Pre-existing Type 2 Diabetes Mellitus Is an Independent Risk Factor for Mortality and Progression in Patients With Renal Cell Carcinoma

Abstract

Malignancies are one of the main causes of mortality in diabetic patients; however, to date, very limited data have been reported on the specific influence of type 2 diabetes mellitus (T2DM) on the survival of patients with renal cell carcinoma (RCC). In the present long-term retrospective study, we investigated whether T2DM may influence the overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) in patients with surgically treated RCC.Medical records of 924 patients treated by radical or partial nephrectomy for sporadic, unilateral RCC were reviewed. Patients with type-1 DM and with T2 DM receiving insulin treatment were excluded. Survival estimates were calculated according to the Kaplan–Meier method and compared with the log-rank test. Univariate and multivariate analyses were performed using the Cox regression model.Of the 924 RCC patients, 152 (16.5%) had T2DM. Mean follow-up was 68.5 months. Mean OS was 41.3 and 96.3 months in T2DM and non-T2DM patients, respectively (P < 0.0001).The estimated CSS rates at 1, 3, and 5 years in T2DM versus non-T2DM patients were 63.4% versus 76.7%, 30.4% versus 56.6%, and 16.3% versus 48.6%, respectively (P = 0.001). Mean PFS was significantly lower (31.5 vs 96.3 months; P < 0.0001) in the T2DM group. At multivariate analysis, T2DM was an independent adverse prognostic factor for OS (hazard ratio [HR] = 3.44; 95% confidence interval [CI]:2.40–4.92), CSS (HR = 6.39; 95% CI: 3.78–10.79), and PFS (HR = 4.71; 95% CI: 3.11–7.15).In conclusion, our findings suggest that patients with RCC and pre-existing T2DM have a shorter OS, increased risk of recurrence, and higher risk for kidney cancer mortality than those without diabetes.

Factors Contributing to Kidney Allograft Loss and Associated Consequences among Post Kidney Transplantation Patients

“…However, a study done by Vavallo et al [62] concluded that, there was no significant impact of gender on the short-and long-term graft and patient's survival. Nevertheless, lower Creatinine level in the male donors to female recipients was reported [62].…”

“…Moreover, it was noted that women have smaller kidneys and fewer nephrons than men do, so the discrepancy between the mass of the grafted kidney and that of the recipient, by inducing nephron overload, could be responsible for the poor long-term outcome of grafts from female donors to male recipients [62]. Nemati and Taghipour [24], Barba et al [62] support that expanded criteria donors may be risk factors to graft failure. Reese et al [63] defined expanded criteria as donors who are greater than 50 years with at least hypertension history, serum creatinine >1.5 mg/dl or cause of death from cerebrovascular accident.…”

“…Nevertheless, lower Creatinine level in the male donors to female recipients was reported [62]. Several aetiologies have been proposed as potential explanations of a gender effect on renal transplantation, including anatomical and immunological mechanisms [62].…”

“…The same authors indicate that the prevalence of hypertension remains high at 80-90%, despite improvement in glomerular filtration rate and fluid status. The pathophysiology of post-transplant hypertension has been linked to immunosuppressant use [62]. Furthermore, control of hypertension in renal transplant recipients has been shown to be inadequate, with only 16.5% of local RTRs achieving blood pressure target levels of <130/80 mmHg.…”

“…Several aetiologies have been proposed as potential explanations of a gender effect on renal transplantation, including anatomical and immunological mechanisms [62]. Moreover, it was noted that women have smaller kidneys and fewer nephrons than men do, so the discrepancy between the mass of the grafted kidney and that of the recipient, by inducing nephron overload, could be responsible for the poor long-term outcome of grafts from female donors to male recipients [62]. Nemati and Taghipour [24], Barba et al [62] support that expanded criteria donors may be risk factors to graft failure.…”