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. 2014 Dec;93(27):e183.
doi: 10.1097/MD.0000000000000183.

Pre-existing type 2 diabetes mellitus is an independent risk factor for mortality and progression in patients with renal cell carcinoma

Antonio Vavallo  1 , Simona Simone, Giuseppe Lucarelli, Monica Rutigliano, Vanessa Galleggiante, Giuseppe Grandaliano, Loreto Gesualdo, Marcello Campagna, Marica Cariello, Elena Ranieri, Giovanni Pertosa, Gaetano Lastilla, Francesco Paolo Selvaggi, Pasquale Ditonno, Michele Battaglia
Affiliations

Pre-existing type 2 diabetes mellitus is an independent risk factor for mortality and progression in patients with renal cell carcinoma

Antonio Vavallo et al. Medicine (Baltimore). 2014 Dec.

Abstract

Malignancies are one of the main causes of mortality in diabetic patients; however, to date, very limited data have been reported on the specific influence of type 2 diabetes mellitus (T2DM) on the survival of patients with renal cell carcinoma (RCC). In the present long-term retrospective study, we investigated whether T2DM may influence the overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) in patients with surgically treated RCC. Medical records of 924 patients treated by radical or partial nephrectomy for sporadic, unilateral RCC were reviewed. Patients with type-1 DM and with T2 DM receiving insulin treatment were excluded. Survival estimates were calculated according to the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate analyses were performed using the Cox regression model.Of the 924 RCC patients, 152 (16.5%) had T2DM. Mean follow-up was 68.5 months. Mean OS was 41.3 and 96.3 months in T2DM and non-T2DM patients, respectively (P < 0.0001).The estimated CSS rates at 1, 3, and 5 years in T2DM versus non-T2DM patients were 63.4% versus 76.7%, 30.4% versus 56.6%, and 16.3% versus 48.6%, respectively (P = 0.001). Mean PFS was significantly lower (31.5 vs 96.3 months; P < 0.0001) in the T2DM group. At multivariate analysis, T2DM was an independent adverse prognostic factor for OS (hazard ratio [HR] = 3.44; 95% confidence interval [CI]:2.40-4.92), CSS (HR = 6.39; 95% CI: 3.78-10.79), and PFS (HR = 4.71; 95% CI: 3.11-7.15). In conclusion, our findings suggest that patients with RCC and pre-existing T2DM have a shorter OS, increased risk of recurrence, and higher risk for kidney cancer mortality than those without diabetes.

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Figures

FIGURE 1
FIGURE 1
Kaplan–Meier OS curves, stratified by T2DM and non-T2DM groups for the overall population (A). Kaplan–Meier OS curves for localized RCC (B). OS = overall survival, RCC = renal cell carcinoma, T2DM = type-2 diabetes mellitus.
FIGURE 2
FIGURE 2
Kaplan–Meier CSS curves, stratified by T2DM and non-T2DM groups for the overall population (A). Kaplan–Meier CSS curves localized RCC (B). CSS = cancer-specific survival, RCC = renal cell carcinoma, T2DM = type-2 diabetes mellitus.
FIGURE 3
FIGURE 3
Kaplan–Meier PFS curves, stratified by T2DM and non-T2DM groups for the overall population (A). Kaplan–Meier PFS curves for localized RCC (B). PFS = progression-free survival, RCC = renal cell carcinoma, T2DM = type-2 diabetes mellitus.
FIGURE 4
FIGURE 4
Kaplan–Meier CSS curves, stratified by T2DM and non-T2DM groups for radical (A) and partial nephrectomy (B). CSS = cancer-specific survival, T2DM = type-2 diabetes mellitus.
FIGURE 5
FIGURE 5
Kaplan–Meier PFS curves, stratified by T2DM and non-T2DM groups for radical (A) and partial nephrectomy (B). PFS = progression-free survival, T2DM = type-2 diabetes mellitus
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