Background: Diabetes is a risk factor for various cancers, but its prognostic role in renal cell carcinoma (RCC) is controversial and understudied. This study investigated the prognostic value of type 2 diabetes (T2D) in RCC patients.
Methods: The clinicopathological and follow-up data of 451 RCC patients undergoing radical or partial nephrectomy at the First Hospital of Shanxi Medical University from 2013 to 2018 were reviewed. Associations of T2D with clinicopathological parameters of RCC were evaluated using the Kaplan-Meier method for survival estimates and Cox regression univariate and multivariate analyses.
Results: Of 451 patients, 74 (16.4%) had T2D. These patients were older, had a higher body mass index, higher incidence rates of hypertension and cardiovascular morbidity, a higher rate of laparoscopic surgery, and smaller neoplasms (all P < .05). Patients with T2D exhibited shorter overall survival (OS; P = .009), cancer-specific survival (CSS; P = .043), and recurrence-free survival (RFS; P = .008) than patients without T2D. Fuhrman grade (hazard ratio [HR] 2.542, 95% confidence interval [CI] 1.115-5.795, P = .026) and T2D (HR 3.391, CI 1.458-7.886, P = .005) were independent predictors of OS; T2D was an independent predictor of CSS (HR = 4.637, 95% CI 1.420-15.139, P = .011) and RFS (HR 3.492, 95% CI 1.516-8.044, P = .003).
Conclusions: Renal cell carcinoma patients with T2D have a shorter OS and higher recurrence rate and mortality risk than those without T2D.
背景: 糖尿病是多种癌症的危险因素, 但其在肾细胞癌预后中的作用一直存在争议以及研究不足。本研究旨在探讨2型糖尿病对肾细胞癌患者的预后价值。 方法: 回顾性分析2013年至2018年山西医科大学第一医院行根治性或部分肾切除术治疗的451例肾细胞癌患者的临床病理资料和随访数据。评估2型糖尿病与肾细胞癌各种临床和病理参数的潜在关联。应用Kaplan-Meier法估算生存率, 应用COX回归模型进行单因素和多因素分析。 结果: 纳入研究的451例患者中, 共有74例患者(16.4%)术前患有2型糖尿病。这些患者的年龄更大, 具有更高的体质指数, 更高的高血压发病率和心血管疾病发病率, 更高的腹腔镜手术率, 以及更小的肿瘤直径(P值均<0.05)。Kaplan-Meier曲线显示2型糖尿病患者的总生存率(OS；P =0.009)、癌症特异性生存率(CSS；P =0.043)和无复发生存率(RFS；P =0.008)均低于非2型糖尿病患者。多因素分析发现, Fuhrman分级(风险比[HR] 2.542, 95%置信区间[CI] 1.115-5.795, P=0.026)和2型糖尿病(HR 3.391, CI 1.458-7.886, P=0.005)是肾细胞癌患者术后总生存率的独立危险因素, 2型糖尿病是肾细胞癌患者术后癌症特异性生存率(HR 4.637, 95% CI 1.420-15.139, P=0.011)和无复发生存率(HR 3.492, 95% CI 1.516- 8.044, P=0.003)的独立危险因素。 结论: 与非2型糖尿病患者相比, 合并2型糖尿病的肾细胞癌患者总生存期更短, 肾癌死亡风险更高, 复发风险增加。.
Keywords: 2型糖尿病; nephrectomy; prognosis; recurrence; renal cell carcinoma; type 2 diabetes; 复发; 肾切除术; 肾细胞癌; 预后.
© 2019 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.