The online version of this article (doi:10.1186/s12916-017-0876-7) contains supplementary material, which is available to authorized users.
The relationship between body size and prostate cancer risk, and in particular risk by tumour characteristics, is not clear because most studies have not differentiated between high-grade or advanced stage tumours, but rather have assessed risk with a combined category of aggressive disease. We investigated the association of height and adiposity with incidence of and death from prostate cancer in 141,896 men in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.
Multivariable-adjusted Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). After an average of 13.9 years of follow-up, there were 7024 incident prostate cancers and 934 prostate cancer deaths.
Height was not associated with total prostate cancer risk. Subgroup analyses showed heterogeneity in the association with height by tumour grade (P heterogeneity = 0.002), with a positive association with risk for high-grade but not low-intermediate-grade disease (HR for high-grade disease tallest versus shortest fifth of height, 1.54; 95% CI, 1.18–2.03). Greater height was also associated with a higher risk for prostate cancer death (HR = 1.43, 1.14–1.80). Body mass index (BMI) was significantly inversely associated with total prostate cancer, but there was evidence of heterogeneity by tumour grade (P heterogeneity = 0.01; HR = 0.89, 0.79–0.99 for low-intermediate grade and HR = 1.32, 1.01–1.72 for high-grade prostate cancer) and stage (P heterogeneity = 0.01; HR = 0.86, 0.75–0.99 for localised stage and HR = 1.11, 0.92–1.33 for advanced stage). BMI was positively associated with prostate cancer death (HR = 1.35, 1.09–1.68). The results for waist circumference were generally similar to those for BMI, but the associations were slightly stronger for high-grade (HR = 1.43, 1.07–1.92) and fatal prostate cancer (HR = 1.55, 1.23–1.96).
The findings from this large prospective study show that men who are taller and who have greater adiposity have an elevated risk of high-grade prostate cancer and prostate cancer death.
Additional file 1: Table S1. List of all of the local ethics committees for the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Table S2. Distribution of cases by tumour grade in men from the EPIC study. Table S3. Baseline characteristics of participants according to fifths of height at recruitment in men from the EPIC study. Table S4. Baseline characteristics of participants according to fifths of waist circumference at recruitment in men from the EPIC study. Table S5. Distribution of study participants and prostate cancer cases by country. Table S6. Multivariable-adjusted hazard ratios (95% CI) for prostate cancer in relation to hip circumference and waist to hip ratio (WHR) at recruitment in men from the EPIC study. Table S7. Multivariable-adjusted hazard ratios (95% CI) for prostate cancer in relation to BMI, waist circumference and WHR using the WHO cut-off points at recruitment in men from the EPIC study. Table S8. Stratified and sensitivity analyses. Multivariable-adjusted hazard ratios (95% CI) for high-grade prostate cancer and death from prostate cancer in relation to height (per 10 cm unit increase) at recruitment in men from the EPIC study. Table S9. Stratified and sensitivity analyses. Multivariable-adjusted hazard ratios (95% CI) for high-grade prostate cancer and death from prostate cancer in relation to BMI (per 5 kg/m2 unit increase) at recruitment in men from the EPIC study. Table S10. Stratified and sensitivity analyses. Multivariable-adjusted hazard ratios (95% CI) for high-grade prostate cancer and death from prostate cancer in relation to waist circumference (per 10 cm unit increase) at recruitment in men from the EPIC study. (DOCX 63 kb)12916_2017_876_MOESM1_ESM.docx
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- Tall height and obesity are associated with an increased risk of aggressive prostate cancer: results from the EPIC cohort study
Paul N. Appleby
Konstantinos K. Tsilidis
H. Bas Bueno-de-Mesquita
J. Ramón Quirós
Julie A. Schmidt
Timothy J. Key
Ruth C. Travis
- BioMed Central
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