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Egen L, Quan A, Gottstein LIM, Haney CM, Walach MT, Mühlbauer J, Worst TS, Michel MS, Kowalewski KF. Relevance of Positive Surgical Margins in Localized Renal Cell Carcinoma After Surgical Resection: Predictive Factors and Survival Implications. Clin Genitourin Cancer 2024; 22:102110. [PMID: 38839503 DOI: 10.1016/j.clgc.2024.102110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/28/2024] [Accepted: 04/28/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION The implications of positive surgical margins (PSM) after surgery for renal cell carcinoma (RCC) remain subject of discussion. This study aimed to identify risk factors for PSM, assess its effect on overall survival (OS), and determine predictors of OS. PATIENTS AND METHODS Data from RCC surgeries at Mannheim University Medical Center between 2010 and 2023 was analyzed. Propensity score matching balanced PSM and control groups using age, surgical approach, tumor stage, histological subtype, and American Association of Anesthesiologists (ASA) score. Logistic and cox regression models predict PSM and OS, respectively. Kaplan-Meier analysis compared OS of PSM patients and controls. RESULTS A total of 1066 RCC patients were included. Propensity score matching yielded 32 PSM patients and 96 controls. Multivariable logistic regression identified tumor stage ≥ T3a (odds ratio [OR] = 2.74, 95% confidence interval [CI] = 1.0-6.8, P = .04) and chromophobe, compared to clear cell, RCC (OR = 3.19, 95% CI = 1.0-8.7, P = .03) as independent predictors of PSM. Multivariable cox regression found age > 65 years (hazard ratio [HR] = 2.65, 95% CI = 1.7-4.2, P < .01) and tumor stage ≥ T3a (HR = 2.25, 95% CI = 1.4-3.7, P < .01) to predict shorter OS. Partial vs. radical nephrectomy was associated with improved OS (HR = 0.49, 95% CI = 0.3-0.9, P = .02). Kaplan-Meier analysis revealed no OS difference between PSM patients and controls (P = .49) over a 45-month median follow-up. CONCLUSION PSM is not a primary determinant of inferior survival, while age and tumor stage play a more prominent role. A well-calibrated follow-up protocol for PSM patients, combining PSM with coinciding factors such as tumor stage, grade, size, or PSM extent, is crucial for adequate surveillance while preventing excessive interventions.
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Affiliation(s)
- Luisa Egen
- Department of Urology and Urosurgery, University Medical Center Mannheim, Mannheim, Germany; Division of Intelligent Systems and Robotics in Urology (ISRU), German Cancer Research Center (DKFZ), Heidelberg, Germany; DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Allison Quan
- Department of Urology and Urosurgery, University Medical Center Mannheim, Mannheim, Germany; Division of Intelligent Systems and Robotics in Urology (ISRU), German Cancer Research Center (DKFZ), Heidelberg, Germany; DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | | | - Caelan Max Haney
- Division of Intelligent Systems and Robotics in Urology (ISRU), German Cancer Research Center (DKFZ), Heidelberg, Germany; DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany; Department of Urology, University of Leipzig, Leipzig, Germany
| | | | - Julia Mühlbauer
- Department of Urology and Urosurgery, University Medical Center Mannheim, Mannheim, Germany
| | - Thomas Stefan Worst
- Department of Urology and Urosurgery, University Medical Center Mannheim, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Mannheim, Germany
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urosurgery, University Medical Center Mannheim, Mannheim, Germany; Division of Intelligent Systems and Robotics in Urology (ISRU), German Cancer Research Center (DKFZ), Heidelberg, Germany; DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany.
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Dai R, Uppot R, Arellano R, Kalva S. Image-guided Ablative Procedures. Clin Oncol (R Coll Radiol) 2024; 36:484-497. [PMID: 38087706 DOI: 10.1016/j.clon.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/19/2023] [Accepted: 11/21/2023] [Indexed: 07/09/2024]
Abstract
Various image-guided ablative procedures include chemical and thermal ablation techniques and irreversible electroporation. These have been used for curative intent for small tumours and palliative intent for debulking, immunogenicity and pain control. Understanding these techniques is critical to avoiding complications and achieving superior clinical outcomes. Additionally, combination with immunotherapy and chemotherapies is rapidly evolving. There are numerous opportunities in interventional radiology to advance ablation techniques and seamlessly integrate into current treatment regimens for both benign and malignant tumours.
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Affiliation(s)
- R Dai
- Massachusetts General Hospital, Department of Radiology, Division of Intervention Radiology, Boston, Massachusetts, USA.
| | - R Uppot
- Massachusetts General Hospital, Department of Radiology, Division of Intervention Radiology, Boston, Massachusetts, USA
| | - R Arellano
- Massachusetts General Hospital, Department of Radiology, Division of Intervention Radiology, Boston, Massachusetts, USA
| | - S Kalva
- Massachusetts General Hospital, Department of Radiology, Division of Intervention Radiology, Boston, Massachusetts, USA
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Okada A, Ohashi K, Hashimoto H, Ota Y, Sugino T, Unno R, Iwatsuki S, Etani T, Taguchi K, Naiki T, Kurokawa S, Hamamoto S, Ando R, Nakane A, Kawai N, Tozawa K, Yasui T. Three-dimensional computed tomography-based resection process map for robot-assisted partial nephrectomy: propensity score matching of a single-center retrospective study. J Surg Oncol 2024; 129:1311-1324. [PMID: 38470556 DOI: 10.1002/jso.27615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/22/2024] [Accepted: 02/11/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND AND OBJECTIVES We aimed to examine the effect of preoperative three-dimensional (3D) computed tomography (CT)-based resection process map (RPM) imaging on the outcomes of robot-assisted partial nephrectomy (RAPN). METHODS We retrospectively analyzed 177 patients (RPM group, n = 92; non-RPM group, n = 85) who underwent this surgery between November 2012 and April 2022. Patient-specific contrast-enhanced CT images were used to construct an RPM, a 3D representation of the kidney showing the planned tumor resection and a 5 mm safety margin. Outcome analyses were performed using propensity score matching. The primary endpoint was the trifecta achievement rate. RESULTS We extracted 90 cases. The trifecta achievement rate showed no significant differences between the RPM (73.3%) and non-RPM groups (73.3%). However, the RPM group had fewer Grade 3 and higher complications (0.0% vs. 13.3%, p = 0.026). The da Vinci Xi (OR 3.38, p = 0.016) and tumor diameter (OR 0.95, p = 0.013) were independent factors affecting trifecta achievement in multivariate analysis. Using RPM imaging was associated with the absence of Grade 3 and higher perioperative complications (OR 5.33, p = 0.036) in univariate analysis. CONCLUSIONS Using preoperative 3D CT-based RPM images before RAPN may not affect trifecta achievement, but may reduce serious complication occurrence by providing detailed information on tumor resection.
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Affiliation(s)
- Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuya Ohashi
- Department of Radiology, Nagoya City University Hospital, Nagoya, Japan
- Department of Radiology, Nagoya City University Midori Municipal Hospital, Nagoya, Japan
| | - Hiroya Hashimoto
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yuya Ota
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Teruaki Sugino
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Rei Unno
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shoichiro Iwatsuki
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshiki Etani
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Taku Naiki
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Kurokawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akihiro Nakane
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Noriyasu Kawai
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keiichi Tozawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Jiang T, Liang Y, Ji Y, Xue Y. Fisetin enhances cisplatin sensitivity in renal cell carcinoma via the CDK6/PI3K/Akt/mTOR signaling pathway. Oncol Lett 2024; 27:165. [PMID: 38426151 PMCID: PMC10902757 DOI: 10.3892/ol.2024.14298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/12/2024] [Indexed: 03/02/2024] Open
Abstract
Cisplatin resistance is ubiquitous among patients with renal cell carcinoma (RCC). The present study assessed the role of fisetin in regulating cisplatin sensitivity and increasing the efficacy of chemotherapy for patients with RCC. Cell Counting Kit-8 and colony formation assays were used to assess the proliferation of RCC cells after fisetin and cisplatin treatment. The mRNA expression levels of cyclin-dependent kinase (CDK)6 were evaluated using reverse transcription-quantitative PCR. The expression levels of CDK6 and key proteins of the PI3K/Akt/mTOR signaling pathway were assessed using western blotting. The present study demonstrated that fisetin inhibited the proliferation and colony-forming ability of RCC cells, and induced apoptosis and cell cycle arrest in a dose-dependent manner. Additionally, fisetin enhanced the antineoplastic effects of cisplatin, as demonstrated by the increase in proliferation inhibition and apoptosis promotion after fisetin and cisplatin combination treatment. Furthermore, fisetin regulated the PI3K/Akt/mTOR signaling pathway through CDK6 inhibition, which enhanced cisplatin sensitivity. Overexpression of CDK6 neutralized the positive effects of fisetin on the improvement of cisplatin sensitivity in RCC cells. In conclusion, fisetin may enhance the sensitivity of RCC cells to cisplatin via the CDK6/PI3K/Akt/mTOR signaling pathway.
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Affiliation(s)
- Tingting Jiang
- Department of Traditional Chinese Medicine, Changzhou Wujin People's Hospital, Changzhou, Jiangsu 213100, P.R. China
| | - Yan Liang
- Department of Emergency Center, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, Shandong 266042, P.R. China
| | - Yenan Ji
- Department of Colorectal Anal Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, Shandong 266042, P.R. China
| | - Yin Xue
- Department of Traditional Chinese Medicine, Changzhou Wujin People's Hospital, Changzhou, Jiangsu 213100, P.R. China
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Egen L, Demmel GS, Grilli M, Studier-Fischer A, Nickel F, Haney CM, Mühlbauer J, Hartung FO, Menold HS, Piazza P, Rivas JG, Checcucci E, Puliatti S, Belenchon IR, Taratkin M, Rodler S, Cacciamani G, Michel MS, Kowalewski KF. Biophotonics-Intraoperative Guidance During Partial Nephrectomy: A Systematic Review and Meta-analysis. Eur Urol Focus 2024; 10:248-258. [PMID: 38278713 DOI: 10.1016/j.euf.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
CONTEXT Partial nephrectomy (PN) with intraoperative guidance by biophotonics has the potential to improve surgical outcomes due to higher precision. However, its value remains unclear since high-level evidence is lacking. OBJECTIVE To provide a comprehensive analysis of biophotonic techniques used for intraoperative real-time assistance during PN. EVIDENCE ACQUISITION We performed a comprehensive database search based on the PICO criteria, including studies published before October 2022. Two independent reviewers screened the titles and abstracts followed by full-text screening of eligible studies. For a quantitative analysis, a meta-analysis was conducted. EVIDENCE SYNTHESIS In total, 35 studies were identified for the qualitative analysis, including 27 studies on near-infrared fluorescence (NIRF) imaging using indocyanine green, four studies on hyperspectral imaging, two studies on folate-targeted molecular imaging, and one study each on optical coherence tomography and 5-aminolevulinic acid. The meta-analysis investigated seven studies on selective arterial clamping using NIRF. There was a significantly shorter warm ischemia time in the NIRF-PN group (mean difference [MD]: -2.9; 95% confidence interval [CI]: -5.6, -0.1; p = 0.04). No differences were noted regarding transfusions (odds ratio [OR]: 0.5; 95% CI: 0.2, 1.7; p = 0.27), positive surgical margins (OR: 0.7; 95% CI: 0.2, 2.0; p = 0.46), or major complications (OR: 0.4; 95% CI: 0.1, 1.2; p = 0.08). In the NIRF-PN group, functional results were favorable at short-term follow-up (MD of glomerular filtration rate decline: 7.6; 95% CI: 4.6, 10.5; p < 0.01), but leveled off at long-term follow-up (MD: 7.0; 95% CI: -2.8, 16.9; p = 0.16). Remarkably, these findings were not confirmed by the included randomized controlled trial. CONCLUSIONS Biophotonics comprises a heterogeneous group of imaging modalities that serve intraoperative decision-making and guidance. Implementation into clinical practice and cost effectiveness are the limitations that should be addressed by future research. PATIENT SUMMARY We reviewed the application of biophotonics during partial removal of the kidney in patients with kidney cancer. Our results suggest that these techniques support the surgeon in successfully performing the challenging steps of the procedure.
