Low body mass index is associated with adverse oncological outcomes following radical prostatectomy in Korean prostate cancer patients

Genetic ancestry and radical prostatectomy findings in Hispanic/Latino patients

Background

African ancestry is a known factor associated with the presentation and aggressiveness of prostate cancer (PC). Hispanic/Latino populations exhibit varying degrees of genetic admixture across Latin American countries, leading to diverse levels of African ancestry. However, it remains unclear whether genetic ancestry plays a role in the aggressiveness of PC in Hispanic/Latino patients. We explored the associations between genetic ancestry and the clinicopathological data in Hispanic/Latino PC patients from Colombia.

Patients and methods

We estimated the European, Indigenous and African genetic ancestry, of 230 Colombian patients with localized/regionally advanced PC through a validated panel for genotypification of 106 Ancestry Informative Markers. We examined the associations of the genetic ancestry components with the Gleason Grade Groups (GG) and the clinicopathological characteristics.

Results

No association was observed between the genetic ancestry with the biochemical recurrence or Gleason GG; however, in a two groups comparison, there were statistically significant differences between GG3 and GG4/GG5 for European ancestry, with a higher mean ancestry proportion in GG4/GG5. A lower risk of being diagnosed at an advanced age was observed for patients with high African ancestry than those with low African ancestry patients (OR: 0.96, CI: 0.92-0.99, p=0.03).

Conclusion

Our findings revealed an increased risk of presentation of PC at an earlier age in patients with higher African ancestry compared to patients with lower African ancestry in our Hispanic/Latino patients.

Obesity and biochemical recurrence in clinically localised prostate cancer: a systematic review and meta-analysis of 86,490 patients

BACKGROUND

The association of obesity with biochemical recurrence (BCR) after treatment of clinically localised prostate cancer (PC) shows inconsistent results. Our aim was to systematically review all evidence evaluating obesity as a prognostic factor for BCR.

METHODS

We searched PubMed, Web of Science and Scopus, from inception to June 1, 2021. Cohort studies reporting BCR among PC patients stratified by body mass index (BMI) were included. To assess the quality of the selected studies, we used the Newcastle-Ottawa scale (NOS). Risk of BCR among obese patients (BMI ≥ 30 kg/m²) was compared with normal weight (BMI < 25), pooling individual hazard ratios (HR) in random-effect meta-analysis. Associations for continuous BMI per 5 kg/m² were also calculated. Subgroup analyses were conducted to assess reasons for heterogeneity and causal criteria were formally evaluated.

RESULTS

We identified 46 cohort studies including 86,490 PC patients. A total of 14,719 (17.1%) patients developed BCR. There was no consistent definition of BCR. Obesity was associated with BCR (HR: 1.25, 95% CI: 1.11-1.39, I²: 70.3%), and there was a 10% increase (95% CI: 4-15%, I²: 66.3%) in BCR per 5 kg/m² increase in BMI. The heterogeneity was high but decreased in the subgroup of highest-quality NOS score and when the BMI was measured by the researchers (I²: 0.0%). The association was consistent in patients receiving radical prostatectomy but not in patients receiving other therapies.

CONCLUSIONS

Obesity showed a moderate, consistent relationship with biochemical recurrence after radical prostatectomy. Measurement of BMI and BCR was variable, highlighting the need for standardised clinical guidelines. Preventive weight control programs may have a role in reducing BCR for clinically localised PC patients.

Effect of obesity on the prognosis and recurrence of prostate cancer after radical prostatectomy: a meta-analysis

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.

Subcutaneous Fat Distribution is a Prognostic Biomarker for Men with Castration Resistant Prostate Cancer

PURPOSE

The relationship between body fat distribution and survival remains unclear in patients with castration resistant prostate cancer treated with docetaxel and androgen receptor axis targeted agents. We investigated whether body composition parameters could predict radiographic progression-free and cancer specific survival in patients with castration resistant prostate cancer.

MATERIALS AND METHODS

In this multicenter retrospective study we evaluated data on 282 consecutive patients diagnosed with castration resistant prostate cancer between September 2009 and March 2017. The subcutaneous fat index, the visceral fat index and the skeletal muscle index at the diagnosis of castration resistant prostate cancer were determined by computerized tomography data. Survival analyses were performed using the subcutaneous fat, visceral fat and skeletal muscle indexes dichotomized at 39.9, 58 and 52.4 cm²/m², respectively.

RESULTS

At the diagnosis of castration resistant prostate cancer, cancer specific survival was independently predicted using prostate specific antigen levels, Gleason score 8 or greater, performance status, a shorter interval from androgen deprivation therapy to castration resistant prostate cancer and a subcutaneous fat index of less than 39.9 cm²/m². During the median followup of 16.0 months patients with a subcutaneous fat index of 39.9 cm²/m² or greater received more docetaxel cycles than patients with a subcutaneous fat index of less than 39.9 cm²/m². Compared to patients with a subcutaneous fat index of less than 39.9 cm²/m² those with an index of 39.9 cm²/m² or greater had better 1-year progression-free and 2-year cancer specific survival (p = 0.009 and 0.021, respectively).

