51
|
Shah P, Kim FJ, Mian BM. Genitourinary cancer management during a severe pandemic: Utility of rapid communication tools and evidence-based guidelines. BJUI COMPASS 2020; 1:45-59. [PMID: 32537615 PMCID: PMC7280667 DOI: 10.1002/bco2.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives: To determine the usefulness of social media for rapid communication with experts to discuss strategies for prioritization and safety of deferred treatment for urologic malignancies during COVID‐19 pandemic, and to determine whether the discourse and recommendations made through discussions on social media (Twitter) were consistent with the current peer‐reviewed literature regarding the safety of delayed treatment. Methods: We reviewed and compiled the responses to our questions on Twitter regarding the management and safety of deferred treatment in the setting of COVID‐19 related constraints on non‐urgent care. We chronicled the guidance published on this subject by various health authorities and professional organizations. Further, we analyzed peerreviewed literature on the safety of deferred treatment (surgery or systemic therapy) to make made evidence‐based recommendations. Results: Due to the rapidly changing information about epidemiology and infectious characteristics of COVID‐19, the health authorities and professional societies guidance required frequent revisions which by design take days or weeks to produce. Several active discussions on Twitter provided real‐time updates on the changing landscape of the restrictions being placed on non‐urgent care. For separate discussion threads on prostate cancer and bladder cancer, dozens of specialists with expertise in treating urologic cancers could be engaged in providing their expert opinions as well as share evidence to support their recommendations. Our analysis of published studies addressing the safety and extent to which delayed cancer care does not compromise oncological outcome revealed that most prostate cancer care and certain aspects of the bladder and kidney cancer care can be safely deferred for 2‐6 months. Urothelial bladder cancer and advanced kidney cancer require a higher priority for timely surgical care. We did not find evidence to support the idea of using nonsurgical therapies, such as hormone therapy for prostate cancer or chemotherapy for bladder cancer for safer deferment of previously planned surgery. We noted that the comments and recommendations made by the participants in the Twitter discussions were generally consistent with our evidence‐based recommendations for safely postponing cancer care for certain types of urologic cancers. Conclusion: The use of social media platforms, such as Twitter, where the comments and recommendations are subject to review and critique by other specialists is not only feasible but quite useful in addressing the situations requiring urgent resolution, often supported by published evidence. In circumstances such as natural disasters, this may be a preferable approach than the traditional expert panels due to its ability to harness the collective intellect to available experts to provide responses and solutions in real‐time. These real‐time communications via Twitter provided sound guidance which was readily available to the public and participants, and was generally in concordance with the peerreviewed data on safety of deferred treatment.
Collapse
Affiliation(s)
- P Shah
- Department of Urology Mayo Clinic Rochester MN USA
| | - F J Kim
- Division of Urology University of Colorado Denver CO USA
| | - B M Mian
- Division of Urology Albany Medical Center Albany NY USA
| |
Collapse
|
52
|
Microbiome within Primary Tumor Tissue from Renal Cell Carcinoma May Be Associated with PD-L1 Expression of the Venous Tumor Thrombus. Adv Urol 2020; 2020:9068068. [PMID: 32148479 PMCID: PMC7049446 DOI: 10.1155/2020/9068068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/13/2019] [Indexed: 12/16/2022] Open
Abstract
Objective To perform a proof of concept microbiome evaluation and PD-L1 expression profiling in clear-cell renal cell carcinoma (cc-RCC) with associated tumor thrombus (TT). Methods After IRB approval, six patients underwent radical nephrectomy (RN) with venous tumor thrombectomy (VTT). We collected fresh tissue specimens from normal adjacent, tumor, and thrombus tissues. We utilized RNA sequencing to obtain PD-L1 expression profiles and perform microbiome analysis. Statistical assessment was performed using Student's t-test, chi-square, and spearman rank correlations using SPSS v25. Results We noted the tumor thrombus to be mostly devoid of diverse microbiota. A large proportion of Staphylococcus epidermidus was detected and unknown if this is a surgical or postsurgical contaminant; however, it was noted more in the thrombus than other tissues. Microbiome diversity profiles were most abundant in the primary tumor compared to the thrombus or normal adjacent tissue. Differential expression of PD-L1 was examined in the tumor thrombus to the normal background tissue and noted three of the six subjects had a threshold above 2-fold. These three similar subjects had foreign microbiota that are typical residents of the oral microbiome. Conclusion Renal tumors have more diverse microbiomes than normal adjacent tissue. Identification of resident oral microbiome profiles in clear-cell renal cancer with tumor thrombus provides a potential biomarker for thrombus response to PD-L1 inhibition.
Collapse
|
53
|
Greally M, Pilson K, Linehan A, O'Keane C, Shields CJ, Conneely JB, McCaffrey JA. Indolent Nodal Relapse of Colon Carcinoma with Associated Tumor Thrombus Invading the Superior Mesenteric Vein. J Gastrointest Cancer 2020; 50:660-664. [PMID: 29663116 DOI: 10.1007/s12029-018-0101-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Megan Greally
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. .,Gastrointestinal Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Keith Pilson
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Anna Linehan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Conor O'Keane
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Conor J Shields
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John B Conneely
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John A McCaffrey
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| |
Collapse
|
54
|
Wang XM, Lu Y, Song YM, Dong J, Li RY, Wang GL, Wang X, Zhang SD, Dong ZH, Lu M, Wang SY, Ge LY, Luo GD, Ma RZ, George Rozen S, Bai F, Wu D, Ma LL. Integrative genomic study of Chinese clear cell renal cell carcinoma reveals features associated with thrombus. Nat Commun 2020; 11:739. [PMID: 32029730 PMCID: PMC7005298 DOI: 10.1038/s41467-020-14601-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/21/2020] [Indexed: 01/10/2023] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is a heterogeneous disease with features that vary by ethnicity. A systematic characterization of the genomic landscape of Chinese ccRCC is lacking, and features of ccRCC associated with tumor thrombus (ccRCC-TT) remain poorly understood. Here, we applied whole-exome sequencing on 110 normal-tumor pairs and 42 normal-tumor-thrombus triples, and transcriptome sequencing on 61 tumor-normal pairs and 30 primary-thrombus pairs from 152 Chinese patients with ccRCC. Our analysis reveals that a mutational signature associated with aristolochic acid (AA) exposure is widespread in Chinese ccRCC. Tumors from patients with ccRCC-TT show a higher mutational burden and genomic instability; in addition, mutations in BAP1 and SETD2 are highly enriched in patients with ccRCC-TT. Moreover, patients with/without TT show distinct molecular characteristics. We reported the integrative genomic sequencing of Chinese ccRCC and identified the features associated with tumor thrombus, which may facilitate ccRCC diagnosis, prognosis and treatment. The genomic heterogeneity of clear cell renal cell carcinoma (ccRCC) across populations is poorly understood. Here, the authors analyse a cohort of Chinese ccRCC cases revealing a mutational signature associated with aristolochic acid exposure, and higher mutational burden and enrichment for BAP1 and SETD2 mutations in ccRCC cases associated with tumor thrombus.
Collapse
Affiliation(s)
- Xiang-Ming Wang
- Biomedical Pioneering Innovation Center (BIOPIC) & Department of Urology, School of Life Sciences, Third Hospital, Peking University, Beijing, China
| | - Yang Lu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Yi-Meng Song
- Biomedical Pioneering Innovation Center (BIOPIC) & Department of Urology, School of Life Sciences, Third Hospital, Peking University, Beijing, China
| | - Jun Dong
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China.,Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Ruo-Yan Li
- Biomedical Pioneering Innovation Center (BIOPIC) & Department of Urology, School of Life Sciences, Third Hospital, Peking University, Beijing, China
| | - Guo-Liang Wang
- Biomedical Pioneering Innovation Center (BIOPIC) & Department of Urology, School of Life Sciences, Third Hospital, Peking University, Beijing, China
| | - Xu Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Shu-Dong Zhang
- Biomedical Pioneering Innovation Center (BIOPIC) & Department of Urology, School of Life Sciences, Third Hospital, Peking University, Beijing, China
| | - Zhou-Huan Dong
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Min Lu
- Biomedical Pioneering Innovation Center (BIOPIC) & Department of Urology, School of Life Sciences, Third Hospital, Peking University, Beijing, China.,Department of Pathology, Peking University Third Hospital, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Shi-Yu Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Li-Yuan Ge
- Biomedical Pioneering Innovation Center (BIOPIC) & Department of Urology, School of Life Sciences, Third Hospital, Peking University, Beijing, China
| | - Guang-Da Luo
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China.,Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Run-Zhuo Ma
- Biomedical Pioneering Innovation Center (BIOPIC) & Department of Urology, School of Life Sciences, Third Hospital, Peking University, Beijing, China
| | - Steve George Rozen
- Centre for Computational Biology, Duke-NUS Medical School, Singapore, Singapore
| | - Fan Bai
- Biomedical Pioneering Innovation Center (BIOPIC) & Department of Urology, School of Life Sciences, Third Hospital, Peking University, Beijing, China.
| | - Di Wu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China.
| | - Lu-Lin Ma
- Biomedical Pioneering Innovation Center (BIOPIC) & Department of Urology, School of Life Sciences, Third Hospital, Peking University, Beijing, China.
| |
Collapse
|
55
|
Rose KM, Navaratnam AK, Faraj KS, Abdul-Muhsin HM, Syal A, Elias L, Moss AA, Eversman WG, Stone WM, Money SR, Davila VJ, Tyson MD, Castle EP. Comparison of Open and Robot Assisted Radical Nephrectomy With Level I and II Inferior Vena Cava Tumor Thrombus: The Mayo Clinic Experience. Urology 2020; 136:152-157. [DOI: 10.1016/j.urology.2019.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/24/2019] [Accepted: 11/02/2019] [Indexed: 10/25/2022]
|
56
|
Surgical complexity and prognostic outcome of small volume renal cell carcinoma with high-level venous tumor thrombus and large volume renal cell carcinoma with low-level thrombus. Chin Med J (Engl) 2020; 132:1780-1787. [PMID: 31306232 PMCID: PMC6759112 DOI: 10.1097/cm9.0000000000000352] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Radical nephrectomy with thrombectomy is one of the most difficult and complicated urological operations. But the roles of renal tumor volume and thrombus level in surgical complexity and prognostic outcome are not clear. This study aimed to evaluate the surgical complexity and prognostic outcome between the volume of renal cell carcinoma (RCC) and the level of venous tumor thrombus. Methods: The clinical data of 67 RCC cases with renal vein or inferior vena cava (IVC) tumor thrombus from January 2015 to May 2018 were retrospectively analyzed. Among these 67 cases, 21 (31.3%) were small tumors with high-level thrombus (tumor ≤7 cm in diameter and thrombus Neves Level II–IV), while 46 (68.7%) were large tumors with low-level thrombus group (tumor >7 cm in diameter and thrombus Level 0–I). Clinical features, operation details, and pathology data were collected. Univariable and multivariable logistic regression analyses were applied to evaluate the risk factors for small tumor with high-level thrombus. Results: Patients with small tumors and high-level thrombus were more likely to have longer operative time (421.9 ± 135.1 min vs. 282.2 ± 101.9 min, t = 4.685, P < 0.001), more surgical bleeding volume (1200 [325, 2900] mL vs. 500 [180, 1000] mL, U = 270.000, P = 0.004), more surgical blood transfusion volume (800 [0, 1400] mL vs. 0 [0, 800] mL, U = 287.500, P = 0.004), more plasma transfusion volume (0 [0, 800] mL vs. 0 [0, 0] mL, U = 319.000, P = 0.004), higher percentage of open operative approach (76.2% vs. 32.6%, χ2 = 11.015, P = 0.001), higher percentage of IVC resection (33.3% vs. 0%, χ2 = 17.122, P < 0.001), and higher percentage of post-operative complications (52.4% vs. 19.6%, χ2 = 7.415, P = 0.010) than patients with large tumors and low-level thrombus. In multivariate analysis, decreased hemoglobin (Hb) (odds ratio [OR]: 0.956, 95% confidence interval [CI]: 0.926–0.986, P = 0.005) and non-sarcomatoid differentiation (OR: 0.050, 95% CI: 0.004–0.664, P = 0.023) were more likely to form small tumors with high-level tumor thrombus rather than large tumor with small tumor thrombus. The estimated mean cancer-specific survival times of small tumor with high-level thrombus and large tumor with low-level thrombus were 31.6 ± 3.8 months and 32.5 ± 2.9 months, without statistical significance (P = 0.955). After univariate and multivariate Cox proportional hazard survival regression analyses, only distant metastasis (hazard ratio [HR]: 3.839, P = 0.002), sarcomatoid differentiation (HR: 7.923, P < 0.001), alkaline phosphatase (HR: 2.661, P = 0.025), and severe post-operative complications (HR: 10.326, P = 0.001) were independent predictors of prognosis. Conclusions: The level of the tumor thrombus was more important than the diameter of the primary kidney tumor in affecting the complexity of surgery. In the same T3 stage, neither the renal tumor diameter nor the tumor thrombus level was an independent risk factor for prognosis.
