Deng Zhengyi, Zhang Chiyuan Amy, Moore Justin X, Khan Saira, Graff Rebecca E, Batai Ken, Bondy Melissa L, Chung Benjamin I, Langston Marvin E
Department of Urology, Stanford University School of Medicine, Palo Alto, California, USA.
Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
Cancer. 2025 Apr 1;131(7):e35763. doi: 10.1002/cncr.35763.
Increased body mass index (BMI) in midlife is a recognized risk factor for renal cell carcinoma (RCC), but data on lifetime BMI patterns and their associations with RCC and subtypes remain limited.
In the National Institutes of Health-American Association of Retired Persons Diet and Health Study (n = 204,364), the authors evaluated lifetime body weight patterns using: 1) BMI at ages 18, 35, 50, and baseline (mean [SD]: 61.6 [5.3] years); 2) BMI trajectory across adulthood; 3) cumulative exposure to excess weight, measured as weighted years overweight/obese (WYO); and 4) BMI change between specific ages. Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for overall RCC (n = 1425), aggressive RCC (n = 583), fatal RCC (n = 339), and histologic subtypes, including clear cell RCC (ccRCC, n = 541), papillary RCC (pRCC, n = 146), and chromophobe RCC (chRCC, n = 64).
Higher BMI at all ages was associated with greater hazard of overall RCC and all subtypes (HR, 1.10-1.40 per 5-unit increase), except chRCC (HR, 0.80-0.98). Similar patterns were observed for BMI trajectories indicating weight gain during adulthood to overweight/obesity, compared to maintaining normal BMI. Higher WYO (per SD increase) was associated with an elevated hazard of overall RCC (HR, 1.17; 95% CI, 1.12-2.22), aggressive RCC (HR, 1.21; 95% CI, 1.13-1.29), fatal RCC (HR, 1.16; 95% CI, 1.06-1.27), and ccRCC (HR, 1.20; 95% CI, 1.13-1.30), but not pRCC (HR, 1.13; 95% CI, 0.97-1.32) and chRCC (HR, 0.92; 95% CI, 0.68-1.25). BMI reduction of ≥10%, particularly after age 50 (HR, 0.72; 95% CI, 0.52-0.99), was associated with lower RCC hazard.
Lifetime excess weight and adult weight gain were associated with increased risk of RCC, particularly ccRCC, whereas weight loss was associated with reduced risk.
中年时体重指数（BMI）升高是肾细胞癌（RCC）公认的危险因素，但关于终生BMI模式及其与RCC及其亚型的关联的数据仍然有限。
在美国国立卫生研究院-美国退休人员协会饮食与健康研究（n = 204,364）中，作者使用以下方法评估终生体重模式：1）18岁、35岁、50岁和基线时的BMI（平均[标准差]：61.6 [5.3]岁）；2）成年期的BMI轨迹；3）累积超重暴露，以加权超重/肥胖年数（WYO）衡量；4）特定年龄之间的BMI变化。Cox模型估计了总体RCC（n = 1425）、侵袭性RCC（n = 583）、致命性RCC（n = 339）以及组织学亚型（包括透明细胞RCC（ccRCC，n = 541）、乳头状RCC（pRCC，n = 146）和嫌色细胞RCC（chRCC，n = 64））的风险比（HRs）和95%置信区间（CIs）。
所有年龄段较高的BMI与总体RCC和所有亚型的更高风险相关（每增加5个单位，HR为1.10 - 1.40），但嫌色细胞癌（chRCC）除外（HR为0.80 - 0.98）。与维持正常BMI相比，BMI轨迹显示成年期体重增加至超重/肥胖的情况也观察到类似模式。较高的WYO（每标准差增加）与总体RCC（HR，1.17；95% CI，1.12 - 2.22）、侵袭性RCC（HR，1.21；95% CI，1.13 - 1.29）、致命性RCC（HR，1.16；95% CI，1.06 - 1.27）和ccRCC（HR，1.20；95% CI，1.13 - 1.30）的风险升高相关，但与pRCC（HR，1.13；95% CI，0.97 - 1.32）和chRCC（HR，0.92；95% CI，0.68 - 1.25）无关。BMI降低≥10%，特别是在50岁以后（HR，0.72；95% CI，0.52 - 0.99），与较低的RCC风险相关。
终生超重和成年期体重增加与RCC风险增加相关，尤其是ccRCC，而体重减轻与风险降低相关。