CONCLUSIONS

Patients with a subcutaneous fat index of 39.9 cm²/m² or greater at the diagnosis of castration resistant prostate cancer showed higher progression-free and cancer specific survival rates than those with a subcutaneous fat index of less 39.9 cm²/m² at diagnosis. The subcutaneous fat index determined by computerized tomography data could serve as a useful objective prognostic factor to discuss patient therapeutic options. Further studies are needed to define the roles of each body composition parameter in relation to pharmacokinetics and oncologic outcome.

Pathological and oncological features of Korean prostate cancer patients eligible for active surveillance: analysis from the K-CaP registry

Background

A web-based multicenter Korean Prostate Cancer Database (K-CaP) was established to provide urologists with information on Korean prostate cancer (PCa) patients treated with radical prostatectomy (RP). We utilized the K-CaP registry to identify pathological features and oncological outcomes of Korean PCa patients eligible for active surveillance (AS).

Methods

The K-CaP registry consisted of 6415 patients who underwent RP from May 2001 to April 2013 at five institutions. Preoperative clinicopathological data were collected to identify patients who were eligible for at least one contemporary AS protocol. Patients who had received neoadjuvant androgen deprivation therapy or a 5α-reductase inhibitor, who had <10 total biopsy cores, or who had incomplete data were excluded. Biochemical recurrence (BCR) was defined as prostate-specific antigen (PSA) level ≥0.2 ng/ml following RP.

Results

A total of 560 patients were identified, and the median follow-up period was 52.0 (interquartile range, 39.0-67.3) months. Pathologically insignificant PCa, defined as organ-confined disease with Gleason score ≤6 was observed in 314 (56.1%) patients. Pathological upgrading (Gleason score ≥7) and upstaging (≥pT3) were observed in 237 (42.3%) and 75 (13.4%) patients, respectively. Unfavorable disease (extracapsular extension, seminal vesicle invasion, or Gleason score ≥8) was observed in 85 (15.2%) patients. PSA density ≤0.2 ng/ml/cc and maximal single core involvement ≤20% were revealed as independent preoperative predictors of pathologically insignificant PCa.

Conclusion

Contemporary Western AS protocols unreliably predict pathologically insignificant PCa in Korean men. Korean men may harbor more aggressive PCa features than Western men, and thus, a more stringent AS protocol is needed.

The impact of a family history of prostate cancer on the prognosis and features of the disease in Korea: results from a cross-sectional longitudinal pilot study

PURPOSE

Reports on the impact of a family history of prostate cancer among Asians are scarce. We evaluated whether a positive prostate cancer family history is associated with the prognosis and features of the disease.

METHODS

From January 2006 to December 2015, patients who received treatment for pathologically diagnosed prostate cancer were enrolled. Information on family history was obtained via self-administered questionnaires between January 2015 and December 2016. The overall survival rate for all patients and the rate of biochemical failure after radical prostatectomy were assessed according to the presence of family history.

RESULTS

Of 1266 patients (median age, 68.1 years; median prostate-specific antigen, 8.73 ng/mL; median follow-up, 40.0 months), 47 (3.8%) were identified as having a family history. Men with a family history had a younger age, higher proportion of cases diagnosed before 55 years of age, and lower stage than those without a family history. Family history was not a potential risk factor for overall survival. In an analysis of patients who underwent radical prostatectomy (median prostate-specific antigen, 7.40 ng/mL; median follow-up, 40.5 months), no differences in pathologic characteristics were found between patients with (n = 39, 93.5%) and without (n = 567, 6.4%) a family history. Family history was not predictive of biochemical failure.

CONCLUSIONS

A family history of prostate cancer seemed to have no effect on prognosis and disease aggressiveness. However, this study proposed a rationale for performing earlier prostate-specific antigen testing in men with a family history of prostate cancer.

Body mass index is associated with higher Gleason score and biochemical recurrence risk following radical prostatectomy in Chinese men: a retrospective cohort study and meta-analysis

BACKGROUND

The aim of the study is to investigate whether body mass index (BMI) affected pathological characteristics and biochemical recurrence (BCR) of prostate cancer after radical prostatectomy in Chinese men.

METHODS

Medical records of 211 Chinese patients who underwent radical prostatectomy between 2006 and 2014 were retrospectively reviewed, with follow-up time of 24.5 ± 27.0 months. Multivariate logistic and Cox regression analyses were applied to address the impact of BMI on adverse pathological outcomes and BCR following prostatectomy. A meta-analysis of published studies from MEDLINE or EMBASE was conducted to determine the relationship between BMI and BCR following prostatectomy among Asian populations.

