Obesity and long-term survival after radical prostatectomy

Heather J. Chalfin, Seung Bae Lee, Byong Chang Jeong, Stephen J. Freedland, Hamid Alai, Zhaoyong Feng, Bruce Trock, Alan Wayne Partin, Elizabeth Humphreys, Patrick Walsh, Misop Han

Research output: Contribution to journalArticle

Abstract

Purpose Obesity is a modifiable risk factor associated with worse outcomes for many cancers, yet implications for prostate cancer are not well understood. Notably the impact of body mass index on long-term survival after treatment is unclear. We performed a retrospective cohort study on a large series of men who underwent radical prostatectomy to assess the impact of obesity on long-term biochemical recurrence-free survival, prostate cancer specific survival and overall survival. Materials and Methods Between 1982 and 2012, 11,152 men underwent radical prostatectomy at a single tertiary referral center. Patients were stratified according to body mass index as normal weight (body mass index less than 25 kg/m2), overweight (body mass index 25 to less than 30 kg/m2), mild obesity (body mass index 30 to less than 35 kg/m2) and moderate/severe obesity (body mass index 35 kg/m2 or greater), comprising 27.6%, 56.0%, 14.1% and 2.3% of the cohort, respectively. Covariates included age, preoperative prostate specific antigen, surgery year, Gleason score, pathological stage, surgical margin and race. Predictors of biochemical recurrence-free survival, prostate cancer specific survival and overall survival were identified using Cox proportional hazard models. Results Median followup was 5 years (range 1 to 27). Actuarial 20-year biochemical recurrence-free survival for mild and moderate/severe obesity was 65% and 51%, respectively, compared to 76% for normal weight men (p ≤0.001). In a multivariate model obesity was a significant predictor of biochemical recurrence-free survival (mild HR 1.30, p = 0.002; moderate/severe HR 1.45, p = 0.028) and overall survival (mild HR 1.41, p = 0.003; moderate/severe HR 1.81, p = 0.033). However, only mild obesity was significantly associated with prostate cancer specific survival (HR 1.51, p = 0.040), whereas moderate/severe obesity was not (HR 1.58, p = 0.356). Conclusions Obese men have higher rates of biochemical recurrence than normal weight patients during long-term followup. Obesity at the time of surgery independently predicts overall survival and biochemical recurrence-free survival but not prostate cancer specific survival.

Original languageEnglish (US)
Pages (from-to)1100-1104
Number of pages5
JournalJournal of Urology
Volume192
Issue number4
DOIs
StatePublished - Oct 1 2014

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Prostatectomy
Obesity
Survival
Body Mass Index
Prostatic Neoplasms
Recurrence
Morbid Obesity
Weights and Measures
Neoplasm Grading
Prostate-Specific Antigen
Proportional Hazards Models
Tertiary Care Centers
Cohort Studies
Retrospective Studies

Keywords

  • mortality
  • obesity body mass index
  • prostatectomy
  • prostatic neoplasms

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Chalfin, H. J., Lee, S. B., Jeong, B. C., Freedland, S. J., Alai, H., Feng, Z., ... Han, M. (2014). Obesity and long-term survival after radical prostatectomy. Journal of Urology, 192(4), 1100-1104. https://doi.org/10.1016/j.juro.2014.04.086

Obesity and long-term survival after radical prostatectomy. / Chalfin, Heather J.; Lee, Seung Bae; Jeong, Byong Chang; Freedland, Stephen J.; Alai, Hamid; Feng, Zhaoyong; Trock, Bruce; Partin, Alan Wayne; Humphreys, Elizabeth; Walsh, Patrick; Han, Misop.

In: Journal of Urology, Vol. 192, No. 4, 01.10.2014, p. 1100-1104.

Research output: Contribution to journalArticle

Chalfin, HJ, Lee, SB, Jeong, BC, Freedland, SJ, Alai, H, Feng, Z, Trock, B, Partin, AW, Humphreys, E, Walsh, P & Han, M 2014, 'Obesity and long-term survival after radical prostatectomy', Journal of Urology, vol. 192, no. 4, pp. 1100-1104. https://doi.org/10.1016/j.juro.2014.04.086
Chalfin HJ, Lee SB, Jeong BC, Freedland SJ, Alai H, Feng Z et al. Obesity and long-term survival after radical prostatectomy. Journal of Urology. 2014 Oct 1;192(4):1100-1104. https://doi.org/10.1016/j.juro.2014.04.086
Chalfin, Heather J. ; Lee, Seung Bae ; Jeong, Byong Chang ; Freedland, Stephen J. ; Alai, Hamid ; Feng, Zhaoyong ; Trock, Bruce ; Partin, Alan Wayne ; Humphreys, Elizabeth ; Walsh, Patrick ; Han, Misop. / Obesity and long-term survival after radical prostatectomy. In: Journal of Urology. 2014 ; Vol. 192, No. 4. pp. 1100-1104.
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abstract = "Purpose Obesity is a modifiable risk factor associated with worse outcomes for many cancers, yet implications for prostate cancer are not well understood. Notably the impact of body mass index on long-term survival after treatment is unclear. We performed a retrospective cohort study on a large series of men who underwent radical prostatectomy to assess the impact of obesity on long-term biochemical recurrence-free survival, prostate cancer specific survival and overall survival. Materials and Methods Between 1982 and 2012, 11,152 men underwent radical prostatectomy at a single tertiary referral center. Patients were stratified according to body mass index as normal weight (body mass index less than 25 kg/m2), overweight (body mass index 25 to less than 30 kg/m2), mild obesity (body mass index 30 to less than 35 kg/m2) and moderate/severe obesity (body mass index 35 kg/m2 or greater), comprising 27.6{\%}, 56.0{\%}, 14.1{\%} and 2.3{\%} of the cohort, respectively. Covariates included age, preoperative prostate specific antigen, surgery year, Gleason score, pathological stage, surgical margin and race. Predictors of biochemical recurrence-free survival, prostate cancer specific survival and overall survival were identified using Cox proportional hazard models. Results Median followup was 5 years (range 1 to 27). Actuarial 20-year biochemical recurrence-free survival for mild and moderate/severe obesity was 65{\%} and 51{\%}, respectively, compared to 76{\%} for normal weight men (p ≤0.001). In a multivariate model obesity was a significant predictor of biochemical recurrence-free survival (mild HR 1.30, p = 0.002; moderate/severe HR 1.45, p = 0.028) and overall survival (mild HR 1.41, p = 0.003; moderate/severe HR 1.81, p = 0.033). However, only mild obesity was significantly associated with prostate cancer specific survival (HR 1.51, p = 0.040), whereas moderate/severe obesity was not (HR 1.58, p = 0.356). Conclusions Obese men have higher rates of biochemical recurrence than normal weight patients during long-term followup. Obesity at the time of surgery independently predicts overall survival and biochemical recurrence-free survival but not prostate cancer specific survival.",
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AU - Chalfin, Heather J.

