Top

Published in:

01-10-2013 | Urologic Oncology

Multi-Institutional Analysis of Localized Renal Cell Carcinoma that Demonstrates the Impact of Diabetic Status on Prognosis After Nephrectomy

Authors: Yun-Sok Ha, MD, PhD, Won Tae Kim, MD, Seok-Joong Yun, MD, PhD, Sang-Cheol Lee, MD, PhD, Wun-Jae Kim, MD, PhD, Yong Hyun Park, MD, Seok Ho Kang, MD, PhD, Sung-Hoo Hong, MD, PhD, Seok-Soo Byun, MD, PhD, Yong-June Kim, MD, PhD

Published in: Annals of Surgical Oncology | Issue 11/2013

Abstract

Background

The purpose of our study was to determine whether preoperative diabetes mellitus (DM) can predict the prognosis of localized clear-cell renal cell carcinoma (RCC).

Methods

At five institutes, 2,597 patients with pT1 and pT2 clear-cell RCC were enrolled. Univariate and multivariable analyses were performed to determine factors that associated with recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). To identify the effect of DM on survival after recurrence, a subgroup of 127 patients who had recurrences was analyzed.

Results

In total, 357 patients had DM. Compared with patients without DM, these patients were older, more likely to be male, and had a higher body mass index, lower GFR, and higher incidence of hypertension. Kaplan–Meier curves showed that patients with DM had a significantly worse rate of RFS, CSS, and OS than patients without DM (log-rank test, all P < 0.05). Multivariate analysis revealed that DM was an independent prognostic factor in terms of RFS, CSS, and OS. In the subgroup analysis of 127 patients with recurrence, DM was associated with a lower survival rate after the initial recurrence.

Conclusions

DM appeared to be an important determinant of prognosis in clear-cell localized RCC, especially in patients experiencing recurrence.

Available only for authorised users

Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–53.PubMedCrossRef

Kim DJ. The epidemiology of diabetes in Korea. Diabetes Metab J. 2011;35:303–8.PubMedCrossRef

Czyzyk A, Szczepanik Z. Diabetes mellitus and cancer. Eur J Intern Med. 2000;11:245–52.PubMedCrossRef

Ye W, Chow WH, Lagergren J, Yin L, Nyren O. Risk of adenocarcinomas of the esophagus and gastric cardia in patients with gastroesophageal reflux diseases and after antireflux surgery. Gastroenterology. 2001;121:1286–93.PubMedCrossRef

Polesel J, Zucchetto A, Montella M, Dal Maso L, Crispo A, La Vecchia C, et al. The impact of obesity and diabetes mellitus on the risk of hepatocellular carcinoma. Ann Oncol. 2009;20:353–7.PubMedCrossRef

Kaaks R, Toniolo P, Akhmedkhanov A, Lukanova A, Biessy C, Dechaud H, et al. Serum C-peptide, insulin-like growth factor (IGF)-I, IGF-binding proteins, and colorectal cancer risk in women. J Natl Cancer Inst. 2000;92:1592–600.PubMedCrossRef

Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004;4:579–91.PubMedCrossRef

Xue F, Michels KB. Diabetes, metabolic syndrome, and breast cancer: a review of the current evidence. Am J Clin Nutr. 2007;86:s823–35.PubMed

Stadler W, Vogelzang NJ. Human renal cancer carcinogenesis: a review of recent advances. Ann Oncol. 1993;4:451–62.PubMed

10.

Jones SC, Saunders HJ, Qi W, Pollock CA. Intermittent high glucose enhances cell growth and collagen synthesis in cultured human tubulointerstitial cells. Diabetologia. 1999;42:1113–9.PubMedCrossRef

11.

Barone BB, Yeh HC, Snyder CF, Peairs KS, Stein KB, Derr RL, et al. Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis. JAMA. 2008;300:2754–64.PubMedCrossRef

12.

Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA. 2001;285:885–92.PubMedCrossRef

13.

Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol. 2010;58:398–406.PubMedCrossRef

14.

Novara G, Ficarra V, Antonelli A, Artibani W, Bertini R, Carini M, et al. Validation of the 2009 TNM version in a large multi-institutional cohort of patients treated for renal cell carcinoma: are further improvements needed? Eur Urol. 2010;58:588–95.PubMedCrossRef

15.

Tate R, Iddenden R, Harnden P, Morris E, Craigs C, Bennett C, et al. Increased incidence of renal parenchymal carcinoma in the Northern and Yorkshire region of England, 1978–1997. Eur J Cancer. 2003;39:961–7.PubMedCrossRef

16.

Damhuis RA, Kirkels WJ. Improvement in survival of patients with cancer of the kidney in Europe. EUROCARE Working Group. Eur J Cancer. 1998;34:2232–5.PubMedCrossRef

17.

Cho E, Adami HO, Lindblad P. Epidemiology of renal cell cancer. Hematol Oncol Clin North Am. 2011;25:651–65.PubMedCrossRef

18.

Chow WH, Gridley G, Fraumeni JF, Jr., Jarvholm B. Obesity, hypertension, and the risk of kidney cancer in men. N Engl J Med. 2000;343:1305–11.PubMedCrossRef

19.

Galeone C, Pelucchi C, Maso LD, Negri E, Talamini R, Montella M, et al. Glycemic index, glycemic load and renal cell carcinoma risk. Ann Oncol. 2009;20:1881–5.PubMedCrossRef

20.

