Department of Urology, McGill University Health Centre, Montreal, QC, Canada.
Department of Oncology, McGill University, 5100 Boulevard de Maisonneuve West, Room 720F, Montreal, QC, H4A 3T2, Canada.
World J Urol. 2019 May;37(5):789-798. doi: 10.1007/s00345-018-2457-6. Epub 2018 Aug 22.
We evaluated whether an increased body-mass index (BMI) and decreased physical activity increase the risk of locally advanced or high-risk prostate cancer (PCa) at radical prostatectomy (RP), and treatment failure after surgery.
Data were collected from the PROCURE Biobank, a prospective cohort of patients with localized PCa undergoing RP in four academic centers in Québec between 2006 and 2013. Treatment failure was defined as biochemical recurrence and/or initiation of secondary, non-adjuvant therapy, and analyzed using the Kaplan-Meier method, log-rank tests, and Cox proportional-hazards models. Uni- and multivariate (ordered) logistic regression was used for time-independent variables.
1813 patients were included. Median follow-up time was 69 months. Patients who reported a lower BMI were generally older, of Asian descent, and physically more active (p < 0.05). Younger, black, and overweight/obese patients reported less physical activity (p < 0.05). In multivariate analyses, a higher BMI increased the risk for locally advanced, high-risk PCa (defined as a pT3, N1 and/or Gleason 8-10 tumor; odds ratio 1.33, p < 0.001), but increased physical activity did not predict high-risk disease (odds ratio 0.84, p = 0.39). Patients with a higher BMI also had a larger prostate at surgery (odds ratio 1.13, p = 0.03). BMI and physical activity were not associated with positive surgical margins or time to treatment failure (p > 0.05).
BMI was an independent predictor for locally advanced, high-risk disease in this cohort of PCa patients undergoing RP, but was unrelated to treatment failure. Physical activity was not related to locally advanced, high-risk PCa or treatment failure.
我们评估了体重指数（BMI）的增加和体力活动的减少是否会增加接受根治性前列腺切除术（RP）的局部晚期或高危前列腺癌（PCa）以及手术后治疗失败的风险。
数据来自 PROCURE 生物库，这是一个前瞻性队列研究，纳入了 2006 年至 2013 年间在魁北克的四个学术中心接受 RP 的局部 PCa 患者。治疗失败定义为生化复发和/或开始二次非辅助治疗，并使用 Kaplan-Meier 方法、对数秩检验和 Cox 比例风险模型进行分析。单变量和多变量（有序）逻辑回归用于时间独立变量。
共纳入 1813 例患者，中位随访时间为 69 个月。报告 BMI 较低的患者通常年龄较大，亚洲裔，体力活动较多（p<0.05）。年轻、黑人、超重/肥胖患者的体力活动较少（p<0.05）。在多变量分析中，较高的 BMI 增加了局部晚期、高危 PCa 的风险（定义为 pT3、N1 和/或 Gleason 8-10 肿瘤；优势比 1.33，p<0.001），但增加体力活动并不能预测高危疾病（优势比 0.84，p=0.39）。BMI 较高的患者在手术时前列腺也较大（优势比 1.13，p=0.03）。BMI 和体力活动与阳性手术切缘或治疗失败时间无关（p>0.05）。
在本队列接受 RP 的 PCa 患者中，BMI 是局部晚期、高危疾病的独立预测因素，但与治疗失败无关。体力活动与局部晚期、高危 PCa 或治疗失败无关。
