Prognostic Significance of Body Mass Index in Asian Patients With Localized Renal Cell Carcinoma

Abstract

We investigated the prognostic value of BMI (body mass index) in Asian patients with RCC (renal cell carcinoma). We evaluated 170 Asian patients who underwent surgery for localized RCC (pathologic T1-4 tumors in the absence of nodal or distant metastases) between 1996 and 2004 at our institution. Patients were stratified by BMI: 22 or less vs. greater than 22. Overall, CSS (cancer-specific survival) and RFS (recurrence-free survival) was estimated using the Kaplan-Meier method. Multivariate analysis was performed with the Cox regression model. The mean age and BMI of all patients was 62.4 ± 11.4 yr and 23.1 ± 3.2 kg/m(2), respectively. Patients' population consisted of 114 (67.1%) men and 56 (32.9%) women. The median follow-up was 50 mo. The BMI was less than 22 in 83 (49%) patients and greater than 22 in 87 (51%). There was a trend toward worse Eastern Cooperative Oncology Group (ECOG) performance status, less likely to have an incidentaloma, higher pathological stage, and more frequent microvascular invasion with lower BMI. Only the correlations between BMI and ECOG performance status (P = 0.003) and pathological stage (P = 0.015) were statistically significant. Of other relevant factors including gender, mode of presentation, ECOG performance status, C-reactive protein, histological type, Fuhrman nuclear grade, microvascular invasion, pathological stage, and adjuvant cytokine therapy, smaller BMI remained an independent predictor for worse CSS (44.5 mo vs. 56.0 mo, P = 0.041, HR = 10.99) and RFS (43.0 mo vs. 55.0 mo, P = 0.03, HR = 2.653), but not for OS (overall survival) (46.0 mo vs. 55.5 mo, P = 0.13, HR = 2.217) on multivariate analysis. Our findings identify increasing BMI in the Asian population as an independent predictor for favorable CSS and RFS in patients with RCC treated by surgery. Further studies, including a multiinstitutional, prospective Asian cohort, are required to confirm these findings.

Localized non‐conventional renal cell carcinoma: Prediction of clinical outcome according to histology

“…The preoperative BMI and albumin were well-known risk factors of prognosis in RCC from many studies. 22,23 As patients with higher BMI had significantly better prognosis in many studies, the present study showed similarly that BMI had a HR 0.76 (P = 0.015, 95% CI 0.611-0.949). Serum albumin was considered as a referring parameter of nutritional and performance status with BMI and other laboratory parameters, which were significant prognostic factors in previous RCC studies.…”

Age‐dependent prognostic value of body mass index for non‐metastatic clear cell renal cell carcinoma: A large multicenter retrospective analysis

“…Many studies have revealed an inverse linear relationship between obesity and RCC prognosis, which is called the obesity paradox, although the relationship has not been well established. [10][11][12][13] The present large multicenter study also revealed that BMI was a good prognostic factor for RFS and CSS among patients with nm-cRCC, although the prognostic value of obesity was affected by age, with high BMI being associated with improved RFS, and CSS among older patients (≥45 years) but not among young patients (<45 years old). To the best of our knowledge, this is the first study to clarify the agerelated prognostic value of BMI for RCC.…”

“…Some studies have failed to detect any relationship between obesity and RCC prognosis, [7][8][9] whereas many others have revealed an inverse linear relationship that is called the "obesity paradox." [10][11][12][13] Meanwhile, a recent study has indicated that the association between obesity and RCC prognosis might be non-linear. 14 These findings suggest that other factor(s) might modify the association between obesity and RCC prognosis.…”

Body mass index and survival in patients with renal cell carcinoma: A clinical‐based cohort and meta‐analysis

“…Overweight and obesity is one of few established causes for RCC,4, 5 accounting for an estimated 40% of all cases in the US and 30% in Europe 6, 7. Paradoxically, patients with higher body mass index (BMI) also had a significantly better RCC prognosis than those with lower BMI in several studies 8–15. However, a possible association between obesity and RCC survival has not been yet generally accepted as causal and there has been no comprehensive systematic review of this association.…”