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Miyake H, Terakawa T, Furukawa J, Muramaki M, Fujisawa M. Prognostic significance of tumor extension into venous system in patients undergoing surgical treatment for renal cell carcinoma with venous tumor thrombus. Eur J Surg Oncol 2012; 38:630-6. [DOI: 10.1016/j.ejso.2012.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/23/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022] Open
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Vergho DC, Loeser A, Kocot A, Spahn M, Riedmiller H. Tumor thrombus of inferior vena cava in patients with renal cell carcinoma - clinical and oncological outcome of 50 patients after surgery. BMC Res Notes 2012; 5:5. [PMID: 22658129 PMCID: PMC3427529 DOI: 10.1186/1756-0500-5-264] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 06/01/2012] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate oncological and clinical outcome in patients with renal cell carcinoma (RCC) and tumor thrombus involving inferior vena cava (IVC) treated with nephrectomy and thrombectomy. Methods We identified 50 patients with a median age of 65 years, who underwent radical surgical treatment for RCC and tumor thrombus of the IVC between 1997 and 2010. The charts were reviewed for pathological and surgical parameters, as well as complications and oncological outcome. Results The median follow-up was 26 months. In 21 patients (42%) distant metastases were already present at the time of surgery. All patients underwent radical nephrectomy, thrombectomy and lymph node dissection through a flank (15 patients/30%), thoracoabdominal (14 patients/28%) or midline abdominal approach (21 patients/42%), depending upon surgeon preference and upon the characteristics of tumor and associated thrombus. Extracorporal circulation with cardiopulmonary bypass (CPB) was performed in 10 patients (20%) with supradiaphragmal thrombus of IVC. Cancer-specific survival for the whole cohort at 5 years was 33.1%. Survival for the patients without distant metastasis at 5 years was 50.7%, whereas survival rate in the metastatic group at 5 years was 7.4%. Median survival of patients with metastatic disease was 16.4 months. On multivariate analysis lymph node invasion, distant metastasis and grading were independent prognostic factors. There was no statistically significant influence of level of the tumor thrombus on survival rate. Indeed, patients with supradiaphragmal tumor thrombus (n = 10) even had a better outcome (overall survival at 5 years of 58.33%) than the entire cohort. Conclusions An aggressive surgical approach is the most effective therapeutic option in patients with RCC and any level of tumor thrombus and offers a reasonable longterm survival. Due to good clinical and oncological outcome we prefer the use of CPB with extracorporal circulation in patients with supradiaphragmal tumor thrombus. Cytoreductive surgery appears to be beneficial for patients with metastatic disease, especially when consecutive therapy is performed. Although sample size of our study cohort is limited consistent with some other studies lymph node invasion, distant metastasis and grading seem to have prognostic value.
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Affiliation(s)
- Daniel Claudius Vergho
- Department of Urology, Julius Maximilian University Medical School, Oberduerrbacher Str, 6, D-97080, Würzburg, Germany.
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Spiess PE, Kurian T, Lin HY, Rawal B, Kim T, Sexton WJ, Pow-Sang JM. Preoperative metastatic status, level of thrombus and body mass index predict overall survival in patients undergoing nephrectomy and inferior vena cava thrombectomy. BJU Int 2012; 110:E470-4. [PMID: 22519938 DOI: 10.1111/j.1464-410x.2012.11155.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Little is known about the prognostic impact of body mass index (BMI) and obesity on patients with locally advanced kidney cancer. Previous studies suggest that clinical/pathological stage, the proximal extent of the tumour thrombus, direct vascular wall invasion, and preoperative performance status may all constitute important prognostic factors within this patient population. The present study shows that a patient's metastatic status, higher level of tumour thrombus, and lower BMI all constitute adverse predictors of overall survival in patients who have RCC with inferior vena cava tumour thrombus. OBJECTIVE • To determine which clinical variables, including body mass index (BMI), predict overall survival (OS) after nephrectomy with inferior vena cava (IVC) thrombectomy for renal cell carcinoma (RCC) with tumour thrombus. PATIENTS AND METHODS • After institutional review board approval, a retrospective analysis of all patients (N= 100) undergoing nephrectomy and IVC thrombectomy for RCC from 1989 to 2010 were reviewed. One patient was excluded owing to missing clinical information leaving 99 patients in the study cohort. • Patients were placed into one of two subgroups, based on their preoperative BMI (BMI ≤30 kg/m(2) or BMI >30 kg/m(2) ). • Complications, blood loss, level of tumour thrombus, side of tumour and follow-up data were tabulated. RESULTS • Fifty-six patients had a BMI ≤30 kg/m(2) and 43 patients had a BMI >30 kg/m(2) . Intraoperative complications occurred in 14% of those with BMI >30 kg/m(2) and 5.4% of those with a BMI ≤30 kg/m(2) (P= 0.171). • On multivariate analysis, a higher thrombus level (III/IV vs I/II) and the presence of metastatic disease at time of diagnosis was associated with a worse OS (P= 0.041 and P < 0.001, respectively). • The subgroup with a higher preoperative BMI had a significantly better OS (hazard ratio 0.42; 95% confidence interval 0.22-0.80, P= 0.009). • Similarly, our Kaplan-Meier survival analysis showed an improved OS in the patient cohort with a BMI >30 kg/m(2) (P= 0.016). CONCLUSION • Important predictors of outcome in patients undergoing nephrectomy with IVC thrombectomy for RCC with tumour thrombus include preoperative BMI, level of IVC tumour thrombus, and metastatic status at time of surgery.
