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Mei J, Yao Y, Wang X, Liu T, Sun L, Zhang G. Construction of a Model for Predicting the Risk of pT3 Based on Perioperative Characteristics in cT1 Renal Cell Carcinoma: A Retrospective Study at a Single Institution. Clin Genitourin Cancer 2024; 22:102122. [PMID: 38861916 DOI: 10.1016/j.clgc.2024.102122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/11/2024] [Accepted: 05/18/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION This study explored the predictors of upstaging and multiple sites of extension, and constructed a predictive model based on perioperative characteristics to calculate the risk of upstaging of cT1 renal cell carcinoma to pT3. METHODS We retrospectively reviewed 1012 patients diagnosed with cT1 renal cell carcinoma who underwent surgical treatment at the Affiliated Hospital of Qingdao University between June 2016 and August 2021. The continuous and categorical variables were analyzed using the Mann-Whitney U test and Chi-square test, respectively. After randomly dividing patients into a training set and an internal validation set with a ratio of 7:3, univariate and multivariate logistic regression analyses were used to explore the predictors of upstaging and multiple sites of extension. A nomogram model was established based on the predictors of upstaging and was validated. RESULTS Ninety-one cases (8.99%) of renal cell carcinoma were upstaged to pT3. In the training set, multivariate logistic regression identified the following predictors of upstaging: maximum tumor diameter, hilus involvement, tumor necrosis, tumor edge irregularity, symptoms, smoking, and platelet-lymphocyte ratio. A nomogram model was established based on the predictors. The area under the receiver operating characteristic curve was 0.810 in the training set, and 0.804 in the validation set. A 10-fold internal cross-validation conducted 200 times showed that the mean area under the curve was 0.797. The calibration curve and decision curve analysis suggested that the nomogram had robust clinical predictive power. Analyses showed higher neutrophil-lymphocyte ratio and tumor necrosis were associated with multiple sites of extrarenal extension in patients with pT3a renal cell carcinoma. CONCLUSIONS We identified 7 predictors of upstaging to pT3 and 2 predictors of multiple sites of extension. A nomogram model was constructed with satisfactory accuracy for predicting upstaging to pT3.
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Affiliation(s)
- Jingchang Mei
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu Yao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xin Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tian Liu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijiang Sun
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guiming Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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2
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Ganeshan D, Khatri G, Ali N, Avery R, Caserta MP, Chang SD, De Leon AD, Gupta RT, Lyshchik A, Michalski J, Nicola R, Pierorazio PM, Purysko AS, Smith AD, Taffel MT, Nikolaidis P. ACR Appropriateness Criteria® Staging of Renal Cell Carcinoma: 2022 Update. J Am Coll Radiol 2023; 20:S246-S264. [PMID: 37236747 DOI: 10.1016/j.jacr.2023.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Renal cell carcinoma is a complex group of highly heterogenous renal tumors demonstrating variable biological behavior. Pretreatment imaging of renal cell carcinoma involves accurate assessment of the primary tumor, presence of nodal, and distant metastases. CT and MRI are the key imaging modalities used in the staging of renal cell carcinoma. Important imaging features that impact treatment include tumor extension into renal sinus and perinephric fat, involvement of pelvicalyceal system, infiltration into adrenal gland, involvement of renal vein and inferior vena cava, as well as the presence of metastatic adenopathy and distant metastases. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Gaurav Khatri
- Panel Chair, UT Southwestern Medical Center, Dallas, Texas
| | - Norman Ali
- The University of Texas MD Anderson Cancer Center, Houston, Texas, Primary care physician
| | - Ryan Avery
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Silvia D Chang
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina
| | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jeff Michalski
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri; Commission on Radiation Oncology
| | - Refky Nicola
- SUNY Upstate Medical University, Syracuse, New York
| | - Phillip M Pierorazio
- Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania; American Urological Association
| | | | - Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Myles T Taffel
- New York University Langone Medical Center, New York, New York
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3
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Marciano Y, del Solar V, Nayeem N, Dave D, Son J, Contel M, Ulijn RV. Encapsulation of Gold-Based Anticancer Agents in Protease-Degradable Peptide Nanofilaments Enhances Their Potency. J Am Chem Soc 2023; 145:234-246. [PMID: 36542079 PMCID: PMC10720394 DOI: 10.1021/jacs.2c09820] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We investigated the use of amphiphilic, protease-cleavable peptides as encapsulation moieties for hydrophobic metallodrugs, in order to enhance their bioavailability and consequent activity. Two hydrophobic, gold-containing anticancer agents varying in aromatic ligand distribution (Au(I)-N-heterocyclic carbene compounds 1 and 2) were investigated. These were encapsulated into amphiphilic decapeptides that form soluble filamentous structures with hydrophobic cores, varying supramolecular packing arrangements and surface charge. Peptide sequence strongly dictates the supramolecular packing within the aromatic core, which in turn dictates drug loading. Anionic peptide filaments can effectively load 1, and to a lesser extent 2, while their cationic counterparts could not, collectively demonstrating that loading efficiency is dictated by both aromatic and electrostatic (mis)matching between drug and peptide. Peptide nanofilaments were nontoxic to cancerous and noncancerous cells. By contrast, those loaded with 1 and 2 displayed enhanced cytotoxicity in comparison to 1 and 2 alone, when exposed to Caki-1 and MDA-MB-231 cancerous cell lines, while no cytotoxicity was observed in noncancerous lung fibroblasts, IMR-90. We propose that the enhanced in vitro activity results from the enhanced proteolytic activity in the vicinity of the cancer cells, thereby breaking the filaments into drug-bound peptide fragments that are taken up by these cells, resulting in enhanced cytotoxicity toward cancer cells.
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Affiliation(s)
- Yaron Marciano
- Nanoscience Initiative, Advanced Science Research Center at The Graduate Center of the City University of New York (CUNY), 85 Saint Nicholas Terrace, New York, NY 10031, USA
- Department of Chemistry, Brooklyn College, CUNY, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
- Ph.D. Program in Chemistry, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
| | - Virginia del Solar
- Department of Chemistry, Brooklyn College, CUNY, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
| | - Nazia Nayeem
- Department of Chemistry, Brooklyn College, CUNY, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
- Ph.D. Program inBiology, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
| | - Dhwanit Dave
- Nanoscience Initiative, Advanced Science Research Center at The Graduate Center of the City University of New York (CUNY), 85 Saint Nicholas Terrace, New York, NY 10031, USA
- Ph.D. Program in Chemistry, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
- Department of Chemistry, Hunter College, CUNY, 695 Park Avenue, New York, NY 10065, USA
| | - Jiye Son
- Nanoscience Initiative, Advanced Science Research Center at The Graduate Center of the City University of New York (CUNY), 85 Saint Nicholas Terrace, New York, NY 10031, USA
| | - María Contel
- Department of Chemistry, Brooklyn College, CUNY, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
- Ph.D. Program in Chemistry, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
- Ph.D. Program in Biochemistry, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
- Ph.D. Program inBiology, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
| | - Rein V. Ulijn
- Nanoscience Initiative, Advanced Science Research Center at The Graduate Center of the City University of New York (CUNY), 85 Saint Nicholas Terrace, New York, NY 10031, USA
- Ph.D. Program in Chemistry, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
- Ph.D. Program in Biochemistry, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
- Department of Chemistry, Hunter College, CUNY, 695 Park Avenue, New York, NY 10065, USA
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4
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Algaba F. [Criteria for an improved prognostic stratification in category pT renal carcinoma]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2020; 54:171-181. [PMID: 34175029 DOI: 10.1016/j.patol.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/20/2022]
Abstract
Asymptomatic renal carcinomas are usually small and localized and thus, for the assessment of pT, precise criteria are required, able to identify the initial phases of a local extension and correlate them with current prognostic prospects. Various studies and consensus meetings have defined precisely how to measure tumoral nodules (solid, cystic and multiple). Furthermore, they have distinguished tumoral extension to the renal sinus, which has a worse prognosis, from that to the perirenal adipose tissue. They have also analyzed the clinical significance of invasion of the sinus vessels, the hilar veins and parenchymal vascular retroinvasion. Our aim is to revise and update the criteria of the different pT subcategories and consider those morphological aspects which could be clinically significant and that are not currently included in the TNM classification.
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Affiliation(s)
- Ferran Algaba
- Sección de Patología, Fundación Puigvert, Universitat Autònoma de Barcelona, Barcelona, España.
