Impact Of BMI On Biochemical Recurrence Rates After Radical Prostatectomy: An Analysis Utilizing Propensity Score Matching

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Obesity / Weight Loss / Fitness
Article Date: 12 Jun 2008 - 11:00 PDT

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UroToday.com - According to a report by Dr. Magheli and colleagues at The Johns Hopkins University, a propensity score matched analysis indicates that a higher body mass index (BMI) is associated with adverse pathologic outcomes and biochemical recurrence after radical prostatectomy. The paper appears in the online version of Urology.

While previous reports have been conflicting about BMI, several suggest higher BMI worsens outcomes. What is different about this study is the use of propensity score matching of patients with normal-weight, overweight and obese BMI's. The authors point out that in propensity score matching, variables are weighted by their relative importance rather than being assigned equal weights. A total of 11,790 patients were studied; normal BMI in 3,365, overweight BMI in 6,548, and obese BMI in 1,877. Normal weight and overweight cohorts were matched 1:1 to the obese patients on the basis of propensity scores and thus 5,631 men formed the study population. Propensity scores matched cohort members for a large number of clinical covariates and clinical and pathological characteristics were analyzed.

Mean follow-up was 4.5 years. Normal weight patients had higher rates of lower Gleason grade disease and lower rates of positive surgical margins. Higher BMI was associated with worse pathologic stage. The Kaplan-Meier analysis found 5- and 10-year biochemical recurrence-free survival rates of 87% and 77% for all patients. The 5- and 10-year biochemical recurrence-free survival rates for normal weight, overweight and obese patients were 90% and 82%, 84% and 77%, and 78% and 63%, respectively. In multivariable analysis, BMI cohort, preoperative PSA level, year of surgery, pathologic Gleason score, pathologic stage and surgical margin status were independent predictors of biochemical recurrence.

Magheli A, Rais-Bahrami S, Trock BJ, Humphreys EB, Partin AW, Han M, Gonzalgo ML
Urology. 2008 Apr 1 (Epub ahead of print)
doi: 10.1016/j.urology.2008.01.052

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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