Body size and renal cell cancer incidence in a large US cohort study

Lipid metabolism reprogramming in renal cell carcinomas

This study investigates the intricate mechanisms underlying the correlation between elevated consumption of harmful fats and the onset of kidney malignancies. The rise in global obesity rates has been accompanied by an increased prevalence of renal cancers, prompting an exploration into the molecular pathways and biological processes linking these phenomena. Through an extensive review of current literature and clinical studies, we identify potential key factors contributing to the carcinogenic influence of harmful fats on renal tissues. Our analysis highlights the role of adipose tissue-derived factors, inflammatory mediators, and lipid metabolism dysregulation in fostering a microenvironment conducive to renal tumorigenesis. Furthermore, we delve into the impact of harmful fats on signaling pathways associated with cell proliferation, apoptosis evasion, and angiogenesis within the renal parenchyma. This review underscores the importance of elucidating the molecular intricacies linking lipid metabolism and kidney malignancies, offering a foundation for future research and the development of targeted preventive and therapeutic interventions. The findings discussed herein contribute to our understanding of the complex relationship between lipid mediators and renal cancer, providing a basis for public health strategies aimed at mitigating the impact of harmful fats on kidney health.

Influence of Dietary Polyunsaturated Fatty Acid Intake on Potential Lipid Metabolite Diagnostic Markers in Renal Cell Carcinoma: A Case-Control Study

Non-invasive diagnostics are crucial for the timely detection of renal cell carcinoma (RCC), significantly improving survival rates. Despite advancements, specific lipid markers for RCC remain unidentified. We aimed to discover and validate potent plasma markers and their association with dietary fats. Using lipid metabolite quantification, machine-learning algorithms, and marker validation, we identified RCC diagnostic markers in studies involving 60 RCC and 167 healthy controls (HC), as well as 27 RCC and 74 HC, by analyzing their correlation with dietary fats. RCC was associated with altered metabolism in amino acids, glycerophospholipids, and glutathione. We validated seven markers (l-tryptophan, various lysophosphatidylcholines [LysoPCs], decanoylcarnitine, and l-glutamic acid), achieving a 96.9% AUC, effectively distinguishing RCC from HC. Decreased decanoylcarnitine, due to reduced carnitine palmitoyltransferase 1 (CPT1) activity, was identified as affecting RCC risk. High intake of polyunsaturated fatty acids (PUFAs) was negatively correlated with LysoPC (18:1) and LysoPC (18:2), influencing RCC risk. We validated seven potential markers for RCC diagnosis, highlighting the influence of high PUFA intake on LysoPC levels and its impact on RCC occurrence via CPT1 downregulation. These insights support the efficient and accurate diagnosis of RCC, thereby facilitating risk mitigation and improving patient outcomes.

Risk reduction of non-hormonal cancers following bariatric surgery

Metabolic and bariatric surgery (MBS) is the most effective intervention for weight loss leading to significant resolution of obesity-related medical conditions. Recent literature has demonstrated risk reduction of certain cancer types after MBS. Studies have shown an overall reduction in the risk of hormonal cancer, such as breast and endometrial cancer. However, the association between bariatric surgery and the incidence of various types of non-hormonal cancer such as esophageal, gastric, liver, gallbladder, colorectal, pancreatic and kidney cancer remains contested. The aim of this study was to highlight obesity and its relationship to cancer development as well as bariatric surgery and its role in cancer reduction with focus on non-hormonal cancers.

Lifetime Body Weight Trajectories and Risk of Renal Cell Cancer: A Large U.S. Prospective Cohort Study

BACKGROUND

Body mass index (BMI) is a known risk factor for renal cell cancer (RCC), but data are limited as to the effect of lifetime exposure to excess body weight.

METHODS

Using the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (N = 138,614, 527 incident RCCs), we identified several anthropometric measures to capture the lifetime BMI patterns: (i) BMI at specific ages; (ii) adulthood BMI trajectories; (iii) cumulative exposure to overweight/obesity denoted as weighted years of living overweight/obese (WYO); and (iv) weight change during each age span. We conducted multivariable Cox model to quantify the association between each anthropometric metric and incident RCC.

RESULTS

A higher BMI at ages 20 and 50 and at baseline was associated with a greater hazard of RCC. Compared with individuals who retained normal BMI throughout adulthood, we observed an increased hazard of RCC for BMI trajectory of progressing from normal BMI to overweight [HR, 1.49; 95% confidence interval (CI), 1.19-1.87], from normal BMI to obesity (HR, 2.22; 95% CI, 1.70-2.90), and from overweight to obesity (HR, 2.78; 95% CI, 1.81-4.27). Compared with individuals who were never overweight (WYO = 0), elevated HRs were observed among individuals who experienced low (HR, 1.31; 95% CI, 0.99-1.74), medium (HR, 1.57; 95% CI, 1.20-2.05), and high (HR, 2.10; 95% CI, 1.62-2.72) WYO tertile. Weight gain of ≥10 kg was associated with increased RCC incidence for each age span.

CONCLUSIONS

Across the lifespan, being overweight/obese, weight gain, and higher cumulative exposure to excess weight were all associated with increased RCC risk.

IMPACT

It is important to avoid weight gain and assess BMI from a life-course perspective to reduce RCC risk.

Future trends in incidence and long-term survival of metastatic cancer in the United States

BACKGROUND

Previous studies have demonstrated epidemiological trends in individual metastatic cancer subtypes; however, research forecasting long-term incidence trends and projected survivorship of metastatic cancers is lacking. We assess the burden of metastatic cancer to 2040 by (1) characterizing past, current, and forecasted incidence trends, and (2) estimating odds of long-term (5-year) survivorship.

METHODS

This retrospective, serial cross-sectional, population-based study used registry data from the Surveillance, Epidemiology, and End Results (SEER 9) database. Average annual percentage change (AAPC) was calculated to describe cancer incidence trends from 1988 to 2018. Autoregressive integrating moving average (ARIMA) models were used to forecast the distribution of primary metastatic cancer and metastatic cancer to specific sites from 2019 to 2040 and JoinPoint models were fitted to estimate mean projected annual percentage change (APC).

RESULTS

The average annual percent change (AAPC) in incidence of metastatic cancer decreased by 0.80 per 100,000 individuals (1988-2018) and we forecast an APC decrease by 0.70 per 100,000 individuals (2018-2040). Analyses predict a decrease in metastases to liver (APC = -3.40, 95% CI [-3.50, -3.30]), lung (APC (2019-2030) = -1.90, 95% CI [-2.90, -1.00]); (2030-2040) = -3.70, 95% CI [-4.60, -2.80]), bone (APC = -4.00, 95% CI [-4.30, -3.70]), and brain (APC = -2.30, 95% CI [-2.60, -2.00]). By 2040, patients with metastatic cancer are predicted to have 46.7% greater odds of long-term survivorship, driven by increasing plurality of patients with more indolent forms of metastatic disease.

CONCLUSIONS

By 2040, the distribution of metastatic cancer patients is predicted to shift in predominance from invariably fatal to indolent cancers subtypes. Continued research on metastatic cancers is important to guide health policy and clinical intervention efforts, and direct allocations of healthcare resources.

Association of Metabolic Syndrome Components and Nutritional Status with Kidney Cancer in Young Adult Population: A Nationwide Population-Based Cohort Study in Korea

The aim of this study was to determine the association of metabolic syndrome (MetS) with kidney cancer and the impact of age and gender on such an association. Using the Korean National Health Insurance Service database, 9,932,670 subjects who had check-ups in 2009 were followed up until the diagnosis of kidney cancer or death or until 2019. Kidney cancer was significantly associated with MetS (HR 1.56). This association was higher in the younger age group (HR: 1.82, 1.5, and 1.37 in 20-39 years, 40-64 years, and ≥65 years, respectively). In terms of the association of kidney cancer with obesity and central obesity, young-aged males showed higher HR for kidney cancer than old-aged ones (HR of obesity: 1.96, 1.52, and 1.25; HR of central obesity: 1.94, 1.53, and 1.3 in 20-39 years, 40-64 years, ≥65 years, respectively), while young-aged females showed lower HR. Kidney cancer was associated with obesity and MetS. The association was higher in younger populations than in older ones. Regarding gender, MetS, obesity, and central obesity showed higher associations with kidney cancer in younger aged male population, while there was no significant difference in such associations according to age in the female population.

