Preoperative Nutritional Status Is an Important Predictor of Survival in Patients Undergoing Surgery for Renal Cell Carcinoma
Abstract Background The role of malnutrition has not been well studied in patients undergoing surgery for renal cell carcinoma (RCC). Objective Our aim was to evaluate whether nutritional deficiency (ND) is an important determinant of survival following surgery for RCC. Design, setting, and particip...
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| Veröffentlicht in: | European urology 2011-06, Vol.59 (6), p.923-928 |
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| creator | Morgan, Todd M Tang, Dominic Stratton, Kelly L Barocas, Daniel A Anderson, Christopher B Gregg, Justin R Chang, Sam S Cookson, Michael S Herrell, S. Duke Smith, Joseph A Clark, Peter E |
| description | Abstract Background The role of malnutrition has not been well studied in patients undergoing surgery for renal cell carcinoma (RCC). Objective Our aim was to evaluate whether nutritional deficiency (ND) is an important determinant of survival following surgery for RCC. Design, setting, and participants A total of 369 consecutive patients underwent surgery for locoregional RCC from 2003 to 2008. ND was defined as meeting one of the following criteria: body mass index |
| doi_str_mv | 10.1016/j.eururo.2011.01.034 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3085569</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0302283811000558</els_id><sourcerecordid>864781060</sourcerecordid><originalsourceid>FETCH-LOGICAL-c613t-31099788b71a8d0fbfd932d385b5beee2f022bef1613392640fd8405f900fb753</originalsourceid><addsrcrecordid>eNqFksGO0zAQhiMEYsvCGyDkC-LUMrbjxLkgoQqWSitYUfZsOc6kuKR2sZ1KPfDu66hlF7ggWfZhvvlnxv8UxUsKCwq0ertd4BjG4BcMKF1APrx8VMyorPm8FhU8LmbAgc2Z5PKieBbjFgC4aPjT4oJR1ogG6lnx6yag32PQyR6QfB5TsMl6pweyTjqNkawi0Y6sdnsfknaJZL6zJvlAfE_WYzjYQ4atIzdZAl2K5NZ1GDbeus0U32A4kj7jX3FSXeKQLx2MdX6nnxdPej1EfHF-L4vbjx--LT_Nr79crZbvr-emojzNOYWmqaVsa6plB33bdw1nHZeiFS0ish4Ya7GnmeYNq0roO1mC6BvIcC34ZfHupLsf2x12JvcZ9KD2we50OCqvrfo74ux3tfEHxUEKUTVZ4M1ZIPifI8akdjaaPIt26MeoZFXWkkIFmSxPpAk-xoD9fRUKajJObdXJODUZpyAfXua0V392eJ_026kMvD4DOho99EE7Y-MDV9Im9woPo2L-z4PFoKLJvpjsWkCTVOft_zr5V8AM1tlc8wceMW79GLKRUVEVmQK1npZs2jFK834JIfkdcRvQdg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>864781060</pqid></control><display><type>article</type><title>Preoperative Nutritional Status Is an Important Predictor of Survival in Patients Undergoing Surgery for Renal Cell Carcinoma</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Morgan, Todd M ; Tang, Dominic ; Stratton, Kelly L ; Barocas, Daniel A ; Anderson, Christopher B ; Gregg, Justin R ; Chang, Sam S ; Cookson, Michael S ; Herrell, S. Duke ; Smith, Joseph A ; Clark, Peter E</creator><creatorcontrib>Morgan, Todd M ; Tang, Dominic ; Stratton, Kelly L ; Barocas, Daniel A ; Anderson, Christopher B ; Gregg, Justin R ; Chang, Sam S ; Cookson, Michael S ; Herrell, S. Duke ; Smith, Joseph A ; Clark, Peter E</creatorcontrib><description>Abstract Background The role of malnutrition has not been well studied in patients undergoing surgery for renal cell carcinoma (RCC). Objective Our aim was to evaluate whether nutritional deficiency (ND) is an important determinant of survival following surgery for RCC. Design, setting, and participants A total of 369 consecutive patients underwent surgery for locoregional RCC from 2003 to 2008. ND was defined as meeting one of the following criteria: body mass index <18.5 kg/m2 , albumin <3.5 g/dl, or preoperative weight loss ≥5% of body weight. Intervention All patients underwent radical or partial nephrectomy. Measurements Primary outcomes were overall and disease-specific mortality. Covariates included age, Charlson comorbidity index (CCI), preoperative anemia, tumor