Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy.
Surg Oncol. 2021 Jun;37:101519. doi: 10.1016/j.suronc.2020.12.013. Epub 2021 Jan 3.
Metabolic syndrome (MetS) and its components (high blood pressure, BMI≥30, altered fasting glucose, low HDL cholesterol and high triglycerides) may undermine early perioperative outcomes after radical prostatectomy (RP). We tested this hypothesis.
MATERIALS & METHODS: Within the National Inpatient Sample database (2008-2015) we identified RP patients. The effect of MetS was tested in four separate univariable analyses, as well as in multivariable regression models predicting: 1) overall complications, 2) length of stay, 3) total hospital charges and 4) non-home based discharge. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics.
Of 91,618 patients: 1) 50.2% had high blood pressure, 2) 8.0% had BMI≥30, 3) 13.0% had altered fasting glucose, 4) 22.8% had high triglycerides and 5) 0.03% had low HDL cholesterol. Respectively, one vs. two vs. three vs. four MetS components were recorded in 36.2% vs. 19.0% vs. 5.5% vs. 0.8% patients. Of all patients, 6.3% exhibited ≥3 components and qualified for MetS diagnosis. The rates of MetS increased over time (EAPC:+9.8%; p < 0.001). All four tested MetS components (high blood pressure, BMI≥30, altered fasting glucose and high triglycerides) achieved independent predictor status in all four examined endpoints. Moreover, a highly statistically significant dose-response was also confirmed for all four tested endpoints.
MetS and its components consistently and strongly predict early adverse outcomes after RP. Moreover, the strength of the effect was directly proportional to the number of MetS components exhibited by each individual patient, even if formal MetS diagnosis of ≥3 components has not been met.
代谢综合征（MetS）及其组成部分（高血压、BMI≥30、空腹血糖改变、低高密度脂蛋白胆固醇和高甘油三酯）可能会影响根治性前列腺切除术（RP）后的早期围手术期结局。我们对此假说进行了检验。
我们在国家住院患者样本数据库（2008-2015 年）中确定了接受 RP 的患者。我们在四项独立的单变量分析中检验了 MetS 的影响，以及在多变量回归模型中预测：1）总体并发症，2）住院时间，3）总住院费用和 4）非家庭为基础的出院。所有模型都进行了加权和聚类调整，以及所有可用的患者和医院特征。
在 91618 例患者中：1）50.2%有高血压，2）8.0%有 BMI≥30，3）13.0%有空腹血糖改变，4）22.8%有高甘油三酯，5）0.03%有低高密度脂蛋白胆固醇。分别为，36.2%的患者有 1 个、2 个、3 个或 4 个 MetS 组成部分，19.0%的患者有 1 个、2 个、3 个或 4 个 MetS 组成部分，5.5%的患者有 2 个、3 个或 4 个 MetS 组成部分，0.8%的患者有 4 个 MetS 组成部分。所有患者中，6.3%有≥3 个组成部分，符合 MetS 诊断标准。MetS 的发生率随时间增加（EAPC：+9.8%；p<0.001）。在所有四个检查的终点中，四个测试的 MetS 组成部分（高血压、BMI≥30、空腹血糖改变和高甘油三酯）都成为独立的预测因素。此外，还证实了所有四个测试的终点都存在高度统计学显著的剂量反应关系。
MetS 及其组成部分一致且强烈地预测 RP 后的早期不良结局。此外，个体患者表现出的 MetS 组成部分数量越多，效果越强，即使尚未达到正式的 MetS 诊断≥3 个组成部分。
