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 |
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| Institution: | 1. Division of Urology, European Institute of Oncology-IRCCS, Milan, Italy;2. Department of Urology, University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania;3. CRTR Rare Tumors Reference Center, AOU Federico II, Napoli, Italy;4. Environment & Health Operational Unit, Zoo-prophylactic Institute of Southern Italy, Portici, Italy;5. Department of Cell and Molecular Biology, University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania;6. Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy;7. Department of Experimental Medicine and Surgery, Tor Vegata University, Rome, Italy;8. Department of Urology, Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy;9. Department of Urology, La Sapienza University of Rome, Rome, Italy;10. Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione “G. Pascale”-IRCCS, Naples, Italy;11. Scientific Directorate, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione “G. Pascale”-IRCCS, Naples, Italy;12. Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University Federico II, Napoli, Italy;13. Department of Urology, University of Bologna, Bologna, Italy;14. Department of Robotic Urologic Surgery, Abano Terme Hospital, Abano Terme, Italy;15. Division of Urology, Department of Experimental Medicine and Surgery, Urology Unit, Tor Vergata University of Rome, Rome, Italy;p. Life and Health Sciences Research Institute, University of Minho, Braga, Portugal;q. Division of Urology, Virginia Commonwealth University, Richmond, VA;r. Department of Urology, University of Medicine and Pharmacy Iuliu Ha?ieganu, Cluj-Napoca, Romania;s. Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy;t. Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy;u. Department of Urology, University of Catania, Catania, Italy;v. Department of Translational Medical Sciences, University Federico II, Napoli, Italy;w. Department of Clinical Medicine and Surgery, University Federico II, Napoli, Italy;x. Department of Medicine, University of Molise, Campobasso, Italy;y. Genitourinary Oncology Section, Dana Farber Cancer Institute, Boston, MA;z. Università degli Studi di Milano, Milan, Italy |
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| Abstract: | ObjectivesThe 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 methodsA 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.ResultsA 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.ConclusionsGiven 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. |
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