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5
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Elie BT, Hubbard K, Layek B, Yang WS, Prabha S, Ramos JW, Contel M. Auranofin-Based Analogues Are Effective Against Clear Cell Renal Carcinoma In Vivo and Display No Significant Systemic Toxicity. ACS Pharmacol Transl Sci 2020. [PMID: 32832867 DOI: 10.1021/acsptsci.9b00107/asset/images/large/pt9b00107_0002.jpeg] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Effective pharmacological treatments for patients with advanced clear cell renal carcinoma (ccRCC) are limited. Bimetallic titanium-gold containing compounds exhibit significant cytotoxicity against ccRCC in vitro and in vivo and inhibit invasion and angiogenisis in vitro and markers driving these phenomena. However, in vivo preclinical evaluations of such compounds have not examined their pharmacokinetics, pathology, and hematology. Here we use NOD.CB17-Prkdc SCID/J mice bearing xenograft ccRCC Caki-1 tumors to evaluate the in vivo efficacies of two titanium-gold compounds Titanocref and Titanofin (based on auranofin analogue scaffolds) accompanied by pharmacokinetic and pathology studies. A therapeutic trial was performed over 21 days at 5 mg/kg/72h of Titanocref and 10 mg/kg/72h of Titanofin tracking changes in tumor size. We observed a significant reduction of 51% and 60%, respectively (p < 0.01) in tumor size in the Titanocref- and Titanofin-treated mice compared to the starting size, while the vehicle-treated mice exhibited a tumor size increase of 138% (p < 0.01). Importantly, no signs of pathological complication as a result of treatment were found. In addition, Titanocref and Titanofin treatment reduced angiogenesis by 38% and 54%, respectively. Microarray and qRT-PCR analysis of ccRCC Caki-1 cells treated with Titanocref revealed that the compound alters apoptosis, JNK MAP kinase, and ROS pathways within 3 h of treatment. We further show activation of apoptosis by Titanocref and Titanofin in vivo by caspase 3 assay. Titanocref is active against additional kidney cancer cells. Titanocref and Titanofin are therefore promising candidates for further evaluation toward clinical application in the treatment of ccRCC.
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Affiliation(s)
- Benelita T Elie
- Department of Chemistry, Brooklyn College, The City University of New York, Brooklyn, New York 11210, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States
| | - Karen Hubbard
- Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,Department of Biology, City College of New York, The City University of New York, New York, New York 10031, United States
| | - Buddhadev Layek
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota 55455, United States
| | - Won Seok Yang
- University of Hawaii Cancer Center, Honolulu, Hawaii 96813, United States
| | - Swayam Prabha
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota 55455, United States
| | - Joe W Ramos
- University of Hawaii Cancer Center, Honolulu, Hawaii 96813, United States
| | - Maria Contel
- Department of Chemistry, Brooklyn College, The City University of New York, Brooklyn, New York 11210, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,University of Hawaii Cancer Center, Honolulu, Hawaii 96813, United States
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6
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Elie BT, Hubbard K, Layek B, Yang WS, Prabha S, Ramos JW, Contel M. Auranofin-Based Analogues Are Effective Against Clear Cell Renal Carcinoma In Vivo and Display No Significant Systemic Toxicity. ACS Pharmacol Transl Sci 2020; 3:644-654. [PMID: 32832867 DOI: 10.1021/acsptsci.9b00107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Indexed: 01/03/2023]
Abstract
Effective pharmacological treatments for patients with advanced clear cell renal carcinoma (ccRCC) are limited. Bimetallic titanium-gold containing compounds exhibit significant cytotoxicity against ccRCC in vitro and in vivo and inhibit invasion and angiogenisis in vitro and markers driving these phenomena. However, in vivo preclinical evaluations of such compounds have not examined their pharmacokinetics, pathology, and hematology. Here we use NOD.CB17-Prkdc SCID/J mice bearing xenograft ccRCC Caki-1 tumors to evaluate the in vivo efficacies of two titanium-gold compounds Titanocref and Titanofin (based on auranofin analogue scaffolds) accompanied by pharmacokinetic and pathology studies. A therapeutic trial was performed over 21 days at 5 mg/kg/72h of Titanocref and 10 mg/kg/72h of Titanofin tracking changes in tumor size. We observed a significant reduction of 51% and 60%, respectively (p < 0.01) in tumor size in the Titanocref- and Titanofin-treated mice compared to the starting size, while the vehicle-treated mice exhibited a tumor size increase of 138% (p < 0.01). Importantly, no signs of pathological complication as a result of treatment were found. In addition, Titanocref and Titanofin treatment reduced angiogenesis by 38% and 54%, respectively. Microarray and qRT-PCR analysis of ccRCC Caki-1 cells treated with Titanocref revealed that the compound alters apoptosis, JNK MAP kinase, and ROS pathways within 3 h of treatment. We further show activation of apoptosis by Titanocref and Titanofin in vivo by caspase 3 assay. Titanocref is active against additional kidney cancer cells. Titanocref and Titanofin are therefore promising candidates for further evaluation toward clinical application in the treatment of ccRCC.
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Affiliation(s)
- Benelita T Elie
- Department of Chemistry, Brooklyn College, The City University of New York, Brooklyn, New York 11210, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States
| | - Karen Hubbard
- Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,Department of Biology, City College of New York, The City University of New York, New York, New York 10031, United States
| | - Buddhadev Layek
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota 55455, United States
| | - Won Seok Yang
- University of Hawaii Cancer Center, Honolulu, Hawaii 96813, United States
| | - Swayam Prabha
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota 55455, United States
| | - Joe W Ramos
- University of Hawaii Cancer Center, Honolulu, Hawaii 96813, United States
| | - Maria Contel
- Department of Chemistry, Brooklyn College, The City University of New York, Brooklyn, New York 11210, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,University of Hawaii Cancer Center, Honolulu, Hawaii 96813, United States
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7
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Elie BT, Hubbard K, Pechenyy Y, Layek B, Prabha S, Contel M. Preclinical evaluation of an unconventional ruthenium-gold-based chemotherapeutic: RANCE-1, in clear cell renal cell carcinoma. Cancer Med 2019; 8:4304-4314. [PMID: 31192543 PMCID: PMC6675714 DOI: 10.1002/cam4.2322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There are few effective treatments for patients with advanced clear cell renal cell carcinoma (CCRCC). Recent findings indicate that ruthenium-gold containing compounds exhibit significant antitumor efficacy against CCRCC in vitro affecting cell viability as well as angiogenesis and markers driving those 2 phenomena. However, no in vivo preclinical evaluation of this class of compounds has been reported. METHODS Following the dose-finding pharmacokinetic determination, NOD.CB17-Prkdc SCID/J mice bearing xenograft CCRCC Caki-1 tumors were treated in an intervention trial for 21 days at 10 mg/kg/72h of RANCE-1. At the end of the trial, tumor samples were analyzed for histopathological and changes in protein expression levels were assessed. RESULTS After 21 days of treatment there was no significant change in tumor size in the RANCE-1-treated mice as compared to the starting size (+3.87%) (P = 0.082) while the vehicle treated mice exhibited a significant tumor size increase (+138%) (P < 0.01). There were no signs of pathological complications as a result of treatment. Significant reduction in the expression of VEGF, PDGF, FGF, EGFR, and HGRF, all key to the proliferation of tumor cells and stromal cells serving protumorigenic purposes was observed. CONCLUSIONS The tumor growth inhibition displayed and favorable pathology profile of RANCE-1 makes it a promising candidate for further evaluation toward clinical use for the treatment of advanced CCRCC.
