Obesity is Associated with Longer Survival Independent of Sarcopenia and Myosteatosis in Metastatic and/or Castrate-Resistant Prostate Cancer

No AccessJournal of UrologyAdult Urology1 Mar 2021Obesity is Associated with Longer Survival Independent of Sarcopenia and Myosteatosis in Metastatic and/or Castrate-Resistant Prostate Cancer Mark C. Xu, Heather L. Huelster, Jeremy B. Hatcher, Svetlana Avulova, Blair T. Stocks, Zachary A. Glaser, Kelvin A. Moses, and Heidi J. Silver Mark C. XuMark C. Xu *Correspondence: E-mail Address: [email protected]. Vanderbilt University School of Medicine, Nashville, Tennessee , Heather L. HuelsterHeather L. Huelster Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee , Jeremy B. HatcherJeremy B. Hatcher Vanderbilt University School of Medicine, Nashville, Tennessee , Svetlana AvulovaSvetlana Avulova Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee , Blair T. StocksBlair T. Stocks Vanderbilt University School of Medicine, Nashville, Tennessee , Zachary A. GlaserZachary A. Glaser Vanderbilt University School of Medicine, Nashville, Tennessee , Kelvin A. MosesKelvin A. Moses Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee , and Heidi J. SilverHeidi J. Silver Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee View All Author Informationhttps://doi.org/10.1097/JU.0000000000001428AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Obesity (body mass index 30 kg/m2 or greater) is associated with better overall survival in metastatic prostate cancer. Conversely, low muscle mass (sarcopenia) and low muscle radiodensity (myosteatosis) are associated with worse overall survival in many cancers. This study seeks to evaluate the relationship of sarcopenia, myosteatosis and obesity with overall survival in men with metastatic or castrate-resistant prostate cancer. Materials and Methods: Retrospective analysis of men with metastatic or castrate-resistant prostate cancer and computerized tomography of abdomen/pelvis presenting to the Vanderbilt Comprehensive Prostate Cancer Clinic from 2012 to 2017 was performed. Demographic, pathological and survival data were described, with sarcopenia and myosteatosis determined from abdominal skeletal muscle area and skeletal muscle radiodensity, respectively. Kaplan-Meier curves and log-rank tests estimated the effect of body composition on survival. Multivariable Cox proportional hazard models were performed adjusting for age, Charlson comorbidity index, race and clinical stage. ANOVA was used to compare obese and nonobese men with and without sarcopenia or myosteatosis. Results: Of 182 men accrued, 37.4% were obese, 53.3% sarcopenic and 59.3% myosteatotic. Over a median followup of 33.9 months, body mass index was associated with reduced mortality (HR 0.93, p=0.02), as was visceral adiposity (HR 0.99, p=0.003). Men with high body mass index without sarcopenia/myosteatosis lived significantly longer than men with high body mass index with sarcopenia/myosteatosis or normal body mass index men (F[3,91]=4.03, p=0.01). Conclusions: Both high body mass index and visceral adiposity in metastatic or castrate-resistant prostate cancer are associated with reduced mortality, independent of sarcopenia and myosteatosis. Therefore, routine clinical workup should include calculation of body mass index and measurement of waist circumference. Morphometric analysis of computerized tomography imaging can identify patients at risk for poor prognosis. References 1. : Cancer statistics. CA Cancer J Clin 2020; 70: 2020. Google Scholar 2. : Characterising the castration-resistant prostate cancer population: a systematic review. Int J Clin Pract 2011; 65: 1180. Google Scholar 3. : Obesity increases the risk for high-grade prostate cancer: results from the REDUCE study. Cancer Epidemiol Biomarkers Prev 2014; 23: 2936. Google Scholar 4. : Obesity, risk of biochemical recurrence, and prostate-specific antigen doubling time after radical prostatectomy: results from the SEARCH database. BJU Int 2019; 124: 69. Google Scholar 5. : Association of body mass index with response and survival in men with metastatic prostate cancer: Southwest Oncology Group trials 8894 and 9916. J Urol 2007; 178: 1946. Link, Google Scholar 6. : Obese patients with castration-resistant prostate cancer may be at a lower risk of all-cause mortality: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BJU Int 2018; 122: 76. Google Scholar 7. : Inverse correlation between body mass index and clinical outcomes in men with advanced castration-recurrent prostate cancer. Cancer 2007; 110: 1478. Google Scholar 8. : Body fat distribution on computed tomography imaging and prostate cancer risk and mortality in the AGES-Reykjavik study. Cancer 2019; 125: 2877. Google Scholar 9. : Subcutaneous fat distribution is a prognostic biomarker for men with castration resistant prostate cancer. J Urol 200; 114: 2018. Google Scholar 10. : Influence of obesity on localized prostate cancer patients treated with radical prostatectomy. Asian J Androl 2013; 15: 747. Google Scholar 11. : Visceral adipose tissue measured by computed tomography and high-grade prostate cancer after radical prostatectomy. Int J Obes (Lond) 2015; 39: 1659. Google Scholar 12. : Impact of body composition parameters on clinical outcomes in