Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
J Urol. 2011 Jun;185(6):2040-4. doi: 10.1016/j.juro.2011.01.079. Epub 2011 Apr 15.
We explored the relationship between urinary total arsenic and risk of renal cell carcinoma, and investigated whether having hypertension or a low estimated glomerular filtration rate would modify the risk of renal cell carcinoma.
The case-control study was conducted between November 2006 and May 2009 with 132 patients with renal cell carcinoma, and 260 sex and age matched controls from a hospital based pool. Pathological verification of renal cell carcinoma was completed by image guided biopsy or surgical resection of renal tumors. Urinary arsenic species, including inorganic arsenic, monomethylarsonic acid and dimethylarsinic acid, were determined with a high performance liquid chromatography linked hydride generator and atomic absorption spectrometry. Estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease Study equation.
Urinary total arsenic was significantly associated with renal cell carcinoma risk in a dose-response relationship after multivariate adjustment. Low estimated glomerular filtration rate or hypertension was significantly related to renal cell carcinoma risk. Estimated glomerular filtration rate was significantly negatively related with urinary total arsenic. A significant interaction was seen between the urinary total arsenic and hypertension on renal cell carcinoma risk. The greatest odds ratio (6.01) was seen in the subjects with hypertension, low estimated glomerular filtration rate and high urinary total arsenic. A trend test indicated that the risk of renal cell carcinoma increased along with the accumulating number of these 3 risk factors (p <0.0001).
Higher urinary total arsenic level was a strong predictor of renal cell carcinoma, and estimated glomerular filtration rate or hypertension interacts with urinary total arsenic in modifying the risk of renal cell carcinoma.
我们探讨了尿总砷与肾细胞癌风险之间的关系，并研究了高血压或低估计肾小球滤过率是否会改变肾细胞癌的风险。
该病例对照研究于 2006 年 11 月至 2009 年 5 月期间进行，共纳入 132 例肾细胞癌患者和 260 例性别和年龄匹配的医院队列对照。肾细胞癌的病理验证通过图像引导活检或肾肿瘤切除术完成。采用高效液相色谱-氢化物发生原子吸收光谱法测定尿砷形态，包括无机砷、一甲基砷酸和二甲基砷酸。采用改良肾脏病饮食研究方程计算估计肾小球滤过率。
经多变量调整后，尿总砷与肾细胞癌风险呈剂量反应关系，与肾细胞癌风险显著相关。低估计肾小球滤过率或高血压与肾细胞癌风险显著相关。估计肾小球滤过率与尿总砷呈显著负相关。尿总砷与高血压对肾细胞癌风险的交互作用有显著差异。在高血压、低估计肾小球滤过率和高尿总砷的患者中，比值比（OR）最大（6.01）。趋势检验表明，随着这 3 个危险因素的累积，肾细胞癌的风险增加（p<0.0001）。
较高的尿总砷水平是肾细胞癌的强烈预测因子，估计肾小球滤过率或高血压与尿总砷相互作用，改变肾细胞癌的风险。