Collapse
|
57
|
Shepherd ARH, Joshi R, Tan CP, Cohen P, Brook NR. Inferior vena cava thrombectomy following complete response to nivolumab/ipilimumab for metastatic renal cell carcinoma. ANZ J Surg 2019; 90:1517-1519. [DOI: 10.1111/ans.15608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/07/2019] [Accepted: 11/20/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew R. H. Shepherd
- Department of UrologyRoyal Adelaide Hospital Adelaide South Australia Australia
- Adelaide Medical SchoolThe University of Adelaide Adelaide South Australia Australia
| | - Rohit Joshi
- Adelaide Medical SchoolThe University of Adelaide Adelaide South Australia Australia
- Department of Medical OncologyLyell McEwin Hospital Adelaide South Australia Australia
| | - Chuan Ping Tan
- Department of SurgeryRoyal Adelaide Hospital Adelaide South Australia Australia
| | - Penelope Cohen
- SA PathologyRoyal Adelaide Hospital Adelaide South Australia Australia
| | - Nicholas R. Brook
- Department of UrologyRoyal Adelaide Hospital Adelaide South Australia Australia
- Adelaide Medical SchoolThe University of Adelaide Adelaide South Australia Australia
| |
Collapse
|
58
|
Li QY, Li N, Huang QB, Luo YK, Wang BJ, Guo AT, Ma X, Zhang X, Tang J. Contrast-enhanced ultrasound in detecting wall invasion and differentiating bland from tumor thrombus during robot-assisted inferior vena cava thrombectomy for renal cell carcinoma. Cancer Imaging 2019; 19:79. [PMID: 31791422 PMCID: PMC6889486 DOI: 10.1186/s40644-019-0265-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022] Open
Abstract
Background Vena cava thrombus is one of the main clinical manifestations of locally aggressive renal cell carcinoma (RCC). Inferior vena cava (IVC) wall invasion and presence of bland thrombus could affect the surgical outcome. This study aims to assess the value of contrast-enhanced ultrasound (CEUS) in detecting wall invasion and differentiating bland thrombus from tumor thrombus during robot-assisted IVC thrombectomy for RCC. Methods The intraoperative CEUS findings of 60 patients with RCC accompanied by IVC tumor thrombus were retrospectively analyzed. The CEUS features were compared with the intra- and post-operative pathological findings. CEUS in patients with wall invasion showed that the tumor thrombus was enhanced synchronously with the IVC wall, and the continuity of the IVC wall was lost. In contrast, in patients without wall invasion, CEUS showed that the contrast agent could pass between the tumor thrombus and the IVC wall, and the continuity of IVC wall was good. Typically, contrast-enhanced perfusion was seen in tumor thrombus but not in bland thrombus. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CEUS were statistically analyzed. Results The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the typical enhancement mode of CEUS were 93.1, 93.5, 93.3, 93.1, and 93.5% in identifying wall invasion and 100, 96, 96.7, 83.3, and 100% in differentiating bland thrombus from tumor thrombus, respectively. There were excellent inter-observer agreements for identifying IVC wall invasion and differentiating bland thrombus from tumor thrombus with kappa coefficients of 0.90 and 0.97. Conclusions The present study indicates that intraoperative CEUS plays an important role in robot-assisted IVC thrombectomy for RCC. It can detect wall invasion and differentiate bland thrombus from tumor thrombus, thus offering real-time information to the operator during surgery.
Collapse
Affiliation(s)
- Qiu-Yang Li
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, 100853, China
| | - Nan Li
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, 100853, China
| | - Qing-Bo Huang
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yu-Kun Luo
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Bao-Jun Wang
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ai-Tao Guo
- Department of Pathology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xin Ma
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xu Zhang
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jie Tang
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, 100853, China.
| |
Collapse
|
59
|
Combination with Stereotactic Body Radiotherapy Offers a Promising Strategy to Overcome Resistance to Immunotherapy in Advanced Renal Cell Cancer. JOURNAL OF ONCOLOGY 2019; 2019:1483406. [PMID: 31871454 PMCID: PMC6906880 DOI: 10.1155/2019/1483406] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/24/2019] [Accepted: 10/26/2019] [Indexed: 02/05/2023]
Abstract
Immunotherapy for renal cell cancer (RCC) has witnessed several developments for more than two decades. Checkpoint inhibitors, including anti-CTLA-4 and anti-PD-1/PD-L1 blockers, have changed the treatment landscape for patients with advanced RCC in the past 3 years. Despite these advances, more than 55% RCC patients become resistant to different immunotherapies without other treatment combination. Among various attempts at overcoming resistance to immunotherapy, stereotactic body radiotherapy (SBRT) has been found to potentiate the activity of immunotherapy agents through several potential mechanisms, including normalization of microvessels to alleviate tumor hypoxia, improvement in efficient delivery of drugs, abundant neoantigen exposure, and recruitment of antitumor immune cells to alter the immunosuppressive tumor microenvironment. Preclinical studies and clinical case reports have predicted that the combination of SBRT, an immunotherapy, may lead to remarkable results. This review aims to provide the biological basis for the feasibility of combining SBRT to overcome immunotherapy resistance and to review the currently available clinical evidence of this combination therapy in patients with advanced RCC.
Collapse
|
60
|
Barrera LM, Vergara FA, Duque Villalobos MF, Suaza-Mart´ínez LR, Rivillas ND, Ramírez Arbálaez JA. Técnicas de trasplante hepático usadas en el manejo del carcinoma renal de células claras con trombos en la cava inferior que ascienden hasta el diafragma: serie de casos. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El carcinoma de células renales corresponde al 3 % de todos los tumores sólidos y, de ellos, cerca del 10 % tiene compromiso de la vena cava inferior. La nefrectomía con trombectomía es la mejor alternativa con intención curativa. La mortalidad perioperatoria se encuentra entre el 2 y el 11 %. El objetivo del presente estudio fue presentar una serie de casos de carcinomas renales con trombos de tipo III según la clasificación de Neves-Zincke, en los cuales se usaron con éxito técnicas del trasplante hepático para su extracción.Materiales y métodos. Se presenta una serie de cinco casos, de pacientes sometidos a nefrectomía radical y que presentaban trombo de la vena cava inferior, atendidos en el periodo comprendido entre enero de 2012 y septiembre de 2018.Resultados. De 26 pacientes encontrados con cáncer de células renales, se seleccionaron cinco con trombos de tipo Neves III, cuatro de ellos de tipo IIIa y uno de tipo IIIc.El promedio de edad fue de 63,2 años, cuatro mujeres y un hombre. El promedio de tiempo operatorio fue de 274 minutos y el de pinzamiento de la vena cava inferior fue de 13,6 minutos. El tiempo promedio de estancia en la unidad de cuidados intensivos fue de 2,8 días y el de estancia hospitalaria fue de 9,6 días. Un paciente no presentó ninguna complicación, y los cuatro restantes presentaron complicaciones quirúrgicas menores, I y II de la clasificación de Clavien-Dindo.Conclusión. El uso de maniobras técnicas del trasplante hepático para extraer trombos de la vena cava inferior que no comprometen la aurícula derecha en pacientes con tumores renales, es una alternativa segura con baja morbimortalidad perioperatoria y que puede llegar a garantizar el control de la enfermedad a largo plazo.
Collapse
|
61
|
Sharma V, Thompson RH. Cytoreductive Nephrectomy in the Wake of CARMENA: When to Consider it. Eur Urol Oncol 2019; 2:379-380. [DOI: 10.1016/j.euo.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
|
62
|
Warren H, Fernando A, Thomas K, Austin C, Chowdhury S, O'Brien T. Surgery for high-risk locally advanced (pT3c) renal tumours: oncological outcomes and prognostic significance of a modified International Metastatic Renal Cell Cancer Database Consortium (IMDC) score. BJU Int 2019; 124:462-468. [PMID: 30908845 DOI: 10.1111/bju.14755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate contemporary oncological outcomes and long-term survival in patients undergoing surgery for urological tumours involving the peridiaphragmatic inferior vena cava up to the level of the right atrium. To apply prognostic factors developed for metastatic renal cancer to patients with very-high-risk but apparently localized tumours, and develop a scoring system. PATIENTS AND METHODS A retrospective cohort study of 54 patients referred between December 2007 and April 2018 to a single surgical and oncological team was conducted. Electronic patient records were used to obtain peri-operative data and oncological follow-up. For operated patients lost to follow-up, survival data were obtained from primary care physicians. We used Kaplan-Meier curves to estimate overall survival (OS) and disease-free survival. For the subgroup undergoing curative surgery (n = 32) the prognostic value of a renal cancer score developed at Guy's Hospital using five of the six criteria in the International Metastatic Renal Cell Carcinoma Database Consortium prognostic model (one point for each of anaemia, neutrophilia, thrombophilia, hypercalcaemia and Karnofsky performance status <80), in order to be relevant for M0 disease, was assessed using the log-rank test. RESULTS The median (interquartile range [IQR]) OS of the whole cohort was 29 (11-57) months. The median (IQR) survival of the curative subgroup (n = 32) was 32 (16-57) months, vs 11 (4-upper limit not reached) months for the cytoreductive subgroup (n = 13; P = 0.14). The median (IQR) follow-up time was 14 (1-65) months for patients alive at analysis. Disease-free survival in the curative subgroup was 10 (6-30) months. The median (IQR) OS by risk category for curative cases, as defined by the Guy's renal cancer score, was not reached in the favourable risk group (score = 0 points) because there were no patient deaths, 43 (30-61) months in the intermediate-risk group (score = 1 point), and 18 months (11-32) months in the poor-risk group (score ≥ 2 points; P = 0.005). CONCLUSION A median survival of 29 months appears to justify this type of surgery. A prognostic model, the Guy's renal cancer score, using five readily available clinical measures, appears promising in patients with very-high-risk locally advanced tumours.