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Affiliation(s)
- Luisa Egen
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
| | - Greta S Demmel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Maurizio Grilli
- Library of the Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Alexander Studier-Fischer
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Caelan M Haney
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - Julia Mühlbauer
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Friedrich O Hartung
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Hanna S Menold
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Pietro Piazza
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Juan Gomez Rivas
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
| | - Enrico Checcucci
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Surgery, FPO-IRCCS Candiolo Cancer Institute, Turin, Italy
| | - Stefano Puliatti
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Urology, University of Modena, and Reggio Emilia, Modena, Italy
| | - Ines Rivero Belenchon
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Urology and Nephrology Department, Virgen del Rocío University Hospital, Seville, Spain
| | - Mark Taratkin
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands
| | - Severin Rodler
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Urology, University Hospital LMU Munich, Munich, Germany
| | - Giovanni Cacciamani
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Maurice S Michel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany; Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands
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Faitatziadis S, Tatanis V, Katsakiori P, Peteinaris A, Gkeka K, Vagionis A, Spinos T, Tsaturyan A, Vrettos T, Kallidonis P, Stolzenburg JU, Liatsikos E. Feasibility study of a novel robotic system for transperitoneal partial nephrectomy: An in vivo experimental animal study. Arch Ital Urol Androl 2023; 95:11852. [PMID: 38058288 DOI: 10.4081/aiua.2023.11852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/23/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE To evaluate the safety and feasibility of partial nephrectomy with the use of the novel robotic system in an in vivo animal model. METHODS Right partial nephrectomy was performed in female pigs by a surgical team consisting of one surgeon and one bedside assistant. Both were experienced in laparoscopic surgery and trained in the use of the novel robotic system. The partial nephrectomies were performed using four trocars (three trocars for the robotic arms and one as an assistant trocar). The completion of the operations, set-up time, operation time, warm ischemia time (WIT) and complication events were recorded. The decrease in all variables between the first and last operation was calculated. RESULTS In total, eight partial nephrectomies were performed in eight female pigs. All operations were successfully completed. The median set-up time was 19.5 (range, 15-30) minutes, while the estimated median operative time was 80.5 minutes (range, 59-114). The median WIT was 23.5 minutes (range, 17-32) and intra- or postoperative complications were not observed. All variables decreased in consecutive operations. More precisely, the decrease in the set-up time was calculated to 15 minutes between the first and third attempts. The operative time was reduced by 55 minutes between the first and last operation, while the WIT was decreased by 15 minutes during the consecutive attempts. No complications were noticed in any operation. CONCLUSIONS Using the newly introduced robotic system, all the advantages of robotic surgery are optimized and incorporated, and partial nephrectomies can be performed in a safe and effective manner.
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Affiliation(s)
| | | | | | | | | | | | | | - Arman Tsaturyan
- Department of Urology, University of Patras, Patras, Greece; Department of Urology, Erebouni Medical Center, Yerevan.
| | | | | | | | - Evangelos Liatsikos
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Patras, Patras.
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Motoyama D, Matsushita Y, Watanabe H, Tamura K, Otsuka A, Fujisawa M, Miyake H. Robot-assisted radical nephrectomy using novel surgical robot platform, hinotori: Report of initial series of 13 cases. Int J Urol 2023; 30:1175-1179. [PMID: 37654155 DOI: 10.1111/iju.15292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES The aims of the present study were to describe the perioperative findings of the first series of patients undergoing robot-assisted radical nephrectomy (RARN) with a newly launched platform, the hinotori surgical robot system, and compare the findings with a similar set receiving RARN with the existing system, da Vinci. METHODS This study included 34 patients, consisting of 13 and 21 undergoing RARN using the hinotori and da Vinci robotic systems, respectively. As a rule, RARN was performed via an intraperitoneal approach employing 3 robotic arms, irrespective of the robotic systems. RESULTS In the hinotori group, the median age, body mass index and tumor diameter were 65 years, 23.3 kg/m2 and 50 mm, respectively. All surgical procedures with hinotori could be completed by a purely robotic approach. In the hinotori group, the median operative time, time using the robotic system, estimated blood loss and length of hospital stay were 157, 83 min, 11 mL and 6 days, respectively, and major perioperative complications did not occur. In this group, 3, 1 and 9 patients were pathologically diagnosed with pT1a, pT1b and pT3a tumors, respectively. No significant differences in baseline characteristics were noted between the hinotori and da Vinci groups, and there were also no significant differences in perioperative findings between them. CONCLUSIONS Despite a case series with a small sample size, this is the first report evaluating RARN using the hinotori surgical robot system, which could be safely conducted and achieved perioperative outcomes similar to that using the da Vinci system.
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Affiliation(s)
- Daisuke Motoyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Developed Studies for Advanced Robotic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Filipas DK, Beatrici E, Nolazco JI, Qian Z, Marks P, Labban M, Stone BV, Pierorazio PM, Lipsitz SR, Trinh QD, Chang SL, Cole AP. The national utilization of nonoperative management for small renal masses over 10 years. JNCI Cancer Spectr 2023; 7:pkad084. [PMID: 37802923 PMCID: PMC10640883 DOI: 10.1093/jncics/pkad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Management of small renal masses often involves a nonoperative approach, but there is a paucity of information about the use and associated predictors of such approaches. This study aimed to determine the trends in and predictors of use of nonoperative management of small renal masses. METHODS Using data from the National Cancer Database for localized small renal masses (N0/M0, cT1a) diagnosed between 2010 and 2020, we conducted a cross-sectional study. Nonoperative management was defined as expectant management (active surveillance or watchful waiting) or focal ablation. Adjusted odds ratios (AORs) were calculated using multivariable logistic regression models. RESULTS Of the 156 734 patients included, 10.5% underwent expectant management, and 13.9% underwent focal ablation. Later year of diagnosis was associated with a higher likelihood of nonoperative management. In 2020, the odds of receiving expectant management and focal ablation were 90% (AOR = 1.90, 95% confidence interval [CI] = 1.71 to 2.11) and 44% (AOR = 1.44, 95% CI = 1.31 to 1.57) higher, respectively, than in 2010. Black patients had increased odds of expectant management (AOR = 1.47, 95% CI = 1.39 to 1.55) but decreased odds of focal ablation (AOR = 0.93, 95% CI = 0.88 to 0.99). CONCLUSION Over the decade, the use nonoperative management of small renal masses increased, with expectant management more frequently used than focal ablation among Black patients. Possible explanations include race-based differences in physicians' risk assessments and resource allocation. Adjusting for Black race in calculations for glomerular filtration rate could influence the differential uptake of these techniques through deflated glomerular filtration rate calculations. These findings highlight the need for research and policies to ensure equitable use of less invasive treatments in small renal masses.
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Affiliation(s)
- Dejan K Filipas
- Department of Urology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Edoardo Beatrici
- Department of Urology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jose I Nolazco
- Department of Urology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Zhiyu Qian
- Department of Urology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Phillip Marks
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Muhieddine Labban
- Department of Urology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Benjamin V Stone
- Department of Urology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Stuart R Lipsitz
- Department of Urology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Quoc-Dien Trinh
- Department of Urology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Steven L Chang
- Department of Urology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alexander P Cole
- Department of Urology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
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9
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Yasuda Y, Zhang JH, Attawettayanon W, Rathi N, Wilkins L, Roversi G, Zhang A, Accioly JPE, Shah S, Munoz-Lopez C, Palacios DA, Hofmann M, Campbell RA, Kaouk J, Haber GP, Eltemamy M, Krishnamurthi V, Abouassaly R, Martin C, Li J, Weight C, Campbell SC. Comprehensive Management of Renal Masses in Solitary Kidneys. Eur Urol Oncol 2023; 6:84-94. [PMID: 36517406 DOI: 10.1016/j.euo.2022.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/20/2022] [Accepted: 11/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND A renal mass in a solitary kidney (RMSK) has traditionally been managed with partial nephrectomy (PN), although radical nephrectomy (RN) is occasionally required. Most RMSK studies have focused on patients for whom PN was achieved. OBJECTIVE To provide a comprehensive analysis of the management strategies/outcomes for an RMSK and address knowledge deficits regarding this challenging disorder. DESIGN, SETTING, AND PARTICIPANTS A total of 1024 patients diagnosed with an RMSK (1975-2022) were retrospectively evaluated. Baseline characteristics and pathologic/functional/survival outcomes were analyzed. INTERVENTION PN/RN/cryoablation (CA)/active surveillance (AS). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Functional outcomes, perioperative morbidity/mortality, and 5-yr recurrence-free survival (RFS) were evaluated. Kruskal-Wallis and chi-square tests were used to compare cohorts, and log-rank test and Cox proportional hazard model were used for survival analysis. RESULTS AND LIMITATIONS Of 1024 patients, 842 underwent PN (82%), 102 CA (10%), 54 RN (5%), and 26 AS (3%). The median tumor size and RENAL([R]adius [tumor size as maximal diameter], [E]xophytic/endophytic properties of tumor, [N]earness of tumor deepest portion to collecting system or sinus, [A]nterior [a]/posterior [p] descriptor, and [L]ocation relative to polar lines) score were 3.7 cm and 8, respectively. The median follow-up was 53 mo. For PN, 95% were clamped, and the median warm and cold ischemia times were 22 and 45 min, respectively. For PN, the median preoperative glomerular filtration rate (GFR) was 57 ml/min/1.73 m2, and the median new baseline and 5-yr GFRs were 47 and 48 ml/min/1.73 m2, respectively. Dialysis-free survival for PN was 97% at 5 yr. Twenty-two (2.1%) patients with clear-cell renal cell carcinoma and RENAL score ≥10 (median = 11) received tyrosine kinase inhibitors (TKIs) to facilitate PN, leading to 57% median decrease of tumor volume; PN was accomplished in 20 (91%). Forty-one patients had planned RN (4.0%), most often due to severe pre-existing chronic kidney disease (CKD), and 13 were converted from PN to RN (1.5%). Clavien III-V perioperative complications were observed in 80 (8%) patients and 90-d mortality was 0.6%. Five-year RFS for PN, CA, and RN were 83%, 80%, and 72%, respectively (p = 0.03 for PN vs RN). CONCLUSIONS Nephron-sparing approaches are feasible and successful in most RMSK patients. PN for an RMSK is often challenging but can be facilitated by selective use of TKIs. RN is occasionally required due to severe CKD, over-riding oncologic concerns, or conversion from PN. This is the first large RMSK study to provide a comprehensive analysis of all management strategies/outcomes. PATIENT SUMMARY Kidney cancer in a solitary kidney is a major challenge for achieving cancer-free status and avoiding dialysis. Although partial nephrectomy is the principal treatment for a renal mass in a solitary kidney, other options are occasionally required to optimize outcomes.
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Affiliation(s)
- Yosuke Yasuda
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | - Jj H Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Institute of Urologic Oncology, Department of Urology, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Worapat Attawettayanon
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Nityam Rathi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lamont Wilkins
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gustavo Roversi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ao Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Snehi Shah
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Martin Hofmann
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Mohamad Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Robert Abouassaly
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Charles Martin
- Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Jianbo Li
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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10
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Dong X, Pan S, Zhou X, Ma W, Guo H, Gan W. Characteristics of peritumoral pseudocapsule in small renal cell carcinoma and its influencing factors. Cancer Med 2023; 12:1260-1268. [PMID: 35766142 PMCID: PMC9883584 DOI: 10.1002/cam4.4991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/21/2022] [Accepted: 06/13/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the peritumoral pseudocapsule (PC) status and identify the factors influencing PC status in small renal cell carcinoma (RCCs). METHODS A total of 147 patients with small RCC (≤4 cm) who had undergone tumor enucleation (TE) were assigned into three groups according to PC status: complete PC, PC absence, and PC invasion. Computed tomography (CT) imaging and clinicopathological features were compared among the three groups. Univariate and multivariate analyses were performed to identify factors associated with incomplete PC. RESULTS The number of patients with complete PC, PC absence, and PC invasion was 87 (59%), 20 (14%), and 40 (27%), respectively. Compared with the other two groups, tumors with complete PC were most common in clear cell RCC (CCRCC) and showed a hyperenhancement pattern (92%) and clear boundary (63%) on CT scanning images (p < 0.001). PC absence was most common in female patients (50%), whereas PC invasion was more common in male patients (85%) (p = 0.017). The tumor diameter in the PC absence group (2.24 ± 0.93 cm) was shorter compared with that of the complete PC group (2.88 ± 0.76 cm) and PC invasion group (3.16 ± 0.64 cm) (p < 0.001). Univariate and multivariate analysis showed that hypoenhancement pattern, unclear boundary, and non-CCRCC subtype were independent risk factors of incomplete PC. CONCLUSIONS Hypoenhancement pattern, unclear boundary, and non-CCRCC subtype were significant predictors of incomplete PC in small RCCs. It remains to be established whether TE is an appropriate procedure for patients with incomplete PC.
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Affiliation(s)
- Xiang Dong
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Sheng Pan
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaodie Zhou
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Wenliang Ma
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weidong Gan
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Urology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
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11
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Lee HJ, Kim SY, Cho JY, Kim TM. CT-based preoperative risk assessment of prolonged urine leak in patients undergoing partial nephrectomy. Eur Radiol 2022; 33:3801-3809. [PMID: 36565351 DOI: 10.1007/s00330-022-09361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/15/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study aims to evaluate risk factors of prolonged urine leak following partial nephrectomy (PN) to identify objective imaging characteristics on preoperative CT. METHODS A total of 865 patients who underwent PN and had preoperative CT and postoperative imaging were included. We set a twofold size-matched control group without urine leak, with all tumors located ≤ 4 mm to the collecting system to identify imaging parameters that increase the risk of urine leak other than tumor size and location. Four CT parameters that show the relationship of the tumor and collecting system, namely, curvilinear border length, protruding distance, margin at the interface, and pelvicalyceal contact, were analyzed. Multivariate logistic regression analyses were performed to identify significant predictors of urine leak. The diagnostic performance of the significant parameters was evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS Fifty-three of 865 patients (6.1%) demonstrated urine leak. Compared with the control group, urine leak group showed longer curvilinear border length, longer protruding distance, frequent non-smooth contact interface, and frequent direct pelvicalyceal contact (p < 0.05 for all). In the multivariate analysis, pelvicalyceal contact was the independent predictor of urine leak (OR = 2.62; 95% C.I 1.02-6.63). Combining four CT parameters, an AUC of 0.70 with a sensitivity of 58.5% and a specificity of 79.2% for identifying urine leak after PN could be obtained. CONCLUSIONS The four CT features that describe the relationship between the tumor and collecting system might be useful for evaluating the risk of urine leak before PN. KEY POINTS • Four CT parameters (curvilinear border length, protruding distance, margin at the interface, and pelvicalyceal contact) were significantly associated with postoperative urine leak after partial nephrectomy. • A comprehensive preoperative imaging evaluation of the relationship between the tumor and renal sinus may help in selecting the optimal surgical options and afford better patient counseling of complication risk.