stage, Fuhrman grade, and lymph node status. Multivariate analysis was performed using a Cox proportional hazards model. Mortality rates were estimated using the Kaplan-Meier product-limit method. Results and limitations Eighty-five patients (23%) were categorized as ND. Three-year overall and disease-specific survival were 58.5% and 80.4% in the ND cohort compared with 85.4% and 94.7% in controls, respectively ( p < 0.001). ND remained a significant predictor of overall mortality (hazard ratio [HR]: 2.41, 95% confidence interval [CI], 1.40–4.18) and disease-specific mortality (HR: 2.76; 95% CI, 1.17–6.50) after correcting for age, CCI, preoperative anemia, stage, grade, and nodal status. This study is limited by its retrospective nature. Conclusions ND is associated with higher mortality in patients undergoing surgery for locoregional RCC, independent of key clinical and pathologic factors. Given this mortality risk, it may be important to address nutritional status preoperatively and counsel patients appropriately.</description><identifier>ISSN: 0302-2838</identifier><identifier>EISSN: 1873-7560</identifier><identifier>DOI: 10.1016/j.eururo.2011.01.034</identifier><identifier>PMID: 21295907</identifier><identifier>CODEN: EUURAV</identifier><language>eng</language><publisher>Kidlington: Elsevier B.V</publisher><subject>Aged ; Biological and medical sciences ; Biomarkers - blood ; Body Mass Index ; Carcinoma, Renal Cell - complications ; Carcinoma, Renal Cell - mortality ; Carcinoma, Renal Cell - pathology ; Carcinoma, Renal Cell - surgery ; Disease-Free Survival ; Female ; Humans ; Hypoalbuminemia ; Kaplan-Meier Estimate ; Kidney Neoplasms - complications ; Kidney Neoplasms - mortality ; Kidney Neoplasms - pathology ; Kidney Neoplasms - surgery ; Kidneys ; Male ; Malnutrition ; Malnutrition - blood ; Malnutrition - complications ; Malnutrition - mortality ; Malnutrition - physiopathology ; Medical sciences ; Metabolic diseases ; Middle Aged ; Neoplasm Staging ; Nephrectomy ; Nephrectomy - adverse effects ; Nephrectomy - mortality ; Nephrology. Urinary tract diseases ; Nutritional Status ; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...) ; Preoperative Period ; Proportional Hazards Models ; Renal cell carcinoma ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Serum Albumin - analysis ; Survival Rate ; Tennessee ; Time Factors ; Treatment Outcome ; Tumors of the urinary system ; Urology ; Weight Loss</subject><ispartof>European urology, 2011-06, Vol.59 (6), p.923-928</ispartof><rights>European Association of Urology</rights><rights>2011 European Association of Urology</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.</rights><rights>2011 European Association of Urology. Published by Elsevier B.V. All rights reserved. 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c613t-31099788b71a8d0fbfd932d385b5beee2f022bef1613392640fd8405f900fb753</citedby><cites>FETCH-LOGICAL-c613t-31099788b71a8d0fbfd932d385b5beee2f022bef1613392640fd8405f900fb753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.eururo.2011.01.034$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24190850$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21295907$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Morgan, Todd M</creatorcontrib><creatorcontrib>Tang, Dominic</creatorcontrib><creatorcontrib>Stratton, Kelly L</creatorcontrib><creatorcontrib>Barocas, Daniel A</creatorcontrib><creatorcontrib>Anderson, Christopher B</creatorcontrib><creatorcontrib>Gregg, Justin R</creatorcontrib><creatorcontrib>Chang, Sam S</creatorcontrib><creatorcontrib>Cookson, Michael S</creatorcontrib><creatorcontrib>Herrell, S. Duke</creatorcontrib><creatorcontrib>Smith, Joseph A</creatorcontrib><creatorcontrib>Clark, Peter E</creatorcontrib><title>Preoperative