Prognostic significance of visceral obesity in patients with advanced renal cell carcinoma undergoing nephrectomy

Lee, Hye Won; Jeong, Byong Chang; Seo, Seong Il; Jeon, Seong Soo; Lee, Hyun Moo; Choi, Han Yong; Jeon, Hwang Gyun

doi:10.1111/iju.12716

Cited by 50 publications

(57 citation statements)

References 27 publications

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“…This result is consistent with Antoun et al who reported that a high amount of subcutaneous adipose tissue independently and significantly associates with longer survival in 120 prostate cancer patients (Antoun et al , 2015). Controversy remains regarding the association between visceral adiposity and cancer survival as visceral adipose tissue is reported to be associated with poorer survival in patients with hepatocellular carcinoma (Fujiwara et al , 2015) or with better prognosis (Kaneko et al , 2015; Lee et al , 2015) in advanced renal cell carcinomas. Adiposity variables such as visceral to subcutaneous adipose tissue ratio have been applied in previous studies (Fujiwara et al , 2015).…”

Section: Discussionmentioning

confidence: 99%

“…Studies assessing the effect of adiposity, either visceral or subcutaneous, on cancer survival have yielded inconsistent results (Rickles et al , 2013; Fujiwara et al , 2015; Kaneko et al , 2015; Lee et al , 2015). Small sample sizes, lack of cancer-specific cut offs associated with survival, exclusion of conventional or body composition variables associated with survival in multivariate analysis as well as focusing on short- or long-term mortality as an outcome contribute to inconsistent results.…”

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confidence: 99%

“…Small sample sizes, lack of cancer-specific cut offs associated with survival, exclusion of conventional or body composition variables associated with survival in multivariate analysis as well as focusing on short- or long-term mortality as an outcome contribute to inconsistent results. Previous studies have applied cut-offs derived from renal cell carcinoma patients in an Asian population (Kaneko et al , 2015; Lee et al , 2015) that may not be generalizable to all cancer populations or to non-Asians. Moreover, adipose tissue distribution differs by sex (Wajchenberg, 2000), which demonstrates the need to apply sex-specific cut offs.…”

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Subcutaneous adiposity is an independent predictor of mortality in cancer patients

et al. 2017

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Background:Prognostic significance of adiposity, at the time of cancer diagnosis, on survival is not clear. Body mass index (kg m−2) does not provide an appropriate assessment of body composition; therefore, the concept of the ‘obesity paradox’ needs to be investigated based on the prognostic significance of fat and muscle. Independent prognostic significance of adipose tissue in predicting mortality, importance of visceral and subcutaneous adiposity in the presence and absence of sarcopenia on survival, was investigated.Methods:Adiposity markers including total adipose index (TATI), visceral adipose tissue index (VATI) and subcutaneous adipose tissue index (SATI) were estimated for 1473 gastrointestinal and respiratory cancer patients and 273 metastatic renal cell carcinoma patients using computed tomography. Univariate and multivariate analysis to determine mortality hazard ratios (HR) were conducted using cox proportional hazard models.Results:Low SATI (SATI <50.0 cm2 m−2 in males and <42.0 cm2 m−2 in females) independently associated with increased mortality (HR: 1.26; 95% CI: 1.11–1.43; P<0.001) and shorter survival (13.1 months; 95% CI, 11.4–14.7) compared to patients with high SATI (19.3 months; 95% CI, 17.6–21.0; P<0.001). In the presence of sarcopenia, the longest survival was observed in patients with high subcutaneous adiposity.Conclusions:Subcutaneous adipose tissues appear to associate with reduction in mortality risk demonstrating the prognostic importance of fat distribution. The effect of sarcopenia on survival was more pronounced in patients with low subcutaneous adiposity.