Obesity, the Adipose Organ and Cancer in Humans: Association or Causation?

Epidemiological observations, experimental studies and clinical data show that obesity is associated with a higher risk of developing different types of cancer; however, proof of a cause-effect relationship that meets the causality criteria is still lacking. Several data suggest that the adipose organ could be the protagonist in this crosstalk. In particular, the adipose tissue (AT) alterations occurring in obesity parallel some tumour behaviours, such as their theoretically unlimited expandability, infiltration capacity, angiogenesis regulation, local and systemic inflammation and changes to the immunometabolism and secretome. Moreover, AT and cancer share similar morpho-functional units which regulate tissue expansion: the adiponiche and tumour-niche, respectively. Through direct and indirect interactions involving different cellular types and molecular mechanisms, the obesity-altered adiponiche contributes to cancer development, progression, metastasis and chemoresistance. Moreover, modifications to the gut microbiome and circadian rhythm disruption also play important roles. Clinical studies clearly demonstrate that weight loss is associated with a decreased risk of developing obesity-related cancers, matching the reverse-causality criteria and providing a causality correlation between the two variables. Here, we provide an overview of the methodological, epidemiological and pathophysiological aspects, with a special focus on clinical implications for cancer risk and prognosis and potential therapeutic interventions.

A comparison of analytic approaches for investigating the obesity paradox in kidney cancer

PURPOSE

Body mass index (BMI) and kidney cancer mortality are inconsistently associated in the scientific literature. To understand how study design affects results, we contrasted associations between pre-diagnosis BMI and mortality under different analytic scenarios in a large, population-based prospective cohort study.

METHODS

Using data from the NIH-AARP Diet and Health Study (1995-2011), we constructed two cohorts: a "full at-risk" cohort with no kidney cancer history at baseline (n = 252,845) and an "incident cancer" subset who developed kidney cancer during follow-up (n = 1,652). Cox Proportional Hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) between pre-diagnosis BMI and mortality for different outcomes (all-cause and cancer-specific mortality), in the different cohorts (full at-risk vs. incident cancer cohort), and with different covariates (minimally vs. fully adjusted). For the incident cancer cohort, we also examined time to mortality using different timescales: from enrollment or diagnosis.

RESULTS

In the full at-risk study population, higher pre-diagnosis BMI was associated with greater cancer-specific mortality in fully adjusted multivariable models, particularly for obese participants [HR, (95% CI): 1.76, (1.38-2.25)]. This association was less pronounced in the incident cancer cohort [1.50, (1.09-2.07)]. BMI was not strongly associated with all-cause mortality in either cohort in fully adjusted models [full cohort: 1.03, (1.01, 1.06); incident cancer cohort: 1.20, (0.97, 1.48)].

CONCLUSIONS

Populations characterized by high adult BMI will likely experience greater population burdens of mortality from kidney cancer, partially because of higher rates of kidney cancer diagnosis. Questions regarding overall mortality burden and post-diagnosis cancer survivorship are distinct and require different study designs.

Lipids as Targets for Renal Cell Carcinoma Therapy

Kidney cancer is among the top ten most common cancers to date. Within the kidney, renal cell carcinoma (RCC) is the most common solid lesion occurring. While various risk factors are suspected, including unhealthy lifestyle, age, and ethnicity, genetic mutations seem to be a key risk factor. In particular, mutations in the von Hippel-Lindau gene (Vhl) have attracted a lot of interest since this gene regulates the hypoxia inducible transcription factors HIF-1α and HIF-2α, which in turn drive the transcription of many genes that are important for renal cancer growth and progression, including genes involved in lipid metabolism and signaling. Recent data suggest that HIF-1/2 are themselves regulated by bioactive lipids which make the connection between lipids and renal cancer obvious. This review will summarize the effects and contributions of the different classes of bioactive lipids, including sphingolipids, glycosphingolipids, eicosanoids, free fatty acids, cannabinoids, and cholesterol to renal carcinoma progression. Novel pharmacological strategies interfering with lipid signaling to treat renal cancer will be highlighted.

Impairment of kidney function and kidney cancer: A bidirectional Mendelian randomization study

BACKGROUND

Many observational epidemiology studies discovered that kidney cancer and impaired kidney function have a bidirectional relationship. However, it remains unclear whether these two kinds of traits are causally linked. In this study, we aimed to investigate the bidirectional causal relation between kidney cancer and kidney function biomarkers (creatinine-based estimated glomerular filtration rate (eGFRcrea), cystatin C-based estimated glomerular filtration rate (eGFRcys), blood urea nitrogen (BUN), serum urate, and urinary albumin-to-creatinine ratio (UACR)).

METHODS

For both directions, single-nucleotide polymorphisms (SNPs), as genetic instruments, for the five kidney function traits were selected from up to 1,004,040 individuals, and SNPs for kidney cancer were from 408,786 participants(1338 cases). In the main analysis, we applied two state-of-the-art MR methods, namely, contamination mixture and Robust Adjusted Profile Score to downweight the effect of weak instrument bias, pleiotropy, and extreme outliers. We additionally conducted traditional MR analyses as sensitivity analyses. Summary-level data of European ancestry were extracted from UK Biobank, Chronic Kidney Disease Genetics Consortium, and Kaiser Permanente.

RESULTS

Based on 99 SNPs, we found that the eGFRcrea had a significant negative causal effect on the risk of kidney cancer (OR = 0.007, 95% CI:2.6 × 10-4 -0.569, p = 0.041). After adjusting for body composition or diabetes, urate had a significant negative causal effect on kidney cancer (OR <1, p < 0.05). For UACR, it showed a strong causal effect on kidney cancer, after adjusting for body composition (OR = 14.503, 95% CI: 2.546-96.001, p = 0.032). Due to lacking significant signals and effect power for the reverse MR, further investigations are warranted.

CONCLUSIONS

Our study suggested a potential causal effect of damaged kidney function on kidney cancer. EGFRcrea and UACR might be causally associated with kidney cancer, especially when patients were comorbid with obesity or diabetes. We called for larger sample-size studies to further unravel the underlying causal relationship and the exact mechanism.

Outcomes of nephrectomy for renal cell carcinoma: An ecologic retrospective study in a middle-income country

OBJECTIVE

The aim of this study was to describe and compare the outcomes and indirect costs of oncological radical (RN) and partial nephrectomies (PN) in hospitals from the São Paulo public health system, Brazil.

MATERIALS AND METHODS

An ecologic retrospective study was performed from 2008 to 2019, using the TabNet Platform of the Brazilian Unified Health System Department of Informatics. Hospitals were classified according to volume of surgeries (low and high-volume, and also into four quartiles according to volume of surgeries), and with or without medical residency program in urology. The results were compared between groups.

RESULTS

In the period analyzed were performed 2.606 RN in 16 hospitals. Data available for PN ranged only from 2013-2019 and included 1.223 surgeries comprising 15 hospitals. Overall mortality rates were 0.41% for PN and 2.87% for RN. The length of hospital stay was significantly higher in low-volume hospitals for both RN and PN (8.97 vs. 5.62 days, p = 0.001, and 7.75 vs. 4.37 days, p = 0.001, respectively), and also for the RN in hospitals without residency program in Urology (9.37 vs. 6.54 days, p = 0.03). When the volume of surgeries was divided into four quartiles, the length of hospital stay and ICU hospitalization days were significantly higher in the first quartile hospitals for RN (p = 0.016) and PN (p = 0.009), respectively. The mortality rates and indirect costs were not different considering PN and RN in the different types of hospitals.

CONCLUSIONS

The length of hospital stay was significantly lower for both PN and RN in high-volume hospitals, and also for RN in hospitals with residency program in Urology.

