Impact of diabetes mellitus on functional and survival outcomes in renal cell carcinoma: An international multicenter study.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 666-666
Author(s):  
Raksha Dutt ◽  
Margaret Frances Meagher ◽  
Dattatraya Patil ◽  
Kazutaka Saito ◽  
Devin Patel ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Risk Factor ◽  
Cell Carcinoma ◽  
Kidney Function ◽  
Tumor Size ◽  
Renal Cell ◽  
Independent Risk Factor ◽  
De Novo ◽  
Functional Decline ◽  
Increased Risk

666 Background: Functional decline is an important consideration in the surgical treatment of renal cell carcinoma (RCC). While radical nephrectomy (RN) may be associated with increased risk of functional decline compared to partial nephrectomy (PN), the modifying effect of DM, an independent risk factor of chronic kidney disease (CKD), is not completely understood. We investigated the relationship between DM and decline in kidney function following surgery for RCC, and impact on overall survival (OS) in patients with RCC. Methods: A multicenter dataset of RCC patients undergoing PN and RN was utilized. The cohort was divided based on DM status [DM vs No DM (NDM)]. Multivariable analysis (MVA) elucidated potential variables associated with decline in kidney function [de novo estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73m2 and de novo eGFR < 30 ml/min/1.73m2] and worse all-cause mortality (ACM). Kaplan-Meier analysis (KMA) was used to investigate OS rates in DM and NDM patients undergoing RN and PN. Results: 2928 patients were analyzed (DM = 406, NDM = 2522). On MVA, independent risk factors associated with eGFR < 45 included age (OR = 1.07, p < 0.001), DM (OR = 1.88, p < 0.001), tumor size (OR = 1.03, p = 0.032), and RN (OR = 1.54, p < 0.001). Variables associated with eGFR < 30 included age (OR = 1.05, p < 0.001), African American race (OR = 2.18, p < 0.001), and DM (OR = 2.09, p < 0.001). MVA for ACM revealed age (OR = 1.02, p = 0.002), HTN (OR = 2.47, p < 0.001), tumor size (OR = 1.12, p < 0.001), tumor grade (OR = 1.87, p < 0.001), RN (OR = 1.55, p = 0.011), eGFR < 45 (OR = 1.40, p = 0.03), and eGFR < 30 (OR = 1.87, p = 0.026) to be independently associated. On KMA, 5-year OS stratified by DM status showed that DM is associated with worse OS for RN patients (p = 0.047), but not for PN patients (p = 0.944). Conclusions: Presence of DM is an independent risk factor for renal functional decline and development of worsening CKD is a risk factor for worsening ACM. Furthermore, decreased survival in DM patients was associated with RN recipients but not with PN recipients. Presence of DM may be considered a strong indicator for nephron preservation management strategies when safe and feasible in RCC patients.

scholarly journals Association of Tumor Size with Risk of Lymph Node Metastasis in Clear Cell Renal Cell Carcinoma: A Population-Based Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Yunlai Zhi ◽  
Xiao Li ◽  
Feng Qi ◽  
Xin Hu ◽  
Wenbo Xu
Keyword(s):  
Renal Cell Carcinoma ◽  
Lymph Node ◽  
Cell Carcinoma ◽  
Tumor Size ◽  
Renal Cell ◽  
Clear Cell ◽  
Personal Characteristics ◽  
Survival Outcomes ◽  
Cell Renal Cell Carcinoma ◽  
Increased Risk

The purpose of this article was to explore the association of tumor size with lymph node metastases (LNM) risk in patients with clear cell renal cell carcinoma (ccRCC). Based on the Surveillance, Epidemiology, and End Result (SEER) database, patients diagnosed with ccRCC from 1988 to 2015 were included in this study. For each patient, personal characteristics, clinicopathological data, and survival outcomes were, respectively, collected. Subsequently, the odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to investigate the potential risk factors for LNM in ccRCC. Finally, Kaplan-Meier (KM) survival plots of overall survival (OS) and ccRCC-specific survival (CSS) were evaluated on the basis of different tumor sizes. A total of 8,292 patients were finally enrolled in the study, 1,170 of whom (14.11%) had LNM. According to the heatmap, we could intuitively interpret that larger tumor size was related to an increased risk of LNM obviously. The risk of LNM was evidently greater for larger tumor size (4-7 cm: OR = 2.415, 95% CI = 1.708–3.415; 7–10 cm: OR = 3.746, 95% CI = 2.677–5.242; and >10 cm: OR = 4.617, 95% CI = 3.302–6.457) compared with smaller tumor size (≤4 cm). According to the KM survival plots of OS and CSS, we observed a gradual decline in survival with increasing tumor size, while the smallest tumor size had the best survival outcomes. These results indicated the positive relationship of tumor size with risk of LNM in ccRCC. And we also noticed continual decrease survival rates of OS and CSS with increasing tumor size.