RESULTS

Higher BMI was positively correlated with higher biopsy Gleason score (odds ratios (OR) 1.163, 95 % confidence interval (CI) 1.023-1.322, P = 0.021) and pathological Gleason score (OR 1.220, 95 % CI 1.056-1.410, P = 0.007) in multivariate analysis. BCR was detected in 48 patients (22.7 %). Multivariate Cox proportional hazards analysis revealed that higher BMI (hazard ratio (HR) 1.145, 95 % CI 1.029-1.273, P = 0.013) and prostate-specific antigen (HR 1.659, 95 % CI 1.102-2.497, P = 0.015) levels were independent predictors of BCR. The meta-analysis enrolled eight Asian studies of 4145 patients treated by radical prostatectomy. Based on random-effects approach, a 5 kg/m(2) increase in BMI was correlated with 28 % higher risk of BCR (HR 1.22, 95 % CI 0.86-1.72) without statistical significance.

CONCLUSIONS

The present study suggested that higher BMI was an independent risk factor for a higher Gleason score, as well as an independent predictor of BCR after radical prostatectomy in Chinese patients. Meta-analysis of Asian studies also indicated that obese patients, although without statistical significance, might be more likely to suffer from BCR.

Disparities in cervical cancer survival among Asian-American women

PURPOSE

We compared overall survival and influencing factors between Asian-American women as a whole and by subgroup with white women with cervical cancer.

METHODS

Cervical cancer data were from the Surveillance, Epidemiology, and End Results registry; socioeconomic information was from the Area Health Resource File. We used standard tests to compare characteristics between groups; the Kaplan-Meier method with log-rank test to assess overall survival and compare it between groups; and Cox proportional hazards models to determine the effect of race and other covariates on overall survival (with and/or without age stratification).

RESULTS

Being 3.3 years older than white women at diagnosis (P < .001), Asian-American women were more likely to be in a spousal relationship, had more progressive disease, and were better off socioeconomically. Women of Filipino, Japanese, and Korean origin had similar clinical characteristics compared to white women. Asian-American women had higher 36- and 60-month survival rates (P = .004 and P = .013, respectively), higher overall survival rates (P = .049), and longer overall survival durations after adjusting for age and other covariates (hazard ratio = 0.77, 95% confidence interval: 0.68-0.86). Overall survival differed across age strata between the two racial groups. With the exception of women of Japanese or Korean origin, Asian-American women grouped by geographic origin had better overall survival than white women.

CONCLUSIONS

Although Asian-American women, except those of Japanese or Korean origin, had better overall survival than white women, their older age at cervical cancer diagnosis suggests that they have less access to screening programs.

Can body mass index predict survival outcomes in patients treated with radical nephroureterectomy for upper-tract urothelial carcinoma?

PURPOSE

To assess the relationship between body mass index (BMI) and survival outcomes in Korean patients with upper-tract urothelial carcinoma (UTUC).

METHODS

A single-institutional retrospective analysis was conducted using clinical and pathological data of 445 UTUC patients who had undergone radical nephroureterectomy with bladder cuff excision from 1997 to 2012. Enrolled patients were classified into normal weight (BMI < 23 kg/m(2)), overweight (BMI 23-24.9 kg/m(2)), and obese (BMI ≥ 25 kg/m(2)) in accordance with BMI cutoffs for Asian populations. The impact of BMI on intravesical recurrence (IVR)-free survival, overall survival (OS), and cancer-specific survival (CSS) was evaluated using Kaplan-Meier analysis with the log-rank test and the Cox proportional hazard model.

RESULTS

The median BMI of all patients was 24.2 kg/m(2) (interquartile range 22.2-25.8). There were no significant differences in the IVR-free survival rates according to BMI classification (p = 0.488). The 5-year OS and CSS rates were 58.8, 66.3, and 76.3 % (p = 0.057) and 67.4, 69.3, and 81.5 % (p = 0.021) in the normal, overweight, and obese groups, respectively. In the univariate analysis, obesity (BMI ≥ 25 kg/m(2)) was a significant predictor of better OS [hazard ratio (HR) 0.63; 95 % confidence interval (CI) 0.43-0.92, p = 0.017] and CSS (HR 0.53; 95 % CI 0.33-0.84, p = 0.007) than normal weight. However, these associations could not be confirmed in the multivariable analysis after adjusting for other clinicopathological factors, such as tumor stage, tumor grade, lymphovascular invasion, and surgical margin.

CONCLUSIONS

Our study results are inconclusive, in that, the multivariate analysis did not identify the influence of BMI on survival, although higher BMI appears clinically associated with favorable survival outcomes in Korean patients with UTUC.