Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Biostatistics Collaboration Unit, Yonsei University, Seoul, Republic of Korea.
J Urol. 2018 Jul;200(1):114-120. doi: 10.1016/j.juro.2018.01.069. Epub 2018 Jan 31.
The relationship between body fat distribution and survival remains unclear in patients with castration resistant prostate cancer treated with docetaxel and androgen receptor axis targeted agents. We investigated whether body composition parameters could predict radiographic progression-free and cancer specific survival in patients with castration resistant prostate cancer.
In this multicenter retrospective study we evaluated data on 282 consecutive patients diagnosed with castration resistant prostate cancer between September 2009 and March 2017. The subcutaneous fat index, the visceral fat index and the skeletal muscle index at the diagnosis of castration resistant prostate cancer were determined by computerized tomography data. Survival analyses were performed using the subcutaneous fat, visceral fat and skeletal muscle indexes dichotomized at 39.9, 58 and 52.4 cm/m, respectively.
At the diagnosis of castration resistant prostate cancer, cancer specific survival was independently predicted using prostate specific antigen levels, Gleason score 8 or greater, performance status, a shorter interval from androgen deprivation therapy to castration resistant prostate cancer and a subcutaneous fat index of less than 39.9 cm/m. During the median followup of 16.0 months patients with a subcutaneous fat index of 39.9 cm/m or greater received more docetaxel cycles than patients with a subcutaneous fat index of less than 39.9 cm/m. Compared to patients with a subcutaneous fat index of less than 39.9 cm/m those with an index of 39.9 cm/m or greater had better 1-year progression-free and 2-year cancer specific survival (p = 0.009 and 0.021, respectively).
Patients with a subcutaneous fat index of 39.9 cm/m or greater at the diagnosis of castration resistant prostate cancer showed higher progression-free and cancer specific survival rates than those with a subcutaneous fat index of less 39.9 cm/m at diagnosis. The subcutaneous fat index determined by computerized tomography data could serve as a useful objective prognostic factor to discuss patient therapeutic options. Further studies are needed to define the roles of each body composition parameter in relation to pharmacokinetics and oncologic outcome.
在接受多西他赛和雄激素受体轴靶向药物治疗的去势抵抗性前列腺癌患者中，体脂分布与生存之间的关系尚不清楚。我们研究了身体成分参数是否可以预测去势抵抗性前列腺癌患者的影像学无进展生存期和癌症特异性生存期。
在这项多中心回顾性研究中，我们评估了 2009 年 9 月至 2017 年 3 月期间连续诊断为去势抵抗性前列腺癌的 282 例患者的数据。通过计算机断层扫描数据确定去势抵抗性前列腺癌诊断时的皮下脂肪指数、内脏脂肪指数和骨骼肌指数。使用皮下脂肪、内脏脂肪和骨骼肌指数分别在 39.9、58 和 52.4cm/m 处进行二分法，对生存分析进行了分析。
在去势抵抗性前列腺癌诊断时，使用前列腺特异性抗原水平、Gleason 评分 8 或更高、表现状态、从雄激素剥夺治疗到去势抵抗性前列腺癌的时间间隔较短以及皮下脂肪指数<39.9cm/m 独立预测癌症特异性生存期。在中位随访 16.0 个月期间，皮下脂肪指数为 39.9cm/m 或更高的患者接受的多西他赛周期比皮下脂肪指数<39.9cm/m 的患者更多。与皮下脂肪指数<39.9cm/m 的患者相比，指数为 39.9cm/m 或更高的患者具有更好的 1 年无进展生存期和 2 年癌症特异性生存期（p=0.009 和 0.021）。
去势抵抗性前列腺癌患者诊断时皮下脂肪指数为 39.9cm/m 或更高的患者比诊断时皮下脂肪指数<39.9cm/m 的患者具有更高的无进展生存期和癌症特异性生存率。计算机断层扫描数据确定的皮下脂肪指数可以作为一个有用的客观预后因素，用于讨论患者的治疗选择。需要进一步的研究来确定每个身体成分参数与药代动力学和肿瘤学结果的关系。
