代谢综合征与膀胱癌分级和分期相关性的研究

Correlation of metabolic syndrome with tumor grade and stage of primary bladder carcinoma

目的：分析代谢综合征及其各组分与膀胱癌分级和分期的相关性。方法回顾性分析2010年10月至2013年10月我院收治的326例原发性膀胱癌患者的资料，包括年龄、性别、身高、体质量、血压、空腹血糖、肿瘤分级、分期。其中男262例，女64例，年龄23～89岁，平均66岁。复发75例。采用2009年TNM分期标准，将Ta、T1期作为低分期，T2、T3、T4期作为高分期。病理分级采用2004版世界卫生组织分级系统，将低度恶性潜能的尿路上皮乳头状瘤作为低级别。肿瘤分期为高分期和低分期者分别为85例和241例，高级别和低级别分别为171例和155例。高血压117例，糖尿病95例，体质指数≥25kg／m2（即肥胖）139例，代谢综合征49例。使用χ2检验对代谢综合征组与非代谢综合征组中膀胱癌复发、病理分期、分级的差异及肥胖、糖尿病、高血压与膀胱癌病理分期、分级的关系进行统计学分析。结果膀胱癌的病理分级和分期与代谢综合征有关（P＝0．001和P＝0．011），糖尿病和肥胖与膀胱癌的病理分级、分期有关（P＝0．006和P＜0．01）。结论膀胱癌合并代谢综合征患者的病理分级、分期较高，糖尿病和肥胖均可增加膀胱癌的病理分级和分期。

Objective To evaluate the relationship between metabolic syndrome , its components and the histopathological findings in bladder cancer patients .Methods The data of 326 patients in our department between October 2010 and October 2013 were retrospectively analyzed.Age, gender, stature, weight, histologic stage, grade, and the presence of hypertension , diabetes mellitus, body mass index （ BMI） were evaluated.There were 64 females, 262 males, aged 23-89 years, including 241 low stage, 85 high stage, 155 low grade, and 171 high grade, respectively.There were 117 cases with hypertension, 95 cases with diabetes mellitus , 139 cases with BMI ≥25 kg/m2 and 49 cases with metabolic syndrome.The TNM classification was used , with Ta and T1 tumor accepted as low stage , T2 , T3 and T4 tumor as high stage bladder cancer.In addition, the pathological grading system adopted by the 2004 World Health Organization was applied.Non-invasive papillary urothelial neoplasms of low malignant potential were regarded as low grade.Analyses were completed using Chi-square tests to evaluate the correlation of diabetes mellitus , hypertension and obesity with the pathologic stage and grade .Moreover , the pathologic stage , grade and recurrence were compared between metabolic syndrome and non-metabolic syndrome groups . Results Metabolic syndrome was significantly associated with histological grade and stage （P=0.001, P=0.011）. Diabetes mellitus and obesity were also associated with histological grade and stage （P=0.006, P〈0.01）. Conclusions Patients with metabolic syndrome were found to have significant higher T stage and grade of bladder cancer .Diabetes mellitus and obesity may promote the grading and staging of bladder cancer .