Obesity: An independent protective factor for localized renal cell carcinoma in a systemic inflammation state

Liu, Zhenhua; Wang, Haifeng; Chen, Yuke; Jin, Jie; Yu, Wei

doi:10.1590/S1677-5538.IBJU.2019.0228

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Sumário

ORIGINAL ARTICLE • Int. braz j urol 46 (4) • Jul-Aug 2020 • https://doi.org/10.1590/S1677-5538.IBJU.2019.0228 copy

Obesity: An independent protective factor for localized renal cell carcinoma in a systemic inflammation state

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives

To explore the prognostic value of obesity (measured by BMI) on RCC in a systemic inflammation state.

Patients and Methods

Clinicopathological and hematological data of 540 surgically treated Chinese localized RCC patients between 2005 and 2010 were retrospectively collected. Found by receiver operating characteristic (ROC) curve for cancer-specific survival (CSS), the optimal cutoff values of neutrophil-lymphocyte ratio (NLR, an indicator of systemic inflammation state) and BMI were 2.12 and 23.32, respectively. Survival curves were drawn using Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to evaluate the prognostic value of BMI in localized RCC patients with different NLR.

Results

Overall, 36 patients died with a median follow-up of 70 months. Median overall survival (OS) was 66 months and the 5-year OS rate was 92.7%. In the multivariate analysis of total patients, higher BMI was an independent protective factor for CSS in total patients (p=0.048). While in systemic inflammation subgroup (high NLR subgroup) patients, higher BMI (obesity) turned out to be an independent protective factor for both CSS (p=0.025) and RFS (p=0.048).

Conclusion

In localized RCC patients, obesity was an independent protective factor for CSS and RFS in a systemic inflammation state.

Obesity; Carcinoma; Inflammation

Characteristics	All patients	BMI<23.32	BMI≥23.32	P value

	N=540 (N%)	N=145 (N%)	N=395 (N%)
Age				0.184
<60	352 (65.2)	88 (60.7)	264 (66.8)
≥60	188 (34.8)	57 (39.3)	131 (33.2)
Gender				0.006*
Male	400 (74.1)	95 (65.5)	305 (77.2)
Female	140 (25.9)	50 (34.5)	90 (22.8)
Tumor laterality				0.428
Left	261 (48.3)	66 (45.5)	195 (49.4)
Right	279 (51.7)	79 (54.5)	200 (50.6)
Cancer related symptoms				0.219
Absent	487 (90.2)	127 (87.6)	360 (91.1)
Present	53 (9.8)	18 (12.4)	35 (8.9)
Surgical procedures
Partial resection	157 (29.1)	40 (27.6)	118 (29.9)	0.605
Radical resection	383 (70.9)	105 (72.4)	277 (70.1)
Histology				0.131
Clear cell	480 (88.9)	124 (85.5)	356 (90.1)
Non-clear cell	60 (11.1)	21 (14.5)	39 (9.9)
Tumor size				0.066
≤7 (T1N0M0)	496 (91.9)	128 (88.3)	368 (93.2)
>7 (T2N0M0)	44 (8.1)	17 (11.7)	27 (6.8)
Fuhrman Grade				0.085
1-2	479 (88.7)	123 (84.8)	356 (90.1)
3-4	61 (11.3)	22 (15.2)	39 (9.9)
Tumor necrosis				0.163
Absent	462 (85.6)	119 (82.1)	343 (86.8)
Present	78 (14.4)	26 (17.9)	52 (13.2)
NLR				0.244
≤2.12	283 (52.4)	70 (48.3)	213 (53.9)
>2.12	257 (47.6)	75 (51.7)	182 (46.1)

Characteristics	Total				Low NLR				High NLR (systemic inflammation state)

	Univariate analysis		Multivariate analysis		Univariate analysis		Multivariate analysis		Univariate analysis		Multivariate analysis