Collapse
Affiliation(s)
- Hannah Warren
- Urology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Kay Thomas
- Urology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Conal Austin
- Cardiothoracics, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Simon Chowdhury
- Medical Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Tim O'Brien
- Urology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
63
|
Rehman ZU, Ather MH, Aziz W. Surgical Interventions for Renal Cell Carcinoma with Thrombus Extending into the Inferior Vena Cava: A Multidisciplinary Approach. Ann Vasc Dis 2019; 12:55-59. [PMID: 30931058 PMCID: PMC6434349 DOI: 10.3400/avd.oa.18-00150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess surgical strategies and the impact of a multidisciplinary approach on patients undergoing inferior vena caval thrombectomy for renal cell carcinoma and to evaluate perioperative morbidity and mortality associated with these procedures. Methodology: A retrospective audit for all adults who underwent nephrectomy and inferior vena caval thrombectomy from January 2008 till November 2018 at a University hospital. Patients with incomplete records were excluded from the study. Results: During the study period, 21 patients underwent inferior vena caval thrombectomy as a completion of radical nephrectomy. Most were males (19 : 2) with a mean age of 54±11.3 years. The most common surgical approach was the 11th rib flank approach (n=8) followed by midline abdominal (n=6) and Mercedes-Benz (n=5). Eight patients had level 1, 10 patients had level 2, and three patients had level 3 tumour thrombus. The cavotomy was closed primarily in 20 patients; one required inferior vena cava (IVC) reconstruction with a pericardial patch. The proximal clamp was applied below the hepatic veins for most patients. Two patients required suprahepatic clamping before thrombectomy. There was no intraoperative mortality. Five patients (24%) developed complications: two required cardiopulmonary resuscitation due to severe hypotension and were revived; one developed acute renal failure; and one patient required a damage control laparotomy for excessive oozing. There was no thirty-day mortality. Conclusion: The IVC thrombectomy, along with radical nephrectomy for renal cell carcinoma for 1–3 level thrombus, can be performed with acceptable morbidity in a multidisciplinary team approach.
Collapse
Affiliation(s)
- Zia Ur Rehman
- Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - M Hammad Ather
- Section of Urology, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Wajahat Aziz
- Section of Urology, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
64
|
Labbate C, Hatogai K, Werntz R, Stadler WM, Steinberg GD, Eggener S, Sweis RF. Complete response of renal cell carcinoma vena cava tumor thrombus to neoadjuvant immunotherapy. J Immunother Cancer 2019; 7:66. [PMID: 30857555 PMCID: PMC6413449 DOI: 10.1186/s40425-019-0546-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/22/2019] [Indexed: 12/13/2022] Open
Abstract
Background Clinically localized renal cell carcinoma is treated primarily with surgery followed by observation or adjuvant sunitinib in selected high-risk patients. The checkpoint inhibitor immunotherapeutic agents nivolumab and ipilimumab have recently shown a survival benefit in the first-line metastatic setting. To date, there have been no reports on the response of localized renal cancer to modern immunotherapy. We report a remarkable response of an advanced tumor thrombus to combined immunotherapy which facilitated curative-intent resection of the non-responding primary renal tumor. We characterized the tumor microenvironment within the responding and non-responding tumors. Case presentation A 54-year-old female was diagnosed with a locally advanced clear cell renal cell carcinoma with a level IV tumor thrombus of the vena cava. She was initially deemed unfit for surgical resection due to poor performance status. She underwent neoadjuvant immunotherapy with nivolumab and ipilimumab with a complete response of the vena cava and renal vein tumor thrombus, but had stable disease within her renal mass. She underwent complete surgical resection with negative margins and remains disease-free longer than 1 year after her diagnosis with no further systemic therapy. Notably, pathologic analysis showed a complete response within the vena cava and renal vein, but substantial viable cancer remained in the kidney. Multichannel immunofluorescence was performed and showed marked infiltration of immune cells including CD8+ T cells and Batf3+ dendritic cells in the thrombus, while the residual renal tumor showed a non-T cell-inflamed phenotype. Conclusions Preoperative immunotherapy with nivolumab and ipilimumab for locally advanced clear cell renal cancer resulted in a complete response of an extensive vena cava tumor thrombus, which enabled curative-intent resection of a non-responding primary tumor. If validated in larger cohorts, preoperative immunotherapy for locally advanced renal cell carcinoma may ultimately impact surgical planning and long-term prognosis.
Collapse
Affiliation(s)
- Craig Labbate
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Ken Hatogai
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Ryan Werntz
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Walter M Stadler
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Gary D Steinberg
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Scott Eggener
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Randy F Sweis
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA.
| |
Collapse
|
65
|
Freifeld Y, Margulis V, Woldu SL, Timmerman R, Brugarolas J, Hannan R. Stereotactic Body Radiation Therapy for Renal Cell Carcinoma with Inferior Vena Cava Thrombus – Initial Experience Report and Literature Review. KIDNEY CANCER 2019. [DOI: 10.3233/kca-180044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yuval Freifeld
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Solomon L. Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Brugarolas
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Division of Hematology/Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
66
|
Calderone CE, Tuck BC, Gray SH, Porter KK, Rais-Bahrami S. The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus. Echocardiography 2018; 35:2047-2055. [DOI: 10.1111/echo.14187] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Carli E. Calderone
- Department of Urology; University of Alabama at Birmingham; Birmingham Alabama
| | - Benjamin C. Tuck
- Department of Anesthesiology; University of Alabama at Birmingham; Birmingham Alabama
| | - Stephen H. Gray
- Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Kristin K. Porter
- Department of Radiology; University of Alabama at Birmingham; Birmingham Alabama
| | - Soroush Rais-Bahrami
- Department of Urology; University of Alabama at Birmingham; Birmingham Alabama
- Department of Radiology; University of Alabama at Birmingham; Birmingham Alabama
| |
Collapse
|
67
|
Liss MA, Chen Y, Rodriguez R, Pruthi D, Johnson-Pais T, Wang H, Mansour A, Kaushik D. Immunogenic Heterogeneity of Renal Cell Carcinoma With Venous Tumor Thrombus. Urology 2018; 124:168-173. [PMID: 30385260 DOI: 10.1016/j.urology.2018.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/07/2018] [Accepted: 09/18/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To perform immune-cell enumeration and programmed death-ligand 1 (PD-L1) expression in clear cell renal cell carcinoma (cc-RCC) with tumor thrombus (TT) to guide therapeutic decisions. METHODS After obtaining IRB approval and surgical consent, 6 patients underwent radical nephrectomy with venous tumor thrombectomy. We utilized RNA Sequencing to obtain RNAseq expression profiles. Computational calculation and enumeration of immune cells were performed using CIBERSORT, xCell, and ingenuity pathway analysis software. Statistical assessment was conducted using a t test, chi-square, ANOVA and Spearman rank correlations using SPSS v21. RESULTS We observed a higher proportion of M1 macrophages in the primary tumor and tumor thrombus, while we noted no difference in M2 macrophages despite M2 representing a high number in thrombus samples. (ANOVA, P = .032, and P = .89, respectively). Validation with xCell and ingenuity pathway analysis analysis showed a high involvement of macrophages. We observed a higher number of M1 macrophages (CIBERSORT mean 0.11 vs 0.03, P < 0.01) and (nonactivated) resting Natural Killer (NK) cells (0.077 vs 0.017, P = .02) associated PD-L1 high expression of the primary tumor. PDL1 expression was variable without differences in tumor stage, level, or immune cell detection. We observed an inverse correlation of mean platelet volume with PD-L1 expression within the primary tumor (Spearman, -0.89, P = 02) and the TT (Spearman, -0.77, P = 0.07). CONCLUSION Renal tumor thrombus has higher levels of M1 macrophages that could be utilized as additional targets for future drug development. The PD-L1 expression on clear cell RCC biopsy may not represent its corresponding TT. Future studies are needed to confirm mean platelet volume as a potential blood-based biomarker for PD-L1 expression in RCC.
Collapse
Affiliation(s)
- Michael A Liss
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX; Department of Cell and Molecular Biology, University of Texas Health San Antonio, San Antonio, TX; Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX; GreeheyChildren's Cancer Research Institute, University of Texas Health San Antonio, SanAntonio, TX.
| | - Yidong Chen
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX; Department of Cell and Molecular Biology, University of Texas Health San Antonio, San Antonio, TX; Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX; GreeheyChildren's Cancer Research Institute, University of Texas Health San Antonio, SanAntonio, TX
| | - Ronald Rodriguez
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX; Department of Cell and Molecular Biology, University of Texas Health San Antonio, San Antonio, TX; Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX; GreeheyChildren's Cancer Research Institute, University of Texas Health San Antonio, SanAntonio, TX
| | - Deepak Pruthi
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX; Department of Cell and Molecular Biology, University of Texas Health San Antonio, San Antonio, TX; Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX; GreeheyChildren's Cancer Research Institute, University of Texas Health San Antonio, SanAntonio, TX
| | - Teresa Johnson-Pais
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX; Department of Cell and Molecular Biology, University of Texas Health San Antonio, San Antonio, TX; Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX; GreeheyChildren's Cancer Research Institute, University of Texas Health San Antonio, SanAntonio, TX
| | - Hanzhang Wang
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX; Department of Cell and Molecular Biology, University of Texas Health San Antonio, San Antonio, TX; Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX; GreeheyChildren's Cancer Research Institute, University of Texas Health San Antonio, SanAntonio, TX
| | - Ahmed Mansour
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX; Department of Cell and Molecular Biology, University of Texas Health San Antonio, San Antonio, TX; Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX; GreeheyChildren's Cancer Research Institute, University of Texas Health San Antonio, SanAntonio, TX
| | - Dharam Kaushik
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX; Department of Cell and Molecular Biology, University of Texas Health San Antonio, San Antonio, TX; Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX; GreeheyChildren's Cancer Research Institute, University of Texas Health San Antonio, SanAntonio, TX
| |
Collapse
|
68
|
Buttigliero C, Allis S, Tucci M, Zichi C, Leone G, Di Stefano RF, Ruo Redda MG, Ricardi U, Scagliotti GV, Di Maio M, Filippi AR. Role of radiotherapy in improving activity of immune-modulating drugs in advanced renal cancer: Biological rationale and clinical evidences. Cancer Treat Rev 2018; 69:215-223. [PMID: 30096699 DOI: 10.1016/j.ctrv.2018.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/17/2022]
Abstract
In the last few years, immune checkpoint inhibitors have been extensively investigated in renal cell carcinoma and led to remarkable results. Radiation therapy may increase the activity of immune modulating agents through different mechanisms, priming the immune system, recruiting immune cells to the tumor environment, and altering the immunosuppressive effects of the tumor microenvironment. Preclinical studies reported increased loco-regional control when radiation is combined with immune-checkpoint blockade. Moreover, increased systemic disease control has been demonstrated when local radiation is combined with both anti-CTLA-4 and anti-PD-1/PD-L1 inhibitors. Actually, several trials are ongoing testing the activity of radiation therapy in combination with different immune-modulating agents for the treatment of metastatic renal cell carcinoma. The aim of this paper is to focus on the biological rationale of adding radiation therapy to immune-modulating agents in renal cell carcinoma and to review the currently available clinical evidence about the combination of radiotherapy and immunotherapy.