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Affiliation(s)
- Hyo Jeong Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Taek Min Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
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12
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Simplified PADUA REnal (SPARE) Nephrometry System can Describe the Surgical Difficulty of Renal Masses With High Accuracy Even Without 3D Renal Models. Urology 2022; 170:132-138. [DOI: 10.1016/j.urology.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/18/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022]
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13
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Kirste S, Rühle A, Zschiedrich S, Schultze-Seemann W, Jilg CA, Neumann-Haefelin E, Lo SS, Grosu AL, Kim E. Stereotactic Body Radiotherapy for Renal Cell Carcinoma in Patients with Von Hippel-Lindau Disease-Results of a Prospective Trial. Cancers (Basel) 2022; 14:5069. [PMID: 36291853 PMCID: PMC9599838 DOI: 10.3390/cancers14205069] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 11/18/2022] Open
Abstract
Von Hippel-Lindau disease (VHL) is a hereditary disorder associated with malignant tumors including clear cell renal cell carcinoma (ccRCC). Partial nephrectomy is complicated by multilocular tumor occurrence and a high recurrence rate. The aim of this study was to evaluate the potential of stereotactic body radiotherapy (SBRT) as an alternative treatment approach in VHL patients with multiple ccRCC. Patients with VHL and a diagnosis of ccRCC were enrolled. SBRT was conducted using five fractions of 10 Gy or eight fractions of 7.5 Gy. The primary endpoint was local control (LC). Secondary endpoints included alteration of renal function and adverse events. Seven patients with a total of eight treated lesions were enrolled. Median age was 44 years. Five patients exhibited multiple bilateral kidney cysts in addition to ccRCC. Three patients underwent at least one partial nephrectomy in the past. After a median follow-up of 43 months, 2-year LC was 100%, while 2-year CSS, 2-year PFS and 2-year OS was 100%, 85.7% and 85.7%, respectively. SBRT was very well tolerated with no acute or chronic toxicities grade ≥ 2. Mean estimated glomerular filtration rate (eGFR) at baseline was 83.7 ± 13.0 mL/min/1.73 m2, which decreased to 76.6 ± 8.0 mL/min/1.73 m2 after 1 year. Although the sample size was small, SBRT resulted in an excellent LC rate and was very well tolerated with preservation of kidney function in patients with multiple renal lesions and cysts.
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Affiliation(s)
- Simon Kirste
- Department of Radiation Oncology, Medical Center—University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), 69120 Heidelberg, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, Medical Center—University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), 69120 Heidelberg, Germany
| | - Stefan Zschiedrich
- Renal Division, Department of Internal Medicine, Bürgerspital Solothurn, 4500 Solothurn, Switzerland
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Wolfgang Schultze-Seemann
- Department of Urology, Medical Center—University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany
| | - Cordula A. Jilg
- Department of Urology, Medical Center—University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany
| | - Elke Neumann-Haefelin
- Renal Division, Department of Medicine, Medical Center—University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany
| | - Simon S. Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center—University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), 69120 Heidelberg, Germany
| | - Emily Kim
- Department of Radiation Oncology, Medical Center—University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), 69120 Heidelberg, Germany
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14
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Zhang S, Yang G, Qian J, Zhu X, Li J, Li P, He Y, Xu Y, Shao P, Wang Z. A novel 3D deep learning model to automatically demonstrate renal artery segmentation and its validation in nephron-sparing surgery. Front Oncol 2022; 12:997911. [PMID: 36313655 PMCID: PMC9614169 DOI: 10.3389/fonc.2022.997911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/28/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose Nephron-sparing surgery (NSS) is a mainstream treatment for localized renal tumors. Segmental renal artery clamping (SRAC) is commonly used in NSS. Automatic and precise segmentations of renal artery trees are required to improve the workflow of SRAC in NSS. In this study, we developed a tridimensional kidney perfusion (TKP) model based on deep learning technique to automatically demonstrate renal artery segmentation, and verified the precision and feasibility during laparoscopic partial nephrectomy (PN). Methods The TKP model was established based on convolutional neural network (CNN), and the precision was validated in porcine models. From April 2018 to January 2020, TKP model was applied in laparoscopic PN in 131 patients with T1a tumors. Demographics, perioperative variables, and data from the TKP models were assessed. Indocyanine green (ICG) with near-infrared fluorescence (NIRF) imaging was applied after clamping and dice coefficient was used to evaluate the precision of the model. Results The precision of the TKP model was validated in porcine models with the mean dice coefficient of 0.82. Laparoscopic PN was successfully performed in all cases with segmental renal artery clamping (SRAC) under TKP model’s guidance. The mean operation time was 100.8 min; the median estimated blood loss was 110 ml. The ischemic regions recorded in NIRF imaging were highly consistent with the perfusion regions in the TKP models (mean dice coefficient = 0.81). Multivariate analysis revealed that the feeding lobar artery number was strongly correlated with tumor size and contact surface area; the supplying segmental arteries number correlated with tumor size. Conclusions Using the CNN technique, the TKP model is developed to automatically present the renal artery trees and precisely delineate the perfusion regions of different segmental arteries. The guidance of the TKP model is feasible and effective in nephron-sparing surgery.
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Affiliation(s)
- Shaobo Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guanyu Yang
- Key Laboratory of Computer Network and Information Integration, Southeast University, Ministry of Education, Nanjing, China
| | - Jian Qian
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaomei Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pu Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuting He
- Key Laboratory of Computer Network and Information Integration, Southeast University, Ministry of Education, Nanjing, China
| | - Yi Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengfei Shao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Pengfei Shao,
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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15
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Song S, Yang Q, Gu C, Yu G, Hua B, Gu X, Wang L, Wang Z, Shi G, Xu B. Long-term outcomes of cryoablation for biopsy-proven T1 stage renal cell carcinoma. World J Surg Oncol 2022; 20:284. [PMID: 36064369 PMCID: PMC9446802 DOI: 10.1186/s12957-022-02752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background To summarize our clinical experience of cryoablation in renal cell carcinoma (RCC) of Chinese population and to evaluate the long-term outcomes of laparoendoscopic single-site (LESS) cryoablation (LCA) as well as percutaneous CT-guided cryoablation (PCA) for biopsy-proven T1a and T1b RCC. Methods This was a multi-center, retrospective study investigating T1 stage RCC patients from 2011 to 2021. The patients were treated by LCA or PCA according to individual situation. Overall survival (OS), cancer-related survival (CSS), and progression-free survival (PFS) were evaluated for oncological outcomes, and kidney function, complications, and hospital stay were used to estimate technical outcomes. Results A total of 163 consecutive patients were included. Among them, 59 cases were treated by LCA and PCA was performed in 104 cases. All operations were processed successfully. Mean diameter of the mass was (2.9±1.4) cm; median blood volume was 45ml (10~200 ml). The mean operation time was 84.0 ± 24.5 min. The median postoperative hospital stay was 3 days (1~6 days). Compared with LCA, procedure time of PCA was shortened, the volume of bleeding was reduced, and the hospital stay was decreased. The overall adverse events rate was 9.8% (16/163). The mean preoperative and postoperative eGFR of LCA were 77.6±15.3 ml/min and 75.6±17.4 ml/min, respectively. Analogously, the values of PCA were 78.7±12.9 ml/min and 76.7±14.3 ml/min. Mean follow-up time was 64.2 ± 30.2 months (range, 7–127 months). Local recurrence was observed in 13 patients (8.0%), 4 (6.8%) cases of LCA and 9 (8.7%) cases of PCA. PFS at 5 and 10 years were 95.5% and 69.2% for LCA and 96.7% and 62.8% for PCA. In total, 26 patients (16.0%) (11 patients from LCA and 15 from PCA) died throughout the follow-up period. OS at 5 and 10 years were 93.8% and 31.4% for LCA, and 97.4% and 52.7% for PCA. Six patients (3.7%) (3 cases from LCA and 3 from PCA) died of metastatic RCC. CCS for LCA were 98.0% and 82.8% at 5 and 10 years, while the data were 100% and 86.4% for PCA. Conclusion LCA and PCA for T1 stage RCC provides satisfactory long-term oncological and renal function preservation outcomes, with acceptable complication rates.
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Affiliation(s)
- Shangqing Song
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Qing Yang
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Chengyuan Gu
- Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Guopeng Yu
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Bao Hua
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Xin Gu
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Linhui Wang
- Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Zhong Wang
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Guohai Shi
- Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
| | - Bin Xu
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China.
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16
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Yao Z, Zhao J, Zheng B, Cong Z, Zhang Y, Lv J, Niu Z, Cheng F, He W. The feasibility and safety of adopting the left lumbar vein to localize the renal artery location during left transperitoneal laparoscopic partial nephrectomy. Front Surg 2022; 9:858798. [PMID: 36132207 PMCID: PMC9483022 DOI: 10.3389/fsurg.2022.858798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Laparoscopic partial nephrectomy (LPN) is the standard of care for localized small renal cancer. The most critical step in this form of surgery is to localize the renal artery. In the present study, we describe a novel technique that uses the left lumbar vein (LV) to access the left renal artery during LPN. Materials and methods This was a retrospective review of 130 cases of transperitoneal laparoscopic partial nephrectomies (TLPNs) performed on patients with renal cancer in our center between January 2018 and December 2021. Either the LV or non-lumbar vein (N-LV) technique was used to locate and manage the left renal artery. We recorded relevant clinical data from all patients, including patient characteristics, tumor data, and perioperative outcomes (artery mobilization time, operative time, estimated blood loss, and complications). Comparative analysis was then carried out between the cases using LV or N-LV vein techniques. Results All TLPNs were successfully accomplished without conversion to open approaches. There were no complications involving the renal vessels during the entire study. The LV technique resulted in a significantly shorter time to mobilize the renal and significantly less estimated blood loss (p < 0.05). There was no significant difference between the two techniques with regard to perioperative complications. Conclusion The left LV represents an anatomical landmark for locating the left renal artery in TLPN. This approach has numerous advantages over the transperitoneal approach including facilitating access to the left renal artery and reducing the duration of surgery.
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Affiliation(s)
- Zhongshun Yao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jiming Zhao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bin Zheng
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zixiang Cong
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yiming Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jiaju Lv
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhihong Niu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Fajuan Cheng
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- Correspondence: Fajuan Cheng Wei He
| | - Wei He
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- Correspondence: Fajuan Cheng Wei He
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Lomoschitz FM, Stummer H. Applied Change Management in Interventional Radiology—Implementation of Percutaneous Thermal Ablation as an Additional Therapeutic Method for Small Renal Masses. Diagnostics (Basel) 2022; 12:diagnostics12061301. [PMID: 35741111 PMCID: PMC9222117 DOI: 10.3390/diagnostics12061301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
Interventional radiology (IR) has the potential to offer minimally invasive therapy. With this potential, new and arising IR methods may sometimes be in competition with established therapies. To introduce new methods, transformational processes are necessary. In organizations, structured methods of change management, such as the eight-step process of Kotter—(1) Establishing a sense of urgency, (2) Creating the guiding coalition, (3) Developing a vision and strategy, (4) Communicating the change vision, (5) Empowering employees for broad-based action, (6) Generating short-term wins, (7) Consolidating gains and producing more change, and (8) Anchoring new approaches in the culture—are applied based on considerable evidence. In this article, the application of Kotter’s model in the clinical context is shown through the structured transformational process of the organizational implementation of the percutaneous thermal ablation of small renal masses. This article is intended to familiarize readers in the medical field with the methods of structured transformational processes applicable to the clinical setting.