Nutritional Status Is an Important Predictor of Survival in Patients Undergoing Surgery for Renal Cell Carcinoma</title><title>European urology</title><addtitle>Eur Urol</addtitle><description>Abstract Background The role of malnutrition has not been well studied in patients undergoing surgery for renal cell carcinoma (RCC). Objective Our aim was to evaluate whether nutritional deficiency (ND) is an important determinant of survival following surgery for RCC. Design, setting, and participants A total of 369 consecutive patients underwent surgery for locoregional RCC from 2003 to 2008. ND was defined as meeting one of the following criteria: body mass index <18.5 kg/m2 , albumin <3.5 g/dl, or preoperative weight loss ≥5% of body weight. Intervention All patients underwent radical or partial nephrectomy. Measurements Primary outcomes were overall and disease-specific mortality. Covariates included age, Charlson comorbidity index (CCI), preoperative anemia, tumor stage, Fuhrman grade, and lymph node status. Multivariate analysis was performed using a Cox proportional hazards model. Mortality rates were estimated using the Kaplan-Meier product-limit method. Results and limitations Eighty-five patients (23%) were categorized as ND. Three-year overall and disease-specific survival were 58.5% and 80.4% in the ND cohort compared with 85.4% and 94.7% in controls, respectively ( p < 0.001). ND remained a significant predictor of overall mortality (hazard ratio [HR]: 2.41, 95% confidence interval [CI], 1.40–4.18) and disease-specific mortality (HR: 2.76; 95% CI, 1.17–6.50) after correcting for age, CCI, preoperative anemia, stage, grade, and nodal status. This study is limited by its retrospective nature. Conclusions ND is associated with higher mortality in patients undergoing surgery for locoregional RCC, independent of key clinical and pathologic factors. Given this mortality risk, it may be important to address nutritional status preoperatively and counsel patients appropriately.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Body Mass Index</subject><subject>Carcinoma, Renal Cell - complications</subject><subject>Carcinoma, Renal Cell - mortality</subject><subject>Carcinoma, Renal Cell - pathology</subject><subject>Carcinoma, Renal Cell - surgery</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Humans</subject><subject>Hypoalbuminemia</subject><subject>Kaplan-Meier Estimate</subject><subject>Kidney Neoplasms - complications</subject><subject>Kidney Neoplasms - mortality</subject><subject>Kidney Neoplasms - pathology</subject><subject>Kidney Neoplasms - surgery</subject><subject>Kidneys</subject><subject>Male</subject><subject>Malnutrition</subject><subject>Malnutrition - blood</subject><subject>Malnutrition - complications</subject><subject>Malnutrition - mortality</subject><subject>Malnutrition - physiopathology</subject><subject>Medical sciences</subject><subject>Metabolic diseases</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Nephrectomy</subject><subject>Nephrectomy - adverse effects</subject><subject>Nephrectomy - mortality</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Nutritional Status</subject><subject>Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...)