Abstract
Introduction & Objectives: Until recently, the incidence of renal cell carcinoma (RCC) has been increasing worldwide, mainly in western countries, at a rate between 2% and 4% per year. However, the reason for this dramatic increase in number has not been fully understood. Diabetes mellitus (DM) is a known risk factor for RCC, but the impact of DM on the prognosis of RCC is unclear. In the present study, we investigated the potential influence of DM on clinicopathological features of localized and metastatic RCC. Material & Methods: We evaluated 863 patients with primary RCC who had undergone renal surgery between 1991 and 2005 in the University Hospital Hannover; the mean follow-up was 58 months. To test the association of DM with survival end-points, Kaplan-Meier Method and Cox multivariable logistic regression models were applied. Results: In total, we identified 123 diabetic patients who suffered from RCC, 9 patients with diabetes type 1 and 114 with type 2. Patients with DM type 2 presented significantly more often with pT1a tumours at diagnosis (40.0 vs. 31.7%, p = 0.02), had less frequently high grade cancer (G3/4; 10.3 vs. 16.2%, p = 0.03), were older (median, 65.3 vs. 61.6 years; p < 0.001), and had a higher BMI at diagnosis (median, 27.6 vs. 25.8, p < 0.001). However, there was no difference between diabetic and non-diabetic patients concerning sex, histological subtype, lymphatic and distant metastasis. In addition, there was no discrepancy in 5-year cancer specific survival between both groups (62.2 vs. 64.9% for patients without and with DM type 2, respectively). Applying multivariable analysis, unlike age, tumour stage, grade and N/M status, diabetes was not identified as a significant independent prognostic factor. Conclusions: To our knowledge this is the first study to show that even though diabetes is a risk factor for RCC it does not seem to influence its prognoses even though it might be diagnosed earlier in diabetic patients.
Highlights
Introduction & ObjectivesUntil recently, the incidence of renal cell carcinoma (RCC) has been increasing worldwide, mainly in western countries, at a rate between 2% and 4% per year
More than 40,000 new cases are diagnosed in the European Union every year and more than half of these patients will die from RCC [1]
As the incidence of diabetes mellitus (DM) increases with body mass [18, 19,21], and obesity has only recently been identified as an independent positive prognostic factor for patients with localized RCC [22], we investigated the role of DM on the prognosis of RCC
Summary
Introduction & ObjectivesUntil recently, the incidence of renal cell carcinoma (RCC) has been increasing worldwide, mainly in western countries, at a rate between 2% and 4% per year. There was no discrepancy in 5-year cancer specific survival between both groups Despite increased health care facilities for imaging and consequent early diagnosis, still up to one third of all patients with RCC will have metastases at time of presentation [3,4,5,6,7]. As patients’ clinical courses vary and are difficult to predict, and as an increasing number of adjuvant and palliative agents has been and is currently being developed for the treatment of RCC, the stratifications of patients to different therapeutic strategies according to specific prognostic factors will become increasingly important. Favourable prognostic factors include complete resectability and a long interval between initial diagnosis and development of metastases [12,13]
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