Korean J Urol Oncol.  2020 Dec;18(3):201-208. 10.22465/kjuo.2020.18.3.201.

Effect of Body Mass Index and Hypertension on the Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy

• Lee M
• Song SH
• Kim H
• Lee S
• Hong SK
• Byun SS
• Lee SE
• Oh JJ

• KMID: 2511119
• DOI: http://doi.org/10.22465/kjuo.2020.18.3.201

Abstract

Purpose
To investigate the impact of preoperative underlying hypertension (HTN) and body mass index (BMI) on oncologic outcomes in patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNUx).
Materials and Methods
From May 2003 to December 2018, 453 UTUC patients who underwent RNUx at a single institution were enrolled in the study. All patients were divided into 2 groups according to preoperative HTN and BMI (cutoff 24 kg/m²) and perioperative parameters and recurrence outcomes were compared. Multivariate Cox proportional hazard analysis was performed to identify the significance of HTN and BMI regarding UTUC recurrence.
Results
Among a total 453 UTUC patients, 233 (51.4%) had HTN, and 222 (49.0%) had BMI ≥24 kg/m². The HTN versus no-HTN group had similar perioperative outcomes, except for the rate of diabetes (p<0.001). The high-BMI versus low-BMI group had similar outcomes, except for the prevalence of HTN (p=0.026). During median follow-up of 23 months, 5-year recurrence-free survival rates were 76.2% in the HTN group and 79.9% in the non-HTN group (p=0.002), and 77.3% in the low-BMI group and 79.0% in the high-BMI group (p=0.007). Multivariate analysis showed that BMI (hazard ratio [HR], 0.740; p=0.046), and HTN (HR, 1.687; p=0.005) were significant predictors of cancer recurrence.
Conclusions
Among UTUC patients who underwent RNUx, patients with HTN and low-BMI showed worse prognosis regarding cancer recurrence. To validate our results, the mechanisms of association between HTN, BMI, and UTUC should be investigated in further prospective studies.

Keyword

Upper tract urothelial carcinoma; Body mass index; Hypertension; Survival