Overcoming Immunotherapeutic Resistance in PDAC: SIRPα-CD47 blockade

A daily increase in the number of new cases of pancreatic ductal adenocarcinoma remains an issue of contention in cancer research. The data revealed that a global cumulated case of about 500, 000 have been reported. This has made PDAC the fourteenth most occurring tumor case in cancer research. Furthermore, PDAC is responsible for about 466,003 deaths annually, representing the seventh prevalent type of cancer mortality. PDAC has no salient symptoms in its early stages. This has exasperated several attempts to produce a perfect therapeutic agent against PDAC. Recently, immunotherapeutic research has shifted focus to the blockade of checkpoint proteins in the management and of some cancers. Investigations have centrally focused on developing therapeutic agents that could at least to a significant extent block the SIRPα-CD47 signaling cascade (a cascade which prevent phagocytosis of tumors by dendritic cells, via the deactivation of innate immunity and subsequently resulting in tumor regression) with minimal side effects. The concept on the blockade of this interaction as a possible mechanism for inhibiting the progression of PDAC is currently being debated. This review examined the structure--function activity of SIRPα-CD47 interaction while discussing in detail the mechanism of tumor resistance in PDAC. Further, this review details how the blockade of SIRPα-CD47 interaction serve as a therapeutic option in the management of PDAC.

Renal Cell Cancer and Obesity

Cancers are a frequent cause of morbidity and mortality. There are many risk factors for tumours, including advanced age, personal or family history of cancer, some types of viral infections, exposure to radiation and some chemicals, smoking and alcohol consumption, as well as obesity. Increasing evidence suggest the role of obesity in the initiation and progression of various cancers, including renal cell carcinoma. Since tumours require energy for their uncontrollable growth, it appears plausible that their initiation and development is associated with the dysregulation of cells metabolism. Thus, any state characterised by an intake of excessive energy and nutrients may favour the development of various cancers. There are many factors that promote the development of renal cell carcinoma, including hypoxia, inflammation, insulin resistance, excessive adipose tissue and adipokines and others. There are also many obesity-related alterations in genes expression, including DNA methylation, single nucleotide polymorphisms, histone modification and miRNAs that can promote renal carcinogenesis. This review focuses on the impact of obesity on the risk of renal cancers development, their aggressiveness and patients’ survival.

Lipid metabolism reprogramming in renal cell carcinoma

Metabolic reprogramming is recognized as a hallmark of cancer. Lipids are the essential biomolecules required for membrane biosynthesis, energy storage, and cell signaling. Altered lipid metabolism allows tumor cells to survive in the nutrient-deprived environment. However, lipid metabolism remodeling in renal cell carcinoma (RCC) has not received the same attention as in other cancers. RCC, the most common type of kidney cancer, is associated with almost 15,000 death in the USA annually. Being refractory to conventional chemotherapy agents and limited available targeted therapy options has made the treatment of metastatic RCC very challenging. In this article, we review recent findings that support the importance of synthesis and metabolism of cholesterol, free fatty acids (FFAs), and polyunsaturated fatty acids (PUFAs) in the carcinogenesis and biology of RCC. Delineating the detailed mechanisms underlying lipid reprogramming can help to better understand the pathophysiology of RCC and to design novel therapeutic strategies targeting this malignancy.

Cancer Therapy Targeting CD47/SIRPα

Simple Summary

The interaction between cluster of differentiation 47 (CD47) on cancer cells and signal regulatory protein alpha (SIRPα) on immune cells, such as macrophages and dendritic cells, generates a “don’t eat me” signal. This is a common mechanism that provides cancer cells an escape from the innate immune system. Several therapeutics directed to CD47 or SIRPα have entered early clinical trials in recent years. In this article, we review the role of CD47/SIRPα axis in cancer, and summarize the literature on the efficacy and safety of therapeutics targeting CD47 or SIRPα. We also discuss the future implementation of these therapeutics in the treatments of various cancer types.

Abstract

In the past decade, the field of cancer immunotherapy has rapidly advanced, establishing a crucial role for immune checkpoint blockers in the treatment of a variety of cancer types. In parallel with these remarkable clinical developments, further efforts have focused on ways of unleashing adaptive immune responses against cancer. CD47, a cell surface molecule overexpressed by several cancer types that facilitates immune escape from macrophages, dendritic cells and natural killer cells, and its ligand SIRPα, have emerged as potential therapeutic targets. A number of agents directed to CD47/SIRPα have been developed and demonstrated preclinical activity. Early phase clinical trials are investigating CD47/SIRPα directed agents with available data, suggesting safety and preliminary activity. Herein, we provide an overview of the mechanistic rationale of targeting CD47/SIRPα axis and associated clinical evidence.

Perioperative impact of body mass index on upper urinary tract and renal robot-assisted surgery: a single high-volume centre experience

To assess the impact of body mass index (BMI) on peri-operative outcomes of kidney and upper tract robot-assisted surgery. Medical audit of patients who underwent robot-assisted kidney and upper tract cancer surgery at a single institution between 2017 and 2019, categorized on BMI into obese patients with a BMI ≥ 30 kg/m² and a control group with BMI < 25 kg/m². Patient and tumour characteristics, surgery time, intraoperative blood loss, intraoperative adverse events (AE) according to the European Association of Urology Intraoperative Adverse Incidents Classification (EAUiaiC), conversion- to-open/radical rate as well as 30-day postoperative AE according to Clavien-Dindo (CD) and length of inpatient stay were analyzed. 366 patients were identified, 141 with a BMI < 25 (normal-weight) and 225 BMI ≥ 30 (obesity). There were no significant differences between the groups in terms of age, gender, comorbidities, tumour size, TNM stage and type of surgery. Obese patients had a higher estimated blood loss (198.05 ml), surgery time (171.75 min), intraoperative AE (all grades) (14.67%, 95% CI (0.10-0.19) as well as adherent perinephric fat (APF) (14.22%, 95% CI (0.09-0.19)) in contrast to the control group (86.85 ml, 148.29 min, 7.04% and 2.12%, respectively). Hospital stay, major intraoperative AE (≥ 3) and major postoperative AE (CD > 2) distributed equally between groups. Robotic kidney and upper tract surgery in obese patients showed an increase in surgery time and blood loss potentially related to APF. However, obesity was not associated with conversion to open surgery or radical nephrectomy in nephron-sparing procedures, length of stay, major intraoperative AE or postoperative complications.

From kidney injury to kidney cancer

Epidemiologic studies document strong associations between acute or chronic kidney injury and kidney tumors. However, whether these associations are linked by causation, and in which direction, is unclear. Accumulating data from basic and clinical research now shed light on this issue and prompt us to propose a new pathophysiological concept with immanent implications in the management of patients with kidney disease and patients with kidney tumors. As a central paradigm, this review proposes the mechanisms of kidney damage and repair that are active during acute kidney injury but also during persistent injuries in chronic kidney disease as triggers of DNA damage, promoting the expansion of (pre-)malignant cell clones. As renal progenitors have been identified by different studies as the cell of origin for several benign and malignant kidney tumors, we discuss how the different types of kidney tumors relate to renal progenitors at specific sites of injury and to germline or somatic mutations in distinct signaling pathways. We explain how known risk factors for kidney cancer rather represent risk factors for kidney injury as an upstream cause of cancer. Finally, we propose a new role for nephrologists in kidney cancer (i.e., the primary and secondary prevention and treatment of kidney injury to reduce incidence, prevalence, and recurrence of kidney cancer).

Risk Prediction for Renal Cell Carcinoma: Results from the European Prospective Investigation into Cancer and Nutrition (EPIC) Prospective Cohort Study

BACKGROUND

Early detection of renal cell carcinoma (RCC) has the potential to improve disease outcomes. No screening program for sporadic RCC is in place. Given relatively low incidence, screening would need to focus on people at high risk of clinically meaningful disease so as to limit overdiagnosis and screen-detected false positives.

METHODS

Among 192,172 participants from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (including 588 incident RCC cases), we evaluated a published RCC risk prediction model (including age, sex, BMI, and smoking status) in terms of discrimination (C-statistic) and calibration (observed probability as a function of predicted probability). We used a flexible parametric survival model to develop an expanded model including age, sex, BMI, and smoking status, with the addition of self-reported history of hypertension and measured blood pressure.

