High body mass index is tied to longer survival in renal cancer

  • Sanchez A & al.
  • Lancet Oncol
  • 20 déc. 2019

  • Par Deepa Koli
  • Résumés d'articles
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Takeaway

  • In clear cell renal cell carcinoma (RCC), patients with obesity have longer OS vs those with normal weight.

Why this matters

  • The authors hypothesize that peritumoral fat might harbor a distinct immunological milieu and possibly contribute to a paradoxical immunotherapy response.

Study design

  • Exploratory analysis of 478 patients with clear cell RCC from the phase 3 COMPARZ study, Cancer Genome Atlas (TCGA), and Memorial Sloan Kettering Cancer Center (MSKCC) cohorts.
  • Funding: Ruth L Kirschstein Research Service Award; others.

Key results

  • Patients with obesity (BMI, ≥30 kg/m²) vs normal weight (BMI, 18.5-24.9 kg/m²) had longer median OS in the:
    • TCGA cohort: 53.5 vs 23.5 months (aHR, 0.41; 95% CI, 0.22-0.75).
    • COMPARZ cohort: 35.7 vs 19.1 months (aHR, 0.68; 95% CI, 0.48-0.96).
  • OS was not different between patients with obesity vs normal weight in the MSKCC immunotherapy cohort (aHR, 0.72; 95% CI, 0.40-1.30).
  • COMPARZ cohort:
    • Tumors from patients with obesity showed significant upregulation in hypoxia, TGF-β, epithelial-mesenchymal transition, and angiogenesis signaling pathways (all adjusted P<.05>
    • Tumor immune microenvironment was not different (cytolytic score, P=.24; T-effector score, P=.07).
    • Perinephric fat near tumor in patients with obesity showed increased inflammation (P=.02) and hypoxia (P=.04).

Limitations

  • Not adjusted for every clinical covariate.