Liu Zenan, Bi Hai, He Wei, Zhu Xuehua, He Jide, Lu Min, Lu Jian
Department of Urology, Peking University Third Hospital, Beijing, China.
Department of Pathology, Peking University Third Hospital, Beijing, China.
Front Oncol. 2022 Apr 5;12:833305. doi: 10.3389/fonc.2022.833305. eCollection 2022.
To investigate the prognostic significance of metabolic syndrome (MetS) and its components in patients with bladder cancer (BCa) treated with radical cystectomy (RC).
A total of 335 BCa patients who underwent RC between 2004 and 2019 at Peking University Third Hospital (PUTH) were analyzed retrospectively. The Kaplan-Meier method with the log-rank test was performed to assess overall survival (OS) and progression-free survival (PFS). Univariate and multivariate Cox proportional hazard models were conducted to identify the prognostic factors of OS and PFS before and after propensity score matching (PSM).
Enrolled patients were allocated into two groups according to the presence or absence of MetS (n=84 MetS vs n=251 non-MetS), and 82 new matched pairs were identified to balance the baseline characteristics after 1:1 PSM. In the Kaplan-Meier analysis, MetS was associated with better OS (P=0.031) than the group without MetS. In addition, a body mass index (BMI) ≥ 25 was associated with better OS (P=0.011) and PFS (P=0.031), while low high-density lipoprotein cholesterol (HDL-C) was associated with worse OS (P=0.033) and PFS (P=0.010). In all patients, multivariate Cox analysis showed that hemoglobin, pathologic tumor stage and lymph node status were identified as independent prognostic factors for both OS and PFS, while age, MetS and HDL-C were independent prognostic factors only for OS. Reproducible results of multivariate analysis can still be observed in propensity matched patients. The results of further subgroup analysis revealed that the association of MetS with increased OS (P=0.043) and BMI ≥25 with increased OS (P=0.015) and PFS (P=0.029) was observed in non-muscle invasive bladder cancer (NMIBC) patients.
MetS was independently associated with better OS in BCa patients after RC, and HDL-C was the only component of MetS that was independently associated with worse OS. MetS and HDL-C may become reliable prognostic biomarkers of OS in BCa patients after RC to provide individualized prognostication and assist in the formulation of clinical treatment strategies.
探讨代谢综合征（MetS）及其组分在接受根治性膀胱切除术（RC）的膀胱癌（BCa）患者中的预后意义。
回顾性分析2004年至2019年期间在北京大学第三医院（PUTH）接受RC的335例BCa患者。采用Kaplan-Meier法和对数秩检验评估总生存期（OS）和无进展生存期（PFS）。在倾向评分匹配（PSM）前后，进行单因素和多因素Cox比例风险模型分析以确定OS和PFS的预后因素。
根据是否存在MetS将纳入患者分为两组（n = 84例MetS患者 vs n = 251例非MetS患者），并在1:1 PSM后确定了82对新的匹配对以平衡基线特征。在Kaplan-Meier分析中，MetS患者的OS优于无MetS组（P = 0.031）。此外，体重指数（BMI）≥25与更好的OS（P = 0.011）和PFS（P = 0.031）相关，而低高密度脂蛋白胆固醇（HDL-C）与较差 的OS（P = 0.033）和PFS（P = 0.010）相关。在所有患者中，多因素Cox分析显示血红蛋白、病理肿瘤分期和淋巴结状态是OS和PFS的独立预后因素，而年龄、MetS和HDL-C仅是OS的独立预后因素。在倾向匹配患者中仍可观察到多因素分析的可重复结果。进一步亚组分析结果显示，在非肌层浸润性膀胱癌（NMIBC）患者中观察到MetS与OS增加相关（P = 0.043），BMI≥25与OS增加（P = 0.015）和PFS增加（P = 0.029）相关。
MetS与RC术后BCa患者更好的OS独立相关，HDL-C是MetS中唯一与较差OS独立相关的组分。MetS和HDL-C可能成为RC术后BCa患者OS的可靠预后生物标志物，以提供个体化预后并协助制定临床治疗策略。
