Qu Yuan-yuan, Dai Bo, Chang Kun, Kong Yun-yi, Gu Cheng-yuan, Zhang Gui-ming, Wan Fang-ning, Wang Hong-kai, Zhang Hai-liang, Zhu Yao, Ye Ding-wei
Department of Urology, Cancer Hospital of Fudan University, Shanghai 200032, China.
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Zhonghua Wai Ke Za Zhi. 2013 Dec;51(12):1089-93.
To investigate the influence of anthropometric measures of obesity, including body mass index (BMI), abdominal subcutaneous adipose tissue and visceral adipose tissue, on pathological characteristics in patients with clinically localized prostate cancer.
From January 2006 to March 2013, the 413 patients of prostate cancer who received radical prostatectomy (RP) and their clinical and pathological data had been collected. The median age for the entire cohort was 68 years, which ranged from 48 to 78 years. All patients were diagnosed with prostate cancer before surgery and the Gleason score ranged from 4 to 10 (median 7). Anthropometric measures of abdominal adiposity including anterior abdominal fat, posterior abdominal fat and anteroposterior diameter were measured from the T2 weighted sagittal localization images of MRI scans and subcutaneous adipose tissue and the percentage of visceral adipose tissue were calculated. The patients' clinical and pathologic characteristics across BMI groups were compared used Student's t test for continuous variables or chi-squared test for categorical variables. Moreover, univariable and multivariable logistic regression models were used to address the influence of anthropometric measures of obesity on pathological outcomes.
The BMI ranged from 14.2 to 34.0 kg/m(2) and the median value was 23.8 kg/m(2). The abdominal subcutaneous adipose tissue ranged from 12.6 to 60.3 mm and the median value was 31.4 mm. The percentage of visceral adipose tissue ranged from 71.1% to 92.1% and the median value was 83.8%. In RP specimens, Gleason score ≥ 8 was observed in 141 patients (34.1%), pathological tumor stage was T3a in 69 patients (16.7%) and pathological tumor stage was T3b in 78 patients (18.9%). Positive surgical margin and lymph node involvement were observed in 71(17.2%) and 38(9.2%) patients, respectively. Although univariate analysis showed that BMI ≥ 25 kg/m(2) was associated with pathological Gleason score ≥ 8 (OR = 1.413, P = 0.035), this positive correlation disappeared in multivariate analysis(P = 0.095). In multivariate analysis, the percentage of visceral adipose tissue was significantly associated with pathological Gleason score (OR = 9.618, P = 0.000), extracapsular extension (OR = 6.750, P = 0.002) and seminal vesicle invasion (OR = 4.419, P = 0.007) after adjusting for patient age, PSA level, clinical stage and biopsy Gleason score.
Anthropometric measures of abdominal adiposity was more sophisticated than simple BMI to evaluate the risk of obesity with regard to the aggressiveness of prostate cancer. The percentage of visceral adipose tissue was an independent factor for pathological Gleason score, extracapsular extension and seminal vesicle invasion in RP specimens.
探讨肥胖的人体测量指标，包括体重指数（BMI）、腹部皮下脂肪组织和内脏脂肪组织，对临床局限性前列腺癌患者病理特征的影响。
收集2006年1月至2013年3月期间接受根治性前列腺切除术（RP）的413例前列腺癌患者及其临床和病理资料。整个队列的中位年龄为68岁，范围为48至78岁。所有患者术前均诊断为前列腺癌，Gleason评分范围为4至10分（中位值为7分）。通过MRI扫描的T2加权矢状位定位图像测量腹部肥胖的人体测量指标，包括前腹壁脂肪、后腹壁脂肪和前后径，并计算皮下脂肪组织和内脏脂肪组织的百分比。采用Student's t检验对连续变量或卡方检验对分类变量比较不同BMI组患者的临床和病理特征。此外，使用单变量和多变量逻辑回归模型来探讨肥胖的人体测量指标对病理结果的影响。
BMI范围为14.2至34.0 kg/m²，中位值为23.8 kg/m²。腹部皮下脂肪组织范围为12.6至60.3 mm，中位值为31.4 mm。内脏脂肪组织百分比范围为71.1%至92.1%，中位值为83.8%。在RP标本中，141例患者（34.1%）观察到Gleason评分≥8分，69例患者（16.7%）病理肿瘤分期为T3a，78例患者（18.9%）病理肿瘤分期为T3b。分别有71例（17.2%）和38例（9.2%）患者出现手术切缘阳性和淋巴结转移。虽然单变量分析显示BMI≥25 kg/m²与病理Gleason评分≥8分相关（OR = 1.413，P = 0.035），但在多变量分析中这种正相关消失（P = 0.095）。在多变量分析中，在调整患者年龄、PSA水平、临床分期和活检Gleason评分后，内脏脂肪组织百分比与病理Gleason评分（OR = 9.618，P = 0.000）、包膜外侵犯（OR = 6.750，P = 0.002）和精囊侵犯（OR = 4.419，P = 0.007）显著相关。
就前列腺癌的侵袭性而言，腹部肥胖的人体测量指标比简单的BMI更能准确评估肥胖风险。内脏脂肪组织百分比是RP标本中病理Gleason评分、包膜外侵犯和精囊侵犯的独立因素。
