Article / Research Article

"MetabolicSyndrome: A High Risk for Urological Malignancies? A Prospective Study"

SJoseph Philipraj*, Karthik Meyappan, Vishal Shet

Department of Urology, Mahatma Gandhi Medical college and Research Institute, Pondicherry, India

*Corresponding author:S.Joseph Philipraj, Department of Urology, Mahatma Gandhi Medical college and Research Institute, Pondy-Cuddallore Main Road, Pillaiyarkuppam, Podicherry- 607402, Tamil Nadu, India. Tel:+919475919727; +919047521148; Email: josephphilipraj@gmail.com. 

Received Date: 26 October, 2017; Accepted Date: 01November, 2017; Published Date: 08November, 2017

1.      Abstract

Metabolic syndrome is collection of risk factors for Cardiovascular disease. It is growing problem worldwide. Available evidence from epidemiologic investigations and experimental, translational, and clinical studies supports the emerging hypothesis that metabolic syndrome may be an important etiologic factor for the development and progression of certain types of cancer and also for overall cancer mortality. Urological diseases have also been linked to the metabolic syndrome. Most established aspects of the metabolic syndrome are linked to Benign Prostatic Hyperplasia (BPH) and prostate cancer. We wanted to study the correlation Between Metabolic Syndrome and urological malignancies seen in our institution. Hence this prospective cohort study is done.

2.      Keywords:Carcinoma Penis; Carcinoma Prostate;Carcinoma Urinary Bladder;Metabolic Syndrome;Renal Cell Carcinoma; Urological Malignancies; Upper Urinary Tract Malignancy

1.      Introduction

The incidence of Urological Malignancies has been increasing globally with a change in people’s lifestyle as well as an increase in the number of patients newly diagnosed with Metabolic Syndrome. The metabolic syndrome is a cluster of risk factors for cardiovascular disease and type 2 diabetes and constitutes a growing problem worldwide[1]. These factors include obesity(particularly central adiposity), dysglycemia,raised blood pressure, elevatedtriglyceride levels, and low HDL cholesterol levels.Available evidence from epidemiologic investigations and experimental, translational, and clinical studies supports the emerging hypothesis that metabolic syndrome may be an important etiologic factor for the development and progression of certain types of cancer and also for overall cancer mortality [2]. Urological diseases have also been linked to the metabolic syndrome. Most established aspects of the metabolic syndrome are linked to Benign Prostatic Hyperplasia (BPH) and prostate cancer. Fasting plasma insulin, in particular, has been linked to BPH and incident, aggressive and lethal prostate cancer. Patients with type 2 diabetes mellitus suffer from a significantly higher risk of urological malignancies and Carcinomabladder[3,4].

The mechanisms of such an increased Cancer risk in the diabetic patients may be related to insulin resistance, hyperinsulinemia, pro inflammatory status and increased oxidative stress [3]. The metabolic syndrome has also been shown to be associated with nonprostatic urological conditions such as male hypogonadism, nephrolithiasis, overactive bladder and erectile dysfunction, although data on these conditions are still sparse. Overall, the results of studies on urological aspects of the metabolic syndrome seem to indicate that BPH and prostate cancer could be regarded as two new aspects of the metabolic syndrome, and that an increased insulin level is a common underlying aberration that promotes both BPH and clinical prostate cancer. Ethnical differences may exist when the risk of specific cancer types is compared between patients with Diabetes mellitus and individuals without Diabetes mellitus. Smoking, obesity, dyslipidemia, hypertension have been identified as potential risk factors for renal malignancy [5-7]. In diabetics, cancer contributes 13% to mortality and high rates of cancer recurrence [8]. Increasing BMI was associated with higher risk of developing invasive penile cancer[9].It is hypothesised that high circulating insulin levels indirectly drive hepatic production of insulin-like growth factor 1 and that this combined effect acts as a ‘fertiliser’, generating a microenvironment that promotes prostate tumour growth[10]. There is a growing body of evidence showing that obesity is associated with an increase in aggressive prostate cancer, increased risk of failure of radical therapy and increased prostate cancer-specific mortality [11]. Increased physical activity appears to offer a small protective effect on subsequent risk of developing prostate cancer[12-15].

2.      Patients and Methods

This isa prospective study of 49 patients with Urological Malignancy who presented to our Institution between January 2016 to June 2017. Association of Metabolic Syndrome(MetS) in these patients were studied and Correlation was evaluated using statistical methods. Individuals with the following UrologicalMalignancies were included in this study: CarcinomaProstate, Renal Cell Carcinoma,Transitional Cell Carcinoma Bladder&Upper Tract, Carcinoma Penis.

