J Korean Med Sci.  2013 Feb;28(2):227-236. 10.3346/jkms.2013.28.2.227.

Influence of Body Mass Index, Smoking, and Blood Pressure on Survival of Patients with Surgically-Treated, Low Stage Renal Cell Carcinoma: A 14-Year Retrospective Cohort Study

• Park B
• Jeong BC
• Seo SI
• Jeon SS
• Choi HY
• Lee HM

• KMID: 1429186
• DOI: http://doi.org/10.3346/jkms.2013.28.2.227

Abstract

The association of body mass index, smoking, and blood pressure, which are related to the three well-established risk factors of renal cell carcinoma, and survival in patients with renal cell carcinoma is not much studied. Our objective was to evaluate this association. A cohort of 1,036 patients with low stage (pT1 and pT2) renal cell carcinoma who underwent radical or partial nephrectomy were enrolled. We retrospectively reviewed medical records and collected survival data. The body mass index, smoking status, and blood pressure at the time of surgery were recorded. Patients were grouped according to their obesity grade, smoking status, and hypertension stage. Survival analysis showed a significant decrease in overall (P = 0.001) and cancer-specific survival (P < 0.001) with being underweight, with no differences of smoking status or perioperative blood pressure. On multivariate analysis, perioperative blood pressure > or = 160/100 mmHg (HR, 2.642; 95% CI, 1.221-5.720) and being underweight (HR, 4.320; 95% CI, 1.557-11.984) were independent predictors of overall and cancer-specific mortality, respectively. Therefore, it is concluded that being underweight and perioperative blood pressure > or = 160/100 mmHg negatively affect cancer-specific and overall survival, respectively, while smoking status does not influence survivals in patients with renal cell carcinoma.

Keyword

Carcinoma, Renal Cell; Body Mass Index; Smoking; Blood Pressure; Survival

MeSH Terms

Adult
Aged
Aged, 80 and over
Blood Pressure
Body Mass Index
Carcinoma, Renal Cell/diagnosis/*mortality/surgery
Cohort Studies
Female
Follow-Up Studies
Humans
Kidney Neoplasms/diagnosis/*mortality/surgery
Male
Middle Aged
Multivariate Analysis
Neoplasm Staging
Nephrectomy
Retrospective Studies
Risk Factors
Smoking
Survival Rate

Figure

• 

  Fig. 1 Life table survival plots according to obesity grade (A), smoking status (B), and periperative blood pressure (C) with regard to the overall and cancer-specific survival in patients with surgically treated, low stage (pT1 and pT2) renal cell carcinoma.

Reference

1. Chow WH, Gridley G, Fraumeni JF Jr, Järvholm B. Obesity, hypertension, and the risk of kidney cancer in men. N Engl J Med. 2000. 343:1305–1311.

2. Flaherty KT, Fuchs CS, Colditz GA, Stampfer MJ, Speizer FE, Willett WC, Curhan GC. A prospective study of body mass index, hypertension, and smoking and the risk of renal cell carcinoma (United States). Cancer Causes Control. 2005. 16:1099–1106.

3. Setiawan VW, Stram DO, Nomura AM, Kolonel LN, Henderson BE. Rick factors for renal cell cancer: the multiethnic cohort. Am J Epidemiol. 2007. 166:932–940.

4. Kamat AM, Shock RP, Naya Y, Rosser CJ, Slaton JW, Pisters LL. Prognostic value of body mass index in patients undergoing nephrectomy for localized renal tumors. Urology. 2004. 63:46–50.

5. Schips L, Lipsky K, Zigeuner R, Gidaro S, Salfellner M, Rehak P, Pummer K, Hubmer G. Does overweight impact on the prognosis of patients with renal cell carcinoma? a single center experience of 683 patients. J Surg Oncol. 2004. 88:57–61.

6. Parker AS, Lohse CM, Cheville JC, Thiel DD, Leibovich BC, Blute ML. Greater body mass index is associated with better pathologic features and improved outcome among patients treated surgically for clear cell renal cell carcinoma. Urology. 2006. 68:741–746.

7. Awakura Y, Nakamura E, Ito N, Yamasaki T, Kamba T, Kamoto T, Ogawa O. Influence of body mass index on prognosis of Japanese patients with renal cell carcinoma. Urology. 2007. 70:50–54.

8. Schrader AJ, Rustemeier J, Rustemeier JC, Timmesfeld N, Varga Z, Hegele A, Olbert PJ, Hofmann R. Overweight is associated with improved cancer-specific survival in patients with organ-confined renal cell carcinoma. J Cancer Res Clin Oncol. 2009. 135:1693–1699.

