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目的探讨身体质量指数(body mass index,BMI)与前列腺癌(PCa)预后因素的关系及BMI与睾酮的相关性。方法回顾性分析我院2003年6月至2007年3月间302例PCa患者的临床资料,统计确诊PCa时的年龄、身高、体重、术前PSA及治疗前睾酮水平、前列腺体积、活检穿刺阳性比(percentage of positive biospies,PPBs)、活检及手术标本的Gleason评分、手术切缘阳性率和淋巴结转移等指标,进行临床分期和病理分级,用SPSS11.0统计软件分别比较不同临床分期和病理分级患者的BMI的差异,分析BMI与若干PCa预后因素的相关性及BMI与睾酮的关系。结果①302例PCa患者BMI高于正常人群(其中210例身高体重资料齐全的患者的BMI呈正态分布),175例患者治疗前测量了睾酮值,不同个体间差异有统计学意义。②BMI与PCa预后因素的关系:经校正年龄因素,不同临床分期之间的BMI差异无统计学意义(方差分析,P>0.05),但不同病理分级之间BMI差异有统计学意义(协方差分析,P<0.01),特别是Gleason评分为8～10组患者的BMI显著高于Gleason评分分别为2～4、5～6及7的其他3个分组(P均<0.01),BMI≥24患者的穿刺活检阳性比(秩和检验,P<0.05)及前列腺肿瘤切缘阳性率(χ2检验,P<0.05)均高于BMI<24者。BMI与治疗前血清总PSA及前列腺体积无明显相关。③BMI与治疗前睾酮呈明显负相关,相关系数为-0.252。结论可初步认为在PCa患者中,BMI较高者睾酮水平较低且预后不良。
Objective To investigate the relationship between body mass index (BMI) and the prognosis of prostate cancer (PCa) and the correlation between BMI and testosterone. Methods The clinical data of 302 PCa patients from June 2003 to March 2007 in our hospital were retrospectively analyzed. The age, height, weight, preoperative PSA, pretest testosterone level, prostate volume and biopsy were statistically analyzed (PPBs), Gleason score of biopsy and surgical specimens, the positive rate of surgical margins and lymph node metastasis, clinical staging and pathological grading, SPSS11.0 statistical software were used to compare different clinical stages and pathological grading Patient BMI differences, analysis of BMI and several PCa prognostic factors and the relationship between BMI and testosterone. Results ① The BMI of 302 PCa patients was higher than that of the normal people (210 of them were normal distribution of BMI). The testosterone values of 175 patients were measured before treatment, and the differences among different individuals were statistically significant. The relationship between BMI and PCa prognostic factors: There was no significant difference in BMI between different clinical stages (adjusted for variance, P> 0.05) by age-adjusted factors, but there was significant difference in BMI between different pathological grades (covariance analysis , P <0.01). In particular, the BMI of patients with Gleason scores of 8 to 10 were significantly higher than those of patients with Gleason scores of 2 to 4,5 to 6 and 7 respectively (all P <0.01). Patients with BMI≥24 The biopsy positive ratio (rank sum test, P <0.05) and the positive rate of prostate cancer margin (χ2 test, P <0.05) were higher than those with BMI <24. There was no significant correlation between BMI and total serum PSA and prostate volume before treatment. ③BMI and testosterone before treatment showed a significant negative correlation coefficient of -0.252. Conclusions It may be preliminarily considered that in patients with PCa, higher BMI results in lower testosterone levels and poor prognosis.