the impact of body mass index on pathological response and survival outcome after neoadjuvant chemotherapy in localized bladder cancer

Background: 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). method: 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. results: 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. conclusion: 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.