9. Jeon HG, Jeong IG, Lee JH, Lee CJ, Kwak C, Kim HH, Lee SE, Lee E. Prognostic value of body mass index in Korean patients with renal cell carcinoma. J Urol. 2010. 183:448–454.

10. Waalkes S, Merseburger AS, Kramer MW, Herrmann TR, Wegener G, Rustemeier J, Hoffman R, Schrader M, Kuczyk MA, Schrader AJ. Obesity is associated with improved survival in patients with organ-confined clear cell kidney cancer. Cancer Causes Control. 2010. 21:1905–1910.

11. Rogde AJ, Gudbrandsdottir G, Hjelle KM, Sand KE, Bostad L, Beisland C. Obesity is associated with an improved cancer-specific survival, but an increased rate of postoperative complications after surgery for renal cell carcinoma. Scand J Urol Nephrol. 2012. 46:348–357.

12. Sweeney C, Farrow DC. Differential survival related to smoking among patients with renal cell carcinoma. Epidemiology. 2000. 11:344–346.

13. Oh WK, Manola J, Renshaw AA, Brodkin D, Loughlin KR, Richie JP, Shapiro CL, Kantoff PW. Smoking and alcohol use may be risk factors for poorer outcome in patients with clear cell renal carcinoma. Urology. 2000. 55:31–35.

14. Parker A, Lohse C, Cheville J, Leibovich B, Igel T, Blute M. Evaluation of the association of current cigarette smoking and outcome for patients with clear cell renal cell carcinoma. Int J Urol. 2008. 15:304–308.

15. Parker A, Freeman LB, Cantor K, Lynch C. Self-report of smoking, obesity and hypertension history and survival among a cohort of Iowa renal cell carcinoma cases. Ann Epidemiol. 2000. 10:467–468.

16. Grossman E, Messerli FH, Boyko V, Goldbourt U. Is there an association between hypertension and cancer mortality? Am J Med. 2002. 112:479–486.

17. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004. 363:157–163.

18. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003. 289:2560–2572.

19. Haferkamp A, Pritsch M, Bedke J, Wagener N, Pfitzenmaier J, Buse S, Hohenfellner M. The influence of body mass index on the long-term survival of patients with renal cell carcinoma after tumour nephrectomy. BJU Int. 2008. 101:1243–1246.

20. Morgan TM, Tang D, Stratton KL, Barocas DA, Anderson CB, Gregg JR, Chang SS, Cookson MS, Herrell SD, Smith JA Jr, et al. Preoperative nutritional status is an important predictor of survival in patients undergoing surgery for renal cell carcinoma. Eur Urol. 2011. 59:923–928.

21. Chang JS, Park YH, Ku JH, Kwak C, Kim HH. Predicting factors for death from other causes in patients with localized renal cell carcinoma. Korean J Urol. 2012. 53:18–22.

22. Yu ML, Asal NR, Geyer JR. Later recurrence and longer survival among obese patients with renal cell carcinoma. Cancer. 1991. 68:1648–1655.

23. Kim HL, Han KR, Zisman A, Figlin RA, Belldegrun AS. Cachexia-like symptoms predict a worse prognosis in localized t1 renal cell carcinoma. J Urol. 2004. 171:1810–1813.

24. Rasmuson T, Grankvist K, Jacobsen J, Olsson T, Ljungberg B. Serum insulin-like growth factor-1 is an independent predictor of prognosis in patients with renal cell carcinoma. Acta Oncol. 2004. 43:744–748.

25. Naya Y, Zenbutsu S, Araki K, Nakamura K, Kobayashi M, Kamijima S, Imamoto T, Nihei N, Suzuki H, Ichikawa T, et al. Influence of visceral obesity on oncologic outcome in patients with renal cell carcinoma. Urol Int. 2010. 85:30–36.

26. Schips L, Zigeuner R, Lipsky K, Quehenberger F, Salfellner M, Winkler S, Pummer K, Hubmer G. Do patients with a higher body mass index have a greater risk of advanced-stage renal cell carcinoma? Urology. 2003. 62:437–441.

27. Yu GP, Ostroff JS, Zhang ZF, Tang J, Schantz SP. Smoking history and cancer patient survival: a hospital cancer registry study. Cancer Detect Prev. 1997. 21:497–509.

28. Fletcher AE, Beevers DG, Bulpitt CJ, Coles EC, Dollery CT, Ledingham JG, Palmer AJ, Petrie JC, Webster J. Cancer mortality and atenolol treatment. BMJ. 1993. 306:622–623.

29. Grove JS, Nomura A, Severson RK, Stemmermann GN. The association of blood pressure with cancer incidence in a prospective study. Am J Epidemiol. 1991. 134:942–947.