RESULTS

The previously published model yielded well-calibrated probabilities and good discrimination (C-statistic [95% CI]: 0.699 [0.679-0.721]). Our model had slightly improved discrimination (0.714 [0.694-0.735], bootstrap optimism-corrected C-statistic: 0.709). Despite this good performance, predicted risk was low for the vast majority of participants, with 70% of participants having 10-year risk less than 0.0025.

CONCLUSIONS

Although the models performed well for the prediction of incident RCC, they are currently insufficiently powerful to identify individuals at substantial risk of RCC in a general population.

IMPACT

Despite the promising performance of the EPIC RCC risk prediction model, further development of the model, possibly including biomarkers of risk, is required to enable risk stratification of RCC.

Impact of Body Mass Index on Perioperative Complications and Oncologic Outcomes in Patients Undergoing Thermal Ablation for Renal Cell Carcinoma

PURPOSE

To determine effect of body mass index (BMI) on safety and cancer-related outcomes of thermal ablation for renal cell carcinoma (RRC).

MATERIALS AND METHODS

This retrospective study evaluated 427 patients (287 men and 140 women; mean [SD] age, 72 [12] y) who were treated with thermal ablation for RCC between October 2006 and December 2017. Patients were stratified by BMI into 3 categories: normal weight (18.5-24.9 kg/m²), overweight (25-29.9 kg/m²), and obese (≥ 30 kg/m²). Of 427 patients, 71 (16%) were normal weight, 157 (37%) were overweight, and 199 (47%) were obese. Complication rates, local recurrence, and residual disease were compared in the 3 cohorts.

RESULTS

No differences in technical success between normal-weight, overweight, and obese patients were identified (P = .72). Primary technique efficacy rates for normal-weight, overweight, and obese patients were 91%, 94%, and 93% (P = .71). There was no significant difference in RCC specific-free survival, disease-free survival, and metastasis-free survival between obese, overweight, and normal-weight groups (P = .72, P = .43, P = .99). Complication rates between the 3 cohorts were similar (normal weight 4%, overweight 2%, obese 3%; P = .71).

CONCLUSIONS

CT-guided renal ablation is safe, feasible, and effective regardless of BMI.

Trends in Cancer Incidence in US Adolescents and Young Adults, 1973-2015

IMPORTANCE

Previous studies have demonstrated that adolescents and young adults (AYAs) with cancer are a distinct cancer population; however, research on long-term epidemiological trends and characteristics of cancers in AYAs is lacking.

OBJECTIVE

To characterize the epidemiology of cancer in AYAs aged 15 to 39 years with respect to (1) patient demographic characteristics, (2) frequencies of cancer types, and (3) cancer incidence trends over time.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective, serial cross-sectional, population-based study used registry data from the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 1973, to December 31, 2015 (SEER 9 and SEER 18). The study population was from geographically distinct US regions, chosen to represent the racial and ethnic heterogeneity of the country. Initial analyses were performed from January 1 to August 31, 2019.

MAIN OUTCOMES AND MEASURES

Incidence rates and descriptive epidemiological statistics for patients aged 15 to 39 years with invasive cancer.

RESULTS

A total of 497 452 AYAs diagnosed from 1973 to 2015 were included in this study, with 293 848 (59.1%) female and 397 295 (79.9%) White participants. As AYAs aged, an increase in the relative incidence of carcinomas and decrease in the relative incidence of leukemias, lymphomas, germ cell and trophoblastic neoplasms, and neoplasms of the central nervous system occurred. Among the female AYAs, 72 564 (24.7%) were diagnosed with breast carcinoma; 48 865 (16.6%), thyroid carcinoma; and 33 828 (11.5%), cervix and uterus carcinoma. Among the male AYAs, 37 597 (18.5%) were diagnosed with testicular cancer; 20 850 (10.2%), melanoma; and 19 532 (9.6%), non-Hodgkin lymphoma. The rate of cancer in AYAs increased by 29.6% from 1973 to 2015, with a mean annual percentage change (APC) per 100 000 persons of 0.537 (95% CI, 0.426-0.648; P < .001). Kidney carcinoma increased at the greatest rate for both male (APC, 3.572; 95% CI, 3.049-4.097; P < .001) and female (APC, 3.632; 95% CI, 3.105-4.162; P < .001) AYAs.

CONCLUSIONS AND RELEVANCE

In this cross-sectional, US population-based study, cancer in AYAs was shown to have a unique epidemiological pattern and is a growing health concern, with many cancer subtypes having increased in incidence from 1973 to 2015. Continued research on AYA cancers is important to understanding and addressing the distinct health concerns of this population.

Biological Support to Obesity Paradox in Renal Cell Carcinoma: A Review

Obesity is a proven risk factor and a debated prognostic factor in renal cell carcinoma (RCC). Termed as an "obesity paradox," the topic has churned controversies, with a few arguing of no true biological association. Suggesting otherwise, a few studies revealed adiposity-induced altered molecular and transcriptomic signatures, at both the systemic and local (tumor and peritumoral adipose tissue) levels, in RCC patients, favoring the paradox. Summarizing such studies suggests of a considerable biological support to adiposity as a promising prognostic factor in RCC patients, although much needs to be clarified before adopting it as a valuable addition to the existing prognostic model.

Diabetes and kidney cancer risk among post-menopausal women: The Iowa women's health study

BACKGROUND

Many studies have reported a positive association between diabetes and kidney cancer. However, it is unclear whether diabetes is a risk factor for kidney cancer independent of other risk factors, such as obesity and hypertension. We comprehensively examined the association of diabetes and its duration with incident kidney cancer in the prospective cohort Iowa Women's Health Study (1986-2011).

METHODS

Diabetes status was self-reported at baseline (1986) and on five follow-up questionnaires. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of baseline and time-dependent diabetes with the risk of incident kidney cancer.

RESULTS

During the 25 years of follow-up, 245 cases of kidney cancer occurred among 36,975 post-menopausal women. In an age-adjusted model, there was a significant association between time-dependent diabetes and the risk of kidney cancer [HR (95% CI) = 1.76 (1.26, 1.45)]; the association was attenuated after multivariable adjustment for age, body mass index (BMI), waist-to-hip ratio (WHR), hypertension, physical activity, diuretic use, pack-years of smoking, alcohol intake, and total caloric intake [HR = 1.35 (0.94, 1.94)]. However, among non-obese women or women with a waist circumference less than 34.6 in., diabetes was significantly associated with kidney cancer risk: for time-dependent diabetes, HRs (95% CIs) were 1.82 (1.10, 3.00) among those with BMI < 30 kg/m² and 2.18 (1.08, 4.38) among those with a waist circumference <34.6 in..

CONCLUSIONS

Our results suggest that diabetes is associated with kidney cancer risk among non-obese post-menopausal women.

Thermal Ablation of Renal Cell Carcinoma in Patients With Morbid Obesity: Assessment of Technique, Safety, and Oncologic Outcomes

BACKGROUND. Obesity is a worldwide problem that impacts patient health as well as the morbidity associated with surgical procedures. Thus, patients with morbid obesity may not be suitable candidates for curative surgery. For this patient population, thermal ablation may be an effective alternative to nephrectomy. OBJECTIVE. The purpose of this study was to determine the feasibility, oncologic outcomes, and survival of patients with morbid obesity and renal cell carcinoma treated with thermal ablation. MATERIALS AND METHODS. A retrospective analysis was performed of 107 patients treated with CT-guided renal ablation for clinical T1 renal cell carcinoma between February 2005 and December 2017. Patients were stratified into two cohorts on body mass index of ≥ 40 kg/m² (morbidly obese) and body mass index (weight in kilograms divided by the square of height in meters) of ≥ 40 (morbidly obese) and 18.5-24.9 (normal weight). Anesthetic and radiation dosages, procedure time, residual disease, and local recurrence, and adverse events were analyzed between the two groups. Kaplan-Meier statistics were used to evaluate cancer-related outcomes for each group. RESULTS. Thirty-four patients were morbidly obese, and 73 patients had normal weight. Morbid obesity was associated with longer procedural duration (p = .001), sedative doses (p = .002) and radiation exposure (p = .001) than normal weight. Hematomas were more prevalent in patients with morbid obesity than in those of normal weight (p = .01), but treatment efficacy and local recurrences were comparable with those for normal-weight individuals (p = .81 and p = .12, respectively). Cancer-related outcomes were equivalent between the two groups based on 5 years of imaging observation data. CONCLUSION. CT-guided thermal ablation remains technically feasible, well-tolerated, and effective in patients with morbid obesity and renal cell carcinoma, with the caveat of increased risk of perinephric hematoma, anesthesia dose, and radiation exposure. CLINICAL IMPACT. CT-guided thermal ablation can be considered a safe and effective treatment for renal cell carcinoma in patients with morbid obesity.