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Affiliation(s)
- Friedrich M. Lomoschitz
- Department of Diagnostic and Interventional Radiology, Clinic Hietzing, Wolkersbergenstrasse 1, A-1130 Vienna, Austria
- Institute for Management and Economics in Health Care, UMIT—University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060 Hall in Tirol, Austria;
- Correspondence:
| | - Harald Stummer
- Institute for Management and Economics in Health Care, UMIT—University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060 Hall in Tirol, Austria;
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Purysko AS, Nikolaidis P, Khatri G, Auron M, De Leon AD, Ganeshan D, Gore JL, Gupta RT, Shek-Man Lo S, Lyshchik A, Savage SJ, Smith AD, Taffel MT, Yoo DC, Lockhart ME. ACR Appropriateness Criteria® Post-Treatment Follow-up and Active Surveillance of Clinically Localized Renal Cell Carcinoma: 2021 Update. J Am Coll Radiol 2022; 19:S156-S174. [PMID: 35550799 DOI: 10.1016/j.jacr.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 11/30/2022]
Abstract
Renal cell carcinoma (RCC) accounts for most malignant renal tumors and is considered the most lethal of all urologic cancers. For follow-up of patients with treated or untreated RCC and those with neoplasms suspected to represent RCC, radiologic imaging is the most valuable component of surveillance, as most relapses and cases of disease progression are identified when patients are asymptomatic. Understanding the strengths and limitations of the various imaging modalities for the detection of disease, recurrence, or progression is essential when planning follow-up regimens. This document addresses the appropriate imaging examinations for asymptomatic patients who have been treated for RCC with radical or partial nephrectomy or ablative therapies. It also discusses the appropriate imaging examinations for asymptomatic patients with localized biopsy-proven or suspected RCC undergoing active surveillance. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Paul Nikolaidis
- Panel Chair, Vice Chair, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Gaurav Khatri
- Panel Vice-Chair, Division Chief, Body MRI; Associate Division Chief, Abdominal Imaging; Program Director, Body MRI Fellowship, UT Southwestern Medical Center, Dallas, Texas
| | - Moises Auron
- Medical Director Blood Management; Quality and Patient Safety Officer, Department of Hospital Medicine; Member, Board of Governors, Cleveland Clinic, Cleveland, Ohio; Primary care physician-Internal medicine
| | | | | | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina; and Chair, ACR Meetings Subcommittee, Commission on Publications and Lifelong Learning
| | - Simon Shek-Man Lo
- Vice Chair for Strategic Planning, Director of SBRT, and Co-chair of Appointment and Promotion Committee of Department of Radiation of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington; and Immediate Past President of CARROS of ACR, Fellowship Committee Chair of CARROS of ACR, ACR Assistant Councilor (on behalf of American Radium Society), Chair of the Committee for ACR Practice Parameter for Radiation Oncology
| | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Stephen J Savage
- Professor and Vice Chairman of Urology, Medical University of South Carolina, Charleston, South Carolina; American Urological Association
| | - Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Myles T Taffel
- Associate Section Head Abdominal Imaging, New York University Langone Medical Center, New York, New York
| | - Don C Yoo
- Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama; and Chair, ACR Appropriateness Committee
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Schmid FA, Bausch K, Wettstein MS, Feicke A, Weltzien B, Schmid DM, Strebel RT, Poyet C, Rupp NJ, Sulser T, Seifert HH, Hermanns T. Long-Term Oncological Efficacy of Retroperitoneoscopic Radical Nephrectomy of Localized Renal Cell Cancer pT1-3 (≤ 12cm). Clin Genitourin Cancer 2022; 20:e411-e418. [DOI: 10.1016/j.clgc.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 11/03/2022]
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20
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Trevisani F, Floris M, Minnei R, Cinque A. Renal Oncocytoma: The Diagnostic Challenge to Unmask the Double of Renal Cancer. Int J Mol Sci 2022; 23:2603. [PMID: 35269747 PMCID: PMC8910282 DOI: 10.3390/ijms23052603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
Renal oncocytoma represents the most common type of benign neoplasm that is an increasing concern for urologists, oncologists, and nephrologists due to its difficult differential diagnosis and frequent overtreatment. It displays a variable neoplastic parenchymal and stromal architecture, and the defining cellular element is a large polygonal, granular, eosinophilic, mitochondria-rich cell known as an oncocyte. The real challenge in the oncocytoma treatment algorithm is related to the misdiagnosis due to its resemblance, at an initial radiological assessment, to malignant renal cancers with a completely different prognosis and medical treatment. Unfortunately, percutaneous renal biopsy is not frequently performed due to the possible side effects related to the procedure. Therefore, the majority of oncocytoma are diagnosed after the surgical operation via partial or radical nephrectomy. For this reason, new reliable strategies to solve this issue are needed. In our review, we will discuss the clinical implications of renal oncocytoma in daily clinical practice with a particular focus on the medical diagnosis and treatment and on the potential of novel promising molecular biomarkers such as circulating microRNAs to distinguish between a benign and a malignant lesion.
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Affiliation(s)
- Francesco Trevisani
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy;
- Unit of Urology, San Raffaele Scientific Institute, 20132 Milan, Italy
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Matteo Floris
- Nephrology, Dialysis and Transplantation, G. Brotzu Hospital, Università degli Studi di Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Roberto Minnei
- Nephrology, Dialysis and Transplantation, G. Brotzu Hospital, Università degli Studi di Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Alessandra Cinque
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
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21
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Miyake H, Motoyama D, Kawakami A, Sato R, Watanabe K, Matsushita Y, Watanabe H, Ito T, Sugiyama T, Otsuka A. Initial experience of robot-assisted radical nephrectomy in Japan: Single institutional study of 12 cases. Asian J Endosc Surg 2022; 15:162-167. [PMID: 34514709 DOI: 10.1111/ases.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To evaluate the initial experience of robot-assisted radical nephrectomy (RARN) in a single institution in Japan. METHODS This study included a total of 12 patients with renal tumors who were not preoperatively regarded as optimal candidates for robot-assisted partial nephrectomy (RAPN) and subsequently treated with RARN between April 2019 and June 2021 at our institution. Comprehensive perioperative outcomes in these patients were retrospectively analyzed. RESULTS Of the 12 included patients, 10 and two were male and female, respectively, and the median age was 66 years. The median tumor diameter was 44 mm, and four, four and four patients were classified into cT1a, cT1b and cT3a, respectively. There was no patient requiring open conversion, and the median operative and console times were 167 and 79 minutes, respectively. The median estimated blood loss was 42 cc, and no patient required blood transfusion. During the perioperative period, no major complication corresponding to Clavien-Dindo grade ≥3 occurred. Nine, two and one patient were pathologically diagnosed with clear cell carcinoma (CCC), non-CCC and benign cyst, respectively, and there was no patient who developed recurrent diseases. CONCLUSIONS Considering complicated tumor characteristics not amenable to RAPN in this series, such as an intravenous tumor thrombus or previous history of open partial nephrectomy, perioperative outcomes of initial experience with RARN in Japan could be considered favorable. Collectively, these findings suggest that RARN may be a promising alternative to laparoscopic radical nephrectomy for patients with complicated renal tumors, contraindicated for RAPN.
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Affiliation(s)
- Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Motoyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Asuka Kawakami
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ryo Sato
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kyohei Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiki Ito
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takayuki Sugiyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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22
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Wenzel M, Kleimaker A, Uhlig A, Würnschimmel C, Becker A, Yu H, Meyer CP, Fisch M, Chun FKH, Leitsmann M. Impact of comorbidities on acute kidney injury and renal function impairment after partial and radical tumor nephrectomy. Scand J Urol 2021; 55:377-382. [PMID: 34427540 DOI: 10.1080/21681805.2021.1948916] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND To test for the impact of patient comorbidities and medical risk factors on kidney function after partial (PN) or radical nephrectomy (RN) in renal cell carcinoma (RCC) patients with normal preoperative renal function. MATERIALS AND METHODS From January 2011 to December 2014, 195 consecutive RCC patients with a preoperative estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73 m2 underwent PN or RN. Stratification was performed according to postoperative acute kidney injury (AKI) vs. no AKI. Moreover, logistic regression models tested for risk factors predicting postoperative AKI and subsequent new-onset chronic kidney disease (eGFR < 60 or < 45 ml/min/1.73 m2). RESULTS Of all eligible patients, 127 (65.1%) exhibited AKI. AKI patients underwent more frequently RN (44.9 vs. 13.2% PN) and harbored more often preoperative diabetes (17.3 vs. 5.9% no diabetes), hypertension (46.5 vs. 23.5% no hypertension) and larger median tumor size (4.5 vs. 2.5 cm, all p < 0.05) than non-AKI patients. Moreover, after median follow-up of 14 months, 18.9% of AKI patients exhibited an eGFR < 60 ml/min/1.73 m2 vs. 7.4% non-AKI patients (p = 0.01). In multivariable models, hypertension and RN were risk factors for postoperative AKI (both p < 0.01). Age > 60 years and RN as well as preoperative diabetes were risk factors for postoperative eGFR < 60 or < 45 ml/min/1.73 m2 (all p < 0.05), respectively. CONCLUSIONS Postoperative AKI is a non-negligible event especially after RN that can be further triggered by comorbidities such as diabetes and hypertension. Comorbidities should be considered in clinical decision-making for RCC surgery and patients need to be counseled about the increased risk of consecutive renal function impairment.
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Alexander Kleimaker
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, Schoen Medical Center Neustadt, Neustadt, Germany
| | - Annemarie Uhlig
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Christoph Würnschimmel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada.,Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Hang Yu
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian P Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Marianne Leitsmann
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
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23
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Wenzel M, Yu H, Uhlig A, Würnschimmel C, Wallbach M, Becker A, Fisch M, Chun FKH, Meyer CP, Leitsmann M. Cystatin C predicts renal function impairment after partial or radical tumor nephrectomy. Int Urol Nephrol 2021; 53:2041-2049. [PMID: 34269968 PMCID: PMC8463386 DOI: 10.1007/s11255-021-02957-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
Purpose To test the value of preoperative and postoperative cystatin C (CysC) as a predictor on kidney function after partial (PN) or radical nephrectomy (RN) in renal cell carcinoma (RCC) patients with normal preoperative renal function. Methods From 01/2011 to 12/2014, 195 consecutive RCC patients with a preoperative estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73m2 underwent surgical RCC treatment with either PN or RN. Logistic and linear regression models tested for the effect of CysC as a predictor of new-onset chronic kidney disease in follow-up (eGFR < 60 ml/min/1.73m2). Moreover, postoperative CysC and creatinine values were compared for kidney function estimation. Results Of 195 patients, 129 (66.2%) underwent PN. In postoperative and in follow-up setting (median 14 months, IQR 10–20), rates of eGFR < 60 ml/min/1.73m2 were 55.9 and 30.2%. In multivariable logistic regression models, preoperative CysC [odds ratio (OR): 18.3] and RN (OR: 13.5) were independent predictors for a reduced eGFR < 60 ml/min/1.73m2 in follow-up (both p < 0.01), while creatinine was not. In multivariable linear regression models, a difference of the preoperative CysC level of 0.1 mg/dl estimated an eGFR decline in follow-up of about 5.8 ml/min/1.73m2. Finally, we observed a plateau of postoperative creatinine values in the range of 1.2–1.3 mg/dl, when graphically depicted vs. postoperative CysC values (‘creatinine blind area’). Conclusion Preoperative CysC predicts renal function impairment following RCC surgery. Furthermore, CysC might be superior to creatinine for renal function monitoring in the early postoperative setting.
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany. .,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.
| | - Hang Yu
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annemarie Uhlig
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Christoph Würnschimmel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.,Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Manuel Wallbach
- Department of Nephrology, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Christian P Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marianne Leitsmann
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
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Ngo DHA, Le Trong B, Le Dinh D, Le Dinh K, Pham Anh V, Nguyen Van M, Nguyen Thanh T. Synchronous Renal Cell Carcinoma and Hepatocellular Carcinoma. Res Rep Urol 2021; 13:251-256. [PMID: 34017801 PMCID: PMC8131089 DOI: 10.2147/rru.s307541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
The coexistence of multiple synchronous primary malignancies is uncommon. The coexistence of hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC) is even rarer. We present a case of a 44-year-old male patient with a history of chronic hepatitis B and a right renal mass treated by radical nephrectomy. At the 2-month follow-up, a new lesion was detected in the left lobe of the liver. Postsurgery histologic evaluation with immunohistochemical study of both lesions confirmed the renal and hepatic lesions to be RCC and HCC, respectively.
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Affiliation(s)
- Dac Hong An Ngo
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Binh Le Trong
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Dam Le Dinh
- Department of Surgery, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Khanh Le Dinh
- Department of Surgery, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Vu Pham Anh
- Department of Surgery, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Mao Nguyen Van
- Department of Histology, Embryology, Pathology and Forensic Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thao Nguyen Thanh
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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Campos TJFL, de V FE, Rocha MFH. Assessment of the complexity of renal tumors by nephrometry (R.E.N.A.L. score) with CT and MRI images versus 3D reconstruction model images. Int Braz J Urol 2021; 47:896-901. [PMID: 33848086 PMCID: PMC8321486 DOI: 10.1590/s1677-5538.ibju.2020.0930] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/16/2020] [Indexed: 12/02/2022] Open
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Teishima J, Inoue S, Miyamoto S, Fukuoka K, Sekino Y, Kitano H, Hieda K, Hayashi T, Matsubara A. Impact of postoperative acute kidney injury on predicting the upstaging of chronic kidney disease after robot-assisted partial nephrectomy. Asian J Endosc Surg 2021; 14:50-56. [PMID: 33118676 DOI: 10.1111/ases.12829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/24/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of our study was to assess the impact of acute kidney injury (AKI) on postoperative upstaging of chronic kidney disease (CKD) after robot-assisted partial nephrectomy (RAPN). METHODS This study consisted of 110 patients who had undergone RAPN and were followed up for at least 6 months after surgery. Patients were classified as AKI or non-AKI based on their serum creatinine level and estimated glomerular filtration rate within 7 days after surgery. Patient characteristics, outcome of RAPN and estimated glomerular filtration rate, and CKD upstage 6 months after surgery were compared between the AKI and non-AKI groups. RESULTS A total of 26 patients (23.6%) experienced AKI after surgery. RENAL (radius, exophytic/endophitic properties, nearness of the tumor to the collecting system or sinus, anterior/posterior, location relative to the polar lines) nephrometry scores were ≥7 for 22 (84.6%) in the AKI group and 39 (46.4%) in the non-AKI group (P = .0006). A significantly smaller proportion of patients in the AKI group than in the non-AKI group recovered 90% of baseline function (38.5% vs 81.0%, P < .0001). CKD upstaging occurred in a total of 27 patients 24.5%) and in a significantly larger proportion of patients in the AKI group than in the non-AKI group (42.3% vs 19.0%, P = .0160). There was no significant difference in characteristics and perioperative outcomes between the patients with and without CKD, except for in those experiencing AKI. CONCLUSION After RAPN, AKI can be associated with CKD upstaging.
