代谢相关因素与肾细胞癌分级、分期的相关研究

摘要

目的：探讨肾细胞癌患者代谢相关因素与分级、分期等肿瘤病理学特征的相关性。方法：回顾性分析2009年1月至2015年1月期间在北京大学人民医院泌尿外科经手术后病理确诊的382例肾癌患者的病历资料，采用 t 检验、秩和检验和 Logistic 回归分析等多种统计学方法，分析常用代谢相关指标（体重、体质指数、腰围、血压、血糖、血清甘油三酯、胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇）与肾癌分级、分期及肿瘤直径的相关性。结果：382例患者中80例（20．94％）为高级别肿瘤，63例（16．49％）为进展性肿瘤，153例（40．05％）肿瘤直径＞4 cm。与低级别肿瘤组相比，高级别肿瘤组患者的高密度脂蛋白胆固醇水平较低（P ＝0．015）；进展性肿瘤患者与局限性患者相比具有较低的体质指数（P ＝0．022）、血清胆固醇（P ＝0．005）和高密度脂蛋白胆固醇（P ＝0．006）；肿瘤直径＞4 cm 组的患者则具有较低的低密度脂蛋白胆固醇水平（P ＝0．030）。Logistic 回归分析显示，体质指数（OR ＝0．906，95％CI：0．852～0．986，P ＝0．023）、血清胆固醇（OR ＝0．660，95％CI：0．492～0．884，P ＝0．005）与肿瘤分期相关，高密度脂蛋白胆固醇与肿瘤分级（OR ＝0．293，95％CI：0．108～0．797，P ＝0．016）和分期（OR ＝0．204，95％CI：0．065～0．635，P ＝0．006）均相关，低密度脂蛋白胆固醇与肿瘤直径相关（OR ＝0．756，95％CI：0．586～0．975，P ＝0．031）。结论：代谢相关因素尤其是肥胖和血脂水平与肾癌分级、分期等组织病理学特征关系密切。%Objective:To investigate the association between metabolic factors,such as obesity,blood pressure,blood glucose,serum lipid profile,and the histopathological characteristics of renal cell carci-noma.Methods:The medical records of 382 consecutive renal cell carcinoma patients who underwent radical or partial nephrectomy at Peking University People’s Hospital from January 2009 to January 2015 were retrospectively reviewed.Metabolic factors were collected from the records,including weight,body mass index,waist circumstance,blood pressure,fasting blood glucose,serum total triglyceride,serum total cholesterol,serum low-density lipoprotein-cholesterol and serum high-density lipoprotein-cholesterol. The patients were divided into different groups according to tumor grade,stage and diameter.Statistics analysis,such as t test,Mann-Whitney U test and Logistic analysis,were performed to investigate the as-sociation between metabolic factors and grade,stage and tumor diameter of renal cell carcinoma.Re-sults:A total of 80 (20.94%)of the tumors were classified as high grade disease,63 (16.49%)were classified as advanced disease and 153 (40.05%)tumor diameter more than 4 cm.The patients in high grade group were found to have lower high-density lipoprotein-cholesterol level than in low grade group (P =0.015),body mass index,total cholesterol and high-density lipoprotein-cholesterol were found to be lower in advanced disease than in localized disease (P =0.022,P =0.005 and P =0.006,respec-tively),and low-density lipoprotein-cholesterol was found to be lower in larger tumors (P =0.030). Other factors were comparable between the different groups.The results of Logistic analyses showed that, body mass index (OR =0.906,95%CI:0.852 -0.986,P =0.023)and total cholesterol (OR =0.660,95%CI:0.492 -0.884,P =0.005)were associated with the tumor stage,high-density lipopro-tein-cholesterol level was significantly associated with tumor grade (OR =0.293,95% CI:0.108 -0.797,P =0.016)and stage (OR =0.204,95%CI:0.065 -0.635,P =0.006),and low-density lipoprotein-cholesterol level was significantly associated with tumor diameter (OR =0.756,95% CI:0.586 -0.975,P =0.031).Conclusion:The results of our study indicate that metabolic factors,espe-cially obesity and serum lipid profile,are closely related with the histopathological characteristics of renal cell carcinoma.