Renal Cell Carcinoma: Do Diabetics Differ from Non-Diabetics?
Deepika Sirohi, Marlo M Nicolas, Thomas J Prihoda, Sherry L Werner. University of Health Science Center at San Antonio, San Antonio, TX
Background: Epidemiological evidence indicates that individuals with diabetes are at higher risk of cancer. Poor glycemic control in diabetics may play a role in increased cancer risk. We showed a strong association between diabetes and renal cell carcinoma (RCC) in a cohort of 473 kidney cancer patients. Whether renal cell cancer and the non-neoplastic tissue morphology in diabetic and non-diabetic patients differ has not been previously evaluated.
Design: A retrospective analysis of 76 consecutive patients who underwent nephrectomy for RCC from 2009 to 2012 was performed. Diabetic and non-diabetic patients with RCC were screened for age, gender and serum glucose levels. RCC cases were analyzed for histologic subtype, Fuhrman nuclear grade, tumor size and tumor stage based on the standard TNM system. Non-neoplastic tissue was available in 14 diabetics and 28 non-diabetics for evaluation and was assessed for morphology on H&E stained sections.
Results: Of the 76 cases with RCC, 23 (30%) had a history of diabetes. At the time of nephrectomy, the mean age of diabetics was higher (56±7) compared to nondiabetics (51±9, p=0.04). Tumors in nondiabetics showed lymphovascular (p=0.02) and renal sinus invasion (p=0.06), whereas these features were not identified in tumors from diabetics. There was no difference in gender, race, tumor size/stage, nuclear grade, renal vein invasion, infiltrative pattern or subtype of RCC in diabetics compared to non-diabetics. In both groups, clear cell type and stage I tumors predominated (>75%). In the non-neoplastic tissue, glomeruli showed increased matrix expansion (p=0.01) and vessels showed increased arteriolonephrosclerosis (p=0.005) in diabetics compared to nondiabetics. There was no difference in mesangial cellularity, glomerular basement membrane thickness, interstitial fibrosis and tubular atrophy and arterionephrosclerosis between the two groups. Only 1 diabetic case with RCC had end-stage renal disease.
Conclusions: In our cohort, RCC occurred at a later age in diabetics compared to non-diabetics and was associated with reduced lymphovascular/renal sinus invasion. Results provide important evidence that advanced diabetic nephropathy is not a prerequisite for the development of RCC, aggressive tumor type or more advanced stage.
Category: Genitourinary (including renal tumors)
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 157, Monday Morning