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Affiliation(s)
- Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Inoue
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shunsuke Miyamoto
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenichiro Fukuoka
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yohei Sekino
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Kitano
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keisuke Hieda
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Malek MM, Behr CA, Aldrink JH, Dasgupta R, Heaton TE, Gehred A, Lautz TB, Baertschiger RM, Christison-Lagay ER, Tracy ET, Rhee DS, Rodeberg D, Austin MT, Ehrlich PF. Minimally invasive surgery for pediatric renal tumors: A systematic review by the APSA Cancer Committee. J Pediatr Surg 2020; 55:2251-2259. [PMID: 32386972 DOI: 10.1016/j.jpedsurg.2020.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/20/2020] [Accepted: 03/23/2020] [Indexed: 12/22/2022]
Abstract
UNLABELLED Minimally invasive nephrectomy is performed routinely for adult renal tumors and for many benign pediatric conditions. Although open radical nephroureterectomy remains the standard of care for Wilms tumor and most pediatric renal malignancies, there are an increasing number of reports of minimally invasive surgery (MIS) for those operations as well. The APSA Cancer Committee performed a systematic review to better understand the risks and benefits of MIS in pediatric patients with renal tumors. METHODS The search focused on MIS for renal tumors in children and followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist. The initial database search identified 491 published articles, and after progressive review of abstracts and full-length articles, 19 were included in this review. RESULTS There were two direct comparison studies where open surgery and MIS were compared. The remaining studies reported only on minimally invasive nephrectomy. Across all studies, there were a total of 151 patients, 126 of which had Wilms tumor and 10 patients had RCC. 104 patients had MIS, with 47 patients having open surgery. In the two studies in which open surgery and MIS were directly compared, more lymph nodes were harvested during open surgery (median = 2 (MIS) vs 5 (open); mean = 2.47 (MIS) vs 3.8 (open)). Many noncomparison studies reported the harvest of 2 of fewer lymph nodes for Wilms tumor. Several MIS patients were also noted to have intraoperative spill or positive margins. Survival between groups was similar. CONCLUSIONS There is a lack of evidence to support MIS for pediatric renal tumors. This review demonstrates that lymph node harvest has been inadequate for MIS pediatric nephrectomy and there appears to be an increased risk for intraoperative spill. Survival data are similar between groups, but follow-up times were inconsistent and patient selection was clearly biased, with only small tumors being selected for MIS. TYPE OF STUDY Review article. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Marcus M Malek
- Department of Surgery, Division of Pediatric Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Christopher A Behr
- Department of Surgery, Division of Pediatric Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Todd E Heaton
- Department of Surgery, Division of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alison Gehred
- Grant Morrow, III MD Medical Library, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Timothy B Lautz
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | | | - Emily R Christison-Lagay
- Division of Pediatric General and Thoracic Surgery, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, CT
| | - Elisabeth T Tracy
- Department of Surgery, Division of Pediatric Surgery, Duke University Medical Center
| | - Daniel S Rhee
- Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Rodeberg
- Department of Surgery, Division of Pediatric Surgery, East Carolina University, Greenville, NC
| | - Mary T Austin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter F Ehrlich
- Department of Pediatric Surgery, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI
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Egen L, Kowalewski KF, Riffel P, Honeck P, Kriegmair MC. Nephrometry Scores: Can Preoperative Assessment of Sectional Imaging Really Mirror Intraoperative Renal Tumor Anatomy? Urol Int 2020; 105:108-117. [PMID: 33045708 DOI: 10.1159/000510684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To compare RENAL, preoperative aspects and dimensions used for an anatomical (PADUA) classification, and Mayo Adhesive Probability (MAP) scores with the respective intraoperative findings and surgeon's assessment in predicting surgical outcome of patients undergoing partial nephrectomy. METHODS Data of 150 eligible patients treated at the University Medical Center Mannheim between 2016 and 2018 were analyzed. Tumors were radiologically and intraoperatively assessed by PADUA, RENAL, and MAP scores and surgeon's assessment. Correlations and regression models were created to predict ischemia time (IT), major complications, and Trifecta (negative surgical margin, IT < 25 min, and absence of major complications). RESULTS There were strong correlations between radiological and intraoperative RENAL (r = 0.68; p < 0.001) and PADUA scores (r = 0.72; p < 0.001). Radiological RENAL, PADUA, and MAP scores and surgeon's assessment were independent predictors of Trifecta (OR = 0.71, p = 0.015; OR = 0.77, p = 0.035; OR = 0.65, p = 0.012; OR = 0.40, p = 0.005, respectively). IT showed significant associations with radiological RENAL, PADUA, and surgeon's assessment (OR = 1.41, p = 0.033; OR = 1.34, p = 0.044; OR = 3.04, p = 0.003, respectively). MAP score proved as only independent predictor of major complications (OR = 2.12, p = 0.002). CONCLUSION Radiologically and intraoperatively assessed scores correlated well with each other. Intraoperative nephrometry did not outperform radiological scores in predicting outcome confirming the value of the existing systems. MAP score correlates well with surgeon's assessment of perirenal fat and major complications underlining the importance of perirenal fat characteristics.
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Affiliation(s)
- Luisa Egen
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Mannheim, Germany
| | | | - Philipp Riffel
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Patrick Honeck
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Mannheim, Germany,
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Howley R, Mansi M, Shinde J, Restrepo J, Chen B. Evaluation of aminolevulinic acid-mediated protoporphyrin IX fluorescence and enhancement by ABCG2 inhibitors in renal cell carcinoma cells. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 211:112017. [PMID: 32919173 DOI: 10.1016/j.jphotobiol.2020.112017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/12/2020] [Accepted: 09/03/2020] [Indexed: 12/31/2022]
Abstract
Aminolevulinic acid (ALA) has been approved as an intraoperative molecular imaging probe for protoporphyrin IX (PpIX) fluorescence-guided resection of glioma. Here we explored its potential application for renal cell carcinoma (RCC) that is showing increased incidence in recent years. ALA-mediated PpIX in cell lysates (intracellular) and culture medium was measured in five human RCC cell lines (786-O, 769-P, A-704, Caki-1, Caki-2) and a non-tumor human kidney epithelial cell line HK-2 by spectrofluorometry and flow cytometry. The activity of PpIX bioconversion enzyme ferrochelatase (FECH) and PpIX efflux transporter ABCG2 was determined to correlate with the PpIX level. We found that ALA-PpIX fluorescence was highly variable among RCC cell lines and A-704 was the only RCC cell line exhibiting significantly higher intracellular PpIX than HK-2 cells. Neither the intracellular PpIX level nor the total amount of PpIX (including PpIX in cell lysates and the medium) had significant correlation with the activity of FECH or ABCG2. To enhance the intracellular PpIX, cells were treated with Ko143, a pharmacological inhibitor of ABCG2. Ko143 significantly increased the intracellular PpIX in cell lines with ABCG2 activity, but not in cell lines with little ABCG2 activity. In fact, there was a positive correlation between the ABCG2 activity and Ko143-induced PpIX enhancement across kidney cell lines. To identify clinically relevant ABCG2 inhibitors, small molecule inhibitors targeting various cell signaling pathways, some of which are known to inhibit ABCG2, were evaluated for the enhancement of ALA-PpIX in Caki-2 cells that had the highest ABCG2 activity in the RCC cell panel. Our screening led to the identification of several clinically available inhibitors that significantly increased the intracellular PpIX. Particularly, kinase inhibitor lapatinib exhibited the strongest enhancement effect. These clinical inhibitors can be used for the enhancement of ALA-PpIX fluorescence in tumors with elevated ABCG2 activity.
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Affiliation(s)
- Richard Howley
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA
| | - Matthew Mansi
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA
| | - Janhavi Shinde
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA
| | - Juliana Restrepo
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA
| | - Bin Chen
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA; Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Castilho TML, Lemos GC, Cha JD, Colombo JR, Claros OR, Lemos MB, Carneiro A. Transition from open partial nephrectomy directly to robotic surgery: experience of a single surgeon to achieve "TRIFECTA". Int Braz J Urol 2020; 46:814-821. [PMID: 32648421 PMCID: PMC7822359 DOI: 10.1590/s1677-5538.ibju.2019.0101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Recent data suggest that robotic platform has become the most accessible minimal invasive surgery even for surgeons without previous training in laparoscopy. Laparoscopic partial nephrectomy (LPN) is a well-stablished procedure, however, with high level of complexity and long learning curve that limit its use. OBJECTIVE To describe safety, efficiency and learning curve of a single surgeon without previous experience in LPN to reach "TRIFECTA" at robot-assisted partial nephrectomy (RAPN). PATIENTS AND METHODS This is a retrospective study, with prospective data collection of 101 patients submitted to RAPN by a single surgeon. In order to analyze the learning curve, sample was chronologically divided in two phases: first phase: P1: 50 first patients, second phase: P2: 51 subsequent patients. TRIFECTA was defined as: ischemia time lower than 25 minutes, negative surgical margin and absence of severe complications (Clavien >2). RESULTS Mean age of patients was 54 years (SD=11.85), median tumor size was 32mm (SD=17) and surgery was performed with zero ischemia time in 33.6% of patients (29.8% at P1 and 40.9% at P2). Demographic data of patients were similar between both groups, except tumor size (P1=27.5mm vs. P2=35.3mm; p=0.02) and body mass index (BMI) (P1=26.6kg/m2 vs. P2=29kg/m2; p=0.03). Rate of bleeding, surgical time, presence of positive margin and peri-operatory surgical complications were similar in both phases. TRIFECTA was higher in P2 in relation to P1 (P1: 58% vs. P2: 87.8%; p=0.002) and median time of hot ischemia was significantly lower at P2 (P1: 17.3 vs. P2: 11.7; p=0.02). At multivariate analysis independent factors related to TRIFECTA included: chronological phase (OR 10.74; 95% IC: 1.63-70.53; p=0.013) and tumor size (OR 0.95; 95% IC: 0.91-0.99; p=0.024). CONCLUSION RAPN seems to be safe and efficient with good functional and oncological results (TRIFECTA) since the beginning. Experience improvement was related to treatment of larger tumors, higher proportion of patients with zero ischemia and higher rate of TRIFECTA.
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Affiliation(s)
| | | | | | | | | | | | - Arie Carneiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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31
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Motta G, Ferraresso M, Lamperti L, Di Paolo D, Raison N, Perego M, Favi E. Treatment options for localised renal cell carcinoma of the transplanted kidney. World J Transplant 2020; 10:147-161. [PMID: 32742948 PMCID: PMC7360528 DOI: 10.5500/wjt.v10.i6.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/07/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023] Open
Abstract
Currently, there is no consensus among the transplant community about the treatment of renal cell carcinoma (RCC) of the transplanted kidney. Until recently, graftectomy was universally considered the golden standard, regardless of the characteristics of the neoplasm. Due to the encouraging results observed in native kidneys, conservative options such as nephron-sparing surgery (NSS) (enucleation and partial nephrectomy) and ablative therapy (radiofrequency ablation, cryoablation, microwave ablation, high-intensity focused ultrasound, and irreversible electroporation) have been progressively used in carefully selected recipients with early-stage allograft RCC. Available reports show excellent patient survival, optimal oncological outcome, and preserved renal function with acceptable complication rates. Nevertheless, the rarity and the heterogeneity of the disease, the number of options available, and the lack of long-term follow-up data do not allow to adequately define treatment-specific advantages and limitations. The role of active surveillance and immunosuppression management remain also debated. In order to offer a better insight into this difficult topic and to help clinicians choose the best therapy for their patients, we performed and extensive review of the literature. We focused on epidemiology, clinical presentation, diagnostic work up, staging strategies, tumour characteristics, treatment modalities, and follow-up protocols. Our research confirms that both NSS and focal ablation represent a valuable alternative to graftectomy for kidney transplant recipients with American Joint Committee on Cancer stage T1aN0M0 RCC. Data on T1bN0M0 lesions are scarce but suggest extra caution. Properly designed multi-centre prospective clinical trials are warranted.
