Radikal Prostatektomi Uygulanan Hastalarda Deri Altı Yağ Kalınlığının Biyokimyasal Nüks ve Nükssüz Sağkalım Üzerine Etkisi

Year 2024, Volume: 16 Issue: 2, 161 - 167, 30.06.2024

Özgür Efiloğlu Ayberk İplikçi Nesrin Gündüz Mahmut Bilal Dogan Mehmet Çağlar Çakıcı Asıf Yıldırım

https://doi.org/10.18521/ktd.1472283

Abstract

Amaç: Bu çalışmanın amacı radikal prostatektomi (RP) uygulanan hastalarda deri altı yağ kalınlığı (DAYK) ile biyokimyasal nüks (BKN) arasındaki ilişkiyi değerlendirmektir.
Gereç ve Yöntem: Çalışmaya Nisan 2015 ile Ocak 2020 tarihleri arasında merkezimizde RP uygulanan toplam 52 metastatik olmayan prostat kanseri tanılı hasta dahil edildi. Tüm hastalara ameliyattan önceki altı ay içinde tüm batın bilgisayarlı tomografi (BT) taraması yapıldı. Yağ, kas ve doku ölçümleri iki radyolog tarafından yapıldı ve BKN’yi etkileyen faktörleri belirlemek için ikili lojistik regresyon analizi uygulandı. DAYK, nüksü etkileyen tek radyolojik faktör olarak tanımlandı. ROC eğrisi kullanılarak kesme değeri (25,6) belirlendi ve hastalar bu değere göre iki gruba ayrıldı.
Bulgular: Grup 1'de (DAYK < 25,6) ortanca nüks süresi 39 (3-65) ay, ortanca takip süresi ise 40,5 (17-65) ay idi. Grup 2'de (DAYK ≥ 25,6) ortanca nüks süresi 20,5 (3-58) ay, ortanca takip süresi ise 43 (12-69) ay idi. Bir yıllık ve üç yıllık nükssüz sağkalım oranları Grup 1'de sırasıyla %82,1 ve %78,4 iken Grup 2'de sırasıyla %62,5 ve %52,2 idi (p=0,047).
Sonuç: Prostat kanserinde nüksü tahmin edebilmek hastalığın yönetimi için çok önemlidir. DAYK ile BKN arasında anlamlı bir ilişki olduğunu ortaya koyan çalışmamız; hastalığın tanı, tedavi ve takibinde radyolojik değerlendirme ve ölçümlerden daha fazla yararlanılacağını düşündürmektedir.

Keywords

biyokimyasal nüks, prostat kanseri, deri altı yağ kalınlığı

Impact of Subcutaneous Fat Thickness on Biochemical Recurrence and Recurrence-Free Survival in Patients Undergoing Radical Prostatectomy

Abstract

Objective: Aim of this study is to evaluate the association between subcutaneous fat thickness (SCFT) and biochemical recurrence (BCR) in patients who have undergone radical prostatectomy (RP).
Material and Methods: Study included 52 patients who had non-metastatic prostate cancer (PCa), underwent RP at our center between April 2015 and January 2020. All patients had a full abdomen computed tomography (CT) scan within six months prior to surgery. Measurements of fat, muscle, and tissue were evaluated by two radiologists, and binary logistic regression analysis was performed to determine factors influencing BCR. SCFT was identified as the only radiological factor influencing recurrence. A cut-off value (25.6) was determined using an ROC curve, and patients were divided into two groups based on this value.
Results: In Group 1 (SCFT < 25.6), the median recurrence time was 39 (3-65) months, and the median follow-up time was 40.5 (17-65) months. In Group 2 (SCFT ≥ 25.6), the median recurrence time was 20.5 (3-58) months, and the median follow-up time was 43 (12-69) months. The one-year and three-year recurrence-free survival rates were 82.1% and 78.4% for Group 1, respectively, while they were 62.5% and 52.2% for Group 2, respectively (p=0.047).
Conclusions: The ability to predict recurrence in PCa is crucial for the management and treatment of the disease. Our study, which demonstrates a significant relationship between SCFT and BCR, suggests that radiological evaluation and measurements will be further utilized in the diagnosis, treatment, and follow-up of the disease.

