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Ni J, Li Z, Song W, Zhang H, Wang Y, Zhang Y, Zhang H, Yang G, Xie J, Wang K, Peng B, Mao W. Prognostic value of glucose to lymphocyte ratio for patients with renal cell carcinoma undergoing laparoscopic nephrectomy: A multi-institutional, propensity score matching cohort study. Front Surg 2022; 9:911411. [PMID: 36248373 PMCID: PMC9556963 DOI: 10.3389/fsurg.2022.911411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background We evaluated the prognostic value of preoperative blood glucose to lymphocyte ratio (GLR) in renal cell carcinoma (RCC) patients who underwent laparoscopic nephrectomy through a multi-institutional clinical study. Methods A total of 420 patients with RCC from three medical centers from 2014 to 2019 were included in this study. The effect of GLR on overall survival (OS) and cancer-specific survival (CSS) in RCC patients was assessed by Kaplan-Meier survival curves, univariate and multivariate Cox regression analysis. Moreover, a 1:1 propensity score matching (PSM) analysis of different GLR groups was utilized to further confirm the prognostic ability of GLR. Results The optimal cut-off value for GLR was 6.8. Patients were divided into high GLR and low GLR groups according to the optimal cut-off value. GLR was significant association with diabetes, cardiovascular disease and AJCC stage. High GLR predicted adverse OS (P = 0.002) and CSS (P < 0.01) in RCC patients. Multivariate Cox regression analysis revealed that high GLR was an independent prognostic factor for OS [hazard ratio (HR): 2.389, 95% confidence interval (CI), 1.136–5.027, P = 0.008] and CSS (HR: 3.474, 95% CI, 1.555–7.761, P = 0.002). After PSM analysis of the patients in the high GLR and low GLR groups, high GLR still predicted poor OS (P = 0.021) and CSS (P = 0.037). Conclusions High GLR is associated with adverse prognosis in RCC patients, and GLR can serve as an independent prognostic marker for OS and CSS in RCC patients receiving laparoscopic nephrectomy.
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Affiliation(s)
- Jinliang Ni
- Department of Urology, Shidong Hospital of Yangpu District, Shanghai, China
- Department of Urology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, Shanghai, China
- Shanghai Clinical College, Anhui Medical University, Shanghai, China
| | - Ziye Li
- Shanghai Clinical College, Anhui Medical University, Shanghai, China
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Song
- Department of Urology, Shidong Hospital of Yangpu District, Shanghai, China
- Department of Urology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, Shanghai, China
- Shanghai Clinical College, Anhui Medical University, Shanghai, China
| | - Houliang Zhang
- Department of Urology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, Shanghai, China
| | - Yidi Wang
- Department of Urology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, Shanghai, China
| | - Yifan Zhang
- Department of Urology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, Shanghai, China
| | - Haipeng Zhang
- Department of Urology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, Shanghai, China
| | - Guangcan Yang
- Department of Urology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, Shanghai, China
| | - Jun Xie
- Department of Urology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, Shanghai, China
| | - Keyi Wang
- Department of Urology, Shidong Hospital of Yangpu District, Shanghai, China
- Department of Urology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, Shanghai, China
- Correspondence: Weipu Mao ; Bo Peng ; Keyi Wang
| | - Bo Peng
- Department of Urology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, Shanghai, China
- Shanghai Clinical College, Anhui Medical University, Shanghai, China
- Correspondence: Weipu Mao ; Bo Peng ; Keyi Wang
| | - Weipu Mao
- Department of Urology, Shidong Hospital of Yangpu District, Shanghai, China
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Correspondence: Weipu Mao ; Bo Peng ; Keyi Wang
