Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Sci Rep. 2018 Aug 10;8(1):11962. doi: 10.1038/s41598-018-30473-y.
Obesity, often represented by higher body mass index (BMI), is not yet fully understood as a potential risk factor for poor clinical outcomes of prostate cancer (PCa) after radical prostatectomy (RP). This study aimed to evaluate the relationship between BMI and biochemical recurrence (BCR)-free survival in RP patients. This study retrospectively reviewed a total of 2.997 PCa patients who underwent RP between 2006 and 2017. The patients were stratified into three BMI groups according to the WHO recommendations for Asian men: normal weight (<23 kg/m), overweight (≥23 to <27.5 kg/m) and obese (≥27.5 kg/m). Multivariable logistic regression analyses were undertaken to evaluate the factors influencing the BCR rates including BMI. Multivariable Cox regression analyses and Kaplan-Meier analyses were performed to test the association of obesity with BCR-free survival. The final pathologic results showed obese patients had greater positive surgical margin rates (13.9%, p < 0.001), extraprostatic invasion (19.9%, p < 0.001), advanced pathological Gleason score (GS) ≥ 8 (50.8%, p = 0.017), and lymph node invasion (LNI) (14.5%, p = 0.021) than overweight and normal weight patients. According to Kaplan-Meier analyses, obese patients, especially with BMI ≥ 27.5, were more likely to have lower BCR-free-survival. Multivariate Cox analysis revealed that diabetes mellitus, LNI status, pT, pathologic GS, extraprostatic invasion, margin positivity and obesity with BMI ≥ 27.5 kg/m were significantly associated with BCR-free survival after RP. Obesity (higher BMI) was significantly associated with BCR after RP. BMI ≥ 27.5 kg/m was an independent predictor of BCR-free survival.
肥胖通常表现为更高的身体质量指数（BMI），但它是否是前列腺癌（PCa）根治性前列腺切除术后（RP）临床结局不良的潜在危险因素尚未得到充分认识。本研究旨在评估 BMI 与 RP 患者生化复发（BCR）无复发生存率之间的关系。本研究回顾性分析了 2006 年至 2017 年间接受 RP 的 2997 例 PCa 患者。根据世界卫生组织（WHO）对亚洲男性的建议，患者被分为三组 BMI：正常体重（<23kg/m）、超重（≥23 至<27.5kg/m）和肥胖（≥27.5kg/m）。采用多变量逻辑回归分析评估包括 BMI 在内的影响 BCR 率的因素。采用多变量 Cox 回归分析和 Kaplan-Meier 分析检验肥胖与 BCR 无复发生存之间的关系。最终的病理结果显示肥胖患者的阳性切缘率更高（13.9%，p<0.001），前列腺外侵犯（19.9%，p<0.001），高级别病理 Gleason 评分（GS）≥8（50.8%，p=0.017）和淋巴结侵犯（LNI）（14.5%，p=0.021）比超重和正常体重患者更常见。根据 Kaplan-Meier 分析，肥胖患者，尤其是 BMI≥27.5 的患者，更有可能出现较低的 BCR 无复发生存率。多变量 Cox 分析显示，糖尿病、LNI 状态、pT、病理 GS、前列腺外侵犯、切缘阳性和 BMI≥27.5kg/m 的肥胖与 RP 后 BCR 无复发生存显著相关。肥胖（更高的 BMI）与 RP 后 BCR 显著相关。BMI≥27.5kg/m 是 BCR 无复发生存的独立预测因子。
