Abstract
BackgroundUrinary bladder carcinoma is common in developed settings, and prognosis may be impacted by lifestyle factors such as excess body weight and diabetes mellitus. The present meta-analysis aimed to systematically collate and analyze evidence on the impact of diabetes and excess BMI on bladder cancer outcomes.MethodsPubMed, Scopus, and Google Scholar databases were screened for relevant studies that examined the association between bladder cancer outcomes and diabetes and/or excess body weight. The primary outcomes for this study were mortality (both all-cause and cancer-specific), risk of cancer progression, and recurrence. Strength of association was presented in the form of pooled adjusted hazard ratios (HR). Statistical analysis was performed using STATA version 16.0.ResultsTwenty-five articles met inclusion criteria. Nine of these examined diabetes mellitus while 16 studied body mass index. All studies were retrospective. Diabetic patients had significantly higher risk for all-cause mortality (HR 1.24, 95% CI: 1.07, 1.44, n=3), cancer specific mortality (HR 1.67, 95% CI: 1.29, 2.16, n=7), disease progression (HR 1.54, 95% CI: 1.15, 2.06, n=8), and recurrence (HR 1.40, 95% CI: 1.32, 1.48, n=8) compared to non-diabetics. No statistically significant risk change for all-cause mortality, cancer specific mortality, disease progression, and recurrence was found for overweight patients. However, obese individuals were at higher risk for disease progression (HR 1.88, 95% CI: 1.41, 2.50, n=3) and recurrence (HR 1.60, 95% CI: 1.06, 2.40, n=7) compared to normal BMI patients.ConclusionsThese findings suggest that diabetes and excess body weight negatively influences bladder cancer prognosis and outcome. The increased risk of mortality due to diabetes was similar to that in the general population. Since retrospective studies are potentially susceptible to bias, future prospective studies on this subject are required.
Highlights
Urinary bladder cancer is quite prevalent, in highincome settings [1]
These tables focus on primary tumor characteristics. Lifestyle factors such as obesity, smoking, as well as the presence of diabetes mellitus, can affect prognosis and modify follow-up schedules. Both diabetes mellitus and obesity are increasing in prevalence globally [9, 10], and insulin resistance and hyperinsulinemia have been proposed to affect bladder cancer risk and prognosis [11,12,13]
Several studies have looked at the link between body mass index and diabetes with cancer risk, few have looked at the impact of these factors on overall survival, tumor recurrence, and progression
Summary
Urinary bladder cancer is quite prevalent, in highincome settings [1]. Bladder cancer is categorized as muscle invasive and non-muscle invasive: muscle invasive bladder cancers have low 5-year survival rates of ~35-40%, while nonmuscle invasive bladder cancers have much higher survival rates (89-98%) accompanied by high five-year progression (~5-20%) and recurrence rates (~28-50%) [2,3,4,5]. These tables focus on primary tumor characteristics Lifestyle factors such as obesity, smoking, as well as the presence of diabetes mellitus, can affect prognosis and modify follow-up schedules. Several studies have looked at the link between body mass index and diabetes with cancer risk, few have looked at the impact of these factors on overall survival, tumor recurrence, and progression. This current study aimed to pool available information and assess the impact of diabetes and elevated BMI on bladder cancer outcomes through a meta-analysis. The present meta-analysis aimed to systematically collate and analyze evidence on the impact of diabetes and excess BMI on bladder cancer outcomes
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