Obesity as defined by waist circumference but not body mass index is associated with higher renal mass complexity

Obesity, typically defined as a body mass index (BMI)≥30kg/m2, is an established risk factor for renal cell carcinoma (RCC) but is paradoxically linked to less advanced disease at diagnosis and improved outcomes. However, BMI has inherent flaws, and alternate obesity-defining metrics that emphasize...

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Published in:Urologic oncology 2017-11, Vol.35 (11), p.661.e1-661.e6
Main Authors: Bertrand, Laura A., Thomas, Lewis J., Li, Peng, Buchta, Claire M., Boi, Shannon K., Orlandella, Rachael M., Brown, James A., Nepple, Kenneth G., Norian, Lyse A.
Format: Article
Language:English
Subjects:
Aged
Body Mass Index
Carcinoma, Renal Cell - pathology
Female
Humans
Kidney - pathology
Kidney Neoplasms - pathology
Male
Middle Aged
Neoplasm Grading
Neoplasm Staging
Nephrometry
Obesity
Obesity - diagnosis
Obesity - physiopathology
Obesity, Abdominal - physiopathology
Prospective Studies
Renal cell carcinoma
Risk Factors
Waist circumference
Waist Circumference - physiology
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Summary:Obesity, typically defined as a body mass index (BMI)≥30kg/m2, is an established risk factor for renal cell carcinoma (RCC) but is paradoxically linked to less advanced disease at diagnosis and improved outcomes. However, BMI has inherent flaws, and alternate obesity-defining metrics that emphasize abdominal fat are available. We investigated 3 obesity-defining metrics, to better examine the associations of abdominal fat vs. generalized obesity with renal tumor stage, grade, or R.E.N.A.L. nephrometry score. In a prospective cohort of 99 subjects with renal masses undergoing resection and no evidence of metastatic disease, obesity was assessed using 3 metrics: body mass index (BMI), radiographic waist circumference (WC), and retrorenal fat (RRF) pad distance. R.E.N.A.L. nephrometry scores were calculated based on preoperative CT or MRI. Univariate and multivariate analyses were performed to identify associations between obesity metrics and nephrometry score, tumor grade, and tumor stage. In the 99 subjects, surgery was partial nephrectomy in 51 and radical nephrectomy in 48. Pathology showed benign masses in 11 and RCC in 88 (of which 20 had stage T3 disease). WC was positively correlated with nephrometry score, even after controlling for age, sex, race, and diabetes status (P = 0.02), whereas BMI and RRF were not (P = 0.13, and P = 0.57, respectively). WC in stage T2/T3 subjects was higher than in subjects with benign masses (P = 0.03). In contrast, subjects with Fuhrman grade 1 and 2 tumors had higher BMI (P
ISSN:1078-1439
1873-2496
DOI:10.1016/j.urolonc.2017.06.058