TY - JOUR
T1 - Preoperative nutritional status is an important predictor of survival in patients undergoing surgery for renal cell carcinoma
AU - Morgan, Todd M.
AU - Tang, Dominic
AU - Stratton, Kelly L.
AU - Barocas, Daniel A.
AU - Anderson, Christopher B.
AU - Gregg, Justin R.
AU - Chang, Sam S.
AU - Cookson, Michael S.
AU - Herrell, S. Duke
AU - Smith, Joseph A.
AU - Clark, Peter E.
N1 - Funding Information:
Funding/Support and role of the sponsor: The design and conduct of the project described was supported in part by Award Number K08 CA113452 (PEC) from the National Institutes of Health.
PY - 2011/6
Y1 - 2011/6
N2 - Background: The role of malnutrition has not been well studied in patients undergoing surgery for renal cell carcinoma (RCC). Objective: Our aim was to evaluate whether nutritional deficiency (ND) is an important determinant of survival following surgery for RCC. Design, setting, and participants: A total of 369 consecutive patients underwent surgery for locoregional RCC from 2003 to 2008. ND was defined as meeting one of the following criteria: body mass index <18.5 kg/m2, albumin <3.5 g/dl, or preoperative weight loss ≥5% of body weight. Intervention: All patients underwent radical or partial nephrectomy. Measurements: Primary outcomes were overall and disease-specific mortality. Covariates included age, Charlson comorbidity index (CCI), preoperative anemia, tumor stage, Fuhrman grade, and lymph node status. Multivariate analysis was performed using a Cox proportional hazards model. Mortality rates were estimated using the Kaplan-Meier product-limit method. Results and limitations: Eighty-five patients (23%) were categorized as ND. Three-year overall and disease-specific survival were 58.5% and 80.4% in the ND cohort compared with 85.4% and 94.7% in controls, respectively (p < 0.001). ND remained a significant predictor of overall mortality (hazard ratio [HR]: 2.41, 95% confidence interval [CI], 1.40-4.18) and disease-specific mortality (HR: 2.76; 95% CI, 1.17-6.50) after correcting for age, CCI, preoperative anemia, stage, grade, and nodal status. This study is limited by its retrospective nature. Conclusions: ND is associated with higher mortality in patients undergoing surgery for locoregional RCC, independent of key clinical and pathologic factors. Given this mortality risk, it may be important to address nutritional status preoperatively and counsel patients appropriately.
AB - Background: The role of malnutrition has not been well studied in patients undergoing surgery for renal cell carcinoma (RCC). Objective: Our aim was to evaluate whether nutritional deficiency (ND) is an important determinant of survival following surgery for RCC. Design, setting, and participants: A total of 369 consecutive patients underwent surgery for locoregional RCC from 2003 to 2008. ND was defined as meeting one of the following criteria: body mass index <18.5 kg/m2, albumin <3.5 g/dl, or preoperative weight loss ≥5% of body weight. Intervention: All patients underwent radical or partial nephrectomy. Measurements: Primary outcomes were overall and disease-specific mortality. Covariates included age, Charlson comorbidity index (CCI), preoperative anemia, tumor stage, Fuhrman grade, and lymph node status. Multivariate analysis was performed using a Cox proportional hazards model. Mortality rates were estimated using the Kaplan-Meier product-limit method. Results and limitations: Eighty-five patients (23%) were categorized as ND. Three-year overall and disease-specific survival were 58.5% and 80.4% in the ND cohort compared with 85.4% and 94.7% in controls, respectively (p < 0.001). ND remained a significant predictor of overall mortality (hazard ratio [HR]: 2.41, 95% confidence interval [CI], 1.40-4.18) and disease-specific mortality (HR: 2.76; 95% CI, 1.17-6.50) after correcting for age, CCI, preoperative anemia, stage, grade, and nodal status. This study is limited by its retrospective nature. Conclusions: ND is associated with higher mortality in patients undergoing surgery for locoregional RCC, independent of key clinical and pathologic factors. Given this mortality risk, it may be important to address nutritional status preoperatively and counsel patients appropriately.
KW - Hypoalbuminemia
KW - Malnutrition
KW - Nephrectomy
KW - Renal cell carcinoma
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U2 - 10.1016/j.eururo.2011.01.034
DO - 10.1016/j.eururo.2011.01.034
M3 - Article
C2 - 21295907
AN - SCOPUS:79955584987
SN - 0302-2838
VL - 59
SP - 923
EP - 928
JO - European urology
JF - European urology
IS - 6
ER -