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Liu F, Wang L, Meagher MF, Afari J, Saitta C, Dhanji S, Ghassemzadeh S, Shah A, Puri D, Nguyen MV, Hakimi K, Schmeusser B, Greenwald R, Medline A, Kamal F, Ali A, Fukuda S, Kobayashi M, Chen W, Fan B, Aida Y, Maezawa Y, Asai S, Tanaka H, Patil D, Fujii Y, Master V, Derweesh IH. Predictive factors for recurrence and outcomes in T1a renal cell carcinoma: Analysis of the INMARC (International Marker Consortium for Renal Cancer) database. Urol Oncol 2024; 42:333.e21-333.e31. [PMID: 38926077 DOI: 10.1016/j.urolonc.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 01/29/2024] [Accepted: 04/01/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Stage migration in renal cell carcinoma (RCC) has led to an increasing proportion of diagnosed small renal masses. Emerging knowledge regarding heterogeneity of RCC histologies and consequent impact on prognosis led us to further explore outcomes and predictive factors in surgically-treated T1a RCC. METHODS The INMARC database was queried for T1aN0M0 RCC. Patients were stratified into groups based on recurrence. Primary outcome was overall survival (OS). Multivariable analyses (MVA) were performed for factors associated with recurrence, cancer-specific (CSM), and all-cause mortality (ACM). Kaplan-Meier analyses (KMA) assessed survival by histology and grade. Subset analysis for time to recurrence was conducted for grade and histologic groups and compared with recent AUA follow-up guidelines [low-risk (AUA-LR), intermediate-risk (AUA-IR), high-risk (AUA-HR), and very-high risk (AUA-VHR) groups]. RESULTS We analyzed 1,878 patients (median follow-up 35.2 months); 101 (5.4%) developed recurrence. MVA for recurrence demonstrated increasing age (P = 0.026), male sex (P = 0.043), diabetes (P = 0.007), high/unclassified grade (P < 0.001-0.007), and variant histology (P = 0.017) as independent risk factors for increased risk, while papillary (P = 0.016) and chromophobe (P = 0.049) were associated with decreased risk. MVA identified high/unclassified grade (P = 0.003-0.004) and pT3a upstaging (P = 0.043) as predictive factors for worsened risk of CSM while papillary (P = 0.034) was associated with improved risk. MVA for ACM demonstrated increasing age (P < 0.001), non-white (P < 0.001), high-grade (P = 0.022), variant histology (P = 0.049), recurrence (P = 0.004), and eGFR<45 at last follow-up (P < 0.001) to be independent risk factors. KMA comparing clear cell, chromophobe, papillary, and variant RCC revealed significant differences for 5-year CSS (P = 0.018) and RFS (P < 0.001), but not OS (P = 0.34). Median time to recurrence was 23.8 months for low-grade (AUA-LR), 17.3 months for high-grade (AUA-IR), 18 months for pT3a upstaging (AUA-HR), and 12 months for variant histology (AUA-VHR; P < 0.001). CONCLUSION We noted differential outcomes in T1a RCC based on histology and grade for recurrence and CSM, while renal functional decline in addition to pathological factors and recurrence were predictive for ACM. Our findings support recently promulgated AUA follow-up guidelines for low-grade and variant histology pT1a RCC, but call for consolidation of follow-up protocols for high-grade pT1a and pT3a upstaged patients, with intensification of frequency of imaging follow-up in pT1a high-grade RCC.
