title: 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.
  
  
  METHODS
  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/m(2), albumin <3.5 g/dl, or preoperative weight loss ≥ 5% of body weight.
  
  
  METHODS
  All patients underwent radical or partial nephrectomy.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN 37215, USA. todd.morgan@vanderbilt.edu
authors.forename: Todd M
authors.initials: TM
authors.lastname: Morgan
authors.forename: Dominic
authors.initials: D
authors.lastname: Tang
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Stratton
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Anderson
authors.forename: Justin R
authors.initials: JR
authors.lastname: Gregg
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: S Duke
authors.initials: SD
authors.lastname: Herrell
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000401:mortality*; D009752:Nutritional Status; D057234:Preoperative Period; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D015996:Survival Rate; D013714:Tennessee; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D015415:Biomarkers; D012709:Serum Albumin