Background: The relationship between body composition and bladder cancer outcomes is complex. While a higher body mass index (BMI) has been associated with an increased risk of bladder cancer development, its impact on survival outcomes is less clear. This study aimed to explore the association between BMI, survival, health-related quality of life, and the performance of ADLs in a cohort of older patients with bladder cancer. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey, including patients diagnosed with bladder cancer who had recorded BMI values. Analysis of variance was used to assess the association between BMI categories and patient demographics as well as cancer/treatment characteristics. Generalized linear models examined the impact of BMI on health-related quality of life, as measured by the physical and mental component summary scores when controlling for confounding variables. Kaplan–Meier survival curves across BMI categories were compared using log-rank tests. Results: The final cohort consisted of 8013 patients (age ≥ 65) with a mean age of 77.7 ± 7.1 years, the majority of whom were White (85.6%) and male (74.8%). We observed no significant association between BMI and cancer/treatment characteristics. The severely obese subgroup had the highest rate of disability in performing ADLs (18.3%) followed by the underweight subgroup (10.3%). Overweight patients exhibited the highest physical and mental component summary scores, indicating better health-related quality of life. BMI was a significant predictor of overall survival, with overweight, obese, and severely obese patients demonstrating improved survival compared to those with healthy or underweight BMI. These findings remained statistically significant in multivariable analysis. Conclusions: Our findings suggest a dual role of BMI in older patients with bladder cancer: higher BMI provides a survival advantage and, to an extent, a QoL advantage. At the same time, severe obesity did lead to the lowest QoL despite improved survival outcomes. These results underscore the complex interplay between BMI, survival, and QoL in this bladder cancer population.
背景：身体成分与膀胱癌预后之间的关系较为复杂。虽然较高的身体质量指数（BMI）与膀胱癌发病风险增加相关，但其对生存结局的影响尚不明确。本研究旨在探讨老年膀胱癌患者队列中BMI与生存率、健康相关生活质量及日常生活活动能力之间的关联。方法：数据来源于监测、流行病学和最终结果-医疗保险健康结局调查，纳入确诊膀胱癌且记录有BMI值的患者。采用方差分析评估BMI分类与患者人口统计学特征及癌症/治疗特征之间的关联。通过广义线性模型，在控制混杂变量的情况下，以生理和心理成分总评分衡量BMI对健康相关生活质量的影响。采用对数秩检验比较不同BMI分类的Kaplan-Meier生存曲线。结果：最终队列包含8013名患者（年龄≥65岁），平均年龄为77.7±7.1岁，其中白人占85.6%，男性占74.8%。未观察到BMI与癌症/治疗特征存在显著关联。重度肥胖亚组的日常生活活动能力障碍率最高（18.3%），其次为体重过轻亚组（10.3%）。超重患者的生理和心理成分总评分最高，表明其健康相关生活质量更优。BMI是总体生存率的显著预测因子，与健康体重或体重过轻者相比，超重、肥胖和重度肥胖患者表现出更好的生存率。多变量分析中这些发现仍具有统计学显著性。结论：我们的研究结果表明，在老年膀胱癌患者中BMI具有双重作用：较高的BMI带来生存优势，并在一定程度上提升生活质量。但同时需注意，尽管生存结局改善，重度肥胖确实导致最低的生活质量。这些结果强调了该膀胱癌人群中BMI、生存率与生活质量之间复杂的相互作用。
肿瘤(癌症)患者之家