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Choi C, Kang M, Seo SI, Suh J, Song C, Chung J, Kim SH, Park JY, Hwang EC, Jeong CW, Kwak C, Kim JK, Hong SH. Retrospective Multicenter Analysis of Prognostic Risk Factors for One Year Recurrence in Patient With Renal Cell Carcinoma After Partial or Radical Nephrectomy: Results of Korean Renal Cancer Study Group (KRoCS) Database. J Korean Med Sci 2024; 39:e11. [PMID: 38258358 PMCID: PMC10803202 DOI: 10.3346/jkms.2024.39.e11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/10/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND We sought to identify prognostic risk factors for one year recurrence in patient with renal cell carcinoma (RCC) after partial or radical nephrectomy. METHODS We performed a retrospective study of 1,269 patients with RCC after partial or radical nephrectomy and diagnosed recurrence using Korean Renal Cancer Study Group (KRoCS) database between January 1991 and March 2017. Recurrence-free survival (RFS), and overall survival (OS) were calculated using the Kaplan-Meier method and multivariate Cox regression analysis were performed to evaluate independent prognostic factors for recurrence. RESULTS The median patient age was 56 years and median follow-up period was 67 months. Multivariable analysis demonstrated BMI greater than or equal to 23 and less than 30 (vs. BMI less than 23, hazard ratio [HR]: 0.707, P = 0.020) reduced recurrence one year postoperatively. Eastern Cooperative Oncology Group performance status (ECOG PS) greater than or equal to 1 (vs. ECOG PS 0, HR: 1.548, P = 0.007), high pathological T stage (pT2 vs. pT1, HR: 2.622, P < 0.001; pT3 vs. pT1, HR: 4.256, P < 0.001; pT4 vs. pT1, HR: 4.558, P < 0.001), and tumor necrosis (vs. no tumor necrosis, HR: 2.822, P < 0.001) were independent predictive factors for early recurrence within one year in patients with RCC. Statistically significant differences on RFS and OS were found among pathological T stages (pT2 vs. pT1; pT3 vs. pT1; pT4 vs. pT1, all P < 0.001). CONCLUSION This large multicenter study demonstrated ECOG PS greater than or equal to 1, high pathological T stage, tumor necrosis and BMI less than 23 were significant prognostic risk factors of early recurrence within one year in patients with RCC who underwent nephrectomy.
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Affiliation(s)
- Changil Choi
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Seoul, Korea
| | - Jungyo Suh
- Department of Urology, Asan Medical Center, Seoul, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, Seoul, Korea
| | - Jinsoo Chung
- Department of Urology, National Cancer Center, Goyang, Korea
| | - Sung Han Kim
- Department of Urology, National Cancer Center, Goyang, Korea
| | - Jae Young Park
- Department of Urology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Jung Kwon Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Hoo Hong
- Department of Urology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
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Purdue MP, Rhee J, Moore L, Gao X, Sun X, Kirk E, Bencko V, Janout V, Mates D, Zaridze D, Petruzella S, Hakimi AA, Linehan WM, Chanock SJ, Brennan P, Furberg H, Troester M, Rothman N. Differences in risk factors for molecular subtypes of clear cell renal cell carcinoma. Int J Cancer 2021; 149:1448-1454. [PMID: 34058014 PMCID: PMC8628648 DOI: 10.1002/ijc.33701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/08/2022]
Abstract
The ccA and ccB molecular subtypes of clear cell renal cell carcinoma (ccRCC) have well-characterized prognostic relevance. However, it is not known whether they possess distinct etiologies. We investigated the relationships between these subtypes and RCC risk factors within a case-control study conducted in Eastern Europe. We analyzed risk factor data for ccA (n = 144) and ccB (n = 106) cases and 1476 controls through case-only and case-control comparisons to assess risk factor differences across subtypes using logistic and polytomous regression models. We also performed a meta-analysis summarizing case-only results from our study and three patient cohorts. Patients with ccB tumors had poorer survival than those with ccA tumors and were more likely to be male (case-only odds ratio [OR] 2.68, 95% confidence interval [CI] 1.43-5.03). In case-control analyses, body mass index was significantly associated with ccA tumors (OR 2.45, 95% CI 1.18-5.10 for ≥35 vs <25 kg/m2 ) but not with ccB tumors (1.52, 0.56-4.12), while trichloroethylene was associated with ccB but not ccA (OR 3.09, 95% CI 1.11-8.65 and 1.25, 0.36-4.39 respectively for ≥1.58 ppm-years vs unexposed). A polygenic risk score of genetic variants identified from genome-wide association studies was associated with both ccA and, in particular, ccB (OR 1.82, 1.11-2.99 and 2.87, 95% CI 1.64-5.01 respectively for 90th vs 10th percentile). In a meta-analysis of case-only results including three patient cohorts, we still observed the ccB excess for male sex and the ccA excess for obesity. In conclusion, our findings suggest the existence of etiologic heterogeneity across ccRCC molecular subtypes for several risk factors.
