Moustafa Elleisy, Heike Zettl, Desiree Louise Dräger, Oliver W. Hakenberg
Journal of Urological Surgery - 2025;12(4):259-268
Objective: To determine the effect of diabetes and anti-diabetic treatments on the obesity paradox in renal cell cancer (RCC). We report preliminary results from a single centre study. Materials and Methods: We retrospectively collected data from 294 patients treated between 2018 and 2023 for radical nephrectomy (RN) or partial nephrectomy (PN) for RCC. Age at diagnosis, histopathological data (pathological T-stage, lymph node involvement), tumor size, body mass index, length of hospital stay, death, recurrence, as well as type 2 diabetes mellitus and antidiabetic drugs were recorded and analyzed. A total of 232 (81%) patients were non-diabetic and 55 (19%) were diabetic patients. Patient data were assessed for differences related to bodyweight and the use of antidiabetics. Results: In the diabetic cohort, a higher age at diagnosis of RN was observed when comparing patients treated with dipeptidyl peptidase-4 inhibitors to those treated with sodium glucose cotransporter 2 inhibitors (81 vs. 59 years, p<0.01), as well as when comparing patients treated with metformin to those treated with sulfonylureas (SU) (67 vs. 81 years, p<0.05). Furthermore, in diabetic patients with PN, compared to those treated with insulin, treated with metformin, no deaths occurred, which was significant (0% vs. 50%, p<0.05). The length of stay after PN for diabetic patients treated with metformin was significantly shorter than that of diabetic patients treated with insulin or SU (p<0.05). Conclusion: In our study, an obesity paradox was observed for obese patients with RCC. However, the beneficial effects of certain antidiabetics should be considered as a potential cause of this paradox.