scholarly journals Prognostic inflammatory markers in metastatic renal cell carcinoma: Neutrophil-to-lymphocyte ratio and prognostic nutritional index

2020 ◽  
Vol 7 (4) ◽  
pp. 459-465
Author(s):  
Mahmut Büyükşimsek ◽  
Ali Oğul
Keyword(s):  
Renal Cell Carcinoma ◽  
Risk Factor ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Independent Risk Factor ◽  
Prognostic Nutritional Index ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Nutritional Index

Objective: According to metastatic renal cell carcinoma treatment protocol, after the use of tyrosine kinase inhibitors (TKI) has been achieved significant improvements for the treatment of metastatic renal cell carcinoma (mRCC). In this study, we aimed to investigate the effect of neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI) on survival in patients with mRCC treated with sunitinib or pazopanib. Material and Methods: Medical data for 38 patients with mRCC were reviewed retrospectively. NLR and PNI values were dichotomized based on receiver operating characteristic (ROC) curve analysis (cut-off values: 3 and 46, respectively). Univariate and multivariate analyses were performed to identify prognostic factors for progression free survival (PFS) and overall survival (OS) using a Cox proportional hazards model. Results: Median PFS and OS were 12 and 27 months, respectively. Median PFS was 10 months in patients with NLR ≥3 while 14 months in patients with NLR <3 (p: 0.008). Median OS was 18 months in patients with NLR ≥3 while 31 months in patients with NLR <3 (p: 0.003). In patients with PNI ≥ 46, PFS was 21 months and OS was 47 months whereas in patients with PNI < 46, PFS was 8 months and OS was 13 months (p values were <0.001, <0.001 respectively). In multivariate analysis, PNI was the independent risk factor for both PFS and OS, while NLR was the independent risk factor for OS only. Conclusion: In patients with mRCC that using sunitinib or pazopanib, NLR and PNI values can be used as easily accessible prognostic markers.

scholarly journals Identification And Validation Of A Hypoxia ‑ Related Prognostic Signature In Clear Cell Renal Cell Carcinoma Patients

2020 ◽  
Author(s):  
Zhengtian Li ◽  
Lingling Jiang ◽  
Rong Zhao ◽  
Wenkang Yang ◽  
Chan Li ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Risk Factor ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Independent Risk Factor ◽  
Clear Cell ◽  
External Validation ◽  
Cell Renal Cell Carcinoma ◽  
Cox Regression Analysis ◽  
Genetic Signatures

Abstract Background: Increasing evidence has shown that hypoxia is closely related to the development, progression and prognosis of clear cell renal cell carcinoma (ccRCC). Nevertheless, reliable prognostic signatures based on hypoxia have not been well-established. This study aimed to construct an optimized prognosis nomogram based on hypoxia-related genetic signatures for patients with ccRCC.Method: We accessed hallmark gene sets of hypoxia, including 200 genes, and an original RNA seq dataset of ccRCC cases with integrated clinical information obtained by mining the Molecular Signatures Database, the TCGA database and the ICGC database. Univariate Cox regression analysis and multivariate Cox proportional hazards regression were performed to identify prognostic hypoxia-related genetic signatures and further generate RiskScore, a new independent prognosis predictor for optimizing prognosis models. External validation of the optimized prognosis model was performed in independent cohorts from the ICGC database.Result: ANKZF1, ETS1, PLAUR, SERPINE1, FBP1 and PFKP were selected as hypoxia-related genetic signatures, and the resultant formula based on those genetic signatures and their respective coefficients helped generate RiskScore. The results of receiver operating characteristic (ROC) curve, risk plot, survival analysis and so on suggested that RiskScore based on hypoxia-related genetic signatures was an independent risk factor. A novel prognosis nomogram optimized via RiskScore showed its promising performance in both a TCGA-ccRCC cohort and an ICGC-ccRCC cohort.Conclusions: Our study reveals that the differential expressions of hypoxia-related genes are associated with the overall survival of patients with ccRCC. RiskScore based on hypoxia-related genetic signatures was an independent risk factor beyond TNM staging and grading. The novel nomogram optimized via RiskScore exhibited a promising prognostic ability. It may be able to serve as a prognostic tool for guiding clinical decisions and selecting effective individualized treatments.

