OBJECTIVE: To evaluate whether poor nutrition is associated with mortality in patients undergoing cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC).
PATIENTS AND METHODS: A multi-institutional review of prospective databases identified 246 patients meeting inclusion criteria who underwent CN for mRCC from 1993-2012. Nutritional markers evaluated were: body mass index < 18.5kg/m2, serum albumin < 3.5g/dl, or preoperative weight loss ≥ 5% of body weight. Primary outcomes were overall (OS) and disease-specific survival (DSS). Secondary outcome was "early mortality" defined as death within 6 months of surgery. Survival curves were estimated using the Kaplan-Meier product-limit method and multivariate analysis using logistic regression was used to test associations between nutritional markers and survival outcomes.
RESULTS: 119 patients (median follow up 17 months) were categorized as having any abnormal nutrition parameter (48%). Hypoalbuminemia was the only independent predictor of OS and DSS (OS: median 8 vs. 23 months, p< 0.001; DSS: 11 vs. 33 months, p< 0.001). On multivariate analysis, hypoalbuminemia remained a significant predictor of death for both overall (HR 2; 95%CI 1.4-2.8, p< 0.001) and disease-specific mortality (HR 2.2; 95%CI 1.4-3.3, p< 0.001). Hypoalbuminemia was also associated with early mortality (overall (p< 0.001) and disease specific (p=0.002)).
CONCLUSION: Patients with mRCC and hypoalbuminemia undergoing CN have decreased OS and CSS, and increased risk of all-cause and disease specific early mortality. As such, serum albumin may help risk stratify patients selected as candidates for upfront CN. Furthermore, future work should evaluate whether nutritional depletion is a modifiable risk factor.
Written by:
Corcoran AT, Kaffenberger SD, Clark PE, Walton J, Handorf E, Piotrowski Z, Tomaszewski JJ, Ginzburg S, Mehrazin R, Plimack E, Chen DY, Smaldone MC, Uzzo RG, Morgan TM, Kutikov A. Are you the author?
Department of Urology, SUNY Stony Brook Medical Center, Stony Brook, NY.
Reference: BJU Int. 2014 Aug 14. Epub ahead of print.
doi: 10.1111/bju.12897
PubMed Abstract
PMID: 25123843