title: Pre-existing type 2 diabetes mellitus is an independent risk factor for mortality and progression in patients with renal cell carcinoma.
abstract: Malignancies are one of the main causes of mortality in diabetic patients; however, to date, very limited data have been reported on the specific influence of type 2 diabetes mellitus (T2DM) on the survival of patients with renal cell carcinoma (RCC). In the present long-term retrospective study, we investigated whether T2DM may influence the overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) in patients with surgically treated RCC. Medical records of 924 patients treated by radical or partial nephrectomy for sporadic, unilateral RCC were reviewed. Patients with type-1 DM and with T2 DM receiving insulin treatment were excluded. Survival estimates were calculated according to the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate analyses were performed using the Cox regression model.Of the 924 RCC patients, 152 (16.5%) had T2DM. Mean follow-up was 68.5 months. Mean OS was 41.3 and 96.3 months in T2DM and non-T2DM patients, respectively (P < 0.0001).The estimated CSS rates at 1, 3, and 5 years in T2DM versus non-T2DM patients were 63.4% versus 76.7%, 30.4% versus 56.6%, and 16.3% versus 48.6%, respectively (P = 0.001). Mean PFS was significantly lower (31.5 vs 96.3 months; P < 0.0001) in the T2DM group. At multivariate analysis, T2DM was an independent adverse prognostic factor for OS (hazard ratio [HR]  = 3.44; 95% confidence interval [CI]:2.40-4.92), CSS (HR = 6.39; 95% CI: 3.78-10.79), and PFS (HR = 4.71; 95% CI: 3.11-7.15). In conclusion, our findings suggest that patients with RCC and pre-existing T2DM have a shorter OS, increased risk of recurrence, and higher risk for kidney cancer mortality than those without diabetes.
authors.affiliation: From the Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari (AV, GL, MR, VG, MC, PS, PD, MB); Department of Medical and Surgical Sciences, Nephrology, Dialysis and Transplantation Unit, University of Foggia, Foggia (GG, ER); Department of Emergency and Organ Transplantation - Nephrology, Dialysis and Transplantation Unit (SS, MC, GP); and Department of Pathology, University of Bari, Bari, Italy (GL).
authors.forename: Antonio
authors.initials: A
authors.lastname: Vavallo
authors.forename: Simona
authors.initials: S
authors.lastname: Simone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucarelli
authors.forename: Monica
authors.initials: M
authors.lastname: Rutigliano
authors.forename: Vanessa
authors.initials: V
authors.lastname: Galleggiante
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grandaliano
authors.forename: Loreto
authors.initials: L
authors.lastname: Gesualdo
authors.forename: Marcello
authors.initials: M
authors.lastname: Campagna
authors.forename: Marica
authors.initials: M
authors.lastname: Cariello
authors.forename: Elena
authors.initials: E
authors.lastname: Ranieri
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pertosa
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lastilla
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Selvaggi
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ditonno
authors.forename: Michele
authors.initials: M
authors.lastname: Battaglia
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors