Diabetes, Obesity, and Pathological Upstaging in Renal Cell Carcinoma: Results From a Large Multi-institutional Consortium

Abstract

Purpose: We sought to determine whether clinical risk factors and morphometric features on preoperative imaging can be utilized to identify those patients with cT1 tumors who are at higher risk of upstaging (pT3a). Materials and Methods: We performed a retrospective international case-control study of consecutive patients treated surgically with radical or partial nephrectomy for nonmetastatic renal cell carcinoma (cT1 N0) conducted between January 2010 and December 2018. Multivariable logistic regression models were used to study associations of preoperative risk factors on pT3a pathological upstaging among all patients, as well as subsets with those with preoperative tumors 4 cm, renal nephrometry scores, tumors 4 cm with nephrometry scores, and clear cell histology. We also examined association with pT3a subsets (renal vein, sinus fat, perinephric fat). Results: Among the 4,092 partial nephrectomy and 2,056 radical nephrectomy patients, pathological upstaging occurred in 4.9% and 23.3%, respectively. Among each group independent factors associated with pT3a upstaging were increasing preoperative tumor size, increasing age, and the presence of diabetes. Specifically, among partial nephrectomy subjects diabetes (OR[1.65; 95% CI 1.17, 2.29), male sex (OR[1.62; 95% CI 1.14, 2.33), and increasing BMI (OR[1.03; 95% CI 1.00, 1.05 per 1 unit BMI) were statistically associated with upstaging. Subset analyses identified hilar tumors as more likely to be upstaged (partial nephrectomy OR[1.91; 95% CI 1.12, 3.16; radical nephrectomy OR[2.16; 95% CI 1.44, 3.25).

This Month in Adult Urology

“…In this issue of The Journal of Urology Ò , Pruthi et al (page 750), in an extensive multinational retrospective study, examined clinical risk factors and morphometric features to predict upstaging from cT1 to pT3a tumors. 2 The findings revealed that increasing preoperative tumor size, older age, and the presence of diabetes were independently associated with pT3a upstaging. Furthermore, male sex and higher BMI also showed associations with upstaging.…”

The association between the triglyceride–glucose index and prognosis in postoperative renal cell carcinoma patients: a retrospective cohort study

“…A growing body of evidence indicates that insulin resistance (IR), which is a major component of metabolic syndrome (MS) ( 7 ), may be associated with an increased risk as well as greater mortality rates for several types of cancers ( 7 , 8 ). Metabolic syndrome comprises a cluster of metabolic abnormalities including hypertension, type 2 diabetes, obesity, and hyperlipidemia, and MS has been proven to be a risk factor for morbidity and poor prognosis of RCC ( 9 – 11 ). Moreover, previous studies showed that each component of MS is considered to have a close causal association with RCC ( 9 , 11 ), and the pathophysiology seems to be largely attributable to IR ( 12 , 13 ).…”

“…Metabolic syndrome comprises a cluster of metabolic abnormalities including hypertension, type 2 diabetes, obesity, and hyperlipidemia, and MS has been proven to be a risk factor for morbidity and poor prognosis of RCC ( 9 – 11 ). Moreover, previous studies showed that each component of MS is considered to have a close causal association with RCC ( 9 , 11 ), and the pathophysiology seems to be largely attributable to IR ( 12 , 13 ). Moreover, the visceral adiposity index (VAI), which is a predictor of IR, has been reported as a useful index to estimate the aggressiveness of RCC ( 14 , 15 ).…”

Editorial Comment

“…In this article, Pruthi et al further show the relationship of diabetes and obesity on adverse pathological features among renal cell carcinoma patients undergoing partial or radical for clinical T1 tumors. 2 This study is important for several reasons, including being more broadly generalizable since it comes from a retrospective international cohort of patients from 11 high-volume academic hospitals. While Pruthi et al also showed that diabetes correlated with higher upstaging to pT3a for all surgical patients, diabetes and higher BMI were also associated with upstaging for only patients undergoing partial nephrectomy.…”