Keehn Aryeh, Srivastava Abhishek, Maiman Richard, Taylor Jacob, DiVito Josheph, Ghavamian Reza, Stern Joshua M
Department of Urology, Albert Einstein College of Medicine , Bronx, New York.
J Endourol. 2015 Mar;29(3):372-6. doi: 10.1089/end.2014.0512. Epub 2014 Oct 9.
It is well known that adipose tissue plays a key role in the metabolic syndrome. We investigated whether visceral fat (VFA) and or subcutaneous fat (SQF) levels are associated with the tumor phenotype of small renal masses. Additionally, we sought to investigate the relationship between VFA and baseline renal function as measured by glomerular filtration rate.
From 2002 through 2011, 144 patients undergoing minimally invasive partial nephrectomy were retrospectively reviewed by a radiologist for VFA and SQF fat measurements, using standard software. A third parameter, visceral adipose tissue percent (VAT%), was also calculated using the formula: (VAT%=[VFA/VFA+SQF]×100%). We used tertiles of VFA and SQF content to compare demographic and clinical characteristics. We also looked at VFA as a continuous variable. Associations between covariables were analyzed using multivariate logistic regression analysis and odds ratios with 95% confidence intervals.
Eighty-one patients had renal-cell carcinoma (RCC) and 30 patients had non-RCC pathology. On multivariate analysis, increasing BMI (p=0.023), VFA (p=0.048), VAT% (p=0.028), and Charlson comorbidity score (p=0.047) were significantly associated with worse preoperative Modification of Diet in Renal Disease (MDRD). In a subset multivariate analysis of the 81 patients with RCC, increasing VFA was statistically associated with worsening Fuhrman grade (p=0.017).
VFA may be linked to the pathophysiology of renal function in patients evaluated for renal masses. Additionally, VFA may be associated with worsening tumor grades in patients with small-volume RCC. Interestingly, SQF did not play such a role. This small study proposes an interesting physiologic link between VFA and the biology of both kidney function and tumor histology. Larger studies are needed to corroborate our findings.
众所周知，脂肪组织在代谢综合征中起关键作用。我们研究了内脏脂肪（VFA）和/或皮下脂肪（SQF）水平是否与小肾肿块的肿瘤表型相关。此外，我们试图研究VFA与通过肾小球滤过率测量的基线肾功能之间的关系。
从2002年到2011年，一名放射科医生使用标准软件对144例行微创部分肾切除术的患者进行回顾性分析，测量其VFA和SQF脂肪含量。还使用公式（内脏脂肪组织百分比（VAT%）=[VFA/（VFA + SQF）]×100%）计算了第三个参数。我们使用VFA和SQF含量的三分位数来比较人口统计学和临床特征。我们还将VFA视为连续变量。使用多变量逻辑回归分析和95%置信区间的比值比分析协变量之间的关联。
81例患者患有肾细胞癌（RCC），30例患者有非RCC病理。多变量分析显示，体重指数增加（p = 0.023）、VFA（p = 0.048）、VAT%（p = 0.028）和Charlson合并症评分（p = 0.047）与术前肾病饮食改良（MDRD）变差显著相关。在对81例RCC患者的亚组多变量分析中，VFA增加与Fuhrman分级恶化在统计学上相关（p = 0.017）。
VFA可能与接受肾肿块评估患者的肾功能病理生理学相关。此外，VFA可能与小体积RCC患者的肿瘤分级恶化相关。有趣的是，SQF未起这样的作用。这项小型研究提出了VFA与肾功能生物学和肿瘤组织学之间一个有趣的生理联系。需要更大规模的研究来证实我们的发现。
