Dai Xiang, Wang Fei, Du Yiqing, Qin Caipeng, Lai Shicong, Song Yuxuan, Huang Zixiong, Han Songchen, Zhang Xiaopeng, Xu Tao
Department of Urology, Peking University People's Hospital, Beijing, China.
Front Oncol. 2022 May 26;12:816915. doi: 10.3389/fonc.2022.816915. eCollection 2022.
To evaluate the prognostic value of metabolic syndrome (MetS) in upper tract urothelial carcinoma (UTUC) patients based on propensity score matching (PSM) analysis.
A total of 573 patients with UTUC after radical nephroureterectomy were included at Peking University People's Hospital from January 2007 to April 2021. MetS was diagnosed according to the criteria of Chinese Diabetes Society and was defined as the presence of 3 or more of the following 4 conditions (obesity, hyperglycemia, hypertension, high triglycerides and/or low high-density lipoprotein-cholesterol). Patients were divided into two groups based on whether they had MetS, whose variables were adjusted using 1:1 PSM analysis with a caliber of 0.02 to minimize selection bias. Univariate and multivariate Cox regression analysis were used to evaluate the association of MetS and its components with pathological outcomes after adjusting preoperative confounders by propensity score matching. The Kaplan-Meier method was used to estimate overall survival (OS), cancer-specific survival (CSS), and intravesical recurrence-free survival (IVRFS) after surgery.
MetS was significantly correlated with older age, a history of coronary heart disease, high Charlson Comorbidity Index, low estimated Glomerular filtration rate, and low aspartate/alanine aminotransferase ratio (all P<0.05). Multivariate Cox regression analysis and Kaplan-Meier curves demonstrated that MetS showed no statistical correlation with lower OS or IVRFS and approaching significance with lower CSS (P=0.063) before PSM. After PSM, the 5-year OS, CSS, and IVRFS were 64.1%, 74.7%, and 77.2%, respectively, in the MetS group, compared with 67.4%, 78.8%, and 77.2%, respectively, in non-MetS group. Univariate Cox regression analyses showed that MetS and its components were not associated with decreased OS, CSS, or IVRFS (all P>0.05).
In our study, no statistical difference was found between MetS and survival outcomes in UTUC, except a marginal association with lower CSS. Further studies are needed to evaluate the role of MetS and its each single component on UTUC.
基于倾向评分匹配（PSM）分析评估代谢综合征（MetS）在上尿路尿路上皮癌（UTUC）患者中的预后价值。
2007年1月至2021年4月，北京大学人民医院共纳入573例行根治性肾输尿管切除术的UTUC患者。根据中国糖尿病学会的标准诊断MetS，定义为存在以下4种情况中的3种或更多（肥胖、高血糖、高血压、高甘油三酯和/或低高密度脂蛋白胆固醇）。根据是否患有MetS将患者分为两组，使用卡尺为0.02的1:1 PSM分析对变量进行调整，以尽量减少选择偏倚。在通过倾向评分匹配调整术前混杂因素后，采用单因素和多因素Cox回归分析评估MetS及其组分与病理结局的相关性。采用Kaplan-Meier法估计术后总生存（OS）、癌症特异性生存（CSS）和膀胱内无复发生存（IVRFS）。
MetS与年龄较大、冠心病史、较高的Charlson合并症指数、较低的估计肾小球滤过率以及较低的天冬氨酸/丙氨酸转氨酶比值显著相关（均P<0.05）。多因素Cox回归分析和Kaplan-Meier曲线显示，在PSM之前，MetS与较低的OS或IVRFS无统计学相关性，与较低的CSS接近显著相关（P=0.063）。PSM后，MetS组的5年OS、CSS和IVRFS分别为64.1%、74.7%和77.2%，非MetS组分别为67.4%、78.8%和77.2%。单因素Cox回归分析显示，MetS及其组分与OS、CSS或IVRFS降低无关（均P>0.05）。
在我们的研究中，除了与较低的CSS有边缘相关性外，未发现MetS与UTUC的生存结局之间存在统计学差异。需要进一步研究来评估MetS及其各单一成分在UTUC中的作用。