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Rysz J, Franczyk B, Ławiński J, Olszewski R, Gluba-Brzózka A. The Role of Metabolic Factors in Renal Cancers. Int J Mol Sci 2020; 21:E7246. [PMID: 33008076 PMCID: PMC7582927 DOI: 10.3390/ijms21197246] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 12/24/2022] Open
Abstract
An increasing number of evidence indicates that metabolic factors may play an important role in the development and progression of certain types of cancers, including renal cell carcinoma (RCC). This tumour is the most common kidney cancer which accounts for approximately 3-5% of malignant tumours in adults. Numerous studies indicated that concomitant diseases, including diabetes mellitus (DM) and hypertension, as well as obesity, insulin resistance, and lipid disorders, may also influence the prognosis and cancer-specific overall survival. However, the results of studies concerning the impact of metabolic factors on RCC are controversial. It appears that obesity increases the risk of RCC development; however, it may be a favourable factor in terms of prognosis. Obesity is closely related to insulin resistance and the development of diabetes mellitus type 2 (DM2T) since the adipocytes in visceral tissue secrete substances responsible for insulin resistance, e.g., free fatty acids. Interactions between insulin and insulin-like growth factor (IGF) system appear to be of key importance in the development and progression of RCC; however, the exact role of insulin and IGFs in RCC pathophysiology remains elusive. Studies indicated that diabetes increased the risk of RCC, but it might not alter cancer-related survival. The risk associated with a lipid profile is most mysterious, as numerous studies provided conflicting results. Even though large studies unravelling pathomechanisms involved in cancer growth are required to finally establish the impact of metabolic factors on the development, progression, and prognosis of renal cancers, it seems that the monitoring of health conditions, such as diabetes, low body mass index (BMI), and lipid disorders is of high importance in clear-cell RCC.
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Affiliation(s)
- Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland; (J.R.); (B.F.)
| | - Beata Franczyk
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland; (J.R.); (B.F.)
| | - Janusz Ławiński
- Department of Urology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszow, Poland;
| | - Robert Olszewski
- Department of Gerontology, Public Health and Education, National Institute of Geriatrics Rheumatology and Rehabilitation, 02-106 Warsaw, Poland;
- Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Anna Gluba-Brzózka
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland; (J.R.); (B.F.)
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Wang S, Lo Galbo MD, Blair C, Thyagarajan B, Anderson KE, Lazovich D, Prizment A. Diabetes and kidney cancer risk among post-menopausal women: The Iowa women's health study. Maturitas 2020; 143:190-196. [PMID: 33308628 DOI: 10.1016/j.maturitas.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 06/22/2020] [Accepted: 07/28/2020] [Indexed: 01/13/2023]
Abstract
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.
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Affiliation(s)
- Shuo Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, United States
| | - Mark D Lo Galbo
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, United States; Children's Minnesota, Minneapolis, MN, United States
| | - Cindy Blair
- Department of Internal Medicine, University of New Mexico, United States; University of New Mexico Comprehensive Cancer Center, United States
| | - Bharat Thyagarajan
- Masonic Cancer Center, University of Minnesota, United States; Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, United States
| | - Kristin E Anderson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, United States; Masonic Cancer Center, University of Minnesota, United States
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, United States; Masonic Cancer Center, University of Minnesota, United States
| | - Anna Prizment
- Masonic Cancer Center, University of Minnesota, United States; Division of Hematology, Oncology and Transplantation, Medical School, University of Minnesota, United States.
