Subcutaneous adipose tissue characteristics and the risk of biochemical recurrence in men with high-risk prostate cancer.

Academic Article

Abstract

  • PURPOSE/OBJECTIVE(S): To assess subcutaneous adipose tissue characteristics by computed tomography (CT) as potential imaging biomarkers predictive of biochemical recurrence in men with high-risk prostate cancer receiving radiotherapy (RT). MATERIALS AND METHODS: This retrospective study included men with high-risk prostate cancer (PSA>20ng/ml, Gleason score ≥8, or clinical extraprostatic extension) treated between 2001 and 2012. All patients received definitive, dose-escalated external beam RT along with a course of neoadjuvant, concurrent, and adjuvant androgen deprivation therapy (ADT). Each patient also had a treatment planning CT that included the L4-L5 vertebral interface and prostate specific antigen (PSA) measurements for at least 2 years following RT. The subcutaneous adipose tissue was contoured on a single axial CT slice at the level of L4-L5. The average CT attenuation, in Hounsfield units (HU), of the structure was calculated and defined as SATHU. SATAREA was defined as the cross-sectional area of the structure (in cm2) that was then normalized by the square of patient height. Biochemical failure (BF) was defined as a PSA rise of 2ng/ml from the nadir. Freedom from BF (FFBF) was calculated from start time of ADT using the Kaplan-Meier method. Estimates of FFBF were stratified by SATHU and SATAREA quartiles. RESULTS: A total of 171 men met the inclusion criteria with a median follow-up of 5.6 years. The mean SATHU (±standard deviation) was -99.2HU (±6.1HU), and the mean SATAREA was 93.2cm2/m2 (±39.4cm2/m2). The 5- and 8-year rates of FFBF across all patients were 81.5% and 73.5%, respectively. Patients in the lowest quartile of SATHU experienced significantly higher FFBF compared to the other quartiles (Q4 vs. Q1, P = 0.017; Q4 vs. Q2, P = 0.045; Q4 vs. Q3, P = 0.044). No other differences in FFBF were observed between quartiles of SATAREA or other quartiles of SATHU. CONCLUSION: Lower subcutaneous adipose tissue density was associated with a lower rate of BF following RT with ADT for men with high-risk prostate cancer. Further research is needed to elucidate the biological underpinnings of this clinical finding and the role adipose tissue plays in modulating oncologic behavior and outcomes.
  • Keywords

  • Adipose tissue density, Body composition, Computed tomography, Imaging biomarker, Prostate cancer, Aged, Androgen Antagonists, Combined Modality Therapy, Dose-Response Relationship, Radiation, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Neoplasm Recurrence, Local, Prostate, Prostate-Specific Antigen, Prostatic Neoplasms, Radiotherapy, Retrospective Studies, Risk Factors, Subcutaneous Fat, Tomography, X-Ray Computed
  • Digital Object Identifier (doi)

    Author List

  • McDonald AM; Fiveash JB; Kirkland RS; Cardan RA; Jacob R; Kim RY; Dobelbower MC; Yang ES
  • Start Page

  • 663.e15
  • End Page

  • 663.e21
  • Volume

  • 35
  • Issue

  • 11