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Affiliation(s)
- Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA. philippe.spiess@moffi tt.org
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Youssef RF, Cost NG, Darwish OM, Margulis V. Prognostic markers in renal cell carcinoma: A focus on the 'mammalian target of rapamycin' pathway. Arab J Urol 2012; 10:110-7. [PMID: 26558012 PMCID: PMC4442886 DOI: 10.1016/j.aju.2012.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 02/23/2012] [Accepted: 02/25/2012] [Indexed: 11/25/2022] Open
Abstract
Objectives Increased knowledge about the molecular pathways involved in tumorigenesis has led to the discovery of new prognostic molecular markers and development of novel targeted therapies for renal cell carcinoma (RCC). In this review we describe the prognostic markers of RCC and highlight the areas of recent discovery with a focus on the mammalian target of rapamycin (mTOR) pathway. Methods We reviewed previous reports, using PubMed with the search terms ‘renal cell carcinoma’, ‘molecular markers’, ‘prognosis’, ‘outcomes’ and ‘mammalian target of rapamycin pathway’ published in the last two decades. We created a library of 100 references and focused on presenting the recent advances in the field. Results Growing evidence suggests that mTOR deregulation is associated with many types of human cancer, including RCC. Consequently, temsirolimus and everolimus, which target mTOR, are approved for treating advanced RCC. There is a demand to integrate clinical, pathological and molecular markers into accurate prognostic models to provide patients with the most personalised cancer care possible. Conclusions The mTOR pathway is highly implicated in RCC tumorigenesis and progression, and its constituents might represent a promising prognostic tool and target for treating RCC. Combining newly discovered molecular markers with classic clinicopathological prognostics might potentially improve the management of RCC.
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Key Words
- 4E-BP1, eukaryotic initiation factor-binding protein-1
- CA-9, carbonic anhydrase 9
- HIF, hypoxia inducible factor
- IRS-1, insulin receptor substrate-1
- LDH, lactate dehydrogenase
- Molecular markers
- PI3k, phosphatidylinositol 3-kinase
- Prognostic
- Renal cell carcinoma
- S6K1, S6 kinase 1
- TKR, tyrosine kinase receptor
- TSC, tuberous sclerosis complex
- VEGF, vascular endothelial growth factor
- VHL, von Hippel-Lindau
- mTOR
- mTOR, mammalian target of rapamycin
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Affiliation(s)
- Ramy F Youssef
- Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nicholas G Cost
- Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Oussama M Darwish
- Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Sameh WM, Hashad MM, Eid AA, Abou Yousif TA, Atta MA. Recurrence pattern in patients with locally advanced renal cell carcinoma: The implications of clinicopathological variables. Arab J Urol 2012; 10:131-7. [PMID: 26558015 PMCID: PMC4442897 DOI: 10.1016/j.aju.2011.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 12/18/2011] [Accepted: 12/24/2011] [Indexed: 12/03/2022] Open
Abstract
Objectives Recurrence rates for patients with locally advanced renal cell carcinoma (LARCC) remain high. To date the predictors of recurrence in those patients remain controversial. The aim of the present study was to assess the relapse pattern in those patients and identify predictors for recurrence. Patients and methods We evaluated retrospectively 112 consecutive patients who underwent surgery for LARCC (T3–T4N0M0) between January 2000 and December 2010. Clinical and pathological data were collected from hospital medical records and compiled into a computerized database. Studied variables were age, mode of presentation, Tumour-Node-Metastasis (TNM) stage, Fuhrman nuclear grade, histological subtype, tumour size, venous thrombus level, collecting-system invasion and sarcomatoid differentiation. Recurrence-free survival (RFS) was estimated using the