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Affiliation(s)
- Benelita T. Elie
- Department of ChemistryBrooklyn College, The City University of New YorkBrooklynNew York
- Biology PhD Program, The Graduate CenterThe City University of New YorkNew YorkNew York
| | - Karen Hubbard
- Biology PhD Program, The Graduate CenterThe City University of New YorkNew YorkNew York
- Department of BiologyCity College of New York, The City University of New YorkNew YorkNew York
| | - Yuriy Pechenyy
- Department of BiologyCity College of New York, The City University of New YorkNew YorkNew York
| | - Buddhadev Layek
- University of Minnesota College of PharmacyMinneapolisMinnesota
| | - Swayam Prabha
- University of Minnesota College of PharmacyMinneapolisMinnesota
| | - Maria Contel
- Department of ChemistryBrooklyn College, The City University of New YorkBrooklynNew York
- Biology PhD Program, The Graduate CenterThe City University of New YorkNew YorkNew York
- Chemistry PhD Program, The Graduate CenterThe City University of New YorkNew YorkNew York
- Biochemistry PhD Program, The Graduate CenterThe City University of New YorkNew YorkNew York
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8
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Yu KJ, Keskin SK, Meissner MA, Petros FG, Wang X, Borregales LD, Gu C, Tamboli P, Matin SF, Wood CG, Karam JA. Renal cell carcinoma and pathologic nodal disease: Implications for American Joint Committee on Cancer staging. Cancer 2018; 124:4023-4031. [PMID: 30276798 DOI: 10.1002/cncr.31661] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/24/2018] [Accepted: 06/20/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Lymph node (LN) metastases are associated with poor outcomes for patients with renal cell carcinoma (RCC). This study compared the survival outcomes of patients with stage III, node-positive disease (pT123 N1 M0 ) and patients with stage III, node-negative disease (pT3 N0 M0 ). METHODS A database of 4652 patients with RCC of any histological subtype treated with surgery at The University of Texas MD Anderson Cancer Center from 1993 to 2012 was retrospectively assessed. A total of 115 patients with pT123 N1 M0 disease, 274 patients with pT3 N0 M0 disease, and 523 patients with pT123 N0/x M1 disease were included. Overall survival (OS) and cancer-specific survival (CSS) were estimated and compared between each cohort. RESULTS Median OS and CSS times were significantly better for pT3 N0 M0 patients than pT123 N1 M0 patients (OS, 10.2 vs 2.4 years, P < .0001; CSS, not reached vs 2.8 years, P < .0001). Similar median OS and CSS times were noted for pT123 N1 M0 and pT123 N0/x M1 patients (OS, 2.4 vs 2.4 years; P = .62; CSS, 2.8 vs 2.4 years; P = .10). In a multivariate analysis, tumor grade (hazard ratio [HR] for OS, 2.47; P < .0001; HR for CSS, 2.99; P < .0001) and pathologic LN involvement (HR for OS, 2.44; P < .0001; HR for CSS, 2.85; P < .0001) were associated with worse OS and CSS. CONCLUSIONS Among RCC patients classified with stage III disease, those with pT123 N1 M0 disease had significantly worse survival than those with pT3 N0 M0 disease. OS and CSS were similar for patients with pT123 N1 M0 disease and patients with pT123 N0/x M1 disease (stage IV). If validated, these findings suggest that RCC patients with nodal disease should be reclassified as having stage IV disease.
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Affiliation(s)
- Kai-Jie Yu
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Urology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Sarp K Keskin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew A Meissner
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Firas G Petros
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Leonardo D Borregales
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cindy Gu
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pheroze Tamboli
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christopher G Wood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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9
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Oh JJ, Lee JK, Do Song B, Lee H, Lee S, Byun SS, Lee SE, Hong SK. Accurate Risk Assessment of Patients with Pathologic T3aN0M0 Renal Cell Carcinoma. Sci Rep 2018; 8:13914. [PMID: 30224666 PMCID: PMC6141461 DOI: 10.1038/s41598-018-32362-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 09/06/2018] [Indexed: 12/27/2022] Open
Abstract
To develop a more precise risk-stratification system by investigating the prognostic impact of tumor growth within fatty tissues surrounding the kidney and/or renal vein. We conducted a retrospective review of the medical records of 211 patients with a pathologic diagnosis of T3aN0M0RCC among 4,483 renal cell carcinoma (RCC) patients from February 1988 to December 2015 according to the number of T3a pathologies—extrarenal fat invasion (EFI) and/or renal venous invasion (RVI). During a mean follow-up duration of 38.8 months, the patients with both pathologies (EFI + RVI) had lower recurrence free survival (RFS) rate than those with only a single pathology (p = 0.001). Using multivariable Cox regression analysis, the presence of both factors was shown to be an independent predictor of RFS (HR = 1.964, p = 0.032); cancer specific survival rate was not different among patients with EFI and/or RVI. Patients with pathologic T3aN0M0 RCC presenting with both EFI and RVI were at an increased risk of recurrence following nephrectomy. Therefore, pathologic T3a RCC could be sub-divided into those with favorable and unfavorable disease according to presence of EFI and/or RVI pathologies.
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Affiliation(s)
- Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Keun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Byung Do Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea. .,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.
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10
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Shah PH, Lyon TD, Lohse CM, Cheville JC, Leibovich BC, Boorjian SA, Thompson RH. Prognostic evaluation of perinephric fat, renal sinus fat, and renal vein invasion for patients with pathological stage T3a clear-cell renal cell carcinoma. BJU Int 2018; 123:270-276. [DOI: 10.1111/bju.14523] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Paras H. Shah
- Department of Urology; Mayo Clinic; Rochester MN USA
| | | | | | - John C. Cheville
- Department of Pathology and Laboratory Medicine; Mayo Clinic; Rochester MN USA
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11
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Chen K, Lee BL, Huang HH, Tan BY, Lee LS, Ng LG, Lau W, Yuen JSP. Tumor size and Fuhrman grade further enhance the prognostic impact of perinephric fat invasion and renal vein extension in T3a staging of renal cell carcinoma. Int J Urol 2016; 24:51-58. [PMID: 27757999 DOI: 10.1111/iju.13237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 09/15/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the prognostic values of perinephric fat invasion and renal vein invasion in pT3a renal cell carcinoma, as stand-alone factors and in combination with tumor size and Fuhrman grade. METHODS Survival data of pT1 and pT2 renal cell carcinomas were analyzed alongside pT3a tumors of similar size bands (pT1 vs pT3a <7 cm, pT2 vs pT3a >7 cm). Patients with adjuvant therapy, positive surgical margins, metastasis or pT3b-pT4 tumors were excluded. RESULTS No significant baseline demographic differences existed between the groups. Patients with renal vein invasion had larger tumors (median, 7.2 ± 3.0 cm vs 5.5 ± 3.6 cm, P = 0.039), and were more symptomatic (90.0% vs 61.7%, P = 0.028) compared with patients with perinephric fat invasion alone. Patients with perinephric fat invasion alone appeared to have better disease-free survival compared with those with renal vein invasion (P = 0.009). Having both perinephric fat invasion and renal vein invasion did not result in a poorer disease-free survival. pT3a (perinephric fat invasion) tumors <4 cm and 4-7 cm have significantly worse disease-free survival compared with pT1a and pT1b tumors (P < 0.001). Similarly, pT3a (perinephric fat invasion) tumors measuring ≥7 show a trend of poorer disease-free survival compared with pT2a and pT2b tumors (P = 0.267). Disease-free survival correlated with Fuhrman grading for patients with perinephric fat invasion (P = 0.008). In multivariate analysis, the survival curve of pT3a perinephric fat invasion group closely approximates that of pT2 group, whereas survival of the renal vein invasion group was significantly worse than the pT2 and perinephric fat invasion groups (P = 0.001). CONCLUSION pT3a tumors with perinephric fat invasion appear to have better prognosis than those with renal vein invasion. Further stratification of pT3a renal cell carcinomas with regard to tumor size and Fuhrman grade further enhances the prognostic value in this group.
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Affiliation(s)
- Kenneth Chen
- Department of Urology, Singapore General Hospital, Singapore
| | - Bing Long Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hong Hong Huang
- Department of Urology, Singapore General Hospital, Singapore
| | | | - Lui Shiong Lee
- Department of Urology, Singapore General Hospital, Singapore
| | - Lay Guat Ng
- Department of Urology, Singapore General Hospital, Singapore
| | - Weber Lau
- Department of Urology, Singapore General Hospital, Singapore
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12
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Vikram R, Beland MD, Blaufox MD, Moreno CC, Gore JL, Harvin HJ, Heilbrun ME, Liauw SL, Nguyen PL, Nikolaidis P, Preminger GM, Purysko AS, Raman SS, Taffel MT, Wang ZJ, Weinfeld RM, Remer EM, Lockhart ME. ACR Appropriateness Criteria Renal Cell Carcinoma Staging. J Am Coll Radiol 2016; 13:518-25. [DOI: 10.1016/j.jacr.2016.01.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/28/2016] [Indexed: 12/22/2022]
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13
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An H, Zhu Y, Xu L, Chen L, Lin Z, Xu J. Notch1 Predicts Recurrence and Survival of Patients With Clear-cell Renal Cell Carcinoma After Surgical Resection. Urology 2015; 85:483.e9-483.e14. [DOI: 10.1016/j.urology.2014.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 09/20/2014] [Accepted: 10/16/2014] [Indexed: 01/06/2023]
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14
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Agochukwu N, Shuch B. Clinical management of renal cell carcinoma with venous tumor thrombus. World J Urol 2014; 32:581-9. [PMID: 24752606 DOI: 10.1007/s00345-014-1276-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 03/06/2014] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Venous invasion is common in advanced renal cell carcinoma (RCC) due to the unique biology of this cancer. The presence of a tumor thrombus often makes clinical management challenging. In this review, we detail specific preoperative, perioperative, and surgical strategies involving the care of the complex kidney cancer patient with venous tumor involvement. METHODS We performed a comprehensive review of selected peer-reviewed publications regarding RCC tumor thrombus biology, medical and surgical management techniques, and immediate and long-term outcomes. RESULTS The perioperative management may require special imaging techniques, preoperative testing, very recent imaging, and consultation with other surgical services. There are various approaches to these patients as the clinical presentation, stage of disease, primary tumor size, level of thrombus, degree of venous occlusion, presence of bland thrombus, and primary tumor laterality influence management. Select patients with metastatic disease can do well with cytoreductive nephrectomy and thrombectomy. Those with localized disease have a high risk of recurrence; however, some patients can exhibit durable survival with surgery alone. The evolving surgical and medical treatments are discussed. CONCLUSIONS Even when these surgeries are performed in high volume centers, significant perioperative complications are common and greater complications are seen with higher thrombus extent. If surgery is attempted, it is important for urologic oncologists to follow strict attention to specific surgical principles. These general principles include complete vascular control, avoidance of thrombus embolization, close hemodynamic monitoring, and institutional resources for caval resection/replacement and venous bypass if necessary.
