title: Hypoalbuminaemia is associated with mortality in patients undergoing cytoreductive nephrectomy.
abstract: OBJECTIVE
  To evaluate whether poor nutrition is associated with mortality in patients undergoing cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC).
  
  
  METHODS
  A multi-institutional review of prospective databases identified 246 patients meeting inclusion criteria who underwent CN for mRCC from 1993 to 2012. Nutritional markers evaluated were: body mass index <18.5 kg/m(2) , serum albumin <3.5 g/dL, or preoperative weight loss of ≥5% of body weight. Primary outcomes were overall (OS) and disease-specific survival (DSS). Secondary outcome was 'early mortality' defined as death at ≤6 months of surgery. Survival curves were estimated using the Kaplan-Meier product-limit method and multivariate analysis using logistic regression was used to test associations between nutritional markers and survival outcomes.
  
  
  RESULTS
  In all, 119 patients (median follow-up 17 months) were categorised as having any abnormal nutrition parameter (48%). Hypoalbuminaemia was the only independent predictor of OS and DSS (OS: median 8 vs 23 months, P < 0.001; DSS: 11 vs 33 months, P < 0.001). On multivariate analysis, hypoalbuminaemia remained a significant predictor of death for both overall [hazard ratio (HR) 2, 95% confidence interval (CI) 1.4-2.8; P < 0.001) and disease-specific mortality (HR 2.2, 95% CI 1.4-3.3; P < 0.001). Hypoalbuminaemia was also associated with early mortality (overall: P < 0.001 and disease specific: P = 0.002).
  
  
  CONCLUSIONS
  Patients with mRCC and hypoalbuminaemia undergoing CN have decreased OS and CSS, and increased risk of all-cause and disease-specific early mortality. As such, serum albumin may help risk stratify patients selected as candidates for CN. Furthermore, future work should evaluate whether nutritional depletion is a modifiable risk factor.
authors.affiliation: Department of Urology, SUNY Stony Brook Medical Center, Stony Brook, NY, USA.
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Corcoran
authors.affiliation: Department of Urology, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Kaffenberger
authors.affiliation: Department of Urology, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
authors.affiliation: Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Walton
authors.affiliation: Biostatistics & Bioinformatics Facility, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Handorf
authors.affiliation: Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
authors.forename: Zack
authors.initials: Z
authors.lastname: Piotrowski
authors.affiliation: Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
authors.forename: Jeffery J
authors.initials: JJ
authors.lastname: Tomaszewski
authors.affiliation: Department of Urology, Einstein Healthcare Network/Urologic Institute of Southeastern Pennsylvania, Philadelphia, PA, USA.
authors.forename: Serge
authors.initials: S
authors.lastname: Ginzburg
authors.affiliation: Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Mehrazin
authors.affiliation: Medical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Plimack
authors.affiliation: Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
authors.forename: David Y T
authors.initials: DY
authors.lastname: Chen
authors.affiliation: Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.affiliation: Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
authors.affiliation: Department of Urology, University of Michigan School of Medicine, Ann Arbor, MI, USA.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Morgan
authors.affiliation: Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D007680:Kidney Neoplasms / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000401:mortality* / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: cytoreductive nephrectomy; metastatic renal cell carcinoma; nutritional status; survival; systemic therapy