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Yang H, Yin K, Wang Y, Xia M, Zhang R, Wang W, Chen J, Wang C, Shuang W. Pre-existing type 2 diabetes is an adverse prognostic factor in patients with renal cell carcinoma. J Diabetes 2019; 11:993-1001. [PMID: 31141620 PMCID: PMC7379251 DOI: 10.1111/1753-0407.12957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/13/2019] [Accepted: 05/26/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Diabetes is a risk factor for various cancers, but its prognostic role in renal cell carcinoma (RCC) is controversial and understudied. This study investigated the prognostic value of type 2 diabetes (T2D) in RCC patients. METHODS The clinicopathological and follow-up data of 451 RCC patients undergoing radical or partial nephrectomy at the First Hospital of Shanxi Medical University from 2013 to 2018 were reviewed. Associations of T2D with clinicopathological parameters of RCC were evaluated using the Kaplan-Meier method for survival estimates and Cox regression univariate and multivariate analyses. RESULTS Of 451 patients, 74 (16.4%) had T2D. These patients were older, had a higher body mass index, higher incidence rates of hypertension and cardiovascular morbidity, a higher rate of laparoscopic surgery, and smaller neoplasms (all P < .05). Patients with T2D exhibited shorter overall survival (OS; P = .009), cancer-specific survival (CSS; P = .043), and recurrence-free survival (RFS; P = .008) than patients without T2D. Fuhrman grade (hazard ratio [HR] 2.542, 95% confidence interval [CI] 1.115-5.795, P = .026) and T2D (HR 3.391, CI 1.458-7.886, P = .005) were independent predictors of OS; T2D was an independent predictor of CSS (HR = 4.637, 95% CI 1.420-15.139, P = .011) and RFS (HR 3.492, 95% CI 1.516-8.044, P = .003). CONCLUSIONS Renal cell carcinoma patients with T2D have a shorter OS and higher recurrence rate and mortality risk than those without T2D.
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Affiliation(s)
- Haosen Yang
- Department of UrologyFirst Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Keqiang Yin
- Department of UrologyFirst Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Yusheng Wang
- Department of UrologyFirst Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Mancheng Xia
- Department of UrologyFirst Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Ruiqin Zhang
- Department of UrologyFirst Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Wenzhan Wang
- Department of GynecologyFirst Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Jiawei Chen
- Department of UrologyFirst Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Chaoqi Wang
- Department of UrologyFirst Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Weibing Shuang
- Department of UrologyFirst Hospital of Shanxi Medical UniversityTaiyuanChina
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Effect of Metformin Use on Survival Outcomes in Patients With Metastatic Renal Cell Carcinoma. Clin Genitourin Cancer 2017; 15:221-229. [DOI: 10.1016/j.clgc.2016.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/17/2016] [Accepted: 06/19/2016] [Indexed: 01/05/2023]
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Li Y, Hu L, Xia Q, Yuan Y, Mi Y. The impact of metformin use on survival in kidney cancer patients with diabetes: a meta-analysis. Int Urol Nephrol 2017; 49:975-981. [PMID: 28271326 PMCID: PMC5443884 DOI: 10.1007/s11255-017-1548-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/14/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE The effects of metformin on the prognosis of kidney cancer patients with diabetes are in controversial. The present study is conducted to classify the association of metformin use with the survival of patients with kidney cancer. METHODS Electronic databases, namely PubMed and Web of Science, were used to search the eligible studies up to December, 2016. Pooled hazard ratio (HR) and its corresponding 95% confidence interval (95% CI) were calculated. It was considered as statistically significant when P value was <0.05. RESULTS Eight cohorts were eligible for the present meta-analysis, including 254,329 kidney cancer patients. The combined HR suggested that the use of metformin could improve the overall survival (OS) (HR 0.643, 95% CI 0.520-0.795, P < 0.001) and cancer-specific survival (CSS) (HR 0.618, 95% CI 0.446-0.858, P = 0.004) in kidney cancer patients. In subgroup analysis, positive associations were found between metformin use and OS/CSS of localized renal cell carcinoma patients (OS: HR 0.634, 95% CI 0.440-0.913, P = 0.014; CSS: HR 0.476, 95% CI 0.295-0.768, P = 0.002). Moreover, we also found that the use of metformin could reduce the risk of death in kidney cancer patients (HR 0.711, 95% CI 0.562-0.899, P = 0.004). CONCLUSION Our findings suggest that the use of metformin is in favor of the prognosis of patients with kidney cancers. Further investigations are needed to evaluate the prognostic value of metformin on kidney cancer patients.
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Affiliation(s)
- Yang Li
- Department of Nephrology, Yongchuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Liyi Hu
- Department of Clinical Laboratory, Yongchuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Qinghong Xia
- Department of Nephrology, Yongchuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Yongqiang Yuan
- Department of Clinical Laboratory, Yongchuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Yonghua Mi
- Department of Clinical Laboratory, Yongchuan Hospital, Chongqing Medical University, Chongqing, 402160, China.