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Affiliation(s)
- Nnenaya Agochukwu
- Department of Urology, Yale School of Medicine, 310 Cedar Street 238A, New Haven, CT, 06510, USA
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15
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Abel EJ, Carrasco A, Karam J, Tamboli P, Delacroix S, Vaporciyan AA, Wood CG. Positive vascular wall margins have minimal impact on cancer outcomes in patients with non-metastatic renal cell carcinoma (RCC) with tumour thrombus. BJU Int 2014; 114:667-73. [DOI: 10.1111/bju.12515] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E. Jason Abel
- Department of Urology; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Alonso Carrasco
- Department of Urology; The University of Texas M.D. Anderson Cancer Center; Houston TX USA
| | - Jose Karam
- Department of Urology; The University of Texas M.D. Anderson Cancer Center; Houston TX USA
| | - Pheroze Tamboli
- Department of Pathology; The University of Texas M.D. Anderson Cancer Center; Houston TX USA
| | - Scott Delacroix
- Department of Urology; The University of Texas M.D. Anderson Cancer Center; Houston TX USA
| | - Ara A. Vaporciyan
- Department of Thoracic Surgery; The University of Texas M.D. Anderson Cancer Center; Houston TX USA
| | - Christopher G. Wood
- Department of Urology; The University of Texas M.D. Anderson Cancer Center; Houston TX USA
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Margulis V, Wood CG. Update on staging controversies for locally advanced renal cell carcinoma. Expert Rev Anticancer Ther 2014; 7:909-14. [PMID: 17627450 DOI: 10.1586/14737140.7.7.909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Preoperative Pulmonary Embolism Does Not Predict Poor Postoperative Outcomes in Patients with Renal Cell Carcinoma and Venous Thrombus. J Urol 2013; 190:452-7. [DOI: 10.1016/j.juro.2013.02.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2013] [Indexed: 11/20/2022]
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Differing risk of cancer death among patients with pathologic T3a renal cell carcinoma: identification of risk categories according to fat infiltration and renal vein thrombosis. Clin Genitourin Cancer 2013; 11:451-7. [PMID: 23816525 DOI: 10.1016/j.clgc.2013.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/01/2013] [Accepted: 05/14/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The study objectives were to evaluate the prognostic impact of fat infiltration and renal vein thrombosis in patients with pT3a renal cell carcinoma (RCC) and to identify new prognostic groups. MATERIAL AND METHODS We analyzed 122 consecutive patients with pT3a who underwent radical nephrectomy for RCC between 2000 and 2011 at the University of Bologna. Cancer-specific survival (CSS) rates were estimated using Kaplan-Meier survival curves; univariable and multivariable analyses were performed with Cox analysis. RESULTS The mean follow-up was 41.7 ± 35.4 months. Patients with peritumoral/hilar fat infiltration (n = 63) and patients with renal vein thrombosis (n = 18) experienced comparable CSS rates, whereas patients with both fat infiltration plus renal vein thrombosis (n = 41) showed worse survival outcomes than the first group (P = .026). Patients were divided in 2 groups: group A, with fat invasion or renal vein thrombosis, and group B, with concomitant fat invasion and renal vein invasion. Group B showed worse cancer-specific survival than group A (P = .024). At multivariate analysis, this new risk-group stratification was found to be an independent prognostic predictor of CSS (P < .05). CONCLUSIONS Patients with T3a RCC with both fat invasion and renal vein thrombosis experience worse survival rates when compared with those patients with only 1 prognostic factor. The TNM classification should consider the concomitant presence of those parameters as a different prognostic predictor.
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Thiel DD, Lohse CM, Arnold ML, Cheville JC, Leibovich BC, Parker AS. Does left side renal cell carcinoma (RCC) with renal vein/vena cava thrombus predict worse prognosis than equivalent right side RCC tumor thrombus? Int Urol Nephrol 2012; 44:1005-12. [DOI: 10.1007/s11255-012-0168-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 03/22/2012] [Indexed: 11/29/2022]
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20
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Pierorazio PM, Hyams ES, Lin BM, Mullins JK, Allaf ME. Laparoscopic Radical Nephrectomy for Large Renal Masses: Critical Assessment of Perioperative and Oncologic Outcomes of Stage T2a and T2b Tumors. Urology 2012; 79:570-5. [DOI: 10.1016/j.urology.2011.10.065] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 10/15/2011] [Accepted: 10/15/2011] [Indexed: 11/26/2022]
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The emerging role of targeted therapy in renal cell carcinoma (RCC): Is it time for a neoadjuvant or an adjuvant approach? Crit Rev Oncol Hematol 2012; 81:151-62. [DOI: 10.1016/j.critrevonc.2011.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 12/16/2010] [Accepted: 02/11/2011] [Indexed: 01/06/2023] Open
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Song T, Yin Y, Liao B, Zheng S, Wei Q. Capsular invasion in renal cell carcinoma: a meta-analysis. Urol Oncol 2012; 31:1321-6. [PMID: 22285007 DOI: 10.1016/j.urolonc.2011.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 12/22/2011] [Accepted: 12/23/2011] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Capsular invasion is frequently detected in localized renal cell carcinoma (RCCs) samples. Whether patients with localized RCCs and capsular invasion will suffer poorer clinical outcome than those without this pathologic finding is still at issue. MATERIALS AND METHODS We performed a systematic literature research of Central, Medline, Embase, and Chinese database CNKI and VIP. Cohort studies comparing the prognosis in patients with localized RCCs and with or without capsular invasion were included. Incidence of capsular invasion in different Fuhrman grade, primary TNM stage, and clinical outcome were analyzed. RESULTS Six cohort studies with 2,295 eligible patients were identified. Capsular invasion was presented in 500 specimens (21.79%). Lower grade (Fuhrman I/II vs. Fuhrman III/IV) and stage (pT1 vs. pT2) diseases were associated with lower incidence of capsular invasion, with OR = 0.56, 95% CI[0.37-0.85] and OR = 0.35, 95% CI[0.25-0.49], respectively. Our pooled analysis showed patients with capsular invasive had 1.80 times the risk of tumor recurrence than patients without these findings (HR = 1.8, 95% CI [1.21, 2.68]), and patients with localized RCCs and capsular invasion were detected at 4.93 times risk in developing cancer related death than those without its presence during follow up (HR = 4.93, 95% CI [2.14, 11.35]). CONCLUSION Patients with localized RCCs and capsular invasion are of poorer prognosis than those without this finding. Capsular invasion may serve as an additional factor in stratifying patient with localized RCCs.
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Affiliation(s)
- Turun Song
- Department of Urology, West China Hospital, Sichuan University, Sichuan, P.R. China
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23
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24
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Abstract
The most important and widely utilized system for providing prognostic information following surgical management for renal cell carcinoma (RCC) is currently the tumor, nodes, and metastasis (TNM) staging system. An accurate and clinically useful staging system is an essential tool used to provide patients with counseling regarding prognosis, select treatment modalities, and determining eligibility for clinical trials. Data published over the last few years has led to significant controversies as to whether further revisions are needed and whether improvements can be made with the introduction of new, more accurate predictive prognostic factors. Staging systems have also evolved with an increase in the understanding of RCC tumor biology. Molecular tumor biomarkers are expected to revolutionize the staging of RCC by providing more effective prognostic ability over traditional clinical variables alone. This review will examine the components of the TNM staging system, current staging modalities including comprehensive integrated staging systems, and predictive nomograms, and introduce the concept of molecular staging for RCC.
