Bhindi Bimal, Xie Wen Y, Kulkarni Girish S, Hamilton Robert J, Nesbitt Michael, Finelli Antonio, Zlotta Alexandre R, Evans Andrew, van der Kwast Theodorus H, Alibhai Shabbir M H, Trachtenberg John, Fleshner Neil E
Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada.
Urology. 2016 Jul;93:77-85. doi: 10.1016/j.urology.2016.01.041. Epub 2016 Mar 22.
Metabolic syndrome (MetS) is associated with an increased risk of finding prostate cancer overall and high-grade disease on biopsy. This study sought to determine if MetS is associated with adverse final pathology and risk of overall recurrence in men undergoing radical prostatectomy (RP).
Men undergoing RP (2004-2013) were identified using our prospectively maintained institutional database. MetS was defined by ≥3 of 5 components (obesity, dysglycemia, hypertension, low high-density lipoprotein-cholesterol, and high triglycerides). Multivariable logistic regression models were created for prostate cancer grade and stage on final pathology. Kaplan-Meier and multivariable Cox regression analyses were performed to model overall recurrence, defined by biochemical recurrence (postoperative serum prostate-specific antigen ≥0.2 ng/mL) or use of salvage therapies.
Of 1939 men, 439 (22.6%) had MetS. MetS (≥3 vs. 0 components) was associated with an increased odds of Gleason 8-10 disease (odds ratio [OR] = 2.49, 95% confidence interval [CI] = 1.32-4.67, P = .005) and extraprostatic disease (OR = 1.35, 95% CI = 1.02-1.80, P = .04). Decreased use of nerve-sparing in men with MetS was noted. In unadjusted analyses, MetS was associated with a significantly increased risk of receiving salvage therapy (hazard ratio [HR] = 1.38, 95% CI = 1.04-1.83, P = .03) and a near-significant increased overall recurrence risk (HR = 1.20, 95% CI = 0.94-1.53, P = .15). These associations were attenuated upon adjusting for disease-specific parameters (salvage therapy: HR = 1.03, 95% CI = 0.76-1.40, P = .87; overall recurrence: HR = 0.94, 95% CI = 0.72-1.21, P = .62).
MetS is associated with an increased odds of extraprostatic and high-grade disease on final RP pathology, which appears to drive an increased risk of needing salvage therapy after RP. However, with more aggressive resection, differences in failure-free outcomes were attenuated, suggesting that men with MetS should not be precluded from RP.
代谢综合征（MetS）与总体上前列腺癌的发病风险增加以及活检时高级别疾病的发病风险增加相关。本研究旨在确定MetS是否与接受根治性前列腺切除术（RP）的男性患者的不良最终病理结果及总体复发风险相关。
利用我们前瞻性维护的机构数据库识别2004年至2013年期间接受RP的男性患者。MetS由5项指标中的≥3项（肥胖、血糖异常、高血压、低高密度脂蛋白胆固醇及高甘油三酯）定义。针对最终病理检查中的前列腺癌分级和分期建立多变量逻辑回归模型。进行Kaplan-Meier分析和多变量Cox回归分析，以对总体复发情况进行建模，总体复发定义为生化复发（术后血清前列腺特异性抗原≥0.2 ng/mL）或采用挽救性治疗。
在1939名男性患者中，439名（22.6%）患有MetS。MetS（≥3项指标vs. 0项指标）与 Gleason 8-10级疾病的发生几率增加相关（比值比[OR]=2.49，95%置信区间[CI]=1.32-4.67，P=0.005），且与前列腺外疾病相关（OR=1.35，95% CI=1.02-1.80，P=0.04）。注意到患有MetS的男性保留神经的手术应用减少。在未经调整的分析中，MetS与接受挽救性治疗的风险显著增加相关（风险比[HR]=1.38，95% CI=1.04-1.83，P=0.03），且总体复发风险接近显著增加（HR=1.20，95% CI=0.94-1.53，P=0.15）。在针对疾病特异性参数进行调整后，这些相关性减弱（挽救性治疗：HR=1.03，95% CI=0.76-1.40，P=0.87；总体复发：HR=0.94，95% CI=0.72-1.21，P=0.62）。
MetS与RP最终病理检查中前列腺外及高级别疾病的发生几率增加相关，这似乎导致RP后需要挽救性治疗的风险增加。然而，随着手术切除更为积极，无失败结局的差异减弱，这表明不应将患有MetS的男性排除在RP手术之外。