</subject><subject>Preoperative Period</subject><subject>Proportional Hazards Models</subject><subject>Renal cell carcinoma</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Serum Albumin - analysis</subject><subject>Survival Rate</subject><subject>Tennessee</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Tumors of the urinary system</subject><subject>Urology</subject><subject>Weight Loss</subject><issn>0302-2838</issn><issn>1873-7560</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFksGO0zAQhiMEYsvCGyDkC-LUMrbjxLkgoQqWSitYUfZsOc6kuKR2sZ1KPfDu66hlF7ggWfZhvvlnxv8UxUsKCwq0ertd4BjG4BcMKF1APrx8VMyorPm8FhU8LmbAgc2Z5PKieBbjFgC4aPjT4oJR1ogG6lnx6yag32PQyR6QfB5TsMl6pweyTjqNkawi0Y6sdnsfknaJZL6zJvlAfE_WYzjYQ4atIzdZAl2K5NZ1GDbeus0U32A4kj7jX3FSXeKQLx2MdX6nnxdPej1EfHF-L4vbjx--LT_Nr79crZbvr-emojzNOYWmqaVsa6plB33bdw1nHZeiFS0ish4Ya7GnmeYNq0roO1mC6BvIcC34ZfHupLsf2x12JvcZ9KD2we50OCqvrfo74ux3tfEHxUEKUTVZ4M1ZIPifI8akdjaaPIt26MeoZFXWkkIFmSxPpAk-xoD9fRUKajJObdXJODUZpyAfXua0V392eJ_026kMvD4DOho99EE7Y-MDV9Im9woPo2L-z4PFoKLJvpjsWkCTVOft_zr5V8AM1tlc8wceMW79GLKRUVEVmQK1npZs2jFK834JIfkdcRvQdg</recordid><startdate>20110601</startdate><enddate>20110601</enddate><creator>Morgan, Todd M</creator><creator>Tang, Dominic</creator><creator>Stratton, Kelly L</creator><creator>Barocas, Daniel A</creator><creator>Anderson, Christopher B</creator><creator>Gregg, Justin R</creator><creator>Chang, Sam S</creator><creator>Cookson, Michael S</creator><creator>Herrell, S. Duke</creator><creator>Smith, Joseph A</creator><creator>Clark, Peter E</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20110601</creationdate><title>Preoperative Nutritional Status Is an Important Predictor of Survival in Patients Undergoing Surgery for Renal Cell Carcinoma</title><author>Morgan, Todd M ; Tang, Dominic ; Stratton, Kelly L ; Barocas, Daniel A ; Anderson, Christopher B ; Gregg, Justin R ; Chang, Sam S ; Cookson, Michael S ; Herrell, S. Duke ; Smith, Joseph A ; Clark, Peter E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c613t-31099788b71a8d0fbfd932d385b5beee2f022bef1613392640fd8405f900fb753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Body Mass Index</topic><topic>Carcinoma, Renal Cell - complications</topic><topic>Carcinoma, Renal Cell - mortality</topic><topic>Carcinoma, Renal Cell - pathology</topic><topic>Carcinoma, Renal Cell - surgery</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Humans</topic><topic>Hypoalbuminemia</topic><topic>Kaplan-Meier Estimate</topic><topic>Kidney Neoplasms - complications</topic><topic>Kidney Neoplasms - mortality</topic><topic>Kidney Neoplasms - pathology</topic><topic>Kidney Neoplasms - surgery</topic><topic>Kidneys</topic><topic>Male</topic><topic>Malnutrition</topic><topic>Malnutrition - blood</topic><topic>Malnutrition - complications</topic><topic>Malnutrition - mortality</topic><topic>Malnutrition - physiopathology</topic><topic>Medical sciences</topic><topic>Metabolic diseases</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Nephrectomy</topic><topic>Nephrectomy - adverse effects</topic><topic>Nephrectomy - mortality</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Nutritional Status</topic><topic>Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...)</topic><topic>Preoperative Period</topic><topic>Proportional Hazards Models</topic><topic>Renal cell carcinoma</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Serum Albumin - analysis</topic><topic>Survival Rate</topic><topic>Tennessee</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Tumors of the urinary system</topic><topic>Urology</topic><topic>Weight Loss</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Morgan, Todd M</creatorcontrib><creatorcontrib>Tang, Dominic</creatorcontrib><creatorcontrib>Stratton, Kelly L</creatorcontrib><creatorcontrib>Barocas, Daniel A</creatorcontrib><creatorcontrib>Anderson, Christopher B</creatorcontrib><creatorcontrib>Gregg, Justin R</creatorcontrib><creatorcontrib>Chang, Sam S</creatorcontrib><creatorcontrib>Cookson, Michael S</creatorcontrib><creatorcontrib>Herrell, S. Duke</creatorcontrib><creatorcontrib>Smith, Joseph A</creatorcontrib><creatorcontrib>Clark, Peter E</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Morgan, Todd M</au><au>Tang, Dominic</au><au>Stratton, Kelly L</au><au>Barocas, Daniel A</au><au>Anderson, Christopher