Setiawan VW, Stram DO, Nomura AM, Kolonel LN, Henderson BE. Risk factors for renal cell cancer: the multiethnic cohort. Am J Epidemiol. 2007;166:932–40.PubMedCrossRef

21.

Joh HK, Willett WC, Cho E. Type 2 diabetes and the risk of renal cell cancer in women. Diabetes Care. 2011;34:1552–6.PubMedCrossRef

22.

Larsson SC, Wolk A. Diabetes mellitus and incidence of kidney cancer: a meta-analysis of cohort studies. Diabetologia. 2011;54:1013–8.PubMedCrossRef

23.

Lee S, Hong SK, Kwak C, Kim HH, Lee SE. Prognostic significance of diabetes mellitus in localized renal cell carcinoma. Jpn J Clin Oncol. 2012;42:318–24.PubMedCrossRef

24.

Antonelli A, Arrighi N, Corti S, Zanotelli T, Cozzoli A, Cosciani Cunico S, et al. Pre-existing type-2 diabetes is not an adverse prognostic factor in patients with renal cell carcinoma: a single-center retrospective study. Urol Oncol. 2012. doi:10.1016/j.urolonc.2011.12.013.

25.

Standards of medical care in diabetes–2010. Diabetes Care. 2010;33 Suppl 1:S11–61.

26.

Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982;6:655–63.PubMedCrossRef

27.

Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461–70.PubMedCrossRef

28.

Cheon J, Kim CS, Lee ES, Hong SJ, Cho YH, Shin EC, et al. Survey of incidence of urological cancer in South Korea: a 15-year summary. Int J Urol. 2002;9:445–54.PubMedCrossRef

29.

Moyad MA. Obesity, interrelated mechanisms, and exposures and kidney cancer. Semin Urol Oncol. 2001;19:270–9.PubMed

30.

Lindblad P, Chow WH, Chan J, Bergstrom A, Wolk A, Gridley G, et al. The role of diabetes mellitus in the aetiology of renal cell cancer. Diabetologia. 1999;42:107–12.PubMedCrossRef

31.

Denton MD, Magee CC, Ovuworie C, Mauiyyedi S, Pascual M, Colvin RB, et al. Prevalence of renal cell carcinoma in patients with ESRD pre-transplantation: a pathologic analysis. Kidney Int. 2002;61:2201–9.PubMedCrossRef

32.

Seo MH, Lee WJ, Park CY, Kim SR, Park JY, Yoon KH, et al. Management of blood pressure in patients with type 2 diabetes mellitus: a nationwide survey in korean. Diabetes Metab J. 2011;35:348–53.PubMedCrossRef

33.

Turner RC, Millns H, Neil HA, Stratton IM, Manley SE, Matthews DR, et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). BMJ. 1998;316:823–8.PubMedCrossRef

34.

Aryal M, Jha B. Assessment of proteinuria as a marker of nephropathy in type 2 diabetes mellitus. Nepal Med Coll J. 2006;8:250–3.PubMed

35.

Cindolo L, Patard JJ, Chiodini P, Schips L, Ficarra V, Tostain J, et al. Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy: a multicenter European study. Cancer. 2005;104:1362–71.PubMedCrossRef

36.

Kattan MW, Reuter V, Motzer RJ, Katz J, Russo P. A postoperative prognostic nomogram for renal cell carcinoma. J Urol. 2001;166:63–7.PubMedCrossRef

37.

Tran TT, Medline A, Bruce WR. Insulin promotion of colon tumors in rats. Cancer Epidemiol Biomarkers Prev. 1996;5:1013–5.PubMed

38.

Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, Koo J, Madarnas Y, et al. Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol. 2002;20:42–51.PubMedCrossRef

Title: Multi-Institutional Analysis of Localized Renal Cell Carcinoma that Demonstrates the Impact of Diabetic Status on Prognosis After Nephrectomy
Authors: Yun-Sok Ha, MD, PhD
Won Tae Kim, MD
Seok-Joong Yun, MD, PhD
Sang-Cheol Lee, MD, PhD
Wun-Jae Kim, MD, PhD
Yong Hyun Park, MD
Seok Ho Kang, MD, PhD
Sung-Hoo Hong, MD, PhD
Seok-Soo Byun, MD, PhD
Yong-June Kim, MD, PhD
Publication date: 01-10-2013
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 11/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-013-3147-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Multi-Institutional Analysis of Localized Renal Cell Carcinoma that Demonstrates the Impact of Diabetic Status on Prognosis After Nephrectomy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2013

Safety of Liver Resection for Hepatocellular Carcinoma After Sorafenib Therapy: A Multicenter Case-Matched Study

Prognostic Value of Mucinous Histology Depends on Microsatellite Instability Status in Patients with Stage III Colon Cancer Treated with Adjuvant FOLFOX Chemotherapy: A Retrospective Cohort Study

Clinical Nodal Stage is a Significant Predictor of Outcome in Patients with Oral Cavity Squamous Cell Carcinoma and Pathologically Negative Neck Metastases: Results of the International Consortium for Outcome Research

Surgical Treatment of Pediatric Desmoid Tumors. A 12-Year, Single-Center Experience

Predicting Postoperative Morbidity Following Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CS+HIPEC) with Preoperative FACT-C (Functional Assessment of Cancer Therapy) and Patient-Rated Performance Status

Interaction Between Age and Race Alters Predicted Survival in Colorectal Cancer