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Affiliation(s)
- Mark P Purdue
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jongeun Rhee
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lee Moore
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Xiaohua Gao
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Xuezheng Sun
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin Kirk
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Vladimir Bencko
- First Faculty of Medicine, Institute of Hygiene and Epidemiology, Charles University, Prague, Czech Republic
| | - Vladimir Janout
- Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | - Dana Mates
- Department of Environmental Health, Institute of Public Health, Bucharest, Romania
| | - David Zaridze
- Institute of Carcinogenesis, Cancer Research Centre, Moscow, Russia
| | - Stacey Petruzella
- Departments of Surgery and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Abraham Ari Hakimi
- Departments of Surgery and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - William Marston Linehan
- Department of Health and Human Services, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul Brennan
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - Helena Furberg
- Departments of Surgery and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Melissa Troester
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Bobulescu IA, Pop LM, Mani C, Turner K, Rivera C, Khatoon S, Kairamkonda S, Hannan R, Palle K. Renal Lipid Metabolism Abnormalities in Obesity and Clear Cell Renal Cell Carcinoma. Metabolites 2021; 11:metabo11090608. [PMID: 34564424 PMCID: PMC8470169 DOI: 10.3390/metabo11090608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 02/07/2023] Open
Abstract
Clear cell renal cell carcinoma is the most common and deadly type of cancer affecting the kidney, and is characterized histologically by large intracellular lipid deposits. These deposits are thought to result from lipid metabolic reprogramming occurring in tumor cells, but the exact mechanisms and implications of these metabolic alterations are incompletely understood. Obesity is an independent risk factor for clear cell renal cell carcinoma, and is also associated with lipid accumulation in noncancerous epithelial cells of the proximal tubule, where clear cell renal cell carcinoma originates. This article explores the potential link between obesity-associated renal lipid metabolic disturbances and lipid metabolic reprogramming in clear cell renal cell carcinoma, and discusses potential implications for future research.
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Affiliation(s)
- Ion Alexandru Bobulescu
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX 79430-6540, USA; (C.M.); (K.T.); (C.R.); (S.K.); (S.K.); (K.P.)
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430-6540, USA
- Correspondence:
| | - Laurentiu M. Pop
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 79430-6540, USA; (L.M.P.); (R.H.)
| | - Chinnadurai Mani
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX 79430-6540, USA; (C.M.); (K.T.); (C.R.); (S.K.); (S.K.); (K.P.)
| | - Kala Turner
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX 79430-6540, USA; (C.M.); (K.T.); (C.R.); (S.K.); (S.K.); (K.P.)
| | - Christian Rivera
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX 79430-6540, USA; (C.M.); (K.T.); (C.R.); (S.K.); (S.K.); (K.P.)
| | - Sabiha Khatoon
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX 79430-6540, USA; (C.M.); (K.T.); (C.R.); (S.K.); (S.K.); (K.P.)
| | - Subash Kairamkonda
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX 79430-6540, USA; (C.M.); (K.T.); (C.R.); (S.K.); (S.K.); (K.P.)
| | - Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 79430-6540, USA; (L.M.P.); (R.H.)
| | - Komaraiah Palle
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX 79430-6540, USA; (C.M.); (K.T.); (C.R.); (S.K.); (S.K.); (K.P.)
