Yang Zhiqiang, Bai Yunjin, Hu Xu, Wang Xiaoming, Han Ping
Department of Urology, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
West China School of Medicine/West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Dose Response. 2020 Dec 15;18(4):1559325820979247. doi: 10.1177/1559325820979247. eCollection 2020 Oct-Dec.
The clinical evidence of body mass index (BMI) for survival has increased in urothelial carcinoma (UC). This study aimed to investigate the prognostic value of BMI on the oncologic outcomes of patients with UC after surgery.
The systematic review and meta-analysis was performed using Pubmed, Embase and Cochrane Library. We collected hazard ratio (HR) and 95% confidence interval (CI) on cancer specific survival (CSS), overall survival (OS) and recurrence-free survival (RFS) from the studies including upper tract urothelial carcinoma (UTUC) and urothelial carcinoma of bladder (UCB).
A total of 13 studies comprising over 12,200 patients were enrolled in the quantitative synthesis. Compared with normal weight, overweight was associated with better CSS (HR = 0.87, 95% CI: 0.79-0.95) and RFS (HR = 0.86, 95% CI: 0.78-0.96). Meanwhile, we found that obese patients had worse CSS (HR = 1.14, 95%CI: 1.03-1.26), OS (HR = 1.31, 95% CI: 1.19-1.44) and RFS (HR = 1.24, 95% CI: 1.12-1.37). We observed that underweight was associated with inferior CSS (HR = 1.87, 95% CI: 1.54-2.26) in UTUC patients.
Overweight was a protective factor for patients with UC after surgery, while obesity and underweight predicted unfavorable survival. Individual BMI may be considered for prognostication after surgeries and patient stratification for clinical trials.
体重指数（BMI）对尿路上皮癌（UC）患者生存影响的临床证据日益增多。本研究旨在探讨BMI对UC患者术后肿瘤学结局的预后价值。
通过PubMed、Embase和Cochrane图书馆进行系统评价和荟萃分析。我们从包括上尿路尿路上皮癌（UTUC）和膀胱尿路上皮癌（UCB）的研究中收集癌症特异性生存（CSS）、总生存（OS）和无复发生存（RFS）的风险比（HR）及95%置信区间（CI）。
共有13项研究纳入了超过12,200例患者进行定量综合分析。与正常体重相比，超重与更好的CSS（HR = 0.87，95% CI：0.79 - 0.95）和RFS（HR = 0.86，95% CI：0.78 - 0.96）相关。同时，我们发现肥胖患者的CSS（HR = 1.14，95%CI：1.03 - 1.26）、OS（HR = 1.31，95% CI：1.19 - 1.44）和RFS（HR = 1.24，95% CI：1.12 - 1.37）较差。我们观察到体重过轻与UTUC患者较差的CSS（HR = 1.87，95% CI：1.54 - 2.26）相关。
超重是UC患者术后的一个保护因素，而肥胖和体重过轻则预示着不良生存结局。术后预后评估及临床试验患者分层时可考虑个体BMI。
