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Corcoran AT , Kaffenberger SD , Clark PE , Walton J , Handorf E , Piotrowski Z , Tomaszewski JJ , Ginzburg S , Mehrazin R , Plimack E , Chen DY , Smaldone MC , Uzzo RG , Morgan TM , Kutikov A
Hypoalbuminaemia is associated with mortality in patients undergoing cytoreductive nephrectomy
BJU Int. 2015 Sep;116(3) :351-7
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OBJECTIVE: To evaluate whether poor nutrition is associated with mortality in patients undergoing cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC). PATIENTS AND METHODS: A multi-institutional review of prospective databases identified 246 patients meeting inclusion criteria who underwent CN for mRCC from 1993 to 2012. Nutritional markers evaluated were: body mass index <18.5 kg/m(2) , serum albumin <3.5 g/dL, or preoperative weight loss of >/=5% of body weight. Primary outcomes were overall (OS) and disease-specific survival (DSS). Secondary outcome was 'early mortality' defined as death at </=6 months of surgery. Survival curves were estimated using the Kaplan-Meier product-limit method and multivariate analysis using logistic regression was used to test associations between nutritional markers and survival outcomes. RESULTS: In all, 119 patients (median follow-up 17 months) were categorised as having any abnormal nutrition parameter (48%). Hypoalbuminaemia was the only independent predictor of OS and DSS (OS: median 8 vs 23 months, P < 0.001; DSS: 11 vs 33 months, P < 0.001). On multivariate analysis, hypoalbuminaemia remained a significant predictor of death for both overall [hazard ratio (HR) 2, 95% confidence interval (CI) 1.4-2.8; P < 0.001) and disease-specific mortality (HR 2.2, 95% CI 1.4-3.3; P < 0.001). Hypoalbuminaemia was also associated with early mortality (overall: P < 0.001 and disease specific: P = 0.002). CONCLUSION: Patients with mRCC and hypoalbuminaemia undergoing CN have decreased OS and CSS, and increased risk of all-cause and disease-specific early mortality. As such, serum albumin may help risk stratify patients selected as candidates for CN. Furthermore, future work should evaluate whether nutritional depletion is a modifiable risk factor.
Corcoran, Anthony T Kaffenberger, Samuel D Clark, Peter E Walton, John Handorf, Elizabeth Piotrowski, Zack Tomaszewski, Jeffery J Ginzburg, Serge Mehrazin, Reza Plimack, Elizabeth Chen, David Y T Smaldone, Marc C Uzzo, Robert G Morgan, Todd M Kutikov, Alexander eng P30 CA006927/CA/NCI NIH HHS/ Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S. England BJU Int. 2015 Sep;116(3):351-7. doi: 10.1111/bju.12897. Epub 2014 Dec 15.