Impact of Body Mass Index on Survival of Patients With Surgically Treated Renal Cell Carcinoma

Donat, S. Machele; Salzhauer, Elan W.; Mitra, Nandita; Yanke, Brent V.; Snyder, Mark E.; Russo, Paul

doi:10.1016/s0022-5347(05)00054-6

Cited by 88 publications

(65 citation statements)

References 13 publications

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“…One of the significant findings of our study was that obesity was independently associated with better survival or lower risk of tumor recurrence in Korean patients with RCC and venous tumor thrombus. There has been a controversy about a prognostic impact of BMI on survival of patients with RCC (17)(18)(19). Recently, we demonstrated that overweight or obese Korean patients with RCC have more favorable pathological features and a better prognosis than those with normal BMI, which is in accordance with the result from a study by Awakura et al evaluating Japanese patients with RCC (20,21).…”

Section: Discussionsupporting

confidence: 89%

Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

et al. 2013

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Purpose: To study the surgical outcomes of radical nephrectomy with thrombectomy and to determine prognostic factors for survival of Korean patients with renal cell carcinoma (RCC) and venous tumor thrombus. Materials and Methods: A total of 124 patients with RCC and venous tumor thrombus who underwent radical nephrectomy and thrombectomy were included in this retrospective study. Cancer-specific survival (CSS) and recurrence-free survival (RFS) rates were analyzed retrospectively according to various prognostic factors. Results: The median overall follow-up period for all patients was 29.0 months; the median survival period was 50.0 months. The 2-, 5-and 10-year CSS rates for all patients were 64.2%, 47.1% and 31.7%, respectively. Those for 76 patients (pN0/xM0) without metastasis at presentation were 80.9%, 64.5% and 44.9%, respectively. For all patients, lower body mass index (BMI), higher Fuhrman grade, presence of symptoms, perinephric fat invasion, invasion of inferior vena cava (IVC) wall, lymph node (LN) involvement and distant metastasis at presentation were independent predictors for decreased CSS on multivariate analysis, while thrombus level was not. For non-metastatic patients, lower BMI, presence of symptoms and tumor size were independently associated with decreased CSS. In terms of RFS, lower BMI, presence of perinephric fat invasion were prognostic factors for recurrence. Conclusions: Our data suggest that obesity is independently associated with better survival or lower risk of tumor recurrence in Korean patients undergoing radical nephrectomy with tumor thrombectomy. Also, our results indicate that Fuhrman grade, presence of symptoms, perinephric fat invasion and invasion of IVC wall, LN involvement and distant metastasis at presentation are independent predictors for survival.

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Section: Discussionsupporting

confidence: 89%

Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

et al. 2013

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“…We found that statin recipients were more likely to have any history of smoking and a higher BMI, as observed by others. [9][10][11] While several studies have shown that both of these factors are significantly associated with survival in kidney cancer, 7,8,[23][24][25] other studies found no such association; [26][27][28] however, many of those studies showing a significant association for obesity with survival did not control for smoking, [23][24][25] and studies demonstrating an association for smoking with survival did not control for obesity. 29,30 Therefore, the independent prognostic importance of smoking and obesity remains unknown.…”

Section: Discussionmentioning

confidence: 99%

The value of complementing administrative data with abstracted information on smoking and obesity: A study in kidney cancer

Nayan

Hamilton

Finelli

et al. 2017

CUAJ

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Introduction: Variables, such as smoking and obesity, are rarely available in administrative databases. We explored the added value of including these data in an administrative database study evaluating the association of statin use with survival in kidney cancer. Methods:We linked administrative data with chart-abstracted data on smoking and obesity for 808 patients undergoing nephrectomy for kidney cancer. Base models consisted of variables from administrative databases (age, sex, year of surgery, and different measures of comorbidity [to compare their sensitivity to smoking and obesity data]); extended models added chart-abstracted data. We compared coefficients for statin use with overall (OS) and cancerspecific survival (CSS), and used the c-statistic and net reclassification improvement (NRI) to compare predications of five-year survival obtained from Cox proportional hazard models. Results: The coefficient for statin use changed minimally following addition of abstracted data (<6% for OS, <2% for CSS). Conclusions:The inclusion of data on smoking and obesity marginally influences survival models in kidney cancer studies using administrative data. IntroductionAdministrative databases are being increasingly used in clinical research over institutional clinical databases, as they provide large sample sizes, have strong external generalizability, and can have comprehensive information on followup;1 however, variables such as smoking and obesity are rarely available in administrative databases, but could be available in institutional databases from chart review. Studies using administrative data often note this as a limitation 2,3 and a measure of comorbidity is often used to account for smoking and obesity, since these factors influence various aspects of health and may relate to a person's overall health status. 4 It remains unknown whether the addition of smoking and obesity data would markedly improve risk prediction compared to a model using a measure of comorbidity derived from administrative data. If including these variables is important for risk prediction, researchers should make efforts to obtain these data to improve the reliability of their results. Conversely, if little value is added, this additional exercise may not be worthwhile, given the costs and time associated with the process.We explore this concept using as an example a cohort study evaluating the association of statin use with kidney cancer survival. Statins are commonly prescribed lipidlowering medications that have recently gained interest in the oncology community based on studies showing that their use is associated with improved survival outcomes in various malignancies. 5,6 In a large, population-based cohort study using administrative data, we recently demonstrated that statin use at the time of diagnosis was not significantly associated with cancer-specific (CSS) or overall survival (OS) in kidney cancer patients (Nayan et al. Manuscript in progress). We used a comorbidity score for risk adjustment, but we were unable ...

