Korean J Urol.  2013 Aug;54(8):499-503. 10.4111/kju.2013.54.8.499.

Effect of Type 2 Diabetes Mellitus on Prognosis of Nonmetastatic Renal Cell Cancer

• Suer E
• Ozturk E
• Gulpinar O
• Kayis A
• Baltaci S

• KMID: 1840460
• DOI: http://doi.org/10.4111/kju.2013.54.8.499

Abstract

PURPOSE
We evaluated the prognostic value of type 2 diabetes mellitus (DM) in patients treated surgically for localized renal cell carcinoma (RCC).
MATERIALS AND METHODS
Between 1995 and 2011, 588 patients with renal tumor diagnoses were treated surgically and 492 patients with pathologically confirmed nonmetastatic RCC diagnoses were included in the study. The associations of clinical and pathologic parameters with a type 2 DM diagnosis were evaluated. Kaplan-Meier estimations for disease-specific survival (DSS) and overall survival (OS) were generated according to type 2 DM diagnosis, and the log-rank test was used to compare survival according to the variables.
RESULTS
The mean age of the patients was 56.7+/-12 years (range, 15 to 84 years; median, 58 years) and the mean length of follow-up was 35.9+/-28 months (range, 1 to 145 months; median, 34.3 months). Of the 492 patients, 62 (12.6%) had a diagnosis of DM at the time of surgery (group I) and 430 did not have DM (group II). The mean age and the incidence of clear cell RCC histological subtype were significantly higher in group I than in group II (p<0.001 and p=0.036, respectively). Although DSS and OS were lower in group I, this difference was not significant. Type 2 DM was not detected as an independent prognostic factor for DSS and OS.
CONCLUSIONS
This study investigated the role and effect of DM on the prognosis of localized RCC that was treated surgically. The present study did not detect DM as an independent prognostic factor for RCC.

Keyword

Prognosis; Renal cell carcinoma; Type 2 diabetes mellitus

MeSH Terms

Carcinoma, Renal Cell
Diabetes Mellitus, Type 2
Follow-Up Studies
Humans
Incidence
Prognosis
Carcinoma, Renal Cell

Figure

• 

  FIG. 1 Kaplan-Meier curve of the two groups for disease-specific survival. DM, diabetes mellitus.

• 

  FIG. 2 Kaplan-Meier curve of the two groups for overall survival. DM, diabetes mellitus.

Reference

1. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007. 57:43–66.

2. European Network of Cancer Registries. Eurocim version 4.0. European incidence database V2.3, 730 entity dictionary (2001). 2001. Lyon: European Network of Cancer Registries.

3. Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006. 98:1331–1334.

4. Lindblad P. Epidemiology of renal cell carcinoma. Scand J Surg. 2004. 93:88–96.

5. Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol. 2010. 58:398–406.

6. Hajjar I, Kotchen JM, Kotchen TA. Hypertension: trends in prevalence, incidence, and control. Annu Rev Public Health. 2006. 27:465–490.

7. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006. 295:1549–1555.

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

9. 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.

10. Fraser GE, Phillips RL, Beeson WL. Hypertension, antihypertensive medication and risk of renal carcinoma in California Seventh-Day Adventists. Int J Epidemiol. 1990. 19:832–838.

11. Bjorge T, Tretli S, Engeland A. Relation of height and body mass index to renal cell carcinoma in two million Norwegian men and women. Am J Epidemiol. 2004. 160:1168–1176.

12. Nicolucci A. Epidemiological aspects of neoplasms in diabetes. Acta Diabetol. 2010. 47:87–95.

13. Tsugane S, Inoue M. Insulin resistance and cancer: epidemiological evidence. Cancer Sci. 2010. 101:1073–1079.

14. Joh HK, Willett WC, Cho E. Type 2 diabetes and the risk of renal cell cancer in women. Diabetes Care. 2011. 34:1552–1556.

15. Zucchetto A, Dal Maso L, Tavani A, Montella M, Ramazzotti V, Talamini R, et al. History of treated hypertension and diabetes mellitus and risk of renal cell cancer. Ann Oncol. 2007. 18:596–600.

16. Lindblad P, Chow WH, Chan J, Bergstrom A, Wolk A, Gridley G, et al. The role of diabetes mellitus in the aetiology of renal cell cancer. Diabetologia. 1999. 42:107–112.

17. American Diabetes Association. Standards of medical care in diabetes: 2012. Diabetes Care. 2012. 35:Suppl 1. S11–S63.

18. Centers for Disease Control and Prevention. National Diabetes Surveillance System: prevalence of diabetes [Internet]. cited 2010 Apr 17. Atlanta: Centers for Disease Control and Prevention;Available from: http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm.

19. Friberg E, Orsini N, Mantzoros CS, Wolk A. Diabetes mellitus and risk of endometrial cancer: a meta-analysis. Diabetologia. 2007. 50:1365–1374.

20. Huxley R, Ansary-Moghaddam A, Berrington de Gonzalez A, Barzi F, Woodward M. Type-II diabetes and pancreatic cancer: a meta-analysis of 36 studies. Br J Cancer. 2005. 92:2076–2083.

21. Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst. 2005. 97:1679–1687.

22. Wideroff L, Gridley G, Mellemkjaer L, Chow WH, Linet M, Keehn S, et al. Cancer incidence in a population-based cohort of patients hospitalized with diabetes mellitus in Denmark. J Natl Cancer Inst. 1997. 89:1360–1365.

23. Papa V, Pezzino V, Costantino A, Belfiore A, Giuffrida D, Frittitta L, et al. Elevated insulin receptor content in human breast cancer. J Clin Invest. 1990. 86:1503–1510.

24. Suh S, Kim KW. Diabetes and cancer: is diabetes causally related to cancer? Diabetes Metab J. 2011. 35:193–198.

25. Washio M, Mori M, Khan M, Sakauchi F, Watanabe Y, Ozasa K, et al. Diabetes mellitus and kidney cancer risk: the results of Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). Int J Urol. 2007. 14:393–397.

26. Antonelli A, Arrighi N, Corti S, Zanotelli T, Cozzoli A, Cosciani Cunico S, et al. Pre-existing type-2 diabetes is not an adverse prognostic factor in patients with renal cell carcinoma: A single-center retrospective study. Urol Oncol. 2012. 01. 24. [Epub]. http://dx.doi.org/10.1016/j.urolonc.2011.12.013.

27. Habib SL, Prihoda TJ, Luna M, Werner SA. Diabetes and risk of renal cell carcinoma. J Cancer. 2012. 3:42–48.

28. Satman I, Yilmaz T, Sengul A, Salman S, Salman F, Uygur S, et al. Population-based study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP). Diabetes Care. 2002. 25:1551–1556.