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Obesity and biochemical recurrence in clinically localised prostate cancer: a systematic review and meta-analysis of 86,490 patients

Prostate Cancer and Prostatic Diseases volume 25, pages 411–421 (2022)Cite this article

Subjects

Abstract

Background

The association of obesity with biochemical recurrence (BCR) after treatment of clinically localised prostate cancer (PC) shows inconsistent results. Our aim was to systematically review all evidence evaluating obesity as a prognostic factor for BCR.

Methods

We searched PubMed, Web of Science and Scopus, from inception to June 1, 2021. Cohort studies reporting BCR among PC patients stratified by body mass index (BMI) were included. To assess the quality of the selected studies, we used the Newcastle–Ottawa scale (NOS). Risk of BCR among obese patients (BMI ≥ 30 kg/m2) was compared with normal weight (BMI < 25), pooling individual hazard ratios (HR) in random-effect meta-analysis. Associations for continuous BMI per 5 kg/m2 were also calculated. Subgroup analyses were conducted to assess reasons for heterogeneity and causal criteria were formally evaluated.

Results

We identified 46 cohort studies including 86,490 PC patients. A total of 14,719 (17.1%) patients developed BCR. There was no consistent definition of BCR. Obesity was associated with BCR (HR: 1.25, 95% CI: 1.11–1.39, I2: 70.3%), and there was a 10% increase (95% CI: 4–15%, I2: 66.3%) in BCR per 5 kg/m2 increase in BMI. The heterogeneity was high but decreased in the subgroup of highest-quality NOS score and when the BMI was measured by the researchers (I2: 0.0%). The association was consistent in patients receiving radical prostatectomy but not in patients receiving other therapies.

Conclusions

Obesity showed a moderate, consistent relationship with biochemical recurrence after radical prostatectomy. Measurement of BMI and BCR was variable, highlighting the need for standardised clinical guidelines. Preventive weight control programs may have a role in reducing BCR for clinically localised PC patients.

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Fig. 1
Fig. 2: Forest plot of the association between obesity (body mass index ≥30), compared with normal weight (body mass index <25) and biochemical recurrence.
Fig. 3: Forest plot of the association between continuous body mass index per 5 kg/m2 and biochemical recurrence.

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Authors and Affiliations

  1. Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain

    Mario Rivera-Izquierdo, Javier Pérez de Rojas, Virginia Martínez-Ruiz & José Juan Jiménez-Moleón

  2. Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain

    Mario Rivera-Izquierdo, Virginia Martínez-Ruiz & José Juan Jiménez-Moleón

  3. Service of Preventive Medicine and Public Health, Hospital Universitario San Cecilio, Granada, Spain

    Mario Rivera-Izquierdo

  4. Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

    Virginia Martínez-Ruiz, Beatriz Pérez-Gómez & José Juan Jiménez-Moleón

  5. Service of Urology, Hospital Universitario San Cecilio, Granada, Spain

    Miguel Ángel Arrabal-Polo

  6. Department of Epidemiology of Chronic Diseases. National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain

    Beatriz Pérez-Gómez

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Contributions

Conceptualisation: MR-I, JPdR, JJJ-M, Data curation: MR-I, JPdR, Formal analysis: MR-I, JPdR, VM-R, JJJ-M, Investigation: MR-I, JPdR, VM-R, MA-P, BP-G, JJJ-M, Methodology: MR-I, JPdR, JJJ-M, Supervision: VM-R, JJJ-M, Validation: MR-I, JPdR, VM-R, MA-P, BP-G, JJJ-M.

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Correspondence to Mario Rivera-Izquierdo.

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Rivera-Izquierdo, M., Pérez de Rojas, J., Martínez-Ruiz, V. et al. Obesity and biochemical recurrence in clinically localised prostate cancer: a systematic review and meta-analysis of 86,490 patients. Prostate Cancer Prostatic Dis 25, 411–421 (2022). https://doi.org/10.1038/s41391-021-00481-7

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