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Affiliation(s)
- John S Lam
- Roy and Patricia Disney Family Cancer Center, Providence Saint Joseph Medical Center, Burbank, CA 91505, USA
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25
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da Costa WH, Moniz RR, da Cunha IW, Fonseca FP, Guimaraes GC, de Cássio Zequi S. Impact of renal vein invasion and fat invasion in pT3a renal cell carcinoma. BJU Int 2011; 109:544-8. [PMID: 21711437 DOI: 10.1111/j.1464-410x.2011.10366.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE • To evaluate the prognostic impact of tumor fat invasion (FI) and renal vein invasion (RVI) in patients with T3a renal cell carcinoma. PATIENTS AND METHODS • In total, 220 consecutive patients treated for renal cell carcinoma between 1992 and 2009 were analyzed. T3a stage cases were selected. • A single pathologist reviewed all cases. RESULTS • The present study cohort included 46 patients with mean follow-up of 28.6 months, of whom 17 (36.9%) died from disease. Patients were initially divided into three groups including 24 (52.1%) of FI only, 11 (23.9%) of RVI only and 11 (23.9%) of both FI and RVI. • In univariate analysis, no significant differences in disease-specific survival (DSS) were noted between FI only and RVI only groups (P= 0.91). DSS was significantly worse in the FI + RVI group compared to the other groups (P= 0.02). • When grouped into FI or RVI vs FI + RVI, DSS remained significantly lower in the group containing the parameters concurrently (P= 0.009). Progression-free survival also was significantly lower in FI + RVI group (P= 0.01). • Metastasis, positive lymph nodes and the presence of FI + RVI remained as isolated predictors of survival. • Patients with FI + RVI presented a 2.6-fold increase in risk of death from cancer and a 2.5-fold increase in risk of disease progression (P= 0.04) compared to those with either of them alone. CONCLUSION • The isolated or concomitant presence of FI and RVI may be used as one of the criteria for staging in the next edition of the Tumour-Node-Metastasis classification because they have significantly different outcomes.
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Bertini R, Roscigno M, Freschi M, Strada E, Angiolilli D, Petralia G, Matloob R, Sozzi F, Capitanio U, Da Pozzo LF, Colombo R, Guazzoni G, Cremonini A, Montorsi F, Rigatti P. Impact of venous tumour thrombus consistency (solid vs friable) on cancer-specific survival in patients with renal cell carcinoma. Eur Urol 2011; 60:358-65. [PMID: 21640483 DOI: 10.1016/j.eururo.2011.05.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 05/09/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND To our knowledge, the impact of venous tumour thrombus (VTT) consistency in patients affected by renal cell carcinoma (RCC) has never been addressed. OBJECTIVE To analyse the effect of VTT consistency on cancer-specific survival (CSS). DESIGN, SETTING, AND PARTICIPANTS We retrospectively analysed 174 consecutive patients with RCC and renal vein or inferior vena cava (IVC) VTT who underwent surgical treatment between 1989 and 2007 at our institute. INTERVENTION All patients underwent radical nephrectomy and thrombectomy. MEASUREMENTS Pathologic specimens were reviewed by a single uropathologist. In addition to traditional pathologic features, the morphologic aspect of the tumour thrombus was evaluated to distinguish solid from friable patterns. The prognostic role of thrombus consistency (solid vs friable) on CSS was assessed by means of Cox regression models. RESULTS AND LIMITATIONS The VTT was solid in 107 patients (61.5%) and friable in 67 patients (38.5%). The presence of a friable VTT increased the risk of having synchronous nodal or distant metastases, higher tumour grade, higher pathologic stage, and simultaneous perinephric fat invasion (all p < 0.05). The median follow-up was 24 mo. The median CSS was 33 mo; the median CSS was 8 mo in patients with a friable VTT and 55 mo in patients with a solid VTT (p < 0.001). On multivariable analyses, the presence of a friable VTT was an independent predictor of CSS (p = 0.02). The power of our conclusion may be somewhat limited by the relatively small study population and the retrospective nature of the study. CONCLUSIONS In patients with RCC and VTT, the presence of a friable thrombus is an independent predictor of CSS. If our finding is confirmed by further studies, the consistency of the tumour thrombus should be introduced into routine pathologic reports to provide better patient risk stratification.
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Affiliation(s)
- Roberto Bertini
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
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Anderson CB, Clark PE, Morgan TM, Stratton KL, Herrell SD, Davis R, Cookson MS, Smith JA, Chang SS. Urinary collecting system invasion is a predictor for overall and disease-specific survival in locally invasive renal cell carcinoma. Urology 2011; 78:99-104. [PMID: 21550647 DOI: 10.1016/j.urology.2011.02.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 01/27/2011] [Accepted: 02/19/2011] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine the impact of urinary collecting system invasion (UCSI) on survival in patients with pathologic stage T3 renal cell carcinoma (RCC). MATERIALS AND METHODS We identified 1420 patients who underwent nephrectomy at a single institution between 1988 and 2008. Patients with pT3 RCC and data on UCSI were examined (n=303). Clinicopathologic variables were compared using chi-square tests, and a multivariate analysis using the Cox proportional hazards method was used to evaluate the relationship between UCSI and survival. RESULTS Of 303 patients with pT3 RCC, 67 (22.1%) had UCSI. UCSI was associated with higher T3 substage, tumor size, lymph node metastasis, and sarcomatoid features, as well as a shorter 5-year overall (51.9% vs 30.4%; P=.003) and disease-specific survival (59% vs 33.9%; P<.001) compared with those without USCI. On multivariate analysis, UCSI was independently associated with overall (HR 1.49; 95% CI, 1.02-2.17) and disease-specific survival (HR 1.76; 95% CI, 1.15-2.68). CONCLUSIONS The presence of UCSI is independently associated with higher overall and disease-specific mortality in patients undergoing nephrectomy for pT3 RCC. Locally advanced tumors crossing an additional anatomic boundary into the urinary collecting system appear to represent a particularly aggressive form of disease. These data suggest consideration for including UCSI in the next TNM staging system for RCC.
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Affiliation(s)
- Christopher B Anderson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-2765, USA.
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Bertini R, Roscigno M, Freschi M, Angiolilli D, Strada E, Petralia G, Sozzi F, Capitanio U, Cremonini A, Rigatti P. The extent of tumour fat invasion affects survival in patients with renal cell carcinoma and venous tumour thrombosis. BJU Int 2010; 108:820-4. [PMID: 21166759 DOI: 10.1111/j.1464-410x.2010.09937.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE • To investigate the effect of presence and extent of tumour fat invasion (TFI) - perinephric invasion (PFI), renal sinus fat invasion (RSFI) or both PFI and RSFI - on cancer-specific mortality (CSM) in patients with renal cell carcinoma (RCC) and venous tumour thrombus (VTT). METHODS • We examined 184 consecutive patients with RCC with VTT treated with nephrectomy between 1987 and 2007. Associations with CSM were evaluated by univariable and multivariable Cox proportional hazard models. RESULTS • Median follow up was 21 months. The 5-year CSM-free survival estimates were 75%, 36% and 20% in patients with VTT without TFI, those with VTT with PFI or RSFI, and those with VTT with both PFI and RSFI, respectively (P < 0.001). In multivariable analyses, presence of either PFI or RSFI was associated with a two-fold increased risk of CSM, whereas presence of both PFI and RSFI was associated with a three-fold increased risk of CSM, relative to VTT-only cases. • The inclusion of the variable describing the presence and extent of TFI in a base model including pT stage, Fuhrman grade and presence of nodal disease and metastatic disease significantly increased the accuracy in predicting CSM (+2.1%; P < 0.001) in patients with VTT. CONCLUSIONS • Patients affected by RCC with VTT and TFI have a higher risk of CSM relative to cases with VTT only. Patients with both PFI and RSFI showed increased CSM compared with patients with either PFI or RSFI. • Our results suggest TFI should be accurately evaluated and included in routine pathological reports to provide better patient risk stratification.
