Diabetes, Obesity, and Pathologic Upstaging in Renal Cell Carcinoma: Results from a large multi-institutional consortium

J Urol. 2023 Aug 14:101097JU0000000000003650. doi: 10.1097/JU.0000000000003650. Online ahead of print.

ABSTRACT

BACKGROUND: To determine whether clinical risk factors and morphometric features on pre-operative imaging can be utilized to identify those patients with cT1 tumors who are at higher risk of upstaging (pT3a).

METHODS: A retrospective international case control study of consecutive patients treated surgically with radical or partial nephrectomy for non-metastatic RCC (cT1 N0) conducted between January 2010 and December 2018. Multivariable logistic regression models were used to study associations of pre-operative risk factors on pT3a pathological upstaging among all patients, as well as subsets with those with pre-operative tumors <4cm, renal nephrometry scores, tumors <4cm with nephrometry scores, and clear cell histology. We also examined association with pT3a subsets (renal vein, sinus fat, perinephric fat).Resultsand Limitations: Among the 4092 PN and 2056 RN patients, pathologic upstaging occurred in 4.9% and 23.3% patients, respectively. Among each group independent factors associated with pT3a upstaging were increasing preoperative tumor size, increasing age, and the presence of diabetes. Specifically, among PN subjects diabetes (odds ratio, OR =1.65; 95% CI 1.17,2.29), male sex (OR = 1.62; 95% CI 1.14,2.33), and increasing BMI (OR =1.03; 95%CI 1.00,1.05 per one unit BMI) were statistically associated with upstaging. Subset analyses identified hilar tumors as more likely to be upstaged (PN OR = 1.91; 95%CI 1.12,3.16 | RN OR = 2.16; 95% 1.44, 3.25).

CONCLUSIONS: Diabetes and higher BMI were associated with pathologic upstaging, as were preoperative tumor size, increased age, and male sex. Similarly, hilar tumors were frequently upstaged.

PMID:37579345 | DOI:10.1097/JU.0000000000003650