Departments of Urology, Center for Urological Cancer, National Cancer Center, Goyang, Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Urol. 2019 Sep;202(3):525-532. doi: 10.1097/JU.0000000000000249. Epub 2019 Aug 8.
Although muscle mass has been associated with survival in patients with various types of solid tumors, the relationship between muscle mass and survival in patients with prostate cancer remains unclear. We retrospectively investigated the association of muscle mass with survival after radical prostatectomy in patients with prostate cancer.
We reviewed the records of 2,042 patients who underwent radical prostatectomy of prostate cancer between 1998 and 2013. Muscle mass was evaluated by measuring the psoas muscle index on preoperative computerized tomography images.
In the lowest, second, third and highest psoas muscle index quartiles the 10-year distant metastasis-free survival rate was 72.5%, 83.8%, 92.3% and 93.7% (p <0.001), the 10-year cancer specific survival rate was 85.7%, 92.1%, 96.8% and 97.6%, and the 10-year overall survival rate was 74.5%, 79.6%, 89.8% and 90.6%, respectively (each p <0.001). The psoas muscle index positively correlated with the body mass index, serum concentrations of IGFBP-3 and bioavailable testosterone, and inversely correlated with patient age, the serum SHBG concentration and the neutrophil-to-lymphocyte ratio. On multivariable analysis the psoas muscle index was independently associated with increased risks of biochemical recurrence, distant metastasis, and cancer specific and overall death.
Low muscle mass may be associated with increased risks of recurrence and mortality in patients who undergo radical prostatectomy of prostate cancer regardless of the body mass index. Large-scale prospective studies are warranted.
尽管肌肉质量与各种类型实体瘤患者的生存相关，但肌肉质量与前列腺癌患者生存的关系尚不清楚。我们回顾性调查了肌肉质量与前列腺癌根治性前列腺切除术后生存的关系。
我们回顾了 1998 年至 2013 年间接受根治性前列腺切除术的 2042 例前列腺癌患者的记录。通过术前计算机断层扫描图像测量腰大肌指数来评估肌肉质量。
在最低、第二、第三和最高腰大肌指数四分位数中，10 年远处无转移生存率分别为 72.5%、83.8%、92.3%和 93.7%（p<0.001），10 年癌症特异性生存率分别为 85.7%、92.1%、96.8%和 97.6%，10 年总生存率分别为 74.5%、79.6%、89.8%和 90.6%（p<0.001）。腰大肌指数与体重指数、血清 IGFBP-3 和生物可利用睾酮浓度呈正相关，与患者年龄、血清 SHBG 浓度和中性粒细胞与淋巴细胞比值呈负相关。多变量分析显示，腰大肌指数与生化复发、远处转移以及癌症特异性和总死亡的风险增加独立相关。
无论体重指数如何，肌肉质量低可能与前列腺癌根治性前列腺切除术后患者的复发和死亡风险增加相关。需要进行大规模前瞻性研究。
