Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
J Urol. 2021 Mar;205(3):800-805. doi: 10.1097/JU.0000000000001428. Epub 2020 Oct 20.
Obesity (body mass index 30 kg/m or greater) is associated with better overall survival in metastatic prostate cancer. Conversely, low muscle mass (sarcopenia) and low muscle radiodensity (myosteatosis) are associated with worse overall survival in many cancers. This study seeks to evaluate the relationship of sarcopenia, myosteatosis and obesity with overall survival in men with metastatic or castrate-resistant prostate cancer.
Retrospective analysis of men with metastatic or castrate-resistant prostate cancer and computerized tomography of abdomen/pelvis presenting to the Vanderbilt Comprehensive Prostate Cancer Clinic from 2012 to 2017 was performed. Demographic, pathological and survival data were described, with sarcopenia and myosteatosis determined from abdominal skeletal muscle area and skeletal muscle radiodensity, respectively. Kaplan-Meier curves and log-rank tests estimated the effect of body composition on survival. Multivariable Cox proportional hazard models were performed adjusting for age, Charlson comorbidity index, race and clinical stage. ANOVA was used to compare obese and nonobese men with and without sarcopenia or myosteatosis.
Of 182 men accrued, 37.4% were obese, 53.3% sarcopenic and 59.3% myosteatotic. Over a median followup of 33.9 months, body mass index was associated with reduced mortality (HR 0.93, p=0.02), as was visceral adiposity (HR 0.99, p=0.003). Men with high body mass index without sarcopenia/myosteatosis lived significantly longer than men with high body mass index with sarcopenia/myosteatosis or normal body mass index men (F[3,91]=4.03, p=0.01).
Both high body mass index and visceral adiposity in metastatic or castrate-resistant prostate cancer are associated with reduced mortality, independent of sarcopenia and myosteatosis. Therefore, routine clinical workup should include calculation of body mass index and measurement of waist circumference. Morphometric analysis of computerized tomography imaging can identify patients at risk for poor prognosis.
肥胖（体重指数≥30kg/m²）与转移性前列腺癌患者的整体生存率提高有关。相反，在许多癌症中，低肌肉量（肌肉减少症）和低肌肉放射密度（肌脂过多症）与整体生存率降低有关。本研究旨在评估肌肉减少症、肌脂过多症和肥胖症与转移性或去势抵抗性前列腺癌患者整体生存率的关系。
回顾性分析了 2012 年至 2017 年期间在范德比尔特综合前列腺癌诊所就诊的转移性或去势抵抗性前列腺癌患者的计算机断层扫描腹部/骨盆图像。描述了人口统计学、病理学和生存数据，通过腹部骨骼肌面积和骨骼肌放射密度分别确定了肌肉减少症和肌脂过多症。使用 Kaplan-Meier 曲线和对数秩检验估计了身体成分对生存的影响。多变量 Cox 比例风险模型用于调整年龄、Charlson 合并症指数、种族和临床分期。方差分析用于比较肥胖和非肥胖男性有无肌肉减少症或肌脂过多症。
共纳入 182 名患者，其中 37.4%为肥胖，53.3%为肌肉减少症，59.3%为肌脂过多症。在中位随访 33.9 个月期间，体重指数与死亡率降低相关（HR 0.93，p=0.02），内脏脂肪也与死亡率降低相关（HR 0.99，p=0.003）。无肌肉减少症/肌脂过多症的高体重指数男性的生存时间明显长于有肌肉减少症/肌脂过多症或正常体重指数男性的高体重指数男性（F[3,91]=4.03，p=0.01）。
转移性或去势抵抗性前列腺癌中，高体重指数和内脏脂肪均与死亡率降低相关，与肌肉减少症和肌脂过多症无关。因此，常规临床检查应包括体重指数的计算和腰围的测量。计算机断层扫描成像的形态计量分析可以识别预后不良的患者。
