Abstract
Fatty liver has emerged as a prognostic marker of cancer, so we investigated the impact of ectopic lipid accumulation in liver on the clinical outcome for patients with renal cell carcinoma (RCC). The records of 230 consecutive patients who had undergone surgery for RCC were reviewed, and liver lipid accumulation was estimated from the attenuation in unenhanced preoperative CT images. The median liver CT values of patients with G3 tumors was lower than that of patients with G1–2 tumors (P = 0.0116), that of patients with pT3–4 tumors was lower than that of patients with pT1–2 tumors (P = 0.0336), and that of patients with visceral obesity defined as a visceral fat area ≥ 100 cm2 was lower than that of patients without visceral obesity (P < 0.0001). In patients without visceral obesity the median liver CT values of patients with pT3–4 tumors was lower than that of patients with pT1–2 tumors (P = 0.0401), that of patients with metastasis was lower than that of patients without metastasis (P = 0.026), and fatty liver was associated with shorter overall survival (P = 0.0009). Ectopic lipid accumulation in liver thus seems to be a predictor of aggressive forms of RCC.
Highlights
The obese population in the world continues to grow, and the diverse health problems associated with obesity have become a major social issue
We investigated the relevance of ectopic fat accumulation in the liver to the degree of malignancy and prognosis of renal cell carcinoma (RCC) with a consideration given to visceral fat obesity
The median age at surgery was 65 years and median follow-up duration was 31.4 months (IQR 15.3–55.6), 14 patients died of cancer, and 6 patients died of other causes
Summary
The obese population in the world continues to grow, and the diverse health problems associated with obesity have become a major social issue. Obesity defined by high BMI is well established as a risk factor for developing RCC, higher BMI is associated with longer survival time, and this phenomenon has been called the obesity paradox in RCC2 To elucidate this paradox, studies considering obesity a change in body composition rather than a change in BMI have been made. With increased obese population in Europe and America and in the Asia-Pacific Region, fat accumulation in the liver— the prevalence of increased fatty liver–is garnering attention as it is considered to be associated with increases in lifestyle-related diseases such as dyslipidemia, diabetes, and heart disease and with the progression of and survival rates for several kinds of cancer[9,10,11]. We investigated the relevance of ectopic fat accumulation in the liver to the degree of malignancy and prognosis of RCC with a consideration given to visceral fat obesity
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