Kaplan–Meier method. Univariate and multivariate analyses were conducted. Results Patients were followed for a mean and median follow-up of 33 and 24 months, respectively, after surgery. During the follow-up, recurrences (distant and/or local) were recorded in 58 patients, representing 52% of the cohort. The mean and median times to recurrence were 25 and 13 months, respectively. Sites of recurrence were multiple in 36 patients (62%), lung only in 14 (24%), and local in eight (14%). RFS rates at 1, 2, and 5 years were 50%, 43% and 34%, respectively, while the median RFS was 23.7 months. Using univariate analysis, RFS after nephrectomy was significantly shorter in patients aged <70 years, symptomatic at presentation, with larger tumours, higher nuclear grade, collecting-system invasion, and/or sarcomatoid differentiation. After multivariate analysis, T-stage, nuclear grade and sarcomatoid differentiation retained their power as independent predictors of RFS (P = 0.032, <0.001 and 0.003, respectively). Conclusions For patients with LARCC, T-stage, grade and sarcomatoid differentiation independently dictate the risk of tumour recurrence. Considering these variables in the postoperative surveillance protocols and in the need for a multimodal therapeutic approach is highly recommended.
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Affiliation(s)
- Wael M Sameh
- Department of Urology, Faculty of Medicine, University of Alexandria, Egypt
| | - Mohammed M Hashad
- Department of Urology, Faculty of Medicine, University of Alexandria, Egypt
| | - Ahmed A Eid
- Department of Urology, Faculty of Medicine, University of Alexandria, Egypt
| | | | - Mohammed A Atta
- Department of Urology, Faculty of Medicine, University of Alexandria, Egypt
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Gaujoux S, Brennan MF. Recommendation for standardized surgical management of primary adrenocortical carcinoma. Surgery 2012; 152:123-32. [PMID: 22306837 DOI: 10.1016/j.surg.2011.09.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 09/22/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Operative resection is the only potentially curative treatment for primary adrenocortical carcinoma (ACC), but standards of operative care are not defined with regards to the extent of local resection. We propose recommendations for operative management. METHODS Anatomic and clinical literature review focusing on local management of ACC, including lymphadenectomy and resection of adjacent organs or large vessels. RESULTS First-order drainage nodes of the adrenal gland include the renal hilum lymph nodes, the celiac lymph nodes, and the para-aortic and paracaval lymph nodes, mainly above the renal pedicle and ipsilateral to the adrenal glands. Lymph node involvement occurs in about 20% of patients with ACC, and is an important prognostic factor, but lymphadenectomy is performed infrequently. The adrenal glands and kidneys are contained in the same anatomic space, but systematic en bloc nephrectomy has no proven benefits for survival. Direct invasion of the kidney or adjacent organs is rare, but major venous invasion with tumor thrombus is relatively common. Both are associated with decreased survival, but complete resection can lead to long-term survival. CONCLUSION Standardization of regional lymphadenectomy including first-order drainage nodes is proposed. Systematic nephrectomy is not necessary in the absence of gross local invasion, but locally involved organs or large veins should be resected en bloc, with tumor thrombus embolectomy, if R0 resection is possible. Operative standardization improves tumor staging, potentially decreases local recurrence, and may be associated with better survival. Evidence-based standards of operative care and prospective investigations within international collaborating groups are necessary.
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Affiliation(s)
- Sébastien Gaujoux
- Department of Digestive and Endocrine Surgery, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France.
