Table 1.
Observational cohort studies on body mass index and prognosis of bladder cancer
| Source (Study location) | Sample (size and key characteristics) | Years of diagnosis | Median follow-up | Outcome | BMI | HR (95% CI) | Covariates adjustment |
| NMIBC | |||||||
| Kluth, 2013, US, Germany, France, Italy, Canada [5] | 892 NMIBC (T1 high grade) | 1996–2007 | Median 42.8 mo (IQR 14.8–70.8) | Recurrence | Continuous | 1.07 (1.04–1.09) | Gender, concomitant carcinoma in situ, tumor size, number of tumors, intravesical therapy |
| 341 recurrence (38%) | 25–30 vs. <251 | 1.05 (0.73–1.51) | |||||
| 104 progression (12%) | ≥30 vs. <251 | 2.72 (2.00–3.69) | |||||
| 184 deaths (21%) | ≥30 vs. <30 | 2.66 (2.12–3.32) | |||||
| 59 UBC deaths (7%) | Progression | Continuous | 1.08 (1.04–1.12) | ||||
| TURB w/wo IVT (70% IVT) | 25–30 vs. <251 | 0.90 (0.49–1.64) | |||||
| ≥30 vs. <251 | 1.43 (0.86–2.38) | ||||||
| ≥30 vs. <30 | 1.49 (1.00–2.21) | ||||||
| ACM | Continuous | 1.29 (1.20–1.37) | |||||
| ≥30 vs. <30 | 3.15 (1.74–5.67) | ||||||
| CSM | Continuous | 1.06 (1.04–1.09) | |||||
| ≥30 vs. <30 | 1.42 (1.06–1.92) | ||||||
| Wyszynski, 2014, US (38) | 338 NMIBC (Ta, T1 Tis) | 1994–2001 | Median 6 y (range 0.25–15) | Recurrence | 24.9–29.9 vs. ≤24.9 | 1.39 (0.96–2.01) | Age, sex, stage, grade, tumor size, multiplicity, treatment, smoking |
| In total sample (n = 726): | ≥30 vs. ≤24.9 | 1.22 (0.80–1.87) | |||||
| 373 recurrence (51%) | >24.9 vs. ≤24.9 | 1.33 (0.94–1.89) | |||||
| In total sample: TURB (75%), TURB with immunotherapy (16%), immunotherapy (9%) | Current smokers: | ||||||
| >24.9 vs. ≤24.9 | 2.24 (1.15–4.34) | ||||||
| Xu, 2015, China (39) | 403 NMIBC (Ta, T1) | 2006–2014 | Median 53 mo (range 6–102) | Recurrence | ≥24–<28 vs. <24 | 1.44 (1.03–2.00) | Prior recurrence, grade, tumor size, tumor in trigone, concomitant CIS |
| 177 recurrence (44%) | ≥28 vs. <24 | 1.71 (1.12–2.60) | |||||
| 30 progression (7.4%) | Progression | ≥24–<28 vs. <24 | 1.36 (0.57–3.23) | ||||
| TURB w/wo intravesical chemotherapy | ≥28 vs. <24 | 3.04 (1.24–7.42) | |||||
| NMIBC and MIBC | |||||||
| Maurer, 2009, Germany (6) | 390 NMIBC and MIBC | 1986–2004 | N/S | 5 year survival rate | 25–29.9 vs. <25 ≥30 vs. <25 | No difference2 | Univariable |
| (% NMIBC N/S) | No difference2 | ||||||
| Radical cystectomy | |||||||
| Chromecki, 2012, US, Austria, Germany, Canada, Czech Republic (18) | 4118 NMIBC and MIBC (32% NMIBC) | 1979–2008 | Median alive at last follow-up 44 mo | Recurrence | 25.0–29.9 vs. <25 | 0.91 (0.76–1.06) | Age, sex, pT stage, tumour grade, lymphvascular invasion, lymph node metastasis, soft tissue surgical margin, concomitant carcinoma in situ, adjuvant chemotherapy |
| >30 vs. <25 | 1.67 (1.46–1.91) | ||||||
| 1365 recurrence (33%) | CSM | 25.0–29.9 vs. <25 | 0.80 (0.68–0.95) | ||||
| >30 vs. <25 | 1.43 (1.24–1.66) | ||||||
| 1121 UBC deaths (27%) | ACM | 25.0–29.9 vs. <25 | 1.40 (1.23–1.57) | ||||
| Radical cystectomy | >30 vs. <25 | 1.81 (1.60–2.05) | |||||
| Bachir, 2014, Canada (16) | 847 NMIBC and MIBC | 1998–2008 | Median 23.4 mo | OS | Continuous | 0.98 (0.96–1.01) | Age, grade, pathological stage, lymph nodal metastasis, surgical margin status, adjuvant chemotherapy |