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Affiliation(s)
- Roberto Bertini
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
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29
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Feifer A, Savage C, Rayala H, Lowrance W, Gotto G, Sprenkle P, Gupta A, Taylor J, Bernstein M, Adeniran A, Tickoo SK, Reuter VE, Russo P. Prognostic impact of muscular venous branch invasion in localized renal cell carcinoma cases. J Urol 2010; 185:37-42. [PMID: 21074196 DOI: 10.1016/j.juro.2010.08.084] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Indexed: 01/12/2023]
Abstract
PURPOSE Beginning with the 2002 American Joint Committee on Cancer staging system, renal sinus muscular venous branch invasion has prognostic equivalence with renal vein invasion in renal cell carcinoma cases. To validate this presumed equivalence we compared patients with isolated muscular venous branch invasion to those with renal vein invasion and those with no confirmed vascular invasion. MATERIALS AND METHODS From routine cataloging at our institution we identified 500 patients who underwent partial or radical nephrectomy from 2003 to 2008. After excluding patients with metastasis or noncortical renal cell carcinoma pathology we identified 85 with positive muscular venous branch invasion (+). The 259 patients with pT1-2 muscular venous branch (-) invasion and the 71 with renal vein (+) invasion served as comparison groups. We used a multivariate Cox model to control for tumor characteristics using the Kattan renal cell carcinoma nomogram. RESULTS On multivariate analysis the risk of recurrence in the pT1-2 muscular venous branch invasion (-) group was lower than in the muscular venous branch invasion (+) group (HR 0.06, 95% CI 0.02-0.18, p < 0.001). Patients with renal vein invasion (+) had a recurrence rate similar to that in those with muscular venous branch invasion (+) (HR 0.80, 95% CI 0.39-1.65, p = 0.6). The overall survival rate was higher in the muscular venous branch invasion (-) group than in the other groups. CONCLUSIONS Patients with muscular venous branch invasion have an outcome inferior to that in patients with pT1-2 disease. This confirms the adverse prognosis of muscular venous branch invasion and supports pathological up-staging. The prognosis of muscular venous branch invasion is similar to that of renal vein invasion, although we cannot exclude the possibility of a difference. Our findings underscore the importance of close patient followup and careful pathological assessment of the nephrectomy specimen.
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Affiliation(s)
- Andrew Feifer
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
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Ficarra V, Novara G. Reply from Authors re: Scott Eggener. TNM Staging for Renal Cell Carcinoma: Time for a New Method. Eur Urol 2010;58:517–9. Eur Urol 2010. [DOI: 10.1016/j.eururo.2010.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pouliot F, Shuch B, LaRochelle JC, Pantuck A, Belldegrun AS. Contemporary Management of Renal Tumors With Venous Tumor Thrombus. J Urol 2010; 184:833-41; quiz 1235. [DOI: 10.1016/j.juro.2010.04.071] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Frédéric Pouliot
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brian Shuch
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jeffrey C. LaRochelle
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Allan Pantuck
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Arie S. Belldegrun
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Novara G, Ficarra V, Antonelli A, Artibani W, Bertini R, Carini M, Cosciani Cunico S, Imbimbo C, Longo N, Martignoni G, Martorana G, Minervini A, Mirone V, Montorsi F, Schiavina R, Schiavina R, Simeone C, Serni S, Simonato A, Siracusano S, Volpe A, Carmignani G. Validation of the 2009 TNM version in a large multi-institutional cohort of patients treated for renal cell carcinoma: are further improvements needed? Eur Urol 2010; 58:588-95. [PMID: 20674150 DOI: 10.1016/j.eururo.2010.07.006] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 07/09/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND A new edition of the TNM was recently released that includes modifications for the staging system of kidney cancers. Specifically, T2 cancers were subclassified into T2a and T2b (< or =10 cm vs >10 cm), tumors with renal vein involvement or perinephric fat involvement were classified as T3a cancers, and those with adrenal involvement were classified as T4 cancers. OBJECTIVE Our aim was to validate the recently released edition of the TNM staging system for primary tumor classification in kidney cancer. DESIGN, SETTING, AND PARTICIPANTS Our multicenter retrospective study consisted of 5339 patients treated in 16 academic Italian centers. INTERVENTION Patients underwent either radical or partial nephrectomy. MEASUREMENTS Univariable and multivariable Cox regression models addressed cancer-specific survival (CSS) after surgery. RESULTS AND LIMITATIONS In the study, 1897 patients (35.5%) were classified as pT1a, 1453 (27%) as pT1b, 437 (8%) as pT2a, 153 (3%) as pT2b, 1059 (20%) as pT3a, 117 (2%) as pT3b, 26 (0.5%) as pT3c, and 197 (4%) as pT4. At a median follow-up of 42 mo, 786 (15%) had died of disease. In univariable analysis, patients with pT2b and pT3a tumors had similar CSS, as did patients with pT3c and pT4 tumors. Moreover, both pT3a and pT3b stages included patients with heterogeneous outcomes. In multivariable analysis, the novel classification of the primary tumor was a powerful independent predictor of CSS (p for trend <0.0001). However, the substratification of pT1 tumors did not retain an independent predictive role. The major limitations of the study are retrospective design, lack of central pathologic review, and the small number of patients included in some substages. CONCLUSIONS The recently released seventh edition of the primary tumor staging system for kidney tumors is a powerful predictor of CSS. However, some of the substages identified by the classification have overlapping prognoses, and other substages include patients with heterogeneous outcomes. The few modifications included in this edition may have not resolved the most critical issues in the previous version.
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Combined Renal Sinus Fat and Perinephric Fat Renal Cell Carcinoma Invasion Has a Worse Prognosis Than Either Alone. J Urol 2010; 184:48-52. [DOI: 10.1016/j.juro.2010.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Indexed: 11/21/2022]
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Rouach Y, Delongchamps N, Timsit MO, Verkarre V, Fontaine E, Peyromaure M, Mejean A. Capsular involvement in patients undergoing partial nephrectomy for localized renal cell carcinoma: an adverse pathological finding? BJU Int 2010; 105:616-9. [DOI: 10.1111/j.1464-410x.2009.08797.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ignee A, Straub B, Schuessler G, Dietrich CF. Contrast enhanced ultrasound of renal masses. World J Radiol 2010; 2:15-31. [PMID: 21160736 PMCID: PMC2998906 DOI: 10.4329/wjr.v2.i1.15] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 01/20/2010] [Accepted: 01/22/2010] [Indexed: 02/06/2023] Open
Abstract
Contrast enhanced ultrasound (CEUS) has gained clinical importance over the last years for the characterization of hepatic masses. Its role in extrahepatic indications has been investigated repeatedly but has been less comprehensively studied. Currently more than 50% of renal masses are incidentally diagnosed, mostly by B-mode ultrasound. The method of choice for characterization of renal lesions is contrast enhanced computed tomography (CECT). In the case of cystic lesions CECT refers to the Bosniak classification for cystic lesions to assess the risk of malignant behavior. The majority of masses are renal cell carcinoma, but the exact proportion is controversial. Disadvantages of CECT are a significant risk for patients with impaired renal function, allergic reactions and hyperthyroidism due to iodinated contrast agents. Several studies concerning CEUS for the characterization of both solid and cystic renal lesions have been published, but prospective multicenter studies are missing, the presented data being mainly descriptive. The aim of the this manuscript is to review the current literature for CEUS in renal masses, to summarize the available data and focus on possible concepts for studies in the future.
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Gabr AH, Gdor Y, Strope SA, Roberts WW, Wolf JS. Patient and pathologic correlates with perioperative and long-term outcomes of laparoscopic radical nephrectomy. Urology 2009; 74:635-40. [PMID: 19616826 DOI: 10.1016/j.urology.2009.01.091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 11/29/2008] [Accepted: 01/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To comprehensively analyze and compare patient and pathologic correlates with perioperative events and with the long-term results of laparoscopic radical nephrectomy. METHODS Laparoscopic radical nephrectomy was performed in 255 patients with renal cell carcinoma. Mean follow-up time was 35.2 months; for 39 patients, it was 5 or more years. RESULTS Multivariate analysis revealed that major intraoperative complications were associated with increased body mass index and that major postoperative complications were associated with a higher American Society of Anesthesiologists (ASA) score. Older age and higher ASA score were associated with longer hospitalization. Patients were classified using a risk group stratification that incorporated grade and stage; 118 patients were low risk, 93 were intermediate risk, and 44 patients were high risk. No pathologic features were associated with perioperative outcomes. Kaplan-Meier recurrence-free, cancer-specific, and overall survival at 5 years were 79.2%, 88%, and 76.2%, respectively. Multivariate analysis revealed that pathologic risk group, mass size, and high-risk histologic subtype were associated with recurrence-free survival, and cancer-specific survival was associated with pathologic risk group and mass size. Age, high-risk pathologic risk group, and a high-risk histologic subtype were associated with overall survival. CONCLUSIONS Our results indicate that perioperative outcomes of laparoscopic radical nephrectomy are associated with body mass index, ASA score, and age, but not with tumor characteristics. Recurrence-free and cancer-specific survival rates were associated with the expected pathologic parameters, confirming the oncologic efficacy of the procedure. Overall survival is associated not only with tumor pathology but also with age, suggesting that competing-cause mortality is important in this setting.
