BODY MASS INDEX AS A PREDICTOR FOR GLEASON SCORE UPGRADING FROM BIOPSY TO PROSTATECTOMY

prostate cancer;upgrading;Gleason score;prostatectomy;Epidemiology

Haupt, Eric C.Platz, Elizabeth A. ;

Johns Hopkins University

关键词: prostate cancer;    upgrading;    Gleason score;    prostatectomy;    Epidemiology;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/38127/HAUPT-THESIS-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Objective: Gleason scores are often higher in radical prostatectomy (RP) specimens compared biopsy. Obese men are at a higher risk of death from prostate cancer therefore body mass index (BMI) may be an important predictor of Gleason sum upgrading.Methods: Between 1993 and 2014, 16,904 men underwent RP at Johns Hopkins and were eligible for this analysis. Upgrading was defined as any increase in Gleason sum and also as upgrading to a higher Gleason sum group: 2-6, 3+4, 4+3, and 8+. The association between higher BMI and upgrading was evaluated in multivariable-adjusted analyses. Separate analyses were performed in Caucasian and African American men and subsets of men with Gleason sum 6 disease, and in men with Gleason sum 6 with stage T1 or T2a, and PSA<10ng/mL.Results: In total, 21% of men upgraded to a higher Gleason sum at RP compared to at biopsy and 8% downgraded. After adjusting for factors that were associated with upgrading, men who were overweight had a 14% higher odds of upgrading (95% CI 1.03, 1.25) and men who were obese had a 24% higher odds of upgrading (95% CI 1.10, 1.39). The association between BMI and upgrading was present among Caucasian, but not African American men (overweight OR = 0.90, 95% CI 0.64, 1.28); obese OR=1.01 95% CI 0.69, 1.49). In Caucasian and African American men with Gleason sum 6, stage T1 or T2a, and PSA <10ng/mL, there was a positive association between obesity and upgrading. Addition of BMI to multivariable-adjusted analyses did not significantly improve prediction of upgrading from Gleason sum 6 prostate cancer.Conclusions: Overweight and obesity were associated with a higher odds of upgrading between biopsy and RP in Caucasian men. In men with low risk disease, who may be eligible for active surveillance – Gleason 6 prostate cancer with PSA < 10 ng/mL and clinical stage of T1 or T2a – obesity was associated with an increased odds of upgrading in both African American and Caucasian men. Our work may inform treatment decision-making for overweight and obese men, including African American obese men, newly diagnosed with prostate cancer.