20 May Diabetes May Have Imply Poorer Prognosis For Renal Cell Cancer
MedicalResearch.com Interview with:
Sarah P. Psutka, MD
Fellow in Urologic Oncology
Department of Urology, Mayo Clinic
MedicalResearch: What are the main findings of each study?
Dr. Psutka: In this study we identified all diabetic patients with localized clear cell renal cell carcinomas who were surgically treated between 1990 and 2008 in our institution and matched them with nondiabetic patients.
Our main findings were that, after controlling for major confounders such as age, sex, type of surgery, renal function, smoking status, performance status, and tumor grade and stage, diabetic patients had inferior overall survival than nondiabetic patients. Furthermore, among patients with clear cell carcinoma, diabetic patients also had shorter cancer-specific survival, suggesting that diabetes is a poor prognostic factor for patients with surgically treated renal cell carcinoma.
MedicalResearch: Were any of the findings unexpected?
Dr. Psutka: We expected that diabetes might be associated with increased all-cause mortality given the health associated with diabetes mellitus; however, previous reports are conflicting regarding whether or not oncologic outcomes of renal cell carcinoma were worse among diabetic patients. In this study, we found that patients with surgically treated, localized, clear cell renal cell carcinoma had increased cancer-specific mortality compared to nondiabetic patients who otherwise had tumors of similar aggressiveness, and were otherwise clinically similar. The substantially different risk of cancer-specific mortality among diabetics (hazard ratio for diabetes compared to no diabetes: 1.53, 95% CI 0.97 – 2.19, p = 0.022) was surprising and very interesting to us. This can be interpreted such that patients with diabetes have a 53% increased risk of death from their cancer, compared to nondiabetics, holding constant all other risk factors that were accounted for in our analysis.
MedicalResearch: What should clinicians and patients take away from each report?
Dr. Psutka: Clinicians and patients might take away the fact that diabetes is an important risk factor that has implications for a patients’ long term survival following surgical resection of renal cell carcinoma. This has implications for how we counsel patients, and also might suggest that careful glycemic control may be of benefit in diabetic patients.
MedicalResearch: What recommendations do you have for future research as a result of each study?
Dr. Psutka: Future studies are necessary to validate these findings. Furthermore, it would be helpful if prospective studies could be performed which not only assessed for the presence of diabetes, but also the severity of diabetes, to evaluate whether or not careful glycemic control might be of benefit in diabetic patients undergoing treatment for renal cell carcinoma