Anthony T Corcoran1, Samuel D Kaffenberger2, Peter E Clark2, John Walton3, Elizabeth Handorf4, Zack Piotrowski3, Jeffery J Tomaszewski3, Serge Ginzburg5, Reza Mehrazin3, Elizabeth Plimack6, David Y T Chen3, Marc C Smaldone3, Robert G Uzzo3, Todd M Morgan7, Alexander Kutikov3. 1. Department of Urology, SUNY Stony Brook Medical Center, Stony Brook, NY, USA. 2. Department of Urology, Vanderbilt University School of Medicine, Nashville, TN, USA. 3. Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA. 4. Biostatistics & Bioinformatics Facility, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA. 5. Department of Urology, Einstein Healthcare Network/Urologic Institute of Southeastern Pennsylvania, Philadelphia, PA, USA. 6. Medical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA. 7. Department of Urology, University of Michigan School of Medicine, Ann Arbor, MI, USA.
Abstract
OBJECTIVE: To evaluate whether poor nutrition is associated with mortality in patients undergoing cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC). PATIENTS AND METHODS: A multi-institutional review of prospective databases identified 246 patients meeting inclusion criteria who underwent CN for mRCC from 1993 to 2012. Nutritional markers evaluated were: body mass index <18.5 kg/m(2) , serum albumin <3.5 g/dL, or preoperative weight loss of ≥5% of body weight. Primary outcomes were overall (OS) and disease-specific survival (DSS). Secondary outcome was 'early mortality' defined as death at ≤6 months of surgery. Survival curves were estimated using the Kaplan-Meier product-limit method and multivariate analysis using logistic regression was used to test associations between nutritional markers and survival outcomes. RESULTS: In all, 119 patients (median follow-up 17 months) were categorised as having any abnormal nutrition parameter (48%). Hypoalbuminaemia was the only independent predictor of OS and DSS (OS: median 8 vs 23 months, P < 0.001; DSS: 11 vs 33 months, P < 0.001). On multivariate analysis, hypoalbuminaemia remained a significant predictor of death for both overall [hazard ratio (HR) 2, 95% confidence interval (CI) 1.4-2.8; P < 0.001) and disease-specific mortality (HR 2.2, 95% CI 1.4-3.3; P < 0.001). Hypoalbuminaemia was also associated with early mortality (overall: P < 0.001 and disease specific: P = 0.002). CONCLUSION: Patients with mRCC and hypoalbuminaemia undergoing CN have decreased OS and CSS, and increased risk of all-cause and disease-specific early mortality. As such, serum albumin may help risk stratify patients selected as candidates for CN. Furthermore, future work should evaluate whether nutritional depletion is a modifiable risk factor.
OBJECTIVE: To evaluate whether poor nutrition is associated with mortality in patients undergoing cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC). PATIENTS AND METHODS: A multi-institutional review of prospective databases identified 246 patients meeting inclusion criteria who underwent CN for mRCC from 1993 to 2012. Nutritional markers evaluated were: body mass index <18.5 kg/m(2) , serum albumin <3.5 g/dL, or preoperative weight loss of ≥5% of body weight. Primary outcomes were overall (OS) and disease-specific survival (DSS). Secondary outcome was 'early mortality' defined as death at ≤6 months of surgery. Survival curves were estimated using the Kaplan-Meier product-limit method and multivariate analysis using logistic regression was used to test associations between nutritional markers and survival outcomes. RESULTS: In all, 119 patients (median follow-up 17 months) were categorised as having any abnormal nutrition parameter (48%). Hypoalbuminaemia was the only independent predictor of OS and DSS (OS: median 8 vs 23 months, P < 0.001; DSS: 11 vs 33 months, P < 0.001). On multivariate analysis, hypoalbuminaemia remained a significant predictor of death for both overall [hazard ratio (HR) 2, 95% confidence interval (CI) 1.4-2.8; P < 0.001) and disease-specific mortality (HR 2.2, 95% CI 1.4-3.3; P < 0.001). Hypoalbuminaemia was also associated with early mortality (overall: P < 0.001 and disease specific: P = 0.002). CONCLUSION:Patients with mRCC and hypoalbuminaemia undergoing CN have decreased OS and CSS, and increased risk of all-cause and disease-specific early mortality. As such, serum albumin may help risk stratify patients selected as candidates for CN. Furthermore, future work should evaluate whether nutritional depletion is a modifiable risk factor.
Authors: Ross J Mason; Lori Wood; Anil Kapoor; Naveen Basappa; George Bjarnason; Stephen A Boorjian; Rodney H Breau; Ilias Cagiannos; Michael A S Jewett; Pierre I Karakiewicz; Wassim Kassouf; Christian Kollmannsberger; Aly-Khan A Lalani; Jean-Baptiste Lattouf; Luke T Lavallée; Stephen Pautler; Nicholas Power; Patrick Richard; Alan So; Simon Tanguay; Ricardo A Rendon Journal: Can Urol Assoc J Date: 2019-06 Impact factor: 1.862
Authors: Andrew W Silagy; Roy Mano; Kyle A Blum; Renzo G DiNatale; Julian Marcon; Satish K Tickoo; Eduard Reznik; Jonathan A Coleman; Paul Russo; A Ari Hakimi Journal: Urology Date: 2019-11-11 Impact factor: 2.649