| > (% NMIBC N/S) | CSM | Continuous | 0.99 (0.96–1.02) | ||||
| >Radical cystecomy | Recurrence | Continuous | 0.98 (0.96–1.00) | ||||
| Kwon, 2014, Korea (23) | 714 NMIBC and MIBC | 1990–2012 | Median 64.1 mo (range 1–231.4) | Recurrence | 23–25 vs. <23 | 0.66 (0.48–0.90) | Age, sex, performance status, serum albumin level, clinical stage, pathological T stage, lymph node metastastis, grade, lymphovascular invasion, soft tissue surgical margin |
| (% NMIBC N/S) | ≥25 vs. <23 | 0.52 (0.37–0.73) | |||||
| Radical cystectomy | CSM | 23–25 vs. <23 | 0.67 (0.48–0.94) | ||||
| ≥25 vs. <23 | 0.41 (0.27–0.62) | ||||||
| Psutka, 2015, US (33) | 262 NMIBC and MIBC (29% NMIBC) | 2000–2008 | Median 6.3 y (IQR 5.7–9.5) | ACM | ≥30 vs. <30 | 0.79 (0.50–1.26) | Age, smoking status, ASA and ECOG score, pTN stage |
| Dabi, 2016, France (19) | 701 NMIBC and MIBC (33% NMIBC) | 1995–2011 | Median 45 mo (IQR 23–75) | Recurrence | 25.1–30 vs. 18–25 | 1.14 (0.78–1.66) | Age, stage, grade, lymphovascular invasion, concomitant CIS, lymph node metastasis |
| 163 recurrence (23%) | >30 vs. 18–25 | 1.58 (1.06–2.34) | |||||
| 127 UBC deaths (18%) | CSM | 25.1–30 vs. 18–25 | 1.13 (0.74–1.74) | ||||
| Radical cystectomy and pelvic lymphadenectomy | >30 vs. 18–25 | 1.58 (1.01–2.48) | |||||
| MIBC | |||||||
| Hafron, 2005, US (22) | 288 MIBC | 1990–1993 | Median 39 mo (range 1–168) | ACM | ≥30 vs. ≤29.9 | 0.87 (0.71–1.06) | Age, sex, pathological stage, lymph node status, soft tissue margin status, urothelial margin, smoking |
| 203 deaths (71%) | CSM | ≥30 vs. ≤29.9 | No difference | ||||
| Radical or partial cystectomy | |||||||
| Leiter, 2016, US, Germany, Greece, Taiwan (25) | 537 MIBC | 1998–2011 | Progression | 18.5–24.99 vs. <18.5 | 1.14 (0.70–1.85) | ECOG-PS ≥1, visceral metastasis | |
| 417 deaths (77%) | ACM | 25–29.99 vs. <18.5 | 1.31 (0.80–2.13) | ||||
| Chemotherapy | ≥30 vs. <18.5 | 1.23 (0.72–2.11) | |||||
| 18.5–24.99 vs. <18.5 | 0.97 (0.59–1.59) | ||||||
| 25–29.99 vs. <18.5 | 1.19 (0.73–1.95) | ||||||
| ≥30 vs. <18.5 | 1.08 (0.63–1.87) | ||||||
| Xu, 2016, US, Canada (40) | 360 MIBC (0.6% NMIBC and 0.6% unknown) | N/S | N/S | ACM | ≥31.2 vs <31.2 | 0.46 (0.26–0.83) | Univariable |
| ≥27 vs. 27 | 0.77 (0.51–1.17) | ||||||
| Necchi, 2017, US, Canada, Europe, Israel (29) | 1020 urothelial cancer (81.2% bladder cancer) | 2006–2011 | Median 31.6 mo (95% CI 29.4–35.0) | ACM | 26.3–29.1 vs.<23.6 | 0.80 (0.69–0.93) | White blood cell count, ECOG-PS, lung/liver/bone metastases, ethnicity, prior perioperative chemotherapy, age |
| 664 deaths (65%)3 | |||||||
| Chemotherapy |
HR (95% CI) printed in bold means result statistically significant at the p < 0.05 level; 1Data needed for this comparison was received from the authors; 2p value not reported; 3Percentage of deaths among primary bladder cancer patients is not reported. Abbreviations: ACM: all-cause mortality; BMI: body mass index; CIS: carcinoma in situ; CSM: cancer-specific mortality; ECOG-PS: Eastern Cooperation Oncology Group Performance Status; IQR: interquartile range; IVT: intravesical therapy; MIBC: muscle invasive bladder cancer; mo: months; NMIBC: non-muscle-invasive bladder cancer; NS: not specified; TURB: transurethral resection of the bladder; y: years.