B</au><au>Gregg, Justin R</au><au>Chang, Sam S</au><au>Cookson, Michael S</au><au>Herrell, S. Duke</au><au>Smith, Joseph A</au><au>Clark, Peter E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative Nutritional Status Is an Important Predictor of Survival in Patients Undergoing Surgery for Renal Cell Carcinoma</atitle><jtitle>European urology</jtitle><addtitle>Eur Urol</addtitle><date>2011-06-01</date><risdate>2011</risdate><volume>59</volume><issue>6</issue><spage>923</spage><epage>928</epage><pages>923-928</pages><issn>0302-2838</issn><eissn>1873-7560</eissn><coden>EUURAV</coden><abstract>Abstract Background The role of malnutrition has not been well studied in patients undergoing surgery for renal cell carcinoma (RCC). Objective Our aim was to evaluate whether nutritional deficiency (ND) is an important determinant of survival following surgery for RCC. Design, setting, and participants A total of 369 consecutive patients underwent surgery for locoregional RCC from 2003 to 2008. ND was defined as meeting one of the following criteria: body mass index <18.5 kg/m2 , albumin <3.5 g/dl, or preoperative weight loss ≥5% of body weight. Intervention All patients underwent radical or partial nephrectomy. Measurements Primary outcomes were overall and disease-specific mortality. Covariates included age, Charlson comorbidity index (CCI), preoperative anemia, tumor stage, Fuhrman grade, and lymph node status. Multivariate analysis was performed using a Cox proportional hazards model. Mortality rates were estimated using the Kaplan-Meier product-limit method. Results and limitations Eighty-five patients (23%) were categorized as ND. Three-year overall and disease-specific survival were 58.5% and 80.4% in the ND cohort compared with 85.4% and 94.7% in controls, respectively ( p < 0.001). ND remained a significant predictor of overall mortality (hazard ratio [HR]: 2.41, 95% confidence interval [CI], 1.40–4.18) and disease-specific mortality (HR: 2.76; 95% CI, 1.17–6.50) after correcting for age, CCI, preoperative anemia, stage, grade, and nodal status. This study is limited by its retrospective nature. Conclusions ND is associated with higher mortality in patients undergoing surgery for locoregional RCC, independent of key clinical and pathologic factors. Given this mortality risk, it may be important to address nutritional status preoperatively and counsel patients appropriately.</abstract><cop>Kidlington</cop><pub>Elsevier B.V</pub><pmid>21295907</pmid><doi>10.1016/j.eururo.2011.01.034</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Biological and medical sciences Biomarkers - blood Body Mass Index Carcinoma, Renal Cell - complications Carcinoma, Renal Cell - mortality Carcinoma, Renal Cell - pathology Carcinoma, Renal Cell - surgery Disease-Free Survival Female Humans Hypoalbuminemia Kaplan-Meier Estimate Kidney Neoplasms - complications Kidney Neoplasms - mortality Kidney Neoplasms - pathology Kidney Neoplasms - surgery Kidneys Male Malnutrition Malnutrition - blood Malnutrition - complications Malnutrition - mortality Malnutrition - physiopathology Medical sciences Metabolic diseases Middle Aged Neoplasm Staging Nephrectomy Nephrectomy - adverse effects Nephrectomy - mortality Nephrology. Urinary tract diseases Nutritional Status Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...) Preoperative Period Proportional Hazards Models Renal cell carcinoma Retrospective Studies Risk Assessment Risk Factors Serum Albumin - analysis Survival Rate Tennessee Time Factors Treatment Outcome Tumors of the urinary system Urology Weight Loss |
| title | Preoperative Nutritional Status Is an Important Predictor of Survival in Patients Undergoing Surgery for Renal Cell Carcinoma |
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