Prognostic Implication of Body Mass Index on Survival Outcomes in Surgically Treated Nonmetastatic Renal Cell Carcinoma: A Single-Institutional Retrospective Analysis of a Large Cohort

PURPOSE

Obesity is a well-known risk factor for renal cell carcinoma (RCC). However, the prognostic role of obesity in RCC has not been clearly established thus far. We aim to assess the effect of preoperative body mass index (BMI) on survival outcomes in nonmetastatic RCC patients.

PATIENTS AND METHODS

We retrospectively analyzed data on 2329 patients who underwent curative surgery for RCC between 2000 and 2014 in a single institution. Patients were divided into normal (< 23 kg/m²), overweight (23-24.9 kg/m²), and obese (≥ 25 kg/m²) groups depending on cutoffs for Asian population. Kaplan-Meier analysis with log-rank test was used to estimate and compare survival outcomes, including recurrence-free, overall, and cancer-specific survival, among each BMI group. The influence of BMI on each survival outcome was evaluated using multivariate Cox regression analyses.

RESULTS

Obese patients presented favorable 5-year recurrent-free (90.7% vs 84.9%, p < 0.001), overall (91.8% vs 86.8%, p = 0.002), and cancer-specific (94.8% vs 89.4%, p = 0.002) survival rates than the normal group. Multivariate analyses revealed that increasing BMI was an independent predictor of favorable survival outcomes (all p values < 0.05). In particular, overweight (p = 0.009) and obese (p = 0.009) patients showed better cancer-specific survival compared with normal patients.

CONCLUSIONS

Our data suggest that overweight and obesity defined based on BMI are generally related to favorable survival outcomes after surgery for RCC. Additional basic research is required to find out the biological mechanisms explaining the correlation between BMI and survival outcomes.

Impact of Vascular Endothelial Growth Factor Gene Polymorphisms and Their Interactions with Environmental Factors on Susceptibility to Renal Cell Carcinoma

AIMS

This study aimed to investigate the association of single nucleotide polymorphisms (SNPs) within vascular endothelial growth factor (VEGF) gene and additional gene-environment interaction with renal cell carcinoma (RCC) risk.

METHODS

PCR-restriction fragment length polymorphism was performed to detect SNPs. Hardy-Weinberg equilibrium and allele frequencies in cases and controls were calculated using SNPStats (http://bioinfo.iconcologia.net/SNPstats). Generalized multifactor dimensionality reduction (GMDR) was used to screen the best interaction combination among 4 SNPs, smoking, and alcohol drinking. Logistic regression was performed to investigate the association between 4 SNPs within VEGF gene, additional gene-smoking interaction, and RCC risk.

RESULTS

RCC risk was significantly higher in carriers with the T allele of rs833061 within VEGF gene than those with CC genotype (CT+TT vs. CC) {adjusted odds ratio (OR) (95% confidence interval [CI]) = 1.71 (1.17-2.32), p = 0.002} and higher in carriers with the A allele of rs699947 within VEGF gene than those with GG genotype (GA+AA vs. GG) (adjusted OR [95% CI] = 1.64 [1.27-2.10], p < 0.001). GMDR analysis indicated a significant 2-locus model (p = 0.0010) involving rs833061 and smoking. The cross-validation consistency of the 2-locus model was 10/10, and the testing accuracy was 60.72%. Current smokers with rs833061-CT+TT genotype had the highest RCC risk, compared to never smokers with rs833061-CC genotype within VEGF gene (OR [95% CI] = 3.02 [1.84-4.23], p < 0.001).

CONCLUSIONS

We found that the T allele of rs833061 and the A allele of rs699947 within VEGF gene, and the interaction between rs833061 and smoking were all associated with increased RCC risk.

Early life body size in relation to risk of renal cell carcinoma in adulthood: a Danish observational cohort study

Adult obesity increases risks of renal cell carcinoma (RCC). This study investigated if birth weight, child body mass index (BMI) and height are associated with adult RCC. The study included 301,418 children (152,569 boys) from the Copenhagen School Health Records Register born 1930-1985 with measured weights and heights at ages 7 to 13 years. Birth weight was obtained by parental report. BMI and height were transformed to z-scores, and BMI was categorized as normal BMI or overweight. RCC was identified by linkage to the Danish Cancer Registry. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated by Cox proportional hazards regression. During follow-up, 1010 individuals (680 men) were diagnosed with RCC. BMI and height were positively associated with RCC with no significant sex-differences (age 13: HR = 1.14, 95% CI 1.06-1.23 per BMI z-score, HR = 1.12, 95% CI 1.05-1.20 per height z-score). Compared to children with normal BMI at ages 7 and 13 years, children with overweight only at age 13 had higher risks of RCC (HR = 1.67, 95% CI 1.24-2.26). Compared to children with average growth in height, persistently taller-than-average children (HR = 1.06, 95% CI 1.03-1.10) and children who changed from average to above-average height (HR = 1.08, 95% CI 1.01-1.15) had increased risks of RCC. Birth weight was positively associated with RCC (HR = 1.12, 95% CI 1.05-1.20 per 500 grams). Birth weight, childhood BMI and height were positively associated with RCC risk in men and women.

Cancer-Specific Loss of Urocortin 3 in Human Renal Cancer

INTRODUCTION

The corticotropin-releasing hormone (CRH) system, its receptors corticotropin-releasing hormone receptor 1 (CRHR1) and 2 (CRHR2), and its corresponding binding protein corticotropin-releasing hormone-binding protein (CRHBP) as well as the urocortin proteins-structural homologues to CRH, which are included in this peptide family-have become interesting oncological targets recently. Carcinogenesis of various human tumors has been reported with an altered presence of members of this system. The aim of the present study was to examine the role of urocortin 3 (UCN3) in renal cell carcinoma (RCC).

METHODS

Therefore, tumoral tissues of 106 patients with RCC and available corresponding normal tissues were analyzed using qPCR for quantitative mRNA expression analysis. Tissue localization and protein signals of UCN3 in normal and tumoral renal specimens were evaluated using western blot and immunohistochemistry. In addition, correlation studies of UCN3 mRNA expression with clinicopathological parameters of patients with RCC and different histological subtypes were evaluated.

RESULTS

UCN3 mRNA was significantly downregulated in nearly all tumoral tissues (p = 7.92 × 10^-13). The same effect was observed at protein level using immunohistochemistry. Level of UCN3 mRNA expression was not directly correlated with clinicopathological parameters.

CONCLUSION

We report for the first time the significant downregulation of UCN3 in RCC. These results demonstrate a possible involvement of the CRH system and its significance in carcinogenesis of RCC.

