Adherence to lifestyle recommendations after non-muscle invasive bladder cancer diagnosis and risk of recurrence

• Published in: The American journal of clinical nutrition Vol. 117; no. 4; pp. 681 - 690
• Main Authors: van Zutphen, Moniek, Hof, Jasper P., Aben, Katja KH, Kampman, Ellen, Witjes, J Alfred, Kiemeney, Lambertus ALM, Vrieling, Alina
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2023; American Society for Clinical Nutrition, Inc
• Subjects: alcohol; Bladder; Bladder cancer; body mass index; Body weight; Cancer; Cancer research; Cohort Studies; Diagnosis; diet; Disease prevention; Health risks; Humans; Invasiveness; Life Style; lifestyle; Lifestyles; Medical diagnosis; Medical research; Muscles; Neoplasm Recurrence, Local; non-muscle invasive bladder cancer; Non-Muscle Invasive Bladder Neoplasms; Physical activity; Population studies; Prevention; Prospective Studies; recurrence; Regression analysis; Regression models; Risk; Risk Factors; Risk reduction; United States; Urinary Bladder Neoplasms; United States; alcohol; SQUASH; NMIBC; TURBT; body mass index; CIS; lifestyle; physical activity; recurrence; WCRF/AICR; GT-UR; SI; EAU; non-muscle invasive bladder cancer; diet
• ISSN: 0002-9165; 1938-3207
• DOI: 10.1016/j.ajcnut.2022.12.022

Patients with non-muscle invasive bladder cancer (NMIBC) are at a high risk of tumor recurrence. It has not been previously investigated if adherence to cancer prevention recommendations lowers the 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 the 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-mo 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 HRs and 95% CIs using Cox proportional hazard regression models. During a median follow-up time of 3.7 y, 320 patients developed ≥1 recurrence(s) and 49 experienced progression. Patients in the highest compared with the 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 the risk of first or multiple recurrence(s) (HR: 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 the power was limited. Better adherence to the WCRF/AICR cancer prevention recommendations 3 mo after NMIBC diagnosis, but not before diagnosis, is associated with a decreased risk of first bladder cancer recurrence. More studies evaluating postdiagnosis lifestyles are needed to provide solid support for lifestyle recommendations for cancer survivors.