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Affiliation(s)
- Gloria Motta
- Urology, IRCCS Policlinico San Donato, San Donato Milanese 27288, Italy
| | - Mariano Ferraresso
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Luca Lamperti
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Dhanai Di Paolo
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Nicholas Raison
- MRC Centre for Transplantation, King’s College London, London WC2R 2LS, United Kingdom
| | - Marta Perego
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
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Zhang W, Zheng X, Xie S, Zhang S, Mao J, Cai Y, Lu X, Chen W, Ni H, Xie L. TBOPP enhances the anticancer effect of cisplatin by inhibiting DOCK1 in renal cell carcinoma. Mol Med Rep 2020; 22:1187-1194. [PMID: 32626999 PMCID: PMC7339706 DOI: 10.3892/mmr.2020.11243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/15/2020] [Indexed: 02/06/2023] Open
Abstract
The treatment of renal cell carcinoma (RCC) with chemotherapy remains a challenge; therefore, improving the knowledge of the molecular mechanisms underlying RCC chemoresistance and developing novel therapeutic strategies is important. Dedicator of cytokinesis 1 (DOCK1), the first member of the DOCK family to be discovered, displays various roles during tumorigenesis; however, its role during RCC progression is not completely understood. Therefore, the present study aimed to clarify the function of DOCK1 and 1-[2-(3′-(trifluoromethyl)-(1,1′-biphenyl)-4-yl)-2-oxoethyl]-5-pyrrolidinylsulfonyl-2 (1H)-pyridone (TBOPP), a DOCK1-sensitive inhibitor, during RCC development and chemoresistance. The results of CCK-8 and EdU assay indicated that TBOPP decreased RCC cell viability and proliferation compared with the control group, and sensitized RCC cells to cisplatin. Moreover, RCC cells with high DOCK1 expression levels displayed increased resistance to cisplatin, whereas DOCK1 knockdown enhanced the lethal effects of cisplatin on RCC cells. Furthermore, the results determined by western blotting, CCK-8 and cell apoptosis assay indicated that TBOPP effectively reduced DOCK1 expression levels compared with the control group, and the TBOPP-mediated cisplatin sensitizing effect was mediated by DOCK1 inhibition. The present study suggests that DOCK1 plays a vital role in RCC cell chemoresistance to cisplatin; therefore, TBOPP may serve as a novel therapeutic agent for RCC chemoresistance.
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Affiliation(s)
- Wei Zhang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Xiaoxiao Zheng
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Shangzhi Xie
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Shufen Zhang
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Jiayan Mao
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Ying Cai
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Xuemei Lu
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Wei Chen
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Haibin Ni
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Liping Xie
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
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De Filippo M, Ziglioli F, Russo U, Pagano P, Brunese L, Bertelli E, Pagnini F, Maestroni U. Radiofrequency ablation (RFA) of T1a renal cancer with externally cooled multitined expandable electrodes. Radiol Med 2020; 125:790-797. [PMID: 32206984 DOI: 10.1007/s11547-020-01175-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/11/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To retrospectively evaluate the mid-term outcomes of percutaneous radiofrequency ablation (RFA) with multitined expandable electrodes externally cooled with saline solution in patients with T1a renal cell carcinoma (RCC). MATERIALS AND METHODS In this retrospective study, we evaluated 39 RCC in 35 patients treated with CT-guided RFA in 41 procedures (2011-2017). All patients were staged T1a, N0, M0 prior to RFA. Mean tumor size was 24.48 mm. A 4-tined expandable RFA electrode cooled with pump-circulating saline was used. Efficacy was evaluated verifying complete tumor necrosis (no contrast enhancement on imaging) at the end of the procedure and on subsequent controls. Follow-up observation period was 5 years. Minor/major complications, hospitalization days, serum creatinine and GFR pre- and post-RFA (compared using paired t test) and post-operative pain (evaluated with NRS after treatment) were considered as safety indicators. Overall survival was also calculated (Kaplan-Meier method). RESULTS Of 35 patients, 30/35 had 1 treatment (primary effectiveness rate 86%), 4/35 had 2 treatments and 1/35 had 3 treatments for residual disease. There were no relapses and no mid-long-term complications; 3 minor (8%) and 1 major (2.7%) complications during perioperative period were reported. Mean before and after RFA serum creatinine rates were, respectively, 1.08 mg/dl and 1.11 mg/dl (p value: 0.4117). NRS median value is 0.8. Hospitalization days median value is [2.8 ± 1.9] days. 91.4% of all patients survived, with a median overall survival time of 65 months. CONCLUSIONS Mid-term results show that CT-guided RFA with multitined expandable electrodes externally cooled with saline solution is an effective and safe treatment in patients with RCC-staged T1aN0M0. Data reported in our study are in line with data reported in the literature from patients treated with other devices.
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Affiliation(s)
- Massimo De Filippo
- Department of Medicine and Surgery, Unit of Radiology, University of Parma, Via Gramsci 14, Parma, Italy.
| | - Francesco Ziglioli
- Department of Surgery, Unit of Urology, University-Hospital of Parma, Via Gramsci 14, Parma, Italy
| | - Umberto Russo
- Department of Medicine and Surgery, Unit of Radiologic Sciences, University-Hospital of Parma, Via Gramsci 14, Parma, Italy
| | - Paolo Pagano
- Department of Medicine and Surgery, Unit of Radiologic Sciences, University-Hospital of Parma, Via Gramsci 14, Parma, Italy
| | - Luca Brunese
- Department of Medicine and Health Science, University of Molise, Via Francesco De Santis 86, Campobasso, Italy
| | - Elena Bertelli
- Department of Radiology, University-Hospital of Careggi, Largo Brambilla 3, Florence, Italy
| | - Francesco Pagnini
- Department of Medicine and Surgery, Unit of Radiology, University of Parma, Via Gramsci 14, Parma, Italy
| | - Umberto Maestroni
- Department of Surgery, Unit of Urology, University-Hospital of Parma, Via Gramsci 14, Parma, Italy
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Ferriero M, Bove AM, Tuderti G, Anceschi U, Brassetti A, Costantini M, Mastroianni R, Guaglianone S, Gallucci M, Simone G. Impact of learning curve on perioperative outcomes of off-clamp minimally invasive partial nephrectomy: propensity score matched comparison of outcomes between training versus expert series. Minerva Urol Nephrol 2020; 73:564-571. [PMID: 32182230 DOI: 10.23736/s2724-6051.20.03673-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Off-clamp robotic partial nephrectomy (Off C-RPN) is a challenging technique, hard to teach since bleeding control is not easily reproducible in training settings. We compared perioperative outcomes of two propensity score matched (PSM) cohorts of patients undergone Off C-RPN by either a training or an expert surgeon in the same Institution. METHODS The prospectively maintained "renal cancer" database was queried for "off-clamp," "robotic," "partial nephrectomy" performed between January 2017 and June 2018. Achievement of main outcomes along the learning curve of training surgeon was assessed with logistic regression and Lowess analysis. A 1:1 PSM analysis generated two populations homogeneous for demographics, ASA score, tumor size, nephrometry score, baseline hemoglobin and estimated glomerular filtration rate (eGFR). Multiple tumors, and imperative indications were excluded. Categorical and continuous variables were compared by χ2 and t-test. RESULTS Overall, 111 were treated by the expert, 51 by the training surgeon, respectively. Training surgeon experienced a significant decrease of console time (P=0.01). Patients treated by the expert surgeon had significantly larger tumors, higher PADUA and ASA scores (all P≤0.04). After applying the PSM, two cohorts of 29 patients, homogeneous for all baseline demographic and clinical variables (all P≥0.34) were selected. Hilar clamping was never necessary. Hospital stay, hemoglobin and eGFR at discharge, complication and positive surgical margins rates were comparable between the two cohorts (all P≥0.15). CONCLUSIONS Our results proved that the impact of learning curve on outcomes of Off C-RPN is negligible after completion of a proper training in minimally invasive surgery.
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Affiliation(s)
| | - Alfredo Maria Bove
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Manuela Costantini
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | | | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
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35
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Kira S, Mitsui T, Sawada N, Nakagomi H, Ihara T, Takahashi N, Takeda M. Feasibility and necessity of the fourth arm of the da Vinci Si surgical system for robot-assisted partial nephrectomy. Int J Med Robot 2020; 16:e2092. [PMID: 32058667 DOI: 10.1002/rcs.2092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND To investigate the feasibility of the fourth arm of the da Vinci Si system for robot-assisted partial nephrectomy (RAPN). METHODS Fifty-eight consecutive patients underwent RAPN with the same port placements. After reviewing the surgical videos and records, 38 patients showing usefulness of the fourth arm were categorized into Group A and those not showing usefulness into Group B. The background data, tumor characteristics, and perioperative outcomes were compared between the groups. RESULTS Group B had a larger proportion of tumors located on the inner side of the kidney, and the console time was significantly longer. Multivariable logistic regression analysis showed that tumors located on the inner side of the kidney were associated with the non-use of the fourth arm of the da Vinci Si system during RAPN. CONCLUSIONS Our findings suggested that use of fourth arm in RAPN by da Vinci Si should be considered for each tumor location.
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Affiliation(s)
- Satoru Kira
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Takahiko Mitsui
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Norifumi Sawada
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Hiroshi Nakagomi
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Tatsuya Ihara
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Nobuhiro Takahashi
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Masayuki Takeda
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
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36
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Zhang C, Wang F, Guo F, Ye C, Yang Y, Huang Y, Hou J, Tian F, Yang B. A 13-gene risk score system and a nomogram survival model for predicting the prognosis of clear cell renal cell carcinoma. Urol Oncol 2020; 38:74.e1-74.e11. [PMID: 31952997 DOI: 10.1016/j.urolonc.2019.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 12/18/2019] [Accepted: 12/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Renal cell carcinoma (RCC) is the second common malignant tumor in the urinary system, and 85% of RCC cases are clear cell RCC (ccRCC). This study is designed to build a risk score system for ccRCC. METHODS The gene methylation and expression data of ccRCC samples were downloaded from The Cancer Genome Atlas database (training set) and ArrayExpress database (validation set). The differentially methylated genes (DMGs) and differentially expressed genes (DEGs) were identified by limma package, and their intersecting genes with negative Pearson correlation coefficients were remained using cor.test function. Prognosis-associated genes were identified by survival package, and the optimal DMGs were obtained using penalized package. After risk score system was built, nomogram survival model was constructed using rms package. Additionally, pathways were enriched for the DEGs between high- and low-risk groups using Gene Set Enrichment Analysis. RESULTS There were 3,638 DMGs and 2,702 DEGs between tumor and normal samples. Among the 312 intersecting genes, 43 prognosis-associated genes were identified. A total of 13 optimal DMGs (BTBD19, ADAM8, BGLAP, TNFRSF13C, JPH4, BEST1, GNRH2, UBE2QL1, CHODL, GDF9, UPB1, KCNH3; and ADAMTSL4) were obtained for building the risk score system. After pathological M, pathological T, platelet qualitative, and RS status were revealed to be independent prognostic factors, a nomogram survival model was constructed. For the 920 DEGs between the high- and low-risk samples, 6 significant pathways were enriched. CONCLUSION The 13-gene risk score system and the nomogram survival model might be used for prognostic prediction of ccRCC patients.
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Affiliation(s)
- Chao Zhang
- Department of Urology, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Fubo Wang
- Department of Urology, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Fei Guo
- Department of Urology, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Chen Ye
- Department of Urology, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Yue Yang
- Department of Urology, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Yuhua Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jianquan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Feng Tian
- Department of Urology, Shanghai Eighth People's Hospital, Shanghai, China.
| | - Bo Yang
- Department of Urology, Changhai Hospital, the Second Military Medical University, Shanghai, China.
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Prognostic urinary miRNAs for the assessment of small renal masses. Clin Biochem 2020; 75:15-22. [DOI: 10.1016/j.clinbiochem.2019.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/19/2019] [Accepted: 10/07/2019] [Indexed: 01/14/2023]
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38
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Di Meo A, Batruch I, Brown MD, Yang C, Finelli A, Jewett MA, Diamandis EP, Yousef GM. Searching for prognostic biomarkers for small renal masses in the urinary proteome. Int J Cancer 2019; 146:2315-2325. [PMID: 31465112 DOI: 10.1002/ijc.32650] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/05/2019] [Indexed: 12/20/2022]
Abstract
Renal cell carcinoma (RCC) is frequently diagnosed incidentally as an early-stage small renal mass (SRM; pT1a, ≤4 cm). Overtreatment of patients with benign or clinically indolent SRMs is increasingly common and has resulted in a recent shift in treatment recommendations. There are currently no available biomarkers that can accurately predict clinical behavior. Therefore, we set out to identify early biomarkers of RCC progression. We employed a quantitative label-free liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) proteomics approach and targeted parallel-reaction monitoring to identify and validate early, noninvasive urinary biomarkers for RCC-SRMs. In total, we evaluated 115 urine samples, including 33 renal oncocytoma (≤4 cm) cases, 30 progressive and 26 nonprogressive clear cell RCC (ccRCC)-SRM cases, in addition to 26 healthy controls. We identified six proteins, which displayed significantly elevated expression in clear cell RCC-SRMs (ccRCC-SRMs) relative to healthy controls. Proteins C12ORF49 and EHD4 showed significantly elevated expression in ccRCC-SRMs compared to renal oncocytoma (≤4 cm). Additionally, proteins EPS8L2, CHMP2A, PDCD6IP, CNDP2 and CEACAM1 displayed significantly elevated expression in progressive relative to nonprogressive ccRCC-SRMs. A two-protein signature (EPS8L2 and CCT6A) showed significant discriminatory ability (areas under the curve: 0.81, 95% CI: 0.70-0.93) in distinguishing progressive from nonprogressive ccRCC-SRMs. Patients (Stage I-IV) with EPS8L2 and CCT6A mRNA alterations showed significantly shorter overall survival (p = 1.407 × 10-6 ) compared to patients with no alterations. Our in-depth proteomic analysis identified novel biomarkers for early-stage RCC-SRMs. Pretreatment characterization of urinary proteins may provide insight into early RCC progression and could potentially help assign patients to appropriate management strategies.