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX 79430-6540, USA
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Darbas T, Forestier G, Leobon S, Pestre J, Jesus P, Lachatre D, Tubiana-Mathieu N, Descazeaud A, Deluche E. Impact of Body Composition in Overweight and Obese Patients With Localised Renal Cell Carcinoma. In Vivo 2021; 34:2873-2881. [PMID: 32871827 DOI: 10.21873/invivo.12115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND/AIM To investigate the impact of body composition on morbidity and mortality at the initial diagnosis of localised renal cell carcinoma (RCC) in patients with overweight or obesity. PATIENTS AND METHODS Sarcopenia was defined using sex-specific cut-off points and other body composition parameters by median values with computed tomography imaging. RESULTS Among the 96 patients, 40 had sarcopenia (43.0%) at diagnosis. Body composition had no effect on morbidity and 5-year disease-free survival contrary to the classic factors (p<0.05). In the subgroup of obese patients, those with sarcopenia had a poor prognosis (p=0.04) but not in the population with overweight (p=0.9). CONCLUSION Sarcopenia was frequently associated with localised RCC at the initial diagnosis. Body composition did not affect morbidity or outcomes. BMI was involved in morbidity and there was paradoxically longer survival in the obesity group.
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Affiliation(s)
- Tiffany Darbas
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Geraud Forestier
- Department of Radiology, Limoges University Hospital, Limoges, France
| | - Sophie Leobon
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Julia Pestre
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Pierre Jesus
- Nutrition Unit, Limoges University Hospital, Limoges, France
| | - Denis Lachatre
- Department of Radiology, Limoges University Hospital, Limoges, France
| | | | | | - Elise Deluche
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
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5
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Tsutsumi T, Komura K, Hashimoto T, Muraoka R, Satake N, Matsunaga T, Tsujino T, Yoshikawa Y, Takai T, Minami K, Taniguchi K, Tanaka T, Uehara H, Hirano H, Nomi H, Ibuki N, Takahara K, Inamoto T, Ohno Y, Azuma H. Distinct effect of body mass index by sex as a prognostic factor in localized renal cell carcinoma treated with nephrectomy ~ data from a multi-institutional study in Japan ~. BMC Cancer 2021; 21:201. [PMID: 33639880 PMCID: PMC7913463 DOI: 10.1186/s12885-021-07883-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 02/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background We assessed the prognostic value of body mass index (BMI) in Asian patients with localized RCC who underwent nephrectomy. Methods A total of 665 patients who underwent nephrectomy for localized RCC were enrolled in the present study and divided into the two BMI groups: i.e., BMI < 25 in 463 (69.6%) and BMI > 25 in 202 (30.4%) patients. Results In total, there were 482 (72.5%) males and 183 (27.5%) females. Five-year cancer-specific survival (CSS) rates were significantly higher in increased BMI than the lower BMI group (97.1 and 92.5%: P = 0.007). When stratified by sex, significantly longer CSS in higher BMI was confirmed in males (5-year CSS of 92.7% in BMI < 25 and 98.1% in BMI > 25, p = 0.005), while there was no difference in CSS between BMI groups for female patients. Multivariable analysis exhibited that higher BMI was an independent predictor for favorable CSS in male (cox model: p = 0.041, Fine & Gray regression model: p = 0.014), but not in the female. Subgroup analysis for CSS revealed that favorable CSS with higher BMI was observed in patient subgroups of age < 65 (p = 0.019), clear cell histology (p = 0.018), and tumor size > 4 cm, p = 0.020) as well as male (p = 0.020). Conclusion Our findings collected from the multi-institutional Japanese dataset demonstrated longer survival in patients with higher BMI than lower BMI for non-metastatic RCC treated with nephrectomy. Intriguingly, this finding was restricted to males, but not to females.
