{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T16:45:33Z","timestamp":1780591533192,"version":"3.54.1"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,12,5]],"date-time":"2020-12-05T00:00:00Z","timestamp":1607126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000009","name":"Foundation for the National Institutes of Health","doi-asserted-by":"publisher","award":["P60Ca091846"],"award-info":[{"award-number":["P60Ca091846"]}],"id":[{"id":"10.13039\/100000009","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate if the obesity paradox, wherein obesity portends worse overall prognosis for a disease but improved outcomes for patients receiving immunotherapy, exists for patients receiving bacillus Calmette\u2013Gu\u00e9rin (BCG) in a contemporary cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>We performed an Institutional Review Board\u2010approved database review to identify patients with non\u2010muscle\u2010invasive bladder cancer (NMIBC) completing at least an induction course of BCG. Clinicopathological variables collected included: body mass index (BMI), medications, and diabetes mellitus (DM). Outcomes of interest included: recurrence\u2010free (RFS), progression\u2010free (PFS), cancer\u2010specific (CSS), and overall survival (OS). Univariate and multivariate modelling were used to evaluate the association between outcomes and clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 579 patients (median follow\u2010up 4.6\u00a0years) received BCG induction for NMIBC; 90% had high\u2010grade disease (47.2% clinical stage T1). In all, 75.7% of patients were overweight or obese and 18% had DM. Aspirin, statins, metformin and \u03b2\u2010blockers were used in 34%, 42%, 11%, and 29% of patients, respectively. Overweight and obese patients had improved PFS, CSS and OS. DM was associated with worse RFS. Medications of interest had no association with outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated BMI is associated with improved outcomes in patients with NMIBC treated with BCG immunotherapy. Patients with DM are at increased risk of recurrence. These findings support a potential obesity paradox in bladder cancer. Evaluation of the underlying mechanism and the role of global patient assessment, counselling, and risk factor modification are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.15296","type":"journal-article","created":{"date-parts":[[2020,12,4]],"date-time":"2020-12-04T11:47:25Z","timestamp":1607082445000},"page":"65-71","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["The obesity paradox: defining the impact of body mass index and diabetes mellitus for patients with non\u2010muscle\u2010invasive bladder cancer treated with bacillus Calmette\u2013Gu\u00e9rin"],"prefix":"10.1111","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5111-6914","authenticated-orcid":false,"given":"Nathan A.","family":"Brooks","sequence":"first","affiliation":[{"name":"Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1957-7999","authenticated-orcid":false,"given":"Andrea","family":"Kokorovic","sequence":"additional","affiliation":[{"name":"Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianchen","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2467-5710","authenticated-orcid":false,"given":"Justin T.","family":"Matulay","sequence":"additional","affiliation":[{"name":"Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1274-7200","authenticated-orcid":false,"given":"Roger","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Genitourinary Oncology Moffitt Cancer Center Tampa FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weranja K.B.","family":"Ranasinghe","sequence":"additional","affiliation":[{"name":"Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supriya","family":"Nagaraju","sequence":"additional","affiliation":[{"name":"Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianjun","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Genitourinary Medical Oncology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neema","family":"Navai","sequence":"additional","affiliation":[{"name":"Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin P.N.","family":"Dinney","sequence":"additional","affiliation":[{"name":"Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. 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