Obesity and positive surgical margins by anatomic location after radical prostatectomy

Results from the shared equal access regional cancer hospital database

Jayakrishnan Jayachandran, William J. Aronson, Martha Kennedy Terris, Joseph C. Presti, Christopher L. Amling, Christopher J. Kane, Stephen J. Freedland

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

OBJECTIVES: To determine if there is predilection for any specific anatomical location of positive surgical margins (PSMs) after radical prostatectomy (RP) for prostate cancer in obese men, as previous studies found that obesity was associated with an increased risk of PSMs. PATIENTS AND METHODS: We analysed retrospectively 1434 men treated with RP between 1989 and 2007 within the Shared Equal Access Regional Cancer Hospital database. The association between increased body mass index (BMI) and overall and site-specific PSMs was assessed using multivariate logistic regression. RESULTS: After adjusting for several preoperative clinical and pathological characteristics, a higher BMI was associated with an increased risk of PSMs both overall and at all specific anatomical locations (all P ≤ 0.007). For mildly obese men, this risk was very similar across all anatomical sites (44-78% increased risk relative to men of normal weight). When BMI was coded as a continuous variable, the odds ratio for the risk of overall PSMs or at any specific locations was nearly identical at 1.05-1.06. Among men with a BMI of ≥35 kg/m2, there was more variation, with the highest excess risk of PSMs at the bladder neck and apex. CONCLUSIONS: Obesity was associated with an increased risk of overall PSMs and at all anatomical locations. Although the excess risk of PSMs was similar across all anatomical locations, there was a suggestion of a higher risk of apical margins among the most obese men, which if validated, further supports the importance of the apical dissection in all men and suggests added difficulty in obese patients.

Original languageEnglish (US)
Pages (from-to)964-968
Number of pages5
JournalBJU International
Volume102
Issue number8
DOIs
StatePublished - Oct 1 2008

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Cancer Care Facilities
Prostatectomy
Obesity
Databases
Body Mass Index
Margins of Excision
Dissection
Prostatic Neoplasms
Urinary Bladder
Logistic Models
Odds Ratio
Weights and Measures

Keywords

  • Margins
  • Obesity
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Obesity and positive surgical margins by anatomic location after radical prostatectomy : Results from the shared equal access regional cancer hospital database. / Jayachandran, Jayakrishnan; Aronson, William J.; Terris, Martha Kennedy; Presti, Joseph C.; Amling, Christopher L.; Kane, Christopher J.; Freedland, Stephen J.

In: BJU International, Vol. 102, No. 8, 01.10.2008, p. 964-968.

Research output: Contribution to journalArticle

Jayachandran, Jayakrishnan ; Aronson, William J. ; Terris, Martha Kennedy ; Presti, Joseph C. ; Amling, Christopher L. ; Kane, Christopher J. ; Freedland, Stephen J. / Obesity and positive surgical margins by anatomic location after radical prostatectomy : Results from the shared equal access regional cancer hospital database. In: BJU International. 2008 ; Vol. 102, No. 8. pp. 964-968.
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abstract = "OBJECTIVES: To determine if there is predilection for any specific anatomical location of positive surgical margins (PSMs) after radical prostatectomy (RP) for prostate cancer in obese men, as previous studies found that obesity was associated with an increased risk of PSMs. PATIENTS AND METHODS: We analysed retrospectively 1434 men treated with RP between 1989 and 2007 within the Shared Equal Access Regional Cancer Hospital database. The association between increased body mass index (BMI) and overall and site-specific PSMs was assessed using multivariate logistic regression. RESULTS: After adjusting for several preoperative clinical and pathological characteristics, a higher BMI was associated with an increased risk of PSMs both overall and at all specific anatomical locations (all P ≤ 0.007). For mildly obese men, this risk was very similar across all anatomical sites (44-78{\%} increased risk relative to men of normal weight). When BMI was coded as a continuous variable, the odds ratio for the risk of overall PSMs or at any specific locations was nearly identical at 1.05-1.06. Among men with a BMI of ≥35 kg/m2, there was more variation, with the highest excess risk of PSMs at the bladder neck and apex. CONCLUSIONS: Obesity was associated with an increased risk of overall PSMs and at all anatomical locations. Although the excess risk of PSMs was similar across all anatomical locations, there was a suggestion of a higher risk of apical margins among the most obese men, which if validated, further supports the importance of the apical dissection in all men and suggests added difficulty in obese patients.",
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AU - Presti, Joseph C.

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N2 - OBJECTIVES: To determine if there is predilection for any specific anatomical location of positive surgical margins (PSMs) after radical prostatectomy (RP) for prostate cancer in obese men, as previous studies found that obesity was associated with an increased risk of PSMs. PATIENTS AND METHODS: We analysed retrospectively 1434 men treated with RP between 1989 and 2007 within the Shared Equal Access Regional Cancer Hospital database. The association between increased body mass index (BMI) and overall and site-specific PSMs was assessed using multivariate logistic regression. RESULTS: After adjusting for several preoperative clinical and pathological characteristics, a higher BMI was associated with an increased risk of PSMs both overall and at all specific anatomical locations (all P ≤ 0.007). For mildly obese men, this risk was very similar across all anatomical sites (44-78% increased risk relative to men of normal weight). When BMI was coded as a continuous variable, the odds ratio for the risk of overall PSMs or at any specific locations was nearly identical at 1.05-1.06. Among men with a BMI of ≥35 kg/m2, there was more variation, with the highest excess risk of PSMs at the bladder neck and apex. CONCLUSIONS: Obesity was associated with an increased risk of overall PSMs and at all anatomical locations. Although the excess risk of PSMs was similar across all anatomical locations, there was a suggestion of a higher risk of apical margins among the most obese men, which if validated, further supports the importance of the apical dissection in all men and suggests added difficulty in obese patients.

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