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北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (4): 636-643. doi: 10.19723/j.issn.1671-167X.2022.04.009

• 论著 • 上一篇    下一篇

代谢综合征与肾透明细胞癌患者预后的相关性

左美妮,杜依青,于路平,戴翔,徐涛*()   

  1. 北京大学人民医院泌尿外科，北京 10044
  • 收稿日期:2022-03-19 出版日期:2022-08-18 发布日期:2022-08-11
  • 通讯作者: 徐涛 E-mail:xutao@pkuph.edu.com
  • 基金资助:
    国家自然科学基金(81872086);北京大学人民医院研究与发展基金(RDY2018-18)

Correlation between metabolic syndrome and prognosis of patients with clear cell renal cell carcinoma

Mei-ni ZUO,Yi-qing DU,Lu-ping YU,Xiang DAI,Tao XU*()   

  1. Department of Urology, Peking University People's Hospital, Beijing 100044, China
  • Received:2022-03-19 Online:2022-08-18 Published:2022-08-11
  • Contact: Tao XU E-mail:xutao@pkuph.edu.com
  • Supported by:
    the National Natural Science Foundation of China(81872086);the Peking University People's Hospital Scientific Research Developments Funds(RDY2018-18)

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摘要：

目的: 探讨肾透明细胞癌(clear cell renal cell carcinoma，ccRCC)手术后患者中代谢综合征(metabolic syndrome，MetS)与ccRCC预后的相关性。方法: 选择2009年1月—2014年11月于北京大学人民医院行根治性肾切除术或部分肾切除术患者的病例资料进行回顾性分析，共收集到342例ccRCC患者，记录患者的临床资料和病理资料，以及治疗前的实验室检查结果。将患者分为合并MetS组及未合并MetS组，对两组患者的总生存期(overall survival，OS)、肿瘤特异性生存期(cancer-specific survival，CSS)和无进展生存期(progression-free survival，PFS)进行单变量Cox回归分析与亚组分析。对两组患者以及各亚组的OS、CSS以及PFS使用Kaplan-Meier法绘制生存曲线进行生存分析。结果: 单变量Cox回归分析发现，MetS是ccRCC术后OS [风险比(hazard ratio，HR)=0.551，95%CI：0.321~0.949，P=0.031]、CSS(HR=0.460，95%CI 0.234~0.905，P=0.025)以及PFS(HR=0.585，95%CI：0.343~0.998，P=0.049)的保护因素。在肿瘤直径≤4 cm的亚组，MetS与术后OS(HR= 0.857，95%CI：0.389~1.890，P=0.702)、CSS(HR=1.129，95%CI：0.364~3.502，P=0.833)以及PFS(HR=1.554，95%CI：0.625~3.864，P=0.343)无明显相关性。在肿瘤直径>4 cm的亚组，MetS是ccRCC术后OS(HR=0.377，95%CI：0.175~0.812，P=0.013)、CSS(HR=0.280，95%CI：0.113~0.690，P=0.006)以及PFS(HR=0.332，95%CI：0.157~0.659，P=0.002)的保护因素；肥胖是术后CSS(HR=0.464，95%CI：0.219~0.981，P=0.044)和PFS(HR=0.445，95%CI：0.238~0.833，P=0.011)的保护因素。Kaplan-Meier生存分析显示，合并MetS较未合并MetS的患者术后远期生存更佳，二者OS(P=0.029)、CSS(P=0.021)以及PFS(P=0.046)差异均具有统计学意义；对肿瘤直径≤4 cm的亚组，合并MetS与未合并MetS的ccRCC患者术后OS(P=0.702)、CSS(P=0.833)以及PFS(P=0.339)差异均无统计学意义；对肿瘤直径> 4 cm的亚组，合并MetS的患者OS(P=0.010)、CSS(P=0.003)以及PFS(P=0.001)均高于未合并MetS的患者。结论: MetS是ccRCC患者术后OS、CSS和PFS的保护因素，该现象在肿瘤直径>4 cm亚组中更为显著；MetS的组分中肥胖与ccRCC术后OS以及CSS相关。

