Association between the metabolic syndrome and high tumor grade and stage of primary urothelial cell carcinoma of the bladder

Is metabolic syndrome associated with high tumor grade and stage of bladder cancer: a systematic review and meta-analysis

BACKGROUND

The aim of our study was to elaborate the association between metabolic syndrome (MS) and the tumor stage and grade of bladder cancer (BC).

METHODS

A systematic review and pooled analysis on PubMed, the Cochrane Library, Embase, Web of Science, CNKI, WANFANG and VIP from databases inception to July 24, 2020 was conducted by two independent authors. Relative risk (RR) was used as pooled effect estimates. The data analysis was accomplished by STATA 14.2.

RESULTS

Three English and four Chinese articles were included in the final analysis. A pooled analysis of six studies showed that patients in MS group were at a 1.94-fold risk of high-stage BC when compared to their counterparts (RR: 1.94; 95% CI: 1.59-2.37), and the difference was statistically significant. For the components of MS, except for hypertension, patients with obesity (RR: 1.61; 95% CI: 1.33-1.95), hyperglycemia (RR: 2.20; 95% CI: 1.49-3.26) and low high-density lipoprotein cholesterol (HDL) (RR: 1.98; 95% CI: 1.51-2.58) had significantly higher risks of high-stage BC than the control groups. A pooled analysis of six studies indicated that MS can contribute substantially to the vulnerability of high-grade BC with significant difference (RR: 1.50; 95% CI: 1.37-1.65). Furthermore, patients with obesity (RR: 1.41; 95% CI: 1.18-1.69), hyperglycemia (RR: 1.42; 95% CI: 1.30-1.56), hypertension (RR: 1.13; 95% CI: 1.03-1.24), low HDL (RR: 1.29; 95% CI: 1.14-1.46) and high triglyceride (TG) (RR: 1.28; 95% CI: 1.11-1.46) were at a higher risk of high-grade BC than their counterparts.

CONCLUSIONS

This meta-analysis revealed that MS and its components might be associated with high BC stage and grade.

The metabolic syndrome is associated with the risk of urothelial carcinoma from a health examination database

PURPOSE

The metabolic syndrome was associated with bladder cancer in the previous studies. However, there have no large-scale cohort studies to elucidate the relationship between metabolic syndromes and urothelial carcinoma including urinary bladder urothelial carcinoma (UBUC) and upper tract urothelial carcinoma (UTUC).

METHODS

We analyze a population-based cohort study by using physical examination data and diagnosis of UC from the Taiwan Cancer Registry Database. Differences in demographic and clinical characteristics among UTUC and non-UTUC groups, UBUC and non-UBUC groups were compared. Odds ratios (ORs) for determining risk factors were estimated through the multiple logistic regression model.

RESULTS

A total of 557,063 records for 211,319 participants which consisted of 31 UTUC and 309 UBUC met the eligibility criteria in this study. Our results showed that female are more likely to develop UTUC than male. As opposed to UTUC, male are more likely to develop UBUC than female. It also showed that participants smoked or chewed betel quid daily are more likely to develop UBUC. Age and estimated glomerular filtration rate (eGFR) are significantly increased the risk of developing UTUC. The association between the eGFR and risk of UTUC is stronger (P < 0.001) for eGFR < 45 (vs. eGFR ≥ 75, OR = 6.795; 95% CI 2.901-15.917). Metabolic syndrome is related to higher risk of UBUC incidence [OR was 1.373 (95% CI 1.104-1.707)].

CONCLUSIONS

There was a significant relationship between the incidence of UBUC and metabolic syndrome. Renal function impairment presents higher risk in both UBUC and UTUC development.

Modulation of Calcium Homeostasis May Be Associated with Susceptibility to Renal Cell Carcinoma in Diabetic Nephropathy Rats

Introduction

Clinical studies have indicated a relationship between diabetic nephropathy (DN) and the incidence and prevalence of renal cell carcinoma (RCC). However, the mechanism linking diabetic nephropathy and renal cell carcinoma has not yet to be identified.

Methods

In this study, a total of 42 male Sprague Dawley (SD) rats were randomly assigned to a DN group (n=35) and a control group (n=7). All animals in the DN group were unilaterally nephrectomized and treated with streptozotocin with the development of blood glucose levels >16.7mmol/L and dominant proteinuria and were compared to controls without such changes. Histopathologic alterations in the kidneys were examined by HE staining and Ki-67 immunohistochemistry. Differentially expressed genes were identified and validated by RNA-seq and PCR.

Results

As the results, except for two rats that failed to develop the DN model and were excluded from the analysis, 33 rats in the DN group with overt signs of DN demonstrated significantly higher food and water intake, urine production, and urine protein and urinary protein/creatinine ratio than controls. Overall, 15.2% (n=5/33) of DN animals developed RCC while none tumors were observed in the control group (n=0/7). RNA-seq analysis in these animals indicated different TRPV5 gene expression and calcium pathway expression in DN animals with developing tumors, when compared with animals with no obvious tumors. In addition, DN animals diagnosed with RCC showed increased expression of GLUT2 and c-met, when compared to controls and DN animals without tumors.

