The Impact of Body Mass Index on Pathological Response and Survival Outcome after Neoadjuvant Chemotherapy in Localized Bladder Cancer

Neoadjuvant chemotherapy (NAC) grants a modest survival benefit in localized muscle-invasive bladder cancer (MIBC). We evaluated the pathological response and survival outcome after NAC in stage II and IIIA MIBC and their correlation with body mass index (BMI). Our retrospective study included stage II (T2 N0) and IIIA (T3 N0, T4 N0, T1-4 N1) MIBC. They received NAC followed by radical cystectomy. The patients were categorized into level I: a BMI of 18.5 – 24.9 kg/m2, level II: a BMI of 25-29.9 kg/m2, and level III: a BMI of ≥ 30 kg/m2. 103 patients with localized MIBC were included. The median age was 63 years; 35 patients (34.0%) belonged to level I, 40 patients (38.8%) belonged to level II, and 28 patients (27.2%) belonged to level III. Smoking status was more common in level II (51.0%) and level III (36.7%) (P < 0.001). Only 18 patients had ECOG PS 2, all belonging to level III (P < 0.001). After NAC, the pCR was 34.3%, 25%, and 10.7% of level I, level II, and level III (P = 0.03), respectively. Of 19 patients who passed away, 10 patients belonged to level III and 6 patients belonged to level II (P = 0.007). For level I, level II, and level III, the disease-free survival was 23.2 months, 12.7 months, and 10.7 months and the overall survival was 61.9, 52.3, and 28.7 months, respectively. Obesity and overweight could be predictive and prognostic markers in localized MIBC. These factors are associated with low pCR after NAC, poor disease-free survival, and overall survival.