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Nayan M, Finelli A, Jewett MAS, Juurlink DN, Austin PC, Kulkarni GS, Hamilton RJ. Diabetes and kidney cancer outcomes: a propensity score analysis. Endocrine 2017; 55:470-477. [PMID: 27815768 DOI: 10.1007/s12020-016-1149-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/17/2016] [Indexed: 01/02/2023]
Abstract
There is conflicting evidence whether diabetes is associated with survival outcomes in patients undergoing a nephrectomy for renal cell carcinoma. We performed a retrospective review of 1034 patients undergoing nephrectomy for unilateral, M0, renal cell carcinoma between 2000 and 2016 at a tertiary academic center. Inverse probability of treatment weights were derived from a propensity score model based on various clinical, surgical, and pathological characteristics. We used Cox proportional hazard models to evaluate the association between diabetes and disease-free survival, cancer-specific survival, and overall survival in the sample weighted by the inverse probability of treatment weights. Furthermore, to evaluate whether severity of diabetes was associated with survival outcomes, we performed separate analyses where inverse probability of treatment weights were computed based on the probability of having diabetes that was controlled by medication. Of the 1034 patients, 180 (17 %) had diabetes. Of these, 139 (77 %) patients required medications for diabetes control while the remaining 41 (23 %) had diet controlled diabetes. Median follow-up was 50 months (IQR 17-86). Diabetes at the time of surgery was not significantly associated with disease-free survival (HR 1.11, 95 % CI 0.64 -1.91), cancer-specific survival (HR 0.96, 95 % CI 0.49-1.91), or overall survival (HR 1.28, 95 % CI 0.84-1.95). We found similar results when we compared diabetics controlled with medication vs. non-diabetics or diet controlled diabetics. In summary, we found no significant association between diabetes and survival outcomes in patients undergoing nephrectomy for M0 renal cell carcinoma. These results suggest that diabetics should be treated and followed in a similar manner to non-diabetics.
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Affiliation(s)
- Madhur Nayan
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - David N Juurlink
- Department of Internal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Institute of Health Management, Policy and Evaluation, University of Toronto, Toronto, ON, Canada
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada.
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Labochka D, Moszczuk B, Kukwa W, Szczylik C, Czarnecka AM. Mechanisms through which diabetes mellitus influences renal cell carcinoma development and treatment: A review of the literature. Int J Mol Med 2016; 38:1887-1894. [DOI: 10.3892/ijmm.2016.2776] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/06/2016] [Indexed: 11/05/2022] Open
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Solarek W, Czarnecka AM, Escudier B, Bielecka ZF, Lian F, Szczylik C. Insulin and IGFs in renal cancer risk and progression. Endocr Relat Cancer 2015; 22:R253-64. [PMID: 26330483 DOI: 10.1530/erc-15-0135] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Insulin and IGFs play a significant role in cancer development and progression, including renal cell carcinoma (RCC). RCC is the most frequent type of kidney cancer in adults and the tenth most common malignancy worldwide. Insulin is normally associated with metabolism control, whereas IGFs are defined as proliferation regulators. Today, there is convincing evidence of an association between obesity and the risk of RCC. Indicated risk factors together with type 2 diabetes are irreversibly connected with circulating insulin and IGF levels. The interplay between these molecules, their receptors, and IGF-binding proteins might be crucial for RCC cell biology and RCC progression. Given the potent activity IGF/IGF receptor 1 (IGF1R) inhibitors demonstrate against RCC in basic research, some type of combination therapy may prove to be beneficial clinically in the management of RCC. This review addresses not only molecular but also clinical associations between insulin and IGF1 signaling pathways and both RCC biology and clinical course. Revealing these interactions may improve our understanding of basic molecular oncology processes in RCC and improve treatment strategies.
