代谢综合征与肾透明细胞癌患者预后的相关性

doi:10.19723/j.issn.1671-167X.2022.04.009

Abstract

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

CLC Number:

R737

Mei-ni ZUO,Yi-qing DU,Lu-ping YU,Xiang DAI,Tao XU. Correlation between metabolic syndrome and prognosis of patients with clear cell renal cell carcinoma[J].Journal of Peking University (Health Sciences), 2022, 54(4): 636-643.

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References 27

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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)

Covariates	OS		CSS		PFS
Covariates	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

Covariates	Tumor size≤4 cm		Tumor size>4 cm
Covariates	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

Covariates	Tumor size≤4 cm		Tumor size>4 cm
Covariates	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

Covariates	Tumor size≤4 cm		Tumor size>4 cm
Covariates	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

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

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