TY  - EJOU
AU  - Wu, Shu-Yu 
AU  - Li, Ching-Chia 
AU  - Wu, Wen-Jeng 
AU  - Huang, Kuan-Hua 
AU  - Liu, Chien-Liang 
AU  - Wang, Shian-Shiang 
AU  - Li, Jian-Ri 
AU  - Weng, Han-Yu 
AU  - Tai, Ta-Yao 
AU  - Chen, Pi-Che 
AU  - Cheong, Ian-Seng 
AU  - Tsai, Chung-You 
AU  - Cheng, Pai-Yu 
AU  - Hong, Jian-Hua 
AU  - Chen, Chung-Hsin 
AU  - Tseng, Jen-Shu 
AU  - Lin, Wun-Rong 
AU  - Jiang, Yuan-Hong 
AU  - Lee, Yu-Khun 
AU  - Lin, Po-Hung 
AU  - Pang, See-Tong 
AU  - Chen, Yung-Tai 
AU  - Chen, Wei-Chieh 
AU  - Wu, Chia-Chang 
AU  - Hsueh, Thomas Y. 
AU  - Huang, Hsu-Che 
AU  - Lin, Wei-Yu 
AU  - Yu, Chia-Cheng 
AU  - Fang, Jen-Kai 
AU  - Yu, Chih-Chin 
AU  - Tsai, Yao-Chou 

TI  - Overweight status predicts improved overall survival after radical nephroureterectomy for upper tract urothelial carcinoma
T2  - Canadian Journal of Urology

PY  - 2026
VL  - 33
IS  - 2
SN  - 1488-5581

AB  -  <b>Introduction:</b> 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). <b>Methods:</b> 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 &lt; 24), overweight (24 ≤ BMI &lt; 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. <b>Results:</b> The median follow-up period was 44.2 months. In multivariable analysis, overweight patients demonstrated significantly better OS compared with normal-weight patients (<i>p</i> = 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. <b>Conclusions:</b> 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.
KW  - Urothelial cancer; body mass index; upper urinary tract urothelial carcinoma; oncological outcomes; radical nephroureterectomy

DO  - 10.32604/cju.2025.069390