Lifestyle and dietary inflammation scores and risks of recurrence and progression among patients with non-muscle invasive bladder cancer.

Abstract

A healthy lifestyle and diet may improve outcomes of patients with non-muscle invasive bladder cancer (NMIBC), potentially through reducing systemic inflammation. Therefore, this study investigated the association of a post-diagnosis Lifestyle (LIS) and Dietary Inflammation Score (DIS), and high-sensitivity C-reactive protein (hsCRP) with the risks of NMIBC recurrence and progression. Patients with newly diagnosed NMIBC between 2014 and 2021 were recruited for the prospective multi-center cohort UroLife. Lifestyle (n = 1334) and/or diet (n = 1306) were self-reported at 3 months post-diagnosis using lifestyle and food frequency questionnaires. The LIS and DIS were calculated to capture the inflammatory potential of lifestyle and diet; higher scores indicate more pro-inflammatory exposures. Plasma hsCRP was measured at 3 months postdiagnosis. The association of LIS and DIS with hsCRP was ascertained in multivariable linear regression models. The association of the LIS, DIS, and hsCRP with risks of first or multiple recurrence(s), and stage and/or grade progression was assessed using multivariable Cox proportional hazards models. Over a median follow-up time of 4.7 years, 466 patients had at least one recurrence, and 155 had progression. Each 1-point increment in LIS and DIS was associated with a 43% (95% CI 29%-58%) and 6% (95% CI 3%-10%) increase in hsCRP, respectively. Higher LIS, DIS, and hsCRP were not associated with risks of first or multiple recurrence(s), and progression. In conclusion, a pro-inflammatory lifestyle and diet, and systemic inflammation, as measured by hsCRP, were not associated with NMIBC outcomes in our cohort. Yet, contributions from specific inflammatory processes or other biomarkers cannot be excluded.