Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.
Ann Surg Oncol. 2013 Oct;20(11):3662-8. doi: 10.1245/s10434-013-3147-7. Epub 2013 Aug 2.
The purpose of our study was to determine whether preoperative diabetes mellitus (DM) can predict the prognosis of localized clear-cell renal cell carcinoma (RCC).
At five institutes, 2,597 patients with pT1 and pT2 clear-cell RCC were enrolled. Univariate and multivariable analyses were performed to determine factors that associated with recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). To identify the effect of DM on survival after recurrence, a subgroup of 127 patients who had recurrences was analyzed.
In total, 357 patients had DM. Compared with patients without DM, these patients were older, more likely to be male, and had a higher body mass index, lower GFR, and higher incidence of hypertension. Kaplan-Meier curves showed that patients with DM had a significantly worse rate of RFS, CSS, and OS than patients without DM (log-rank test, all P < 0.05). Multivariate analysis revealed that DM was an independent prognostic factor in terms of RFS, CSS, and OS. In the subgroup analysis of 127 patients with recurrence, DM was associated with a lower survival rate after the initial recurrence.
DM appeared to be an important determinant of prognosis in clear-cell localized RCC, especially in patients experiencing recurrence.
本研究旨在探讨术前糖尿病（DM）是否能预测局限性肾透明细胞癌（RCC）的预后。
在五家医院共纳入 2597 例 pT1 和 pT2 肾透明细胞癌患者。采用单因素和多因素分析确定与无复发生存（RFS）、癌症特异性生存（CSS）和总生存（OS）相关的因素。为了明确 DM 对复发后生存的影响，对 127 例有复发的患者进行亚组分析。
共 357 例患者患有 DM。与无 DM 患者相比，这些患者年龄更大，男性更多，体重指数更高，肾小球滤过率（GFR）更低，高血压发生率更高。Kaplan-Meier 曲线显示，DM 患者的 RFS、CSS 和 OS 明显低于无 DM 患者（对数秩检验，均 P<0.05）。多因素分析显示，DM 是 RFS、CSS 和 OS 的独立预后因素。在 127 例有复发的患者的亚组分析中，DM 与初始复发后生存率降低相关。
DM 似乎是肾透明细胞局限性 RCC 预后的一个重要决定因素，尤其是在有复发的患者中。
