Association between Visceral Obesity and Tumor Grade in Middle-aged and Elderly Patients with Renal Cell Carcinoma
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摘要:
目的 探讨中老年肾癌患者内脏型肥胖与肿瘤病理学分级的相关性。 方法 回顾性分析2009年1月至2014年9月北京大学人民医院278例经病理证实的中老年(年龄≥ 50岁)肾癌患者资料。采用术前脐平面CT平扫进行内脏脂肪、皮下脂肪和总脂肪含量测定。内脏型肥胖以内脏脂肪占总脂肪的百分比表示。应用Logistic回归分析方法进行统计学分析, 评估临床常用指标及肥胖评估指标与高级别肾癌风险肿瘤分级的相关性。 结果 278例肾癌患者中, 29例(10.43%)为高级别肿瘤。与低级别肿瘤组相比, 高级别肿瘤组内脏型肥胖患者比例较高[(47.80±8.33)%比(43.24±10.24)%, P=0.022], 肿瘤直径较大[(5.42±2.99)cm比(4.11±2.27)cm, P=0.021], 但体质量指数、总脂肪含量、内脏脂肪含量和皮下脂肪含量在两组间无明显差异。Logistic回归分析提示, 内脏型肥胖与较高的肿瘤分级相关(OR=1.045, 95% CI:1.002~1.090, P=0.042)。亚组分析显示, 在进展性肾癌和肿瘤直径较大(>4 cm)的病例中, 内脏型肥胖与肿瘤分级相关(OR=1.131, 95% CI:1.017~1.256, P=0.023;OR=1.061, 95% CI:1.005~1.121, P=0.032), 而在局限性肾癌和肿瘤直径较小(≤ 4 cm)的病例中未观察到该现象。 结论 在中老年肾癌患者中, 尤其是进展性肾癌和肿瘤直径较大的患者中, 内脏型肥胖与肿瘤分级相关, 内脏型肥胖可能是高级别肾癌的危险因素。 Abstract:Objective In this retrospective study, we investigated whether visceral obesity is associated with Fuhrman grade in middle-aged and elderly patients with renal cell carcinoma. Methods Medical records of 278 middle-aged and elderly patients who underwent radical or partial nephrectomy at Peking University People's Hospital from January 2009 to September 2014 were retrospectively reviewed. The quantities of visceral, subcutaneous and total adipose tissue were measured with pre-operative computed tomography scans at the level of umbilicus. Visceral obesity was indicated by the percentage of visceral adipose tissue. The logistic regression analysis was used to determine the risk factor of high grade disease(Fuhrman grade Ⅲ or Ⅳ). Results A total of 29(10.43%) tumors were classified as high-grade disease. Patients in high-grade group were found to have a higher percentage of visceral adipose tissue(P=0.022) and a larger tumor size(P=0.021). However, body mass index, total adipose tissue, visceral adipose tissue, and subcutaneous adipose tissue were comparable between low-grade and high-grade groups. The result of logistic analysis showed that visceral obesity was associated with high-grade tumors(OR=1.045, 95% CI:1.002-1.090, P=0.042). In the subgroup analysis, the percentage of visceral adipose tissue was associated with Fuhrman grade in advanced patients(OR=1.131, 95% CI:1.017-1.256, P=0.023) or patients with a larger tumor(OR=1.061, 95% CI:1.005-1.121, P=0.032), but not in patients with an organ-confined disease or a smaller tumor. Conclusions Visceral obesity was associated with higher Furhman grade in middle-aged and elderly patients with renal cell carcinoma, especially in patients with an advanced disease or a larger tumor. Vesceral obesity may be the risk factor of high-grade renal cell carcinoma. -
Key words:
- renal cell carcinoma /
- Furhman grade /
- obesity
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表 1 278例肾癌患者一般资料
