Influence of Body Mass Index, Smoking, and Blood Pressure on Survival of Patients with Surgically-Treated, Low Stage Renal Cell Carcinoma: A 14-Year Retrospective Cohort Study

Abstract

The association of body mass index, smoking, and blood pressure, which are related to the three well-established risk factors of renal cell carcinoma, and survival in patients with renal cell carcinoma is not much studied. Our objective was to evaluate this association. A cohort of 1,036 patients with low stage (pT1 and pT2) renal cell carcinoma who underwent radical or partial nephrectomy were enrolled. We retrospectively reviewed medical records and collected survival data. The body mass index, smoking status, and blood pressure at the time of surgery were recorded. Patients were grouped according to their obesity grade, smoking status, and hypertension stage. Survival analysis showed a significant decrease in overall (P = 0.001) and cancer-specific survival (P < 0.001) with being underweight, with no differences of smoking status or perioperative blood pressure. On multivariate analysis, perioperative blood pressure ≥ 160/100 mmHg (HR, 2.642; 95% CI, 1.221-5.720) and being underweight (HR, 4.320; 95% CI, 1.557-11.984) were independent predictors of overall and cancer-specific mortality, respectively. Therefore, it is concluded that being underweight and perioperative blood pressure ≥ 160/100 mmHg negatively affect cancer-specific and overall survival, respectively, while smoking status does not influence survivals in patients with renal cell carcinoma.

Intraoperative hypotension is associated with shortened overall survival after lung cancer surgery

“…Perioperative hypertension is associated with an increased risk of adverse events, including cardiovascular morbidity or even death [26,27]. Regarding long-term outcome, it was reported that pre-and postoperative hypertension negatively affects long-term survival in patients after renal or rectal cancer surgery [12,13]. However, the opposite effects of intraoperative hypertension were also reported.…”

“…Second, microenvironmental hypoxia, which is a common feature in solid cancer [33], might have been aggravated by intraoperative hypotension and thus promoted cancer aggressiveness and metastasis via hypoxia inducible factor mechanisms [34,35]. Third, hypoxia resulting from intraoperative hypotension might have augmented systematic inflammation [36] which enhances cancer recurrence and cancer-related death [37]. Interestingly, a recent study showed that individualized intraoperative blood pressure management reduced systemic inflammatory response syndrome and organ dysfunction after surgery…”

The Nephrologist's Management of Renal Cell Carcinoma After Kidney Surgery

“…Although obesity is considered a risk factor for RCC, survival has been shown to be more favorable in patients with a BMI that is higher than the underweight category. 53 Therefore, overaggressive weight reduction may not be beneficial.…”

Renal cell carcinoma: links and risks

“…[66][67][68][69][70] Perioperative blood pressure $150/100 mmHg negatively affects the overall survival in Korean patients with RCC. 46 Yet, in a study of RCC cases in the USA, a self-reported history of hypertension was associated with a better overall survival. 71 The biological mechanism underlying the relationship between elevated blood pressure and increased risk of RCC remains unknown.…”

“…44,45 Furthermore, Korean and German studies suggest that being underweight at the time of surgery worsens cancer-specific survival by more than four times that of normal weight individuals. 46,47 BMI is an imperfect measurement of body fat as it does not distinguish between fat and muscle and between visceral and subcutaneous fat. Based on the results of multiple Japanese studies, visceral obesity rather than BMI may be a more useful predictor of disease-recurrence survival rather than BMI since high visceral fat has been associated with longer cancer-specific survival and overall survival.…”