Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
Jpn J Clin Oncol. 2013 Jul;43(7):740-6. doi: 10.1093/jjco/hyt070. Epub 2013 May 31.
To investigate the associations of diabetes mellitus with recurrence and prognosis after surgery for non-metastatic renal cell carcinoma and the effect modification of obesity on the above relationships.
We retrospectively evaluated 543 patients with non-metastatic renal cell carcinoma (pT1-4N0M0) who underwent radical or partial nephrectomy. The association of diabetes mellitus with recurrence was analyzed using the Kaplan-Meier method and the Cox regression model. We also examined whether the above relationships were modified by obesity using subgroup analysis and tests of interaction. For subgroup analysis, the body mass index was categorized as non-obese (<25 kg/m(2)) and obese (≥25 kg/m(2)).
Eighty-two patients (15.1%) had a history of diabetes mellitus. During the mean follow-up of 66.7 months, 68 patients (12.5%) developed recurrence. Although the body mass index was not associated with recurrence, diabetes mellitus was an independent predictor of recurrence in multivariate analysis (hazard ratio 2.43, P = 0.003), along with tumor diameter, grade and pathological T stage. In further subgroup analysis, the same relationship between diabetes mellitus and recurrence was clearly shown in the obese group (hazard ratio 4.07, P = 0.010), but not in the non-obese group (hazard ratio 1.95, P = 0.125). At the same time, obesity modified the effect of diabetes mellitus on recurrence with a trend (P-interaction = 0.086). In the obese group, 5-year recurrence-free survival rates were 75.3 and 91.9% for diabetes mellitus and non-diabetes mellitus patients, respectively (P < 0.001). Restricting analyses to patients with clear cell type histology did not materially change these results.
Diabetes mellitus is a predictor of recurrence following surgery for non-metastatic renal cell carcinoma, especially in obese patients.
探讨糖尿病与非转移性肾细胞癌手术后复发和预后的关系，并研究肥胖对上述关系的影响修饰作用。
我们回顾性评估了 543 例接受根治性或部分肾切除术的非转移性肾细胞癌（pT1-4N0M0）患者。采用 Kaplan-Meier 法和 Cox 回归模型分析糖尿病与复发的关系。我们还通过亚组分析和交互作用检验，检验肥胖是否改变了上述关系。对于亚组分析，将体质指数分为非肥胖（<25kg/m2）和肥胖（≥25kg/m2）。
82 例（15.1%）患者有糖尿病病史。在平均 66.7 个月的随访期间，68 例（12.5%）患者复发。虽然体质指数与复发无关，但在多变量分析中，糖尿病是复发的独立预测因素（危险比 2.43，P=0.003），同时与肿瘤直径、分级和病理 T 分期相关。进一步的亚组分析显示，肥胖组中糖尿病与复发之间存在相同的关系（危险比 4.07，P=0.010），而非肥胖组中则无此关系（危险比 1.95，P=0.125）。同时，肥胖对糖尿病与复发之间的关系具有修饰作用（P 交互=0.086）。在肥胖组中，糖尿病和非糖尿病患者的 5 年无复发生存率分别为 75.3%和 91.9%（P<0.001）。将分析仅限于透明细胞型组织学患者，并没有改变这些结果。
糖尿病是预测非转移性肾细胞癌手术后复发的一个因素，尤其是在肥胖患者中。
