&lt;p&gt;The influence of sex on the prognostic value of body mass index in non-metastasis renal cell carcinoma&lt;/p&gt;

Zheng, Yangqin; Bao, Lianmin; Chen, Jingfeng; Pan, Yue; Wang, Qinquan; Chen, Lianguo; Gao, Xianhua

doi:10.2147/cmar.s197457

Cited by 5 publications

(5 citation statements)

References 27 publications

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“…Though obesity in particular is known to significantly increase the risk of developing clear cell RCC [ 6 – 8 , 11 , 12 ], several independent groups have shown that patients with clear cell RCC who have a higher BMI paradoxically have a better prognosis than those of normal weight [ 23 , 14 , 15 ]. This “obesity paradox” was most recently described in two studies [ 17 , 18 ], which found that the benefits of an elevated BMI were restricted to the male study population.…”

Section: Discussionmentioning

confidence: 94%

“…Our finding that renal vein invasion, which is a known sign of poor prognosis [ 29 ], was significantly associated with a lower BMI in males with clear cell RCC might provide an explanation for the so-called “protective effect” of a higher BMI [ 13 , 14 ] in males [ 17 , 18 ]. The fact that this association remained statistically significant even after adjusting for age and Fuhrman grade suggests the presence of a distinct and more aggressive subtype in these patients, influenced by epidemiological features.…”

Section: Discussionmentioning

confidence: 99%

“…Though an elevated BMI is considered a major risk factor for the development of kidney cancer and is thought to be the cause of up to 27–40% of all RCCs in the United States [ 11 , 12 ], several independent reports have indicated that outcomes are better in obese patients than in patients of normal weight [ 13 – 16 ]. However, recent studies [ 17 , 18 ] indicate that the protective effect of obesity extended only to men and not to women. The causes of the paradoxical nature of obesity as both a risk factor and a protective characteristic in men are still unknown but may lie in the genomic make-up of the tumor [ 19 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Renal cell carcinoma: Associations between tumor imaging features and epidemiological risk factors

Hötker

Karlo

Paolo

et al. 2020

European Journal of Radiology

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Purpose: To investigate associations between imaging features of tumors and age, gender and body mass index (BMI) in patients with renal cell carcinoma. Method: This IRB-approved, HIPAA-compliant study included 1348 patients with histopathologically confirmed renal cell carcinoma of the clear cell subtype (ccRCC, n = 904) or non-clear cell subtype ( n = 444), who underwent pre-treatment CT imaging less than 180 days before nephrectomy between 1999 and 2011. Two radiologists independently, retrospectively analyzed all imaging studies and identified features (necrosis, renal vein invasion, contact with renal sinus fat, multicystic appearance and nodular enhancement), which were then correlated with patient age, gender and BMI at time of surgery. Results: Inter-reader agreement on imaging features ranged from substantial to excellent (kappa: 0.688 to 0.982). In the ccRCC group, multicystic tumor appearance was significantly associated with lower patient age ( p < 0.05) and lower BMI ( p < 0.05); the presence of renal vein invasion was significantly associated with lower BMI in males ( p < 0.05); and both tumor contact with the renal sinus and nodular enhancement were significantly associated with greater patient age ( p < 0.05). In the non-clear cell RCC group, necrosis was associated with lower BMI for females ( p < 0.05). Conclusions: This study demonstrated significant associations between imaging features of RCC and patient age and BMI, hinting an influence of these factors on tumor biology and genomic make-up. These findings could aid future studies in selecting patients while investigating genomic, molecular and metabolic variables in RCC and might potentially impact on future stratification and therapy of patients.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Renal cell carcinoma: Associations between tumor imaging features and epidemiological risk factors

Hötker

Karlo

Paolo

et al. 2020

European Journal of Radiology

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“…In all, 10 studies compared a BMI of <25 vs >25 kg/m 2 , while eight studies compared a BMI of <25 vs 25-30 vs >30 kg/m 2 . Table 1 [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] highlights the characteristics of the 18 studies included in this meta-analysis.…”

