Yonekura Satoru, Terauchi Fumihito, Hoshi Kenji, Yamaguchi Takehiko, Kawai Shigeo
Department of Pathology, Tochigi Medical Center Shimotsuga, Tochigi 329-4498, Japan.
Department of Urology, Tochigi Medical Center Shimotsuga, Tochigi 329-4498, Japan.
Oncol Lett. 2018 Sep;16(3):4049-4056. doi: 10.3892/ol.2018.9068. Epub 2018 Jul 4.
In Japanese patients with non-muscle-invasive urothelial carcinoma of the bladder, the impact of body mass index (BMI) on recurrence following transurethral resection of bladder tumor (TURBT) is unclear. The present study retrospectively examined data collected from 50 patients diagnosed with primary urothelial carcinoma of the bladder (pTa, pTis, and pT1) who had previously undergone TURBT surgery. Two BMI cut-off points for predicting disease recurrence were evaluated: i) A threshold generated through receiver operating characteristic (ROC) curve analysis; ii) the World Health Organization BMI index (24 kg/m) for overweight status in Japanese populations. Univariate and multivariate analyses were applied to assess individual variables (BMI included) and the effect they had on recurrence-free survival (RFS). Median RFS and BMI values of 19.72 months (range, 3.13-72.13 months) and 23.37 kg/m2 (range, 14.72-36.84 kg/m2), respectively, were recorded. In multivariate analyses, higher continuous BMI was significantly associated with shorter RFS (P=0.019). Based on a ROC-generated BMI cut-off point (23.4 kg/m2), patients were ranked with either a high (≥23.4 kg/m2) or low (<23.4 kg/m2) BMI status. Multivariate analysis indicated that BMI values >23.4 kg/m2 were significantly associated with shorter RFS (P=0.028). Intravesical Bacillus Calmette-Guérin treatment and history of upper-tract urothelial carcinoma were also independently associated (P=0.044 and P=0.010, respectively). However, BMI values >24 kg/m2 (customary cut-off point) had no significant impact on RFS (P=0.066). Thus, a higher BMI status was revealed to be independently predictive of shorter RFS in Japanese patients undergoing TURBT for urothelial carcinoma of the bladder. A greater number of samples are required in order to determine optimal BMI cut-off points in Japanese patients and to investigate whether weight reduction intervention may improve prognosis.
在日本非肌层浸润性膀胱尿路上皮癌患者中，体重指数（BMI）对经尿道膀胱肿瘤切除术（TURBT）后复发的影响尚不清楚。本研究回顾性分析了50例曾接受TURBT手术的原发性膀胱尿路上皮癌（pTa、pTis和pT1）患者的资料。评估了两个用于预测疾病复发的BMI切点：i）通过受试者工作特征（ROC）曲线分析得出的阈值；ii）日本人群中超重状态的世界卫生组织BMI指数（24kg/m²）。采用单因素和多因素分析来评估各个变量（包括BMI）及其对无复发生存期（RFS）的影响。记录的中位RFS和BMI值分别为19.72个月（范围3.13 - 72.13个月）和23.37kg/m²（范围14.72 - 36.84kg/m²）。在多因素分析中，较高的连续BMI与较短的RFS显著相关（P = 0.019）。根据ROC得出的BMI切点（23.4kg/m²），将患者分为高BMI（≥23.4kg/m²）或低BMI（<23.4kg/m²）状态。多因素分析表明，BMI值>23.4kg/m²与较短的RFS显著相关（P = 0.028）。膀胱内卡介苗治疗和上尿路尿路上皮癌病史也分别独立相关（P = 0.044和P = 0.010）。然而，BMI值>24kg/m²（习惯切点）对RFS无显著影响（P = 0.066）。因此，较高的BMI状态被证明是日本膀胱尿路上皮癌患者接受TURBT后RFS较短的独立预测因素。需要更多样本以确定日本患者的最佳BMI切点，并研究减重干预是否可改善预后。