Discussion

In conclusion, the disordered calcium metabolism, especially disturbed TRPV5 mediated Ca²⁺ signal, may have been related to the development of RCC in DN rats. Further studies related to the detailed mechanism are still needed.

Is Cardiometabolic Index a Predictive Marker for Renal Cell Cancer Aggressiveness?

Studies show that metabolic syndrome is a factor for developing renal cell cancer (RCC) and tumour aggressiveness. In our study, we evaluated the association between renal cell cancer and cardiometabolic index (CMI) which meets the main components of the metabolic syndrome. We retrospectively reviewed the records of 310 consecutive patients with RCC who underwent radical nephrectomy at our institution. We evaluated the tumour size, histologic subtype, Fuhrman nuclear grade. CMI was calculated as the product of waist circumference (WC) to waist-to-height ratio (WHtR) and triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-c). CMI were statistically higher in patients with tumour size ≥ 7 cm than those &lt; 7 cm (p&lt;0.05). Mean CMI level was 2.34 ± 0.84 in patients with high tumour size; and 1.18 ± 0.74 in the other group. The patients with high tumour size had higher TG levels, higher WC and lower HDL-c levels. Similarly, CMI levels were statistically higher in patients with Fuhrman grade 3 and 4 than patients with Fuhrman grade 1 and 2 (p&lt;0.001). The patients with high Fuhrman grade had higher TG levels, higher WC and lower HDL-c levels. The simplicity of WC and height measurement and TG and HDL assessment make CMI an easily applicable index for the evaluation of cardiovascular dysfunction. The components of CMI may have effect on tumour carcinogenesis in similar pathways. In this context, CMI which meets the main components of the metabolic syndrome, can be a useful index for the evaluation and calculation of renal cell cancer aggressiveness.

Optimal body mass index cut-point for predicting recurrence-free survival in patients with non-muscle-invasive urothelial carcinoma of bladder

In Japanese patients with non-muscle-invasive urothelial carcinoma of the bladder, the impact of body mass index (BMI) on recurrence following transurethral resection of bladder tumor (TURBT) is unclear. The present study retrospectively examined data collected from 50 patients diagnosed with primary urothelial carcinoma of the bladder (pTa, pTis, and pT1) who had previously undergone TURBT surgery. Two BMI cut-off points for predicting disease recurrence were evaluated: i) A threshold generated through receiver operating characteristic (ROC) curve analysis; ii) the World Health Organization BMI index (24 kg/m²) for overweight status in Japanese populations. Univariate and multivariate analyses were applied to assess individual variables (BMI included) and the effect they had on recurrence-free survival (RFS). Median RFS and BMI values of 19.72 months (range, 3.13-72.13 months) and 23.37 kg/m2 (range, 14.72-36.84 kg/m2), respectively, were recorded. In multivariate analyses, higher continuous BMI was significantly associated with shorter RFS (P=0.019). Based on a ROC-generated BMI cut-off point (23.4 kg/m2), patients were ranked with either a high (≥23.4 kg/m2) or low (<23.4 kg/m2) BMI status. Multivariate analysis indicated that BMI values >23.4 kg/m2 were significantly associated with shorter RFS (P=0.028). Intravesical Bacillus Calmette-Guérin treatment and history of upper-tract urothelial carcinoma were also independently associated (P=0.044 and P=0.010, respectively). However, BMI values >24 kg/m2 (customary cut-off point) had no significant impact on RFS (P=0.066). Thus, a higher BMI status was revealed to be independently predictive of shorter RFS in Japanese patients undergoing TURBT for urothelial carcinoma of the bladder. A greater number of samples are required in order to determine optimal BMI cut-off points in Japanese patients and to investigate whether weight reduction intervention may improve prognosis.

The metabolic syndrome is associated with more aggressive prostate cancer

PURPOSE

The aim of this study was to analyze any association between the metabolic syndrome (MetS) and risk of prostate cancer (PCa) and cancer grade among men undergoing radical prostatectomy for PCa.

MATERIALS AND METHODS

50 patients with MetS and 50 patients without MetS who undervent radical prostatectomy (RP) were included in the study. Age at biopsy, height, weight, digital rectal examination (DRE), pre-biopsy PSA levels, prostate volume, histopathologic diagnosis after surgery and Gleason scores were collected data from all patients. Histologic material obtained at biopsy was given a Gleason score; tumours with a Gleason score ≥7 were considered high grade and <7 were considered low grade.

RESULTS

The mean age at the time of biopsy was 63.7 ± 5.94 in patients with MetS and 61.6 ± 6.14 in patients without MetS. Men with MetS had significantly lower PSA levels (p=0.01) (7.21 ± 2.74 and 8.81 ± 2.72, respectively). Also, the men with MetS had higher RP tumor grade (p=0.04).