The Role of Obesity in Renal Cell Carcinoma Patients: Clinical-Pathological Implications

Obesity is a well-known risk factor for renal cell carcinoma (RCC) development. However, the RCC–obesity link has not been fully addressed when considering a comprehensive scenario starting from pathogenetic aspects through pathological issues up to the outcome of medical treatment. We therefore conducted an electronic PubMed search using keywords “obesity”, “body mass index”, “overweight”, “renal cell carcinoma/kidney cancer”, “medical treatment”, “targeted therapy”, and “immunotherapy/immune checkpoint inhibitors”. The selected data supported a crosstalk between adipose tissue (adipocytes and other white adipose tissue cells) and cancer cells inducing several signaling pathways that finally stimulated angiogenesis, survival, and cellular proliferation. Accurate sampling of renal sinus fat correlated with a prognostic value. Retrospective clinical evidence in metastatic RCC patients with higher body mass index (BMI) and treated with targeted therapies and/or immune checkpoint inhibitors showed advantageous survival outcomes. Therefore, obesity may influence the course of RCC patients, although the interplay between obesity/BMI and RCC warrants a large prospective confirmation. We are therefore still far from determining a clear role of obesity as a prognostic/predictive factor in metastatic RCC patients undergoing targeted therapy and immunotherapy.

Increased UCP1 expression in the perirenal adipose tissue of patients with renal cell carcinoma

Perirenal adipose tissue (PAT) has been implicated in renal cell carcinoma (RCC). The expression of uncoupling protein 1 (UCP1) is higher in PAT compared with that in back subcutaneous adipose tissue (bSAT). The aim of the present study was to determine UCP1 expression in different parts of PAT and to analyze the correlation between UCP1 expression in PAT and RCC. PAT from the upper and lower renal poles and bSAT samples were collected from 50 patients with RCC (RCC group) and 54 patients with renal cysts (control group) who had undergone renal surgery. Both UCP1 mRNA and protein levels were found to be significantly higher and adipocytes appeared to be smaller in the PAT of the RCC group. Furthermore, the RCC group had more multilocular UCP1-positive adipocytes. UCP1 staining in the PAT was significantly stronger in the RCC group, but there was no significant difference in UCP1 staining in the bSAT between the two groups. Furthermore, Fuhrman grade and T stage were higher in the high UCP1 expression group of RCC patients. In conclusion, high UCP1 expression in the PAT may serve as an indicator of poor prognosis in RCC.

Cancers Attributable to Overweight and Obesity From 2012 to 2014 in Nigeria: A Population-Based Cancer Registry Study

Background: Overweight and obesity are known risk factors for chronic diseases including cancers. In this study, we evaluated the age standardized incidence rates (ASR) and proportion of cancers attributable to overweight and obesity in Nigeria. Methods: We obtained incidence data from the databases of two population-based cancer registries (PBCRs) in Nigeria (Abuja and Enugu cancer registries), on cancer site for which there is established evidence of an association with overweight or obesity based on the International Agency for Research on Cancer (IARC) and the World Cancer Research Fund (WCRF) classification. We analyzed the data using population attributable fraction (PAF) for overweight or obesity associated cancers calculated using prevalence data and relative risk estimates in previous studies. Results: The two PBCRs reported 4,336 new cancer cases (ASR 113.9 per 100,000) from 2012 to 2014. Some 21% of these cancers were associated with overweight and obesity. The ASR for overweight and obesity associated cancers was 24.5 per 100,000; 40.7 per 100,000 in women and 8.2 per 100,000 in men. Overall, only 1.4% of incident cancers were attributable to overweight and obesity. The ASR of cancers attributable to overweight and obesity was 2.0 per 100,000. Postmenopausal breast cancer was the most common cancer attributable to overweight and obesity (n = 25; ASR 1.2 per 100,000). Conclusion: Our results suggest that a small proportion of incident cancer cases in Nigeria are potentially preventable by maintaining normal body weight. The burden of cancer attributed to overweight and obesity in Nigeria is relatively small, but it may increase in future.

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

Purpose: The prognostic value of obesity in patients with renal cell carcinoma (RCC) remains controversial. This study aimed to assess the sex-dependent prognostic role of body mass index (BMI) in patients with nonmetastatic RCC who underwent radical or partial nephrectomy.

Patients and methods: We retrospectively analyzed 643 consecutive patients with nonmetastatic RCC who underwent curative nephrectomy in our center between 2004 and 2014. Associations among BMI, sex, overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) were analyzed.

Results: Males were more likely to have a higher BMI than females (BMI as a categorical variable: P<0.001; BMI as a continuous variable: P=0.002). In men, a high BMI was significantly correlated with better 5-year OS, CSS, and MFS rates (P=0.001, 0.014, and 0.001, respectively), and multivariate analysis identified that a high BMI was independently associated with greater OS, CSS, and MFS (OS: hazard ratio [HR]=0.207, P=0.011; CSS: HR=0.225, P=0.005; MFS: HR=0.243, P=0.004). However, in women, there was no significant difference in 5-year OS, CSS, and MFS rates according to BMI (P=0.781, 0.812, and 0.538, respectively). Moreover, a high BMI was no longer independently associated with OS, CSS, or MFS (P=0.821, 0.832, and 0.801, respectively). Among patients with clear cell RCC, BMI was significantly associated with OS, CSS, and MFS only among men (all P<0.05) and not among women (all P>0.05).

Conclusion: Among patients with nonmetastatic RCC, a high BMI was a favorable prognostic factor in males rather than females. Therefore, sex might influence the correlation between obesity and urological outcomes in nonmetastatic RCC.

Prognostic biomarkers in renal cell carcinoma: is there a relationship with obesity?

Obesity is a recognized risk factor for renal cell carcinoma (RCC) the commonest form of kidney cancer. Both obesity and RCC are serious diseases with increasing incidence yearly. This review examined certain obesity associated measurements and adipokines as detection/prognostic indicators for RCC. The obesity related measurements such as body mass index (BMI), waist circumstance (WC), waist-hip ratio (WHR) in predicting RCC are valid when used in conjunction with other risk factors such as age and sex or with histological findings. The adipokine adiponectin holds promising outcomes as a predictive marker in assessing the risk of developing RCC. In addition, tissue leptin/leptin receptor may be a distinguishing marker for RCC subtypes. However, circulating leptin may not be a suitable detection or prognostic biomarker for RCC. The other less investigated adipokines; omentin, visfatin, apelin and resistin are also expressed in RCC but their prognostic capabilities are still inconclusive. BMI, WC and adipokines may be useful additions in a nomogram which includes TNM staging and pathological grading system to detect, confirm and follow-up RCC cases.

The association between BMI and kidney cancer risk: An updated dose-response meta-analysis in accordance with PRISMA guideline

OBJECTIVE

Obesity is considered as one of the risk factors of kidney cancer. However, the results are not consistent in reported original studies, as well as in published meta-analysis. This study aims to clarify the relationship between overweight/obesity and kidney cancer by an updated overall and dose-response meta-analysis.

METHODS

This meta-analysis was conducted in accordance with PRISMA guideline. Relevant studies were searched using PubMed, Embase, and Web of Science databases. The studies were limited to human cohort studies in English and Chinese language. Random-effect models and dose-response meta-analysis were used to synthesize the results. Subgroup analyses were also conducted based on the characteristics of participants.

RESULTS

Twenty-four cohort studies with 8,953,478 participants were included in our meta-analysis. Compared to the normal weight, the pooled RRs of kidney cancer was 1.35 (1.27-1.43) in overweight and 1.76 (1.61-1.91) in obese participants. An increased kidney cancer risk of 1.06 (1.05-1.06) for each 1 kg/m increase in BMI was showed in dose-response meta-analysis. No significant heterogeneity was found across studies with I = 39.4% for overweight, and I = 43.3% for obesity.

CONCLUSION

The overall and dose-response meta-analysis suggested that overweight/obesity increases the risk of kidney cancer both in men and women.

