Abstract
449 Background: Obesity increases the risk of renal cell carcinoma (RCC); however, obese patients experience longer survival than non-obese patients. The mechanism of this “obesity paradox” is unknown. We examined the impact of obesity, total adiponectin (AD) level, and intratumoral AD receptors expression on RCC aggressiveness and survival, and also investigated the mechanism underlying enhanced cancer aggressiveness in RCC cells with exogenous adiponectin stimulation. Methods: A total of 129 RCC patients treated with surgery were included in the analyses. Preoperative BMI, serum total adiponectin (AD) level, total AD secretion from perinephric adipose tissue, and intratumoral AD receptors mRNA and protein expression were analyzed. Caki-2 and 786- cells were used for in vitro functional analyses. Results: Overweight and obese patients had significantly lower grade cancers than normal patients in all patients and in those without metastasis (p = 0.003, and p = 0.027, respectively). Cancer-specific survival in overweight and obese patients was significantly better than in normal patients in all patients (p = 0.035). A weak inverse correlation existed between serum AD level and BMI in RCC patients (r = −0.344). Tumor size was slightly correlated with serum AD level, and high serum AD was significantly associated with poor overall survival in patients without metastasis (p = 0.035). The AD level of perinephric adipose tissue and intratumoral AdipoR1/R2 expression in tumors did not correlate with RCC aggressiveness and survival. Exogenous AD significantly enhanced proliferation, but not invasion or migration in 786-O and Caki-2 cells. Exogenous AD significantly inhibited starvation- and metformin-induced apoptosis, and up-regulated p-AMPK and Bcl-xL in these cells. Conclusions: Low BMI and high AD level are associated with cancer aggressive and poor survival in RCC patients treated surgically. AD modulates proliferation and apoptosis, which may underlie the “obesity paradox” of RCC.
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