BACKGROUND: Conflicting data exist regarding the interaction of diabetes mellitus (DM) with outcomes for patients with renal cell carcinoma (RCC).
Herein, we evaluate the association of DM with survival among patients with clear cell RCC (ccRCC) treated with nephrectomy.
METHODS: We reviewed 1964 patients treated surgically for sporadic, unilateral, M0 ccRCC between 1990 and 2008. One pathologist re-reviewed all specimens to confirm ccRCC. Diabetic patients (n=257) were matched 1:2 to referent nondiabetics according to clinicopathologic and surgical features. Cancer-specific (CSS) and overall survival (OS) were estimated using the Kaplan-Meier method and Cox models were used to evaluate associations with outcomes.
RESULTS: A total of 257 (13%) patients had DM. Diabetic patients were significantly older, more likely to be obese, and had higher Charlson scores, renal impairment, rates of smoking, and worse performance status at surgery (p< 0.001), while pathologic features were similar between groups. Median postoperative follow-up was 8.7 years. Five-year CSS was similar between diabetics and nondiabetics (82% vs. 86%, p=0.1), while 5-year OS was significantly worse among diabetics (65% vs. 74%; p< 0.001). On multivariable analysis, DM independently predicted both cancer-specific mortality (hazard ratio [HR] 1.55; 95% CI 1.08-2.21; p=0.02) and all-cause mortality (HR 1.32; 95% CI 1.06-1.64; p=0.01).
CONCLUSION: Our results suggest that DM is independently associated with decreased CSS and OS among patients with surgically treated ccRCC.
Written by:
Psutka SP, Stewart SB, Boorjian SA, Lohse CM, Tollefson MK, Cheville JC, Leibovich BC, Thompson RH. Are you the author?
Department of Urology, Mayo Clinic, Rochester, Minnesota; Department of Health Services Research, Mayo Clinic, Rochester, Minnesota; Department of Pathology, Mayo Clinic, Rochester, Minnesota.
Reference: J Urol. 2014 Jun 12. pii: S0022-5347(14)03764-1.
doi: 10.1016/j.juro.2014.06.014
PubMed Abstract
PMID: 24931804
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