Patients with non-muscle invasive bladder cancer (NMIBC) are at high risk of tumor recurrence. It has not been previously investigated if adherence to cancer prevention recommendations lowers risk of recurrence.
We examined whether the standardized lifestyle score measuring adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations was associated with risk of recurrence and progression among patients with NMIBC.
The study population included patients diagnosed with primary NMIBC between 2014 and 2017 from the prospective cohort UroLife. Lifestyle was assessed at baseline (n=979; reflecting the prediagnosis period) and 3-months postdiagnosis (n=885). The standardized 2018 WCRF/AICR score was constructed based on recommendations for body weight, physical activity, diet, and alcohol intake. We computed multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazard regression models.
During a median follow-up time of 3.7 years, 320 patients developed ≥1 recurrence(s) and 49 experienced progression. Patients in the highest versus lowest tertile of postdiagnosis WCRF/AICR scores had a lower risk of first bladder cancer recurrence (HR, 0.74; 95%CI: 0.56, 0.98). No associations were observed for multiple recurrences (HR, 0.90; 95%CI 0.70, 1.15) or for the baseline score with either first (HR, 1.07; 95%CI 0.82, 1.40) or multiple recurrences (HR, 1.04; 95%CI: 0.82, 1.31). Improving lifestyle after diagnosis (per 1-point increase) was not significantly associated with risk of first or multiple recurrence(s) (HRs 0.87; 95% CI: 0.74, 1.02; HR 0.93; 95%CI: 0.80, 1.08, respectively). No associations were observed for bladder cancer progression, but power was limited.
Better adherence to the WCRF/AICR cancer prevention recommendations 3-months after NMIBC diagnosis, but not before diagnosis, is associated with a decreased risk of first bladder cancer recurrence. More studies evaluating postdiagnosis lifestyle are needed to provide solid support for lifestyle recommendations for cancer survivors.
The American journal of clinical nutrition. 2023 Feb 11 [Epub ahead of print]
Moniek van Zutphen, Jasper P Hof, Katja Kh Aben, Ellen Kampman, J Alfred Witjes, Lambertus Alm Kiemeney, Alina Vrieling
Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands., Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands., Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands., Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands., Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands., Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: .