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Affiliation(s)
- Takeshi Tsutsumi
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Kazumasa Komura
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan. .,Translational Research Program, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan.
| | - Takeshi Hashimoto
- Department of Urology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Ryu Muraoka
- Department of Urology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Naoya Satake
- Department of Urology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Tomohisa Matsunaga
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Takuya Tsujino
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Yuki Yoshikawa
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Tomoaki Takai
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Koichiro Minami
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Kohei Taniguchi
- Translational Research Program, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Tomohito Tanaka
- Translational Research Program, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Hirofumi Uehara
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Hajime Hirano
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Hayahito Nomi
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Naokazu Ibuki
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita-Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, Japan
| | - Teruo Inamoto
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Yoshio Ohno
- Department of Urology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
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Recurrence after radical and partial nephrectomy in high complex renal tumor using propensity score matched analysis. Sci Rep 2021; 11:2919. [PMID: 33536492 PMCID: PMC7859240 DOI: 10.1038/s41598-021-82700-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/18/2021] [Indexed: 01/20/2023] Open
Abstract
We evaluated the recurrence after radical and partial nephrectomy in patients with RENAL nephrometry score [RENAL] ≥ 10. A total of 474 patients (radical nephrectomy [RN, n = 236] & partial nephrectomy [PN, n = 238]) in a single tertiary referral institution from December 2003 to December 2019 were assessed. Functional outcomes, defined as estimated glomerular filtration rate changes, relapse pattern, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were evaluated using propensity score-matched analysis. The predictors of recurrence and survival were assessed by Cox-regression analysis. 44 patients in the RN group and 88 in the PN group were included without significant differences in preoperative clinical factors after matching. The PN patients achieved significantly higher renal function preservation rates (p < 0.001). There were five recurrences in RN and six in PN. The PN patients revealed 5-year RFS rate (86.8%), 5-year CSS rate (98.5%), and 5-year OS rate (98.5%) comparable to the RN patients (RFS: 88.7% [p = 0.780], CSS: 96.7% [p = 0.375], and OS: 94.3% [p = 0.248]). Patients with a body mass index (BMI) ≥ 23 had lower 5-year RFS rates (85.5%) and OS rates (95.6%) than those with BMI < 23 (RFS: 90.0% [p = 0.195], OS: 100% [p = 0.117]) without significance. The significant predictor of recurrence was the pathologic T stage (hazard ratio [HR] 3.99, 95% confidence [CI] 1.10–14.50, p = 0.036). The significant predictor of death was the R domain of the RENAL (HR 3.80, 95% CI 1.03–14.11, p = 0.046). PN, if technically feasible, could be considered to preserve renal function in patients with RENAL ≥ 10. Nonetheless, PN needs to be implemented with caution in some patients due to the higher potentiality for recurrence and poor survival.
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Seon DY, Kwak C, Kim HH, Ku JH, Kim HS. 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. Ann Surg Oncol 2020; 27:2459-2467. [PMID: 32246312 DOI: 10.1245/s10434-020-08417-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Dong Young Seon
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung Suk Kim
- Department of Urology, Dongguk University Ilsan Medical Center, Dongguk University College of Medicine, Goyang-si, Gyeonggi-do, Korea.
