Murakami Yasukiyo, Matsumoto Kazumasa, Ikeda Masaomi, Utsunomiya Takuji, Hirayama Takahiro, Koguchi Dai, Matsuda Daisuke, Okuno Norihiko, Taoka Yoshinori, Irie Akira, Iwamura Masatsugu
Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan.
Department of Urology, Kanagawa Prefectural Federation of Agricultural Cooperatives for Health and Welfare Sagamihara Kyodo Hospital, Kanagawa, Japan.
Asia Pac J Clin Oncol. 2018 Aug;14(4):310-317. doi: 10.1111/ajco.12848. Epub 2018 Apr 6.
To evaluate the impact of body mass index (BMI) on the oncological outcomes of urothelial carcinoma (UC) patients.
We retrospectively analyzed data from 818 patients with upper tract urothelial cancer (UTUC) and bladder cancer (BC) who were treated with radical nephroureterectomy (RNU) or radical cystectomy (RC) between 1990 and 2015 at six different institutions in Japan. Patients with distant metastasis at diagnosis and those who received neoadjuvant therapies were excluded, leaving 727 eligible patients (UTUC: n = 441; BC: n = 286). Patients were classified into four groups according to World Health Organization BMI criteria: underweight (BMI <18.5 kg/m ), normal weight (BMI 18.5-25 kg/m ), overweight (BMI 25.1-30 kg/m ), and obese (BMI >30 kg/m ).
Overweight UTUC and BC patients achieved significantly better cancer-specific survival (CSS) than the other three groups. However, obese UTUC and BC patients had significantly worse CSS than the other three groups (UTUC: P = 0.031; BC: P = 0.0019). Multivariate analysis of BC patients demonstrated that obesity was an independent predictor of unfavorable CSS (hazard ratio [HR] = 7.47; P = 0.002) and that being underweight was an independent predictor of favorable CSS (HR = 0.37; P = 0.029). However, BMI was not a prognostic factor for CSS in UTUC patients according to multivariate analysis.
Obesity was an independent predictor of BC patients requiring RC. Conversely, being underweight was associated with a favorable prognosis for BC patients. However, BMI was not an independent prognostic factor in patients with upper urinary tract cancer.
评估体重指数（BMI）对尿路上皮癌（UC）患者肿瘤学结局的影响。
我们回顾性分析了1990年至2015年间在日本六个不同机构接受根治性肾输尿管切除术（RNU）或根治性膀胱切除术（RC）的818例上尿路尿路上皮癌（UTUC）和膀胱癌（BC）患者的数据。排除诊断时伴有远处转移的患者以及接受新辅助治疗的患者，最终纳入727例符合条件的患者（UTUC：n = 441；BC：n = 286）。根据世界卫生组织的BMI标准，将患者分为四组：体重过轻（BMI <18.5 kg/m²）、正常体重（BMI 18.5 - 25 kg/m²）、超重（BMI 25.1 - 30 kg/m²）和肥胖（BMI >30 kg/m²）。
超重的UTUC和BC患者的癌症特异性生存率（CSS）显著优于其他三组。然而，肥胖的UTUC和BC患者的CSS显著低于其他三组（UTUC：P = 0.031；BC：P = 0.0019）。对BC患者的多因素分析表明，肥胖是CSS不良的独立预测因素（风险比[HR] = 7.47；P = 0.002），而体重过轻是CSS良好的独立预测因素（HR = 0.37；P = 0.029）。然而，根据多因素分析，BMI并非UTUC患者CSS的预后因素。
肥胖是需要接受RC的BC患者的独立预测因素。相反，体重过轻与BC患者的良好预后相关。然而，BMI并非上尿路癌患者的独立预后因素。
