Metabolically Abnormal Obesity Increases The Risk Of Advanced Prostate Cancer In Chinese Patients Undergoing Radical Prostatectomy

Objective:Approximately 10%to 25%of obese individuals do not have obesity-related metabolic abnormalities and are often referred to as having metabolically healthy obesity(MHO).Conversely,some people without obesity also have some form of metabolic abnormalities.The metabolically abnormal but normal weight(MANW)and metabolically abnormal obesity(MAO)phenotypes are associated with an increased risk of breast cancer and advanced colorectal adenoma.However,no study to date has focused on the effects of different metabolic obesity phenotypes on prostate cancer(PCa)progression.The aim of this study is to examine whether a relationship exists between different metabolic obesity phenotypes and the pathological characteristics of PCa among Chinese men.Materials and Methods:We performed a retrospective cross-sectional study of 1016 patients with PCa who underwent radical prostatectomy and whose metabolic status and body mass index(BMI)were examined.Participants with two or more of the following four parameters were defined as having a metabolically abnormal state,and those with one or no metabolic components were defined as metabolically healthy:high fasting plasma glucose level,high blood pressure,high triglyceride level and low high-density lipoprotein cholesterol level.A BMI cutoff point of 25kg/m~2 was used to define obesity(≥25 kg/m~2)or normal weight(<25 kg/m~2).We cross-classified participants according to categories of the BMI and metabolic status,yielding four phenotypes:1)metabolically healthy and normal weight(MHNW)group,2)MANW group,3)MHO group,and 4)MAO group.The pathological outcomes of PCa included prostatectomy Gleason score(GS),pathological tumor stage(p T),lymph node involvement(LNI),seminal vesicle invasion,extracapsular extension,and surgical margin.Multivariate logistic regression analysis was performed to examine the relationship between different metabolic obesity phenotypes and the pathological outcomes of PCa.Results:In total,1016 consecutive patients with clinical localized or locally advanced PCa undergoing radical prostatectomy were enrolled in this study.Among 1016 men,551(54.2%),106(10.4%),238(23.4%),and 121(11.9%)were assigned to MHNW group,MANW group,MHO group,and MAO group,respectively.The pathological features of PCa,including p T and seminal vesicle invasion,were associated with the classification of obesity and metabolic status(P=0.005 and 0.005,respectively).Compared with the MHNW group,the MAO group had a significantly greater risk of a higher prostatectomy GS[odds ratio(OR),1.907;95%confidence interval(95%CI),1.144–3.182],pathological tumor stage(OR,1.606;95%CI,1.035–2.493),and seminal vesicle invasion(OR,1.673;95%CI,1.041–2.687).In contrast,the ORs were not increased in the MHO or MANW group.In the context of normal weight,metabolic disorders were associated with lymph node involvement.The metabolic status and body mass index were not associated with extracapsular extension or surgical margins in any of the four groups.Conclusion:In conclusion,we demonstrated that the MAO phenotype was associated with aggressive PCa,including a higher prostatectomy GS,p T,and seminal vesicle invasion.In contrast,neither the MHO nor MANW phenotype was associated with high-risk pathological features of PCa.Obesity and metabolic disorders act synergistically to increase the pathological risk.These findings indicate that controlling the BMI and metabolic status is necessary to prevent aggressive PCa and progression of PCa.