Poor Nutrition May Worsen Kidney Cancer Surgery Outcomes

Low serum albumin levels increase the risk of death in patients undergoing cytoreductive nephrectomy for metastatic renal cell carcinoma.
Low serum albumin levels increase the risk of death in patients undergoing cytoreductive nephrectomy for metastatic renal cell carcinoma.

Nutritional deficiency, as indicated by low serum albumin levels, is associated with decreased overall and disease-specific survival among patients undergoing cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC), according to a new study.

A team led by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia, studied 246 patients who underwent CN for mRCC from 1993–2012. They evaluated 3 markers of nutritional deficiency: hypoalbuminemia (serum albumin level less than 3.5 g/dL), a body mass index below 18.5 kg/m2, and preoperative weight loss of 5% or more of body weight. Of the 246 patients, 119 (48%) were nutritionally deficient.

Hypoalbuminemia, which was present in 62 patients (25%), was the only independent predictor of overall survival (OS) and disease-specific survival (DSS). Median OS and DSS was 8 months and 11 months, respectively, in patients in hypoalbuminemia compared with 23 months and 33 months among those who did not have hypoalbuminemia, Dr. Kutikov and his colleagues reported online ahead of print in BJU International.

On multivariate analysis, hypoalbuminemia was associated with a 2-fold increased risk of death from any cause and from mRCC.

“Serum albumin – a readily available, easily measured parameter – when low, identifies patients at increased risk for early mortality and is highly prevalent in patients with advanced RCC,” the authors concluded.

The investigators said they believe that ideally these data and recent data from other institutions would spark interest determining whether poor nutrition is a modifiable risk or simply a marker of poor prognosis or perioperative risk or both.

“Certainly, if a trial of targeted therapy is chosen up front or if surgical intervention is delayed for any reason, dietary intervention to potentially correct hypoalbuminemia is not likely to harm and may offer benefits.”

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