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8
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Liu Z, Wang H, Chen Y, Jin J, Yu W. Obesity: An independent protective factor for localized renal cell carcinoma in a systemic inflammation state. Int Braz J Urol 2020; 46:585-598. [PMID: 32213207 PMCID: PMC7239303 DOI: 10.1590/s1677-5538.ibju.2019.0228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/11/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives To explore the prognostic value of obesity (measured by BMI) on RCC in a systemic inflammation state. Patients and Methods Clinicopathological and hematological data of 540 surgically treated Chinese localized RCC patients between 2005 and 2010 were retrospectively collected. Found by receiver operating characteristic (ROC) curve for cancer-specific survival (CSS), the optimal cutoff values of neutrophil-lymphocyte ratio (NLR, an indicator of systemic inflammation state) and BMI were 2.12 and 23.32, respectively. Survival curves were drawn using Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to evaluate the prognostic value of BMI in localized RCC patients with different NLR. Results Overall, 36 patients died with a median follow-up of 70 months. Median overall survival (OS) was 66 months and the 5-year OS rate was 92.7%. In the multivariate analysis of total patients, higher BMI was an independent protective factor for CSS in total patients (p=0.048). While in systemic inflammation subgroup (high NLR subgroup) patients, higher BMI (obesity) turned out to be an independent protective factor for both CSS (p=0.025) and RFS (p=0.048). Conclusion In localized RCC patients, obesity was an independent protective factor for CSS and RFS in a systemic inflammation state.
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Affiliation(s)
- Zhenhua Liu
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Haifeng Wang
- Department of Anesthesiology, Peking University First Hospital, Peking University, Beijing, China
| | - Yuke Chen
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Jie Jin
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Wei Yu
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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Abstract
The opportunity to prevent, to improve their prognosis, or even to cure uro-oncological diseases by modifying the lifestyle habits is a very modern topical subject and represents a great and fascinating challenge for the future. A PubMed and Web of Science databases search has been performed to review the published knowledge on most important lifestyle habits, such as smoking, physical activity, nutrition, sexual activity, and personal hygiene, highlighting modifiable factors influencing development and progression of urological cancers. Cigarette smoking has been historically established as risk factors for urothelial cancer, and an association with risk of renal cell carcinoma and worse prognosis of prostate cancer has been sufficiently demonstrated. Poor genital hygiene is a recognized risk factor for penile cancer. Furthermore, a convincing evidence has been found on the association between physical activity and both risk and prognosis of bladder and prostate cancer. Obesity is strongly associated with increased risk of developing lethal prostate cancer. An unequivocal evidence of a direct relationship between most of the other lifestyle habits and development of the uro-oncological diseases has not been found.
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Affiliation(s)
- Sacco Emilio
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Vaccarella Luigi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Bientinesi Riccardo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gandi Carlo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
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Wen L, Yu Y, Lv H, He Y, Yang B. FTO mRNA expression in the lower quartile is associated with bad prognosis in clear cell renal cell carcinoma based on TCGA data mining. Ann Diagn Pathol 2018; 38:1-5. [PMID: 30380400 DOI: 10.1016/j.anndiagpath.2018.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/04/2018] [Accepted: 10/23/2018] [Indexed: 01/31/2023]
Abstract
Fat mass and obesity associated (FTO) is a protein-coding gene, also known as the obesity gene. It has been reported previously to be associated with a variety of malignant cancers, such as breast, thyroid and acute myeloid leukemia. The aim of the present study was to investigate the FTO mRNA expression in human clear cell renal cell carcinoma and its clinical value. FTO mRNA expression and its prognostic value were investigated by bioinformatic analysis of the data from The Cancer Genome Atlas (TCGA, https://cancergenome.nih.gov/). The Kaplan-Meier analysis showed that FTO mRNA expression in the lower quartile is significantly associated with poor survival in clear cell renal cell carcinoma patients (P < 0.0001). This study indicated that higher FTO mRNA expression may have a protective role and it may be a vital molecular marker in the prognosis of clear cell renal cell carcinoma patients.
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Affiliation(s)
- Lijie Wen
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yang Yu
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Hang Lv
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yi He
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Bo Yang
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China.