Keywords

biochemical recurrence, prostate cancer, subcutaneous fat thickness

References

• 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49.
• 2. Van den Broeck T, van den Bergh RCN, Arfi N, Gross T, Moris L, Briers E, et al. Prognostic Value of Biochemical Recurrence Following Treatment with Curative Intent for Prostate Cancer: A Systematic Review. Eur Urol. 2019;75(6):967–87.
• 3. Walz J, Chun FK, Klein EA, Reuther A, Saad F, Graefen M, et al. Nomogram Predicting the Probability of Early Recurrence After Radical Prostatectomy for Prostate Cancer. J Urol. 2009;181(2):601–8.
• 4. Remmers S, Hollemans E, Nieboer D, Luiting HB, van Leenders GJLH, Helleman J, et al. Improving the prediction of biochemical recurrence after radical prostatectomy with the addition of detailed pathology of the positive surgical margin and cribriform growth. Ann Diagn Pathol. 2022;56:151842. 5. Remmers S, Verbeek JFM, Nieboer D, van der Kwast T, Roobol MJ. Predicting biochemical recurrence and prostate cancer-specific mortality after radical prostatectomy: comparison of six prediction models in a cohort of patients with screening- and clinically detected prostate cancer: External validation of recurrence and PCa mortality. BJU Int. 2019;124(4):635–42.
• 6. Xia HZ, Bi H, Yan Y, Yang B, Ma RZ, He W, et al. A novel nomogram provides improved accuracy for predicting biochemical recurrence after radical prostatectomy. Chin Med J (Engl). 2021;134(13):1576–83.
• 7. Ebadi M, Martin L, Ghosh S, Field CJ, Lehner R, Baracos VE, et al. Subcutaneous adiposity is an independent predictor of mortality in cancer patients. Br J Cancer. 2017;117(1):148–55.
• 8. Vidal AC, Howard LE, Moreira DM, Castro-Santamaria R, Andriole GL, Freedland SJ. Obesity Increases the Risk for High-Grade Prostate Cancer: Results from the REDUCE Study. Cancer Epidemiol Biomarkers Prev. 2014;23(12):2936–42.
• 9. Freedland SJ, Branche BL, Howard LE, Hamilton RJ, Aronson WJ, Terris MK, et al. Obesity, risk of biochemical recurrence, and prostate-specific antigen doubling time after radical prostatectomy: results from the SEARCH database. BJU Int. 2019;124(1):69–75.
• 10. Montgomery RB, Goldman B, Tangen CM, Hussain M, Petrylak DP, Page S, et al. 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(5):1946–51.
• 11. Cao Y, Ma J. Body Mass Index, Prostate Cancer–Specific Mortality, and Biochemical Recurrence: a Systematic Review and Meta-analysis. Cancer Prev Res (Phila Pa). 2011;4(4):486–501.
• 12. Vidal AC, Oyekunle T, Howard LE, De Hoedt AM, Kane CJ, Terris MK, et al. Obesity, race, and long‐term prostate cancer outcomes. Cancer. 2020;126(16):3733–41.
• 13. Langlais CS, Cowan JE, Neuhaus J, Kenfield SA, Van Blarigan EL, Broering JM, et al. Obesity at Diagnosis and Prostate Cancer Prognosis and Recurrence Risk Following Primary Treatment by Radical Prostatectomy. Cancer Epidemiol Biomarkers Prev. 2019;28(11):1917–25.
• 14. Leal-García M, Canto P, Cárdenas-Cárdenas E, Feria-Bernal G, García-García E, Méndez JP. Overweight and obesity in men with prostate cancer do not constitute risk factors for biochemical recurrence. Aging Male. 2020;23(5):1283–8.
• 15. Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev. 2010;11(1):11–8.
• 16. Kim C, Dabelea D, Kalyani RR, Christophi CA, Bray GA, Pi-Sunyer X, et al. Changes in Visceral Adiposity, Subcutaneous Adiposity, and Sex Hormones in the Diabetes Prevention Program. J Clin Endocrinol Metab. 2017;102(9):3381–9.
• 17. Dickerman BA, Torfadottir JE, Valdimarsdottir UA, Giovannucci E, Wilson KM, Aspelund T, et al. Body fat distribution on computed tomography imaging and prostate cancer risk and mortality in the AGES-Reykjavik study. Cancer. 2019;125(16):2877-85.
• 18. Laurent V, Guérard A, Mazerolles C, Le Gonidec S, Toulet A, Nieto L, et al. Periprostatic adipocytes act as a driving force for prostate cancer progression in obesity. Nat Commun. 2016;7:10230.
• 19. Dahran N, Szewczyk-Bieda M, Wei C, Vinnicombe S, Nabi G. Normalized periprostatic fat MRI measurements can predict prostate cancer aggressiveness in men undergoing radical prostatectomy for clinically localised disease. Sci Rep. 2017;7(1):4630.
• 20. Woo S, Cho JY, Kim SY, Kim SH. Periprostatic Fat Thickness on MRI: Correlation With Gleason Score in Prostate Cancer. Am J Roentgenol. 2015;204(1):W43–7.
• 21. Zhang Q, Sun LJ, Qi J, Yang ZG, Huang T, Huo RC. Periprostatic adiposity measured on magnetic resonance imaging correlates with prostate cancer aggressiveness. Urol J. 2014;11(4):1793-9.
• 22. Lopez P, Newton RU, Taaffe DR, Singh F, Buffart LM, Spry N, et al. Associations of fat and muscle mass with overall survival in men with prostate cancer: a systematic review with meta-analysis. Prostate Cancer Prostatic Dis. 2022;25(4):615-626.
• 23. Irlbeck T, Massaro JM, Bamberg F, O’Donnell CJ, Hoffmann U, et al. Association between single-slice measurements of visceral and abdominal subcutaneous adipose tissue with volumetric measurements: the Framingham Heart Study. Int J Obes. 2010;34(4):781–7.
• 24. Lee JJ, Pedley A, Hoffmann U, Massaro JM, Keaney JF Jr, Vasan RS, et al. Cross‐Sectional Associations of Computed Tomography (CT)‐Derived Adipose Tissue Density and Adipokines: The Framingham Heart Study. J Am Heart Assoc. 2016;5(3):e002545.
• 25. McDonald AM, Fiveash JB, Kirkland RS, Cardan RA, Jacob R, Kim RY, et al. Subcutaneous adipose tissue characteristics and the risk of biochemical recurrence in men with high-risk prostate cancer. Urol Oncol Semin Orig Investig. 2017;35(11):663.e15-663.e21.