Morlacco Alessandro, Dal Moro Fabrizio, Rangel Laureano J, Carlson Rachel E, Schulte Phillip J, Jeffrey Karnes R
Department of Urology, Mayo Clinic, Rochester, MN; Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Clinica Urologica, Università degli Studi di Padova, Padova, Italy.
Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Clinica Urologica, Università degli Studi di Padova, Padova, Italy.
Urol Oncol. 2018 Dec;36(12):528.e1-528.e6. doi: 10.1016/j.urolonc.2018.10.003. Epub 2018 Nov 13.
The associations between metabolic syndrome (MetS) and prostate cancer (CaP) outcomes following radical prostatectomy (RP) are not clear. This study aims to understand the role of MetS in influencing oncological outcomes at RP.
Patients who underwent RP for CaP at our institution from 2000 to 2010 were identified; MetS prior to RP was ascertained with a modified version of the IDF-AHA/NHLBI using ICD-9 codes. Histopathological outcomes included surgical margins, pathological stage, and Gleason score (GS) upgrading. Long-term outcomes included biochemical recurrence (BCR), local recurrence, systemic progression, and CaP-specific mortality. Multivariable adjusted logistic regression and Cox proportional hazards regression assessed the association between MetS status and histopathological and long-term outcomes, respectively.
Of 8,504 RP patients, 1,054 (12.4%) had MetS at the time of RP. MetS patients were older, had higher biopsy GS, but lower pre-op prostatic specific antigen (PSA), higher pathological GS, and larger prostate volume. Adjusted logistic regression suggested an association between MetS and positive margins (odds ratio [OR] = 1.22, P = 0.025) and GS upgrading (OR = 1.28, P = 0.002). There was evidence of an increased risk of local recurrence (hazard ratio [HR] = 1.33, P = 0.037) and CaP-specific mortality (HR = 1.58, P < 0.001) for MetS patients. There was no evidence to suggest an association with BCR or systemic progression.
Men with MetS are at higher risk of GS upgrade and positive surgical margins at surgery, local recurrence, and CaP-specific mortality. Pathological stage, BCR, and systemic progression were not associated with MetS. Our data may be useful in patients' counseling, especially when active surveillance is an option.
根治性前列腺切除术（RP）后代谢综合征（MetS）与前列腺癌（CaP）预后之间的关联尚不清楚。本研究旨在了解MetS在影响RP肿瘤学预后方面的作用。
确定2000年至2010年在我院因CaP接受RP的患者；使用ICD-9编码，通过国际糖尿病联盟-美国心脏协会/美国国立心肺血液研究所（IDF-AHA/NHLBI）的改良版本确定RP前的MetS。组织病理学结果包括手术切缘、病理分期和Gleason评分（GS）升级。长期结果包括生化复发（BCR）、局部复发、全身进展和CaP特异性死亡率。多变量调整逻辑回归和Cox比例风险回归分别评估MetS状态与组织病理学和长期结果之间的关联。
在8504例RP患者中，1054例（12.4%）在RP时患有MetS。MetS患者年龄较大，活检GS较高，但术前前列腺特异性抗原（PSA）较低，病理GS较高，前列腺体积较大。调整后的逻辑回归表明MetS与切缘阳性（比值比[OR]=1.22，P=0.025）和GS升级（OR=1.28，P=0.002）之间存在关联。有证据表明MetS患者局部复发风险增加（风险比[HR]=1.33，P=0.037）和CaP特异性死亡率增加（HR=1.58，P<0.001）。没有证据表明与BCR或全身进展有关联。
患有MetS的男性在手术时GS升级、手术切缘阳性、局部复发和CaP特异性死亡率的风险更高。病理分期、BCR和全身进展与MetS无关。我们的数据可能有助于患者咨询，尤其是在可选择主动监测的情况下。