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Trestini I, Carbognin L, Monteverdi S, Zanelli S, De Toma A, Bonaiuto C, Nortilli R, Fiorio E, Pilotto S, Di Maio M, Gasbarrini A, Scambia G, Tortora G, Bria E. Clinical implication of changes in body composition and weight in patients with early-stage and metastatic breast cancer. Crit Rev Oncol Hematol 2018; 129:54-66. [DOI: 10.1016/j.critrevonc.2018.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 05/28/2018] [Accepted: 06/15/2018] [Indexed: 02/08/2023] Open
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Allegra A, Innao V, Gerace D, Allegra AG, Vaddinelli D, Bianco O, Musolino C. The adipose organ and multiple myeloma: Impact of adipokines on tumor growth and potential sites for therapeutic intervention. Eur J Intern Med 2018; 53:12-20. [PMID: 29859797 DOI: 10.1016/j.ejim.2018.05.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 02/06/2023]
Abstract
In addition to its capacity to store lipids the adipose tissue is now identified as a real organ with both endocrine and metabolic roles. Preclinical results indicate that modifying adipose tissue and bone marrow adipose tissue (BMAT) could be a successful multiple myeloma (MM) therapy. BMAT interrelates with bone marrow cells and other immune cells, and may influence MM disease progression. The BM adipocytes may have a role in MM progression, bone homing, chemoresistance, and relapse, due to local endocrine, paracrine, or metabolic factors. BM adipocytes isolated from MM subjects have been shown to increase myeloma growth in vitro and may preserve cells from chemotherapy-induced apoptosis. By producing free fatty acids and emitting signaling molecules such as growth factors and adipokines, BM adipocytes are both an energy font and an endocrine signaling factory. This review should suggest future research approaches toward developing novel treatments to target MM by targeting BMAT and its products.
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Affiliation(s)
- Alessandro Allegra
- Division of Hematology, Department of Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Via Consolare Valeria, 90100 Messina, Italy.
| | - Vanessa Innao
- Division of Hematology, Department of Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Via Consolare Valeria, 90100 Messina, Italy
| | - Demetrio Gerace
- Division of Hematology, Department of Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Via Consolare Valeria, 90100 Messina, Italy
| | - Andrea Gaetano Allegra
- Division of Hematology, Department of Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Via Consolare Valeria, 90100 Messina, Italy
| | - Doriana Vaddinelli
- Division of Hematology, Department of Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Via Consolare Valeria, 90100 Messina, Italy
| | - Oriana Bianco
- Division of Hematology, Department of Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Via Consolare Valeria, 90100 Messina, Italy
| | - Caterina Musolino
- Division of Hematology, Department of Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Via Consolare Valeria, 90100 Messina, Italy
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Trestini I, Carbognin L, Bonaiuto C, Tortora G, Bria E. The obesity paradox in cancer: clinical insights and perspectives. Eat Weight Disord 2018; 23:185-193. [PMID: 29492860 DOI: 10.1007/s40519-018-0489-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/12/2018] [Indexed: 01/06/2023] Open
Abstract
A series of evidence demonstrated that obesity represents an established risk factor for an increase in the incidence of multiple cancer types and for poor cancer survival. Nevertheless, recent studies suggested that, in a series of cancers, patients with a normal body mass index (BMI) have worse outcomes than obese patients. This phenomenon, named 'obesity paradox' or 'reverse epidemiology' in cancer, is not well understood and presents controversial aspects. Therefore, this review aims to explore the available studies concerning the relationship between obesity and cancer incidence or survival and to highlight the hypothetical explanations and the methodological framework. In this regard, we underline the limits of BMI as a potential marker of adiposity and the relevance to assessing body composition, beyond the body size. Further studies are needed to define the impact of obesity in cancer patients, to tailor weight management after cancer diagnosis and to hopefully improve overall clinical outcome.
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Affiliation(s)
- Ilaria Trestini
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, P.le L.A. Scuro 10, 37124, Verona, Italy
| | - Luisa Carbognin
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, P.le L.A. Scuro 10, 37124, Verona, Italy
| | - Clelia Bonaiuto
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, P.le L.A. Scuro 10, 37124, Verona, Italy
| | - Giampaolo Tortora
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, P.le L.A. Scuro 10, 37124, Verona, Italy
| | - Emilio Bria
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, P.le L.A. Scuro 10, 37124, Verona, Italy.