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Affiliation(s)
- Ahmed H Gabr
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan 48109-0330, USA
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Zini L, Perrotte P, Jeldres C, Capitanio U, Duclos A, Jolivet-Tremblay M, Arjane P, Péloquin F, Pharand D, Villers A, Montorsi F, Patard JJ, Karakiewicz PI. A population-based comparison of survival after nephrectomy vs nonsurgical management for small renal masses. BJU Int 2009; 103:899-904; discussion 904. [PMID: 19154499 DOI: 10.1111/j.1464-410x.2008.08247.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine population-based rates of cancer-specific and other-cause mortality after either non-surgical management (NSM) or nephrectomy, in patients with small renal masses, as several reports from selected institutions support the applicability of surveillance in patients with small renal masses, but there are no population-based studies confirming the general applicability of this therapy. PATIENTS AND METHODS Of 43 143 patients with renal cell carcinoma identified in the 1988-2004 Surveillance, Epidemiology and End Results database, 10 291 had localized small renal masses (<or=4 cm) and were offered NSM (433, 4.2%) or nephrectomy (9858, 95.8%). Univariable matched and multivariable unmatched competing-risks regression models were used in the analyses. RESULTS Cumulative incidence plots based on unmatched data, where the effect of other-cause mortality was controlled for, showed a 5.2%, 6.5% and 9.4% survival benefit for nephrectomy vs NSM at 1, 2 and 5 years after nephrectomy or diagnosis, respectively. The same magnitude of the benefit (4.5%, 5.6% and 8.0%) persisted in analyses matched for age, tumour size and year of diagnosis or of nephrectomy. Finally, in multivariable analyses, treatment type, age, tumour size and year of diagnosis or of nephrectomy were independent predictors. CONCLUSION Relative to nephrectomy, NSM appears to undermine the overall and cancer-specific survival of patients with small renal masses by as much as 9.4%, at 5 years.
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Affiliation(s)
- Laurent Zini
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
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Eichelberg C, Junker K, Ljungberg B, Moch H. Diagnostic and prognostic molecular markers for renal cell carcinoma: a critical appraisal of the current state of research and clinical applicability. Eur Urol 2009; 55:851-63. [PMID: 19155123 DOI: 10.1016/j.eururo.2009.01.003] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 01/02/2009] [Indexed: 02/06/2023]
Abstract
CONTEXT Earlier detection of renal cell carcinoma (RCC) and the recent expansion of treatment possibilities have positively influenced the outlook for patients with this disease. However, progression and treatment response are still not sufficiently predictable. Molecular markers could help to refine individual risk stratification and treatment planning, although they have not yet become clinically routine. OBJECTIVE This review presents an overview of diagnostic and prognostic molecular markers for RCC and a subgrouping of these markers for different clinical issues. EVIDENCE ACQUISITION Literature and recent meeting abstracts were searched using these terms: renal (cell) carcinoma, molecular/tumor markers, biopsy, blood, urine, disease progression/prognosis, immunohistochemistry, risk factors, and survival. Due to the resulting large number of articles, studies were subjectively selected according to the importance of a study on the field, number of investigated patients, originality, multivariate analyses performed, contrast with previously published data, actuality, and assumed clinical applicability of the described results. More then 90% of the selected studies originated from the past 10 yr; >50% of the articles were written in 2006 or later. EVIDENCE SYNTHESIS These data were predominantly obtained via nonrandomized, retrospective, but often controlled studies. Thereby, the resulting level of evidence is 2A/2B. The broad spectrum of described molecular markers (MMs) for RCC consists of markers already extensively studied in other malignancies (eg, p53), as well as MMs typically associated with specific RCC-altered gene functions and pathways (eg, von Hippel-Lindau [VHL]). The main goal of using MMs is to refine the prediction of clinical end points like tumor progression, treatment response, and cancer-specific and/or overall survival. Further, MMs might facilitate the clinical work-up of undefined renal masses and prove to be more convenient tools for screening and follow-up in blood and urine. CONCLUSIONS Presently, there are a number of promising MMs for diverse clinical questions, but the available data are not yet valid enough for routine, clinical application. We should comply with the demand for large multicenter prospective investigations, stratified for RCC type and treatment modalities, to lift the use of molecular markers in RCC to a practical level, thereby providing a better consultation for our patients regarding diagnosis, treatment, and follow-up.
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Affiliation(s)
- Christian Eichelberg
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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The prognostic relevance of interactions between venous invasion, lymph node involvement and distant metastases in renal cell carcinoma after radical nephrectomy. BMC Urol 2008; 8:19. [PMID: 19099564 PMCID: PMC2635370 DOI: 10.1186/1471-2490-8-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 12/19/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate a possible prognostic significance of interactions between lymph node invasion (LNI), synchronous distant metastases (SDM), and venous invasion (VI) adjusted for mode of detection, Eastern Cooperative Oncology Group performance status (ECOG PS), erythrocyte sedimentation rate (ESR) and tumour size (TS) in 196 patients with renal cell carcinoma treated with radical nephrectomy. METHODS Median follow-up was 5.5 years (mean 6.9 years; range 0.01-19.4). The mode of detection, ECOG PS, ESR and TS were obtained from the patients' records. Vena cava invasion and distant metastases were detected by preoperative imaging. The surgical specimens were examined for pathological stage, LNI and VI. RESULTS The univariate analyses showed significant impact of VI, LNI, SDM, ESR and TS (p < 0.001), as well as mode of detection (p = 0.003) and ECOG PS (p = 0.002) on cancer specific survival. In multivariate analyses LNI was significantly associated with survival only in patients without SDM or VI (p < 0.001) with a hazard ratio of 9.0. LNI lost its prognostic significance when SDM or VI was present. CONCLUSION Our findings underline the prognostic importance of the status of the lymph nodes. LNI, SDM, ESR, and VI were independently associated with cancer specific survival after radical nephrectomy. LNI provided the strongest prognostic information for patients without SDM or VI whereas SDM and VI had strongest impact on survival when there was no nodal involvement.
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Bedke J, Buse S, Pritsch M, Macher-Goeppinger S, Schirmacher P, Haferkamp A, Hohenfellner M. Perinephric and renal sinus fat infiltration in pT3a renal cell carcinoma: possible prognostic differences. BJU Int 2008; 103:1349-54. [PMID: 19076147 DOI: 10.1111/j.1464-410x.2008.08236.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the influence of perinephric (PN) and renal sinus (RS) fat infiltration on cancer-specific survival beyond other prognostic factors, as the Tumour-Node-Metastasis (TNM) classification system defines stage T3a renal cell carcinoma (RCC) as infiltration of perirenal fat and/or direct infiltration of the adrenal gland. Perirenal fat invasion is differentiated into RS and PN fat infiltration, but not further classified for the prognosis. PATIENTS AND METHODS From 1990 to October 2007 106 patients with advanced RCC (T3a) were followed prospectively at one academic centre; all had a radical nephrectomy. To identify prognostic effects of PN, RS or RS + PN fat infiltration, univariable and multivariable Cox proportional hazard regression models were applied, including lymph node status, metastases, presence of sarcomatoid features and tumour necrosis, Fuhrman's grade, Karnofsky performance status, and tumour size. RESULTS PN fat invasion alone was present in 58, RS in 21, and PN + RS in 27 patients. The median follow-up was 2.9 years; 49 patients died from RCC. In univariable and multivariable analyses RS fat infiltration was an unfavourable prognostic factor (adjusted hazard ratio, HR, 2.24, P = 0.019). Univariable analysis of RS + PN fat infiltration showed the worst prognostic effect (HR 3.25, P < 0.001). In multivariable analysis this combination was an independent prognostic factor (HR 2.75, P = 0.007), as was the presence of metastasis (HR 5.64, P < 0.001). In this group of RS + PN fat infiltration the 5-year cancer-specific survival was 31%. CONCLUSION Univariable and multivariable analyses showed that the combination of RS and PN fat infiltration is an independent unfavourable prognostic marker. We recommend that perirenal fat infiltration should be further differentiated into RS fat or PN infiltration in the TNM classification. This will better stratify patient prognosis and might allow those in need of adjuvant therapy to be identified.
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Affiliation(s)
- Jens Bedke
- Department of Medical Biometry, University of Heidelberg, Heidelberg, Germany.
