Original article
Modifiable risk factors to reduce renal cell carcinoma incidence: Insight from the PLCO trial

https://doi.org/10.1016/j.urolonc.2018.04.011Get rights and content

Highlights

  • Lifestyle modifications can impact kidney cancer incidence and outcomes.

  • Modifying lifestyle factors could be utilized in prevention of kidney cancer in high-risk patients.

  • Obesity, hypertension ion, and smoking could be aggressively targeted to reduce renal cell cancer.

Abstract

Introduction

Identify modifiable factors contributing to renal cell carcinoma in the PCLO to target disease prevention and reduce health care costs.

Methods

The prostate, lung, colorectal, and ovarian database were queried for the primary outcome of kidney cancer. Demographics were investigated, specifically focusing on modifiable risk factors. Statistical analysis includes the Student t-test for continuous variables, chi-squared or Fisher’s exact tests for dichotomous and categorical variables for bivariate analysis. The Cox proportional hazards model was used in a multivariate time-to-event analysis.

Results

We investigate existing data relating specifically to renal cancer. After missing data were excluded, we analyzed 149,683 subjects enrolled in the prostate, lung, colorectal, and ovarian trial and noted 0.5% (n = 748) subjects developed renal cancer. Age, male gender, body mass index, diabetes, and hypertension were all significant associated with renal cancer in bivariate analysis (P<0.05). Men have a significant increased risk of kidney cancer over women (hazard ratio [HR] = 1.85; 95% CI: 1.58–2.16; P<0.0001). Nonmodifiable risk factors that are associated with kidney cancer include age (HR = 1.05; 95% CI: 1.01; 1.05, P = 0.001). Modifiable risk factors include obesity measured by body mass index (HR = 1.05; 95% CI: 1.02–1.07; P<0.0001), hypertension (HR = 1.32; 95% CI: 1.13–1.54; P = 0.0004), and smoking in pack-years (HR = 1.04; 95% CI: 1.02–1.07; P = 0.0002).

Conclusions

Obesity, hypertension, and smoking are the 3 modifiable risk factors that could aggressively be targeted to reduce renal cell carcinoma.

Introduction

Kidney cancer is estimated to have as worldwide incidence of 270,000 cases yearly and nearly 116,000 deaths [1]. In the Unites states, estimates indicate 65,000 new cases and over 13,000 deaths from kidney and renal pelvis cancers in 2013 with approximately 35% presenting as metastatic disease [2].

Although there is no recommendation for screening for renal cell carcinoma (RCC), the frequency of RCC continues to rise [3]. The rising number of RCC cases is believed to be a result of improved imaging techniques and increased incidental tumor discovery [4]. However, it has been found that there is marked regional variability, likely related to demographic, environmental, and genetic factors [5]. Moreover, RCC can be attributed to the increased prevalence of associated risk factors such as obesity and hypertension [3]. Risk factors that can be changed to potentially effect health outcomes have been termed modifiable risk factors. The modification of risk factors may have the potential to reduce incidence of RCC and potentially improve survival.

Lifestyle modifications have been shown to reduce the incidence of a variety of cancers as well as improve cancer specific survival [6]. Therefore, lifestyle interventions can be an inexpensive preventative and adjunctive program tailored to the individual patient and may affect outcomes. To investigate specific modifiable lifestyle risk factors, we examine the prostate, lung, colorectal, and ovarian (PLCO) screening trial for potential impact of altering these factors.

Section snippets

Study population

After IRB approval and data transfer agreement, we obtained de-identified data from subjects enrolled in the PLCO Cancer Screening Trial. The PLCO is a National Cancer Institute sponsored randomized trial investigating the effects of screening on cancer outcomes in subjects aged 55 to 74 years from 1993 to 2001 and have followed them for 13 years.

Outcomes and risk factors

The primary outcome of this study was kidney cancer incidence defined by questionnaire and medical record confirmation. Predictor variables were

Discussion

In our investigation of the PLCO screening trial, we identified 3 modifiable lifestyle interventions that could be implemented to reduce the incidence of renal cancer: hypertension, obesity, and smoking. The strongest factor for developing RCC was a positive answer on the baseline questionnaire of whether or not the subject had hypertension. If “yes” the patient had a 32% increased risk of RCC then nonhypertensive patients over the next 13 years. Hypertension has previously been associated with

Conclusions

Obesity, hypertension, and smoking are the three modifiable risk factors that could aggressively be targeted to reduce RCC. In particular, future investigation regarding aggressive management of hypertension with lower systolic and diastolic pressures than 140/90 set by the Joint National Committee and weight loss interventions, especially in at risk men, could prove to be the most beneficial prevention strategy. Further research is needed to elucidate mechanism of increased incidence of RCC in

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