Preoperative nutritional status is an important predictor of survival in patients undergoing surgery for renal cell carcinoma.
Preoperative nutritional status is an important predictor of survival in patients undergoing surgery for renal cell carcinoma.
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DOI：
10.1016/j.eururo.2011.01.034
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发表时间：
2011-06
期刊：
影响因子：
23.4
通讯作者：
Clark, Peter E.
中科院分区：
文献类型：
--
作者：
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., Jr.;Clark, Peter E.
营养不良对接受肾细胞癌 (RCC) 手术的患者的影响尚未得到充分研究。我们的目的是评估营养缺乏（ND）是否是肾细胞癌术后生存的重要决定因素。 2003年至2008年，共有369名连续患者接受了局部肾细胞癌手术。ND定义为满足以下标准之一：体重指数<18.5 kg/m2，白蛋白<3.5 g/dl，或术前体重减轻≥体重的5%。所有患者均接受根治性或部分肾切除术。主要结局是总体死亡率和疾病特异性死亡率。协变量包括年龄、查尔森合并症指数（CCI）、术前贫血、肿瘤分期、Fuhrman 分级和淋巴结状态。使用 Cox 比例风险模型进行多变量分析。使用 Kaplan-Meier 乘积限制法估计死亡率。 85 名患者 (23%) 被归类为 ND。 ND 队列的三年总体生存率和疾病特异性生存率分别为 58.5% 和 80.4%，而对照组的三年总体生存率和疾病特异性生存率分别为 85.4% 和 94.7%（p < 0.001）。在校正年龄、CCI、术前贫血、分期、分级和淋巴结状态后，ND 仍然是总体死亡率（风险比 [HR]：2.41，95% 置信区间 [CI]，1.40-4.18）和疾病特异性死亡率（HR：2.76；95% CI，1.17-6.50）的重要预测因子。这项研究因其回顾性而受到限制。 ND 与接受局部肾细胞癌手术的患者较高的死亡率相关，与关键的临床和病理因素无关。鉴于这种死亡风险，术前解决营养状况并为患者提供适当的建议可能很重要。
The role of malnutrition has not been well studied in patients undergoing surgery for renal cell carcinoma (RCC). Our aim was to evaluate whether nutritional deficiency (ND) is an important determinant of survival following surgery for RCC. 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. All patients underwent radical or partial nephrectomy. 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. Eighty-five patients (23%) were categorized as ND. Three-year overall and disease-specific survival was 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. 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.
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