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Zini L, Perrotte P, Jeldres C, Capitanio U, Pharand D, Arjane P, Lapointe S, Montorsi F, Patard JJ, Karakiewicz PI. Nephrectomy improves the survival of patients with locally advanced renal cell carcinoma. BJU Int 2008; 102:1610-4. [DOI: 10.1111/j.1464-410x.2008.07917.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jung SJ, Ro JY, Truong LD, Ayala AG, Shen SS. Reappraisal of T3N0/NxM0 renal cell carcinoma: significance of extent of fat invasion, renal vein invasion, and adrenal invasion. Hum Pathol 2008; 39:1689-94. [DOI: 10.1016/j.humpath.2008.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 04/24/2008] [Accepted: 04/24/2008] [Indexed: 11/29/2022]
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Shalhav AL. Editorial Comment. J Urol 2008. [DOI: 10.1016/j.juro.2008.04.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wood C, Srivastava P, Bukowski R, Lacombe L, Gorelov AI, Gorelov S, Mulders P, Zielinski H, Hoos A, Teofilovici F, Isakov L, Flanigan R, Figlin R, Gupta R, Escudier B. An adjuvant autologous therapeutic vaccine (HSPPC-96; vitespen) versus observation alone for patients at high risk of recurrence after nephrectomy for renal cell carcinoma: a multicentre, open-label, randomised phase III trial. Lancet 2008; 372:145-154. [PMID: 18602688 DOI: 10.1016/s0140-6736(08)60697-2] [Citation(s) in RCA: 233] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Treatment of localised renal cell carcinoma consists of partial or radical nephrectomy. A substantial proportion of patients are at risk for recurrence because no effective adjuvant therapy exists. We investigated the use of an autologous, tumour-derived heat-shock protein (glycoprotein 96)-peptide complex (HSPPC-96; vitespen) as adjuvant treatment in patients at high risk of recurrence after resection of locally advanced renal cell carcinoma. METHODS In this open-label trial, patients were randomly assigned to receive either vitespen (n=409) or observation alone (n=409) after nephrectomy. Randomisation was done in a one to one ratio by a computer-generated pseudo-random number generator, with a block size of four, and was stratified by performance score, lymph node status, and nuclear grade. Vitespen was given intradermally once a week for 4 weeks, then every 2 weeks until vaccine depletion. The primary endpoint was recurrence-free survival. The final analysis of recurrence-free survival was planned to take place after 214 or more events of disease recurrence or deaths before recurrence had occurred. Analysis was by intention to treat (ITT). This study is registered with ClinicalTrials.gov, number NCT00033904. FINDINGS 48 patients in the vitespen group and 42 in the observation group were excluded from the ITT population because they did not meet post-surgery inclusion criteria; the ITT population thus consisted of 361 patients in the vitespen group and 367 in the observation group. Final analysis of recurrence-free survival was triggered in November, 2005. Re-review of all patients in the ITT population by the clinical events committee identified 149 actual recurrences (73 in the vitespen group and 76 in the observation group), nine deaths before recurrence (two in the vitespen group and seven in the observation group), and 124 patients with baseline metastatic or residual disease (61 in the vitespen group and 63 in the observation group). Thus, after a median follow-up of 1.9 years (IQR 0.9-2.5) in the ITT population, recurrence events were reported in 136 (37.7%) patients in the vitespen group and 146 (39.8%) in the observation group (hazard ratio 0.923, 95% CI 0.729-1.169; p=0.506). After continued follow-up until March, 2007, there had been 70 deaths in the vitespen group and 72 in the observation group (p=0.896); however, overall survival data were not mature, and patients continue to be followed up for survival. In predefined exploratory analyses by AJCC stage, recurrence events in patients with stage I or II disease were reported in 19 (15.2%) patients in the vitespen group and 31 (27.0%) in the observation group (hazard ratio 0.576, 95% CI 0.324-1.023; p=0.056). The most commonly reported adverse events in the vitespen group were injection-site erythema (n=158) and injection-site induration (n=153). One serious adverse event-autoimmune thyroiditis of grade 2 severity-was reported in the vitespen group; no treatment-related grade 3 or 4 adverse events were reported. INTERPRETATION No difference in recurrence-free survival was seen between patients given vitespen and those who received no treatment after nephrectomy for renal cell carcinoma. A possible improvement in recurrence-free survival in patients with early stage disease who received vitespen will require further validation.
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Affiliation(s)
| | | | | | - Louis Lacombe
- CHUQ-Hôtel-Dieu de Québec, Pavillon de Recherche de L'Hôpital I'Hôtel Dieu, Quebec City, Quebec, Canada
| | | | | | | | | | - Axel Hoos
- Bristol-Myers Squibb, New York, NY, USA
| | | | | | | | - Robert Figlin
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Fujita T, Iwamura M, Yanagisawa N, Muramoto M, Okayasu I, Baba S. Reclassification of the current tumor, node, metastasis staging in pT3 renal cell carcinoma. Int J Urol 2008; 15:582-6. [DOI: 10.1111/j.1442-2042.2008.02062.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Terrone C, Gontero P, Volpe A, Porpiglia F, Bollito E, Zattoni F, Frea B, Tizzani A, Fontana D, Scarpa RM, Rossetti SR. Proposal of an improved prognostic classification for pT3 renal cell carcinoma. J Urol 2008; 180:72-8. [PMID: 18485380 DOI: 10.1016/j.juro.2008.03.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE The prognostic accuracy of the current TNM 2002 staging system for locally advanced renal cell carcinoma has been questioned. To contribute to the development of a more accurate classification for this stage of disease we assessed the correlation between patterns of invasion in the pT3 category and outcomes in a large multi-institutional series. MATERIALS AND METHODS Pathological data and clinical followup on 513 pT3 renal cell carcinoma cases treated with radical nephrectomy between 1983 and 2005 at 3 Italian academic centers were retrospectively reviewed. Cause specific survival rates were calculated with the Kaplan-Meier method and multivariate analysis was performed using the Cox proportional hazards regression model. RESULTS Estimated overall 5-year cause specific survival was 50.1% at a median followup of 61.5 months in survivors. The current TNM classification was not a significant outcome prognosticator. Patients with a tumor invading only the perirenal or sinus fat were at lowest risk for death from the disease. Patients at intermediate risk had tumors with invasion of the venous system alone. Simultaneous perirenal fat and sinus fat invasion or perirenal fat and vascular invasion as well as adrenal gland involvement characterized high risk tumors. Low risk tumors could be further divided into 2 groups with different outcomes based on a size cutoff of 7 cm. Our classification was a significant predictor of survival on multivariate analysis as well as M stage, N stage, Fuhrman grade and tumor size. CONCLUSIONS We confirm that the prognostic usefulness of the current 2002 TNM system for pT3 renal cell carcinoma is limited. We have identified 4 groups of tumors with distinct patterns of invasion and significantly different survival probabilities in this category. Large prospective series are needed to validate these findings.
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Affiliation(s)
- C Terrone
- Department of Urology, Azienda Ospedaliera Maggiore della Carità, Novara, Italy.
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Aghdam Sha H, Nazer Adl K, Ebrahim Ne Y, SalamatDou R, Ahmadzadeh A. Effect of Dietary Fat Type and Different Levels of Vitamin E on Broiler Breeder Performance and Vitamin E Levels of Egg. ACTA ACUST UNITED AC 2008. [DOI: 10.3923/ajava.2008.147.154] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Shuch B, Riggs SB, LaRochelle JC, Kabbinavar FF, Avakian R, Pantuck AJ, Patard JJ, Belldegrun AS. Neoadjuvant targeted therapy and advanced kidney cancer: observations and implications for a new treatment paradigm. BJU Int 2008; 102:692-6. [PMID: 18410444 DOI: 10.1111/j.1464-410x.2008.07660.x] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate our early experience with neoadjuvant therapy (sunitinib or sorafenib) in advanced renal cell carcinoma (RCC), to explore the effect on both tumour biology and potential for downstaging advanced tumours, as systemic therapy for RCC has historically resulted in little if any primary tumour response, but recent experience with targeted therapy suggests otherwise. PATIENTS AND METHODS The preliminary experience with neoadjuvant therapy for the surgical management of RCC was reviewed at two large referral centres. Several unique patients were identified who had a novel response to systemic therapy that altered the surgical strategy. RESULTS Four patients who had targeted therapy before surgery are described and in whom there were effects on tumour biology not seen previously with chemotherapy and cytokine therapy. The selected patients who had neoadjuvant targeted therapy had shrinkage of a tumour thrombus in the inferior vena cava, nodal involvement, renal fossa recurrence and tumour within a solitary kidney. CONCLUSIONS The introduction of new molecular agents has revolutionized the treatment of patients with metastatic RCC. Responses to targeted therapy within the primary tumour, tumour thrombus, renal fossa recurrence, and lymph node metastases are novel findings not seen during treatment with immunotherapeutic-based strategies. This might be a signal for urological surgeons to re-evaluate the paradigm for the surgical management of advanced RCC. Potential applications are presented to encourage further investigations with targeted therapy in the neoadjuvant setting.
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Affiliation(s)
- Brian Shuch
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, CA 90095, USA
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