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Kriegmair MC, Mandel P, Porubsky S, Dürr J, Huck N, Nuhn P, Pfalzgraf D, Michel MS, Wagener N. Metabolic Syndrome Negatively Impacts the Outcome of Localized Renal Cell Carcinoma. Discov Oncol 2017; 8:127-134. [PMID: 28247362 DOI: 10.1007/s12672-017-0289-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/20/2017] [Indexed: 01/26/2023] Open
Abstract
The aim of this study was to analyze the impact of metabolic syndrome (MetS) on outcome of patients with localized renal cell carcinoma (RCC). A retrospective database was compiled consisting of 646 patients who underwent surgery for localized RCC between 2005 and 2014. A total of 439 patients were eligible for final analysis. For diagnosis of MetS, the WHO criteria of 1998 were used. Median follow-up was 32 months (ranging from 2 to 119). Kaplan-Meier and log-rank analyses were performed to compare patients with and without MetS or its components. Univariate and multivariate logistic regression identified prognostic factors for progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). In our cohort, 9.8% (n = 43) of patients were diagnosed with MetS. There were no differences between patients with and without MetS regarding clinicopathological parameters with the exception of patients' age (p = 0.002). Kaplan-Meier and log-rank analyses revealed a shorter PFS for patients with MetS (p = 0.018), whereas no differences were found for each of the single components of MetS, namely, diabetes mellitus (DM) (p = 0.332), BMI >30 kg/m2 (p = 0.753), hypertension (p = 0.451), and hypertriglyceridemia (p = 0.891). Logistic regression identified age (HR = 1.92, p = 0.03), tumor stage (HR = 4.37, p < 0.001), grading (HR = 4.57, p < 0.001), nodal status (HR = 3.73, p = 0.04), surgical margin (HR = 1.96, p = 0.04), concomitant sarcomatoid differentiation (HR = 5.06, p < 0.001), and MetS (HR = 1.98, p = 0.04) as independent factors for PFS. For CSS, only age (HR = 2.62, p = 0.035), tumor stage (HR = 3.06, p < 0.02), and grading (HR = 6.83, p < 0.001) were significant. In conclusion, patients with localized RCC and MetS show significantly reduced PFS and might profit from specific consultation and follow-up.
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Affiliation(s)
- Maximilian Christian Kriegmair
- Department of Urology, Mannheim Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Philipp Mandel
- Department of Urology, UKE Medical Center, University of Hamburg, Hamburg, Germany
| | - Stefan Porubsky
- Department of Pathology, Mannheim Medical Center, University of Heidelberg, Heidelberg, Germany
| | - Julia Dürr
- Department of Urology, Mannheim Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Nina Huck
- Department of Urology, Mannheim Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology, Mannheim Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Daniel Pfalzgraf
- Department of Urology, Mannheim Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology, Mannheim Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Nina Wagener
- Department of Urology, Mannheim Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Ito R, Narita S, Huang M, Nara T, Numakura K, Takayama K, Tsuruta H, Maeno A, Saito M, Inoue T, Tsuchiya N, Satoh S, Habuchi T. The impact of obesity and adiponectin signaling in patients with renal cell carcinoma: A potential mechanism for the "obesity paradox". PLoS One 2017; 12:e0171615. [PMID: 28178338 PMCID: PMC5298294 DOI: 10.1371/journal.pone.0171615] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/23/2017] [Indexed: 11/18/2022] Open
Abstract
Although obesity increases the risk of renal cell carcinoma (RCC), obese patients with RCC experience longer survival than non-obese patients. However, the mechanism of this "obesity paradox" is unknown. We examined the impact of preoperative BMI, serum total adiponectin (sAd) level, total adiponectin secretion from perinephric adipose tissue, and intratumoral expression of adiponectin receptors on RCC aggressiveness and survival. We also investigated the mechanism underlying enhanced cancer aggressiveness in RCC cells stimulated with exogenous adiponectin. Overweight and obese patients had significantly lower grade cancers than normal patients in all patients and in those without metastasis (p = 0.003 and p = 0.027, respectively). Cancer-specific survival was significantly longer in overweight and obese patients than in normal patients in all patients (p = 0.035). There was a weak inverse correlation between sAd level and BMI in RCC patients (r = -0.344, p = 0.002). Tumor size was slightly correlated with sAd level, and high sAd was significantly associated with poor overall survival rates in patients with non-metastatic RCC (p = 0.035). Adiponectin levels in perinephric adipose tissue and intratumoral AdipoR1/R2 expression were not correlated with RCC aggressiveness or survival. Proliferation significantly increased in 786-O and Caki-2 cells exposed to exogenous adiponectin, whereas cell invasion and migration were unaffected. In addition, exogenous adiponectin significantly inhibited starvation- and metformin-induced apoptosis, and up-regulated p-AMPK and Bcl-xL levels. In summary, low BMI and high adiponectin levels are associated with aggressive cell behaviors and poor survival in surgically-treated RCC patients. The effects of adiponectin on proliferation and apoptosis might underlie the "obesity paradox" of RCC.
