Urologic Oncology: Seminars and Original Investigations
Original articleObesity is associated with biochemical recurrence after radical prostatectomy: A multi-institutional extended validation study
Introduction
Prostate cancer (PCa) is the most common malignancy in men and the second leading cause of cancer-related mortality among European men [1]. Radical prostatectomy (RP) and radiation therapy are the standard of care for clinically localized PCa, although up to 40% of patients subsequently experience biochemical recurrence (BCR) [2]. Nomograms can predict BCR before and after RP, although their accuracy remains suboptimal [3].
Body fat is typically measured using body mass index (BMI) that is calculated using body weight and height. According to the World Health Organization definitions, overweight and obese status are defined using BMI values of≥25 and≥30 kg/m², respectively. It has been hypothesized that both overweight and obese status can affect the carcinogenic, endocrine, and biochemical microenvironments, which subsequently lead to tumor development and progression [4]. Several studies have evaluated the effects of overweight and obese status on PCa incidence, pathological features, and BCR after RP. Those studies revealed that increasing BMI values were associated with a higher incidence of PCa, as well as adverse pathological features at the diagnosis [5]. Furthermore, a recent meta-analysis of 36,927 patients revealed that a 5-kg/m² increase in BMI was associated with a 16% increase in the risk of BCR after RP and radiation therapy [5]. However, that study was limited by the nonlinear relationship between BMI and BCR, which could not be addressed using conventional meta-analytical techniques. Moreover, other studies failed to identify a significant association between BMI and outcomes after RP [6], [7]. Therefore, this study aimed to assess the association between BMI and BCR in a large international contemporary cohort of patients who underwent RP for PCa.
Section snippets
Patient selection and data collection
This study was performed using institutional data from the participating institutions. The appropriate ethical review boards approved this study׳s design, and all participating institutions signed data-sharing agreements before the study׳s initiation. Data from 7,402 patients with clinically localized PCa who underwent RP at 5 centers between 2000 and 2011 were reviewed and entered into a computerized database. However, we excluded patients with a clinical suspicion of lymph node metastasis,
Patient characteristics
The patients׳ baseline characteristics are shown in Table 1. The median BMI was 28 kg/m2 (interquartile range: 24–32 kg/m2); 2,155 patients (33.1%) were overweight (BMI: 25–29.9 kg/m2) and 2,462 patients (37.7%) were obese (BMI≥30 kg/m2). Overweight and obese patients were significantly more likely to have a biopsy Gleason score of 6 (vs. patients with a normal BMI; P<0.001), although no significant difference was observed after the RP (P = 0.71). Overweight or obese patients were also
Discussion
Obesity is a major health issue in industrialized countries, and two-thirds of American adults are considered either overweight or obese based on their BMI. Obesity is also associated with an increased risk of death that is related to cardiovascular disease or diabetes or both. Furthermore, solid evidence now suggests that obesity is associated with a higher incidence of cancer and poor outcomes. Therefore, this study aimed to assess the prognostic value of overweight or obese status among a
Conclusion
Being overweight or obese was associated with a higher likelihood of having more locally advanced PCa and of experiencing BCR after supposedly successful RP. Although the addition of BMI did not significantly improve the discriminative ability of the established prognostic factors, its consistent associations with aggressive biology and poor outcomes support further research regarding the underlying mechanism for this biological phenomenon.
Ethical standards
This study was approved by the appropriate ethics committees.
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Cited by (14)
Poor Adherence to International Cancer Prevention Recommendations Among Patients With Prostate Cancer: First Results From the MARTINI-Lifestyle Cohort
2020, European Urology FocusCitation Excerpt :Decreased physical activity and a sedentary behavior contribute to higher body weight and high BMI. Recent research suggests that elevated BMI and weight gain after RP is associated with adverse oncological outcomes, including higher PCa-specific mortality [24,25]. Thus, weight loss programs and helping prevent weight gain after diagnosis should be emphasized to all patients.
OBESITY AND CANCER: AN UNDERESTIMATED TOXIC RELATIONSHIP
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