Does overweight influence the prognosis of renal cell carcinoma? Results of a multicenter study.

OBJECTIVES: To assess the impact of overweight on prognosis of renal cell carcinoma patients. PATIENTS AND METHODS: A total of 2030 patients who underwent surgery for renal cell carcinoma from 1990 to 2011 in three University Medical Centers were included in this retrospective analysis. For all patients, height and weight measurements at the time of diagnosis were available for review. The median (mean) follow up was 56.6 months (66.0 months). RESULTS: A low body mass index was significantly associated with poor tumor differentiation, histology, microscopic vascular invasion and metastatic disease at the time of diagnosis. A lower-than-average body surface area - stratified according to the European average for men (1.98 m(2)) and women (1.74 m(2)) - was significantly related to older age, poor tumor differentiation, the histological subtype and microscopic vascular invasion. In addition, a low visceral fat area calculated in a subgroup of 133 evaluable patients was associated with a higher risk of advanced disease (pT3-4 and/or N/M+) at diagnosis. The tumor-specific 5-year survival rate was 71.3, 78.7 and 80.1%, for patients with a body mass index of, <25, 25-30 and ≥30. Multivariate analysis confirmed body mass index as an independent prognostic factor. CONCLUSION: Our findings suggest that overweight represents an independent prognostic factor in renal cell carcinoma patients. Further research should address the question of why obese people have a higher incidence of renal cell carcinoma, but at the same time a significantly better prognosis than other patients, particularly in the case of localized disease.

Quantifying damage contributions from convective and stratiform weather types: How well do precipitation and discharge data indicate the risk?

Convective precipitation is intensifying in many regions, but potential implications of shifts in precipitation types on impacts have not been quantified. Furthermore, risk assessments often focus on rare extremes, but also more frequent hydro-meteorological events burden private and public budgets. Here synoptic, hydrological, meteorological, and socio-economic data are merged to analyse 25 years of damage claims in 480 Austrian municipalities. Exceedance probabilities of discharge and precipitation associated with damage reports are calculated and compared for convective and stratiform weather patterns. During April to November, 60% of claims are reported under convective conditions. Irrespective of the weather type, most of the accumulated cost links to minor hazard levels, not only indicating that frequent events are a highly relevant expense factor, but also pointing to deficiencies in observational data. High uncertainty in damage costs attributable to extreme events demonstrates the questionable reliability of calculating low-frequency event return levels. Significant differences exist among weather types. Stratiform weather types are up to 10 times more often associated with damaging extreme discharge or precipitation, while convective weather shows the highest nuisance level contributions. The results show that changes in convective precipitation are pertinent to risk management as convective weather types have contributed significantly to damage in the past.