肥胖对前列腺癌根治术后预后及复发的影响：一项荟萃分析
Effect of obesity on the prognosis and recurrence of prostate cancer after radical prostatectomy: a meta-analysis.
作者信息
Luo Runtian, Chen Yongbo, Ran Ke, Jiang Qing
机构信息
Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
出版信息
Transl Androl Urol. 2020 Dec;9(6):2713-2722. doi: 10.21037/tau-20-1352.
BACKGROUND
Obesity has been found to be closely related to the increased risk of fatal prostate cancer (PCa), however there remains no evidence that further clarifies the relationship between obesity and the postoperative recurrence and poor prognosis of PCa. In this study, a systematic review and meta-analysis were performed to systematically evaluate the effect of obesity on the prognosis and recurrence of PCa after radical prostatectomy (RP).
METHODS
A literature search of the PubMed, Web of Science, and Embase databases was performed covering articles published between January 2013 and January 2020. Articles regarding the correlation between body mass index (BMI) and the prognosis and recurrence of PCa following RP were included in the meta-analysis. Two investigators independently screened the literature and extracted relevant data including publication information, key results, number of cancer cases, and multivariable-adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Meta-analysis was performed using RevMan 5.3 and Stata 16.0 software, and forest plots, funnel plots, and sensitivity analysis were also conducted.
RESULTS
A total of 14 articles were included, all of which were analyzed for clinicopathological characteristics. Eight articles reported the biochemical recurrence (BCR) with prostate-specific antigen (PSA) as the predictor, and six articles reported the positive surgical margins (PSM). The meta-analysis showed that obese PCa patients had more postoperative recurrence and poor prognosis compared with the normal weight PCa patients, and the difference was statistically significant (OR =1.25, 95% CI: 1.10, 1.43). BCR exhibited no significant difference between obese and non-obese PCa patients after surgery (OR =1.2, 95% CI: 0.96, 1.46), and there were also no notable differences in PSM between the groups (OR =1.16, 95% CI: 0.99, 1.36). Subgroup analysis showed that obese PCa patients in the Americas (95% CI: 1.11, 1.37) and Europe (95% CI: 1.11, 1.78) were more likely to have surgical recurrence and poor prognosis (OR =1.40). Obese patients in the Americas were also more likely to have BCR after surgery (95% CI: 1.07, 1.36).
CONCLUSIONS
Obesity easily leads to poor prognosis and recurrence of PCa after RP.
背景
肥胖已被发现与致命性前列腺癌（PCa）风险增加密切相关，然而，仍没有证据能进一步阐明肥胖与PCa术后复发及预后不良之间的关系。在本研究中，进行了一项系统评价和荟萃分析，以系统评估肥胖对根治性前列腺切除术（RP）后PCa预后和复发的影响。
方法
对PubMed、Web of Science和Embase数据库进行文献检索，涵盖2013年1月至2020年1月发表的文章。关于体重指数（BMI）与RP后PCa预后和复发相关性的文章纳入荟萃分析。两名研究者独立筛选文献并提取相关数据，包括发表信息、关键结果、癌症病例数以及多变量调整比值比（OR）和95%置信区间（CI）。使用RevMan 5.3和Stata 16.0软件进行荟萃分析，并绘制森林图、漏斗图和进行敏感性分析。
结果
共纳入14篇文章，并对所有文章进行了临床病理特征分析。8篇文章以前列腺特异性抗原（PSA）为预测指标报告了生化复发（BCR），6篇文章报告了手术切缘阳性（PSM）。荟萃分析表明，与正常体重的PCa患者相比，肥胖的PCa患者术后复发更多且预后更差，差异具有统计学意义（OR =1.25，95%CI：1.10，1.43）。术后肥胖与非肥胖PCa患者的BCR无显著差异（OR =1.2，95%CI：0.96，1.46），两组间PSM也无显著差异（OR =1.16，95%CI：0.99，1.36）。亚组分析显示，美洲（95%CI：1.11，1.37）和欧洲（95%CI：1.11，1.78）的肥胖PCa患者手术复发和预后不良的可能性更大（OR =1.40）。美洲的肥胖患者术后发生BCR的可能性也更大（95%CI：1.07，1.36）。
结论
肥胖容易导致RP后PCa预后不良和复发。
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