title: Multi-institutional analysis of localized renal cell carcinoma that demonstrates the impact of diabetic status on prognosis after nephrectomy.
abstract: BACKGROUND
  The purpose of our study was to determine whether preoperative diabetes mellitus (DM) can predict the prognosis of localized clear-cell renal cell carcinoma (RCC).
  
  
  METHODS
  At five institutes, 2,597 patients with pT1 and pT2 clear-cell RCC were enrolled. Univariate and multivariable analyses were performed to determine factors that associated with recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). To identify the effect of DM on survival after recurrence, a subgroup of 127 patients who had recurrences was analyzed.
  
  
  RESULTS
  In total, 357 patients had DM. Compared with patients without DM, these patients were older, more likely to be male, and had a higher body mass index, lower GFR, and higher incidence of hypertension. Kaplan-Meier curves showed that patients with DM had a significantly worse rate of RFS, CSS, and OS than patients without DM (log-rank test, all P < 0.05). Multivariate analysis revealed that DM was an independent prognostic factor in terms of RFS, CSS, and OS. In the subgroup analysis of 127 patients with recurrence, DM was associated with a lower survival rate after the initial recurrence.
  
  
  CONCLUSIONS
  DM appeared to be an important determinant of prognosis in clear-cell localized RCC, especially in patients experiencing recurrence.
authors.affiliation: Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.
authors.forename: Yun-Sok
authors.initials: YS
authors.lastname: Ha
authors.forename: Won Tae
authors.initials: WT
authors.lastname: Kim
authors.forename: Seok-Joong
authors.initials: SJ
authors.lastname: Yun
authors.forename: Sang-Cheol
authors.initials: SC
authors.lastname: Lee
authors.forename: Wun-Jae
authors.initials: WJ
authors.lastname: Kim
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Park
authors.forename: Seok Ho
authors.initials: SH
authors.lastname: Kang
authors.forename: Sung-Hoo
authors.initials: SH
authors.lastname: Hong
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.forename: Yong-June
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000401:mortality* / Q000601:surgery; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D007680:Kidney Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000401:mortality*; D011379:Prognosis; D015996:Survival Rate