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Background <p>Higher body mass index (BMI) has been associated with favorable prognosis in renal cell carcinoma (RCC), a phenomenon known as the “obesity paradox”. However, this relationship may differ by sex. Moreover, previous studies have insufficiently accounted for laboratory-based nutritional status and mainly focused on low-risk populations. Consequently, the prognostic value of BMI in patients with high-risk localized RCC remains unclear.</p> Methods <p>We conducted a retrospective multicenter study of patients with high-risk localized RCC who underwent curative surgery between 2010 and 2022. Patients were stratified by BMI (≥ 25 vs. &lt; 25&#xa0;kg/m<sup>2</sup>) and sex. Disease-free survival (DFS) and overall survival (OS) were evaluated using Kaplan–Meier analysis and Cox proportional hazards models adjusted for clinicopathological variables and laboratory-based nutritional biomarkers.</p> Results <p>A total of 668 patients were included, of which 243 developed disease recurrence during follow-up. In the overall cohort, BMI ≥ 25&#xa0;kg/m<sup>2</sup> was significantly associated with longer DFS and OS. A significant interaction between BMI and sex was observed (<i>P</i> = 0.043), indicating that the prognostic value of BMI differed between males and females. In multivariable sex-stratified analyses, higher BMI was independently associated with improved DFS in males (hazard ratio = 0.61), but not in females. This relationship remained robust after adjustment for laboratory-based nutritional biomarkers and in sensitivity analyses restricted to patients with preserved nutritional status.</p> Conclusion <p>Higher BMI was independently associated with more favorable oncological outcomes in patients with high-risk localized RCC, particularly in males. BMI may therefore have sex-specific prognostic value in this population.</p>

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Sex differences in the prognostic value of body mass index after curative nephrectomy for high-risk renal cell carcinoma: a multicenter cohort study

  • 期刊论文

  • 发表日期：

    2026年7月16日

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  • Shigeki Koterazawa,
  • Takayuki Sumiyoshi,
  • Noboru Shibasaki,
  • Toshinari Yamasaki,
  • Noriyuki Ito,
  • Takehiko Segawa,
  • Koji Inoue,
  • Sojun Kanamaru,
  • Toru Yoshida,
  • Kazutoshi Okubo,
  • Yoshio Sugino,
  • Toru Kanno,
  • Norihiko Masuda,
  • Masakatsu Ueda,
  • Shuhei Koike,
  • Akihiro Hoshiyama,
  • Hiromasa Araki,
  • Ken Maekawa,
  • Takaaki Takuma,
  • Takehiro Yamane,
  • Yuki Kita,
  • Takayuki Goto,
  • Takashi Kobayashi,
  • Kimihiko Masui

摘要

Background

Higher body mass index (BMI) has been associated with favorable prognosis in renal cell carcinoma (RCC), a phenomenon known as the “obesity paradox”. However, this relationship may differ by sex. Moreover, previous studies have insufficiently accounted for laboratory-based nutritional status and mainly focused on low-risk populations. Consequently, the prognostic value of BMI in patients with high-risk localized RCC remains unclear.

Methods

We conducted a retrospective multicenter study of patients with high-risk localized RCC who underwent curative surgery between 2010 and 2022. Patients were stratified by BMI (≥ 25 vs. < 25 kg/m2) and sex. Disease-free survival (DFS) and overall survival (OS) were evaluated using Kaplan–Meier analysis and Cox proportional hazards models adjusted for clinicopathological variables and laboratory-based nutritional biomarkers.

Results

A total of 668 patients were included, of which 243 developed disease recurrence during follow-up. In the overall cohort, BMI ≥ 25 kg/m2 was significantly associated with longer DFS and OS. A significant interaction between BMI and sex was observed (P = 0.043), indicating that the prognostic value of BMI differed between males and females. In multivariable sex-stratified analyses, higher BMI was independently associated with improved DFS in males (hazard ratio = 0.61), but not in females. This relationship remained robust after adjustment for laboratory-based nutritional biomarkers and in sensitivity analyses restricted to patients with preserved nutritional status.

Conclusion

Higher BMI was independently associated with more favorable oncological outcomes in patients with high-risk localized RCC, particularly in males. BMI may therefore have sex-specific prognostic value in this population.