Introduction:

While hypertension (HTN) is an important co-morbidity, it’s not included in the Charlson Comorbidity Index (CCI), which assess impact of comorbidities on survival, and impact of HTN on oncologic outcomes in Renal Cell Carcinoma (RCC) is uncertain. We sought to analyze the impact of HTN on RCC outcomes in a contemporary cohort of patients who underwent surgery.

Methods:

We performed a multi-center retrospective analysis of patients who underwent radical (RN) or partial nephrectomy (PN) for RCC utilizing the INMARC database. Primary outcome was all-cause mortality (ACM); secondary outcomes included cancer-specific mortality (CSM), and recurrence. Multivariable analysis (MVA) via cox regression were fitted to elucidate predictors for outcomes, and Kaplan-Meier analyses (KMA), were performed to analyze overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS).

Results:

We analyzed 4859 patients (2,018 with HTN/2841 without HTN); median follow-up 55.5 months. MVA revealed age (HR 1.01, p<0.001), HTN (HR 1.44, p<0.001), CCI (HR 1.04, p<0.001), tumor size (HR 1.04, p<0.001), RN (HR 1.36, p<0.001), stage IV (HR 1.86, p=0.003), and tumor necrosis (HR 1.23, p=0.005), as associated with increased risk of ACM. MVA for CSM revealed HTN (HR 1.42, p=0.001), CCI (HR 1.07, p<0.001), tumor size (HR 1.04, p=0.003), and stage IV (HR 2.71, p<0.001) as associated with increased risk of CSM. MVA for recurrence revealed HTN (HR 1.36, p<0.001), tumor size (HR 1.07, p<0.001), and stage IV (HR 3.25, p<0.001), as  associated with recurrence. KMA comparing non HTN vs. HTN revealed 5-year OS of 88.2% vs. 72.2%, 5-year CSS of 94% vs. 83.8%, and 5-year RFS of 93.1% vs. 82.8% (all p<0.001, Figure).

Conclusion:

Hypertension is an independent risk factor for worsened oncologic and survival outcomes in patients undergoing surgical treatment for RCC. Further investigation is warranted to confirm these findings and elucidate mechanisms of action and explore strategies to improve outcomes with improved control of hypertension.

Funding: N/A