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Affiliation(s)
- Ryuichi Ito
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
- AMED-CREST, Japan Agency for Medical Research and Development
- * E-mail:
| | - Mingguo Huang
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
- AMED-CREST, Japan Agency for Medical Research and Development
| | - Taketoshi Nara
- Department of Urology, Yamagata University Graduate School of Medicine, Yamagata, Japan
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Koichiro Takayama
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Tsuruta
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Atsushi Maeno
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Mitsuru Saito
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Takamitsu Inoue
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
- AMED-CREST, Japan Agency for Medical Research and Development
| | - Norihiko Tsuchiya
- Department of Urology, Yamagata University Graduate School of Medicine, Yamagata, Japan
| | - Shigeru Satoh
- Center for Kidney Disease and Transplantation, Akita University Hospital, Akita, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
- AMED-CREST, Japan Agency for Medical Research and Development
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Abstract
Purpose Evidence on overweight, obesity, and an increased risk of cancer continues to accumulate and was updated in the 2016 handbook on weight control from the International Agency for Research on Cancer (IARC). The underlying primary data, together with dose-response meta-analysis and, finally, pooled analysis of individual participant data, add insight into the relation between obesity and cancer risk and prognosis. We summarize the evidence for mortality from prostate cancer, hematologic malignancies, and kidney cancer. Methods We reviewed pooled analysis of rare end points across cohorts, regardless of primary results reported from the individual studies, further reducing risk of publication bias. Of these cancer sites, only kidney cancer was included in the IARC 2002 report, although mortality from prostate cancer and hematologic malignancies was noted in the American Cancer Society prospective cohort study in 2003. The 2016 update from the IARC added details for prostate and hematologic malignancies, classifying the evidence as sufficient to conclude that avoiding excess body fatness lowers the risk of multiple myeloma but found that the evidence for it lowering the risk of prostate cancer mortality or diffuse large B-cell lymphoma was limited. Results A higher body mass index is associated with an increased risk of advanced prostate cancer and prostate cancer mortality and is associated with worse survival in most subtypes of hematologic malignancies, in a dose-response fashion. Evidence for kidney cancer is built mostly on retrospective data, which supports an obesity paradox in patients with the clear cell variant; however, population-based cohort data indicate that a higher cohort-entry body mass index is associated with worse kidney cancer–specific survival. Conclusion Together, these data add support to the evidence for a growing cancer burden caused by adiposity in both early adult and later adult life, yet leave open the question of the means of weight management after diagnosis as a strategy to improve survival.
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Affiliation(s)
- Lin Yang
- Lin Yang, Bettina F. Drake, and Graham A. Colditz, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO; and Lin Yang, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Bettina F. Drake
- Lin Yang, Bettina F. Drake, and Graham A. Colditz, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO; and Lin Yang, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Graham A. Colditz
- Lin Yang, Bettina F. Drake, and Graham A. Colditz, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO; and Lin Yang, Center for Public Health, Medical University of Vienna, Vienna, Austria
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