Collapse
Affiliation(s)
- Consuelo Buttigliero
- Division of Medical Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Simona Allis
- Radiation Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Marcello Tucci
- Division of Medical Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.
| | - Clizia Zichi
- Division of Medical Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Gianmarco Leone
- Division of Medical Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Rosario Francesco Di Stefano
- Division of Medical Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Maria Grazia Ruo Redda
- Radiation Oncology, Ordine Mauriziano Hospital, Department of Oncology, University of Turin, Via Magellano 1, 10028 Turin, Italy
| | - Umberto Ricardi
- Radiation Oncology, Città della Salute e della Scienza di Torino, Department of Oncology, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Giorgio Vittorio Scagliotti
- Division of Medical Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Massimo Di Maio
- Division of Medical Oncology, Ordine Mauriziano Hospital, Department of Oncology, University of Turin, Via Magellano 1, 10028 Turin, Italy
| | - Andrea Riccardo Filippi
- Radiation Oncology, San Luigi Gonzaga Hospital, Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| |
Collapse
|
69
|
Haidar GM, Hicks TD, El-Sayed HF, Davies MG. Treatment options and outcomes for caval thrombectomy and resection for renal cell carcinoma. J Vasc Surg Venous Lymphat Disord 2018; 5:430-436. [PMID: 28411712 DOI: 10.1016/j.jvsv.2016.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/13/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Advanced renal cell carcinoma (RCC) has a significant predisposition to vascular invasion. Tumor vascular invasion and thrombus are found in the renal vein and the inferior vena cava (IVC) in up to 10% to 25% of patients. This study reviewed the current status of radical nephrectomy with IVC thrombectomy for advanced RCC. METHODS A two-level search strategy of the literature (MEDLINE, PubMed, The Cochrane Library, and Google Scholar) for relevant articles listed between January 2000 and December 2015 was performed. The review was confined to patients with primary RCC associated with vascular invasion. RESULTS Untreated RCC with intravascular thrombus has a median survival of 5 months. Surgical exposure and intervention are tailored to the level of tumor thrombus. The 30-day mortality for radical nephrectomy with IVC thrombectomy is low (1.5%-10%), and the complication rates have been reported to be 18%, 20%, 26%, and 47% for IVC tumor thrombus level I, II, III, and IV disease, respectively. Disease-specific survival ranges from 40% to 60% at 5 years after nephrectomy and removal of the intravascular tumor. CONCLUSIONS Radical nephrectomy with IVC thrombectomy is an effective cancer control operation that can be safely performed with acceptable mortality and morbidity. Preoperative imaging coupled with perioperative surgical management of the IVC is critical to procedural success and patient outcomes.
Collapse
Affiliation(s)
- Georges M Haidar
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex; South Texas Center for Vascular Care, University Hospital System, San Antonio, Tex
| | - Taylor D Hicks
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex; South Texas Center for Vascular Care, University Hospital System, San Antonio, Tex
| | - Hosam F El-Sayed
- Division of Vascular Diseases and Surgery, Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, Ohio
| | - Mark G Davies
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex; South Texas Center for Vascular Care, University Hospital System, San Antonio, Tex.
| |
Collapse
|
70
|
Gu L, Li H, Wang Z, Wang B, Huang Q, Lyu X, Shen D, Gao Y, Fan Y, Li X, Xie Y, Du S, Liu K, Tang L, Peng C, Ma X, Zhang X. A systematic review and meta-analysis of clinicopathologic factors linked to oncologic outcomes for renal cell carcinoma with tumor thrombus treated by radical nephrectomy with thrombectomy. Cancer Treat Rev 2018; 69:112-120. [PMID: 29960124 DOI: 10.1016/j.ctrv.2018.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND There remain discrepancies over the factors that influence oncologic outcomes after radical nephrectomy with thrombectomy (RNTE). To assess significant predictors of oncologic outcomes after RNTE from a systematic review and meta-analysis. METHODS A comprehensive search of PubMed, Embase, Cochrane Library and Web of Science was performed to identify eligible studies. The endpoints included cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS). A formal meta-analysis was performed for studies containing non-metastatic and metastatic tumors. Additionally, a sensitivity analysis including the subgroup of studies containing non-metastatic tumors only was conducted. Cumulative analyses of hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were conducted. RESULTS Overall, 35 retrospective studies of low to moderate risk of bias including 11,929 patients were included. The results indicated that large tumor size, high Fuhrman grade, tumor necrosis, positive lymph node, and metastasis at surgery were adverse significant predictors for both CSS and OS. Also, IVC tumor thrombus, sarcomatoid differentiation, perinephretic fat invasion, and adrenal gland invasion were associated with poor CSS. In the subset of non-metastatic patients, the significant predictors were clinical symptom, thrombus level, Fuhrman grade and adrenal gland invasion for CSS; thrombus consistency, Fuhrman grade and tumor necrosis for OS; tumor size, Fuhrman grade and perinephretic fat invasion for RFS. CONCLUSIONS A meta-analysis of available data identified significant prognostic factors of CSS, OS and RFS that should be systematically evaluated to propose a risk-adapted approach to postoperative patient counseling, risk stratification, and therapy selection.
Collapse
Affiliation(s)
- Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Zihuan Wang
- Institute of Occupational Health, Beijing Center for Disease Control and Prevention, Beijing, China
| | - Baojun Wang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Qingbo Huang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xiangjun Lyu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Dan Shen
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yu Gao
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yang Fan
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xintao Li
- Department of Urology, Chinese Air Force General Hospital, Beijing, China
| | - Yongpeng Xie
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Songliang Du
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Kan Liu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Lu Tang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Cheng Peng
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xin Ma
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
| |
Collapse
|
71
|
Adams LC, Ralla B, Engel G, Diederichs G, Hamm B, Busch J, Fuller F, Makowski MR. Assessing venous thrombus in renal cell carcinoma: preliminary results for unenhanced 3D-SSFP MRI. Clin Radiol 2018; 73:757.e9-757.e19. [PMID: 29779758 DOI: 10.1016/j.crad.2018.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/04/2018] [Indexed: 12/01/2022]
Abstract
AIM To test the potential of unenhanced cardiac- and respiratory-motion-corrected three-dimensional steady-state free precession (3D-SSFP) magnetic resonance imaging (MRI) for the assessment of inferior vena cava (IVC) thrombus in patients with clear-cell renal cell carcinoma (cRCC), compared to standard contrast-enhanced (CE)-MRI and CE-computed tomography (CT). MATERIALS AND METHODS Eighteen patients with cRCC and IVC thrombus, who received CE-MRI and 3D-SSFP at 1.5 T between June 2015 and December 2017, were included. The diagnostic performance of 3D-SSFP in determining the level of thrombus extension, contrast-to-noise ratio (CNR), and image quality were compared with standard MRI/CT and validated against intraoperative and histopathology results. RESULTS There was 100% agreement between 3D-SSFP, 83.3% agreement between CE-MRI, and 71.4% agreement between CE-CT and surgical findings regarding the level of IVC thrombus. In addition, 3D-SSFP showed a slightly superior estimate of pathological IVC volume. 3D-SSFP reached a significantly higher CNR in the supra- and infrarenal IVC compared to the morphological sequence T2-weighted half-Fourier axial single-shot fast spin-echo (T2-HASTE) and all phases of CE-MRI. More specifically, 3D-SSFP showed a significantly higher CNR in the infrarenal IVC (mean CNR of 10.09±5.74 versus 4.21±2.33 in the delayed phase, p≤0.001) and in the suprarenal IVC (mean CNR of 9.22±4.11 versus 4.84±5.74 in the late arterial phase, p=0.015). CE-CT also was significantly inferior to 3D-SSFP (p≤0.01) and slightly inferior to CE-MRI (p>0.05). The thrombus delineation score for 3D-SSFP (4.38±0.67) was higher compared to CE-MRI (3.76±0.56, p=0.005). CONCLUSION This preliminary study indicates that 3D-SSFP can achieve an accurate assessment of IVC thrombus in cRCC patients without the need for contrast medium administration, being superior to standard MRI and CT.
Collapse
Affiliation(s)
- L C Adams
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany.
| | - B Ralla
- Department of Urology, Charité, Charitéplatz 1, 10117 Berlin, Germany
| | - G Engel
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany
| | - G Diederichs
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany
| | - B Hamm
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany
| | - J Busch
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany
| | - F Fuller
- Department of Urology, Charité, Charitéplatz 1, 10117 Berlin, Germany
| | - M R Makowski
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
72
|
Pruthi DK, Wang H, Satsangi A, Cajipe M, Iffrig K, Haidar GM, Hicks T, Sako EY, Liss MA, Chowdhury WH, Rodriguez R, Kaushik D. Contemporary surgical outcomes of venous tumour thrombectomy managed with intraoperative Doppler ultrasound for kidney cancer. Can Urol Assoc J 2018; 12:E391-E397. [PMID: 29787368 DOI: 10.5489/cuaj.5013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Radical nephrectomy (RN) with venous tumour thrombectomy (VTT) carries a significant morbidity and mortality risk. Examination of a contemporary single-institution series permits the development of a management algorithm and an audit its results. We report outcomes following the use of intraoperative colour Doppler ultrasound and our surgical pathway. METHODS We retrospectively reviewed the records of all patients who underwent RN with VTT for kidney cancer between January 1, 2013 and October 1, 2016. Surgical complications, postoperative complications (Clavien-Dindo classification ≥3), 90-day readmission rates, and outcomes are reported. Multivariate linear regression, logistic regression, and Cox proportional hazard modelling were used to identify associations. RESULTS Fifty-eight patients underwent RN with VTT. Of these, 26 (45%) patients had Mayo Clinic level III or IV thrombus and nineteen required venovenous/cardiopulmonary bypass. Three patients required patch grafting. The median length of hospital stay was eight days and there were 20 major complications. The 30-day readmission rate was 21% and the 90-day mortality rate was 8.9%. In multivariate analysis, low serum albumin and age-adjusted Charlson comorbidity score predicted length of stay. Increased intraoperative blood loss was significantly associated with increasing body mass index, serum creatinine, tumour thrombus level, and a history of significant weight loss >9.1kg. Low serum hematocrit predicted 90-day mortality. CONCLUSIONS Intraoperative colour Doppler ultrasound is a useful tool and can facilitate caval preservation. Caval grafting can be avoided in most cases. Venovenous bypass can be avoided in many level III cases. Early therapeutic anticoagulation should be instituted with caution.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Edward Y Sako
- Department of Cardiothoracic Surgery; University of Texas Health San Antonio, San Antonio, TX, United States
| | | | | | | | | |
Collapse
|
73
|
Genomic features of renal cell carcinoma with venous tumor thrombus. Sci Rep 2018; 8:7477. [PMID: 29748622 PMCID: PMC5945671 DOI: 10.1038/s41598-018-25544-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 04/25/2018] [Indexed: 12/17/2022] Open
Abstract
A venous tumor thrombus (VTT) is a potentially lethal complication of renal cell carcinoma (RCC) but virtually nothing is known about the underlying natural history. Based on our observation that venous thrombi contain significant numbers of viable tumor cells, we applied multiregion whole exome sequencing to a total of 37 primary tumor and VTT samples including normal tissue specimens from five consecutive patients. Our findings demonstrate mutational heterogeneity between primary tumor and VTT with 106 of 483 genes (22%) harboring functional SNVs and/or indels altered in either primary tumor or thrombus. Reconstruction of the clonal phylogeny showed clustering of tumor samples and VTT samples, respectively, in the majority of tumors. However, no new subclones were detected suggesting that pre-existing subclones of the primary tumor drive VTT formation. Importantly, we found several lines of evidence for “BRCAness” in a subset of tumors. These included mutations in genes that confer “BRCAness”, a mutational signature and an increase of small indels. Re-analysis of SNV calls from the TCGA KIRC-US cohort confirmed a high frequency of the “BRCAness” mutational signature AC3 in clear cell RCC. Our findings warrant further pre-clinical experiments and may lead to novel personalized therapies for RCC patients.
