Abstract
Obesity has been established as a risk factor for renal cell carcinoma (RCC). Recently, studies have described obesity as a probable protecting factor in the metastatic stage of RCC. In this study, we assessed the relationship between body mass index (BMI) and overall survival in patients under systemic therapy.The correlation between BMI and overall median survival was studied in 76 patients diagnosed with metastatic RCC under systemic therapy. The groups were divided into overweight and obesity (BMI > 25 kg/m2) and underweight or normal (BMI < 25 kg/m2). Statistical analysis was performed using the Cox regression model adjusted by gender.A total of 76 patients were studied: 16 women (21%) and 60 men (79%). The median BMI was 27.96 kg/m2; 24 patients (31.6%) had low BMI and 52 (68.4%) had high BMI. Median overall survival in the group with BMI > 25 kg/m2 was 17 months (95% confidence interval [CI]: 13–34 months), while in the group with BMI ≤ 25 kg/m2, it was 14 months (95% CI: 8–20 months). When adjusted by gender, the group with BMI > 25 kg/m2 presented a hazards ratio of 0.54 (95% CI: 0.30–0.96), P = 0.044 (Log Rank).A high BMI significantly acts as a protecting factor. We observed an increased overall survival of overweight and obese patients within the context of metastatic RCC under systemic treatment. These data confirm the findings published in other studies that suggest the role of lipid metabolism in this type of tumors.
Highlights
Obesity is a major worldwide health condition linked to angiogenic-related diseases such as diabetes, cardiovascular events, and cancer [1]
Our objective was to explain the relationship that exists between body mass index (BMI) and overall survival in our metastatic renal cell carcinoma (RCC) patients treated with systemic therapy based on tyrosine kinase inhibitors (TKI) and rapamycin inhibitors
This is a single center retrospective cohort study with survival analysis performed in a regional secondary level hospital, where physicians of the Urology team studied metastatic RCC Caucasian patients treated with systemic therapy between 2006 and 2017
Summary
Obesity is a major worldwide health condition linked to angiogenic-related diseases such as diabetes, cardiovascular events, and cancer [1]. Some angiogenic growth factors and hormones are produced by fatty tissues [3], including vascular and endothelial growth factor (VEGF), tumoral necrosis factor (TNF), and leptin [4]. These factors derived from fatty cells have a crucial role in tissue and organ regulation due to angiogenic checkpoint control; the overexpression of these factors could not be sufficient to boost it because the feedback control of many other activators and inhibitors [5]. It is known that overweight and obesity can cause potential changes in hormonal metabolism (insulin, Insulin-like Growth Factor-1 [IGF-1], and sexual steroids), and proteins produced by fatty tissues (adipokines) are involved in immune regulation (leptin), inflammatory response (TNFα, interleukin-6 [IL-6], and amyloid A), stromal response, and angiogenesis (VEGF-1) as well as extracellular matrix components (collagen type 6 [Col VI]) [6]
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