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Obstructive sleep apnea and Fuhrman grade in patients with clear cell renal cell carcinoma treated surgically

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Abstract

Purpose

To assess the association between obstructive sleep apnea (OSA) and Fuhrman grade in patients with clear cell renal cell carcinoma (ccRCC). As secondary endpoints, we studied its association with tumor size, metastasis-free survival (MFS) and cancer-specific survival (CSS).

Methods

We reviewed the databases of two tertiary care centers, identifying 2579 patients who underwent partial or radical nephrectomy for ccRCC between 1991 and 2014. Descriptive statistics were used to compare pathologic variables between patients with and without OSA. Linear and logistic regression models were used to assess the association of OSA with Fuhrman grade and tumor size. A Cox proportional hazards model was used to determine OSA association with MFS and CSS. A pathway analysis was performed on a cohort with available gene expression data.

Results

In total, 172 patients (7 %) had self-reported OSA at diagnosis. More patients with OSA had high Fuhrman grade compared to those without OSA [51 vs. 38 %; 13 % risk difference; 95 % confidence interval (CI), 5–20 %; p = 0.003]. On multivariable analysis, the association remained significant (OR 1.41; 95 % CI 1.00–1.99; p = 0.048). OSA was not associated with tumor size (p > 0.5), MFS (p = 0.5) or CSS (p = 0.4). A trend toward vascular endothelial growth factor pathway enrichment was seen in OSA patients (p = 0.08).

Conclusions

OSA is associated with high Fuhrman grade in patients undergoing surgery for ccRCC. Pending validation of this novel finding in further prospective studies, it could help shape future research to better understand etiological mechanisms associated.

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Acknowledgments

We thank Amy Plofker for her reviews on the manuscript and Felisa Alcázar for her help in collecting data.

Author contribution

Vilaseca helped in protocol/project development, data collection or management, data analysis and manuscript writing/editing. Nguyen contributed to data collection or management and manuscript writing/editing. Vertosick helped in data analysis. Corradi helped in data collection or management and manuscript writing/editing. Musquera helped in protocol/project development and data analysis. Pérez helped in data collection or management. Fossati contributed to data collection or management. Sjoberg contributed to data analysis. Farré contributed to protocol/project development. Almendros contributed to data collection or management. Montserrat helped in data analysis. Benfante helped in data collection or management. Hakimi helped in data analysis and manuscript writing/editing. Skanderup contributed to data analysis. Russo contributed to protocol/project development and manuscript writing/editing. Alcaraz contributed to protocol/project development and manuscript writing/editing. Touijer helped in protocol/project development and data analysis.

Author information

Authors and Affiliations

  1. Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

    Antoni Vilaseca, Daniel P. Nguyen, Renato B. Corradi, Nicola Fossati, Nicole E. Benfante, A. Ari Hakimi, Paul Russo & Karim A. Touijer

  2. Urology Department, Hospital Clínic de Barcelona, Barcelona, Spain

    Antoni Vilaseca, Mireia Musquera, Meritxell Pérez & Antonio Alcaraz

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Emily A. Vertosick & Daniel D. Sjoberg

  4. Unit of Biophysics and Bioengineering, Universitat de Barcelona, Barcelona, Spain

    Ramon Farré & Isaac Almendros

  5. Pneumology Department, Hospital Clínic de Barcelona, Barcelona, Spain

    Josep M. Montserrat

  6. Computational and Systems Biology, Genome Institute of Singapore, Singapore, Singapore

    Anders J. Skanderup

  7. Weill Cornell Medical College, New York, NY, USA

    Paul Russo & Karim A. Touijer

Authors
  1. Antoni Vilaseca
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  2. Daniel P. Nguyen
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  3. Emily A. Vertosick
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  11. Josep M. Montserrat
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Corresponding author

Correspondence to Karim A. Touijer.

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The authors declare that they have no conflict of interest.

Ethical standard

The creation and retrospective review of the MSKCC Kidney Cancer Database and the Hospital Clínic de Barcelona Database were approved by the institutional review board of each hospital and therefore conform to the ethical standards laid down in the 1964 Helsinki Declaration and its later amendments. No information with the potential to disclose patient identities was included.

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Vilaseca, A., Nguyen, D.P., Vertosick, E.A. et al. Obstructive sleep apnea and Fuhrman grade in patients with clear cell renal cell carcinoma treated surgically. World J Urol 35, 51–56 (2017). https://doi.org/10.1007/s00345-016-1830-6

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  • DOI: https://doi.org/10.1007/s00345-016-1830-6

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