Prognostic significance of obesity-related biochemical indices in patients with prostate cancer before radical prostatectomy
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摘要: 目的 探讨前列腺癌根治术(RP)前肥胖相关生化指标[总胆汁酸、空腹血糖(FBG)、血尿酸、总胆固醇、甘油三酯、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)]预测前列腺癌患者预后的价值。方法 选取635例前列腺癌手术患者，根据指南分为低、中、高危三组，在RP前检测并收集其肥胖相关生化指标。根据各指标的正常值，将各组前列腺癌患者分别分为偏高组与非偏高组。采用χ2检验评价各指标组间差异，采用Kaplan-Meier生存曲线分析前列腺癌患者的生存曲线，并用Cox回归分析评估各项指标对前列腺癌手术患者预后的价值。结果 Kaplan-Meier分析显示，无论是1年总生存率(OS)或肿瘤特异性生存率(CSS)，高总胆汁酸、高FBG、高血尿酸和高LDL的患者的死亡率均明显高于非偏高组患者(P< 0.05)。Cox回归分析结果显示，高总胆汁酸、高FBG是前列腺癌患者OS、CSS的独立危险因素(P< 0.05)，而低HDL仅是前列腺癌患者CSS的独立危险因素，并且总胆固醇与前列腺癌患者预后无关。结论 术前总胆汁酸、FBG可作为预测前列腺癌手术患者预后的独立指标，高总胆汁酸、高FBG的前列腺癌患者在接受手术后预后较差。Abstract: Objective To investigate the roles of pretreatment obesity-related biochemical markers [total bile acid, fasting blood glucose (FBG), blood uric acid, total cholesterol, triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL)] in the prognosis of prostate cancer patients.Methods Six hundred and thirty-five patients with prostate cancer which were treated by surgery were enrolled. According to the guidelines, patients were divided into three groups, low, medium and high risk. Obesity-related biochemical markers were determined and gathered before radical prostatectomy. According to the normal value of each marker, each group of prostate cancer patients were divided into high group and non-high group. Chi-square test was used for the intergroup difference among various indicators. Kaplan-Meier method was used for survival analysis, and Cox regression analysis was used to evaluate the prognostic value of each index in patients with prostate cancer of surgery.Results Kaplan-Meier analysis showed that, whether it is 1-year overall survival rate (OS) or cancer specific survival rate(CSS), patients with high total bile acid, high FBG, high serum uric acid and high LDL have a significantly higher mortality than those patients in non-high group(P< 0.05).Cox regression analysis showed that total bile acid and FBG were independent risk factors for OS and CSS in prostate cancer patients(P< 0.05).However, Low HDL was only independent risk factor for CSS in prostate cancer patients. Furthermore, Triglyceride is not associated with prognosis in prostate cancer patients.Conculsion Total bile acid and FBG can be used as independent indicators to predict the prognosis of patients undergoing radical prostatectomy. Patients with high total bile acid and high FBG have a poor prognosis after surgery.