Following Criteria were used for the clinical Identification of the Metabolic Syndrome -(Any 3 of the Following),

*Abdominal obesity * Waist circumference:

Men - >102 cm (>40 in)

Women >88 cm (>35 in)

*Triglycerides >150 mg/dL

*HDL cholesterol

Men <40 mg/dL

Women <50 mg/dL

*Blood pressure >130/>85 mm Hg

*Fasting glucose >110 mg/dL

(National Cholesterol Education Program ATP III Guidelines)

FollowingVariables were studied

·                     Age

·                     Sex

·                     H/o Smoking

·                     H/o Alcoholism

·                     Height in meters

·                     Weight in kg

·                     BMI

·                     Waist circumference in inches

·                     Fasting Sugars in mg/dl or diagnosed DM on treatment

·                     BP in mm of Hg or diagnosed HTN on treatment

·                     S. Triglycerides in mg/dL

·                     S. HDL in mg/dL

3.      Results

3.1.  Statistical Analysis

The data analysis pertaining to the different cancer regions and related parameters are reported.Frequency analysis, Descriptive summary of the clinical parameters across cancer regions, relational understanding between clinical parameters with respect to different malignancies, cross tabulations are reported.Along with these outcomes, a classifier rule is built to assess the risk involved to observing a prostate malignancy using several clinical parameters.To do so, a multinomial logistic regression is applied, and the entire analysis is carried out in IBM SPSS 19.0 version.All the comparisons are made at 0.05 level of significance (Table 1) (Figure 1,2).

The comparable malignancy is Prostate and accordingly the models are developed. With respect to Prostate and Bladder cancer, individuals who have the alcohol intake are 2.4 times susceptible to have prostate malignancy and similarly when we compare the Prostate and Penis Malignancy, the individuals who have the habit of alcohol, they are observed to have risk 7 times than that of non-alcoholic(Table 3).

These are pertaining to Prostate cancer samples.It is obvious that, BMI and Waist circumference are highly and positively correlated (r=0.971).In rest of the parameters, moderate amount of correlation is noticed.Poor correlation is observed between Triglycerides and HDL, Waist Circumference(Table 6).

4.      Discussion

Of the total 49 patients in our study 17 had CarcinomaProstate, 6 had CarcinomaBladder, 8 had CarcinomaPenis, 5 had Renal Cell Carcinomaand 3 had Transitions Cell Carcinoma of the Upper Tract.In the individuals with prostate cancer, the mean age is observed to be 69.82 and it is 61.75 for the individuals diagnosed with Bladder cancer.Further, mean Triglyceride level is observed to be little higher in the individuals of Bladder cancer than that of Prostate cancer.With respect to Prostate and Bladder cancer, individuals who have the alcohol intake are 2.4 times susceptible to have prostate malignancy and similarly when we compare the Prostate and Penile Malignancy, the individuals who have the habit of alcoholconsumption, they are observed to have risk 7 times than that of non-alcoholic.

5.      Conclusions

Many adverse health consequences result from Metabolic Syndrome including the increased risk for several cancers. Our study shows a higherincidence of Metabolic Syndrome in patients with Urological Malignancies. Most factors responsible for metabolic syndrome are modifiable hence greater emphasis on Lifestyle modification and control of co-morbid conditions like Diabetes and Hypertension may be beneficial in reducing the incidences of Urological Malignancies over the long run.


Figure 1: Shows the various types of malignancies and their percentage appearance in our set up.



Figure 2:Shows the incidence of Components of Metabolic Syndrome.

 

Parameter

 

Category

 

Frequency

 

Percent

Cancer Region

Prostate

17

34.7

Bladder

16

32.7

Penis

8

16.3

RCC

5

10.2

Upper Tract

3

6.1

Total

49

100.0

Sex

Male

45

91.8

Female

4

8.2

Total

49

100.0

Hypertension

Yes

26

53.1

No

23

46.9

Total

49

100.0

Diabetes Mellitus

Yes

22

44.9

No

27

55.1

Total

49

100.0

Infertility

Yes

2

4.1

No

47

95.9

Total

49

100.0

Alcohol Intake

Yes

28

57.1

No

21

42.9

Total

49

100.0

Smoking

Yes

28

57.1

No

21

42.9

Total

49

100.0

 

 

Table 1:Shows the incidence of Type of malignancy and Other factors which can be associated with the malignan

  

The results reported in the (Table 2).

 

Parameters

Cancer Region

Statistics

Prostate

Bladder

Penis

RCC

Upper Tract

Age

Mean

69.82

61.75

54.75

47.00

64.00

Std. Deviation

10.120

12.715

20.141

13.000

10.817

Body Mass Index

Mean

29.71

28.69

29.13

30.00

28.67

Std. Deviation

4.832

5.805

7.259

5.874

3.055

Waist Circumference

Mean

35.12

34.56

34.00

36.40

34.00

Std. Deviation

5.419

6.377

8.264

5.595

4.583

Triglycerides

Mean

151.06

160.75

127.50

114.60

145.67

Std. Deviation

44.732

57.676

36.975

30.892

48.583

HDL

Mean

41.00

40.94

46.38

45.40

45.67

Std. Deviation

10.404

9.595

10.676

6.148

4.933

 

Table 2:Summarizes the fact about the parameters and how they vary between different malignancies.

 

Cancer Region

 

B

Std. Error

Wald

df

Sig.