	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Gender (female vs. male)	0.574 (0.252-1.311)	0.188			0.790 (0.210-2.978)	0.728			0.517 (0.177-1.507)	0.227
Age (<60 vs. ≥60)	3.734 (1.867-7.468)	<0.001*	4.010 (1.987-8.091)	<0.001	9.482 (2.048-43.911)	0.004*	9.040 (1.948-41.949)	0.005*	2.471 (1.110-5.501)	0.027*	3.348 (1.424-7.873)	0.006*
Tumor laterality (left vs. right)	1.417 (0.730-2.749)	0.303			1.330 (0.406-4.361)	0.638			1.379 (0.619-3.072)	0.431
Cancer related symptoms (absent vs. present)	2.322 (0.965-5.589)	0.06	3.073 (1.241-7.614)	0.015*	2.116 (0.455-9.828)	0.339			2.736 (0.938-7.978)	0.065	3.872 (1.263-11.869)	0.018*
Surgical procedures (partial vs. radical)	2.603 (1.012-6.699)	0.047*			5.677 (0.726-44.349)	0.098			1.465 (0.503-4.271)	0.484
Tumor size (≤7 vs. >7)	2.778 (1.156-6.677)	0.022*	2.483 (1.022-6.030)	0.045*	2.358 (0.302-18.444)	0.414			2.290 (0.859-6.108)	0.098	2.856 (1.047-7.793)	0.040*
Histology (clear cell vs. non-clear cell)	1.085 (0.384-3.070)	0.877			0.675 (0.146-3.131)	0.616			1.424 (0.336-6.040)	0.632
Tumor necrosis (no vs yes)	1.563 (0.684-3.573)	0.29			3.346 (0.879-12.731)	0.077			0.935 (0.321-2.726)	0.902
Fuhrman grade (1-2 vs. 3-4)	3.051 (1.433-6.498)	0.004*			4.377 (1.153-16.615)	0.030*	3.887 (1.001-15.098)	0.0499*	2.200 (0.877-5.520)	0.093
NLR (≤2.12 vs. >2.12)	2.762 (1.359-5.614)	0.005*	2.761 (1.340-5.690)	0.006*
BMI (<23.32 vs.≥ 23.32)	0.428 (0.222-0.828)	0.012*			0.334 (0.102-1.097)	0.071			0.540 (0.244-1.191)	0.127

Characteristics	Total				Low NLR				High NLR (systemic inflammation state)

	Univariate analysis		Multivariate analysis		Univariate analysis		Multivariate analysis		Univariate analysis		Multivariate analysis

	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)	P
Gender (female vs. male)	0.752 (0.321-1.761)	0.511			0.711 (0.143-3.522)	0.676			0.839 (0.307-2.292)	0.732
Age (<60 vs. ≥ 60)	3.084 (1.456-6.530)	0.003*	3.024 (1.339-6.827)	0.003*	6.326 (1.276-31.365)	0.024*	6.326 (1.276-31.365)	0.024*	2.198 (0.926-5.218)	0.074	2.991 (1.165-7.682)	0.023*
Tumor laterality (left vs. right)	1.251 (0.602-2.601)	0.549			1.103 (0.276-4.414)	0.89			1.236 (0.521-2.936)	0.631
Cancer related symptoms (absent vs. present)	3.146 (1.280-6.847)	0.012*	4.597 (1.746-12.101)	0.003*	3.328 (0.669-16.547)	0.142			3.415 (1.148-10.164)	0.027*	5.285 (1.624-17.200)	0.006*
Surgical procedures (partial vs. radical)	2.599 (0.904-7.469)	0.076			3.851 (0.474-31.308)	0.207			1.689 (0.497-5.736)	0.401
Tumor size (≤7 vs. >7)	3.641 (1.481-8.949)	0.005*	2.889 (1.160-7.195)	0.023*	3.363 (0.413-27.387)	0.257			2.901 (1.061-7.930)	0.038*	3.968 (1.420-11.086)	0.009*
Histology (clear cell vs. non-clear cell)	1.168 (0.353-3.859)	0.799			0.435 (0.088-2.156)	0.308			2.484 (0.333-18.514)	0.375
Tumor necrosis (no vs yes)	1.032 (0.359-2.969)	0.953			2.802 (0.563-13.933)	0.208			0.521 (0.121-2.237)	0.38
Fuhrman grade (1-2 vs. 3-4)	2.410 (0.980-5.928)	0.055			4.076 (0.821-20.242)	0.086			1.622 (0.544-4.831)	0.385
NLR (≤2.12 vs. >2.12)	3.212 (1.422-7.254)	0.005*	3.360 (1.453-7.769)	0.005*
BMI (<23.32 vs.≥ 23.32)	0.363 (0.175-0.753)	0.006*	0.474 (0.226-0.994)	0.048*	0.461 (0.110-1.933)	0.29			0.378 (0.160-0.893)	0.027*	0.367 (0.153-0.879)	0.025*

