Impact of Body Mass Index on Survival After Docetaxel Chemotherapy for Metastatic Castration-resistant Prostate Cancer.

Abstract

Background/aim: Several recent studies, varying in design and the number of baseline parameters analyzed, suggest that a lower body mass index (BMI) is associated with shorter survival in men beginning treatment for metastatic castration-resistant prostate cancer (MCRPC), including treatments such as docetaxel. This study aimed to analyze the impact of BMI and numerous covariates on survival in a homogeneously treated cohort of Caucasian men who received first-line docetaxel for MCRPC.

Patients and methods: This retrospective analysis included 112 consecutive patients managed between 2009 and 2023. Comorbidity, medications, and blood tests were included. Both, uni- and multivariate tests were performed.

Results: The median age of the patients was 70 years with a median BMI of 26.8 kg/m². Most patients were free from serious comorbidities, had bone-only metastases, and experienced metachronous development of metastases. Hemoglobin values were significantly lower in patients with lower BMI (median 11.9 versus 13.0 g/dl, p=0.001). Lean patients had numerically shorter survival compared to overweight/obese patients (median 11.8 versus 19.4 months, p=0.15). In multivariate analysis of prognostic factors, only three baseline parameters retained statistical significance: serum lactate dehydrogenase (p=0.03), hemoglobin (p=0.007), and the presence of non-bone metastases (p=0.004).

Conclusion: An interaction between BMI and hemoglobin was present in metastatic castration-resistant prostate cancer patients after docetaxel chemotherapy, explaining the observed survival difference between lean and overweight/obese patients. Comorbidities and medications had no significant impact on survival in this population with limited prognosis (median survival 16.1 months).