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Key words:
- total bile acid /
- fasting blood glucose /
- prostate cancer /
- prognosis
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表 1 低危组-生化指标各自的组间比较
指标 OS CSS χ2 OR(95%CI) P值 χ2 OR(95%CI) P值 总胆汁酸 62.067 100.800(17.086~594.669) < 0.001 41.562 45.600(8.757~237.454) < 0.001 FBG 14.732 8.750(2.486~30.801) < 0.001 17.982 13.625(3.146~58.999) < 0.001 血尿酸 16.799 9.364(2.769~31.660) < 0.001 7.394 6.000(1.439~25.026) 0.007 总胆固醇 25.374 15.313(4.282~54.760) < 0.001 19.750 18.421(3.551~95.558) < 0.001 甘油三酯 0.606 0.591(0.155~2.248) 0.436 1.712 0.266(0.032~2.207) 0.191 HDL 0.962 0.467(0.099~2.207) 0.327 0.996 0.335(0.043~2.953) 0.318 LDL 14.719 10.000(2.547~39.268) < 0.001 15.840 12.800(2.798~58.550) < 0.001 
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表 2 中危组-生化指标各自的组间比较
指标 OS CSS χ2 OR(95%CI) P值 χ2 OR(95%CI) P值 总胆汁酸 59.017 51.600(12.768~208.539) < 0.001 64.261 65.000(15.040~280.919) < 0.001 FBG 25.050 12.889(3.949~42.062) < 0.001 20.956 10.989(3.323~36.341) < 0.001 血尿酸 0.187 1.345(0.349~5.180) 0.665 0.324 1.481(0.380~5.761) 0.569 总胆固醇 68.180 70.950(16.613~303.006) < 0.001 74.176 95.333(20.072~452.795) < 0.001 甘油三酯 0.552 0.609(0.163~2.277) 0.457 0.349 0.671(0.178~2.538) 0.555 HDL 5.409 0.124(0.016~0.971) 0.020 4.835 0.135(0.017~1.063) 0.028 LDL 27.729 15.867(4.777~52.697) < 0.001 33.050 20.000(5.573~71.770) < 0.001
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表 3 高危组-生化指标各自的组间比较
指标 OS CSS χ2 OR(95%CI) P值 χ2 OR(95%CI) P值 总胆汁酸 92.729 25.150(10.817~58.474) < 0.001 69.463 20.352(8.228~50.340) < 0.001 FBG 30.510 5.639(2.906~10.944) < 0.001 30.574 8.989(3.643~22.182) < 0.001 血尿酸 11.264 2.969(1.540~5.725) 0.001 14.800 4.447(1.968~10.050) < 0.001 总胆固醇 64.435 11.895(5.916~23.918) < 0.001 63.738 19.265(7.630~48.642) < 0.001 甘油三酯 3.477 1.834(0.963~3.492) 0.062 0.349 0.671(0.178~2.538) 0.555 HDL 0.718 1.321(0.693~2.516) 0.397 6.837 2.826(1.262~6.331) 0.009 LDL 7.712 2.423(1.280~4.587) 0.005 0.131 20.000(5.573~71.770) 0.717
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表 4 Kaplan-Meier生存分析
指标 低危组 中危组 高危组 OS CSS OS CSS OS CSS 总胆汁酸 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 FBG < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 血尿酸 < 0.001 0.008 0.796 0.704 0.001 < 0.001 总胆固醇 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 甘油三酯 0.394 0.189 0.402 0.483 0.010 0.002 HDL 0.274 0.291 0.023 0.030 0.423 0.598 LDL 0.001 < 0.001 < 0.001 < 0.001 0.002 < 0.001
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表 5 多因素Cox比例风险回归分析
项目 低危组 中危组 高危组 OS CSS OS CSS OS CSS HR P值 HR P值 HR P值 HR P值 HR P值 HR P值 总胆汁酸 < 0.001 0.013 0.007 0.002 < 0.001 < 0.001 非偏高组 1 1 1 1 1 1 偏高组 3.106 3.157 2.536 3.036 1.881 1.834 FBG 0.004 0.020 0.015 0.029 0.016 0.013 非偏高组 1 1 1 1 1 1 偏高组 2.317 2.210 1.841 1.934 0.917 1.287 血尿酸 0.100 0.895 0.965 0.723 0.208 0.098 非偏高组 1 1 1 1 1 1 偏高组 1.183 0.128 0.039 0.332 0.445 0.757 总胆固醇 0.068 0.210 0.002 0.003 < 0.001 0.001 非偏高组 1 1 1 1 1 1 偏高组 1.315 1.322 5.047 5.765 1.689 1.989 甘油三酯 0.612 0.349 0.798 0.972 0.550 0.229 非偏高组 1 1 1 1 1 1 偏高组 -0.483 -1.447 -0.214 -0.031 0.2 0.511 HDL 0.761 0.945 0.413 0.629 0.057 0.621 非偏轻组 1 1 1 1 1 1 偏轻组 -0.281 -0.09 -0.959 -0.609 0.198 0.227 LDL 0.132 0.062 0.085 0.107 0.237 0.753 非偏高组 1 1 1 1 1 1 偏高组 1.002 1.501 -3.183 -3.094 -0.491 -0.18
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