Rajpurohit Mitesh, Golzy Mojgan, Chen Nai-Wei, Murray Katie S, Rosen Geoffrey
Department of Biomedical Informatics, Biostatistics and Medical Epidemiology, University of Missouri at Columbia, Columbia, MO 65201, USA.
Department of Urology, NYU-Langone Health, New York, NY 10016, USA.
Cancers (Basel). 2025 Apr 1;17(7):1200. doi: 10.3390/cancers17071200.
The relationship between body composition and bladder cancer outcomes is complex. While a higher body mass index (BMI) has been associated with an increased risk of bladder cancer development, its impact on survival outcomes is less clear. This study aimed to explore the association between BMI, survival, health-related quality of life, and the performance of ADLs in a cohort of older patients with bladder cancer.
Data were obtained from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey, including patients diagnosed with bladder cancer who had recorded BMI values. Analysis of variance was used to assess the association between BMI categories and patient demographics as well as cancer/treatment characteristics. Generalized linear models examined the impact of BMI on health-related quality of life, as measured by the physical and mental component summary scores when controlling for confounding variables. Kaplan-Meier survival curves across BMI categories were compared using log-rank tests.
The final cohort consisted of 8013 patients (age ≥ 65) with a mean age of 77.7 ± 7.1 years, the majority of whom were White (85.6%) and male (74.8%). We observed no significant association between BMI and cancer/treatment characteristics. The severely obese subgroup had the highest rate of disability in performing ADLs (18.3%) followed by the underweight subgroup (10.3%). Overweight patients exhibited the highest physical and mental component summary scores, indicating better health-related quality of life. BMI was a significant predictor of overall survival, with overweight, obese, and severely obese patients demonstrating improved survival compared to those with healthy or underweight BMI. These findings remained statistically significant in multivariable analysis.
Our findings suggest a dual role of BMI in older patients with bladder cancer: higher BMI provides a survival advantage and, to an extent, a QoL advantage. At the same time, severe obesity did lead to the lowest QoL despite improved survival outcomes. These results underscore the complex interplay between BMI, survival, and QoL in this bladder cancer population.
身体组成与膀胱癌预后之间的关系很复杂。虽然较高的体重指数（BMI）与膀胱癌发生风险增加相关，但其对生存预后的影响尚不清楚。本研究旨在探讨BMI、生存、健康相关生活质量以及一组老年膀胱癌患者日常生活活动能力之间的关联。
数据来自监测、流行病学和最终结果-医疗保险健康结果调查，包括诊断为膀胱癌且记录了BMI值的患者。方差分析用于评估BMI类别与患者人口统计学特征以及癌症/治疗特征之间的关联。广义线性模型在控制混杂变量时，通过身体和心理成分汇总得分来检验BMI对健康相关生活质量的影响。使用对数秩检验比较不同BMI类别的Kaplan-Meier生存曲线。
最终队列由8013名患者（年龄≥65岁）组成，平均年龄为77.7±7.1岁，其中大多数为白人（85.6%）和男性（74.8%）。我们未观察到BMI与癌症/治疗特征之间存在显著关联。重度肥胖亚组在进行日常生活活动时的残疾率最高（18.3%），其次是体重过轻亚组（10.3%）。超重患者的身体和心理成分汇总得分最高，表明健康相关生活质量更好。BMI是总生存的显著预测因素，超重、肥胖和重度肥胖患者与BMI正常或体重过轻的患者相比生存情况有所改善。这些发现在多变量分析中仍具有统计学意义。
我们的研究结果表明BMI在老年膀胱癌患者中具有双重作用：较高的BMI提供了生存优势，并在一定程度上提供了生活质量优势。同时，尽管生存结果有所改善，但重度肥胖确实导致了最低的生活质量。这些结果强调了BMI、生存和生活质量在膀胱癌人群中的复杂相互作用。
