Pathologic variables and recurrence rates as related to obesity and race in men with prostate cancer undergoing radical prostatectomy
Pathologic variables and recurrence rates as related to obesity and race in men with prostate cancer undergoing radical prostatectomy
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DOI：
10.1200/jco.2004.03.132
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发表时间：
2004-02-01
影响因子：
45.3
通讯作者：
McLeod, DG
中科院分区：
文献类型：
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作者：
Amling, CL;Riffenburgh, RH;McLeod, DG
目的确定肥胖是否与前列腺癌根治术(RP)后较高的前列腺特异性抗原复发率有关，并探索体重指数(BMI)的种族差异作为黑人和白人男性预后差异的潜在解释。患者与方法对1987至2002年间在美国9个军事医疗中心接受根治性前列腺癌根治术的3162名男性进行了多机构的回顾性综合分析。患者最初被归类为肥胖(BMI大于或等于30 kg/m(2))、超重(BMI 25至30 kg/m(2))或正常(BMI小于或等于25 kg/m(2))。将正常组和超重组合并(BMI+lt；30 kg/m(2))，并与肥胖组(BMI≥30 kg/m(2))比较，比较RP.BMI是较高Gleason分级癌症的独立预测因子(P<；.001)，并与较高的生化复发风险相关(P=.027)。黑人的BMI(P<；.001)和复发率(P=.003)均高于白人。BMI(P=.028)和黑人(P=.002)都预示着较高的前列腺特异性抗原复发率。在种族、BMI和病理因素的多因素分析中，黑人(P=.021)仍然是复发的显著独立预测因素。结论肥胖与较高级别的癌症和较高的RP术后复发率相关。黑人男性的复发率和BMI高于白人男性。这些发现支持肥胖与潜伏期到临床显性前列腺癌(PC)的进展有关的假设，并表明BMI可能在一定程度上解释了PC风险的种族差异。
Purpose To determine if obesity is associated with higher prostate specific antigen recurrence rates after radical prostatectomy (RP), and to explore racial differences in body mass index (BMI) as a potential explanation for the disparity in outcome between black and white men.Patients and Methods A retrospective, multi-institutional pooled analysis of 3,162 men undergoing RP was conducted at nine US military medical centers between 1987 and 2002. Patients were initially categorized as obese (BMI greater than or equal to 30 kg/m(2)), overweight (BMI 25 to 30 kg/m(2)), or normal (BMI less than or equal to 25 kg/m(2)). For analysis, normal and overweight groups were combined (BMI < 30 kg/m(2)) and compared with the obese group (BMI greater than or equal to 30 kg/m(2)) with regard to biochemical recurrence (prostate-specific antigen greater than or equal to 0.2 ng/mL) after RP.Results Of 3,162 patients, 600 (19.0%) were obese and 2,562 (81%) were not obese. BMI was an independent predictor of higher Gleason grade cancer (P < .001) and was associated with a higher risk of biochemical recurrence (P = .027). Blacks had higher BMI (P < .001) and higher recurrence rates (P = .003) than whites. Both BMI (P = .028) and black race (P = .002) predicted higher prostate specific antigen recurrence rates. In multivariate analysis of race, BMI, and pathologic factors, black race (P = .021) remained a significant independent predictor of recurrence.Conclusion Obesity is associated with higher grade cancer and higher recurrence rates after RP. Black men have higher recurrence rates and greater BMI than white men. These findings support the hypothesis that obesity is associated with progression of latent to clinically significant prostate cancer (PC) and suggest that BMI may account, in part, for the racial variability in PC risk.