Odds Ratio

Lower Confidence Interval

Upper Confidence Interval

Bladder

Intercept

-1.28

0.87

2.18

1.00

0.14

 

0.76

7.60

ALCOHOL

0.88

0.59

2.21

1.00

0.14

2.40

Penis

Intercept

-3.77

1.32

8.09

1.00

0.00

 

1.54

33.56

ALCOHOL

1.97

0.79

6.32

1.00

0.01

7.20

 

Table 3:The result obtained on performing the multinomial logistic regression analysis.

 

In the (Table 4,5).

 

Observed

Predicted

 

Prostate

Bladder

Penis

Percent Correct

Prostate

12

5

0

70.60%

Bladder

8

8

0

50.00%

Penis

2

6

0

0.00%

Overall Percentage

53.70%

46.30%

0.00%

48.80%

 

Table 4:Confusion matrix and on the whole, using the obtained model, around 48.8% of accuracy is observed in predicting the malignancy status of an individual.

 

Parameters

Response

Cancer Region

Prostate

Bladder

Penis

RCC

Upper Tract

Count

Column N %

Count

Column N %

Count

Column N %

Count

Column N %

Count

Column N %

Hypertension

Yes

10

58.80%

9

56.30%

3

37.50%

2

40.00%

2

66.70%

No

7

41.20%

7

43.80%

5

62.50%

3

60.00%

1

33.30%

Diabetes Mellitus

Yes

9

52.90%

8

50.00%

3

37.50%

1

20.00%

1

33.30%

No

8

47.10%

8

50.00%

5

62.50%

4

80.00%

2

66.70%

Infertility

Yes

0

0.00%

0

0.00%

0

0.00%

2

40.00%

0

0.00%

No

17

100.00%

16

100.00%

8

100.00%

3

60.00%

3

100.00%

Alcohol Intake

Yes

12

70.60%

8

50.00%

2

25.00%

4

80.00%

2

66.70%

No

5

29.40%

8

50.00%

6

75.00%

1

20.00%

1

33.30%

Smoking

Yes

9

52.90%

9

56.30%

5

62.50%

3

60.00%

2

66.70%

No

8

47.10%

7

43.80%

3

37.50%

2

40.00%

1

33.30%

 

Table 5: Shows the incidence of Various components of metabolic syndrome with urological malignancies.

 

Cancer type = Prostate

 

Body Mass Index

Waist Circumference

Triglycerides

HDL

Body Mass Index

Pearson Correlation

1

.971**

.450

-.444

Sig. (2-tailed)

 

.000

.070

.074

Waist Circumference

Pearson Correlation

.971**

1

.381

-.411

Sig. (2-tailed)

.000

 

.132

.101

Triglycerides

Pearson Correlation

.450

.381

1

-.228

Sig. (2-tailed)

.070

.132

 

.379

HDL

Pearson Correlation

-.444

-.411

-.228

1

Sig. (2-tailed)

.074

.101

.379

 

Table 6:The correlation values depict the inter dependency between the clinical parameters.

 In(Table7),

 

Cancer Type=Bladder

 

Body Mass Index

Waist Circumference

Triglycerides

HDL

Body Mass Index

Pearson Correlation

1

.976**

.271

-.426

Sig. (2-tailed)

 

.000

.310

.099

Waist Circumference

Pearson Correlation

.976**

1

.313

-.360

Sig. (2-tailed)

.000

 

.238

.171

Triglycerides

Pearson Correlation

.271

.313

1

-.679**

Sig. (2-tailed)

.310

.238

 

.004

HDL

Pearson Correlation

-.426

-.360

-.679**

1

Sig. (2-tailed)

.099

.171

.004

 

 

Table 7:The correlation values depict the inter dependency between the clinical parameters for Bladder cancer samples, moderate amount of correlation is noticed between BMI and HDL, Waist circumference and Triglycerides. Good amount of relation (negative) is observed between Triglycerides and HDL. In (Table 8)

 

   

Body Mass Index

Waist Circumference

Triglycerides

HDL

Body Mass Index

Pearson Correlation

1

.974**

.672

-.843**

Sig. (2-tailed)

 

.000

.068

.009

Waist Circumference

Pearson Correlation

.974**

1

.575

-.805*

Sig. (2-tailed)

.000

 

.136

.016

Triglycerides

Pearson Correlation

.672

.575

1

-.837**

Sig. (2-tailed)

.068

.136

 

.010

HDL

Pearson Correlation

-.843**

-.805*

-.837**

1

Sig. (2-tailed)

.009

.016

.010

 

 

Table 8: The correlation values depict the inter dependency between the clinical parameters for Penis malignancy samples, Significant correlation values are observed between almost all pairs of parameters. HDL and BMI are highly and negatively correlated, BMI and Triglycerides are moderately correlated with positive magnitude, HDL and Waist circumference are related to a maximum extent in negative magnitude. Similar sort of negative relation is noticed between HDL and Triglycerides.

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Citation:Philipraj SJ,Meyappan K, Shet V (2017) Metabolic Syndrome: A High Risk for Urological Malignancies? A Prospective Study. J Urol Ren DisJURD-162.DOI: 10.29011/2575-7903.000062