AU - Lee, Seung Bae

AU - Jeong, Byong Chang

AU - Freedland, Stephen J.

AU - Alai, Hamid

AU - Feng, Zhaoyong

AU - Trock, Bruce

AU - Partin, Alan Wayne

AU - Humphreys, Elizabeth

AU - Walsh, Patrick

AU - Han, Misop

PY - 2014/10/1

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N2 - Purpose Obesity is a modifiable risk factor associated with worse outcomes for many cancers, yet implications for prostate cancer are not well understood. Notably the impact of body mass index on long-term survival after treatment is unclear. We performed a retrospective cohort study on a large series of men who underwent radical prostatectomy to assess the impact of obesity on long-term biochemical recurrence-free survival, prostate cancer specific survival and overall survival. Materials and Methods Between 1982 and 2012, 11,152 men underwent radical prostatectomy at a single tertiary referral center. Patients were stratified according to body mass index as normal weight (body mass index less than 25 kg/m2), overweight (body mass index 25 to less than 30 kg/m2), mild obesity (body mass index 30 to less than 35 kg/m2) and moderate/severe obesity (body mass index 35 kg/m2 or greater), comprising 27.6%, 56.0%, 14.1% and 2.3% of the cohort, respectively. Covariates included age, preoperative prostate specific antigen, surgery year, Gleason score, pathological stage, surgical margin and race. Predictors of biochemical recurrence-free survival, prostate cancer specific survival and overall survival were identified using Cox proportional hazard models. Results Median followup was 5 years (range 1 to 27). Actuarial 20-year biochemical recurrence-free survival for mild and moderate/severe obesity was 65% and 51%, respectively, compared to 76% for normal weight men (p ≤0.001). In a multivariate model obesity was a significant predictor of biochemical recurrence-free survival (mild HR 1.30, p = 0.002; moderate/severe HR 1.45, p = 0.028) and overall survival (mild HR 1.41, p = 0.003; moderate/severe HR 1.81, p = 0.033). However, only mild obesity was significantly associated with prostate cancer specific survival (HR 1.51, p = 0.040), whereas moderate/severe obesity was not (HR 1.58, p = 0.356). Conclusions Obese men have higher rates of biochemical recurrence than normal weight patients during long-term followup. Obesity at the time of surgery independently predicts overall survival and biochemical recurrence-free survival but not prostate cancer specific survival.

AB - Purpose Obesity is a modifiable risk factor associated with worse outcomes for many cancers, yet implications for prostate cancer are not well understood. Notably the impact of body mass index on long-term survival after treatment is unclear. We performed a retrospective cohort study on a large series of men who underwent radical prostatectomy to assess the impact of obesity on long-term biochemical recurrence-free survival, prostate cancer specific survival and overall survival. Materials and Methods Between 1982 and 2012, 11,152 men underwent radical prostatectomy at a single tertiary referral center. Patients were stratified according to body mass index as normal weight (body mass index less than 25 kg/m2), overweight (body mass index 25 to less than 30 kg/m2), mild obesity (body mass index 30 to less than 35 kg/m2) and moderate/severe obesity (body mass index 35 kg/m2 or greater), comprising 27.6%, 56.0%, 14.1% and 2.3% of the cohort, respectively. Covariates included age, preoperative prostate specific antigen, surgery year, Gleason score, pathological stage, surgical margin and race. Predictors of biochemical recurrence-free survival, prostate cancer specific survival and overall survival were identified using Cox proportional hazard models. Results Median followup was 5 years (range 1 to 27). Actuarial 20-year biochemical recurrence-free survival for mild and moderate/severe obesity was 65% and 51%, respectively, compared to 76% for normal weight men (p ≤0.001). In a multivariate model obesity was a significant predictor of biochemical recurrence-free survival (mild HR 1.30, p = 0.002; moderate/severe HR 1.45, p = 0.028) and overall survival (mild HR 1.41, p = 0.003; moderate/severe HR 1.81, p = 0.033). However, only mild obesity was significantly associated with prostate cancer specific survival (HR 1.51, p = 0.040), whereas moderate/severe obesity was not (HR 1.58, p = 0.356). Conclusions Obese men have higher rates of biochemical recurrence than normal weight patients during long-term followup. Obesity at the time of surgery independently predicts overall survival and biochemical recurrence-free survival but not prostate cancer specific survival.

KW - mortality

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