title: Diabetes Mellitus as an Independent Predictor of Survival of Patients Surgically Treated for Renal Cell Carcinoma: A Propensity Score Matching Study.
abstract: OBJECTIVE
  Controversy continues about the prognostic significance of diabetes mellitus in patients with renal cell carcinoma. We investigated the relationship between diabetes mellitus and prognosis in patients with renal cell carcinoma who underwent surgical treatment.
  
  
  METHODS
  We reviewed data on 3,075 consecutive patients treated with radical or partial nephrectomy for nonmetastatic renal cell carcinoma from 1988 to 2013. The propensity score of a diabetes mellitus history was calculated and 417 patients with diabetes were matched to 814 without diabetes in a 1:2 ratio. The potential association of preexisting diabetes and preoperative HbA1c with outcomes was tested. Univariate and multivariate analyses were performed to identify independent predictors of progression-free, cancer specific and overall survival.
  
  
  RESULTS
  Before matching, patients with diabetes showed worse prognosis in terms of progression-free, overall and cancer specific survival (each p<0.001). In matched cohorts 1,231 patients with diabetes showed progression-free (p=0.001), cancer specific (p<0.001) and overall survival (p<0.001) inferior to that in patients without diabetes. On multivariate analyses diabetes was an independent predictor of disease progression (HR 1.766 p=0.002), all cause mortality (OR 1.825, p=0.001) and cancer specific mortality (HR 2.266, p=0.001). Among patients with diabetes who had available preoperative HbA1c data high HbA1c independently predicted postoperative disease progression (HR 2.221, p=0.023).
  
  
  CONCLUSIONS
  Diabetes mellitus is an independent predictor of cancer specific and overall survival in patients who undergo surgery for renal cell carcinoma. Also, in patients with diabetes mellitus poor glycemic control is associated with a higher risk of progression.
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Urology, Seoul National University Hospital (CK, HHK), Seoul, Republic of Korea.
authors.forename: Hakmin
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Urology, Seoul National University Hospital (CK, HHK), Seoul, Republic of Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Urology, Seoul National University Hospital (CK, HHK), Seoul, Republic of Korea.
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Urology, Seoul National University Hospital (CK, HHK), Seoul, Republic of Korea.
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Urology, Seoul National University Hospital (CK, HHK), Seoul, Republic of Korea.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Urology, Seoul National University Hospital (CK, HHK), Seoul, Republic of Korea. Electronic address: skhong@snubh.org.
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D048909:Diabetes Complications / Q000401:mortality*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009392:Nephrectomy; D011379:Prognosis; D057216:Propensity Score; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: carcinoma; diabetes mellitus; disease progression; kidney; mortality; renal cell