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Section: Discussionmentioning

confidence: 99%

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Subcutaneous adiposity is an independent predictor of mortality in cancer patients

et al. 2017

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“…Nowadays, body composition, including adipose tissue and skeletal muscle, can be directly evaluated using CT imaging, especially in the surgical field. Although recent studies have shown that a higher visceral fat area (VFA) evaluated using CT imaging was significantly associated with poor survival in several cancers [42][43][44][45][46], the association between VFA and prognosis remains controversial [47][48][49]. Our previous study also evaluated the VFA for a definition of visceral obesity, and obesity was considered present when the VFA was ≥100 cm 2 in both males and females [50].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Visceral Adiposity and Muscularity Predict Poor Outcomes after Hepatectomy for Hepatocellular Carcinoma

et al. 2018

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Objective: Visceral adiposity, defined as a high visceral-to-subcutaneous adipose tissue area ratio (VSR), has been shown to be associated with poor outcomes in several cancers. However, in the surgical field, the significance of visceral adiposity remains controversial. The present study investigated the impact of visceral adiposity as well as sarcopenic factors (low muscularity) on outcomes in patients undergoing hepatectomy for hepatocellular carcinoma (HCC). Patients and Methods: This retrospective study analyzed data from 606 patients undergoing hepatectomy for HCC at our institution between April 2005 and March 2016. Using preoperative plain computed tomography imaging at the level of the third lumbar vertebra, visceral adiposity, skeletal muscle mass, and muscle quality were evaluated by the VSR, skeletal muscle mass index (SMI), and intramuscular adipose tissue content (IMAC), respectively. The impact of these parameters on outcomes after hepatectomy for HCC was analyzed. Results: The overall survival rate was significantly lower among patients with a high VSR (p < 0.001) than among patients with a normal VSR. Similarly, the recurrence-free survival rate was significantly lower among patients with a high VSR (p = 0.016). A high VSR, low SMI, and high IMAC contributed to an increased risk of death (p < 0.001) and HCC recurrence (p < 0.001) in an additive manner. Multivariate analysis showed that not only preoperative low muscularity but also visceral adiposity was a significant risk factor for mortality (hazard ratio [HR] = 1.566, p < 0.001) and HCC recurrence (HR = 1.329, p = 0.020) after hepatectomy for HCC. Conclusions: Preoperative visceral adiposity, as well as low muscularity, was closely related to poor outcomes after hepatectomy for HCC. It is crucial to establish a new strategy including perioperative nutritional interventions with rehabilitation for better outcomes after hepatectomy for HCC.

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“…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. [48][49][50] Multiple mechanisms linking obesity to increased risk of RCC have been proposed. Adipose tissue secretes molecules known as adipokines into the blood stream, which play a role in energy balance, macromolecule metabolism, Kabaria et al and signaling to the rest of the body.…”

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confidence: 99%

Renal cell carcinoma: links and risks

Kabaria¹,

Klaassen²,

Terris³

2016

IJNRD

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This review provides an overview of the incidence of renal cell carcinoma (RCC) and a summary of the most commonly associated risk factors. A literature review was performed with a focus on recent studies with a high level of evidence (large prospective cohort studies and meta-analyses). The incidence rate of RCC varies globally, with the rate rising rapidly in more developed regions, demonstrating the effects of increased use of diagnostic imaging and prevalence of modifiable risk factors. Based on the current evidence, cigarette smoking, obesity, and hypertension are the most well-established risk factors for sporadic RCC worldwide. Acquired cystic kidney disease is also a significant risk factor, specifically in dialysis patients. There is increasing evidence for an inverse association between RCC risk and moderate alcohol consumption. Certain analgesics and occupational exposure have been linked to an increased risk of RCC, although data are limited. Diets rich in fruits and vegetables may provide a protective effect.

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Prognostic significance of visceral obesity in patients with advanced renal cell carcinoma undergoing nephrectomy

Cited by 50 publications

References 27 publications

Subcutaneous adiposity is an independent predictor of mortality in cancer patients

Subcutaneous adiposity is an independent predictor of mortality in cancer patients

Preoperative Visceral Adiposity and Muscularity Predict Poor Outcomes after Hepatectomy for Hepatocellular Carcinoma

Renal cell carcinoma: links and risks

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