Abstract
Objectives
Overweight/obesity is known to increase the risk of developing renal cell carcinoma (RCC). However, data on the prognostic impact of overweight in RCC is still conflicting. We assessed whether different body mass index (BMI) levels at the time of surgery had an effect on the long-term prognosis of RCC patients.
Methods
We evaluated 771 patients, with complete information about their BMI, who had undergone renal surgery for RCC between 1990 and 2005 at the authors’ institution; the mean follow-up was 5.48 years.
Results
Underweight, normal weight, pre-obesity, and obesity were diagnosed in 4 (0.5%), 239 (31%), 356 (46.2%), and 172 (22.3%) RCC patients, respectively. Overweight (BMI >25) was significantly associated with younger age (P = 0.004) and positive nodal status (P = 0.04) but not with tumor stage, grade, visceral metastasis, gender, histological subtype, or tumor-related symptoms. Overweight patients had a significantly lower risk of cancer-related death; their median 5-year tumor-specific survival rate was 80% as opposed to 72% for patients with a BMI below 25 (P = 0.003). Interestingly, subgroup analysis revealed that the positive association between overweight and survival was even more pronounced in organ-confined (P < 0.001) RCC, but no correlation was observed in advanced disease (P = 0.23).
Conclusion
We were able to identify overweight as an independent prognostic marker of improved tumor-specific survival in patients with organ-confined RCC. Basic research is required to resolve the dilemma of why, if a higher BMI predisposes to RCC, it concurrently prolongs survival after patients have undergone (partial) nephrectomy.
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References
Asal NR, Risser DR, Kadamani S, Geyer JR, Lee ET, Cherng N (1988) Risk factors in renal cell carcinoma: I. Methodology, demographics, tobacco, beverage use, and obesity. Cancer Detect Prev 11:359–377
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348:1625–1638. doi:10.1056/NEJMoa021423
Chow WH, Gridley G, Fraumeni JF Jr, Jarvholm B (2000) Obesity, hypertension, and the risk of kidney cancer in men. N Engl J Med 343:1305–1311. doi:10.1056/NEJM200011023431804
Dhote R, Thiounn N, Debre B, Vidal-Trecan G (2004) Risk factors for adult renal cell carcinoma. Urol Clin North Am 31:237–247. doi:10.1016/j.ucl.2004.01.004
Donat SM, Salzhauer EW, Mitra N, Yanke BV, Snyder ME, Russo P (2006) Impact of body mass index on survival of patients with surgically treated renal cell carcinoma. J Urol 175:46–52. doi:10.1016/S0022-5347(05)00054-6
Haferkamp A, Pritsch M, Bedke J, Wagener N, Pfitzenmaier J, Buse S, Hohenfellner M (2008) The influence of body mass index on the long-term survival of patients with renal cell carcinoma after tumour nephrectomy. BJU Int 101:1243–1246. doi:10.1111/j.1464-410X.2007.07375.x
Kamat AM, Shock RP, Naya Y, Rosser CJ, Slaton JW, Pisters LL (2004) Prognostic value of body mass index in patients undergoing nephrectomy for localized renal tumors. Urology 63:46–50. doi:10.1016/j.urology.2003.08.009
Kirkali Z (2007) The motion: open partial nephrectomy is the standard of care for small resectable solid renal masses. Eur Urol 51:561–562. doi:10.1016/j.eururo.2006.10.030
Moyad MA (2001) Obesity, interrelated mechanisms, and exposures and kidney cancer. Semin Urol Oncol 19:270–279
Pan SY, Johnson KC, Ugnat AM, Wen SW, Mao Y (2004) Association of obesity and cancer risk in Canada. Am J Epidemiol 159:259–268. doi:10.1093/aje/kwh041
Parker AS, Lohse CM, Cheville JC, Thiel DD, Leibovich BC, Blute ML (2006) Greater body mass index is associated with better pathologic features and improved outcome among patients treated surgically for clear cell renal cell carcinoma. Urology 68:741–746. doi:10.1016/j.urology.2006.05.024
Schips L, Lipsky K, Zigeuner R, Gidaro S, Salfellner M, Rehak P, Pummer K, Hubmer G (2004) Does overweight impact on the prognosis of patients with renal cell carcinoma? A single center experience of 683 patients. J Surg Oncol 88:57–61. doi:10.1002/jso.20139
Schlehofer B, Pommer W, Mellemgaard A, Stewart JH, McCredie M, Niwa S, Lindblad P, Mandel JS, McLaughlin JK, Wahrendorf J (1996) International renal-cell-cancer study. VI. The role of medical and family history. Int J Cancer 66:723–726. doi:10.1002/(SICI)1097-0215(19960611)66:6<723::AID-IJC2>3.0.CO;2-1
Schrader AJ, Hofmann R (2008) Metastatic renal cell carcinoma: recent advances and current therapeutic options. Anticancer Drugs 9:235–245. doi:10.1097/CAD.0b013e3282f444de
Schrader AJ, Varga Z, Hegele A, Pfoertner S, Olbert P, Hofmann R (2006) Second-line strategies for metastatic renal cell carcinoma: classics and novel approaches. J Cancer Res Clin Oncol 132:137–149. doi:10.1007/s00432-005-0058-4
Storkel S, Eble JN, Adlakha K, Amin M, Blute ML, Bostwick DG, Darson M, Delahunt B, Iczkowski K (1997) Classification of renal cell carcinoma: workgroup no. 1. Union Internationale Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer 80:987–989. doi:10.1002/(SICI)1097-0142(19970901)80:5<987::AID-CNCR24>3.0.CO;2-R
Wolk A, Gridley G, Niwa S, Lindblad P, McCredie M, Mellemgaard A, Mandel JS, Wahrendorf J, McLaughlin JK, Adami HO (1996a) International renal cell cancer study. VII. Role of diet. Int J Cancer 65:67–73. doi:10.1002/(SICI)1097-0215(19960103)65:1<67::AID-IJC12>3.0.CO;2-F
Wolk A, Lindblad P, Adami HO (1996b) Nutrition and renal cell cancer. Cancer Causes Control 7:5–18. doi:10.1007/BF00115634
Wolk A, Gridley G, Svensson M, Nyren O, McLaughlin JK, Fraumeni JF, Adam HO (2001) A prospective study of obesity and cancer risk (Sweden). Cancer Causes Control 12:13–21. doi:10.1023/A:1008995217664
Yu MC, Mack TM, Hanisch R, Cicioni C, Henderson BE (1986) Cigarette smoking, obesity, diuretic use, and coffee consumption as risk factors for renal cell carcinoma. J Natl Cancer Inst 77:351–356
Yu ML, Asal NR, Geyer JR (1991) Later recurrence and longer survival among obese patients with renal cell carcinoma. Cancer 68:1648–1655. doi:10.1002/1097-0142(19911001)68:7<1648::AID-CNCR2820680731>3.0.CO;2-5
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Schrader, A.J., Rustemeier, J., Rustemeier, J.C. et al. Overweight is associated with improved cancer-specific survival in patients with organ-confined renal cell carcinoma. J Cancer Res Clin Oncol 135, 1693–1699 (2009). https://doi.org/10.1007/s00432-009-0616-2
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DOI: https://doi.org/10.1007/s00432-009-0616-2