关键词: 代谢综合征, 肾透明细胞癌, 总生存期, 肿瘤特异性生存期, 无进展生存期

Abstract:

Objective: To investigate the effects of MetS on the prognosis of patients with clear cell renal cell carcinoma (ccRCC). Methods: Clinical and pathological data and the laboratory test of ccRCC 342 patients with diverticular stones who underwent ccRCC who underwent radical or partial nephrectomy were retrospectively collected and analyzed.The patients were divided into MetS group and non-MetS group, and the subgroups were defined according to the tumor size. The overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) of the two groups were analyzed by univariate Cox analysis, and the subgroup analyses were also performed. Kaplan-Meier survival curve and survival analysis for OS, CSS, and PFS of the two groups and the subgroups were conducted. Results: Univariate Cox analysis showed that MetS was a protective factor of postoperative OS [hazard ratio (HR)=0.551, 95%CI: 0.321-0.949, P=0.031], CSS (HR=0.460, 95%CI: 0.234-0.905, P=0.025), and PFS (HR 0.585, 95%CI: 0.343-0.998, P=0.049) in the patients with ccRCC. In the subgroup with tumor size≤4 cm, MetS was not associated with postoperative OS (HR=0.857, 95%CI: 0.389-1.890, P=0.702), CSS (HR=1.129, 95%CI: 0.364-3.502, P=0.833), and PFS (HR=1.554, 95%CI: 0.625-3.864, P=0.343). In the subgroup with tumor size>4 cm, Mets was a protective factor of postoperative OS (HR=0.377, 95%CI: 0.175-0.812, P=0.013), CSS (HR=0.280, 95%CI: 0.113-0.690, P=0.006), and PFS (HR=0.332, 95%CI: 0.157-0.659, P=0.002); Obesity was a protective factor of postoperative CSS (HR=0.464, 95%CI: 0.219-0.981, P=0.044), and PFS (HR=0.445, 95%CI: 0.238-0.833, P=0.011). Kaplan-Meier survival analysis showed that the long-term survival of patients with MetS was better than those without MetS in OS (P=0.029), CSS (P=0.021), and PFS (P=0.046); for the subgroup with tumor size≤4 cm, there was no significant difference in postoperative OS (P=0.702), CSS (P=0.833), and PFS (P=0.339) between patients with and without MetS; For the subgroup with tumor size>4 cm, the OS (P=0.010), CSS (P=0.003), and PFS (P=0.001) of patients with MetS were better than those without MetS. Conclusion: MetS was a protective factor of postoperative OS, CSS, and PFS in the patients with ccRCC, which was more obvious in subgroup with tumor size>4 cm. And obesity, the component of MetS, was correlated with postoperative OS and CSS.

Key words: Metabolic syndrome, Clear cell renal cell carcinoma, Overall survival, Cancer-specific survival, Progression-free survival

中图分类号: 

  • R737

表1

肾透明细胞癌患者基础数据"

Variable non-MetS
(n=184)		 MetS
(n=158)		 P
Age/years, n(%) 0.009
     < 60 111 (60.33) 73 (46.20)
    ≥60 73 (39.67) 85 (53.80)
Gender, n(%) < 0.001
    Male 146 (79.35) 81 (51.27)
    Female 38 (20.65) 77 (48.73)
Smoking, n(%) 0.097
    No 116 (63.04) 113 (71.52)
    Yes 68 (36.96) 45 (28.48)
Clinical manifestation, n(%) 0.790
    Incidental 128 (69.57) 112 (70.89)
    Symptomatic 56 (30.43) 46 (29.11)
Tumor size, n(%) 0.846
    ≤4 cm 116 (63.04) 98 (62.03)
    >4 cm 68 (36.96) 60 (37.97)
T stage, n(%) 0.083
    T1-T2 167 (90.76) 151 (95.57)
    T3-T4 17(9.24) 7(4.43)
Tumor grade, n(%) 0.536
    1-2 164 (89.13) 144 (91.14)
    3-4 20 (10.87) 14 (8.86)

