Abstract
This study aims to evaluate differences in the risk factors for biochemical recurrence (BCR) for radical prostatectomy stratified by degree of obesity, focusing on the surgical method used. All 3099 patients who underwent radical prostatectomy in two medical centres from January 2008 to March 2018 were retrospectively reviewed. Patients were divided into three groups based on body mass index: ‘normal’, ‘overweight’, and ‘obese’. Risk factors associated with biochemical recurrence were compared between different degrees of obesity. We analysed the contributing risk factors of BCR-free survival using univariate and multivariable Cox hazard models. There were 378 (12.2%) and 1815 (58.6%) patients in the ‘obese’ and ‘overweight’ groups, respectively. Accordingly, 1324 patients underwent retropubic radical prostatectomy (RRP), and 1775 underwent robotic-assisted laparoscopic prostatectomy (RALP). Multivariable analysis showed that patients who underwent RALP had significantly lower BCR free survival in the ‘overweight’ and ‘obese’ groups than those who underwent RRP, with adjusted hazard ratios of 0.75 (95% CI 0.59–0.95, p-value = 0.01) and 0.55 (95% CI 0.33–0.90, p-value = 0.02), respectively. The degree of obesity was not directly associated with BCR-free survival. Robotic prostatectomy showed greater benefits in BCR-free survival than open prostatectomy in the ‘overweight’ and ‘obese’ groups.
Highlights
This study aims to evaluate differences in the risk factors for biochemical recurrence (BCR) for radical prostatectomy stratified by degree of obesity, focusing on the surgical method used
Research of the Shared Equal Access Regional Cancer Hospital (SEARCH) database found that obesity was related to positive surgical margins[10]
A recent meta-analysis revealed that robotic-assisted laparoscopic prostatectomy (RALP) showed superior results in functional outcomes[12,13] than open retropubic radical prostatectomy (RRP), there is still little evidence regarding oncological outcomes[14,15]
Summary
This study aims to evaluate differences in the risk factors for biochemical recurrence (BCR) for radical prostatectomy stratified by degree of obesity, focusing on the surgical method used. Multivariable analysis showed that patients who underwent RALP had significantly lower BCR free survival in the ‘overweight’ and ‘obese’ groups than those who underwent RRP, with adjusted hazard ratios of 0.75 (95% CI 0.59–0.95, p-value = 0.01) and 0.55 (95% CI 0.33–0.90, p-value = 0.02), respectively. A recent meta-analysis revealed that robotic-assisted laparoscopic prostatectomy (RALP) showed superior results in functional outcomes[12,13] than open retropubic radical prostatectomy (RRP), there is still little evidence regarding oncological outcomes[14,15]. We hypothesize that the degree of obesity has an effect on the oncological outcome in patients with prostate cancer due to the associated surgical difficulty in performing radical prostatectomy. After adjusting for confounding factors, we assessed differences in the operation method affecting BCR stratified by the degree of obesity
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