Section: Study Characteristicsmentioning

confidence: 99%

The impact of body mass index on oncological and surgical outcomes of patients undergoing nephrectomy: a systematic review and meta‐analysis

et al. 2023

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ObjectiveTo perform a systematic review and meta‐analysis to evaluate the impact of body mass index (BMI) on oncological (primary) and surgical (secondary) outcomes of patients who underwent nephrectomy, as obesity or high BMI is a known risk factor for renal cell carcinoma (RCC) and predictor of poorer outcomes.MethodsStudies were identified from four electronic databases from database inception to 2 June 2021, according to the Preferred Reporting Items for Systematic Review and Meta‐analysis statement. The review protocol was registered in the International Prospective Register of Systematic Reviews with the identification number: CRD42021275124.ResultsA total of 18 studies containing 13 865 patients were identified for the final meta‐analysis. Regarding oncological outcomes, higher BMI predicted higher overall survival (BMI >25 vs BMI <25 kg/m2: hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.58–0.85), cancer‐specific survival (BMI >25 vs BMI <25 kg/m2: HR 0.60, 95% CI 0.50–0.73; BMI 25–30 vs BMI <25 kg/m2: HR 0.46, 95% CI 0.23–0.95; BMI >30 vs BMI <25 kg/m2: HR 0.50, 95% CI 0.36–0.69), and recurrence‐free survival rates (BMI >25 vs BMI <25 kg/m2: HR 0.72, 95% CI 0.63–0.82; BMI 25–30 vs BMI <25 kg/m2: HR 0.59, 95% CI 0.42–0.82). Those with a lower BMI fared better in surgical outcomes, such as operation time and warm ischaemic time, although the absolute difference was minimal and unlikely to be clinically significant. There was no difference between groups for length of hospital stay, intraoperative or postoperative complications, blood transfusion requirements, and conversion to open surgery.ConclusionOur study suggests that a higher BMI is associated with improved long‐term oncological survival and similar perioperative outcomes as a lower BMI. More research into the underlying biological and physiological mechanisms will enable better understanding of the effect of BMI, beyond mere association, on post‐nephrectomy outcomes.

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“…In some studies in several types of cancer, a gender-based obesity paradox has also been suggested (13). Sex differences in the biology of the disease, genetic expression, hormonal effects, and in body mass composition have been proposed to explain the gender-specific association between BMI and mortality (14)(15)(16), suggesting that sex should be considered when evaluating the prognostic value of obesity. Studies evaluating the association of BMI with survival included adults aged from 19 to 100 but did not specifically analyze older cancer patients, whereas the obesity paradox was originally shown in older populations.…”

Section: Introductionmentioning

confidence: 99%

The obesity paradox for mid- and long-term mortality in older cancer patients: a prospective multicenter cohort study

Martínez-Tapia

Diot

Oubaya

et al. 2021

The American Journal of Clinical Nutrition

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Background Overweight and obesity are associated with adverse health outcomes. However, substantial literature suggests that they are associated with longer survival among older people. This “obesity paradox” remains controversial. In the context of cancer, the association between overweight/obesity and mortality is complicated by concomitant weight loss (WL). Sex differences in the relation between BMI (in kg/m2) and survival have also been observed. Objectives We studied whether a high BMI was associated with better survival, and whether the association differed by sex, in older patients with cancer. Methods We studied patients aged ≥70 y from the ELCAPA (Elderly Cancer Patients) prospective open cohort (2007–2016; 10 geriatric oncology clinics, Greater Paris urban area). The endpoints were 12- and 60-mo mortality. We created a variable combining BMI at cancer diagnosis and WL in the previous 6 mo, and considered 4 BMI categories—underweight (BMI < 22.5), normal weight (BMI = 22.5–24.9), overweight (BMI = 25–29.9), and obesity (BMI ≥ 30)—and 3 WL categories—<5% (minimal), 5% to <10% (moderate), and ≥10% (severe). Univariate and multivariate Cox proportional hazards analyses were conducted in men and women. Results A total of 2071 patients were included (mean age: 81 y; women: 48%; underweight: 30%; normal weight: 23%; overweight: 33%; obesity: 14%; predominant cancer sites: colorectal (18%) and breast (16%); patients with metastases: 49%). By multivariate analysis, obese women with WL < 5% had a lower 60-mo mortality risk than normal-weight women with WL < 5% (adjusted HR: 0.56; 95% CI: 0.37, 0.86; P = 0.012). Overweight/obese women with WL ≥ 5% did not have a lower mortality risk than normal-weight women with WL < 5%. Overweight and obese men did not have a lower mortality risk, irrespective of WL. Conclusions By taking account of prediagnosis WL, only older obese women with cancer with minimal WL had a lower mortality risk than their counterparts with normal weight. This trial was registered at clinicaltrials.gov as NCT02884375.

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<p>The influence of sex on the prognostic value of body mass index in non-metastasis renal cell carcinoma</p>

Cited by 5 publications

References 27 publications

Renal cell carcinoma: Associations between tumor imaging features and epidemiological risk factors

Renal cell carcinoma: Associations between tumor imaging features and epidemiological risk factors

The impact of body mass index on oncological and surgical outcomes of patients undergoing nephrectomy: a systematic review and meta‐analysis

The obesity paradox for mid- and long-term mortality in older cancer patients: a prospective multicenter cohort study

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