表2

预测总生存期的单因素Cox回归分析"

CovariatesOS CSS PFS
HR(95%CI) P HR(95%CI) P HR(95%CI) P
Age (≥ 60 years vs. < 60 years) 1.709 (1.013-2.885) 0.045 1.061 (0.570-1.973) 0.852 0.983 (0.589-1.640) 0.947
Gender (male vs. female) 2.075 (1.099-3.918) 0.024 1.634 (0.798-3.342) 0.179 1.754 (0.962-3.195) 0.067
Smoking (yes vs.no) 1.249 (0.735-2.124) 0.411 0.999 (0.515-1.936) 0.998 1.059 (0.617-1.816) 0.836
Clinical manifestation (symptomatic vs. incidental) 2.127 (1.267-3.571) 0.004 2.142 (1.149-3.996) 0.017 2.307 (1.381-3.853) 0.001
Tumor size (>4 cm vs.≤4 cm) 2.354 (1.399-3.961) 0.001 4.055 (2.062-7.975) < 0.001 3.895 (2.255-6.730) < 0.001
T stage (T3-T4 vs. T1-T2) 2.156 (0.977-4.759) 0.057 2.183 (0.854-5.582) 0.103 2.014 (0.914-4.440) 0.083
Tumor grade (3-4 vs. 1-2) 2.166 (1.122-4.182) 0.021 2.780 (1.323-5.840) 0.007 2.246 (1.166-4.326) 0.016
MetS (yes vs. no) 0.551 (0.321-0.949) 0.031 0.460 (0.234-0.905) 0.025 0.585 (0.343-0.998) 0.049
Obesity (yes vs. no) 0.511 (0.304-0.859) 0.011 0.532 (0.285-0.993) 0.048 0.629 (0.377-1.049) 0.075
Hypertension (yes vs. no) 0.887 (0.512-1.535) 0.667 0.820 (0.428-1.572) 0.550 0.949 (0.549-1.639) 0.851
Diabetes mellitus (yes vs. no) 1.262 (0.754-2.114) 0.376 1.045 (0.562-1.944) 0.890 0.839 (0.501-1.407) 0.506
Hyper TG (yes vs. no) 0.727 (0.357-1.481) 0.380 0.574 (0.225-1.465) 0.246 0.805 (0.408-1.589) 0.532
Low HDL-C (yes vs. no) 1.021 (0.579-1.799) 0.943 0.969 (0.492-1.908) 0.928 1.211 (0.673-2.177) 0.523

图1

代谢综合征与RCC患者预后的相关性分析"

表3

不同肿瘤直径亚组分析与OS"

CovariatesTumor size≤4 cm Tumor size>4 cm
HR(95%CI) P HR(95%CI) P
Age (≥ 60 years vs. < 60 years) 3.129 (1.306-7.494) 0.010 1.099 (0.553-2.182) 0.788
Gender (male vs. female) 2.943 (1.010-8.575) 0.048 1.596 (0.719-3.545) 0.251
Smoking (yes vs.no) 1.398 (0.628-3.113) 0.412 1.123 (0.551-2.287) 0.750
Clinical manifestation(symptomatic vs.incidental) 2.064 (0.890-4.787) 0.091 1.534 (0.770-3.054) 0.223
T stage (T3-T4 vs. T1-T2) 2.305 (0.541-9.815) 0.259 1.649 (0.634-4.288) 0.305
Tumor grade (3-4 vs. 1-2) 2.503 (0.855-7.327) 0.094 1.618 (0.701-3.736) 0.259
MetS (yes vs. no) 0.857 (0.389-1.890) 0.702 0.377 (0.175-0.812) 0.013
Obesity (yes vs. no) 0.517 (0.234-1.142) 0.103 0.506 (0.255-1.004) 0.051
Hypertension (yes vs. no) 0.905 (0.399-2.051) 0.811 0.734 (0.349-1.545) 0.416
Diabetes mellitus (yes vs. no) 1.879 (0.829-4.260) 0.131 1.069 (0.535-2.133) 0.851
Hyper TG (yes vs. no) 0.460 (0.138-1.539) 0.208 1.299 (0.534-3.157) 0.564
Low HDL-C (yes vs. no) 0.993 (0.428-2.305) 0.988 0.936 (0.434-2.019) 0.866