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Affiliation(s)
- W Solarek
- Laboratory of Molecular Oncology Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141 Warsaw, Poland School of Molecular Medicine Medical University of Warsaw, Warsaw, Poland Institut Gustave Roussy 114 rue Edouard Vaillant, 94805 Villejuif, France Emory University School of Medicine Atlanta, Georgia, USA Laboratory of Molecular Oncology Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141 Warsaw, Poland School of Molecular Medicine Medical University of Warsaw, Warsaw, Poland Institut Gustave Roussy 114 rue Edouard Vaillant, 94805 Villejuif, France Emory University School of Medicine Atlanta, Georgia, USA
| | - A M Czarnecka
- Laboratory of Molecular Oncology Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141 Warsaw, Poland School of Molecular Medicine Medical University of Warsaw, Warsaw, Poland Institut Gustave Roussy 114 rue Edouard Vaillant, 94805 Villejuif, France Emory University School of Medicine Atlanta, Georgia, USA
| | - B Escudier
- Laboratory of Molecular Oncology Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141 Warsaw, Poland School of Molecular Medicine Medical University of Warsaw, Warsaw, Poland Institut Gustave Roussy 114 rue Edouard Vaillant, 94805 Villejuif, France Emory University School of Medicine Atlanta, Georgia, USA
| | - Z F Bielecka
- Laboratory of Molecular Oncology Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141 Warsaw, Poland School of Molecular Medicine Medical University of Warsaw, Warsaw, Poland Institut Gustave Roussy 114 rue Edouard Vaillant, 94805 Villejuif, France Emory University School of Medicine Atlanta, Georgia, USA Laboratory of Molecular Oncology Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141 Warsaw, Poland School of Molecular Medicine Medical University of Warsaw, Warsaw, Poland Institut Gustave Roussy 114 rue Edouard Vaillant, 94805 Villejuif, France Emory University School of Medicine Atlanta, Georgia, USA
| | - F Lian
- Laboratory of Molecular Oncology Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141 Warsaw, Poland School of Molecular Medicine Medical University of Warsaw, Warsaw, Poland Institut Gustave Roussy 114 rue Edouard Vaillant, 94805 Villejuif, France Emory University School of Medicine Atlanta, Georgia, USA
| | - C Szczylik
- Laboratory of Molecular Oncology Department of Oncology, Military Institute of Medicine, Szaserow 128, 04-141 Warsaw, Poland School of Molecular Medicine Medical University of Warsaw, Warsaw, Poland Institut Gustave Roussy 114 rue Edouard Vaillant, 94805 Villejuif, France Emory University School of Medicine Atlanta, Georgia, USA
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Chen L, Li H, Gu L, Ma X, Li X, Gao Y, Zhang Y, Shen D, Fan Y, Wang B, Bao X, Zhang X. The Impact of Diabetes Mellitus on Renal Cell Carcinoma Prognosis: A Meta-Analysis of Cohort Studies. Medicine (Baltimore) 2015; 94:e1055. [PMID: 26131819 PMCID: PMC4504607 DOI: 10.1097/md.0000000000001055] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Previous studies that investigated the relationship between DM and survival in renal cell carcinoma (RCC) patients reported inconsistent findings. Hence, we conducted a meta-analysis to obtain a more precise evaluation of the prognostic significance of DM in RCC. A systematic review was conducted with PubMed, Embase, and Web of Science to identify relevant articles that evaluated the effect of DM on RCC patients. Based on the inclusion and quality assessment criteria, 18 studies were eligible for the meta-analysis. Pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) for overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were calculated by standard meta-analysis techniques. The results suggested that DM was associated with poor OS (HR 1.56, 95% CI, 1.35-1.81, P < 0.001), poor CSS (HR 2.03, 95% CI, 1.37-3.01, P < 0.001), and poor RFS (HR 1.73, 95% CI, 1.25-2.39, P = 0.012). In addition, for patients with localized RCC, patients with clear cell RCC, or patients receiving nephrectomy, DM was associated with both poor OS and CSS by subgroup analyses. Our study revealed that there was a significant negative impact of DM on OS, CSS, and RFS in RCC patients. Therefore, more attention should be paid to RCC patients with preexisting DM because of their poor prognosis.
