Madhur Nayan1, Shreya Jalali2, Anil Kapoor3, Antonio Finelli1, Alan So4, Ricardo Rendon5, Rodney H Breau6, Luke T Lavallee6, Simon Tanguay7, Daniel Heng8, Jun Kawakami9, Naveen S Basappa10, Georg Bjarnason11, Frederic Pouliot12, Robert J Hamilton13. 1. Division of Urology, University of Toronto, Toronto, Canada. 2. Faculty of Medicine, University of Ottawa, Ottawa, Canada. 3. Division of Urology, McMaster University, Hamilton, Canada. 4. Department of Urologic Sciences, University of British Columbia, Vancouver, Canada. 5. Department of Urology, Dalhousie University, Halifax, Canada. 6. Division of Urology, University of Ottawa, Ottawa, Canada. 7. Division of Urology, McGill University, Montreal, Canada. 8. Tom Baker Cancer Centre, University of Calgary, Calgary, Canada. 9. Division of Urology, University of Calgary, Calgary, Canada. 10. Cross Cancer Institute, University of Alberta, Edmonton, Canada. 11. Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada. 12. Division of Urology, Université Laval, Quebec City, Canada. 13. Division of Urology, University of Toronto, Toronto, Canada. Electronic address: rob.hamilton@uhn.ca.
Abstract
INTRODUCTION: Diabetes has been associated with worse survival outcomes in various malignancies; however, there are conflicting data in kidney cancer. Determining whether diabetes is associated with survival in kidney cancer may help guide treatment in a comorbid patient population. METHODS: We used the Canadian Kidney Cancer information system database to identify patients undergoing partial or radical nephrectomy between 1989 and 2017 for localized renal cell carcinoma at 16 institutions across Canada. We derived inverse probability of treatment weights (IPTW) from a propensity score model based on various clinical, surgical, and pathological characteristics. We used Cox proportional hazard models to evaluate the association between diabetes and cancer-specific and overall survival, in the sample weighted by the IPTW. RESULTS: 4828 patients met inclusion criteria, of whom 948 (19.6%) were diabetic. Median follow-up in those without death was 26.6 months (interquartile range 9.7-53.8). Among the entire cohort, 901 deaths were from any cause, and 299 deaths from kidney cancer. Before propensity score methods, diabetics were older, more likely to have comorbidities and clear cell histopathology. After propensity score adjustment, all characteristics were balanced between groups (standardized difference <0.10). IPTW-adjusted Cox proportional hazard models demonstrated no significant association between diabetes and cancer-specific (hazard ratio 1.13, 95% confidence interval 0.78-1.62), or overall survival (hazard ratio 1.14, 95% confidence interval 0.94-1.38). CONCLUSIONS: Our multi-centre study found that diabetes and nondiabetics have similar survival following nephrectomy for kidney cancer.
INTRODUCTION:Diabetes has been associated with worse survival outcomes in various malignancies; however, there are conflicting data in kidney cancer. Determining whether diabetes is associated with survival in kidney cancer may help guide treatment in a comorbid patient population. METHODS: We used the Canadian Kidney Cancer information system database to identify patients undergoing partial or radical nephrectomy between 1989 and 2017 for localized renal cell carcinoma at 16 institutions across Canada. We derived inverse probability of treatment weights (IPTW) from a propensity score model based on various clinical, surgical, and pathological characteristics. We used Cox proportional hazard models to evaluate the association between diabetes and cancer-specific and overall survival, in the sample weighted by the IPTW. RESULTS: 4828 patients met inclusion criteria, of whom 948 (19.6%) were diabetic. Median follow-up in those without death was 26.6 months (interquartile range 9.7-53.8). Among the entire cohort, 901 deaths were from any cause, and 299 deaths from kidney cancer. Before propensity score methods, diabetics were older, more likely to have comorbidities and clear cell histopathology. After propensity score adjustment, all characteristics were balanced between groups (standardized difference <0.10). IPTW-adjusted Cox proportional hazard models demonstrated no significant association between diabetes and cancer-specific (hazard ratio 1.13, 95% confidence interval 0.78-1.62), or overall survival (hazard ratio 1.14, 95% confidence interval 0.94-1.38). CONCLUSIONS: Our multi-centre study found that diabetes and nondiabetics have similar survival following nephrectomy for kidney cancer.