血脂代谢异常和肥胖患者发生高危前列腺癌的风险可能更高

Effects of dyslipidemia and obesity on high-risk prostate cancer

目的探讨血脂代谢异常和肥胖因素是否影响高危前列腺癌的发生,旨在为前列腺癌的防治提供参考。方法回顾性分析石河子大学第二附属医院(新疆生产建设兵团医院)泌尿外科2016年6月—2022年6月收治的175例前列腺癌患者的临床资料,其中高危前列腺癌组122例,非高危前列腺癌组53例。采用logistic回归分析影响高危前列腺癌发生的独立危险因素,通过受试者工作特征(ROC)曲线评估年龄、胆固醇、身体质量指数(BMI)、前列腺特异性抗原(PSA)等风险因素对高危前列腺癌发生的预测价值及最佳截断值。采用Spearman分析Gleason评分与不同风险因素间的相关性。结果高危前列腺癌组的年龄、BMI、胆固醇水平、PSA水平、肥胖(BIM≥25)及高胆固醇占比均高于非高危前列腺癌组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示年龄(OR=1.097,95%CI:1.005~1.198,P=0.039)、肥胖(OR=4.459,95%CI:1.305~15.239,P=0.017)、PSA(OR=1.170,95%CI:1.069~1.280,P=0.001)、高胆固醇(OR=5.544,95%CI:1.304~23.577,P=0.020)是高危前列腺癌发生的危险因素。ROC曲线显示年龄、胆固醇、BMI、PSA最佳截断值分别为74.50岁(AUC:0.748,95%CI:0.678~0.818)、3.70 mmol/L(AUC:0.800,95%CI:0.731~0.870)、24.97(AUC:0.621,95%CI:0.532~0.711)、18.67 ng/mL(AUC:0.864,95%CI:0.813~0.916),且年龄、胆固醇、BMI、PSA 4项指标联合预测高危前列腺癌的价值最高(AUC:0.931,95%CI:0.895~0.967)。Spearman分析发现前列腺癌患者的年龄(r=0.464,P<0.001)、BMI(r=0.222,P=0.003)、胆固醇(r=0.501,P<0.001)、PSA(r=0.473,P<0.001)与Gleason评分呈正相关。结论肥胖、年龄、PSA及胆固醇水平是高危前列腺癌发生的影响因素,且当患者的年龄≥74.50岁、胆固醇≥3.70 mmol/L、BMI≥24.97、PSA≥18.67 ng/mL时发生高危前列腺癌的可能性更高。

Objective To explore the effects of dyslipidemia and obesity on high-risk prostate cancer,so as to provide reference for the prevention and treatment of prostate cancer.Methods The clinical data of 175 patients with prostate cancer admitted to our hospital during Jun.2016 and Jun.2022 were retrospectively analyzed,including 122 high-risk prostate cancer and 53 non-high-risk prostate cancer.The logistic regression analysis were conducted to identify independent risk factors affecting the occurrence of high-risk prostate cancer.Evaluate the predictive value and optimal cutoff value of risk factors such as age,cholesterol,body mass index(BMI),and prostate-specific antigen(PSA)for the occurrence of high-risk prostate cancer through receiver operating characteristic(ROC)curves.Spearman analysis was used to investigate the correlation between Gleason scores and different risk factors.Results The age,BMI,cholesterol,PSA,incidence of obesity(BIM≥25)and high cholesterol in the high-risk prostate cancer group were all higher than those in the non-high-risk prostate cancer group(P<0.05).Multivariate logistic regression showed that age(OR=1.097,95%CI:1.005-1.198,P=0.039),obesity(OR=4.459,95%CI:1.305-15.239,P=0.017),PSA(OR=1.170,95%CI:1.069-1.280,P=0.001),and cholesterol(OR=5.544,95%CI:1.304-23.577,P=0.020)were risk factors for high-risk prostate cancer.The ROC curve showed that the optimal cutoff values for age,cholesterol,BMI,and PSA were 74.50 years(AUC:0.748,95%CI:0.678-0.818),3.70 mmol/L(AUC:0.800,95%CI:0.731-0.870),24.97(AUC:0.621,95%CI:0.532-0.711),and 18.67 ng/mL(AUC:0.864,95%CI:0.813-0.916),respectively,and the combined prediction value of age,cholesterol,BMI,and PSA for high-risk prostate cancer was the highest(AUC:0.931,95%CI:0.895-0.967).The age(r=0.464,P<0.001),BMI(r=0.222,P=0.003),cholesterol(r=0.501,P<0.001),and PSA(r=0.473,P<0.001)were positively correlated with Gleason by Spearman analysis.Conclusion Obesity,age,PSA,and cholesterol level are independent risk factors for high-risk prostate cancer.When the age is≥74.50 years,cholesterol level is≥3.70 mmol/L,BMI is≥24.97,PSA level is≥18.67 ng/mL,the possibility of developing high-risk prostate cancer is high.