Original Article

Comorbidity Is a Competing Factor for Disease Recurrence Postnephrectomy

Authors: Lael Reinstatler, MD, MPH, Zachary Klaassen, MD, Rabii Madi, MD, Martha K. Terris, MD, Kelvin A. Moses, MD, PhD

Abstract

Objective: There is a relation between tumor stage and grade with the risk of cancer recurrence in patients undergoing surgical treatment for kidney cancer. The association of patient comorbidity with disease recurrence is less well characterized. The objective of this study was to explore the association between comorbidity and the recurrence of kidney cancer.

Methods: We performed a retrospective analysis of 263 patients who received a partial or radical nephrectomy from January 1, 2000 through April 30, 2013. Patient data included race, sex, body mass index, age-adjusted Charlson Comorbidity Index (aaCCI) score, tumor histology, tumor T classification, and Fuhrman grade. The primary outcome was cancer recurrence, either local or distant. Logistic regression was used to assess the association of these risk factors with the outcome.

Results: The median follow-up time was 19.6 months (interquartile range 5.2–53.7). There were 101 (38.4%) African American patients and 150 (57.0%) men. The median body mass index was 28.3 and the median aaCCI was 3.0. The Fuhrman grade was G1 in 9.5% of patients, G2 in 45.2%, G3 in 32.8%, and G4 in 12.5%. Nineteen (7.2%) patients experienced disease recurrence, including 13 (4.9%) patients with metastatic disease. The risk factors significantly associated with recurrence included Fuhrman grade (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.23–7.30), tumor T classification (OR 1.33, 95% CI 1.00–1.76), and CCI (OR 0.74, 95% CI 0.57–0.95).

Conclusions: Physiologic factors, in addition to tumor characteristics, play a significant role in predicting cancer-specific survival in patients with kidney cancer. The reduced odds of recurrence with higher aaCCI may indicate that competing health factors have an impact before recurrence on survival in certain patients.

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References

1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012;62:10-29.
 
2. Chow WH, Dong LM, Devesa SS. Epidemiology and risk factors for kidney cancer. Nat Rev Urol 2010;7:245-257.
 
3. Rodriguez-Covarrubias F, Gomez-Alvarado MO, Sotomayor M, et al. Time to recurrence after nephrectomy as a predictor of cancer-specific survival in localized clear-cell renal cell carcinoma. Urol Int 2011;86:47-52.
 
4. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA 2006;295:1549-1555.
 
5. Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003;348:1625-1638.
 
6. Adams KF, Leitzmann MF, Albanes D, et al. Body size and renal cell cancer incidence in a large US cohort study. Am J Epidemiol 2008;168:268-277.
 
7. Polednak AP. Estimating the number of U.S. incident cancers attributable to obesity and the impact on temporal trends in incidence rates for obesity-related cancers. Cancer Detect Prev 2008;32:190-199.
 
8. Chow WH, Gridley G, Fraumeni JF, Jr et al. Obesity, hypertension, and the risk of kidney cancer in men. N Engl J Med 2000;343:1305-1311.
 
9. Cindolo L, de la Taille A, Messina G, et al. A preoperative clinical prognostic model for non-metastatic renal cell carcinoma. BJU Int 2003;92:901-905.
 
10. Karakiewicz P, Suardi N, Capitanio U, et al. A preoperative prognostic model for patients treated with nephrectomy for renal cell carcinoma. Eur Urol 2009;55:287-295.
 
11. Raj GV, Thompson RH, Leibovich BC, et al. Preoperative nomogram predicting 12-year probability of metastatic renal cancer. J Urol 2008;179:2146-2151.
 
12. Kanao K, Mizuno R, Kikuchi E, et al. Preoperative prognostic nomogram (probability table) for renal cell carcinoma based on TNM classification. J Urol 2009;181:480-485.
 
13. Kattan MW, Reuter V, Motzer RJ, et al. A postoperative prognostic nomogram for renal cell carcinoma. J Urol 2001;166:63-67.
 
14. Zisman A, Pantuck AJ, Dorey F, et al. Improved prognostication of renal cell carcinoma using an integrated staging system. J Clin Oncol 2001;19:1649-1657.
 
15. Frank I, Blute ML, Cheville JC, et al. An outcome prediction model for patients with clear cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score. J Urol 2002;168:2395-2400.
 
16. Sorbellini M, Kattan MW, Snyder ME, et al. A postoperative prognostic nomogram predicting recurrence for patients with clear cell renal cell carcinoma. J Urol 2005;173:48-51.
 
17. Karakiewicz PI, Briganti A, Chun FK, et al. Multi-institutional validation of a new renal cancer-specific survival nomogram. J Clin Oncol 2007;25:1316-1322.
 
18. Sogaard M, Thomsen RW, Bossen KS, et al. The impact of comorbidity on cancer survival: a review. Clin Epidemiol 2013;5(Suppl 1):3-29.
 
19. Lund L, Jacobsen J, Norgaard M, et al. The prognostic impact of comorbidity on renal cancer, 1995 to 2006: a Danish population based study. J Urol 2009;185:35-40.
 
20. Berger DA, Megwalu II, Vlahiotis A, et al. Impact of comorbidity on overall survival in patients surgically treated for renal cell carcinoma. Urology 2008;72:359-363.
 
21. Santos Arrontes D, Fernández Acenero MJ, Garcia González JI, et al. Survival analysis of clear cell renal carcinoma according to the Charlson comorbidity index. J Urol 2008;179:857-861.
 
22. Gettman MT, Boelter CW, Cheville JC, et al. Charlson co-morbidity index as a predictor of outcome after surgery for renal cell carcinoma with renal vein, vena cava or right atrium extension. J Urol 2003;169:1282-1286.
 
23. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383.
 
24. Fukushima H, Masuda H, Yokoyama M, et al. Diabetes mellitus with obesity is a predictor of recurrence in patients with non-metastatic renal cell carcinoma. Jpn J Clin Oncol 2013;43:740-746.
 
25. Son HS, Jeon SH, Chang SG. Factors affecting the time to recurrence after radical nephrectomy for localized renal cell carcinoma. Korean J Urol 2013;54:744-749.
 
26. Patard JJ, Leray E, Rioux-Leclerq N, et al. Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience. J Clin Oncol 2005;23:2763-2771.
 
27. Pierorazio PM, Johnson MH, Patel HD, et al. Management of renal masses and localized renal cancer: systematic review and meta-analysis. J Urol 2016;196:989-999.
 
28. Hollingsworth JM, Miller DC, Diagnault S, et al. Five-year survival after surgical treatment for kidney cancer: a population-based competing risk analysis. Cancer 2007;109:1763-1768.
 
29. Sun M, Thuret R, Abdollah F, et al. Age-adjusted incidence, mortality, and survival rates of stage-specific renal cell carcinoma in North America: a trend analysis. Eur Urol 2011;59:135-141.
 
30. Ha YS, Kim WT, Yun SJ, et al. Multi-institutional analysis of localized renal cell carcinoma that demonstrates the impact of diabetic status on prognosis after nephrectomy. Ann Surg Oncol 2013;20:3662-3668.
 
31. Lopez-Beltran A, Scarpelli M, Montironi R, et al. 2004 WHO classification of the renal tumors of the adults. Eur Urol 2006;49:798-805.