剖析代谢综合征与前列腺癌风险之间的关联：一项大型临床队列研究分析。

Dissecting the association between metabolic syndrome and prostate cancer risk: analysis of a large clinical cohort.

机构信息

Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Division of Urology, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.

出版信息

Eur Urol. 2015 Jan;67(1):64-70. doi: 10.1016/j.eururo.2014.01.040. Epub 2014 Feb 14.

DOI:10.1016/j.eururo.2014.01.040

PMID:24568896

Abstract

BACKGROUND

A biologic rationale exists for the association between metabolic syndrome (MetS) and prostate cancer (PCa). However, epidemiologic studies have been conflicting.

OBJECTIVE

To evaluate the association between MetS and the odds of PCa diagnosis in men referred for biopsy.

DESIGN, SETTING, AND PARTICIPANTS: Patients without prior PCa diagnosis undergoing prostate biopsy were identified from a large prostate biopsy cohort (in Toronto, Canada). The definition of MetS was based on the most recent interim joint consensus definition, requiring any three of five components (obesity, elevated blood pressure, diabetes or impaired fasting glucose, low high-density lipoprotein-cholesterol, and hypertriglyceridemia). Both the individual components of MetS and the cumulative number of MetS components were evaluated.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

The outcomes were PCa detection overall, clinically significant PCa (CSPC; defined as any Gleason pattern ≥ 4, >50% involvement of a single biopsy core, or more than one of three total number of cores involved), and intermediate- or high-grade PCa (I-HGPC; Gleason 7-10). Tests for trend and multivariable logistic regression analyses were performed.

RESULTS AND LIMITATIONS

Of 2235 patients, 494 (22.1%) had MetS. No individual MetS component was independently associated with PCa. However, increasing number of MetS components was associated with higher PCa grade (p<0.001), as well as progressively higher odds of PCa outcomes (three or more; ie, MetS) compared with no MetS components: Odds ratios were 1.54 for PCa overall (95% confidence interval [CI], 1.17-2.04; p=0.002), 1.56 for CSPC (95% CI, 1.17-2.08; p=0.002), and 1.56 for I-HGPC (95% CI, 1.16-2.10; p=0.003) in multivariable analyses. The main limitation is the retrospective design.

CONCLUSIONS

Although the individual MetS components are not independently associated with PCa outcomes, MetS is significantly associated with higher odds of PCa diagnosis, CSPC, and I-HGPC. There is a biologic gradient between the number of MetS components and the risk of PCa, as well as cancer grade.

PATIENT SUMMARY

Metabolic syndrome is a collection of metabolic abnormalities that increases one's risk for heart disease. Our study shows that an increasing degree of metabolic abnormality is also associated with an increased risk of diagnosis of overall and aggressive prostate cancer.

摘要

背景

代谢综合征（MetS）与前列腺癌（PCa）之间存在生物学关联。然而，流行病学研究结果存在冲突。

目的

评估代谢综合征与接受前列腺活检男性 PCa 诊断几率之间的关联。

设计、地点和参与者：从加拿大多伦多一个大型前列腺活检队列中确定了没有前列腺癌既往诊断史的患者。代谢综合征的定义基于最新的联合临时共识定义，需要符合以下五个组成部分中的任意三个（肥胖、血压升高、糖尿病或空腹血糖受损、低高密度脂蛋白胆固醇血症和高甘油三酯血症）。评估了代谢综合征的各个组成部分以及代谢综合征组成部分的累积数量。

结局测量和统计分析

结局为总体 PCa 检出率、临床显著型 PCa（CSPC；定义为任何 Gleason 评分≥4、单个活检核心中>50%受累或三个核心总数中有一个以上受累）和中高级别 PCa（I-HGPC；Gleason 7-10）。进行了趋势检验和多变量逻辑回归分析。

结果和局限性

在 2235 名患者中，有 494 名（22.1%）患有代谢综合征。没有任何一个代谢综合征组成部分与 PCa 独立相关。然而，随着代谢综合征组成部分数量的增加，与更高的 PCa 分级相关（p<0.001），并且与无代谢综合征组成部分相比，PCa 结局（三个或更多；即，代谢综合征）的几率也逐渐升高：总体 PCa 的比值比为 1.54（95%置信区间[CI]，1.17-2.04；p=0.002），CSPC 的比值比为 1.56（95%CI，1.17-2.08；p=0.002），I-HGPC 的比值比为 1.56（95%CI，1.16-2.10；p=0.003），在多变量分析中。主要局限性在于回顾性设计。