Einfluss des Body-Mass-Index auf histopathologische und intraoperative Kriterien in einer konsekutiven Serie von Patienten mit roboterassistierter radikaler Prostatektomie

Zusammenfassung

Hintergrund: In verschiedenen Studien konnte das Risiko der Obesitas hinsichtlich ungünstigerer Tumorstadien, höherer Gleason-Scores (GS), positiver chirurgischer Schnittränder (R1) und bestimmter perioperativer Parameter (höherer Blutverlust, längere Operationszeit, häufiger Komplikationen) nach radikaler Prostatektomie belegt werden. Für die roboterassistierte radikale Prostatektomie (RARP) existieren hierzu nur wenige Studien mit teils widersprüchlichen Ergebnissen, wobei keine dieser vorliegenden Untersuchungen den klinischen Alltag in einem europäischen Zentrum darstellt.

Material und Methoden: 346 Patienten mit RARP als Primärtherapie eines lokal begrenzten Prostatakarzinoms wurden prospektiv erfasst. Neben weiteren klinischen und histopathologischen Parametern wurde von diesen Patienten der Body-Mass-Index (BMI) aufgezeichnet. Hierbei wurde ein BMI von <25 kg/m² als Normalgewicht, ≥25–29,9 kg/m² als Übergewicht und ≥30 kg/m² als Obesitas klassifiziert. Die potentiellen Zusammenhänge zwischen dem BMI einerseits und verschiedenen Kriterien einer aggressiven Tumorbiologie bzw. definierten perioperativen Parametern andererseits wurde univariat und multivariat geprüft.

Ergebnisse: 22,8% (n=79), 59% (n=204) und 18,2% (n=63) der Studiengruppe wiesen Normalgewicht, Übergewicht bzw. eine Obesitas auf. In verschiedenen multivariaten Regressionsmodellen bestand kein signifikanter Einfluss der Obesitas auf das pathologische Tumorstadium, die pN-Kategorie, den Anteil undifferenzierter Tumoren (≥GS7b), das Upgrading und die R1-Rate. Patienten mit Obesitas zeigten einen signifikant höheren intraoperativen Blutverlust und eine längere Operationszeit, wiesen jedoch nicht häufiger Komplikationen der Clavien-Dindo Grade 3a/b im 90 d-Verlauf auf.

Schlussfolgerung: In dieser Serie konsekutiver Patienten mit primärer RARP bestanden für Patienten mit Obesitas keine Hinweise auf eine aggressivere Tumorbiologie und auch keine höhere Komplikationsdichte. Weiterführende Arbeiten zu diesem Thema sollten die onkologischen und funktionellen Ergebnisse in der Langzeitbeobachtung integrieren.

Abstract

Background: In various studies it has been shown that obesity enhances the risk for a unfavorable pathological tumour stages, higher Gleason scores (GS), positive surgical margins (PSM), and certain perioperative parameters (higher blood loss, higher length of surgery, higher complication rates) after radical prostatectomy. However, for robot-assisted radical prostatectomy (RARP) there are only a few studies addressing this topic with partially conflicting results. Furthermore, none of these studies actually represents the clinical practice pattern as performed in a European centre.

Material and Methods: Beside further clinical and histopathological parameters, also body mass index (BMI) of patients undergoing RARP was recorded. The following categories were registered: BMI of < 25 kg/m², ≥ 25–29.9 kg/m², and ≥ 30 kg/m² defined as normal weight, overweight, and obesity, respectively. The potential correlation between BMI on the one hand and various criteria of aggressive tumour biology and specific perioperative parameters on the other hand has been examined on univariate and multivariable analyses.

Results: 22.8% (n=79), 59% (n=204), and 18.2% (n=63) of patients of the study group presented with normal weight, overweight, and obesity, respectively. Based on the results of various multivariable regression models there was no significant influence of obesity on pathological tumour stage, pN category, undifferentiated tumour growth (≥ GS7b), upgrading, or PSM rates. Furthermore, obese patients showed a significantly higher intraoperative blood loss and a higher length of surgery, which, however, did not result in a higher rate of grade 3a/b complications according to Clavien-Dindo classification after 90 days.

Conclusions: In the present series of consecutive patients undergoing RARP there was no evidence for a more aggressive tumour biology or a higher complication rate in obese patients.

Schlüsselwörter

Prostatakarzinom - Obesitas - pathologische Tumorstadien - positive chirurgische Schnittränder - Komplikationen

Key words

prostate cancer - obesity - pathological tumour stage - positive surgical margins - complications

^* Die Autoren Matthias May und Steffen Lebentrau teilen sich die Letztautorenschaft

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