临床资料 数值 年龄(x±s,岁) 63.55±8.80 性别[n(%)] 男 183(65.83) 女 95(34.17) 吸烟史[n(%)] 有 91(32.73) 无 187(67.27) 身高(x±s, cm) 166.86±7.80 体重(x±s, kg) 69.73±11.42 BMI (x±s, kg/m2) 25.06±3.47 <23 89(32.01) 23~<25 63(22.66) ≥25 126(45.32) TAT(x±s, mm2) 15 812.13±5965.03 VAT(x±s, mm2) 6891.80±2914.86 SAT(x±s, mm2) 8920.33±3949.61 VAT% 43.72±10.14 SAT% 56.31±10.16 肿瘤直径(x±s, cm) 4.25±2.38 组织学分型[n(%)] 透明细胞癌 267(96.04) 非透明细胞癌 17(6.12) Fuhrman分级[n(%)] Ⅰ 109(39.21) Ⅱ 140(50.36) Ⅲ 22(7.91) Ⅳ 7(2.52) BMI:体质量指数;TAT:总脂肪;VAT:内脏脂肪;SAT:皮下脂肪 表 2 两组肾癌患者临床资料比较
临床特征 低级别肿瘤(n=249) 高级别肿瘤(n=29) P值 年龄(x±s,岁) 63.48±8.69 64.14±9.82 0.753 性别[n(%)] 0.106 男 160(64.26) 23 (79.31) 女 89(35.74) 6 (20.69) 吸烟史[n(%)] 0.059 有 77(30.92) 14(48.28) 无 172(69.08) 15(51.72) 身高(x±s,cm) 166.70±7.97 168.46± 5.85 0.344 体重(x±s,kg) 69.81±11.43 69.06± 11.51 0.746 BMI (x±s,kg/m2) 25.13±3.49 24.39± 3.24 0.324 TAT(x±s,mm2) 15 929.48± 6030.99 14 804.52±5354.46 0.337 VAT(x±s,mm2) 6867.56± 2928.13 7099.93±2839.55 0.685 SAT(x±s,mm2) 9061.92± 4024.21 7704.59±3029.74 0.080 VAT%(x±s) 43.24±10.24 47.80±8.33 0.022 SAT%(x±s) 56.78±10.26 52.20±8.33 0.021 肿瘤直径(x±s,cm) 4.11±2.27 5.42±2.99 0.021 BMI、TAT、VAT、SAT:同表 1 表 3 29例高级别肿瘤患者与临床指标相关性回归分析结果
变量 单因素分析 多因素分析 Wald值 OR值(95% CI) P值 Wald值 OR值(95% CI) P值 年龄 0.145 1.008(0.966~1.053) 0.704 - - - 性别 2.519 2.132(0.837~5.432) 0.112 - - - 吸烟史 3.440 2.085(0.959~4.531) 0.064 1.888 1.757(0.786~3.924) 0.169 BMI 0.977 0.939(0.829~1.064) 0.323 - - - TAT 0.926 0.997(0.990~1.003) 0.336 - - - VAT% 5.171 1.048(1.007~1.091) 0.023 4.123 1.045(1.002~1.090) 0.042 SAT% 5.199 0.954(0.916~0.993) 0.023 - - - 肿瘤直径 7.059 1.202(1.049~1.376) 0.008 7.041 1.202(1.049~1.377) 0.008 BMI、TAT、VAT、SAT:同表 1 表 4 29例高级别肿瘤患者根据AJCC分期分层后与临床指标相关性回归分析结果
变量 局限性肾癌 进展性肾癌 Wald值 OR值(95% CI) P值 Wald值 OR值(95% CI) P值 年龄 0.119 1.010(0.956~1.066) 0.730 0.188 1.018(0.940~1.102) 0.665 性别 1.613 2.100(0.668~6.598) 0.204 0.171 1.440(0.256~8.096) 0.679 吸烟史 2.762 2.273(0.863~5.985) 0.097 0.519 1.667(0.415~6.692) 0.471 BMI 0.918 0.927(0.793~1.083) 0.338 0.071 1.029(0.834~1.268) 0.790 TAT 2.055 0.994(0.986~1.002) 0.152 0.870 1.006(0.994~1.017) 0.351 VAT% 0.790 1.022(0.974~1.072) 0.374 5.205 1.131(1.017~1.256) 0.023 SAT% 0.805 0.978(0.933~1.026) 0.370 5.205 0.884(0.796~0.983) 0.023 AJCC:美国癌症联合会;BMI、TAT、VAT、SAT:同表 1 表 5 29例高级别肿瘤患者根据肿瘤大小分层后与临床指标相关性回归分析结果
变量 肿瘤直径≤4 cm 肿瘤直径>4 cm Wald值 OR值(95% CI) P值 Wald值 OR值(95% CI) P值 年龄 0.681 1.030(0.961~1.104) 0.409 0.010 0.997(0.943~1.055) 0.922 性别 1.728 2.835(0.599~13.408) 0.189 0.484 1.754(0.531~5.799) 0.357 吸烟史 1.912 2.304(0.706~7.524) 0.167 1.435 1.892(0.666~5.374) 0.231 BMI 0.104 1.033(0.848~1.259) 0.747 2.199 0.878(0.739~1.043) 0.138 TAT 0.032 1.001(0.992~1.010) 0.859 2.246 0.993(0.984~1.002) 0.134 VAT% 1.112 1.034(0.972~1.100) 0.292 4.599 1.061(1.005~1.121) 0.032 SAT% 1.129 0.967(0.909~1.029) 0.288 4.599 0.942(0.892~0.995) 0.032 BMI、TAT、VAT、SAT:同表 1 -
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