Influence of nutritional deficiency on prognosis of renal cell carcinoma (RCC)

Authors


Correspondence: Hyeon H. Kim, Department of Urology, Seoul National University Hospital, 28, Yongon-dong, Jongno-gu, Seoul 110-744, Korea.

e-mail: hhkim@snu.ac.kr

Abstract

Objective

  • To evaluate the prognosis of patients with renal cell carcinoma (RCC) by nutritional status defined by body mass index (BMI), serum albumin and cholesterol.

Patients and Methods

  • This study retrospectively enrolled 1437 patients who underwent radical nephrectomy (932) or partial nephrectomy (505) for RCC.
  • We assigned nutritional status according to the presence of none or one nutritional risk factor (control group) and two or all three of the following nutritional risk factors (nutritional deficiency group).
  • The nutritional factors and thresholds were preoperative albumin level (<3.5 g/dL), preoperative cholesterol level (<220 mg/dL), and preoperative BMI (<23 kg/m2)

Results

  • The patients' mean (sd) age was 55.23 (12.41) years and BMI was 24.36 (3.17) kg/m2. The mean (sd) serum cholesterol level was 180.07 (38.24) mg/dL, and the albumin level was 4.2 (0.45) g/dL.
  • In all, 141 (9.8%) patients had none of the nutritional deficiency criteria, 802 (55.8%) had one, 429 (29.9%) had two, and 65 (4.5%) had all three.
  • Clinicopathological variables, i.e. female gender, high tumour stage, positive lymph node metastasis, positive distant metastasis, high nuclear grade and non-clear cell type histopathology were associated with the nutritional deficiency group.
  • In multivariate Cox analysis, nutritional deficiency was an independent predictor for RCC recurrence (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.05–1.83, P = 0.020) and RCC-related mortality (HR 2.06, 95% CI 1.39–3.03, P < 0.001).

Conclusion

  • Nutritional deficiency defined by BMI, serum albumin and cholesterol is an important factor that predicts postoperative prognosis of patients with RCC who have undergone radical or partial nephrectomy.

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