Collapse
|
74
|
Nini A, Capitanio U, Larcher A, Dell’Oglio P, Dehò F, Suardi N, Muttin F, Carenzi C, Freschi M, Lucianò R, La Croce G, Briganti A, Colombo R, Salonia A, Castiglioni A, Rigatti P, Montorsi F, Bertini R. Perioperative and Oncologic Outcomes of Nephrectomy and Caval Thrombectomy Using Extracorporeal Circulation and Deep Hypothermic Circulatory Arrest for Renal Cell Carcinoma Invading the Supradiaphragmatic Inferior Vena Cava and/or Right Atrium. Eur Urol 2018; 73:793-799. [DOI: 10.1016/j.eururo.2017.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
|
75
|
Wang Z, Zhang K, Zhang H, Sun D, Li Y, Tan Q, Fu Q. A rare case report of one stage surgical treatment for left renal cell carcinoma with level IV intravenous tumor thrombus combined with severe coronary artery stenosis. Medicine (Baltimore) 2018; 97:e0433. [PMID: 29742686 PMCID: PMC5959390 DOI: 10.1097/md.0000000000010433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Renal cell carcinoma (RCC) exhibits a natural tendency to extend from the kidney into inferior vena cava (IVC) and growing into the right atrium is a rare complication. We report a 65-year-old patient with an RCC with intravascular extension through renal vein into the IVC and right atrial combined with severe coronary artery disease. This case has not been described in the literature and there is no treatment guideline for it. PATIENT CONCERNS A 65-year-old patient was admitted to our clinic with complaints of edema of both lower extremities. DIAGNOSES On the basis of the magnetic resonance imaging scan and coronary angiography, we strongly suspected an RCC with intravascular extension through renal vein into the IVC and right atrial combined with severe coronary artery disease. INTERVENTIONS We performed open left radical nephrectomy, IVC, and right atrium thrombectomy under cardiopulmonary bypass and coronary artery bypass grafting on beating heart. OUTCOMES The postoperative course was uneventful. The patient has been discharged from hospital. LESSONS Coexistence of severe coronary artery disease and RCC infiltrating inferior vena cava and right atrium rendered this operation as very high-risk procedure. We hope that our operational manners can prove the possibility of simultaneous difficult cardiac and urologic operation. The basic point of our report concerns the fact that the oncologic treatment was not delayed despite severe heart disease.
Collapse
Affiliation(s)
| | | | | | | | - Yong Li
- Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Qi Tan
- Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | | |
Collapse
|
76
|
Shah PH, Thompson RH, Boorjian SA, Lohse CM, Lyon TD, Shields RC, Froehling D, Leibovich BC, Viers BR. Symptomatic Venous Thromboembolism is Associated with Inferior Survival among Patients Undergoing Nephrectomy with Inferior Vena Cava Tumor Thrombectomy for Renal Cell Carcinoma. J Urol 2018; 200:520-527. [PMID: 29709665 DOI: 10.1016/j.juro.2018.04.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE We investigated the incidence and survival impact of symptomatic venous thromboembolism after nephrectomy with inferior vena cava tumor thrombectomy. MATERIALS AND METHODS We retrospectively reviewed the records of 183 patients who underwent nephrectomy with inferior vena cava tumor thrombectomy (level I-IV) for renal cell carcinoma between 2000 and 2010. Postoperative venous thromboembolism was defined as symptomatic bland thrombus or embolism confirmed on imaging. The cumulative incidence of venous thromboembolism was estimated by the Kaplan-Meier method. Associations of clinicopathological features with time to thromboembolism after surgery and all cause mortality were evaluated on multivariable analysis with Cox models. RESULTS Symptomatic venous thromboembolism developed in 55 patients a median of 23 days (IQR 5-142) postoperatively, including pulmonary thrombosis in 24, deep venous thrombosis in 17, bland inferior vena cava thrombosis in 13 and portal vein thrombosis in 1. The cumulative incidence of thromboembolism 30, 90 and 365 days following surgery was 17%, 22% and 27%, respectively. A history of smoking (HR 2.15, 95% CI 1.09-4.24, p = 0.028), ECOG (Eastern Cooperative Oncology Group) performance status 1 or greater (HR 2.15, 95% CI 1.17-3.93, p = 0.013), hypercoagulability disorder (HR 5.12, 95% CI 1.93-13.59, p = 0.001) and bulky lymphadenopathy at surgery (HR 4.84, 95% CI 1.87-12.51, p = 0.001) was significantly associated with an increased risk of venous thromboembolism on multivariable analysis. Postoperative venous thromboembolism was significantly associated with an increased risk of all cause mortality (HR 1.53, 95% CI 1.04-2.23, p = 0.029). CONCLUSIONS Venous thromboembolism after nephrectomy and tumor thrombectomy is common within 90 days of surgery. Symptomatic venous thromboembolism in this population is independently associated with a greater risk of mortality.
Collapse
Affiliation(s)
- Paras H Shah
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Raymond C Shields
- Division of Vascular Medicine, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - David Froehling
- Division of Vascular Medicine, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
77
|
Turajlic S, Xu H, Litchfield K, Rowan A, Chambers T, Lopez JI, Nicol D, O'Brien T, Larkin J, Horswell S, Stares M, Au L, Jamal-Hanjani M, Challacombe B, Chandra A, Hazell S, Eichler-Jonsson C, Soultati A, Chowdhury S, Rudman S, Lynch J, Fernando A, Stamp G, Nye E, Jabbar F, Spain L, Lall S, Guarch R, Falzon M, Proctor I, Pickering L, Gore M, Watkins TBK, Ward S, Stewart A, DiNatale R, Becerra MF, Reznik E, Hsieh JJ, Richmond TA, Mayhew GF, Hill SM, McNally CD, Jones C, Rosenbaum H, Stanislaw S, Burgess DL, Alexander NR, Swanton C. Tracking Cancer Evolution Reveals Constrained Routes to Metastases: TRACERx Renal. Cell 2018; 173:581-594.e12. [PMID: 29656895 PMCID: PMC5938365 DOI: 10.1016/j.cell.2018.03.057] [Citation(s) in RCA: 525] [Impact Index Per Article: 87.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/06/2018] [Accepted: 03/20/2018] [Indexed: 01/17/2023]
Abstract
Clear-cell renal cell carcinoma (ccRCC) exhibits a broad range of metastatic phenotypes that have not been systematically studied to date. Here, we analyzed 575 primary and 335 metastatic biopsies across 100 patients with metastatic ccRCC, including two cases sampledat post-mortem. Metastatic competence was afforded by chromosome complexity, and we identify 9p loss as a highly selected event driving metastasis and ccRCC-related mortality (p = 0.0014). Distinct patterns of metastatic dissemination were observed, including rapid progression to multiple tissue sites seeded by primary tumors of monoclonal structure. By contrast, we observed attenuated progression in cases characterized by high primary tumor heterogeneity, with metastatic competence acquired gradually and initial progression to solitary metastasis. Finally, we observed early divergence of primitive ancestral clones and protracted latency of up to two decades as a feature of pancreatic metastases.
Collapse
Affiliation(s)
- Samra Turajlic
- Translational Cancer Therapeutics Laboratory, the Francis Crick Institute, London NW1 1AT, UK; Renal and Skin Units, the Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK
| | - Hang Xu
- Translational Cancer Therapeutics Laboratory, the Francis Crick Institute, London NW1 1AT, UK
| | - Kevin Litchfield
- Translational Cancer Therapeutics Laboratory, the Francis Crick Institute, London NW1 1AT, UK
| | - Andrew Rowan
- Translational Cancer Therapeutics Laboratory, the Francis Crick Institute, London NW1 1AT, UK
| | - Tim Chambers
- Translational Cancer Therapeutics Laboratory, the Francis Crick Institute, London NW1 1AT, UK
| | - Jose I Lopez
- Department of Pathology, Cruces University Hospital, Biocruces Institute, University of the Basque Country, Barakaldo, Spain
| | - David Nicol
- Department of Urology, the Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Tim O'Brien
- Urology Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - James Larkin
- Renal and Skin Units, the Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK
| | - Stuart Horswell
- Department of Bioinformatics and Biostatistics, The Francis Crick Institute, London NW1 1AT, UK
| | - Mark Stares
- Translational Cancer Therapeutics Laboratory, the Francis Crick Institute, London NW1 1AT, UK; Renal and Skin Units, the Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK
| | - Lewis Au
- Renal and Skin Units, the Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK
| | - Mariam Jamal-Hanjani
- Cancer Research UK Lung Cancer Centre of Excellence London, University College London Cancer Institute, London WC1E 6DD, UK
| | - Ben Challacombe
- Urology Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Ashish Chandra
- Department of Cellular Pathology, Guy's & St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Steve Hazell
- Department of Pathology, the Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Claudia Eichler-Jonsson
- Translational Cancer Therapeutics Laboratory, the Francis Crick Institute, London NW1 1AT, UK
| | - Aspasia Soultati
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Simon Chowdhury
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarah Rudman
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joanna Lynch
- Renal and Skin Units, the Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK
| | - Archana Fernando
- Urology Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Gordon Stamp
- Experimental Histopathology Laboratory, the Francis Crick Institute, London NW1 1AT, UK
| | - Emma Nye
- Experimental Histopathology Laboratory, the Francis Crick Institute, London NW1 1AT, UK
| | - Faiz Jabbar
- Translational Cancer Therapeutics Laboratory, the Francis Crick Institute, London NW1 1AT, UK
| | - Lavinia Spain
- Renal and Skin Units, the Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK
| | - Sharanpreet Lall
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rosa Guarch
- Department of Pathology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Mary Falzon
- Department of Pathology, University College London Hospitals, London WC1E 6DE, UK
| | - Ian Proctor
- Department of Pathology, University College London Hospitals, London WC1E 6DE, UK
| | - Lisa Pickering
- Renal and Skin Units, the Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK
| | - Martin Gore
- Renal and Skin Units, the Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK
| | - Thomas B K Watkins
- Translational Cancer Therapeutics Laboratory, the Francis Crick Institute, London NW1 1AT, UK
| | - Sophia Ward
- Translational Cancer Therapeutics Laboratory, the Francis Crick Institute, London NW1 1AT, UK; Cancer Research UK Lung Cancer Centre of Excellence London, University College London Cancer Institute, London WC1E 6DD, UK
| | - Aengus Stewart
- Department of Pathology, Cruces University Hospital, Biocruces Institute, University of the Basque Country, Barakaldo, Spain
| | - Renzo DiNatale
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria F Becerra
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ed Reznik
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James J Hsieh
- Molecular Oncology, Department of Medicine, Siteman Cancer Center, Washington University, St. Louis, MO, USA
| | - Todd A Richmond
- Roche Sequencing Solutions, Madison, Research & Development, Madison, WI, 53719, USA
| | - George F Mayhew
- Roche Sequencing Solutions, Madison, Research & Development, Madison, WI, 53719, USA
| | | | | | - Carol Jones
- Ventana Medical Systems, Tucson, AZ 85755, USA
| | - Heidi Rosenbaum
- Roche Sequencing Solutions, Madison, Research & Development, Madison, WI, 53719, USA
| | | | - Daniel L Burgess
- Roche Sequencing Solutions, Madison, Research & Development, Madison, WI, 53719, USA
| | | | - Charles Swanton
- Translational Cancer Therapeutics Laboratory, the Francis Crick Institute, London NW1 1AT, UK; Cancer Research UK Lung Cancer Centre of Excellence London, University College London Cancer Institute, London WC1E 6DD, UK; Department of Medical Oncology, University College London Hospitals, London NW1 2BU, UK.
| |
Collapse
|
78
|
López JI, Pulido R, Lawrie CH, Angulo JC. Loss of PD-L1 (SP-142) expression characterizes renal vein tumor thrombus microenvironment in clear cell renal cell carcinoma. Ann Diagn Pathol 2018; 34:89-93. [PMID: 29661736 DOI: 10.1016/j.anndiagpath.2018.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/13/2018] [Accepted: 03/23/2018] [Indexed: 12/19/2022]
Abstract
Immunotherapy is a promising tool in the treatment of patients with advancer renal cancer, in particular the blockage of immune checkpoint inhibitors. Clear cell renal cell carcinoma is an example of heterogeneous neoplasm and this particular characteristic is responsible of many therapeutic failures so far. Since variations in the local microenvironment across a tumor may conditionate the effect of this new therapy, a deeper knowledge of this issue seems advisable for any treatment success. We have analyzed the PD-L1 (SP142) expression in three different areas in the tumor and in two areas in the renal vein/caval thrombi in 39 advanced clear cell renal cell carcinomas to determine the extent and potential clinical significance of this regional variability. A statistically significant decrease in PD-L1 expression has been detected between the main tumor and its thrombus faction (p < 0.0001). Also, we have observed a high variability in the PD-L1 positivity across the three different areas of the main tumor tested, with only three cases being uniformly positive in all tested areas. In conclusion, PD-L1 expression display a highly variable distribution in clear cell renal cell carcinomas and this particularity should be kept in mind when selecting the tumor samples to be tested for immunotherapy.
