title: Hypertension is the primary component of metabolic syndrome associated with pathologic features of kidney cancer.
abstract: OBJECTIVE
  To determine whether individual and/or cumulative components of metabolic syndrome (obesity, hypertension, dyslipidemia, and hyperglycemia) are associated with pathologic features of kidney cancer.
  
  
  METHODS
  A review of our kidney tumor database identified 462 patients who underwent partial or radical nephrectomy for renal cell carcinoma. The NCEP ATP-III criteria were used to define metabolic syndrome (MetS). Linear fixed effects modeling and ordinal logistic regression examined the relationship between MetS (individual and cumulative components) and pathologic characteristics.
  
  
  RESULTS
  Two hundred and seventy-eight men and 184 women with a median age of 58 years, BMI of 31 kg/m2, tumor size of 3.7 cm, and nephrometry score of 6 were included. Ninety-seven (21 %) patients met NCEP ATP-III criteria for MetS. Hypertension was the only individual component of MetS associated with pathologic features of kidney cancer including increased tumor size [geometric mean ratio 1.17 (1.05-1.32), P = 0.03], higher tumor grade [OR 1.49 (1.03-2.17), P = 0.04], increasing nephrometry score [OR 1.77 (1.28-2.48), P = 0.001], and non-clear cell histology [OR 1.42 (1.01-2.02), P = 0.05]. Furthermore, combinations of MetS components were associated with increased tumor grade (P = 0.02), tumor stage (P = 0.02), nephrometry score (P ≤ 0.001), and non-clear cell histology (P = 0.02), only when hypertension was included.
  
  
  CONCLUSIONS
  MetS is composed of four risk factors each implicated in carcinogenesis. We identified hypertension as the primary component associated with specific pathologic features of kidney cancer. Further studies are necessary to elucidate whether the effect of hypertension is a function of severity and/or chronicity.
authors.affiliation: Division of Urology, Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, H055, Hershey, PA, 17033-0850, USA.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Kocher
authors.affiliation: Division of Urology, Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, H055, Hershey, PA, 17033-0850, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Rjepaj
authors.affiliation: Division of Urology, Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, H055, Hershey, PA, 17033-0850, USA.
authors.forename: Haley
authors.initials: H
authors.lastname: Robyak
authors.affiliation: Division of Urology, Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, H055, Hershey, PA, 17033-0850, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Lehman
authors.affiliation: Division of Urology, Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, H055, Hershey, PA, 17033-0850, USA. jraman@hmc.psu.edu.
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000453:epidemiology / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009392:Nephrectomy; D012189:Retrospective Studies; D012307:Risk Factors; D047368:Tumor Burden; D055815:Young Adult
keywords: Hypertension; Metabolic syndrome; Renal cell carcinoma