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Reese AC, Whitson JM, Meng MV. Natural history of untreated renal cell carcinoma with venous tumor thrombus. Urol Oncol 2012; 31:1305-9. [PMID: 22237466 DOI: 10.1016/j.urolonc.2011.12.006] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/08/2011] [Accepted: 12/08/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The natural history of untreated renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is poorly characterized. We aimed to describe the natural history of this disease, and to identify prognostic factors associated with disease-specific survival. MATERIALS AND METHODS We identified patients in the Surveillance, Epidemiology, and End Results (SEER) database with untreated renal cell carcinoma and venous tumor thrombi. Disease-specific median and 1-year survival rates were determined, and disease-free survival curves were plotted using the Kaplan-Meier method. Multivariable Cox regression analyses were performed to identify factors associated with disease-specific and overall survival in this patient group. RESULTS Of 2,265 patients with RCC and VTT, 390 (17%) underwent no treatment; 278 (71%) patients died during follow-up; of these, 243 deaths (87%) were due to RCC. Median and 1-year disease-specific survival for this group was 5 months and 29%, respectively. On multivariable analysis, the extent of tumor thrombus (HR 1.7 for T3c vs. T3b, 95% CI 1.0-2.7) and the presence of metastases (HR 3.1 for M+ vs. M0, 95% CI 1.7-5.5) were most strongly associated with disease-specific mortality. CONCLUSIONS Prognosis is poor for the majority of untreated patients with RCC and VTT. Supradiaphragmatic thrombi and distant metastases are adverse prognostic factors in this patient group. This information is important when counseling patients as to the risk and benefits of surgical vs. nonoperative management of RCC and VTT.
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Affiliation(s)
- Adam C Reese
- Department of Urology, University of California San Francisco, San Francisco, CA 94143, USA.
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Mazzoccoli G, Piepoli A, Carella M, Panza A, Pazienza V, Benegiamo G, Palumbo O, Ranieri E. Altered expression of the clock gene machinery in kidney cancer patients. Biomed Pharmacother 2011; 66:175-9. [PMID: 22436651 DOI: 10.1016/j.biopha.2011.11.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 11/09/2011] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND AND AIM Kidney cancer is associated with alteration in the pathways regulated by von Hippel-Lindau protein and hypoxia inducible factor α. Tight interrelationships have been evidenced between hypoxia response pathways and circadian pathways. The dysregulation of the circadian clock circuitry is involved in carcinogenesis. The aim of our study was to evaluate the clock gene machinery in kidney cancer. METHODS mRNA expression levels of the clock genes ARNTL1, ARNTL2, CLOCK, PER1, PER2, PER3, CRY1, CRY2, TIMELESS, TIPIN and CSNK1E and of the clock controlled gene SERPINE1 were evaluated by DNA microarray assays and by qRT-PCR in primary tumor and matched nontumorous tissue collected from a cohort of 11 consecutive kidney cancer patients. RESULTS In kidney tumor tissue, we found down-regulation of PER2 (median=0.658, Q1-Q3=0.562-0.744, P<0.01), TIMELESS (median=0.705, Q1-Q3=0.299-1.330, P=0.04) and TIPIN (median=0.556, Q1-Q3=0.385-1.945, P=0.01), up-regulation of SERPINE1 (median=1.628, Q1-Q3=0.339-4.071, P=0.04), whereas the expression of ARNTL2 (median=0.605, Q1-Q3=0.318-1.738, P=0.74) and CSNK1E (median=0.927, Q1-Q3=0.612-2.321, P=0.33) did not differ. A statistically significant correlation was evidenced between mRNA levels of PER2 and CSNKIE (r=0.791, P<0.01), PER2 and TIPIN (r=0.729, P=0.01), PER2 and SERPINE1 (r=0.704, P=0.01), TIMELESS and TIPIN (r=0.605, P=0.04), TIMELESS and CSNKIE (r=0.637, P=0.03), TIPIN and CSNKIE (r=0.940, P<0.01). CONCLUSION In kidney cancer, the circadian clock circuitry is deregulated and the altered expression of the clock genes might be involved in disease onset and progression.
