Park Yong Hyun, Moon Hyong Woo, Cho Hyuk Jin, Ha U-Syn, Hong Sung-Hoo, Lee Ji Youl, Kim Sae Woong, Han Kyungdo, Ko Seung-Hyun
Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul, Republic of Korea.
Department of Statistics and Actuarial Science, Soongsil University Seoul, Republic of Korea.
Am J Cancer Res. 2021 Oct 15;11(10):5016-5026. eCollection 2021.
Obesity is one of the most important prognostic factors of kidney cancer. However, little is known regarding the cumulative impacts of obesity on kidney cancer risk. We aimed to analyze the dose- and time-dependent impact of obesity on kidney cancer risk using the Korean National Health Insurance System database. This longitudinal nationwide cohort study used data from the Korean National Health Insurance System database between 2012 and 2013. In total, 3,102,240 participants who received annual health examination more than four times consecutively were included in the final analysis. The primary endpoint was newly diagnosed kidney cancer according to the dose- and time-dependent impact of obesity. Dose-dependent impact was measured using body mass index (BMI) and waist circumference (WC), and time-dependent impact was measured using general and abdominal cumulative obesity exposure (gCOE and aCOE). COE was defined as the number of years since obesity diagnosis during the exposure period. We identified 1,831 participants with newly diagnosed kidney cancer (median follow-up: 4.3 years). The hazard ratios (HRs) for kidney cancer increased significantly alongside BMI and WC. The HRs for kidney cancer increased significantly in the higher gCOE groups ( for trend <0.001) as follows: 1 (1.33, 95% confidence intervals: 1.10-1.60), 2 (1.33, 1.08-1.63), 3 (1.55, 1.30-1.85), and 4 (1.82, 1.64-2.03) years. Similar trends were observed for aCOE ( for trend <0.001) as follows: 1 (1.42, 1.23-1.64), 2 (1.71, 1.46-2.02), 3 (1.76, 1.48-2.08), and 4 (2.11, 1.84-2.42) years. Risks of kidney cancer related to COE were much more pronounced in participants with the following characteristics: younger than 65 years old, male gender, diabetes, hypertension, and dyslipidemia. Longer COE was associated with an increased risk of kidney cancer in the Korean population. Participants with prolonged obesity and metabolic syndrome need active surveillance for kidney cancer.
肥胖是肾癌最重要的预后因素之一。然而，关于肥胖对肾癌风险的累积影响，人们知之甚少。我们旨在利用韩国国民健康保险系统数据库分析肥胖对肾癌风险的剂量和时间依赖性影响。这项全国性纵向队列研究使用了2012年至2013年韩国国民健康保险系统数据库中的数据。最终分析纳入了总共3102240名连续接受年度健康检查超过4次的参与者。主要终点是根据肥胖的剂量和时间依赖性影响新诊断的肾癌。使用体重指数（BMI）和腰围（WC）来衡量剂量依赖性影响，使用总体和腹部累积肥胖暴露（gCOE和aCOE）来衡量时间依赖性影响。COE定义为暴露期内自肥胖诊断以来的年数。我们确定了1831名新诊断为肾癌的参与者（中位随访时间：4.3年）。肾癌的风险比（HRs）随着BMI和WC的增加而显著升高。在较高gCOE组中，肾癌的HRs显著增加（趋势P<0.001），如下所示：1年（1.33，95%置信区间：1.10 - 1.60）、2年（1.33，1.08 - 1.63）、3年（1.55，1.30 - 1.85）和4年（1.82，1.64 - 2.03）。aCOE也观察到类似趋势（趋势P<0.001），如下所示：1年（1.42，1.23 - 1.64）、2年（1.71，1.46 - 2.02）、3年（1.76，1.48 - 2.08）和4年（2.11，1.84 - 2.42）。在具有以下特征的参与者中，与COE相关的肾癌风险更为明显：年龄小于65岁、男性、糖尿病、高血压和血脂异常。在韩国人群中，更长的COE与肾癌风险增加相关。肥胖持续时间长且患有代谢综合征的参与者需要对肾癌进行积极监测。