Body fatness at a young age and risks of eight types of cancer: systematic review and meta-analysis of observational studies

The associations between body fatness at a young age (childhood, adolescence and young adulthood; age ≤ 30 years) and diffuse large B-cell lymphoma (DLBCL), oesophageal adenocarcinoma, gastric cardia cancer, hepatocellular carcinoma, multiple myeloma, pancreatic cancer, renal cell cancer and thyroid cancer remain inconclusive. We performed a comprehensive systematic literature review and meta-analysis of observational studies to clarify the associations between body fatness at a young age and the risks of these cancers. PubMed and Web of Science databases were searched for relevant observational studies. Fifty-six articles yielded data on 27,559 cancer cases, including 3,170 DLBCL, 1,491 oesophageal adenocarcinoma, 1,103 gastric cardia cancer, 1,067 hepatocellular carcinoma, 3,090 multiple myeloma, 7,220 pancreatic cancer, 6,212 renal cell cancer and 4,206 thyroid cancer cases. Each 5 kg m^-2 increase in body mass index at a young age was positively associated with DLBCL (relative risk [RR] 1.21, 95% confidence interval [CI] 1.09, 1.35), oesophageal adenocarcinoma (RR 1.88, 95% CI 1.37, 2.57), gastric cardia cancer (RR 1.59, 95% CI 1.15, 2.21), hepatocellular carcinoma (RR 1.31, 95% CI 1.13, 1.51), multiple myeloma (RR 1.23, 95% CI 1.15, 1.30), pancreatic cancer (RR 1.17, 95% CI 1.11, 1.24), renal cell cancer (RR 1.22, 95% CI 1.16, 1.28) and thyroid cancer (RR 1.12, 95% CI 1.07, 1.17). In summary, higher body fatness at a young age increases the risks of developing various types of cancer later in life. Prevention of overweight and obesity in children, adolescents and young adults should therefore be emphasized to reverse the obesity epidemic and thereby avoid further increases in the burden of cancer attributed to excess body fatness.

Genetic variants in macrophage colony-stimulating factor are associated with risk of renal cell carcinoma in a Chinese population

OBJECTIVE

This study was performed to investigate whether CSF-1 polymorphisms influenced the risk of renal cell carcinoma in a Chinese population.

METHODS

The potentially functional polymorphisms in CSF-1 (rs333951 and rs2050462) were genotyped in this hospital-based case-control study, comprising 1512 renal cell carcinoma patients and 1691 controls in a Chinese population using the TaqMan assay. Furthermore, odds ratios (ORs) and 95% confidence intervals (CI) were used to estimate such an association. The logistic regression was used to assess the association between these genetic polymorphisms and the risk of renal cell carcinoma.

RESULTS

We found the genotype and allele frequency distribution of rs2050462 were significantly associated with the increasing risk of renal cell carcinoma ( P = 0.007). However, no statistical significance was found in the association between CSF-1 rs333951 polymorphism and the susceptibility of renal cell carcinoma ( P = 0.589). The analysis of combined risk alleles revealed that patients with two to four risk alleles showed no elevated risk of renal cell carcinoma compared to those with zero to one risk alleles (adjusted OR 1.09; 95% CI 0.95, 1.26; P = 0.226). Furthermore, compared with the genotypes containing A allele (AC and AA), the patients carrying the CC genotype in rs2050462 had a significantly greater prevalence of clinical stage II and IV (adjusted OR 0.67; 95% CI 0.47, 0.94; P = 0.021; adjusted OR 0.50; 95% CI 0.29, 0.88; P = 0.015, respectively).

CONCLUSIONS

The functional rs2050462 in CSF-1 might have a substantial influence on the renal cell carcinoma susceptibility and evolution in the Chinese population.

Kidney cancer in Saudi Arabia. A 25-year analysis of epidemiology and risk factors in a tertiary center

OBJECTIVES

To evaluate available epidemiological data and risk factors for kidney cancer in a tertiary care center in Riyadh, Saudi Arabia, over a period of 25 years.

METHODS

This retrospective study conducted in a tertiary care center included all adult patients with primary kidney cancer who presented and were managed between 1990 and 2015. Based on this information, we forecast the incidence of the disease in our center over the next 5 years (2016 to 2020).

RESULTS

In total, 371 patients were included in the study. The mean age of the patients was 56.3 years and the majority were male (61%). Among the patients, 55.8% were diagnosed incidentally. At the time of diagnosis, 53.2% were hypertensive, 46.2% were diabetic, 39.1% had dyslipidemia, and 25% were smokers. In addition, most patients were obese (42.3%) or overweight (30%). The most frequent histopathological variants were clear cell and chromophobe. Most patients presented with Stage 1. Minimally invasive surgery (laparoscopic, robotic) was performed in 55% of cases. Based on these data, we predicted that 172 new cases will present at our tertiary care center in 5 years from 2016 to 2020.

CONCLUSION

The incidence in kidney cancer is increasing and is associated with an alarming increase in the prevalence of associated risk factors.

Adiponectin gene polymorphisms and obesity increase the susceptibility to arsenic-related renal cell carcinoma

Our recent study found that high urinary total arsenic levels were associated with renal cell carcinoma (RCC). Recent studies demonstrated that low circulating adiponectin was related to RCC. The aim of the present study was to explore the relationship between adiponectin gene (ADIPOQ) polymorphisms and RCC and investigate whether individuals with an ADIPOQ risk genotype, obesity, and high urinary total arsenic levels have a modified odds ratio (OR) of RCC. A total of 389 RCC patients and 389 age- and sex-matched controls were recruited between November 2006 and December 2012 in Taiwan. Image-guided biopsy or surgical resection of renal tumors was performed to pathologically verify RCC. Genomic DNA was used to examine the genotypes of the ADIPOQ rs182052, ADIPOQ rs2241766, ADIPOQ rs1501299, and ADIPOQ rs1063539 SNPs by PCR-RFLP. HPLC-HG-AAS was used to measure the concentrations of urinary arsenic species. Participants with the ADIPOQ rs182052 G/A+A/A genotype had a significantly higher OR of RCC compared with those with the ADIPOQ rs182052 G/G genotype. The OR (95% confidence interval [CI]) was 1.70 (1.23-2.36). The OR of RCC for the combined effect of high urinary total arsenic levels and obesity, which was dose-dependent, in individuals with the ADIPOQ rs182052 G/A+A/A genotype was 9.33 (3.85-22.62). The present study found significant combined effects of obesity and the ADIPOQ rs182052 G/A+A/A genotype on the arsenic-related risk of RCC in a population with low arsenic exposure. Arsenic exposure, obesity, and the ADIPOQ rs182052 polymorphism could be predictors of a higher OR of RCC.

Lifestyle Risk Factors in the Development of Kidney Cancer: A Russian Experience

The objective of our study was the evaluation of major lifestyle risk factors for the development of renal cell carcinoma (RCC) and the assessment of chances of developing this disease among inhabitants in the region, in the presence of and with combinations of the studied risk factors. Risk factors for developing RCC that are associated with lifestyle (smoking, obesity and hypertension) were observed in 500 patients with RCC aged 30-64 years who were investigated at the Krasnoyarsk Oncology Dispensary (study group) and 858 participants in the Krai (control group). The results of our study showed that smoking increases the risk of developing RCC 2.9 times and arterial hypertension 3.3 times in men; in women, obesity and hypertension increased these risks 2.6 and 3.2 times, respectively. All three risk factors were combined in 13.6% of men and in 8.4% of women with RCC. Our data may be useful for the prevention, development of screening programmes and early diagnosis of RCC.

Kidney, Ureteral, and Bladder Cancer: A Primer for the Internist

Malignancies of the urinary tract (kidney, ureter, and bladder) are distinct clinical entities. Hematuria is a unifying common presenting symptom for these malignancies. Surgical management of localized disease continues to be the mainstay of treatment, and early detection is important in the prognosis of disease. Patients often require life-long follow-up and assessment for recurrence.

Vascular endothelial growth factor gene polymorphisms and the risk of renal cell carcinoma: Evidence from eight case-control studies

Background

Vascular endothelial growth factor (VEGF) protein plays important role in renal cell carcinoma (RCC) development and progression. VEGF gene polymorphisms can alter the protein concentrations and might be associated with renal cell carcinoma risk. However, the results of studies investigating the association between VEGF polymorphisms and renal cell carcinoma risk are inconsistent. Thus, a meta-analysis was performed.

Methods

We selected eligible studies via electronic searches. Only high-quality studies were included based on specific inclusion criteria and the Newcastle-Ottawa Scale (NOS).