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Affiliation(s)
- Luyao Chen
- From the State Key Laboratory of Kidney Diseases, Department of Urology, Chinese PLA Medical School, Chinese PLA General Hospital, Beijing (LC, HL, LG, XM, XL, YG, YZ, DS, YF, BW, XZ); and Medical School, Nankai University, Tianjin, People's Republic of China (XB)
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Lee H, Kwak C, Kim HH, Byun SS, Lee SE, Hong SK. Diabetes Mellitus as an Independent Predictor of Survival of Patients Surgically Treated for Renal Cell Carcinoma: A Propensity Score Matching Study. J Urol 2015; 194:1554-60. [PMID: 26066406 DOI: 10.1016/j.juro.2015.05.097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE Controversy continues about the prognostic significance of diabetes mellitus in patients with renal cell carcinoma. We investigated the relationship between diabetes mellitus and prognosis in patients with renal cell carcinoma who underwent surgical treatment. MATERIALS AND METHODS We reviewed data on 3,075 consecutive patients treated with radical or partial nephrectomy for nonmetastatic renal cell carcinoma from 1988 to 2013. The propensity score of a diabetes mellitus history was calculated and 417 patients with diabetes were matched to 814 without diabetes in a 1:2 ratio. The potential association of preexisting diabetes and preoperative HbA1c with outcomes was tested. Univariate and multivariate analyses were performed to identify independent predictors of progression-free, cancer specific and overall survival. RESULTS Before matching, patients with diabetes showed worse prognosis in terms of progression-free, overall and cancer specific survival (each p<0.001). In matched cohorts 1,231 patients with diabetes showed progression-free (p=0.001), cancer specific (p<0.001) and overall survival (p<0.001) inferior to that in patients without diabetes. On multivariate analyses diabetes was an independent predictor of disease progression (HR 1.766 p=0.002), all cause mortality (OR 1.825, p=0.001) and cancer specific mortality (HR 2.266, p=0.001). Among patients with diabetes who had available preoperative HbA1c data high HbA1c independently predicted postoperative disease progression (HR 2.221, p=0.023). CONCLUSIONS Diabetes mellitus is an independent predictor of cancer specific and overall survival in patients who undergo surgery for renal cell carcinoma. Also, in patients with diabetes mellitus poor glycemic control is associated with a higher risk of progression.
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Affiliation(s)
- Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Urology, Seoul National University Hospital (CK, HHK), Seoul, Republic of Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Urology, Seoul National University Hospital (CK, HHK), Seoul, Republic of Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Urology, Seoul National University Hospital (CK, HHK), Seoul, Republic of Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Urology, Seoul National University Hospital (CK, HHK), Seoul, Republic of Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Urology, Seoul National University Hospital (CK, HHK), Seoul, Republic of Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Urology, Seoul National University Hospital (CK, HHK), Seoul, Republic of Korea.
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13
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Vavallo A, Simone S, Lucarelli G, Rutigliano M, Galleggiante V, Grandaliano G, Gesualdo L, Campagna M, Cariello M, Ranieri E, Pertosa G, Lastilla G, Selvaggi FP, Ditonno P, Battaglia M. Pre-existing type 2 diabetes mellitus is an independent risk factor for mortality and progression in patients with renal cell carcinoma. Medicine (Baltimore) 2014; 93:e183. [PMID: 25501064 PMCID: PMC4602816 DOI: 10.1097/md.0000000000000183] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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.
