TY - JOUR
T1 - Obesity and long-term survival after radical prostatectomy
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 J.
AU - Partin, Alan W.
AU - Humphreys, Elizabeth
AU - Walsh, Patrick C.
AU - Han, Misop
N1 - Publisher Copyright:
© 2014 American Urological Association Education and Research, Inc.
PY - 2014/10/1
Y1 - 2014/10/1
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
KW - obesity body mass index
KW - prostatectomy
KW - prostatic neoplasms
UR - http://www.scopus.com/inward/record.url?scp=84921968868&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84921968868&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2014.04.086
DO - 10.1016/j.juro.2014.04.086
M3 - Article
C2 - 24769031
AN - SCOPUS:84921968868
SN - 0022-5347
VL - 192
SP - 1100
EP - 1104
JO - Journal of Urology
JF - Journal of Urology
IS - 4
ER -