Preoperative nutritional status is an important predictor of survival in patients undergoing surgery for renal cell carcinoma.

Morgan TM, Tang D, Stratton KL, Barocas DA, Anderson CB, Gregg JR, Chang SS, Cookson MS, Herrell SD, Smith JA, Clark PE
Eur Urol. 2011 59 (6): 923-8

PMID: 21295907 · PMCID: PMC3085569 · DOI:10.1016/j.eururo.2011.01.034

BACKGROUND - The role of malnutrition has not been well studied in patients undergoing surgery for renal cell carcinoma (RCC).

OBJECTIVE - Our aim was to evaluate whether nutritional deficiency (ND) is an important determinant of survival following surgery for RCC.

DESIGN, SETTING, AND PARTICIPANTS - A total of 369 consecutive patients underwent surgery for locoregional RCC from 2003 to 2008. ND was defined as meeting one of the following criteria: body mass index <18.5 kg/m(2), albumin <3.5 g/dl, or preoperative weight loss ≥ 5% of body weight.

INTERVENTION - All patients underwent radical or partial nephrectomy.

MEASUREMENTS - Primary outcomes were overall and disease-specific mortality. Covariates included age, Charlson comorbidity index (CCI), preoperative anemia, tumor stage, Fuhrman grade, and lymph node status. Multivariate analysis was performed using a Cox proportional hazards model. Mortality rates were estimated using the Kaplan-Meier product-limit method.

RESULTS AND LIMITATIONS - Eighty-five patients (23%) were categorized as ND. Three-year overall and disease-specific survival were 58.5% and 80.4% in the ND cohort compared with 85.4% and 94.7% in controls, respectively (p<0.001). ND remained a significant predictor of overall mortality (hazard ratio [HR]: 2.41, 95% confidence interval [CI], 1.40-4.18) and disease-specific mortality (HR: 2.76; 95% CI, 1.17-6.50) after correcting for age, CCI, preoperative anemia, stage, grade, and nodal status. This study is limited by its retrospective nature.

CONCLUSIONS - ND is associated with higher mortality in patients undergoing surgery for locoregional RCC, independent of key clinical and pathologic factors. Given this mortality risk, it may be important to address nutritional status preoperatively and counsel patients appropriately.

Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

MeSH Terms (26)

Aged Biomarkers Body Mass Index Carcinoma, Renal Cell Disease-Free Survival Female Humans Kaplan-Meier Estimate Kidney Neoplasms Male Malnutrition Middle Aged Neoplasm Staging Nephrectomy Nutritional Status Preoperative Period Proportional Hazards Models Retrospective Studies Risk Assessment Risk Factors Serum Albumin Survival Rate Tennessee Time Factors Treatment Outcome Weight Loss

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