Abstract 2953: Genomic DNA hypomethylation as an independent risk factor for renal cell carcinoma

2015 ◽  
Author(s):  
Julia Mendoza Perez ◽  
Jian Gu ◽  
Nizar M. Tannir ◽  
Surena Matin ◽  
Jose A. Karam ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Risk Factor ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Genomic Dna ◽  
Independent Risk Factor ◽  
Dna Hypomethylation

Impact of tumor size on survival outcome in metastatic renal cell carcinoma patients (mRCC) treated with targeted therapy.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 667-667
Author(s):  
Wanling Xie ◽  
Renzo DiNatale ◽  
A. Ari Hakimi ◽  
Frede Donskov ◽  
Camillo Porta ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Targeted Therapy ◽  
Cell Carcinoma ◽  
Tumor Size ◽  
Primary Tumor ◽  
Renal Cell ◽  
De Novo ◽  
Survival Outcome ◽  
First Line ◽  
Primary Tumor Size

667 Background: Recent research suggested that patients (pts) with small renal masses (4cm or less) were at low risk of disease recurrence after surgery. The impact of tumor size on survival in mRCC patients treated with targeted therapy (TKI) is unclear. Methods: Two cohorts were identified from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC). Cohort 1 pts had initial nephrectomy for M0 RCC and subsequently developed metastasis during follow-up. Cohort 2 pts presented with de novo metastasis with or without cytoreductive nephrectomy. Cox regression was performed to assess the associations of primary tumor size (≤4 vs > 4cm) and overall survival (OS) on first line TKI, adjusted for histology, sarcomatoid features, tumor stage, number of metastasis, IMDC risk groups and age at TKI initiation. Results: 4089 pts with mRCC treated with first line TKI had primary tumor size data available. Patient characteristics were generally balanced between tumor size groups (≤4 vs > 4cm), except pts with ≤4cm tumors were more likely to have single metastasis (29% vs 18%, p = 0.001) and less likely to have IMDC poor risk (32% vs 39%, p = 0.04) in pts from cohort 2. For pts from cohort 1, tumor size at initial nephrectomy did not impact OS after TKI initiation (p = 0.689). However, in pts presenting with de novo metastasis (cohort 2), small primary tumors were associated with improved OS after TKI initiation, but only in T1-2 tumors (Table). Conclusions: Tumor size impacts survival outcome with targeted therapy in mRCC patients presenting with de novo metastasis and T1-2 disease. This may need to be taken in consideration in clinical trial designs. [Table: see text]

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

Medicine ◽  
2014 ◽  
Vol 93 (27) ◽  
pp. e183 ◽  
Author(s):  
Antonio Vavallo ◽  
Simona Simone ◽  
Giuseppe Lucarelli ◽  
Monica Rutigliano ◽  
Vanessa Galleggiante ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Renal Cell Carcinoma ◽  
Type 2 Diabetes Mellitus ◽  
Risk Factor ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Independent Risk Factor

scholarly journals Serum Concentrations of Per- and Polyfluoroalkyl Substances and Risk of Renal Cell Carcinoma

2020 ◽  
Author(s):  
Joseph J Shearer ◽  
Catherine L Callahan ◽  
Antonia M Calafat ◽  
Wen-Yi Huang ◽  
Rena R Jones ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Kidney Function ◽  
Renal Cell ◽  
Statistical Tests ◽  
Conditional Logistic Regression ◽  
Weight Of Evidence ◽  
Serum Concentrations ◽  
Increased Risk ◽  
Polyfluoroalkyl Substances

Abstract Background Per- and polyfluoroalkyl substances (PFAS) are highly persistent chemicals that have been detected in the serum of over 98% of the US population. Studies among highly exposed individuals suggest an association with perfluorooctanoic acid (PFOA) exposure and kidney cancer. It remains unclear whether PFOA or other PFAS are renal carcinogens or if they influence risk of renal cell carcinoma (RCC) at concentrations observed in the general population. Methods We measured prediagnostic serum concentrations of PFOA and 7 additional PFAS in 324 RCC cases and 324 individually matched controls within the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Multivariable conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs) relating serum PFAS concentrations and RCC risk. Individual PFAS were modeled continuously (log2-transformed) and categorically, with adjustment for kidney function and additional potential confounders. All statistical tests were 2-sided. Results We observed a positive association with RCC risk for PFOA (doubling in serum concentration, ORcontinuous = 1.71, 95% CI = 1.23 to 2.37, P = .002) and a greater than twofold increased risk among those in the highest quartile vs the lowest (OR = 2.63, 95% CI = 1.33 to 5.20, Ptrend = .007). The association with PFOA was similar after adjustment for other PFAS (ORcontinuous = 1.68, 95% CI = 1.07 to 2.63, P = .02) and remained apparent in analyses restricted to individuals without evidence of diminished kidney function and in cases diagnosed 8 or more years after phlebotomy. Conclusions Our findings add substantially to the weight of evidence that PFOA is a renal carcinogen and may have important public health implications for the many individuals exposed to this ubiquitous and highly persistent chemical.

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