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Systematic Review

Obesity as a Risk Factor for Prostate Cancer Mortality: A Systematic Review and Dose-Response Meta-Analysis of 280,199 Patients

1
Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain
2
Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
3
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
4
National Centre for Epidemiology, Department of Epidemiology of Chronic Diseases, Instituto de Salud Carlos III, 28029 Madrid, Spain
5
Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain
*
Author to whom correspondence should be addressed.
Cancers 2021, 13(16), 4169; https://doi.org/10.3390/cancers13164169
Received: 21 July 2021 / Revised: 16 August 2021 / Accepted: 17 August 2021 / Published: 19 August 2021
(This article belongs to the Section Systematic Review or Meta-Analysis in Cancer Research)
Results from individual studies on the association between obesity and prostate cancer mortality remain inconclusive; additionally, several large cohort studies have recently been conducted. We aimed to systematically review all available evidence and synthetize it using meta-analytic techniques. The results of our study showed that obesity was associated with prostate cancer specific mortality and all-cause mortality. The temporal association was consistent with a dose-response relationship. Our results demonstrated that obesity, a potentially modifiable prognostic factor, was associated with higher prostate cancer mortality. This study improved the evidence regarding the potential impact of lifestyle on improving prostate cancer prognosis. Strategies aimed at maintaining normal, or reducing abnormal, body mass index in diagnosed prostate cancer patients might improve survival. These results should guide urologists, oncologists, patients, policy-makers and primary care providers with respect to evidence-based practice and counselling concerning lifestyle changes after prostate cancer diagnosis.
The aim of this study was to systematically review all evidence evaluating obesity as a prognostic factor for PC mortality. Cohort and case-control studies reporting mortality among PC patients stratified by body mass index (BMI) were included. The risk of mortality among obese patients (BMI ≥ 30) was compared with the risk for normal weight (BMI < 25) patients, pooling individual hazard ratios (HR) in random-effects meta-analyses. Reasons for heterogeneity were assessed in subgroup analyses. Dose-response associations for BMI per 5 kg/m2 change were assessed. Among 7278 citations, 59 studies (280,199 patients) met inclusion criteria. Obesity was associated with increased PC-specific mortality (HR: 1.19, 95% CI: 1.10–1.28, I2: 44.4%) and all-cause mortality (HR: 1.09, 95% CI: 1.00–1.18, I2: 43.9%). There was a 9% increase (95% CI: 5–12%, I2: 39.4%) in PC-specific mortality and 3% increase (95% CI: 1–5%, I2: 24.3%) in all-cause mortality per 5 kg/m2 increase in BMI. In analyses restricted to the higher quality subgroup (NOS ≥ 8), obesity was associated with increased PC-specific mortality (HR: 1.24, 95% CI: 1.14–1.35, I2: 0.0%) and maintained the dose-response relationship (HR: 1.11 per 5 kg/m2 increase in BMI, 95% CI: 1.07–1.15, I2: 26.6%). Obesity had a moderate, consistent, temporal, and dose-response association with PC mortality. Weight control programs may have a role in improving PC survival. View Full-Text
Keywords: body mass index; prostate cancer specific mortality; all-cause mortality; outcomes; causation body mass index; prostate cancer specific mortality; all-cause mortality; outcomes; causation
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MDPI and ACS Style

Rivera-Izquierdo, M.; Pérez de Rojas, J.; Martínez-Ruiz, V.; Pérez-Gómez, B.; Sánchez, M.-J.; Khan, K.S.; Jiménez-Moleón, J.J. Obesity as a Risk Factor for Prostate Cancer Mortality: A Systematic Review and Dose-Response Meta-Analysis of 280,199 Patients. Cancers 2021, 13, 4169. https://doi.org/10.3390/cancers13164169

AMA Style

Rivera-Izquierdo M, Pérez de Rojas J, Martínez-Ruiz V, Pérez-Gómez B, Sánchez M-J, Khan KS, Jiménez-Moleón JJ. Obesity as a Risk Factor for Prostate Cancer Mortality: A Systematic Review and Dose-Response Meta-Analysis of 280,199 Patients. Cancers. 2021; 13(16):4169. https://doi.org/10.3390/cancers13164169

Chicago/Turabian Style

Rivera-Izquierdo, Mario, Javier Pérez de Rojas, Virginia Martínez-Ruiz, Beatriz Pérez-Gómez, María-José Sánchez, Khalid S. Khan, and José J. Jiménez-Moleón. 2021. "Obesity as a Risk Factor for Prostate Cancer Mortality: A Systematic Review and Dose-Response Meta-Analysis of 280,199 Patients" Cancers 13, no. 16: 4169. https://doi.org/10.3390/cancers13164169

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