CONCLUSIONS

Men with MetS undergoing RP have lower PSA levels and have significantly higher grade PCa. We must be careful for screening PCa in patients with MetS. Although the patients had lower PSA levels, they may have high grade disease.

The association between metabolic syndrome and the risk of urothelial carcinoma of the bladder: a case-control study in China

BACKGROUND

Evidence of the association of metabolic syndrome (MetS) with cancer risk is accumulating. However, uncertainties still exist as to the link of MetS with bladder cancer. This study aimed to assess the relationship between MetS and the risk of urothelial carcinoma of the bladder (UC) in a Chinese population.

METHODS

We retrospectively analyzed clinicopathological data of 972 newly diagnosed UC patients and 1098 cancer-free controls matched to the cases by age and gender. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression in both unadjusted and adjusted models.

RESULTS

MetS was not significantly associated with the overall UC risk (p=0.08). However, a significant association of MetS with UC was observed in female patients (p=0.006). Diabetes mellitus (crude OR 1.339, 95% CI 1.079-1.662, p=0.008; adjusted OR 1.767, 95% CI 1.308-2.386, p<0.001) and hypertriglyceridemia (crude OR 1.245, 95% CI 1.018-1.522, p=0.033; adjusted OR 1.254, 95% CI 1.020-1.542, p=0.032) were significantly associated with UC risk. As the number of MetS components increased, the UC risk was elevated. Having three or more (versus zero) components of MetS was significantly related to risk of overall UC (OR 1.315; 95% CI 1.006-1.719; p=0.045) and non-muscle invasive bladder cancer (OR 1.354; 95% CI 1.019-1.798; p=0.037).

CONCLUSIONS

The present study indicated a marginal association between MetS and UC risk, and a significant association with UC risk in female patients. The results need to be evaluated in large-scale prospective cohorts.

Laparoscopic Retroperitoneal Nephroureterectomy is a Safe and Adherent Modality for Obese Patients with Upper Urinary Tract Urothelial Carcinoma

OBJECTIVE

We evaluated the association of body mass index (BMI) with perioperative outcomes in patients who underwent laparoscopic or open radical nephroureterectomy.

MATERIALS AND METHODS

This retrospective single-center study included 113 patients who had been diagnosed with upper urinary tract cancer from January 1998 to June 2013 and were treated with laparoscopic nephroureterectomy (Lap group, n=60) or open nephroureterectomy (Open group, n=53). Laparoscopic nephroureterectomy was performed via a retroperitoneal approach following an open partial cystectomy. The two surgical groups were stratified into a normal-BMI group (<25) and a high-BMI group (BMI≥25). The high-BMI group included 27 patients: 13 in the Lap group and 14 in the Open group.

RESULTS

Estimated blood loss (EBL) in the Lap group was much lower than that in the Open group irrespective of BMI (p<0.01). Operative time was significantly prolonged in normal-BMI patients in the Lap group compared to those in the Open group (p=0.03), but there was no difference in operative time between the Open and Lap groups among the high-BMI patients. Multivariate logistic regression analysis of the data for all the cohorts revealed that the open procedure was a significant risk factor for high EBL (p<0.0001, hazard ratio 8.02). Normal BMI was an independent predictor for low EBL (p=0.01, hazard ratio 0.25). There was no significant risk factor for operative time in multivariate analysis. There were no differences in blood transfusion rates or adverse event rates between the two surgical groups.

CONCLUSIONS

Laparoscopic radical nephroureterectomy via a retroperitoneal approach can be safely performed with significantly reduced EBL even in obese patients with upper urinary tract cancer.

Diabetes mellitus and ovarian cancer: more complex than just increasing risk

OBJECTIVE

Diabetes mellitus (DM) is a risk factor for endometrial cancer and is associated with poorer outcomes in breast and colon cancers. This association is less clear in epithelial ovarian cancer (EOC). We sought to examine the effect of DM on progression-free (PFS) and overall survival (OS) in women with EOC.

METHODS

A retrospective cohort study of EOC patients diagnosed between 2004 and 2009 at a single institution was performed. Demographic, pathologic and DM diagnosis data were abstracted. Pearson chi-square test and t test were used to compare variables. The Kaplan-Meier method and the log rank test were used to compare PFS and OS between non-diabetic (ND) and DM patients.

RESULTS

62 (17%) of 367 patients had a diagnosis of DM. No differences in age, histology, debulking status, or administration of intraperitoneal chemotherapy between ND and DM patients were present, although there were more stage I and IV patients in the ND group (p=0.04). BMI was significantly different between the two groups (ND vs. DM, 27.5 vs. 30.7kg/m(2), p<0.001). While there were no differences in survival based on BMI, diabetic patients had a poorer PFS (10.3 vs. 16.3months, p=0.024) and OS (26.1 vs. 42.2months, p=0.005) compared to ND patients. Metformin use among diabetic patients did not appear to affect PFS or OS.

CONCLUSIONS

EOC patients with DM have poorer survival than patients without diabetes; this association is independent of obesity. Metformin use did not affect outcomes. The pathophysiology of this observation requires more inquiry.