表4

不同肿瘤直径亚组分析与CSS"

CovariatesTumor size≤4 cm Tumor size>4 cm
HR(95%CI) P HR(95%CI) P
Age (≥ 60 years vs. < 60 years) 2.388 (0.719-7.930) 0.155 0.726 (0.340-1.550) 0.408
Gender (male vs. female) 1.113 (0.335-3.698) 0.861 1.906 (0.772-4.704) 0.162
Smoking (yes vs.no) 0.420 (0.092-1.919) 0.263 1.316 (0.616-2.811) 0.478
Clinical manifestation(symptomatic vs.incidental) 0.882 (0.193-4.027) 0.871 1.752 (0.828-3.707) 0.143
T stage (T3-T4 vs. T1-T2) 0.047 (0.000-24607) 0.649 2.011 (0.760-3.321) 0.159
Tumor grade (3-4 vs. 1-2) 2.853 (0.624-13.032) 0.176 2.054 (0.872-4.840) 0.100
MetS (yes vs. no) 1.129 (0.364-3.502) 0.833 0.280 (0.113-0.690) 0.006
Obesity (yes vs. no) 0.692 (0.223-2.148) 0.524 0.464 (0.219-0.981) 0.044
Hypertension (yes vs. no) 1.054 (0.317-3.505) 0.931 0.597 (0.275-1.294) 0.191
Diabetes mellitus (yes vs. no) 3.067 (0.830-11.335) 0.093 0.798 (0.369-1.730) 0.568
Hyper TG (yes vs. no) 0.317 (0.041-2.457) 0.272 0.947 (0.328-2.739) 0.921
Low HDL-C (yes vs. no) 1.356 (0.366-5.018) 0.648 0.727 (0.328-1.610) 0.431

表5

不同肿瘤直径亚组分析与PFS"

CovariatesTumor size≤4 cm Tumor size>4 cm
HR(95%CI) P HR(95%CI) P
Age (≥ 60 years vs. < 60 years) 1.642 (0.660-4.082) 0.286 0.750 (0.398-1.413) 0.374
Gender (male vs. female) 1.601 (0.576-4.445) 0.367 1.716 (0.817-3.606) 0.154
Smoking (yes vs.no) 0.393 (0.115-1.349) 0.138 1.483 (0.792-2.779) 0.218
Clinical manifestation(symptomatic vs.incidental) 1.586 (0.571-4.408) 0.376 1.656 (0.887-3.091) 0.113
T stage (T3-T4 vs. T1-T2) 0.047 (0.000-1409) 0.561 1.826 (0.806-4.141) 0.149
Tumor grade (3-4 vs. 1-2) 0.767 (0.102-5.750) 0.796 2.115 (1.033-4.330) 0.041
MetS (yes vs. no) 1.554 (0.625-3.864) 0.343 0.332 (0.157-0.659) 0.002
Obesity (yes vs. no) 1.182 (0.465-3.004) 0.726 0.445 (0.238-0.833) 0.011
Hypertension (yes vs. no) 1.137 (0.432-2.996) 0.794 0.691 (0.356-1.339) 0.273
Diabetes mellitus (yes vs. no) 2.229 (0.847-5.867) 0.104 0.586 (0.298-1.154) 0.122
Hyper TG (yes vs. no) 0.933 (0.310-2.811) 0.902 0.953 (0.399-2.276) 0.913
Low HDL-C (yes vs. no) 3.925 (0.906-17.004) 0.068 0.676 (0.349-1.312) 0.248

图2

不同肿瘤直径亚组中代谢综合征与RCC患者预后的相关性分析"

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