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ARTICLE

Overweight status predicts improved overall survival after radical nephroureterectomy for upper tract urothelial carcinoma

Shu-Yu Wu1,2, Ching-Chia Li3,4,5, Wen-Jeng Wu3,4,5, Kuan-Hua Huang6,7, Chien-Liang Liu8,9, Shian-Shiang Wang10,11,12, Jian-Ri Li10,11, Han-Yu Weng13, Ta-Yao Tai13, Pi-Che Chen14, Ian-Seng Cheong14, Chung-You Tsai15,16, Pai-Yu Cheng15,17, Jian-Hua Hong18,19, Chung-Hsin Chen19, Jen-Shu Tseng20,21,22, Wun-Rong Lin20,21, Yuan-Hong Jiang2,23, Yu-Khun Lee2,23, Po-Hung Lin24,25,26, See-Tong Pang24, Yung-Tai Chen27, Wei-Chieh Chen28, Chia-Chang Wu29,30,31, Thomas Y. Hsueh32,33, Hsu-Che Huang34,35, Wei-Yu Lin36,37,38, Chia-Cheng Yu39, Jen-Kai Fang40, Chih-Chin Yu1,2, Yao-Chou Tsai1,2,28,*
1 Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 231, Taiwan
2 Department of Urology, School of Medicine, Tzu Chi University, Hualien, 970, Taiwan
3 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan
4 Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
5 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
6 Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, 710, Taiwan
7 Department of Medical Science Industries, College of Health Sciences, Chang Jung Christian University, Tainan, 711, Taiwan
8 Division of Urology, Division of Urological Oncology, Department of Surgery, Chi-Mei Medical Center, Tainan, 710, Taiwan
9 Chia Nan University of Pharmacy and Science, Tainan, 717, Taiwan
10 Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, 407, Taiwan
11 Institute of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan
12 Department of Applied Chemistry, National Chi Nan University, Nantou, 545, Taiwan
13 Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan
14 Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, 600, Taiwan
15 Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, 220, Taiwan
16 Department of Electrical Engineering, Yuan Ze University, Taoyuan, 320, Taiwan
17 Department of Biomedical Engineering, National Taiwan University, Taipei, 106, Taiwan
18 Institute of Biomedical Engineering, National Taiwan University, Taipei, 106, Taiwan
19 Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
20 Department of Urology, MacKay Memorial Hospital, Taipei, 104, Taiwan
21 Mackay Medical College, Taipei, 252, Taiwan
22 Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
23 Department of Urology, Hualien Tzu Chi Hospital, Tzu Chi Medical Foundation, Hualien, 970, Taiwan
24 Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
25 Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
26 School of Medicine, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
27 Department of Urology, Taiwan Adventist Hospital, Taipei, 105, Taiwan
28 Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, 110, Taiwan
29 Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 235, Taiwan
30 Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
31 TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, 110, Taiwan
32 Division of Urology, Department of Surgery, Taipei City Hospital, Taipei, 103, Taiwan
33 Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
34 Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, 231, Taiwan
35 Department of Life Science, College of Science, National Taiwan Normal University, Taipei, 106, Taiwan
36 Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, 613, Taiwan
37 Chang Gung University of Science and Technology, Chiayi, 613, Taiwan
38 Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
39 Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, 813, Taiwan
40 Department of Urology, China Medical University Hospital, Taichung, 404, Taiwan
* Corresponding Author: Yao-Chou Tsai. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2025.069390

Received 22 June 2025; Accepted 16 December 2025; Published online 04 February 2026

Abstract

Introduction: Upper urinary tract urothelial carcinoma (UTUC) is a rare malignancy, particularly in the ureter, and is associated with high rates of recurrence and metastasis. Although body mass index (BMI) has been associated with prognosis in multiple cancer types, its role as a predictive factor in UTUC is still debated. This study aimed to investigate how BMI influences survival outcomes in patients with UTUC treated with radical nephroureterectomy (RNU). Methods: This multi-center retrospective analysis by the Taiwan UTUC Collaboration Group involved 2503 patients who underwent treatment across 19 hospitals from 1988 to 2022. Patients were categorized into normal (18.5 ≤ BMI < 24), overweight (24 ≤ BMI < 27), and obese (BMI ≥ 27) groups. Demographic, clinical, and pathological data were analyzed. Overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IVRFS) were assessed using Kaplan–Meier analysis and Cox proportional hazards models. Results: The median follow-up period was 44.2 months. In multivariable analysis, overweight patients demonstrated significantly better OS compared with normal-weight patients (p = 0.033), and the obesity group showed a favorable, though not statistically significant, trend toward better OS. However, BMI was not an independent predictor of CSS, DFS, or IVRFS. Independent predictors of worse outcomes included older age, end-stage renal disease, ureteral tumor location, tumor size ≥3 cm, and high-grade urothelial carcinoma. Tumor stage and grade were comparable across BMI groups. Conclusions: Overweight status was associated with better OS in patients with UTUC treated with RNU, while BMI had no significant impact on CSS, DFS, or IVRFS. These findings suggest a potential protective effect of higher BMI on OS, warranting further investigation in prospective studies. However, BMI alone should not guide clinical decisions and may instead reflect broader patient health characteristics.

Keywords

Urothelial cancer; body mass index; upper urinary tract urothelial carcinoma; oncological outcomes; radical nephroureterectomy

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