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Affiliation(s)
- Gianluigi Mazzoccoli
- Division of Internal Medicine and Chronobiology Unit, IRCCS Scientific Institute and Regional General Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
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Martínez-Salamanca JI, Osorio Cabello L. Editorial comment to Reassessment of the UICC revision of T3 renal cell carcinomas in a Japanese institute. Int J Urol 2011; 18:865. [PMID: 22142465 DOI: 10.1111/j.1442-2042.2011.02893.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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161
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Nagata M, Kume H, Homma Y. Reassessment of the UICC revision of T3 renal cell carcinomas in a Japanese institute. Int J Urol 2011; 18:864-5. [PMID: 21988271 DOI: 10.1111/j.1442-2042.2011.02862.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Current World Literature. Curr Opin Support Palliat Care 2011; 5:297-305. [DOI: 10.1097/spc.0b013e32834a76ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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163
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Lee C, You D, Park J, Jeong IG, Song C, Hong JH, Ahn H, Kim CS. Validation of the 2009 TNM Classification for Renal Cell Carcinoma: Comparison with the 2002 TNM Classification by Concordance Index. Korean J Urol 2011; 52:524-30. [PMID: 21927698 PMCID: PMC3162217 DOI: 10.4111/kju.2011.52.8.524] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/16/2011] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess the validity of the 2009 TNM classification for renal cell carcinoma (RCC) and compare its ability to predict survival relative to the 2002 classification. MATERIALS AND METHODS We identified 1,691 patients who underwent radical nephrectomy or partial nephrectomy for unilateral, sporadic RCC between 1989 and 2007. Cancer-specific survival was estimated by the Kaplan-Meier method and was compared among groups by the log-rank test. Associations of the 2002 and 2009 TNM classifications with death from RCC were evaluated by Cox proportional hazards regression models. The predictive abilities of the two classifications were compared by using Harrell's concordance (c) index. RESULTS There were 234 deaths from RCC a mean of 38 months after nephrectomy. According to the 2002 primary tumor classification, 5-year cancer-specific survival was 97.6% in T1a, 92.0% in T1b, 83.3% in T2, 61.9% in T3a, 51.1% in T3b, 40.0% in T3c, and 33.6% in T4 (p for trend<0.001). According to the 2009 classification, 5-year cancer-specific survival was 83.2% in T2a, 83.8% in T2b, 62.6% in T3a, 41.1% in T3b, 50.0% in T3c, and 26.1% in T4 (p for trend<0.001). The c index for the 2002 primary tumor classification was 0.810 in the univariate analysis and increased to 0.906 in the multivariate analysis. The c index for the 2009 primary tumor classification was 0.808 in the univariate analysis and increased to 0.904 in the multivariate analysis. CONCLUSIONS Our data suggest that the predictive ability the 2009 TNM classification is not superior to that of the 2002 classification.
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Affiliation(s)
- Chunwoo Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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164
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Russo P. The role of surgery in the management of early-stage renal cancer. Hematol Oncol Clin North Am 2011; 25:737-52. [PMID: 21763965 DOI: 10.1016/j.hoc.2011.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
There were an estimated 58,240 new cases and 13,040 deaths from kidney cancer in the United States in 2010. The increased treatment and cure of small, incidentally discovered renal tumors, most of which are nonlethal in nature, has not offset the increased mortality caused by advanced and metastatic tumors. In this article, the optimum approach to the surgical management of localized renal tumors and its impact on renal function are discussed.
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Affiliation(s)
- Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, Weill Medical College, Cornell University, 1275 York Avenue, New York, NY 10021, USA.
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Ishida N, Takemura H, Shimabukuro K, Matsuno Y. Complete resection of asymptomatic solitary right atrial metastasis from renal cell carcinoma without inferior vena cava involvement. J Thorac Cardiovasc Surg 2011; 142:e142-4. [PMID: 21596393 DOI: 10.1016/j.jtcvs.2011.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 04/18/2011] [Indexed: 11/19/2022]
Affiliation(s)
- Narihiro Ishida
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
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Oncological outcomes in patients undergoing radical nephrectomy and vena cava thrombectomy for renal cell carcinoma with venous extension: a single-centre experience. Eur J Surg Oncol 2011; 37:422-8. [PMID: 21330093 DOI: 10.1016/j.ejso.2011.01.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 12/30/2010] [Accepted: 01/25/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To report on the effectiveness of the surgical management of renal cell carcinoma (RCC) in patients with a neoplastic thrombus of the vena cava. PATIENTS AND METHODS We examined pre- and post-operative clinical data for all patients who had received a nephrectomy for the management of RCC with a neoplastic thrombus of the vena cava between spanning 10 years. The procedure depended on the exact location and size of the thrombus according to the Mayo Clinic and the 2009 TNM classifications. RESULTS A total of 32 patients underwent surgery. Eight of these patients had stage I, nine had stage II, six had stage III and nine had stage IV thrombi according to the Mayo Clinic staging, and twenty were T3b, eight were T3c and four were T4 according to the 2009 TNM classifications. An open abdominal approach was performed in patients with stage I and II thrombi, whereas five of the stage III patients and all of the stage IV patients required combined sternotomies. Five patients whose thrombi extended to the right atrium were treated with a cardiac bypass. The complication rate was 53% and the peri-operative mortality rate was 12.5%. The median follow-up interval was 64 months. The overall and cancer-specific five-year survival rates for all stages combined were 47% and 52%, respectively. CONCLUSION Surgical resection remains the first-line treatment for patients with RCC infiltrating the vena cava, but surgical morbidity is prevalent and survival is poor.
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