World Journal of Urology

, Volume 36, Issue 7, pp 1067–1072 | Cite as

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

  • Jonas Schiffmann
  • Pierre I. Karakiewicz
  • Michael Rink
  • L. Manka
  • Georg Salomon
  • Derya Tilki
  • Lars Budäus
  • Raisa Pompe
  • Sami-Ramzi Leyh-Bannurah
  • Alexander Haese
  • P. Hammerer
  • Hartwig Huland
  • Markus Graefen
  • Pierre Tennstedt
Original Article

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.

Keywords

BMI Body mass index Metastases Obesity Obesity paradox Outcomes Prostate cancer Radical prostatectomy Survival 

Notes

Author 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.

Compliance with ethical standards

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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jonas Schiffmann
    • 1
  • Pierre I. Karakiewicz
    • 2
    • 3
  • Michael Rink
    • 4
  • L. Manka
    • 1
  • Georg Salomon
    • 5
  • Derya Tilki
    • 4
    • 5
  • Lars Budäus
    • 5
  • Raisa Pompe
    • 2
    • 5
  • Sami-Ramzi Leyh-Bannurah
    • 4
  • Alexander Haese
    • 5
  • P. Hammerer
    • 1
  • Hartwig Huland
    • 5
  • Markus Graefen
    • 5
  • Pierre Tennstedt
    • 5
  1. 1.Department of UrologyAcademic Hospital BraunschweigBrunswickGermany
  2. 2.Cancer Prognostics and Health Outcomes UnitUniversity of Montreal Health CenterMontrealCanada
  3. 3.Department of UrologyUniversity of Montreal Health CenterMontrealCanada
  4. 4.Department of UrologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  5. 5.Martini-Klinik Prostate Cancer CenterUniversity Medical Center Hamburg-EppendorfHamburgGermany

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