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Affiliation(s)
- Ashley Di Meo
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ihor Batruch
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Marshall D Brown
- Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Chuance Yang
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Antonio Finelli
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Michael A Jewett
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Eleftherios P Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - George M Yousef
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Vasudev NS, Hutchinson M, Trainor S, Ferguson R, Bhattarai S, Adeyoju A, Cartledge J, Kimuli M, Datta S, Hanbury D, Hrouda D, Oades G, Patel P, Soomro N, Stewart GD, Sullivan M, Webster J, Messenger M, Selby PJ, Banks RE. UK Multicenter Prospective Evaluation of the Leibovich Score in Localized Renal Cell Carcinoma: Performance has Altered Over Time. Urology 2019; 136:162-168. [PMID: 31705948 PMCID: PMC7043004 DOI: 10.1016/j.urology.2019.09.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022]
Abstract
Objective To examine changes in outcome by the Leibovich score using contemporary and historic cohorts of patients presenting with renal cell carcinoma (RCC) Patients and Methods Prospective observational multicenter cohort study, recruiting patients with suspected newly diagnosed RCC. A historical cohort of patients was examined for comparison. Metastasis-free survival (MFS) formed the primary outcome measure. Model discrimination and calibration were evaluated using Cox proportional hazard regression and the Kaplan-Meier method. Overall performance of the Leibovich model was assessed by estimating explained variation. Results Seven hundred and six patients were recruited between 2011 and 2014 and RCC confirmed in 608 (86%) patients. Application of the Leibovich score to patients with localized clear cell RCC in this contemporary cohort demonstrated good model discrimination (c-index = 0.77) but suboptimal calibration, with improved MFS for intermediate- and high-risk patients (5-year MFS 85% and 50%, respectively) compared to the original Leibovich cohort (74% and 31%) and a historic (1998-2006) UK cohort (76% and 37%). The proportion of variation in outcome explained by the model is low and has declined over time (28% historic vs 22% contemporary UK cohort). Conclusion Prognostic models are widely employed in patients with localized RCC to guide surveillance intensity and clinical trial selection. However, the majority of the variation in outcome remains unexplained by the Leibovich model and, over time, MFS rates among intermediate- and high-risk classified patients have altered. These findings are likely to have implications for all such models used in this setting.
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Affiliation(s)
- Naveen S Vasudev
- Leeds Institute of Medical Research at St James's, St. James's University Hospital, Leeds, UK.
| | - Michelle Hutchinson
- Leeds Institute of Medical Research at St James's, St. James's University Hospital, Leeds, UK
| | - Sebastian Trainor
- Leeds Institute of Medical Research at St James's, St. James's University Hospital, Leeds, UK
| | - Roisean Ferguson
- Leeds Institute of Medical Research at St James's, St. James's University Hospital, Leeds, UK
| | - Selina Bhattarai
- Department of Pathology, St James's University Hospital, Leeds, UK
| | | | - Jon Cartledge
- Department of Urology, St James's University Hospital, Leeds, UK
| | - Michael Kimuli
- Department of Urology, St James's University Hospital, Leeds, UK
| | - Shibendra Datta
- University Hospital of Wales, Cardiff Heath Park, Cardiff, Wales
| | | | - David Hrouda
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Poulam Patel
- Divison of Cancer & Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Naeem Soomro
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Mark Sullivan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Michael Messenger
- Leeds Institute of Medical Research at St James's, St. James's University Hospital, Leeds, UK
| | - Peter J Selby
- Leeds Institute of Medical Research at St James's, St. James's University Hospital, Leeds, UK
| | - Rosamonde E Banks
- Leeds Institute of Medical Research at St James's, St. James's University Hospital, Leeds, UK
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Purysko AS, Nikolaidis P, Dogra VS, Ganeshan D, Gore JL, Gupta RT, Heilbrun ME, Khatri G, Kishan AU, Lyshchik A, Savage SJ, Smith AD, Wang ZJ, Wolfman DJ, Wong-You-Cheong JJ, Yoo DC, Lockhart ME. ACR Appropriateness Criteria® Post-Treatment Follow-up and Active Surveillance of Clinically Localized Renal Cell Cancer. J Am Coll Radiol 2019; 16:S399-S416. [DOI: 10.1016/j.jacr.2019.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 01/03/2023]
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Shao IH, Kan HC, Liu CY, Lin PH, Yu KJ, Pang ST, Wu CT, Chuang CK, Chang YH. Role Of Robot-Assisted Partial Nephrectomy For Renal Cell Carcinomas In The Purpose Of Nephron Sparing. Onco Targets Ther 2019; 12:8189-8196. [PMID: 31632069 PMCID: PMC6781943 DOI: 10.2147/ott.s214060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/10/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Surgery remains the standard treatment for localized renal cell carcinomas, and partial nephrectomy is considered before radical nephrectomy with the aim of preserving renal function. This study aimed to compare robot-assisted and open partial nephrectomy for the purpose of nephron sparing. MATERIALS AND METHODS We retrospectively enrolled consecutive patients who received partial nephrectomy at a single tertiary medical center from January 2008 to January 2015. Medical records and radiographic images were reviewed. We analyzed the patients' general characteristics, underlying disease, complications, length of hospital stay, renal tumor complexity, surgery type, renal function, and specimen and tumor size. A comparison between open and robot-assisted nephrectomy groups was performed. RESULTS A total of 136 patients were enrolled, with a male to female ratio of 2:3 and a mean age of 57.8 years. Of these, 71 and 65 patients received open and robot-assisted surgery, respectively. Compared with the open group, patients who underwent robot-assisted surgery were significantly younger (56.0 versus 60.1 years old), had a longer operative time (303 versus 224 min), and a lower kidney ischemic time (33.4 versus 46.9 min). Given similar tumor sizes, the tumor-to-excision ratio was significantly higher in the robot-assisted group (51.7% versus 39.8%), and the excisional volume loss (EVL) was smaller (12.7 versus 19.6 mL). Preoperative glomerular filtration rate and EVL were significant predictors of long-term renal function preservation in the multivariate analysis. CONCLUSION When performing partial nephrectomy, a robot-assisted procedure could increase the accuracy of excision without increasing the risk of positive surgical margin. Lower EVL could assist in better long-term postoperative renal function preservation.
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Affiliation(s)
- I-Hung Shao
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Cheng Kan
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Yi Liu
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Lin
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kai-Jie Yu
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - See-Tong Pang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Te Wu
- Division of Urology, Department of Surgery, KeeLung Chang Gung Memorial Hospital, KeeLung, Taiwan
| | - Cheng-Keng Chuang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hsu Chang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Zhu R, Ge J, Ma J, Zheng J. Carcinoembryonic antigen related cell adhesion molecule 6 promotes the proliferation and migration of renal cancer cells through the ERK/AKT signaling pathway. Transl Androl Urol 2019; 8:457-466. [PMID: 31807423 DOI: 10.21037/tau.2019.09.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Carcinoembryonic antigen related cell adhesion molecule 6 (CEACAM6) is a versatile glycoprotein and a member of the CEACAM family. Studies suggested that it served as a diagnostic and prognostic biomarker in some malignancies. In addition, it is involved in tumorigenesis by stimulating proliferation, suppressing apoptosis, facilitating migration and invasion, promoting angiogenesis, and inducing drug resistance. In the present study, we demonstrated the oncogenic effects of CEACAM6 in clear cell renal cell carcinoma (ccRCC). Methods CEACAM6 expression was detected by quantitative real-time PCR (qRT-PCR), immunohistochemical staining and western blot in ccRCC tumor tissues and cell lines. Survival analysis was performed using the data of TCGA database. Cell proliferation and migration were detected by CCK-8 and transwell assays with the overexpression or silencing of CEACAM6. LY294002 was used to block the activation of PI3K/AKT pathway. Associated pathway proteins were detected by western blot. Results CEACAM6 was upregulated in ccRCC cell lines and tumor tissues. Longer overall survival was observed in patients with relatively low CEACAM6 levels. Furthermore, overexpression of CEACAM6 promoted the proliferation and migration of ccRCC cells. Conversely, shRNA-mediated CEACAM6 depletion modulated those changes. Further investigation demonstrated that the ERK/AKT signaling pathway activation played a pivotal role. In addition, PI3K/AKT pathway blockade abrogated the effects of CEACAM6 overexpression. Conclusions Aberrantly high expression of CEACAM6 is a stimulus for the formation and progression of ccRCC.
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Affiliation(s)
- Rujian Zhu
- Department of Urology, The Affiliated Shanghai No.10 People's Hospital, Nanjing Medical University, Shanghai 200072, China.,Department of Urology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399, China
| | - Jiong Ge
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Junjie Ma
- Department of Urology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399, China
| | - Junhua Zheng
- Department of Urology, The Affiliated Shanghai No.10 People's Hospital, Nanjing Medical University, Shanghai 200072, China.,Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
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Tanaka H, Ding X, Ye Y, Wang Y, Campbell RA, DeWitt-Foy ME, Suk-Ouichai C, Ward RD, Remer EM, Li J, Campbell SC. Infiltrative Renal Masses: Clinical Significance and Fidelity of Documentation. Eur Urol Oncol 2019; 4:264-273. [PMID: 31439434 DOI: 10.1016/j.euo.2019.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/02/2019] [Accepted: 07/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The prevalence of infiltrative renal masses (IRMs) and fidelity of documentation of infiltrative features remain unclear. OBJECTIVE To investigate the prevalence/significance of IRMs and assess whether infiltrative features were documented preoperatively. DESIGN, SETTING, AND PARTICIPANTS A total of 522 patients with renal tumors managed with partial/radical nephrectomy (2012-2014) whose pathology demonstrated locally advanced and/or aggressive histology were analyzed. Preoperative computed tomography/magnetic resonance imaging was retrospectively/independently reviewed by two radiologists. IRMs were required to have a poorly defined interface with parenchyma and nonelliptical shape in one or more distinct/unequivocal areas. Infiltrative features were defined as extensive or focal. INTERVENTION Partial/radical nephrectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cancer-specific mortality (CSM) was estimated using cumulative-incidence analysis. Significant and independent predictors of CSM were evaluated using Cox proportional hazard analysis. RESULTS AND LIMITATIONS Median tumor size was 6.9cm; renal cell carcinomas (RCCs) predominated (92%). Image review confirmed 133 IRMs (25%), including 103 RCCs; 59 had sarcomatoid or poorly differentiated features. IRMs were larger and more often symptomatic compared than non-IRMs, and disseminated disease was also more common for IRMs (all p<0.001). Overall, 109 IRMs were imaged at our center; 42 were documented as IRMs in preoperative radiology reports, while infiltrative features were not documented in 67 (61%). Only four (6%) of these 67 were documented as infiltrative by the surgical team. Infiltrative features were more often focal in undocumented IRMs. On multivariable analysis, infiltrative features, disseminated disease, and non-RCC histology were independent predictors of CSM (hazard ratio or HR [95% confidence interval {CI}]=1.73 [1.21-2.47], 2.98 [2.10-4.23], and 2.79 [1.86-4.62], respectively). Among IRMs, extensive infiltrative features and disseminated disease were associated with CSM (HR [95% CI]=1.98 [1.27-3.07] and 2.35 [1.52-3.63], respectively), while documentation status failed to show an association. Excluding patients with disseminated disease or residual cancer after surgery, recurrence rates were 62% for IRMs versus 22% for non-IRMs (p<0.001), and there was again no significant difference between documented and undocumented IRMs (p=0.36). Limitations include a retrospective design. CONCLUSIONS Twenty-five percent of locally advanced/histologically aggressive renal tumors exhibited infiltrative features, although many were not documented as IRMs. Among this high-risk surgical population, infiltrative features were independent predictors of CSM, irrespective of whether they were documented or not. Our data suggest that infiltrative features should be assessed and documented routinely during evaluation of renal masses. PATIENT SUMMARY Infiltrative renal masses may be more common than previously appreciated, although many were not documented as infiltrative during preoperative evaluation. Our data suggest that infiltrative features have a strong impact on prognosis and should be assessed and documented routinely during radiologic and clinical evaluation of renal masses.
