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Obesity paradox in prostate cancer: increased body mass index was associated with decreased risk of metastases after surgery in 13,667 patients

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Abstract

Introduction

Obesity might negatively affect prostate cancer (PCa) outcomes. However, evidence according to the associations between obesity and metastases-free survival after radical prostatectomy (RP) is still inconsistent.

Methods

We relied on PCa patients treated with RP at the Martini-Klinik Prostate Cancer Center between 2004 and 2015. First, multivariable Cox regression analyses examined the impact of obesity on metastases after RP. Last, in a propensity score matched cohort, Kaplan–Meier analyses assessed metastases-free survival according to body mass index (kg/m2) (BMI) strata (≥ 30 vs. < 25).

Results

Of 13,667 individuals, 1990 (14.6%) men were obese (BMI ≥ 30). Median follow-up was 36.4 month (IQR 13.3–60.8). Obese patients were less likely to exhibit metastases after RP (HR 0.7, 95% CI 0.5–0.97, p = 0.03). Similarly, after propensity score adjustment, obesity was associated with increased metastases-free survival (log rank p = 0.001).

Conclusion

We recorded the obesity paradox phenomenon in PCa patients. In particular, high BMI (≥ 30) was associated with decreased risk of metastases after RP, despite an increased risk being anticipated. Whether statin use might have affected the results was not assessed. Further research is needed to unravel the controversially debated association between obesity and PCa.

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Authors and Affiliations

  1. Department of Urology, Academic Hospital Braunschweig, Salzdahlumerstrasse 90, 38126, Brunswick, Germany

    Jonas Schiffmann, L. Manka & P. Hammerer

  2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada

    Pierre I. Karakiewicz & Raisa Pompe

  3. Department of Urology, University of Montreal Health Center, Montreal, Canada

    Pierre I. Karakiewicz

  4. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Michael Rink, Derya Tilki & Sami-Ramzi Leyh-Bannurah

  5. Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Georg Salomon, Derya Tilki, Lars Budäus, Raisa Pompe, Alexander Haese, Hartwig Huland, Markus Graefen & Pierre Tennstedt

Authors
  1. Jonas Schiffmann
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  2. Pierre I. Karakiewicz
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  3. Michael Rink
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  4. L. Manka
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  5. Georg Salomon
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  6. Derya Tilki
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  7. Lars Budäus
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  8. Raisa Pompe
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  9. Sami-Ramzi Leyh-Bannurah
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  10. Alexander Haese
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  11. P. Hammerer
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  12. Hartwig Huland
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  13. Markus Graefen
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  14. Pierre Tennstedt
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Contributions

JS protocol/project development, data analysis, manuscript writing/editing, data collection or management. PIK manuscript writing/editing. MR data collection or management. LM manuscript writing/editing. GS data collection or management. DT data collection or management. LB data collection or management. RP data collection or management. S-RL-B data collection or management. AH data collection or management. PH manuscript writing/editing. HH data collection or management. MG data collection or management, protocol/project development. PT data collection or management, protocol/project development, data analysis.

Corresponding author

Correspondence to Jonas Schiffmann.

Ethics declarations

The study was conducted according to the principles of the declaration of Helsinki.

Conflict of interest

The authors declare that they have no conflict of interest.

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Schiffmann, J., Karakiewicz, P.I., Rink, M. et al. Obesity paradox in prostate cancer: increased body mass index was associated with decreased risk of metastases after surgery in 13,667 patients. World J Urol 36, 1067–1072 (2018). https://doi.org/10.1007/s00345-018-2240-8

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  • DOI: https://doi.org/10.1007/s00345-018-2240-8

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