Association Between Metabolic Syndrome And Its Components And Non-muscle Invasive Bladder Cancer

【Background】Bladder cancer is the most common malignant tumor in the urinary system and the tenth most common malignant tumor in the world.Bladder cancer is more common in men than women,and the incidence of men is about 3 to 4 times that of women.The incidence of bladder cancer ranks first in malignant tumors of the urogenital system in China,and the incidence rate is increasing every year.Non-muscle invasive bladder cancer(NMIBC)accounts for about 70%of bladder cancer cases,and 10%to 30%of NMIBC patients still progress to muscular invasive bladder cancer after surgery,recurring within 5years The rate can be as high as 40%～50%.In recent years,people have paid more and more attention to the connection between Metabolic Syndrome(MetS)and cancer development.Many studies have shown that MetS can increase the cancer mortality rate of various cancer types.Some scholars believe that MetS can increase the risk of bladder cancer,and the pathological grade and stage of patients with MetS bladder cancer are higher,but there are few reports on the correlation between MetS patients and the occurrence and development of NMIBC.Similarly,only a few studies have comprehensively evaluated the relationship between each MetS metabolic component(eg obesity,diabetes)and the occurrence and development of NMIBC.Therefore,this study collected clinical data of 162 NMIBC patients and 178control group disease control patients for a case-control study.Retrospective analysis of the effects of MetS and its metabolic components on the risk of NMIBC onset and recurrence will provide great help for treatment guidance and prognosis of NMIBC patients.【Objective】To analyze the impact of metabolic syndrome and its components on the risk of onset and recurrence of non-muscle invasive bladder cancer.【Methods】First,using a case-control study method,162 primary NMIBC patients in the Second Affiliated Hospital of Guangzhou Medical University from June 2014 to June 2019 were selected as the case group.At the same time,178 patients with non-urinary system and non-tumor-related diseases matching the age and sex of NMIBC case group hospitalized in the same period were randomly selected as the control group.Collect clinical data of patients,including gender,age,smoking status,height(cm),body weight(kg),body mass index(BMI),fasting blood glucose(mmol/L),triglyceride concentration(mmol/L),high density Lipoprotein cholesterol(mmol/L).The tumor size,tumor number and tumor stage of the case group were collected,followed by medical records and telephone follow-up to collect the recurrence of the case group after operation.An unconditional logistic regression model univariate and multivariate analysis was used to analyze the correlation between MetS and various metabolic factors and the risk of NIMBC.Then,the patients in the NMIBC group were further subdivided into MetS and non-MetS groups,and retrospective research methods were used to further analyze the correlation between MetS and its metabolic components and the risk of NMIBC recurrence.Kaplan-Meier method was used to evaluate the effect of MetS and its components on NMIBC recurrence free survival(RFS),and the log-rank test method was used to compare survival curves.Finally,the Cox regression model was used to evaluate the relationship between MetS and its components and RFS in NMIBC patients.【Results】1.A total of 162 patients with NMIBC were followed up for 7-69 months,with an average follow-up time of 33 months,of which 65 patients relapsed.The age distribution of the case group was 27-91 years old,with an average age of 63.5±14.4 years old.There were 123 males and 39 females,with a male to female ratio of 3.15:1.There were 178patients in the control group,with age distribution ranging from 26 to 88 years,with an average age of 63.4±14.0 years.There were 134 males and 44 males,with a male to female ratio of 3.05:1.There was no statistically significant difference in age and gender between the two groups(P>0.05).2.Univariate and multivariate logistic regression analysis showed that hyperglycemia,MetS and NMIBC risk were significantly correlated.The risk of NMIBC in hyperglycemic patients was 1.6 times that of patients without hyperglycemia(OR=1.669,95%CI:1.035～2.693,P=0.036),the risk of NMIBC in MetS patients was twice that of patients without MetS(OR=2.023,95%CI:1.046～3.912,P=0.036),the difference between the two groups was statistically significant.However,no correlation was found between obesity,hypertension or dyslipidemia and the risk of NMIBC,and there was no statistically significant difference between the two groups(P=0.584,P=0.612,P=0.481)Compared with patients without MetS components,a component with MetS is not associated with an increased risk of NMIBC(P>0.05),but a component with two or more MetS is significantly associated with the overall risk of NMIBC(OR=2.220,95%CI:1.072～4.598,P=0.032;OR=2.260,95%CI:1.099～4.647,P=0.027),the difference was statistically significant.3.There were 27 NMIBC patients with MetS and 135 NMIBC patients without MetS.The analysis of the distribution of different variables between the two groups showed that the variables of age,gender,smoking,tumor grade,tumor stage,tumor number,tumor size and other variables were not statistically significant(P>0.05);those with MetS group The recurrence rate of NMIBC was significantly higher than that of the pure NMIBC group,the recurrence rates were 59.2%and 36.3%,respectively,and the difference between the two groups was statistically significant(P<0.05).The metabolic components of NMIBC patients with MetS group were significantly higher than those of NMIBC group alone,and the difference between the two groups was statistically significant(P<0.001).4.Compared with the relapse rate of NMIBC in MetS and non-MetS groups,the recurrence rates were 59.2%and 36.3%,respectively.The recurrence rate of MetS group was higher than that of non-MetS group(P=0.026),the difference was statistically significant(P<0.05).The recurrence rate of the obese group,diabetes group,and dyslipidemia group was higher than that of the non-obese group,non-diabetic group,and non-dyslipidemia group(P=0.026,P=0.016,P=0.039),the difference was statistically significant(P<0.05)However,there was no statistically significant difference between the hypertensive group and the non-hypertensive group(P>0.05).5.The average RFS of patients in the hyperglycemia group and non-diabetic group were 36.5 months and 50.0 months,respectively.The RFS of the diabetic group was significantly lower than that of the non-diabetic group,the difference was statistically significant(χ~2=8.984,P=0.003)The average RFS of the obese group and non-obese group were 34.5 months and 48.9 months,respectively.The RFS of the obese group was significantly lower than that of the non-obese group,and the difference was statistically significant(χ~2=8.084,P=0.004);The average RFS of the MetS group was 33.9 months and 46.6 months respectively.The RFS of the MetS group was significantly lower than that of the non-MetS group,and the difference was statistically significant(χ~2=6.450,P=0.011);There was no statistically significant difference in RFS between the non-hypertensive group and the non-dyslipidemia group(χ~2=0.781,P=0.377;χ~2=2.452,P=0.117).6.Cox multivariate survival analysis showed that obesity and hyperglycemia can increase recurrence after NMIBC(HR=1.816,95%CI 1.073～3.075,P=0.026;HR=1.710,95%CI 1.003～2.915,P=0.049)The risk of MetS,hypertension,and dyslipidemia was not significantly related to the risk of recurrence after NMIBC(P>0.05).【Conclusions】1.Compared with people without hyperglycemia and MetS,the risk of NMIBC in patients with hyperglycemia and MetS is increased,and as the number of MetS metabolic components increases,the risk of NMIBC patients is higher.Risk factors.2.For people without hyperglycemia and obesity,obesity and diabetes may increase the risk of recurrence of NMIBC patients after surgery.MetS,obesity and diabetes may be risk factors for NMIBC recurrence.