MP50-03 IMPACT OF DIABETES MELLITUS ON FUNCTIONAL AND SURVIVAL OUTCOMES IN RENAL CELL CARCINOMA

INTRODUCTION AND OBJECTIVE: Functional decline is an important consideration in the surgical treatment of renal cell carcinoma (RCC), especially in those patients with diabetes mellitus (DM) who may be at increased risk of chronic kidney disease. We investigated the relationship between DM and decline in kidney function following surgery for RCC, and impact on overall survival (OS) in patients with RCC. METHODS: We conducted a multicenter retrospective analysis of patients who underwent radical (RN) and partial nephrectomy (PN) for RCC. The cohort was divided based on DM status (DM diabetes mellitus, NDM no diabetes mellitus). Multivariable analysis (MVA) was conducted to elucidate potential variables associated with decline in kidney function [de novo estimated glomerular filtration rate<45 ml/min/1.73m2 (eGFR<45) and eGFR<30] and worsened all-cause mortality (ACM). Kaplan-Meier analysis (KMA) was used to investigate OS rates in DM and NDM patients undergoing RN and PN. RESULTS: 2928 patients were analyzed (DM 406/NDM 2522). On MVA, independent risk factors associated with development of de novo eGFR<45 included increasing age (OR 1.07, p<0.001), presence of DM (OR 1.88, p<0.001), increasing tumor size (OR 1.03, p=0.032), and RN (OR 1.54, p<0.001). Variables associated with risk of development of de novo eGFR<30 included increasing age (OR 1.05, p<0.001), African-American race (OR 2.18, p<0.001), and DM (OR 2.09, p<0.001). MVA for ACM revealed increasing age (OR 1.02, p=0.002), HTN (OR 2.47, p<0.001), increasing clinical tumor size (OR 1.12, p<0.001), high tumor grade (OR 1.87, p<0.001), RN (OR 1.55, p=0.011), eGFR<45 (OR 1.41, p=0.03), and eGFR<30 (OR 1.87, p=0.026) to be independently associated. On KMA (Figure), 5-year OS stratified by DM status showed that DM is associated with worse OS for patients treated with RN (DM 76.6% vs. NDM OS 79.6%, p=0.047), but not for patients treated with PN (DM 76.6% vs. NDM 73.0%, p=0.944). CONCLUSIONS: Presence of DM is an independent risk factor for renal functional decline and development of worsening CKD is a risk factor for worsened ACM. Furthermore, decreased survival in DM patients was noted in patients who underwent RN but not PN. Presence of DM may be considered a strong indicator for nephron preservation management strategies when safe and feasible.Source of Funding: Stephen Weissman Kidney Cancer Research Fund