Obesity is associated with worse oncological outcomes in patients treated with radical cystectomy
Bibliographic record
Abstract
What's known on the subject? and What does the study add? Little is known on the association between obesity and urothelial carcinoma of the bladder ( UCB ). Most studies have shown that higher body mass index ( BMI ) is associated with higher rates of perioperative complications. Only one study specifically investigated obesity and bladder cancer‐specific outcomes and reported no significant association between higher BMI and disease‐specific survival in patients with UCB treated with radical cystectomy. However, that study was limited by its small sample size and a high rate of preoperative therapies. In contrast to the only previous study evaluating the association of BMI with oncological outcomes in UCB , we found that obesity ( BMI ≥30 kg/m 2 ) was associated with features of biologically aggressive UCB and clinical outcomes after radical cystectomy and, even when adjusting for the effects of standard clinicopathological features, obesity remained an independent predictor of cancer recurrence, cancer‐specific mortality and overall mortality. Objective To investigate the association between body mass index ( BMI ) and oncological outcomes in patients after radical cystectomy ( RC ) for urothelial carcinoma of the bladder ( UCB ) in a large multi‐institutional series. Patients and Methods Data were collected from 4118 patients treated with RC and pelvic lymphadenectomy for UCB . Patients receiving preoperative chemotherapy or radiotherapy were excluded. Univariable and multivariable models tested the effect of BMI on disease recurrence, cancer‐specific mortality and overall mortality. BMI was analysed as a continuous and categorical variable (<25 vs 25–29 vs ≥30 kg/m 2 ). Results Median BMI was 28.8 kg/m 2 (interquartile range 7.9); 25.3% had a BMI <25 kg/m 2 , 32.5% had a BMI between 25 and 29.9 kg/m 2 , and 42.2% had a BMI ≥30 kg/m 2 . Patients with a higher BMI were older ( P < 0.001), had higher tumour grade ( P < 0.001), and were more likely to have positive soft tissue surgical margins ( P = 0.006) compared with patients with lower BMI . I n multivariable analyses that adjusted for the effects of standard clinicopathological features, BMI >30 was associated with higher risk of disease recurrence (hazard ratio ( HR ) 1.67, 95% confidence interval ( CI ) 1.46–1.91, P < 0.001), cancer‐specific mortality ( HR 1.43, 95% CI 1.24–1.66, P < 0.001), and overall mortality ( HR 1.81, CI 1.60–2.05, P < 0.001). Themain limitation is the retrospective design of the study. Conclusions Obesity is associated with worse cancer‐specific outcomes in patients treated with RC for <jats:
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".