Collapse
Affiliation(s)
- José I López
- Department of Pathology, Cruces University Hospital, Barakaldo, Spain; Biomarkers in Cancer Unit, Biocruces Research Institute, Barakaldo, Spain; Department of Medical-Surgical Specialties, University of the Basque Country (UPV/EHU), Leioa, Spain.
| | - Rafael Pulido
- Biomarkers in Cancer Unit, Biocruces Research Institute, Barakaldo, Spain; IKERBASQUE, The Basque Foundation for Science, Bilbao, Spain
| | - Charles H Lawrie
- IKERBASQUE, The Basque Foundation for Science, Bilbao, Spain; Molecular Oncology, Biodonostia Research Institute, Donostia-San Sebastián, Spain; Department of Physiology, University of the Basque Country (UPV/EHU), Leioa, Spain; Radcliffe Department of Medicine, University of Oxford, UK
| | - Javier C Angulo
- Service of Urology, University Hospital of Getafe, Getafe, Madrid, Spain; Clinical Department, European University of Madrid, Laureate Universities, Madrid, Spain
| |
Collapse
|
79
|
Oncological outcomes after cytoreductive nephrectomy for patients with metastatic renal cell carcinoma with inferior vena caval tumor thrombus. Int J Clin Oncol 2018; 23:553-558. [DOI: 10.1007/s10147-017-1232-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
|
80
|
Anesthesia for Nephrectomy with Vena Cava Thrombectomy. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
81
|
Catalá-Ripoll JV, Mateo-Rodríguez E, Juez-López M, Martín-González I, Doménech-Pérez C, Martínez-León J, Carmona-García P, Genovés-Crespo M. Cirugía de tumores retroperitoneales con afectación de vena cava: revisión de 18 casos. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
82
|
Tilki D, Chandrasekar T, Capitanio U, Ciancio G, Daneshmand S, Gontero P, Gonzalez J, Haferkamp A, Hohenfellner M, Huang WC, Linares Espinós E, Lorentz A, Martinez-Salamanca JI, Master VA, McKiernan JM, Montorsi F, Novara G, Pahernik S, Palou J, Pruthi RS, Rodriguez-Faba O, Russo P, Scherr DS, Shariat SF, Spahn M, Terrone C, Vera-Donoso C, Zigeuner R, Libertino JA, Evans CP. Impact of lymph node dissection at the time of radical nephrectomy with tumor thrombectomy on oncological outcomes: Results from the International Renal Cell Carcinoma-Venous Thrombus Consortium (IRCC-VTC). Urol Oncol 2017; 36:79.e11-79.e17. [PMID: 29129353 DOI: 10.1016/j.urolonc.2017.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 09/11/2017] [Accepted: 10/09/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus. PATIENTS AND METHODS The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates. RESULTS LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN-) disease was documented in 573 patients, 447 of them underwent LND with 43 cN- patients (9.6%) revealing positive LNs at pathology. LN positive cN- patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015). CONCLUSIONS The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1 patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting.
Collapse
Affiliation(s)
- Derya Tilki
- Department of Urology, University of California, Davis School of Medicine, Sacramento, CA
| | - Thenappan Chandrasekar
- Department of Urology, University of California, Davis School of Medicine, Sacramento, CA
| | - Umberto Capitanio
- Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy
| | - Gaetano Ciancio
- Department of Urology, Miami Transplant Institute, University of Miami, Miami, FL
| | - Siamak Daneshmand
- Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Paolo Gontero
- Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy
| | - Javier Gonzalez
- Department of Urology, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain
| | - Axel Haferkamp
- Department of Urology, University of Frankfurt, Frankfurt, Germany
| | | | - William C Huang
- Department of Urology, New York University School of Medicine, New York City, NY
| | | | - Adam Lorentz
- Department of Urology, Emory University, Atlanta, GA
| | - Juan I Martinez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - James M McKiernan
- Department of Urology, Columbia University College of Physicians and Surgeons, New York City, NY
| | - Francesco Montorsi
- Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy
| | - Giacomo Novara
- Department of Urology, University of Padua, Padua, Italy
| | - Sascha Pahernik
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Juan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Raj S Pruthi
- Department of Urology, UNC at Chappel Hill, Chapel Hill, NC
| | | | - Paul Russo
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical Center, New York City, NY
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Martin Spahn
- Department of Urology, University of Würzburg, Würzburg, Germany; Department of Urology, University Hospital Bern, Bern, Switzerland
| | - Carlo Terrone
- Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy
| | - Cesar Vera-Donoso
- Department of Urology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
| | | | - Christopher P Evans
- Department of Urology, University of California, Davis School of Medicine, Sacramento, CA.
| |
Collapse
|
83
|
Cytoreductive Nephrectomy for Renal Cell Carcinoma with Venous Tumor Thrombus. J Urol 2017; 198:281-288. [DOI: 10.1016/j.juro.2017.03.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 11/20/2022]
|
84
|
Gangadaran SGD. Current Management Options in Metastatic Renal Cell Cancer. Oncol Rev 2017; 11:339. [PMID: 28680539 PMCID: PMC5481727 DOI: 10.4081/oncol.2017.339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/07/2017] [Accepted: 05/31/2017] [Indexed: 02/06/2023] Open
Abstract
Renal cancer accounts for 2.4% of all cancers. Localised disease accounts for the majority of renal cancers (70-75%), however 20-25% of these ultimately develop distant metastasis. The median overall survival of un treated metastatic disease is 5 months with 1-year survival of only 29%. The management of metastatic renal cell cancers traditionally relied on systemic immunotherapy with attendant high morbidity but after the year 2005 the use of effective targeted therapy with tolerable side effect profile has improved the survival from 10.2 months in the cytokine era to 17.7 months. This article reviews the past, present and future options in the management of metastatic renal cancer.
Collapse
|
85
|
Shinder BM, Rhee K, Farrell D, Farber NJ, Stein MN, Jang TL, Singer EA. Surgical Management of Advanced and Metastatic Renal Cell Carcinoma: A Multidisciplinary Approach. Front Oncol 2017; 7:107. [PMID: 28620578 PMCID: PMC5449498 DOI: 10.3389/fonc.2017.00107] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/08/2017] [Indexed: 12/12/2022] Open
Abstract
The past decade has seen a rapid proliferation in the number and types of systemic therapies available for renal cell carcinoma. However, surgery remains an integral component of the therapeutic armamentarium for advanced and metastatic kidney cancer. Cytoreductive surgery followed by adjuvant cytokine-based immunotherapy (predominantly high-dose interleukin 2) has largely given way to systemic-targeted therapies. Metastasectomy also has a role in carefully selected patients. Additionally, neoadjuvant systemic therapy may increase the feasibility of resecting the primary tumor, which may be beneficial for patients with locally advanced or metastatic disease. Several prospective trials examining the role of adjuvant therapy are underway. Lastly, the first immune checkpoint inhibitor was approved for metastatic renal cell carcinoma (mRCC) in 2015, providing a new treatment mechanism and new opportunities for combining systemic therapy with surgery. This review discusses current and historical literature regarding the surgical management of patients with advanced and mRCC and explores approaches for optimizing patient selection.
Collapse
Affiliation(s)
- Brian M Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Kevin Rhee
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Douglas Farrell
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Mark N Stein
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| |
Collapse
|
86
|
Mansukhani NA, Havelka GE, Helenowski IB, Rodriguez HE, Hoel AW, Eskandari MK. The enduring patency of primary inferior vena cava repair. Surgery 2017; 161:1414-1422. [PMID: 28011005 PMCID: PMC5404996 DOI: 10.1016/j.surg.2016.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/19/2016] [Accepted: 11/05/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inferior vena cava repair after planned and unplanned venotomy is performed by either interposition bypass, patch venopasty, or lateral venorrhaphy and primary repair. Primary repair of the inferior vena cava avoids the use of foreign material and allows an all-autologous repair in an expeditious fashion. The purpose of this study was to demonstrate the utility of inferior vena cava repair, determine the degree of inferior vena cava stenosis, and examine clinical outcomes after primary repair. METHODS We conducted a single-center retrospective review of patients who underwent primary inferior vena cava repairs between January 2002 and January 2014 at a tertiary care center. Primary repair followed lateral venorrhaphy for tumor extraction or for repair of an iatrogenic inferior vena cava injury. Patient demographics, cross-sectional vena cava dimensions, and patient outcomes were tabulated. RESULTS In total, 47 (30 men and 17 women) patients underwent primary inferior vena cava repair (median age 58 years, range 31-83 years). Twenty-six patients (15 men and 11 women) underwent en bloc radical nephrectomy, inferior vena cava tumor thrombus extraction, and primary lateral venorrhaphy (median age 61 years, range 39-83 years). The majority, 92% of these patients, had renal cell carcinoma on final pathology, with a median follow-up period of 39 months (range 1-108 months). Twenty-one patients (15 men and 6 women) underwent primary repair for iatrogenic inferior vena cava injury (median age 54 years, range 31-82 years). The median follow-up period was 18.5 months (3-110 months). Clinic follow-up with postoperative imaging was obtained in 76.9% of those undergoing tumor thrombus extraction (n = 20) and 76.2% of those undergoing repair of an iatrogenic injury (n = 16). Overall, there was a 13% infrarenal inferior vena cava diameter loss, 17% inferior vena cava diameter loss at the level of the renal veins, and 10% suprarenal inferior vena cava diameter loss when comparing postoperative with preoperative imaging. All patients remained asymptomatic; therefore, inferior vena cava narrowing associated with primary repair was clinically insignificant. CONCLUSION Primary inferior vena cava repair is associated with less than 20% inferior vena cava diameter loss and does not compromise venous outflow from the extremities. Primary inferior vena cava repair is a safe and expeditious technique that provides excellent clinical outcomes and long-term patency.
