@article{a9a9b7bc8d2f4677883f696d198cbbaf,
title = "The obesity paradox: defining the impact of body mass index and diabetes mellitus for patients with non-muscle-invasive bladder cancer treated with bacillus Calmette–Gu{\'e}rin",
abstract = "Objectives: To evaluate if the obesity paradox, wherein obesity portends worse overall prognosis for a disease but improved outcomes for patients receiving immunotherapy, exists for patients receiving bacillus Calmette–Gu{\'e}rin (BCG) in a contemporary cohort. Patients and Methods: We performed an Institutional Review Board-approved database review to identify patients with non-muscle-invasive bladder cancer (NMIBC) completing at least an induction course of BCG. Clinicopathological variables collected included: body mass index (BMI), medications, and diabetes mellitus (DM). Outcomes of interest included: recurrence-free (RFS), progression-free (PFS), cancer-specific (CSS), and overall survival (OS). Univariate and multivariate modelling were used to evaluate the association between outcomes and clinical factors. Results: A total of 579 patients (median follow-up 4.6 years) received BCG induction for NMIBC; 90% had high-grade disease (47.2% clinical stage T1). In all, 75.7% of patients were overweight or obese and 18% had DM. Aspirin, statins, metformin and β-blockers were used in 34%, 42%, 11%, and 29% of patients, respectively. Overweight and obese patients had improved PFS, CSS and OS. DM was associated with worse RFS. Medications of interest had no association with outcomes. Conclusion: Elevated BMI is associated with improved outcomes in patients with NMIBC treated with BCG immunotherapy. Patients with DM are at increased risk of recurrence. These findings support a potential obesity paradox in bladder cancer. Evaluation of the underlying mechanism and the role of global patient assessment, counselling, and risk factor modification are warranted.",
keywords = "#Bladder Cancer, #blcsm, #uroonc, Bacillus Calmette–Gu{\'e}rin, body mass index, diabetes mellitus, non-muscle-invasive bladder cancer, obesity paradox",
author = "Brooks, {Nathan A.} and Andrea Kokorovic and Lianchen Xiao and Matulay, {Justin T.} and Roger Li and Ranasinghe, {Weranja K.B.} and Supriya Nagaraju and Yu Shen and Jianjun Gao and Neema Navai and Dinney, {Colin P.N.} and Grossman, {H. Barton} and Kamat, {Ashish M.}",
note = "Funding Information: Dr. Ranasinghe reports grants from AUA Urology Care Foundation, outside the submitted work. Dr. Dinney reports grants from FKD, grants from NIH, grants from Univ of East Finland (UEFHS), during the conduct of the study; In addition, Dr. Dinney has a patent on CDKN2A Companion Diagnostic for Bladder Cancer Interferon Therapy licensed. Dr. Navai reports personal fees from Aduro BioTech, Inc and Schlesinger group and a financial relationship with Allongene Therapeutics. Dr. Kamat reports personal fees and other from Merck, personal fees from Abbott Molecular, personal fees from Arquer, personal fees from ArTara, personal fees from Asieris, personal fees and other from Photocure, personal fees from Astra Zeneca, personal fees from BioClin Therapeutics, personal fees and other from BMS, personal fees from Cepheid, personal fees from Cold Genesys, other from FKD Industries, personal fees from Eisai, personal fees from Engene, Inc., personal fees from Ferring, personal fees from FerGene, personal fees from Imagin, personal fees from Janssen, personal fees from MDxHealth, personal fees from Medac, personal fees from Pfizer, personal fees from Roviant, personal fees from Sessen Bio, personal fees from ProTara, personal fees from Nucleix, personal fees from Seattle Genetics, grants from CEC Oncology, personal fees from Theralase, personal fees from TMC Innovation, personal fees from US Biotest, other from Adolor, other from Heat Biologics, outside the submitted work; In addition, Dr. Kamat has a patent CyPRIT‐Cytokine Panel for Response to Intravesical Immunotherapy pending. Dr. Gao reports personal fees from Astra‐Zeneca, personal fees from Nektar, personal fees from ARMO Biosciences, personal fees from Pfizer, personal fees from Symphogen, personal fees from Janssen Biotech, personal fees from CRISPR Therapeutics, personal fees from Jouce Therapeutics, personal fees from Seattle Genetics, outside the submitted work. Dr. Li reports member on the Clinical trial protocol committee – CG Oncology; Scientific advisor/consultant – BMS, Ferring, Fergene, Arquer Diagnostics. Funding Information: This research project was supported by the Wayne B. Duddlesten Professorship in Cancer Research, the Raymond and Maria Floyd Bladder Cancer Research Foundation Grant to Ashish M. Kamat, and National Institutes of Health/National Cancer Institute University of Texas M. D. Anderson Specialized Programs of Research Excellence (SPORE) in Genitourinary Cancer (Bladder) (P50CA91846) to Colin P.N. Dinney. Funding Information: This research project was supported by the Wayne B. Duddlesten Professorship in Cancer Research, the Raymond and Maria Floyd Bladder Cancer Research Foundation Grant to Ashish M. Kamat, and National Institutes of Health/National Cancer Institute University of Texas M. D. Anderson Specialized Programs of Research Excellence (SPORE) in Genitourinary Cancer (Bladder) (P50CA91846) to Colin P.N. Dinney. Publisher Copyright: {\textcopyright} 2020 The Authors BJU International {\textcopyright} 2020 BJU International",
year = "2021",
month = jul,
doi = "10.1111/bju.15296",
language = "English (US)",
volume = "128",
pages = "65--71",
journal = "BJU international",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "1",
}