patients with metastatic castrate-resistant prostate cancer treated with docetaxel. Clin Nutr ESPEN 2016; 13: e39. Google Scholar 13. : Association of body composition with outcome of docetaxel chemotherapy in metastatic prostate cancer: a retrospective review. PLoS One 2015; 10: e0122047. Google Scholar 14. : Presence of sarcopenic obesity and evaluation of the associated muscle quality in Japanese older men with prostate cancer undergoing androgen deprivation therapy. J Geriatr Oncol 2019; 10: 835. Google Scholar 15. : Obesity paradox in cancer: new insights provided by body composition. Am J Clin Nutr 2014; 99: 999. Google Scholar 16. : Myosteatosis and prognosis in cancer: systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 145: 102839. Google Scholar 17. : Frailty and skeletal muscle in older adults with cancer. J Geriatr Oncol 2018; 9: 68. Google Scholar 18. : Trial design and objectives for castration-resistant prostate cancer: updated recommendations from the Prostate Cancer Clinical Trials Working Group 3. J Clin Oncol 2016; 34: 1402. Google Scholar 19. : Automated segmentation of muscle and adipose tissue on CT images for human body composition analysis. In: SPIE Medical Imaging. Edited by MI Miga and KH Wong. Bellingham, Washington: SPIE 2009; p 8. Google Scholar 20. : Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 2013; 31: 1539. Google Scholar 21. : Body composition phenotypes and obesity paradox. Curr Opin Clin Nutr Metab Care 2015; 18: 535. Google Scholar 22. : Estradiol suppresses tissue androgens and prostate cancer growth in castration resistant prostate cancer. BMC Cancer 2010; 10: 244. Google Scholar 23. : Interrelation of energy intake, body size, and physical activity with prostate cancer in a large prospective cohort study. Cancer Res 2003; 63: 8542. Google Scholar 24. : Prognostic value of radiologically determined sarcopenia prior to treatment in urologic tumors: a meta-analysis. Medicine (Baltimore) 2019; 98: e17213. Google Scholar 25. : Perioperative oral nutrition supplementation reduces prevalence of sarcopenia following radical cystectomy: results of a prospective randomized controlled trial. J Urol 2019; 201: 470. Link, Google Scholar 26. : Sarcopenia during androgen-deprivation therapy for prostate cancer. J Clin Oncol 2012; 30: 3271. Google Scholar 27. : High subcutaneous adipose tissue predicts the prognosis in metastatic castration-resistant prostate cancer patients in post chemotherapy setting. Eur J Cancer 2015; 51: 2570. Google Scholar 28. : Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?J Cachexia Sarcopenia Muscle 2018; 9: 295. Google Scholar 29. : Cancer-associated malnutrition and CT-defined sarcopenia and myosteatosis are endemic in overweight and obese patients. JPEN J Parenter Enteral Nutr 2020; 44: 227. Google Scholar 30. : Psoas as a sentinel muscle for sarcopenia: a flawed premise. J Cachexia Sarcopenia Muscle 2017; 8: 527. Google Scholar Data management was facilitated by Vanderbilt University's Research Electronic Data Capture (REDCap) system, supported by the Vanderbilt Institute for Clinical and Translational Research grant (VR52941, UL1TR000011 from NCATS/NIH). © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byStangl-Kremser J, Mari A, Lai L, Lee C, Vince R, Zaslavsky A, Salami S, Fajkovic H, Shariat S and Palapattu G (2021) Sarcopenic Obesity and its Prognostic Impact on Urological Cancers: A Systematic ReviewJournal of Urology, VOL. 206, NO. 4, (854-865), Online publication date: 1-Oct-2021. Volume 205Issue 3March 2021Page: 800-805 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsobesitymusclesprostatic neoplasmssarcopeniatomography, x-ray computedAcknowledgmentsWe thank the men who participated in Comprehensive Prostate Cancer clinic data collection and shared their experience with prostate cancer. The Vanderbilt Diet, Body Composition, and Human Metabolism Core provided morphometric analysis of CT images.MetricsAuthor Information Mark C. Xu Vanderbilt University School of Medicine, Nashville, Tennessee *Correspondence: E-mail Address: [email protected]. Equal study contribution. More articles by this author Heather L. Huelster Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee Equal study contribution. More articles by this author Jeremy B. Hatcher Vanderbilt University School of Medicine, Nashville, Tennessee More articles by this author Svetlana Avulova Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author Blair T. Stocks Vanderbilt University School of Medicine, Nashville, Tennessee More articles by this author Zachary A. Glaser Vanderbilt University School of Medicine, Nashville, Tennessee More articles by this author Kelvin A. Moses Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee Equal study contribution. Financial interest and/or other relationship with Astellas, Pfizer and Dendreon. More articles by this author Heidi J. Silver Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee Equal study contribution. More articles by this author Expand All Data management was facilitated by Vanderbilt University's Research Electronic Data Capture (REDCap) system, supported by the Vanderbilt Institute for Clinical and Translational Research grant (VR52941, UL1TR000011 from NCATS/NIH). Advertisement PDF downloadLoading ...