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Affiliation(s)
- Antonio Vavallo
- From the Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari (AV, GL, MR, VG, MC, PS, PD, MB); Department of Medical and Surgical Sciences, Nephrology, Dialysis and Transplantation Unit, University of Foggia, Foggia (GG, ER); Department of Emergency and Organ Transplantation - Nephrology, Dialysis and Transplantation Unit (SS, MC, GP); and Department of Pathology, University of Bari, Bari, Italy (GL)
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14
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Psutka SP, Stewart SB, Boorjian SA, Lohse CM, Tollefson MK, Cheville JC, Leibovich BC, Thompson RH. Diabetes Mellitus is Independently Associated with an Increased Risk of Mortality in Patients with Clear Cell Renal Cell Carcinoma. J Urol 2014; 192:1620-7. [DOI: 10.1016/j.juro.2014.06.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 12/31/2022]
Affiliation(s)
| | | | | | - Christine M. Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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15
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The association between metformin use and oncologic outcomes among surgically treated diabetic patients with localized renal cell carcinoma. Urol Oncol 2014; 33:67.e15-23. [PMID: 25153774 DOI: 10.1016/j.urolonc.2014.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 07/17/2014] [Accepted: 07/17/2014] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Metformin inhibits renal cell carcinoma (RCC) cell proliferation both in vitro and in vivo; however, clinical data regarding the effect of metformin in patients with RCC are lacking. We evaluated the association of metformin use with outcomes among patients with surgically treated localized RCC. MATERIALS AND METHODS We identified 283 consecutive diabetic patients treated surgically for localized RCC between January 1, 1994 and December 31, 2008. Clinicopathologic features were compared between patients exposed to metformin (n = 83, 29%) and those who were not (n = 200, 71%). Progression-free, cancer-specific, and overall survival rates were estimated with the Kaplan-Meier analysis, and Cox models were used to evaluate the association of metformin use with outcomes. RESULTS AND CONCLUSIONS Patients receiving metformin had a better renal function (median estimated glomerular filtration rate = 65 vs. 55 ml/min/1.73 m(2), P<0.001), performance status (Eastern Cooperative Oncology Group<1: 89% vs. 71%, P = 0.001), and lower Charlson comorbidity index (median = 2 vs. 3, P = 0.02) compared with those who did not, but were otherwise similar across other clinicopathologic features (P>0.05 for all). At a median postoperative follow-up of 8.1 years, patients exposed to metformin had similar 5-year progression-free (80% vs. 75%, P = 0.6) and cancer-specific survival rates (91% vs. 81%, P = 0.16), but significantly improved overall survival rate (79% vs. 62%, P = 0.01). However, metformin was not independently associated with the risks of progression, RCC-specific mortality, or all-cause mortality on multivariable analyses. In this surgical cohort of diabetic patients with M0 RCC, preoperative metformin exposure was associated with improved overall survival on unadjusted analysis. Although metformin was not independently associated with oncologic or survival outcomes, future studies appear warranted.
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16
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Höfner T, Zeier M, Hatiboglu G, Eisen C, Schönberg G, Hadaschik B, Teber D, Duensing S, Trumpp A, Hohenfellner M, Pahernik S. The impact of type 2 diabetes on the outcome of localized renal cell carcinoma. World J Urol 2013; 32:1537-42. [PMID: 24370691 DOI: 10.1007/s00345-013-1231-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 12/14/2013] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To evaluate the influence of type 2 diabetes on cancer-specific outcome in patients undergoing surgery for localized renal cell carcinoma (RCC). METHODS A total of 1,140 patients with localized RCC undergoing radical or partial nephrectomy were enrolled into this retrospective case-control study. Primary outcome was the cancer-specific survival comparing patients with and without type 2 diabetes at the time of surgery. Secondary outcomes were recurrence-free survival and metastases-free survival comparing the same groups. Additionally, the influence of accompanying factors on cancer-specific survival and overall survival of patients was evaluated in a multivariate analysis. Among 1,140 patients included in the analyses, 202 had diabetes at the time of surgery and 938 patients without diabetes served as control. RESULTS The univariate comparisons between patients with and without diabetes regarding recurrence-free, metastases-free, and cancer-specific survival revealed no significant differences. Multivariate results demonstrate that age, BMI, and diabetes had no significant effect on cancer-specific hazard among participants. After adjustment of the factors in terms of overall survival, however, increased age, increased BMI, and type 2 diabetes at the time of surgery were independent risk factors for the occurrence of the event death. CONCLUSIONS Type 2 diabetes and obesity at the time of surgery have no significant impact on cancer-specific and recurrence-free survival in patients with localized renal cancer.
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Affiliation(s)
- Thomas Höfner
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany,
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