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Affiliation(s)
- Franklin Liu
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, La Jolla, CA 92037
| | - Luke Wang
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, La Jolla, CA 92037
| | - Margaret F Meagher
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, La Jolla, CA 92037
| | - Jonathan Afari
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, La Jolla, CA 92037
| | - Cesare Saitta
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, La Jolla, CA 92037
| | - Sohail Dhanji
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, La Jolla, CA 92037
| | - Saeed Ghassemzadeh
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, La Jolla, CA 92037
| | - Aastha Shah
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, La Jolla, CA 92037
| | - Dhruv Puri
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, La Jolla, CA 92037
| | - Mimi V Nguyen
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, La Jolla, CA 92037
| | - Kevin Hakimi
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, La Jolla, CA 92037
| | - Benjamin Schmeusser
- Department of Urology, Emory University School of Medicine, Building B Suite 1403 1365-B Clifton Road NE, Atlanta, GA 30322
| | - Rachel Greenwald
- Department of Urology, Emory University School of Medicine, Building B Suite 1403 1365-B Clifton Road NE, Atlanta, GA 30322
| | - Alexandra Medline
- Department of Urology, Emory University School of Medicine, Building B Suite 1403 1365-B Clifton Road NE, Atlanta, GA 30322
| | - Fatima Kamal
- Department of Urology, Emory University School of Medicine, Building B Suite 1403 1365-B Clifton Road NE, Atlanta, GA 30322
| | - Adil Ali
- Department of Urology, Emory University School of Medicine, Building B Suite 1403 1365-B Clifton Road NE, Atlanta, GA 30322
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Kobayashi
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Wei Chen
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Bo Fan
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Aida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuya Maezawa
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shintaro Asai
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Building B Suite 1403 1365-B Clifton Road NE, Atlanta, GA 30322
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Viraj Master
- Department of Urology, Emory University School of Medicine, Building B Suite 1403 1365-B Clifton Road NE, Atlanta, GA 30322
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, La Jolla, CA 92037.
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Grand T, Delavaud C, Dariane C, Ramtohul T, Guinebert S, Hélénon O, Mejean A, Timsit MO, Correas JM, Bodard S. Contrast enhancement early after renal malignancy cryoablation: imaging findings associated with benignity. Eur Radiol 2023; 33:8703-8714. [PMID: 37405502 DOI: 10.1007/s00330-023-09814-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/16/2023] [Accepted: 04/15/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES Contrast enhancement by MRI done early after cryoablation for renal malignancies may suggest residual tumor (RT). However, we have observed MRI enhancement within 48 h of cryoablation in patients who had no contrast enhancement 6 weeks later. Our purpose was to identify features of 48-h contrast enhancement in patients without RT. METHODS This single-center retrospective study included consecutive patients who underwent percutaneous cryoablation of renal malignancies in 2013-2020, exhibited cryoablation-zone MRI contrast enhancement 48 h later, and had available 6-week MRI scans. Persistent or growing CE at 6 weeks vs. 48 h was classified as RT. A washout index was calculated for each 48-h MRI, and its performance for predicting RT was assessed by receiver operating characteristic curve analysis. RESULTS We included 60 patients with 72 cryoablation procedures and 83 cryoablation zones exhibiting 48-h contrast enhancement; mean age was 66 ± 17 years. Clear-cell renal cell carcinoma accounted for 95% of tumors. Of the 83 48-h enhancement zones, RT was observed in eight while 75 were benign. The 48-h enhancement was consistently visible at the arterial phase. Washout was significantly associated with RT (p < 0.001) and gradually increasing contrast enhancement with benignity (p < 0.009). A washout index below - 1.1 predicted RT with 88% sensitivity and 84% specificity. CONCLUSION MRI contrast enhancement 48 h after cryoablation of renal malignancies was usually benign. Washout was associated with residual tumor, with a washout index value below - 1.1 exhibiting good performance in predicting residual tumor. These findings may help to guide decisions about repeat cryoablation. CLINICAL RELEVANCE STATEMENT Magnetic resonance imaging contrast enhancement 48 h after cryoablation of renal malignancies rarely indicates residual tumor, which is characterized by washout with a washout index lower than - 1.1. KEY POINTS • Contrast enhancement at the arterial phase of magnetic resonance imaging done 48 h after cryoablation of a renal malignancy is usually benign. • Residual tumor manifesting as contrast enhancement at the arterial phase is characterized by subsequent marked washout. • A washout index below - 1.1 has 88% sensitivity and 84% specificity for residual tumor.
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Affiliation(s)
- Téodor Grand
- AP-HP, Hôpital Necker Enfants Malades, Service d'Imagerie Adulte, F-75015, Paris, France.