Collapse
Affiliation(s)
- Neel A Mansukhani
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - George E Havelka
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Irene B Helenowski
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Heron E Rodriguez
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew W Hoel
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark K Eskandari
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
| |
Collapse
|
87
|
Yoo S, Song SH, Go H, You D, Song C, Hong JH, Kim CS, Ahn H, Jeong IG. Fate of newly developed pulmonary embolism after surgery for renal cell carcinoma with vena cava thrombus. Int Urol Nephrol 2017; 49:1157-1163. [DOI: 10.1007/s11255-017-1583-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/01/2017] [Indexed: 12/29/2022]
|
88
|
Jiménez-Romero C, Conde M, de la Rosa F, Manrique A, Calvo J, Caso Ó, Muñoz C, Marcacuzco A, Justo I. Treatment of caval vein thrombosis associated with renal tumors. Cir Esp 2017; 95:152-159. [PMID: 28242025 DOI: 10.1016/j.ciresp.2017.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 01/11/2017] [Accepted: 01/19/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Renal carcinoma represents 3% of all solid tumors and is associated with renal or inferior caval vein (IVC) thrombosis between 2-10% of patients, extending to right atrial in 1% of cases. METHODS This is a retrospective study that comprises 5 patients who underwent nephrectomy and thrombectomy by laparotomy because of renal tumor with IVC thrombosis level iii. RESULTS Four patients were males and one was female, and the mean age was 57,2 years (range: 32-72). Most important clinical findings were hematuria, weight loss, weakness, anorexia, and pulmonary embolism. Diagnostic confirmation was performed by CT scanner. Metastatic disease was diagnosed before surgery in 3 patients. Suprahepatic caval vein and hepatic hilium (Pringle's maneouver) were clamped in 4 patients, and ligation of infrarrenal caval vein was carry out in one patient. Five patients developed mild complications (Clavien I/II). No patient died and the mean hospital stay was 8,6 days. All patients were treated with chemotherapy, and 3 died because distant metastasis, but 2 are alive, without recurrence, at 5 and 60 months, respectively. CONCLUSIONS Nephrectomy and thrombectomy in renal tumors with caval thrombosis can be curative in absence of metastasis or, at less, can increase survival or quality of live. Then these patients must be treated in liver transplant units because major surgical and anesthesiologic expertise. Adjuvant treatment with tyrosin kinase inhibitors must be validate in the future with wider experiences.
Collapse
Affiliation(s)
- Carlos Jiménez-Romero
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España.
| | - María Conde
- Servicio de Cirugía General, Hospital Universitario Lucus Augusti, Lugo, España
| | | | - Alejandro Manrique
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Jorge Calvo
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Óscar Caso
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Carlos Muñoz
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Alberto Marcacuzco
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Iago Justo
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España
| |
Collapse
|
89
|
Management of IVC Thrombus-Surgical Strategies and Outcomes. Indian J Surg Oncol 2017; 8:156-159. [PMID: 28546711 DOI: 10.1007/s13193-016-0583-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/15/2016] [Indexed: 10/20/2022] Open
Abstract
Renal cell carcinoma is the most lethal among all urological cancers. The lethality increases with advancing stages of the disease. Renal tumors show a peculiar propensity to invade the venous system. Such invasion not only worsens the disease prognosis but also increases the surgical morbidity making treatment of such tumors challenging. Several small volume series have been published regarding management and outcomes of renal tumors with inferior vena cava (IVC) thrombus which show encouraging results when addressed properly. In this article, we review the outcomes and also describe the step-by-step approach to management of these tumors.
Collapse
|
90
|
Choi DK, Jeon HG, Jeong CW, Kwak C, Song C, Chung J, Hong SK, Hong SH, Seo SI. Surgical treatment of renal cell carcinoma: Can morphological features of inferior vena cava tumor thrombus on computed tomography or magnetic resonance imaging be a prognostic factor? Int J Urol 2017; 24:102-109. [DOI: 10.1111/iju.13272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 11/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Don Kyoung Choi
- Department of Urology; Hallym University Kangnam Sacred Heart Hospital; Hallym University School of Medicine; Seoul Korea
| | - Hwang Gyun Jeon
- Department of Urology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Chang Wook Jeong
- Department of Urology; Seoul National University Hospital; Seoul National University of Medicine; Seoul Korea
| | - Cheol Kwak
- Department of Urology; Seoul National University Hospital; Seoul National University of Medicine; Seoul Korea
| | - Cheryn Song
- Department of Urology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Jinsoo Chung
- Department of Urology; National Cancer Center; Goyang Korea
| | - Sung Kyu Hong
- Department of Urology; Seoul National University Bundang Hospital; Seongnam Korea
| | - Sung-Hoo Hong
- Department of Urology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Seong Il Seo
- Department of Urology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | | |
Collapse
|
91
|
Qi N, Wu P, Chen J, Li T, Ning X, Wang J, Gong K. Cytoreductive nephrectomy with thrombectomy before targeted therapy improves survival for metastatic renal cell carcinoma with venous tumor thrombus: a single-center experience. World J Surg Oncol 2017; 15:4. [PMID: 28056988 PMCID: PMC5217450 DOI: 10.1186/s12957-016-1066-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 12/14/2016] [Indexed: 01/19/2023] Open
Abstract
Background The aim of the study is to evaluate the role of cytoreductive nephrectomy (CN) with thrombectomy before targeted molecular therapy (TMT) on survival in metastatic renal cell carcinoma (mRCC) with venous tumor thrombus. Methods We performed a retrospective analysis of 47 patients treated in our center from April 2008 to October 2014. In the study, 20 patients underwent CN with thrombectomy followed by targeted therapy (group 1); 15 patients received targeted therapy alone (group 2); and 12 patients underwent CN with thrombectomy alone (group 3). The overall survival (OS) and cancer-specific survival (CSS) were calculated according to the Kaplan-Meier survival curve method, and prognostic variables were assessed by Cox regression analyses. Results The median follow-up times of group 1, group 2, and group 3 were 24.5, 12, and 6.5 months, respectively. During follow-up, in both group 1 and group 3, 12 patients died. In group 2, 14 patients died. The median OS of group 1, group 2, and group 3 was 22, 12, and 6 months, respectively (P < 0.001). Compared with surgery alone and targeted therapy alone, patients with cytoreductive surgery before targeted therapy had statistically better survival benefits (P < 0.001, P = 0.009, respectively). On univariate analysis, the number of metastatic sites (P = 0.004) was a statistically significant prognostic factor influencing OS. Conclusions Our single-center experience showed that CN with thrombectomy before targeted therapy improved the survival of patients with mRCC with venous tumor thrombus. The number of metastatic sites was an independent prognostic factor influencing OS.
Collapse
Affiliation(s)
- Nienie Qi
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
| | - Pengjie Wu
- Department of Urology, Beijing Hospital, Beijing, China
| | - Jinchao Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
| | - Teng Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
| | - Xianghui Ning
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
| | - Jin Wang
- Department of cardiac surgery, Peking University First Hospital, Beijing, China
| | - Kan Gong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University; National Urological Cancer Center, No. 8, Xishiku St., Xicheng Dist, Beijing, 100034, China.
| |
Collapse
|
92
|
Wang J, Cheng Y, Lee YZ, Wang Y, Zheng Y, Dong R, Lai Y, Tang X, Yang Y, Wang S, He N, Jia Y, Cheng W, Liu D, Wang X, Zhang C. Sonography and Transthoracic Echocardiography for Diagnosis of Systemic Cardiovascular Metastatic Tumor Thrombi. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1993-2027. [PMID: 27492390 DOI: 10.7863/ultra.15.10038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/23/2015] [Indexed: 06/06/2023]
Abstract
Sonography and transthoracic echocardiography (TTE) are seldom used for assessment of metastatic tumor thrombi in the cardiovascular system in routine clinical practice. We performed this retrospective study to evaluate the combination of sonography with TTE for diagnosis of metastatic tumor thrombi in heart and systemic vessels. Vascular, abdominal, pelvic, and small-part sonography was applied in 18 patients, and TTE was conducted simultaneously in 14 patients. Tumor thrombi invaded into the inferior vena cava system in 12 patients, superior vena cava system in 5 patients, and aorta in 1 patient; they extended to the right cardiac chambers in 11 patients. Six patients had diagnoses by pathologic examination. The primary neoplasms were identified by conventional imaging in 17 patients. The morphologic and echogenic characteristics of the tumor thrombi were diverse and depended on their original tumors. The thrombi were either contiguous or discrete from the original tumors. The neoplastic vascularity of the thrombi and the invasive extension were the primary characteristics that distinguished them from bland thrombi. Simultaneous application of sonography and TTE is a feasible way to comprehensively evaluate cardiovascular metastatic tumor thrombi in most patients.
Collapse
Affiliation(s)
- Jiong Wang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China, Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina USA, Department of Medical Ultrasonography, Peking University International Hospital, Beijing, China
| | - Yi Cheng
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yueh Z Lee
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina USA
| | - Yongmei Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Ye Zheng
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yongqiang Lai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiaobin Tang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yaoguo Yang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Sheng Wang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Nan He
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yunfeng Jia
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wei Cheng
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Dan Liu
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiaona Wang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Chun Zhang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| |
Collapse
|
93
|
Gagné-Loranger M, Lacombe L, Pouliot F, Fradet V, Dagenais F. Renal cell carcinoma with thrombus extending to the hepatic veins or right atrium: operative strategies based on 41 consecutive patients. Eur J Cardiothorac Surg 2016; 50:317-21. [PMID: 27016196 DOI: 10.1093/ejcts/ezw023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/12/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The natural history of renal cell carcinoma (RCC) with tumour thrombus extending at or above the hepatic veins is dismal. Different surgical approaches have been described including cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest. We here report our experience in terms of surgical techniques and outcomes on 41 consecutive patients presenting an RCC extending to the hepatic veins or the right atrium. A surgical decision-making algorithm is discussed. METHODS Retrospective review of 41 patients operated for RCC extending in the retrohepatic vena cava (extent level III-IV) between 2000 and 2015. Patients were operated by a dedicated urology/cardiac surgery team. RESULTS The mean age was 62.6 ± 10.4 years; 39% were female. Surgery was emergent in 7.3% of patients, 2.4% of patients had preoperative dialysis, 4.9% required a redo sternotomy and 19.5% had coronary artery disease. Tumour thrombus extended above the diaphragm in 23 patients (level IV) and to the level of hepatic veins (level III) in 18 patients. CPB was used in 38 patients. Arterial cannulation was in the aorta or femoral artery in 14 patients during the initial experience. In the current era, the axillary artery and the innominate artery were used in 12 patients each. Mean CPB, cross-clamp and circulatory arrest times were, respectively, 96.5 ± 42.9, 21.1 ± 16.4 and 10.2 ± 8.2 min (mean temperature of 25.7 ± 4.9°C). Hepatic exclusion without the use of CPB was performed to excise the thrombus in 3 patients. A right nephrectomy was performed in 25 patients, a left in 15 patients and a bilateral nephrectomy in 1 patient. Five patients had a partial inferior vena cava (IVC) resection, with 4 patients requiring a patch reconstruction of the IVC. Three patients had an infrarenal IVC ligation. One patient suffered a cerebrovascular accident in the postoperative period. One in-hospital death occurred (in-hospital mortality 2.4%). The mean follow-up was 1.9 ± 2.0 years. Twenty-three patients died during follow-up; 21 were disease-related. Three-year survival rate was 37.1%. CONCLUSION High-level RCC tumour thrombus is a rare clinical entity, the treatment of which is complex and requires dedicated operative teams. The operative technique should be tailored according to the level of extension and the extent of vena cava obstruction/occlusion of the tumour thrombus. Contemporary operative techniques may be conducted with excellent results. Mid-term survival is limited, supporting the necessity to pursue research efforts towards establishing effective adjunct therapies.
Collapse
Affiliation(s)
- Maude Gagné-Loranger
- Department of Cardiovascular Surgery, Quebec Heart and Lung Institute, Laval University, Sainte-Foy, Canada
| | - Louis Lacombe
- Department of Urology, Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Québec, Canada
| | - Frédéric Pouliot
- Department of Urology, Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Québec, Canada
| | - Vincent Fradet
- Department of Urology, Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Québec, Canada
| | - François Dagenais
- Department of Cardiovascular Surgery, Quebec Heart and Lung Institute, Laval University, Sainte-Foy, Canada
| |
Collapse
|
94
|
Hevia V, Ciancio G, Gómez V, Álvarez S, Díez-Nicolás V, Burgos FJ. Surgical technique for the treatment of renal cell carcinoma with inferior vena cava tumor thrombus: tips, tricks and oncological results. SPRINGERPLUS 2016; 5:132. [PMID: 26933631 PMCID: PMC4761352 DOI: 10.1186/s40064-016-1825-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/15/2016] [Indexed: 11/15/2022]
Abstract
Renal cell carcinoma represents 3 % of all cancers. Around 4–10 % of cases present with inferior vena cava involvement, generally with tumor thrombus. Clinical and preoperative stage will be classified depending of the thrombus extension. A high quality preoperative workup is essential to properly plan surgical approach. Complete surgical resection of the tumor is potentially the only curative treatment, although it supposes a real challenge due to operative difficulty, potential for massive bleeding or tumor pulmonary thromboembolism. Surgery includes techniques derived from transplantation surgery and, in some cases, cardiovascular intervention with cardiopulmonary bypass. Long-term oncological outcomes after complete removal of the entire tumor burden are acceptable. In this report we describe step-by-step surgical maneuvers depending on the thrombus lever, and focusing in complete abdominal approach for the complete excision of the tumor. Moreover, a recent literature review about oncological results is reported.
