Mp36-10 Unraveling the “Obesity Paradox” in Renal Cortical Tumors: Insights From the Inmarc Registry

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP36)1 May 2024MP36-10 UNRAVELING THE "OBESITY PARADOX" IN RENAL CORTICAL TUMORS: INSIGHTS FROM THE INMARC REGISTRY Cesare Saitta, Jonathan A. Afari, Mimi V. Nguyen, Kevin Hakimi, Dattatraya Patil, Hajime Tanaka, Julian Cortes, Margaret F. Meagher, Mirha Mahmood, Joshua Matian, Mariam Mansour, Dhruv Puri, Clara Cerrato, Kit L. Yuen, Masaki Kobayashi, Shohei Fukuda, Yasuhisa Fujii, Viraj Master, and Ithaar H. Derweesh Cesare SaittaCesare Saitta , Jonathan A. AfariJonathan A. Afari , Mimi V. NguyenMimi V. Nguyen , Kevin HakimiKevin Hakimi , Dattatraya PatilDattatraya Patil , Hajime TanakaHajime Tanaka , Julian CortesJulian Cortes , Margaret F. MeagherMargaret F. Meagher , Mirha MahmoodMirha Mahmood , Joshua MatianJoshua Matian , Mariam MansourMariam Mansour , Dhruv PuriDhruv Puri , Clara CerratoClara Cerrato , Kit L. YuenKit L. Yuen , Masaki KobayashiMasaki Kobayashi , Shohei FukudaShohei Fukuda , Yasuhisa FujiiYasuhisa Fujii , Viraj MasterViraj Master , and Ithaar H. DerweeshIthaar H. Derweesh View All Author Informationhttps://doi.org/10.1097/01.JU.0001008612.93052.9d.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Obesity has been reported as a risk factor for development of Renal Cell Carcinoma (RCC). Emerging reports also suggest that obesity may improve survival outcomes in RCC, a phenomenon known as the "obesity paradox". The preponderance of these data have come from cohorts predominantly of clear cell (ccRCC) histology, restricting the generalizability of findings regarding obesity and outcomes in non-ccRCC. We sought to compare and assess association of obesity with survival outcomes in ccRCC and non-ccRCC. METHODS: We queried the INMARC database for patients older than 18 years old with RCC. The following renal tumors were analyzed: ccRCC and non-ccRCC (papillary , chromophobe and variant histologies). Patients were stratified according to the most recent World Health Organization classification of obesity, defined as BMI >30 Kg/m2 in non-Asian, and BMI >27.5 Kg/m2 in Asian. Primary outcome was all-cause mortality (ACM); secondary outcome was cancer-specific mortality (CSM). Multivariable analysis (MVA) via Cox regression was conducted for ACM and CSM for ccRCC and non-ccRCC groups. An additional subset MVA analysis for ACM and CSM was conducted for the ccRCC cohort stratifying by AJCC stage (stage I-III and stage IV). RESULTS: 3,880 patients (2,895 ccRCC) were analyzed. MVA for ACM in ccRCC revealed tumor size (HR=1.04, p<0.001), and high-grade (HR=1.48, p<0.001) as risk factors, while obesity (HR=0.76, p=0.018) was associated with decreased ACM. Upon MVA for ACM in non-ccRCC obesity was not associated with decreased ACM (p=0.8). MVA for CSM in ccRCC revealed, tumor size (HR=1.05, p=0.003), stage (HR=5.30, p<0.001), high-grade (HR=2.71, p<0.001) as risk factors, while obesity (HR=0.70, p=0.04) was associated with decreased CSM. MVA for CSM in non-ccRCC revealed tumor size (HR=1.12, p<0.001) and stage (HR=6.75, p<0.001) as risk factors, while obesity was not (p=0.72). Stratifying by stage in ccRCC, obesity was associated with decreased ACM (HR=0.67, p=0.043) and CSM (HR=0.58, p=0.01) in stage IV ccRCC, but not in stage I-III (p=0.26; p=0.38 respectively). CONCLUSIONS: Our findings refute a broad applicability of the "obesity paradox" for RCC. Obesity was not associated with improved survival in non-ccRCC. In ccRCC, when stratified by stage, obesity was not associated with improved survival in localized disease and was only associated with improved outcomes in the subset of obese patients with metastatic RCC. Our findings call for further investigation into the mechanisms by which obesity may impact patients and systemic therapy in advanced RCC. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e595 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Cesare Saitta More articles by this author Jonathan A. Afari More articles by this author Mimi V. Nguyen More articles by this author Kevin Hakimi More articles by this author Dattatraya Patil More articles by this author Hajime Tanaka More articles by this author Julian Cortes More articles by this author Margaret F. Meagher More articles by this author Mirha Mahmood More articles by this author Joshua Matian More articles by this author Mariam Mansour More articles by this author Dhruv Puri More articles by this author Clara Cerrato More articles by this author Kit L. Yuen More articles by this author Masaki Kobayashi More articles by this author Shohei Fukuda More articles by this author Yasuhisa Fujii More articles by this author Viraj Master More articles by this author Ithaar H. Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...