Results

Eight studies primarily focusing on seven polymorphisms were included in our meta-analysis. Our results showed dramatically high risks for renal cell carcinoma were found regarding most genetic models and alleles of the +936C/T polymorphism (except CT vs. CC). In addition, significant increased renal cell carcinoma risks were found regarding all genetic models and alleles of the -2578C/A polymorphism. However, no significant associations were found between renal cell carcinoma risk and the +1612G/A, -460T/C, -634G/C, -405G/C or -1154G/A polymorphisms.

Conclusions

Our meta-analysis indicates that the +936C/T and -2578C/A polymorphisms of VEGF are associated with an increased risk for renal cell carcinoma. Additional rigorous analytical studies are needed to confirm our results.

Genetic polymorphisms in cyclin D1 are associated with risk of renal cell cancer in the Chinese population

Recently, the functional polymorphisms in Cyclin D1 (CCND1) have been shown the potential influence to risk of renal cell cancer (RCC). Therefore, the present study was performed to investigate whether these polymorphisms could influence the susceptibility of RCC. Four potentially functional polymorphisms in CCND1 (rs1944129, rs7177, rs9344 and rs678653) were genotyped in this hospital-based case-control study, comprising of 1,488 RCC patients and 1,677 cancer-free controls in a Chinese population by the TaqMan assay. The logistic regression was used to assess the associations between CCND1 polymorphisms and the risk of RCC. We found the genotype and allele frequency distribution of rs1944129 and rs7177 were significantly associated with risk of RCC (P = 0.015 and P = 0.018, respectively). The analysis of combined risk alleles revealed that patients with 2-4 risk alleles showed an elevated risk of RCC compared to those with 0-1 risk alleles (OR = 1.35, 95% CI = 1.15 - 1.58, P < 0.001). Furthermore, compared with the genotypes containing G allele (AG and GG), the patients carrying the AA genotype in CCND1 rs1944129 polymorphism had a significantly greater prevalence of high clinical stage disease (OR = 0.56, 95% CI = 0.33 - 0.94, P = 0.029). These results suggested that these CCND1 polymorphisms rs1944129 and rs7177 might contribute to the susceptibility of RCC in the Chinese population.

Sex-Specific Prognostic Significance of Obesity in Nonmetastatic Clear-Cell Renal-Cell Carcinoma in Korea: A Large Multicenter Cohort Analysis

INTRODUCTION

We assessed the prognostic significance of obesity in relation to sex in patients with nonmetastatic clear-cell renal-cell carcinoma (nm-cRCC) in a large multicenter setting in Korea.

PATIENTS AND METHODS

A total of 2097 patients with nm-cRCC who underwent surgery with curative intent were enrolled from 6 institutions in Korea between April 2000 and February 2014. Obesity was determined by body mass index (BMI) before surgery. BMI was used as a continuous variable and was categorized as normal (≥ 18.5 to < 25.0 kg/m2, normal BMI) and overweight or obese (≥ 25 kg/m2, high BMI). The relationships between BMI, sex, recurrence-free survival (RFS), and cancer-specific survival (CSS) were evaluated.

RESULTS

Male patients had a greater high BMI ratio than female patients (P = .030). In men, the 5-year RFS and CSS rates in the high BMI group were greater than those in the normal BMI group (P = .003 and .006, respectively). Multivariate analyses revealed that in men, a high BMI was associated with greater RFS or CSS rates (hazard ratio: RFS, 0.901, P = .001; CSS, 0.822, P < .001). In women, there were no significant differences in the 5-year RFS and CSS rates according to BMI (P = .531 and .323, respectively), and high BMI was not associated with RFS or CSS (P = .250 and .180, respectively).

CONCLUSION

In patients with nm-cRCC, obesity was a favorable prognosticator in male but not female patients. Therefore, the association between obesity and nm-cRCC prognosis might differ by sex.

Kidney Cancer Incidence in California: End of the Trend?

Background and Objective: Since the 1990s, multiple studies have reported on an increased incidence of renal cell carcinomas (RCC), which has been considered incidental to the high use of abdominal diagnostic imaging. This population-based study used data from the California Cancer Registry to (i) update trends in RCC incidence and mortality by several tumor and demographic characteristics after reports of decreased use of diagnostic imaging in recent years, and (ii) examine changes in surgical treatment for early-stage RCC.

Methods: Records of patients diagnosed with RCC from 1988 through 2013 and mortality data from the same period were examined. Joinpoint regression was used to estimate annual percent changes in age-adjusted RCC incidence and mortality rates, stratified by sex, race/ethnicity, stage at diagnosis, grade, and tumor size. Trends in the proportion of partial or total/radical nephrectomies were evaluated by Cochran-Armitage tests.

Results: A total of 77,363 incident cases of RCC and 28,590 deaths were evaluated. While mortality rates significantly decreased, the incidence of small localized RCC increased in virtually all groups examined after the mid-1990s until 2008-2009, when incidence trends stabilized in all groups concomitant with a decrease in imaging. The proportion of partial nephrectomies among patients with small localized tumors increased from 13.8% in 1988 to 74.6% in 2013.

Conclusions: Earlier trends in RCC were consistent with the incidental discovery of small tumors. In parallel with the increase in early-stage RCC, the use of partial nephrectomies increased markedly. Following the decreased use of advanced diagnostic imaging, the trend of increasing RCC incidence appears to have ended in California.

Association of Human Development Index with global bladder, kidney, prostate and testis cancer incidence and mortality

OBJECTIVES

To describe contemporary worldwide age-standardized incidence and mortality rates for bladder, kidney, prostate and testis cancer and their association with development.

MATERIALS AND METHODS

We obtained gender-specific, age-standardized incidence and mortality rates for 184 countries and 16 major world regions from the GLOBOCAN 2012 database. We compared the mortality-to-incidence ratios (MIRs) at national and regional levels in males and females, and assessed the association with socio-economic development using the 2014 United Nations Human Development Index (HDI).

RESULTS

Age-standardized incidence rates were 2.9 (bladder) to 7.4 (testis) times higher for genitourinary malignancies in more developed countries compared with less developed countries. Age-standardized mortality rates were 1.5-2.2 times higher in more vs less developed countries for prostate, bladder and kidney cancer, with no variation in mortality rates observed in testis cancer. There was a strong inverse relationship between HDI and MIR in testis (regression coefficient 1.65, R² = 0.78), prostate (regression coefficient -1.56, R² = 0.85), kidney (regression coefficient -1.34, R² = 0.74), and bladder cancer (regression coefficient -1.01, R² = 0.80).

CONCLUSION

While incidence and mortality rates for genitourinary cancers vary widely throughout the world, the MIR is highest in less developed countries for all four major genitourinary malignancies. Further research is needed to understand whether differences in comorbidities, exposures, time to diagnosis, access to healthcare, diagnostic techniques or treatment options explain the observed inequalities in genitourinary cancer outcomes.

Geriatric Nutrition Risk Index is an Important Predictor of Cancer-Specific Survival, but not Recurrence-Free Survival, in Patients Undergoing Surgical Resection for Non-Metastatic Renal Cell Carcinoma

BACKGROUND

The objective of this study was to assess the prognostic value of the Geriatric Nutrition Risk Index (GNRI), a simplified, objective screening parameter of nutrition-related risk for various pathological conditions, on patients with non-metastatic renal cell carcinoma (RCC) who underwent surgical resection.

PATIENTS AND METHODS

This study included 432 consecutive patients with non-metastatic RCC who received complete surgical resection. The prognostic outcomes of these patients were evaluated focusing on the significance of GNRI, calculated from serum albumin and the body mass index.

RESULTS

Of the 432 patients, 107 (24.8%) and 325 (75.2%) were classified into low (GNRI ≤ 98) and high (GNRI > 98) nutritional groups, respectively. Both recurrence-free survival and cancer-specific survival in the low nutritional group were significantly poorer compared with those in the high nutritional group. Despite the lack of independent significance as a predictor of recurrence-free survival, GNRI, in addition to microvascular invasion, appeared to be independently associated with cancer-specific survival on multivariate analysis.

CONCLUSION

A low nutritional status evaluated by GNRI may have an unfavorable impact on postoperative cancer control, particularly cancer-specific survival, in non-metastatic RCC patients who received surgical resection.