Type 2 diabetes mellitus predicts worse outcomes in patients with high-grade T1 bladder cancer receiving bacillus Calmette-Guérin after transurethral resection of the bladder tumor.

Abstract

OBJECTIVES:

The aim of this multicenter study was to investigate the prognostic role of type 2 diabetes mellitus (T2DM) comorbidity in a large multi-institutional cohort of patients with primary T1HG/G3 non-muscle-invasive bladder cancer (NMIBC) treated with transurethral resection of the bladder (TURB).

MATERIALS AND METHODS:

A total of 1,172 patients with primary T1 HG/G3 who had NMIBC on re-TURB and who received adjuvant intravesical bacillus Calmette-Guérin therapy with maintenance were included. Endpoints were recurrence-free survival and progression-free survival.

RESULTS:

A total of 231 (19.7%) of patients had T2DM prior to TURB. Five-year recurrence-free survival estimates were 12.5% in patients with T2DM compared to 36% in patients without T2DM, P < 0.0001. Five-year PFS estimates were 60.5% in patients with T2DM compared to 70.2% in patients without T2DM, P = 0.003. T2DM was independently associated with disease recurrence (hazard ratio = 1.41; 95% confidence interval = 1.20-1.66, P < 0.001) and progression (hazard ratio = 1.27; 95% confidence interval = 0.99-1.63, P < 0.001), after adjusting for other known predictive factors such as tumor size, multifocality, T1G3 on re-TURB, body mass index, lymphovascular invasion, and neutrophil-to-lymphocytes ratio.

CONCLUSIONS:

Given the potential implications for management, prospective validation of this finding along with translational studies designed to investigate the underlying biology of such an association are warranted.

• Authors: Matteo Ferro, Martha Orsolya Katalin, Carlo Buonerba, Raluca Marian, Francesco Cantiello, Gennaro Musi, Savino Di Stasi, Rodolfo Hurle, Giorgio Guazzoni, Gian Maria Busetto, Francesco Del Giudice, Sisto Perdonà, Paola Del Prete, Vincenzo Mirone, Marco Borghesi, Angelo Porreca, Walter Artibani, Pierluigi Bove, Estevao Lima, Riccardo Autorino, Nicolae Crisan, Abdal Rahman Abu Farhan, Michele Battaglia, Pasquale Ditonno, Vincenzo Serretta, Giorgio Ivan Russo, Daniela Terracciano, Giuseppe di Lorenzo, Rocco Damiano, Guru Sonpavde, Mihai Dorin Vartolomei, Ottavio de Cobelli, Giuseppe Lucarelli
• Journal: Urologic oncology (Urol Oncol) Vol. 38 Issue 5 Pg. 459-464 (05 2020) ISSN: 1873-2496 [Electronic] United States
• PMID: 32173242 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Chemical References

• Adjuvants, Immunologic
• BCG Vaccine

Topics

• Adjuvants, Immunologic (therapeutic use)
• Aged
• BCG Vaccine (therapeutic use)
• Chemotherapy, Adjuvant
• Cystectomy (methods)
• Diabetes Mellitus, Type 2 (complications)
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Grading
• Neoplasm Invasiveness
• Neoplasm Staging
• Prognosis
• Progression-Free Survival
• Retrospective Studies
• Urethra
• Urinary Bladder Neoplasms (complications, pathology, therapy)