James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Seoul National University Boramae Hospital (SBL), Seoul, South Korea; Sungkyunkwan University Samsung Medical Center (BCJ), Seoul, South Korea; Duke University Medical Center, Durham, North Carolina (SJF).
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Seoul National University Boramae Hospital (SBL), Seoul, South Korea; Sungkyunkwan University Samsung Medical Center (BCJ), Seoul, South Korea; Duke University Medical Center, Durham, North Carolina (SJF).
J Urol. 2014 Oct;192(4):1100-4. doi: 10.1016/j.juro.2014.04.086. Epub 2014 Apr 21.
Obesity is a modifiable risk factor associated with worse outcomes for many cancers, yet implications for prostate cancer are not well understood. Notably the impact of body mass index on long-term survival after treatment is unclear. We performed a retrospective cohort study on a large series of men who underwent radical prostatectomy to assess the impact of obesity on long-term biochemical recurrence-free survival, prostate cancer specific survival and overall survival.
Between 1982 and 2012, 11,152 men underwent radical prostatectomy at a single tertiary referral center. Patients were stratified according to body mass index as normal weight (body mass index less than 25 kg/m(2)), overweight (body mass index 25 to less than 30 kg/m(2)), mild obesity (body mass index 30 to less than 35 kg/m(2)) and moderate/severe obesity (body mass index 35 kg/m(2) or greater), comprising 27.6%, 56.0%, 14.1% and 2.3% of the cohort, respectively. Covariates included age, preoperative prostate specific antigen, surgery year, Gleason score, pathological stage, surgical margin and race. Predictors of biochemical recurrence-free survival, prostate cancer specific survival and overall survival were identified using Cox proportional hazard models.
Median followup was 5 years (range 1 to 27). Actuarial 20-year biochemical recurrence-free survival for mild and moderate/severe obesity was 65% and 51%, respectively, compared to 76% for normal weight men (p ≤0.001). In a multivariate model obesity was a significant predictor of biochemical recurrence-free survival (mild HR 1.30, p = 0.002; moderate/severe HR 1.45, p = 0.028) and overall survival (mild HR 1.41, p = 0.003; moderate/severe HR 1.81, p = 0.033). However, only mild obesity was significantly associated with prostate cancer specific survival (HR 1.51, p = 0.040), whereas moderate/severe obesity was not (HR 1.58, p = 0.356).
Obese men have higher rates of biochemical recurrence than normal weight patients during long-term followup. Obesity at the time of surgery independently predicts overall survival and biochemical recurrence-free survival but not prostate cancer specific survival.
肥胖是许多癌症预后较差的可改变风险因素，但前列腺癌的影响尚不清楚。值得注意的是，体重指数对治疗后长期生存的影响尚不清楚。我们对在一家三级转诊中心接受根治性前列腺切除术的大量男性进行了回顾性队列研究，以评估肥胖对长期生化无复发生存率、前列腺癌特异性生存率和总生存率的影响。
1982 年至 2012 年期间，有 11152 名男性在一家三级转诊中心接受了根治性前列腺切除术。根据体重指数将患者分为正常体重（体重指数<25kg/m2）、超重（体重指数 25-<30kg/m2）、轻度肥胖（体重指数 30-<35kg/m2）和中度/重度肥胖（体重指数≥35kg/m2），分别占队列的 27.6%、56.0%、14.1%和 2.3%。协变量包括年龄、术前前列腺特异性抗原、手术年份、Gleason 评分、病理分期、手术切缘和种族。使用 Cox 比例风险模型确定生化无复发生存率、前列腺癌特异性生存率和总生存率的预测因素。
中位随访时间为 5 年（1-27 年）。轻度和中度/重度肥胖患者的 20 年生化无复发生存率分别为 65%和 51%，而正常体重男性为 76%（p≤0.001）。在多变量模型中，肥胖是生化无复发生存率的显著预测因素（轻度 HR 1.30，p=0.002；中度/重度 HR 1.45，p=0.028）和总生存率（轻度 HR 1.41，p=0.003；中度/重度 HR 1.81，p=0.033）。然而，只有轻度肥胖与前列腺癌特异性生存率显著相关（HR 1.51，p=0.040），而中度/重度肥胖则没有（HR 1.58，p=0.356）。
在长期随访中，肥胖男性的生化复发率高于正常体重患者。手术时的肥胖独立预测总生存率和生化无复发生存率，但不预测前列腺癌特异性生存率。