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“…Given that the incidence of both RCC [18] and extreme obesity [9] are increasing, urologists will increasingly have to consider the potential benefits of treatment vs the higher risk of surgical and anaesthetic complications in very obese patients [19]. Recent studies have suggested that obesity increases the risk of developing RCC [1], although mild or moderate obesity is not necessarily associated with worse outcomes [4][5][6][7][19][20][21][22]. In the present study, we evaluated the largest series to date of RCC patients with extreme obesity, and found similar CSS and recurrence rates when compared with patients with lower body mass.…”

Section: Discussionmentioning

confidence: 99%

Extreme obesity does not predict poor cancer outcomes after surgery for renal cell cancer

et al. 2015

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ObjectiveTo assess whether extreme obesity (body mass index [BMI] ≥ 40 kg/m 2 ) is associated with peri-operative outcomes, overall survival (OS), cancer-specific survival (CSS), or recurrencefree survival (RFS) after surgical treatment for renal cell carcinoma (RCC). Patients and MethodsAfter institutional review board approval, we used an institutional database to identify patients treated surgically between January 2000 and December 2014 with a pathological diagnosis of RCC. Comprehensive clinical and pathological data were reviewed. Kaplan-Meier analyses were used to estimate OS, RFS and CSS. Univariate and multivariate Cox proportional hazards analysis was used to evaluate associations with OS, CSS and RFS in patients with extreme obesity, among other known predictive variables. ResultsIn all, 100 patients (11.9%) with a BMI ≥ 40 kg/m 2 and 743 patients (88.1%) with a BMI < 40 kg/m 2 who were treated surgically for RCC were identified. Morbid obesity was not associated with an increased risk of blood transfusion (odds ratio [OR] 1, 95% confidence interval [CI] 0.587-1.70; P = 1.0). The median (interquartile range) length of hospital stay (LOS) was 4 (3-6) days. Morbid obesity was not associated with longer LOS (P = 0.26) or 30-day hospital readmission rates (P = 1.0). Major complications (Clavien ≥ 3a) were recorded in 67 patients (7.95%). BMI ≥ 40 kg/m 2 was not a predictor of major complications (OR 0.58, 95% CI 0.227-1.47; P = 0.251) or 90-day mortality (P = 0.4067). BMI ≥ 40 kg/m 2 was not associated with worse OS (P = 0.7), CSS (P = 0.2) or RFS (P = 0.5). BMI ≥ 35 kg/m 2 was also not associated with worse OS, CSS or RFS (P = 0.3, 0.1, 0.5, respectively). The 5-year OS rate was 68.9% for the entire cohort, including 69 and 70% for patients with BMI < 40 kg/ m 2 and BMI ≥ 40 kg/m 2 , respectively (P = 0.69). The 5-year CSS was 79.5% for the entire cohort, including 78.4 and 87.9% (P = 0.16) for patients with BMI < 40 kg/m 2 and BMI ≥ 40 kg/m 2 , respectively. The 5-year RFS rates for BMI < 40 kg/m 2 and BMI ≥ 40 kg/m 2 were 84.1 and 90.6%, respectively (P = 0.48). ConclusionsExtreme obesity is not associated with worse peri-operative or cancer outcomes after surgery for RCC. Surgery should remain a standard treatment option in well selected morbidly obese patients.

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Impact of Body Mass Index on Survival of Patients With Surgically Treated Renal Cell Carcinoma

Abstract: Although an increased BMI was associated with a greater proportion of clear cell histology, comorbidity, and surgical morbidity, BMI did not adversely impact overall or progression-free survival.

Cited by 88 publications

References 13 publications

Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

The value of complementing administrative data with abstracted information on smoking and obesity: A study in kidney cancer

Extreme obesity does not predict poor cancer outcomes after surgery for renal cell cancer

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