Influence of obesity on biochemical and clinical failure after external-beam radiotherapy for localized prostate cancer.
BACKGROUND
Several reports have shown that obesity is associated with increased risk of biochemical failure after radical prostatectomy. However, limited information is available regarding the impact of obesity on prostate cancer progression after radiotherapy. The current study sought to determine whether obesity was an independent predictor of biochemical failure (BF) and clinical recurrence (CF) among patients treated with external-beam radiotherapy (EBRT).


METHODS
A retrospective analysis was performed on 873 patients receiving EBRT as the sole treatment for localized prostate cancer between 1988 and 2001. The Kaplan-Meier method, log-rank test, and Cox proportional hazards analyses were performed.


RESULTS
Of the 873 patients, 18% were mildly obese and 5% were moderately to severely obese. Obesity was related to younger age at diagnosis (P < .001), more recent year of diagnosis (P = .03), and race (P = .03), with African-American men having the highest obesity rates. During a mean follow-up of 96 months, 295 patients experienced BF and 127 had CF. On multivariate analysis, controlling for clinical and treatment characteristics, increased body mass index (BMI) significantly predicted BF (hazards ratio [HR] = 1.04; 95% confidence interval [95% CI], 1.02-1.07) with a positive trend by BMI category (P = .001). Similar results were found when the outcome was CF; BMI remained an independent predictor of progression (HR = 1.05; 95% CI, 1.01-1.09), with a statistically significant trend by increased BMI category (P = .03).


CONCLUSIONS
The current findings validate the important role of obesity, not only on BF but also on CF, and suggest a link to the biologic basis of tumor progression that can be therapeutically exploited.
Strom
Sara S
SS
Department of Epidemiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. sstrom@manderson.org
Kamat
Ashish M
AM
Gruschkus
Stephen K
SK
Gu
Yun
Y
Wen
Sijin
S
Cheung
Min Rex
MR
Pisters
Louis L
LL
Lee
Andrew K
AK
Rosser
Charles J
CJ
Kuban
Deborah A
DA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003710:Demography; D048909:Diabetes Complications / Q000097:blood*; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity; D018579:Patient Selection; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000209:etiology* / Q000532:radiotherapy*; D012189:Retrospective Studies; D017211:Treatment Failure
D017430:Prostate-Specific Antigen