Department of Urology, Weill Cornell Medical Center, New York, New York, USA.
J Urol. 2011 Jul;186(1):66-72. doi: 10.1016/j.juro.2011.03.031. Epub 2011 May 14.
The relationship between body mass index and urothelial carcinoma is poorly understood. We investigated the association between body mass index and oncological outcomes in patients with upper tract urothelial carcinoma.
We retrospectively reviewed the records of 520 patients treated with radical nephroureterectomy for upper tract urothelial carcinoma. Univariate Cox regression analysis was done to evaluate estimated recurrence-free, cancer specific and overall survival. We created a multivariate model based on preoperative and postoperative characteristics.
Median patient body mass index was 27.9 kg/m(2) (IQR 6.7). Patients with a higher body mass index were more likely to have infiltrative architecture (p <0.001) and lymphovascular invasion (p = 0.012). In the preoperative model body mass index 25 to 29 (HR 2.25, 95% CI 1.3-3.8, p = 0.003) and 30 kg/m(2) or greater (HR 3.72, 95% CI 2.2-6.3, p <0.001) was associated with disease recurrence. Body mass index 30 kg/m(2) or greater (HR 4.24, 95% CI 2.4-7.5, p <0.001) was associated with cancer specific death. In the postoperative model tumor stage (p <0.001), positive lymph nodes (HR 2.52, 95% CI 1.59-4.0, p <0.001), and body mass index 25 to 29 (HR 2.18, 95% CI 1.27-3.73, p = 0.005) and 30 kg/m(2) or greater (HR 3.52, 95% CI 2.08-5.95, p <0.001) were associated with disease recurrence. Tumor stage (p <0.001), positive lymph nodes (HR 3.1, 95% CI 1.84-5.21, p <0.001) and body mass index 30 kg/m(2) or greater (HR 4.13, 95% CI 2.32-7.36, p <0.001) were associated with worse cancer specific and overall survival.
Higher body mass index is associated with worse recurrence-free, cancer specific and overall survival in patients treated with radical nephroureterectomy for upper tract urothelial carcinoma. Improving oncological outcomes by also focusing on patient modifiable factors such as body mass index has significant individual and public health implications in patients with upper tract urothelial carcinoma.
体重指数与尿路上皮癌之间的关系尚不清楚。我们研究了体重指数与上尿路上皮癌患者的肿瘤结局之间的关系。
我们回顾性分析了 520 例接受根治性肾输尿管切除术治疗上尿路上皮癌患者的记录。使用单因素 Cox 回归分析评估估计的无复发生存率、癌症特异性生存率和总生存率。我们根据术前和术后特征建立了多变量模型。
患者的平均体重指数为 27.9kg/m2（IQR 6.7）。体重指数较高的患者更可能具有浸润性结构（p<0.001）和血管淋巴管侵犯（p=0.012）。在术前模型中，体重指数为 25 至 29（HR 2.25，95%CI 1.3-3.8，p=0.003）和 30kg/m2 或更高（HR 3.72，95%CI 2.2-6.3，p<0.001）与疾病复发相关。体重指数为 30kg/m2 或更高（HR 4.24，95%CI 2.4-7.5，p<0.001）与癌症特异性死亡相关。在术后模型中，肿瘤分期（p<0.001）、阳性淋巴结（HR 2.52，95%CI 1.59-4.0，p<0.001）和体重指数为 25 至 29（HR 2.18，95%CI 1.27-3.73，p=0.005）和 30kg/m2 或更高（HR 3.52，95%CI 2.08-5.95，p<0.001）与疾病复发相关。肿瘤分期（p<0.001）、阳性淋巴结（HR 3.1，95%CI 1.84-5.21，p<0.001）和体重指数为 30kg/m2 或更高（HR 4.13，95%CI 2.32-7.36，p<0.001）与癌症特异性和总生存率降低相关。
体重指数较高与接受根治性肾输尿管切除术治疗的上尿路上皮癌患者的无复发生存率、癌症特异性生存率和总生存率降低相关。通过关注体重指数等可改变的患者因素来改善肿瘤学结局，对上尿路上皮癌患者具有重要的个体和公共卫生意义。
