Obstructive sleep apnea and Fuhrman grade in patients with clear cell renal cell carcinoma treated surgically.
OBJECTIVE
To assess the association between obstructive sleep apnea (OSA) and Fuhrman grade in patients with clear cell renal cell carcinoma (ccRCC). As secondary endpoints, we studied its association with tumor size, metastasis-free survival (MFS) and cancer-specific survival (CSS).


METHODS
We reviewed the databases of two tertiary care centers, identifying 2579 patients who underwent partial or radical nephrectomy for ccRCC between 1991 and 2014. Descriptive statistics were used to compare pathologic variables between patients with and without OSA. Linear and logistic regression models were used to assess the association of OSA with Fuhrman grade and tumor size. A Cox proportional hazards model was used to determine OSA association with MFS and CSS. A pathway analysis was performed on a cohort with available gene expression data.


RESULTS
In total, 172 patients (7 %) had self-reported OSA at diagnosis. More patients with OSA had high Fuhrman grade compared to those without OSA [51 vs. 38 %; 13 % risk difference; 95 % confidence interval (CI), 5-20 %; p = 0.003]. On multivariable analysis, the association remained significant (OR 1.41; 95 % CI 1.00-1.99; p = 0.048). OSA was not associated with tumor size (p > 0.5), MFS (p = 0.5) or CSS (p = 0.4). A trend toward vascular endothelial growth factor pathway enrichment was seen in OSA patients (p = 0.08).


CONCLUSIONS
OSA is associated with high Fuhrman grade in patients undergoing surgery for ccRCC. Pending validation of this novel finding in further prospective studies, it could help shape future research to better understand etiological mechanisms associated.
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.|Urology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
Antoni
A
Vilaseca
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
Daniel P
DP
Nguyen
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Emily A
EA
Vertosick
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
Renato B
RB
Corradi
Urology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
Mireia
M
Musquera
Urology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
Meritxell
M
Pérez
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
Nicola
N
Fossati
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Daniel D
DD
Sjoberg
Unit of Biophysics and Bioengineering, Universitat de Barcelona, Barcelona, Spain.
Ramon
R
Farré
Unit of Biophysics and Bioengineering, Universitat de Barcelona, Barcelona, Spain.
Isaac
I
Almendros
Pneumology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
Josep M
JM
Montserrat
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
Nicole E
NE
Benfante
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
A Ari
AA
Hakimi
Computational and Systems Biology, Genome Institute of Singapore, Singapore, Singapore.
Anders J
AJ
Skanderup
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.|Weill Cornell Medical College, New York, NY, USA.
Paul
P
Russo
Urology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
Antonio
A
Alcaraz
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA. touijera@mskcc.org.|Weill Cornell Medical College, New York, NY, USA. touijera@mskcc.org.
Karim A
KA
Touijer
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009392:Nephrectomy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015398:Signal Transduction / Q000235:genetics; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000235:genetics; D059467:Transcriptome; D047368:Tumor Burden; D042461:Vascular Endothelial Growth Factor A / Q000235:genetics
D042461:Vascular Endothelial Growth Factor A
Clear cell renal cell carcinoma; Intermittent hypoxia; Risk factors; Sleep apnea syndrome