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Affiliation(s)
- Hajime Tanaka
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Xiaobo Ding
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Imaging Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Yunlin Ye
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yanbo Wang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, First Hospital of Jilin University, Changchun, China
| | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Molly E DeWitt-Foy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chalairat Suk-Ouichai
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ryan D Ward
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Erick M Remer
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jianbo Li
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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Cronan J, Dariushnia S, Bercu Z, Ermentrout RM, Majdalany B, Findeiss L, Newsome J, Kokabi N. Systematic Review of Contemporary Evidence for the Management of T1 Renal Cell Carcinoma: What IRs Need to Know for Kidney Cancer Tumor Boards. Semin Intervent Radiol 2019; 36:194-202. [PMID: 31435127 DOI: 10.1055/s-0039-1693119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Renal cell carcinoma is a relatively common malignancy, with 60 to 70 thousand cases a year in the United States alone. Increased utilization of cross-sectional imaging has led to an increase in the number of early renal cell cancers seen by the medical establishment. In addition, certain patient populations have an increased risk of developing kidney cancers which may mandate aggressive screening protocols. This article discusses the epidemiology of renal cell cancers; discusses the current management guidelines from multiple specialty societies; discusses some of the surgical and interventional techniques used in the treatment of such lesions; and provides a review of the literature regarding treatments of early-stage renal cell cancers.
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Affiliation(s)
- Julie Cronan
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Sean Dariushnia
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Zachary Bercu
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Robert Mitchell Ermentrout
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Bill Majdalany
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Laura Findeiss
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Janice Newsome
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nima Kokabi
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Zhu M, Qi Y, He H, Lou J, Pei Q, Mei Y. Analgesic effect of the ultrasound-guided subcostal approach to transmuscular quadratus lumborum block in patients undergoing laparoscopic nephrectomy: a randomized controlled trial. BMC Anesthesiol 2019; 19:154. [PMID: 31412770 PMCID: PMC6694477 DOI: 10.1186/s12871-019-0825-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022] Open
Abstract
Background Quadratus lumborum block (QLB) is an effective analgesia that lowers opioid consumption after lower abdominal and hip surgeries. The subcostal approach to transmuscular QLB is a novel technique that can provide postoperative analgesia by blocking more dermatomes. The aim of this study is to evaluate the efficacy and viability of subcostal approach to QLB after laparoscopic nephrectomy. Methods Sixty patients who underwent laparoscopic nephrectomy were randomly divided into the subcostal approach to QLB group (QLB group, n = 30) and the control group (C group, n = 30). All patients underwent ultrasound-guided subcostal approach to QLB in an ipsilateral parasagittal oblique plane at the L1–L2 level. The QLB group received 0.4 cc/kg of 0.3% ropivacaine, and the C group received 0.4 cc/kg of 0.9% saline. Postoperatively, a patient-controlled intravenous analgesic pump with sufentanil was attached to all the patients. The primary outcome was sufentanil consumption within the first 24 h after surgery. The secondary outcomes included the Ramsey sedation scale (RSS) scores and Bruggemann comfort scale (BCS) scores 6 h (T1), 12 h (T2), and 24 h (T3) after surgery, intraoperative remifentanil consumption, number of patients requiring rescue analgesia, time to recovery of intestinal function, mobilization time after surgery, and presence of side effects. Results Sufentanil consumption within the first 24 h after surgery was significantly lower in the QLB group than in the C group (mean [standard deviation]: 34.1 [9.9] μg vs 42.1 [11.6] μg, P = .006). The RSS scores did not differ between the two groups, and the BCS scores of the QLB group at T1 and T2 time points was significantly higher than those of the C group(P<0.05). The consumption of remifentanil intraoperatively and the number of patients requiring rescue analgesia were significantly lower in the QLB group (P<0.05). Time to recovery of intestinal function and mobilization time after surgery were significantly earlier in the QLB group (P<0.05). The incidence of postoperative nausea and vomiting was significantly lower in the QLB group (P<0.05). Conclusions The ultrasound-guided subcostal approach to QLB is an effective analgesic technique in patients undergoing laparoscopic nephrectomy as it reduces the consumption of sufentanil postoperatively. Trial registration ChiCTR1800020296 0 (Prospective registered). Initial registration date was 22/12/2018.
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Affiliation(s)
- Manhua Zhu
- Department of Anesthesiology, Ningbo Medical Center Lihuili Eastern Hospital, Taipei Medical University Ningbo Medical Center, No.1111 jiangnan Road, Ningbo, Zhejiang, 315040, China
| | - Yong Qi
- Department of Anesthesiology, Ningbo Medical Center Lihuili Eastern Hospital, Taipei Medical University Ningbo Medical Center, No.1111 jiangnan Road, Ningbo, Zhejiang, 315040, China
| | - Huijuan He
- Department of Anesthesiology, Ningbo Medical Center Lihuili Eastern Hospital, Taipei Medical University Ningbo Medical Center, No.1111 jiangnan Road, Ningbo, Zhejiang, 315040, China
| | - Jinfeng Lou
- Department of Anesthesiology, Ningbo Medical Center Lihuili Eastern Hospital, Taipei Medical University Ningbo Medical Center, No.1111 jiangnan Road, Ningbo, Zhejiang, 315040, China
| | - Qingqing Pei
- Department of Anesthesiology, Ningbo Beilun People's Hospital, Ningbo, Zhejiang, China, No.1288 lushan east Road, Ningbo, 315800, China
| | - Yuliu Mei
- Department of Anesthesiology, Ningbo Beilun People's Hospital, Ningbo, Zhejiang, China, No.1288 lushan east Road, Ningbo, 315800, China.
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Cristea O, Warren J, Blew B, Rowe N. Transplanting kidneys from donors with small renal masses - a strategy to expand the donor pool. Can Urol Assoc J 2019; 14:E32-E38. [PMID: 31348749 DOI: 10.5489/cuaj.5926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Renal transplantation is the optimal treatment for end-stage renal disease, but organ demand continues to outstrip supply. The transplantation of kidneys from donors with small renal masses (SRMs) represents a potential avenue to expand the donor pool. We reviewed all published cases of transplants from donors with SRMs and we present followup data, best practices, and outline an actionable series of steps to guide the implementation of such transplants at individual centers. METHODS A detailed literature search of the MEDLINE/PubMed and SCOPUS databases was performed. Thirty unique data sets met inclusion criteria and described the transplantation of tumor-ectomized kidneys; nine data sets described the transplantation of contralateral kidneys from donors with SRMs. RESULTS A total of 147 tumorectomized kidneys have been transplanted. Pathology revealed 120 to be renal cell carcinomas (RCCs), of which 116 were stage T1a (0.3-4 cm). The mean followup time was 44.2 months (1-200). A single suspected tumor recurrence occurred in one patient nine years post-transplantation and it was managed with active surveillance. Twenty-seven kidneys have been transplanted from deceased donors with contralateral renal masses. Pathology revealed 25 to be RCCs, of which 19 were confirmed to be stage T1 (<7 cm). The mean followup time was 46.7 months (0.5-155). One recipient developed an RCC and underwent curative allograft nephrectomy. CONCLUSIONS Careful use of kidneys from donors with SRMs is feasible and safe, with an overall recurrence rate of less than 1.5%. The use of such kidneys could help alleviate the organ shortage crisis.
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Affiliation(s)
- Octav Cristea
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Jeff Warren
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Brian Blew
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Neal Rowe
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
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Zhang S, Yang G, Tang L, Lv Q, Li J, Xu Y, Zhu X, Li P, Shao P, Wang Z. Application of a Functional3-dimensional Perfusion Model in Laparoscopic Partial Nephrectomy With Precise Segmental Renal Artery Clamping. Urology 2019; 125:98-103. [DOI: 10.1016/j.urology.2018.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 01/20/2023]
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48
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Zhang B, Wu Q, Wang Z, Xu R, Hu X, Sun Y, Wang Q, Ju F, Ren S, Zhang C, Qin L, Ma Q, Zhou YL. The promising novel biomarkers and candidate small molecule drugs in kidney renal clear cell carcinoma: Evidence from bioinformatics analysis of high-throughput data. Mol Genet Genomic Med 2019; 7:e607. [PMID: 30793530 PMCID: PMC6503072 DOI: 10.1002/mgg3.607] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/14/2019] [Indexed: 01/05/2023] Open
Abstract
Background Kidney renal clear cell carcinoma (KIRC) is the most common subtype of renal tumor. However, the molecular mechanisms of KIRC pathogenesis remain little known. The purpose of our study was to identify potential key genes related to the occurrence and prognosis of KIRC, which could serve as novel diagnostic and prognostic biomarkers for KIRC. Methods Three gene expression profiles from gene expression omnibus database were integrated to identify differential expressed genes (DEGs) using limma package. Enrichment analysis and PPI construction for these DEGs were performed by bioinformatics tools. We used Gene Expression Profiling Interactive Analysis (GEPIA) database to further analyze the expression and prognostic values of hub genes. The GEPIA database was used to further validate the bioinformatics results. The Connectivity Map was used to identify candidate small molecules that could reverse the gene expression of KIRC. Results A total of 503 DEGs were obtained. The PPI network with 417 nodes and 1912 interactions was constructed. Go and KEGG pathway analysis revealed that these DEGs were most significantly enriched in excretion and valine, leucine, and isoleucine degradation, respectively. Six DEGs with high degree of connectivity (ACAA1, ACADSB, ALDH6A1, AUH, HADH,and PCCA) were selected as hub genes, which significantly associated with worse survival of patients. Finally, we identified the top 20 most significant small molecules and pipemidic acid was the most promising small molecule to reverse the KIRC gene expression. Conclusions This study first uncovered six key genes in KIRC which contributed to improving our understanding of the molecular mechanisms of KIRC pathogenesis. ACAA1, ACADSB, ALDH6A1, AUH, HADH,and PCCA could serve as the promising novel biomarkers for KIRC diagnosis, prognosis, and treatment.
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Affiliation(s)
- Bo Zhang
- Medical School of Nantong University, Nantong, P.R. China.,The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, P.R. China
| | - Qiong Wu
- Medical School of Nantong University, Nantong, P.R. China.,The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, P.R. China
| | - Ziheng Wang
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, P.R. China.,Department of Medicine, Nantong University Xinling college, Nantong, P.R. China
| | - Ran Xu
- Medical School of Nantong University, Nantong, P.R. China
| | - Xinyi Hu
- Department of Medicine, Nantong University Xinling college, Nantong, P.R. China
| | - Yidan Sun
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, P.R. China
| | - Qiuhong Wang
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, P.R. China
| | - Fei Ju
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, P.R. China
| | - Shiqi Ren
- Department of Medicine, Nantong University Xinling college, Nantong, P.R. China
| | - Chenlin Zhang
- Department of Spine, Chinese medicine hospital, Wuxi, P.R. China
| | - Lin Qin
- Department of Urology, The First people's Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Qianqian Ma
- Emergency office, Wuxi Center for disease control and prevention, Wuxi, P.R. China
| | - You Lang Zhou
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, P.R. China
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Deng W, Chen L, Wang Y, Liu X, Wang G, Liu W, Zhang C, Zhou X, Li Y, Fu B. Cryoablation versus Partial Nephrectomy for Clinical Stage T1 Renal Masses: A Systematic Review and Meta-Analysis. J Cancer 2019; 10:1226-1236. [PMID: 30854132 PMCID: PMC6400682 DOI: 10.7150/jca.28881] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/20/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction: Cryoablation has been considered as the most efficacious ablative alternative to partial nephrectomy (PN) for selected patients. Our objective is to assess the existing evidence relating to the safety and efficacy of cryoablation compared with PN for clinical T1 renal masses. Materials and Methods: A comprehensive search of PMC, EMBASE, and the Cochrane Library was conducted to identify studies containing comparison of cryoablation and PN. By utilizing those included studies, a systematic review and cumulative meta-analyses were performed to assess the safety and efficacy between cryoablation and PN for T1 renal masses. Results: 17 retrospective studies providing available data were included in our study. Significant differences were found about all oncological variables including all-cause death, cancer-specific death, metastasis and local-recurrence (p < 0.001, p = 0.03, p < 0.001, and p < 0.001, respectively) between the PN group and the cryoablation group. The mean difference between two groups for percent estimated glomerular filtration rate decrease and creatinine increase was -4.84 and 0.15 respectively (p < 0.001 and p = 0.006, respectively). The incidences of overall and postoperative complications in the PN group were significantly higher than that in the cryoablation group (p = 0.001 and p < 0.001, respectively), but the result about intraoperative complications didn't show a significant difference between the two groups (p = 0.53). Conclusions: Comparing with PN, cryoablation for clinical T1 renal tumors is associated with poorer oncological outcomes, but the existing disadvantages are accompanied by lower rate of overall and postoperative complications and superior renal functional preservation. For patients with imperative indications for nephron-sparing surgery who can't risk more invasive PN, cryoablation could be an attractive option. Owing to the inherent limitations of eligible studies, conclusions drawn from our meta-analyses should be interpreted cautiously and be confirmed further with well-designed randomized controlled trials with extensive follow-up length.
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Affiliation(s)
- Wen Deng
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Luyao Chen
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Yibing Wang
- Department of Emergency, the Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Xiaoqiang Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Gongxian Wang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Weipeng Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Cheng Zhang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Xiaochen Zhou
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Yu Li
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Bin Fu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
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50
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Surgical Methods in Treatment of Kidney Tumors: Open Surgery Versus Laparoscopy Versus Robotic Surgery. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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