Donat S Machele, Salzhauer Elan W, Mitra Nandita, Yanke Brent V, Snyder Mark E, Russo Paul
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
J Urol. 2006 Jan;175(1):46-52. doi: 10.1016/S0022-5347(05)00054-6.
Population studies link increased BMI with an increased risk of cancer and cancer mortality and in particular a greater risk of RCC. We evaluated the impact of BMI and other clinical/pathological characteristics on survival in patients with RCC treated with radical or partial nephrectomy.
Between 1995 and 2003 patients undergoing radical (760) or partial (399) nephrectomy for RCC were entered into a database. BMI data were available on 1,137 of 1,159 (98%). Demographic and clinical/pathological parameters were analyzed. World Health Organization BMI definitions (normal-less than 25 kg/m(2), overweight-25 to 29.9 kg/m(2), obese-30 kg/m(2) or more) were used.
A total of 75% of patients had greater than normal BMI with 472 (41.5%) overweight and 387 (34.0%) obese. Median followup was 33 months with a median overall survival of 110 months and a 5-year overall survival probability of 0.79. BMI categories were similar in age, gender, smoking status, presenting symptoms, tumor size, stage, and type of surgery. Significant increases in blood loss and operative time (p <0.05) were seen with increasing BMI. Although BMI 30 kg/m(2) or greater was associated with a higher proportion of clear cell histology (p = 0.002), it did not translate into an increased pathological stage, or incidence of metastasis. Multivariate analysis revealed age older than 65 years, systemic symptoms, surgery type, and pathological stage impacted overall survival (p <0.05).
Although an increased BMI was associated with a greater proportion of clear cell histology, comorbidity, and surgical morbidity, BMI did not adversely impact overall or progression-free survival.
人群研究表明，体重指数（BMI）升高与癌症风险及癌症死亡率增加相关，尤其是肾细胞癌（RCC）风险更高。我们评估了BMI及其他临床/病理特征对接受根治性或部分肾切除术的RCC患者生存情况的影响。
1995年至2003年间，因RCC接受根治性肾切除术（760例）或部分肾切除术（399例）的患者被纳入数据库。1159例患者中有1137例（98%）有BMI数据。对人口统计学和临床/病理参数进行分析。采用世界卫生组织的BMI定义（正常：低于25kg/m²，超重：25至29.9kg/m²，肥胖：30kg/m²及以上）。
共有75%的患者BMI高于正常，其中472例（41.5%）超重，387例（34.0%）肥胖。中位随访时间为33个月，中位总生存期为110个月，5年总生存概率为0.79。不同BMI类别在年龄、性别、吸烟状况、临床表现、肿瘤大小、分期及手术类型方面相似。随着BMI增加，失血量和手术时间显著增加（p<0.05）。虽然BMI≥30kg/m²与透明细胞组织学比例较高相关（p = 0.002），但这并未转化为病理分期增加或转移发生率升高。多因素分析显示，年龄大于65岁、全身症状、手术类型及病理分期影响总生存期（p<0.05）。
虽然BMI升高与透明细胞组织学比例较高、合并症及手术并发症相关，但BMI并未对总生存期或无进展生存期产生不利影响。