Collapse
Affiliation(s)
- Vital Hevia
- Urology Department, Renal Surgery and Kidney Transplant Section, Hospital Universitario Ramón y Cajal, Ctra Colmenar km 9,100, 28034 Madrid, Spain
| | - Gaetano Ciancio
- Department of Surgery, Division of Transplantation, University of Miami Miller School of Medicine, Miami, FL USA
| | - Victoria Gómez
- Urology Department, Renal Surgery and Kidney Transplant Section, Hospital Universitario Ramón y Cajal, Ctra Colmenar km 9,100, 28034 Madrid, Spain
| | - Sara Álvarez
- Urology Department, Renal Surgery and Kidney Transplant Section, Hospital Universitario Ramón y Cajal, Ctra Colmenar km 9,100, 28034 Madrid, Spain
| | - Víctor Díez-Nicolás
- Urology Department, Renal Surgery and Kidney Transplant Section, Hospital Universitario Ramón y Cajal, Ctra Colmenar km 9,100, 28034 Madrid, Spain
| | - Francisco Javier Burgos
- Urology Department, Renal Surgery and Kidney Transplant Section, Hospital Universitario Ramón y Cajal, Ctra Colmenar km 9,100, 28034 Madrid, Spain
| |
Collapse
|
95
|
Psutka SP, Leibovich BC. Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma. Ther Adv Urol 2015; 7:216-29. [PMID: 26445601 PMCID: PMC4580091 DOI: 10.1177/1756287215576443] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The diagnosis of renal cell carcinoma is accompanied by intravascular tumor thrombus in up to 10% of cases, of which nearly one-third of patients also have concurrent metastatic disease. Surgical resection in the form of radical nephrectomy and caval thrombectomy represents the only option to obtain local control of the disease and is associated with durable oncologic control in approximately half of these patients. The objective of this clinical review is to outline the preoperative evaluation for, and operative management of patients with locally advanced renal cell carcinoma with venous tumor thrombi involving the inferior vena cava. Cornerstones of the management of these complex patients include obtaining high-quality imaging to characterize the renal mass and tumor thrombus preoperatively, with further intraoperative real-time evaluation using transesophageal echocardiography, careful surgical planning, and a multidisciplinary approach. Operative management of patients with high-level caval thrombi should be undertaken in high-volume centers by surgical teams with capacity for bypass and invasive intraoperative monitoring. In patients with metastatic disease at presentation, cytoreductive nephrectomy and tumor thrombectomy may be safely performed with simultaneous metastasectomy if possible. In the absence of level one evidence, neoadjuvant targeted therapy should continue to be viewed as experimental and should be employed under the auspices of a clinical trial. However, in patients with significant risk factors for postoperative complications and mortality, and especially in those with metastatic disease, consultation with medical oncology and frontline targeted therapy may be considered.
Collapse
Affiliation(s)
| | - Bradley C Leibovich
- Department of Urology, Mayo Clinic, 200 First Street SW, Gonda 7, Rochester, MN 55905, USA
| |
Collapse
|
96
|
Rogers C, Barod R, Schwartz S, Menon M. Endovascular Extraction of Caval Tumor Thrombus to Facilitate Minimally Invasive Cytoreductive Nephrectomy for Metastatic Kidney Cancer. Eur Urol 2015; 68:167-8. [DOI: 10.1016/j.eururo.2015.03.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
|
97
|
Nguyen HG, Tilki D, Dall'Era MA, Durbin-Johnson B, Carballido JA, Chandrasekar T, Chromecki T, Ciancio G, Daneshmand S, Gontero P, Gonzalez J, Haferkamp A, Hohenfellner M, Huang WC, Espinós EL, Mandel P, Martinez-Salamanca JI, Master VA, McKiernan JM, Montorsi F, Novara G, Pahernik S, Palou J, Pruthi RS, Rodriguez-Faba O, Russo P, Scherr DS, Shariat SF, Spahn M, Terrone C, Vergho D, Wallen EM, Xylinas E, Zigeuner R, Libertino JA, Evans CP. Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy: Multi-Institutional Analysis. J Urol 2015; 194:304-308. [PMID: 25797392 DOI: 10.1016/j.juro.2015.02.2948] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The impact of cardiopulmonary bypass in level III-IV tumor thrombectomy on surgical and oncologic outcomes is unknown. We determine the impact of cardiopulmonary bypass on overall and cancer specific survival, as well as surgical complication rates and immediate outcomes in patients undergoing nephrectomy and level III-IV tumor thrombectomy with or without cardiopulmonary bypass. MATERIALS AND METHODS We retrospectively analyzed 362 patients with renal cell cancer and with level III or IV tumor thrombus from 1992 to 2012 at 22 U.S. and European centers. Cox proportional hazards models were used to compare overall and cancer specific survival between patients with and without cardiopulmonary bypass. Perioperative mortality and complication rates were assessed using logistic regression analyses. RESULTS Median overall survival was 24.6 months in noncardiopulmonary bypass cases and 26.6 months in cardiopulmonary bypass cases. Overall survival and cancer specific survival did not differ significantly in both groups on univariate analysis or when adjusting for known risk factors. On multivariate analysis no significant differences were seen in hospital length of stay, Clavien 1-4 complication rate, intraoperative or 30-day mortality and cancer specific survival. Limitations include the retrospective nature of the study. CONCLUSIONS In our multi-institutional analysis the use of cardiopulmonary bypass did not significantly impact cancer specific survival or overall survival in patients undergoing nephrectomy and level III or IV tumor thrombectomy. Neither approach was independently associated with increased mortality on multivariate analysis. Greater surgical complications were not independently associated with the use of cardiopulmonary bypass.
Collapse
Affiliation(s)
- Hao G Nguyen
- Department of Urology, UC Davis Medical Center, Sacramento, California, USA
| | - Derya Tilki
- Department of Urology, UC Davis Medical Center, Sacramento, California, USA
| | - Marc A Dall'Era
- Department of Urology, UC Davis Medical Center, Sacramento, California, USA
| | | | - Joaquín A Carballido
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Thomas Chromecki
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Gaetano Ciancio
- Miami Transplant Institute, University of Miami, Miami, FL, USA
| | - Siamak Daneshmand
- USC/Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Paolo Gontero
- Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy
| | - Javier Gonzalez
- Department of Urology, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain
| | - Axel Haferkamp
- Department of Urology, University of Frankfurt, Frankfurt, Germany
| | | | - William C Huang
- Department of Urology, New York University School of Medicine, New York, USA
| | - Estefania Linares Espinós
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Philipp Mandel
- Institute of of Empirical Economic Research, University of Leipzig, Leipzig, Germany
| | - Juan I Martinez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Viraj A Master
- Department of Urology, Emory University, Atlanta, Georgia, USA
| | - James M McKiernan
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, USA
| | - Francesco Montorsi
- Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy
| | | | - Sascha Pahernik
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Juan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Raj S Pruthi
- Department of Urology, UNC at Chappel Hill, Chapel Hill, North Carolina, USA
| | | | - Paul Russo
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical Center, New York, USA
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | | | - Carlo Terrone
- Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy
| | | | - Eric M Wallen
- Department of Urology, UNC at Chappel Hill, Chapel Hill, North Carolina, USA
| | - Evanguelos Xylinas
- Department of Urology, Weill Cornell Medical Center, New York, USA.,Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
| | - John A Libertino
- Department of Urology, Lahey Clinic, Burlington, Massachusetts, USA
| | | |
Collapse
|
98
|
Chen X, Li S, Xu Z, Wang K, Fu D, Liu Q, Wang X, Wu B. Clinical and oncological outcomes in Chinese patients with renal cell carcinoma and venous tumor thrombus extension: single-center experience. World J Surg Oncol 2015; 13:14. [PMID: 25650039 PMCID: PMC4332967 DOI: 10.1186/s12957-015-0448-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 01/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the clinical and oncological outcomes and to identify prognostic factors for survival in Chinese patients with renal cell carcinoma (RCC) and venous tumor thrombus (VTT). METHODS A total of 86 patients who underwent nephrectomy and tumor thrombectomy for RCC and venous tumor thrombus extension from 2003 to 2013 were included in this retrospective study. The records of these patients were reviewed. Kaplan-Meier analysis was used to determine cancer-specific survival (CSS). Prognostic factors for CSS were identified by univariate and multivariate analyses using the Cox proportional hazards regression mode. RESULTS All patients in this cohort received radical nephrectomy and tumor thrombectomy. Median follow-up period was 27.0 months (range 3-111). No patients died intraoperatively, and the complication rate was 36.0%. The 1-, 3-, and 5-year CSS rates for all patients were 93.0%, 70.9%, and 58.1%, respectively, and those for patients without distant metastasis at presentation were 95.3%, 82.6%, and 68.6%, respectively. Multivariate Cox regression analysis showed that lymph node invasion, distant metastasis at presentation, and invasion of the inferior vena cava (IVC) wall were the independent prognostic factors for CSS in all patients. For patients without distant metastasis, tumor grade, lymph node invasion, and perinephric fat invasion were significantly associated with CSS on multivariate analysis. CONCLUSIONS Survival rates for patients with RCC and VTT were still poor. Our results indicated that lymph node invasion, distant metastasis at presentation, and invasion of the IVC wall were independent negative prognostic factors.
Collapse
Affiliation(s)
- Xiaonan Chen
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, People's Republic of China.
| | - Shijie Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, People's Republic of China.
| | - Zhenqun Xu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, People's Republic of China.
| | - Kefeng Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, People's Republic of China.
| | - Donghui Fu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, People's Republic of China.
| | - Qiang Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, People's Republic of China.
| | - Xia Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, People's Republic of China.
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, People's Republic of China.
| |
Collapse
|
99
|
Westesson KE, Klink JC, Rabets JC, Fergany AF, Klein EA, Stephenson AJ, Rini BI, Navia J, Krishnamurthi V. Surgical Outcomes After Cytoreductive Nephrectomy With Inferior Vena Cava Thrombectomy. Urology 2014; 84:1414-9. [DOI: 10.1016/j.urology.2014.05.078] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 04/04/2014] [Accepted: 05/02/2014] [Indexed: 11/28/2022]
|
100
|
Patil MB, Montez J, Loh-Doyle J, Cai J, Skinner EC, Schuckman A, Thangathurai D, Skinner DG, Daneshmand S. Level III-IV Inferior Vena Caval Thrombectomy Without Cardiopulmonary Bypass: Long-Term Experience with Intrapericardial Control. J Urol 2014; 192:682-8. [DOI: 10.1016/j.juro.2014.03.112] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Mukul B. Patil
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jeremy Montez
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jeffrey Loh-Doyle
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jie Cai
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Eila C. Skinner
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Anne Schuckman
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Duraiyah Thangathurai
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Donald G. Skinner
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Siamak Daneshmand
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|