Characteristics	Total				Low NLR					High NLR (systemic inflammation state)

	Univariate analysis		Multivariate analysis		Univariate analysis			Multivariate analysis		Univariate analysis			Multivariate analysis

	HR (95%CI)	P	HR (95%CI)	P	HR (95%CI)		P	HR (95%CI)	P	HR (95%CI)		P	HR (95%CI)	P
Gender (female vs. male)	0.707 (0.380-1.315)	0.273				0.836 (0.346-2.022)	0.692				0.613 (0.251-1.469)	0.282
Age (<60 vs. ≥ 60)	1.494 (0.876-2.548)	0.14				2.277 (1.019-5.088)	0.045				1.027 (0.498-2.117)	0.943
Tumor laterality (left vs. right)	0.922 (0.545-1.558)	0.761				1.065 (0.478-2.371)	0.878				0.840 (0.419-1.685)	0.624
Cancer related symptoms (absent vs. present)	3.065 (1.610-5.833)	0.001*	2.501 (1.294-4.836)	0.006*		2.061 (0.701-6.055)	0.189				4.429 (1.968-9.967)	<0.001*t	5.671 (2.393-13.440)	<0.001*
Surgical procedures (partial vs. radical)	2.210 (1.080-4.522)	0.030*				1.370 (0.567-3.312)	0.484				4.398 (1.046-18.500)	0.043*	4.151 (0.929-18.545)	0.062
Tumor size (≤7 vs. >7)	4.823 (2.656-8.757)	<0.001*	3.837 (2.048-7.187)	<0.001*		3.049 (0.900-10.332)	0.073				5.737 (2.757-11.937)	<0.001*	4.574 (2.125-9.848)	<0.001*
Histology (clear cell vs. non-clear cell)	1.769 (0.639-4.897)	0.273				1.134 (0.336-3.825)	0.84				3.706 (0.505-27.184)	0.198
Tumor necrosis (no vs yes)	1.476 (0.741-2.941)	0.268				2.602 (0.955-7.094)	0.062				0.911 (0.346-2.402)	0.851
Fuhrman grade (1-2 vs. 3-4)	2.957 (1.626-5.378)	<0.001*	1.990 (1.051-3.768)	0.035*		4.923 (1.996-12.144)	0.001*	4.923 (1.996-12.144)	0.001*		1.885 (0.833-4.266)	0.128
NLR (≤2.12 vs. >2.12)	1.604 (0.944-2.726)	0.081
BMI (<23.32 vs.≥ 23.32)	0.467 (0.274-0.797)	0.005*				0.358 (0.157-0.815)	0.014*				0.595 (0.292-1.211)	0.152	0.477 (0.229-0.994)	0.048*

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[1] Correspondence address: Jie Jin, MD, PhD Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, 8 Xishiku Street, Xicheng District, Beijing 100034, China. E-mail: jinjie@vip.163.com