Tsivian Efrat, Tsivian Matvey, Tay Kae Jack, Longo Thomas, Zukerman Ziv, Martorana Giuseppe, Schiavina Riccardo, Brunocilla Eugenio, Polascik Thomas J
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC.
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC.
Urol Oncol. 2017 Jul;35(7):459.e1-459.e5. doi: 10.1016/j.urolonc.2017.02.004. Epub 2017 Mar 18.
To investigate the potential association between body mass index (BMI) and clinicopathological features of clinically localized renal masses.
An international, multi-institutional retrospective review of patients who underwent surgery for clinically localized renal masses between 2000 and 2010 was undertaken after an institutional review board approval. Patients were divided into 4 absolute BMI groups based on the entire cohort׳s percentiles and 4 relative BMI groups based on their respective population (American or Italian). Renal mass pathological diagnosis, renal cell carcinoma (RCC) subtype, Fuhrman grade (low and high), and clinical stage were compared among groups using Fisher׳s exact test, Kruskal-Wallis test, and the Cochran-Armitage trend test. A multivariate logistic analysis was performed to evaluate independent association between tumor and patient characteristics with tumor pathology (Fuhrman grade).
A total of 1,748 patients having a median BMI of 28 (interquartile range 25-32) were evaluated. Benign masses and RCC cases had similar proportion across BMI groups (P = 0.4). The most common RCC subtype was clear cell followed by papillary carcinoma, chromophobe, and other subtypes. Their distribution was comparable across BMI groups (P = 0.7). Similarly, clinical stage distribution was comparable with the overall cohort. The distribution of Fuhrman grade in RCC, however, demonstrated an increased proportions of low grade with increasing BMI (P<0.05). This trend was maintained in subgroups according to gender, stage and age (P<0.05 in all subgroup analysis). In a multivariable model that included potential confounders (i.e., age, sex, and tumor size) higher BMI groups had lower odds of presenting a high Fuhrman grade.
In this study, higher BMI was associated with lower grade of RCC in clinically localized renal masses. This may, in part, explain better survival rates in patients with higher BMI and may correlate with a possible link between adipose tissue and RCC biology.
探讨体重指数（BMI）与临床局限性肾肿块的临床病理特征之间的潜在关联。
在获得机构审查委员会批准后，对2000年至2010年间接受临床局限性肾肿块手术的患者进行了一项国际多机构回顾性研究。根据整个队列的百分位数将患者分为4个绝对BMI组，并根据其各自人群（美国或意大利）分为4个相对BMI组。使用Fisher精确检验、Kruskal-Wallis检验和Cochran-Armitage趋势检验对各组之间的肾肿块病理诊断、肾细胞癌（RCC）亚型、Fuhrman分级（低和高）及临床分期进行比较。进行多因素逻辑分析以评估肿瘤和患者特征与肿瘤病理（Fuhrman分级）之间的独立关联。
共评估了1748例患者，中位BMI为28（四分位间距25 - 32）。良性肿块和RCC病例在各BMI组中的比例相似（P = 0.4）。最常见的RCC亚型是透明细胞癌，其次是乳头状癌、嫌色细胞癌和其他亚型。它们在各BMI组中的分布具有可比性（P = 0.7）。同样，临床分期分布与整个队列具有可比性。然而，RCC中Fuhrman分级的分布显示，随着BMI增加，低分级的比例增加（P<0.05）。根据性别、分期和年龄分组分析，这一趋势在各亚组中均保持（所有亚组分析中P<0.05）。在包含潜在混杂因素（即年龄、性别和肿瘤大小）的多变量模型中，较高BMI组出现高Fuhrman分级的几率较低。
在本研究中，较高BMI与临床局限性肾肿块中较低分级的RCC相关。这可能部分解释了BMI较高患者的生存率较高，并可能与脂肪组织和RCC生物学之间的潜在联系相关。
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