Editorial Comment to Radical prostatectomy in obese patients: Improved surgical outcomes in recent years
Notice bibliographique
Résumé
On the one hand, prostate cancer has attracted an enormous amount of attention in the field of scientific research as well as the non-professional press. The discovery of prostate-specific antigen (PSA), public prostate awareness and shifting population age distributions towards the elderly in many populations has prioritized prostate cancer research. On the other hand, obesity is one of the most challenging and growing health problems in industrialized countries. In the USA, over the past 20 years, the prevalence of obesity among adults has doubled to 30%.1 Although obesity is less common in Europe, the prevalence has also more than doubled during the past two decades.2 In summary, it is expected that urologists will increasingly be confronted with obese men having a localized prostate cancer. The risk of obesity in developing prostate cancer is controversial.3-5 However, more agreement exists on the increased risk of biochemical recurrence in obese men who have undergone a radical prostatectomy.6-8 Of note, all studies were carried out in the USA. Several recent reports from Europe could not confirm this relationship.9, 10 In this issue of International Journal of Urology, Linder et al. from the University of Toronto also failed to show a positive link between obesity and biochemical recurrence.11 Of note, the mean follow-up was just 4.5 years and the study population consisted of 491 patients. Although not significant, the obese patients had more often positive surgical margins compared with their thinner counterparts (22% vs 11%). It is generally held that obesity makes many urological procedures technically more challenging. Positive surgical margins might a result of bad surgical technique and/or from the extension of the tumor beyond the planned limits of resection. However, in the study of Linder et al. obese patients were not at higher risk of developing biochemical recurrence. A problem of measuring obesity with body mass index is that it is a marker of general obesity. The most metabolic fat, however, is the abdominal visceral fat. In a large cohort study of 129 502 men,12 waist circumference and waist-to-hip ratio (as a measure of abdominal obesity) were positively associated with the risk of advanced prostate cancer disease. These data suggest that an increased risk of advanced prostate cancer is more strongly associated with abdominal adiposity than with body mass index. A computed tomography or magnetic resonance imaging scan are excellent techniques to distinguish and quantify subcutaneous and visceral fat. A future step would be to measure the activity of fat by collecting fat from different parts of the body (e.g. during a radical prostatectomy) and to determine the cytokine production of the fat cells collected from different locations. By linking these data with anthropometric data of the patient and its prostate cancer characteristics, a better insight might be gained in the exact role of obesity in prostate cancer. A first step is made by Finley et al.13 They recently investigated the periprostatic fat quality by analyzing the periprostatic fat and found that high levels of IL-6 correlated with tumor grade.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».