代谢综合征及其代谢组分与T1期高级别膀胱癌的预后关系

Association between the metabolic syndrome and T1 high grade urothelial carcinoma of the bladder

目的探讨代谢综合征（metabolic syndrome, MS）及其各组分与T1期高级别膀胱癌的预后关系。 方法回顾性分析2010年1月至2014年6月收治的200例原发性T1期高级别膀胱癌患者的临床资料，男155例，女45例。年龄24～86岁，平均66岁。根据病史或血糖水平将患者分为糖尿病组41例（20.5%）和非糖尿病组159例（79.5%）；根据体重指数（body mass index，BMI）分为肥胖组（≥25 kg/m2）98例（49.0%）和非肥胖组（〈25 kg/m2）102例（51.0%）；根据血压水平分为高血压组71例（35.5%）和非高血压组129例（64.5%）。分析MS及其各组分与膀胱肿瘤复发、进展的关系，应用Kaplan-Meier法评价MS及其各组分对肿瘤无进展生存期（progress-free survival，PFS）及无复发生存期（recurrence-free survival，RFS）的影响，用Cox回归模型多因素分析评价MS及其各组分与膀胱癌PFS及RFS的关系。 结果本组200例中，16例（8.0%）伴MS。肿瘤复发121例（60.5%），进展84例（42.0%）。糖尿病组与非糖尿病组患者的平均RFS分别为21.7个月和29.3个月，差异有统计学意义（χ2＝10.115，P＝0.001）；平均PFS分别为32.8个月和39.8个月，差异有统计学意义（χ2＝14.760，P〈0.001）。肥胖组与非肥胖组的平均RFS分别为34.7个月和42.0个月，差异有统计学意义（χ2＝16.077，P〈0.001）；平均PFS分别为22.8个月和32.6个月，差异有统计学意义（χ2＝16.174，P〈0.001）。MS组与非MS组的平均RFS分别为21.5个月和28.4个月，差异有统计学意义（χ2＝5.429，P＝0.02）；平均PFS分别为35.1个月和38.7个月，差异有统计学意义（χ2＝3.854，P〈0.05）。Cox多因素生存分析显示糖尿病、肥胖可增加T1期高级别膀胱癌复发（HR＝0.559, P〈0.001; HR＝0.492, P〈0.001）和进展（HR＝1.792, P＝0.013; HR＝2.498, P〈0.001）的风险。 结论糖尿病、肥胖是T1期高级别膀胱尿路上皮癌复发、进展的高危因素，而MS与T1期高级别膀胱尿路上皮癌的预后无关。

Objective To summarize the relationship between metabolic syndrome （MS）, its components and T1 stage with high grade urothelial carcinoma （ HGUC ） of the Bladder. Methods The clinical data of 200 patients with T~ high grade bladder cancer who were admitted to our hospital from January 2010 to June 2014 were retrospectively analyzed, including 155 males and 45 females. Ages were 24 to 86 years old, average 66 years old. Based on the history or blood glucose levels, patients were divided into diabetic group （n = 41 ） （20. 5% ） and non diabetes group 159 cases （79.5%） ; According to the body mass index （BMI） were divided into obese group （ t〉 25 kg / m2） of 98 cases （49.0%） and non obese group （ 〈 25 kg / m2 ） of 102 cases （51.0%）. According to the blood pressure level, 71 cases （35.5%） were divided into hypertension group and 129 cases of non hypertension group （ 64. 5% ）. MS and its components and the relationship between the recurrence and progress of bladder cancer were analyzed. The Kaplan Meier method was used to assess MS and its components division of tumor progression free smwival （progress-free survival, PFS） and recurrence free survival （recurrence-free survival, RFS） influence. Cox regression model of multi factor analysis were used to evaluate the PFS and RFs of MS and its components with bladder cancer. Results Of the 200 cases, 16 cases （8.0%） were MS. Tumor recurrence occurred in 121 cases （60. 5% ）, and 84 patients （42.0%） were in progress. Diabetes and non diabetes groups the average RFs were 21.7 and 29. 3 months respectively, and the difference was statistically significant （X2 = 10. 115, P = 0. 001 ） ; The median PFS were 32. 8 and 39. 8 months respectively, the difference has statistical significance （ X2 = 14. 760, P 〈 0. 001 ）. Obese group and non obese group average RFs were 34. 7 and 42. 0 months respectively, and the difference were statistically significant （ X2 = 16. 077, P 〈 0. 001 ） ; The median PFS were 22. 8 and 32. 6 months respectively, the difference was statistically significant （X2 = 16. 174, P 〈 0. 001 ）. The average RFS of MS group and non MS group were 21.5 and 28. d months respectively, the difference was statistically significant （ X2 = 5.429, P = 0. 02） ; the average PFS was 35.1 and 38. 7 months respectively, and the difference was statistically significant （ ~z = 3. 854, P 〈 0. 05 ）. Cox multivariate survival analysis showed that diabetes and obesity can increase the risk of recurrence and progression of T1 advanced stage bladder cancer （HR = 1. 792, P =0. 013, HR =2. 498, P 〈0. 001 ; HR = 0. 559, P 〈 0. 001 ; HR = 0. 492, P 〈 0. 001 ）. Conclusions Diabetes mellitus and obesity are high risk factors for the recurrence and progression of T1 advanced stage bladder cancer, but MS is not related to the prognosis of T1 patients with advanced bladder cancer.