomy; Radical nephroureterectomy