Association between metabolic syndrome and recurrence of nonmuscle-invasive bladder cancer in older adults

Tullika Garg; Amanda J Young; Maureen O'Keeffe-Rosetti; Carmit K McMullen; Matthew E Nielsen; Terrence E Murphy; H Lester Kirchner

doi:10.1016/j.urolonc.2020.04.010

Association between metabolic syndrome and recurrence of nonmuscle-invasive bladder cancer in older adults

Urol Oncol. 2020 Sep;38(9):737.e17-737.e23. doi: 10.1016/j.urolonc.2020.04.010. Epub 2020 May 12.

Authors

Tullika Garg¹, Amanda J Young², Maureen O'Keeffe-Rosetti³, Carmit K McMullen³, Matthew E Nielsen⁴, Terrence E Murphy⁵, H Lester Kirchner⁶

Affiliations

¹ Department of Urology, Geisinger, Danville, PA; Department of Population Health Sciences, Geisinger, Danville, PA. Electronic address: tgarg@geisinger.edu.
² Biostatistics Core, Geisinger, Danville, PA.
³ Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
⁴ Department of Urology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; Department of Epidemiology, Health Policy, and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC.
⁵ Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
⁶ Department of Population Health Sciences, Geisinger, Danville, PA.

Abstract

Background: Nonmuscle-invasive bladder cancer (NMIBC) disproportionately affects older adults who often have coexisting chronic conditions such as metabolic syndrome (MetS). Although prior research suggests that MetS is a risk factor for NMIBC, limited data exists on whether MetS is associated with NMIBC recurrence. Our objective was to evaluate the association between MetS and recurrence in older adults treated for NMIBC.

Methods: We identified 1,485 older (age ≥60 years) NMIBC patients (American Joint Committee on Cancer Stage ≤1) from 2community-based health systems. Using data from the health systems' electronic medical record, MetS was defined as the presence of three of the following: diagnosis codes indicating hypertension, hyperlipidemia, diabetes, or body mass index >30. Follow up time was determined by date of the last follow up in the tumor registry and censored at 10 years. Cox proportional hazards regression of time to recurrence that accounts for the competing risk of death included adjustment for age, sex, smoking status, health system, NMIBC stage/grade, tumor size, and number of specimens with cancer.

Results: Overall, 341 patients (23%) met MetS criteria. Median follow up was 5.9 years and 582 patients (39.2%) died. Patients with MetS were more frequently male (84.2%), and mostly current/former smokers (82.6%). By 10 years, 34.1% of the cohort had experienced a recurrence. After accounting for the competing risk of death, there was no association between MetS and time to recurrence (adjusted hazard ratio, 0.88, 95% confidence interval 0.70-1.11, P = 0.28). Patients without MetS had more 0a/low grade recurrences (49.1% vs. 41.4%), though differences were not significant.

Conclusion: We found no association between MetS and risk of NMIBC recurrence in this large, multisite cohort of older adults with NMIBC. In order to design personalized care for older NMIBC patients, future research is needed to evaluate associations between common chronic conditions and a variety of oncologic outcomes.

Keywords: Bladder cancer;Geriatric oncology;Outcomes;Metabolic syndrome;Multiplechronic conditions.

MeSH terms

Age Factors
Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Male
Metabolic Syndrome / complications*
Neoplasm Invasiveness
Neoplasm Recurrence, Local / epidemiology*
Retrospective Studies
Urinary Bladder Neoplasms / complications*
Urinary Bladder Neoplasms / pathology

Abstract

MeSH terms

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