- Adult Radiology Department, Necker University Hospital, 149 Rue de Sèvres, 75015, Paris, France.
| | - Christophe Delavaud
- AP-HP, Hôpital Necker Enfants Malades, Service d'Imagerie Adulte, F-75015, Paris, France
| | - Charles Dariane
- AP-HP, Hôpital Européen Georges Pompidou, Service d'urologie, F-75015, Paris, France
- Université de Paris Cité, F-75006, Paris, France
| | - Toulsie Ramtohul
- Institut Curie, Service de Radiologie, PSL Research University, F-75005, Paris, France
| | - Sylvain Guinebert
- AP-HP, Hôpital Necker Enfants Malades, Service d'Imagerie Adulte, F-75015, Paris, France
- Université de Paris Cité, F-75006, Paris, France
| | - Olivier Hélénon
- AP-HP, Hôpital Necker Enfants Malades, Service d'Imagerie Adulte, F-75015, Paris, France
- Université de Paris Cité, F-75006, Paris, France
| | - Arnaud Mejean
- AP-HP, Hôpital Européen Georges Pompidou, Service d'urologie, F-75015, Paris, France
- Université de Paris Cité, F-75006, Paris, France
| | - Marc-Olivier Timsit
- AP-HP, Hôpital Européen Georges Pompidou, Service d'urologie, F-75015, Paris, France
- Université de Paris Cité, F-75006, Paris, France
| | - Jean-Michel Correas
- AP-HP, Hôpital Necker Enfants Malades, Service d'Imagerie Adulte, F-75015, Paris, France
- Université de Paris Cité, F-75006, Paris, France
- Sorbonne Université, CNRS, INSERM Laboratoire d'Imagerie Biomédicale, Paris, France
| | - Sylvain Bodard
- AP-HP, Hôpital Necker Enfants Malades, Service d'Imagerie Adulte, F-75015, Paris, France
- Université de Paris Cité, F-75006, Paris, France
- Sorbonne Université, CNRS, INSERM Laboratoire d'Imagerie Biomédicale, Paris, France
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de Jager NS, van Oostenbrugge TJ, Pätz T, Jenniskens SFM, Fütterer JJ, Langenhuijsen JF, Overduin CG. Intraoperative MRI-derived volumetric ablation margins and initial correlation with local outcome after MRI-guided cryoablation of renal tumors. Cancer Imaging 2023; 23:31. [PMID: 36998028 PMCID: PMC10064595 DOI: 10.1186/s40644-023-00546-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE To assess volumetric ablation margins derived from intraoperative pre- and post-ablation MRI after magnetic resonance imaging (MRI)-guided percutaneous cryoablation of renal tumors and explore its correlation with local treatment success. METHODS Retrospective analysis was performed on 30 patients (mean age 69y) who underwent percutaneous MRI-guided cryoablation between May 2014 and May 2020 for 32 renal tumors (size: 1.6-5.1 cm). Tumor and ice-ball volumes were segmented on intraprocedural pre- and post-ablation MR images using Software Assistant for Interventional Radiology (SAFIR) software. After MRI-MRI co-registration, the software automatically quantified the minimal treatment margin (MTM),defined as the smallest 3D distance between the tumor and ice-ball surface. Local tumor progression (LTP) after cryoablation was assessed on follow-up imaging. RESULTS Median follow-up was 16 months (range: 1-58). Local control after cryoablation was achieved in 26 cases (81%) while LTP occurred in 6 (19%). The intended MTM of ≥5 mm was achieved in 3/32 (9%) cases. Median MTM was significantly smaller for cases with (- 7 mm; IQR:-10 to - 5) vs. without LTP (3 mm; IQR:2 to 4) (P < .001). All cases of LTP had a negative MTM. All negative treatment margins occurred in tumors > 3 cm. CONCLUSIONS Determination of volumetric ablation margins from intraoperative MRI was feasible and may be useful in predicting local outcome after MRI-guided renal cryoablation. In our preliminary data, an intraoperative MRI-derived minimal margin extending at least 1 mm beyond the MRI-visible tumor led to local control and this was more difficult to achieve in tumors > 3 cm. Ultimately, online margin analysis may be a valuable tool to intraoperatively assess therapy success, but larger prospective studies are needed to establish a reliable threshold for clinical use.
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Affiliation(s)
- Nienke S de Jager
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands
| | - Tim J van Oostenbrugge
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, Netherlands
| | - Torben Pätz
- Fraunhofer Institute for Digital Medicine, Max-von-Laue-Str. 2, 28359, Bremen, Germany
| | - Sjoerd F M Jenniskens
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands
| | - Jurgen J Fütterer
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands
| | - Johan F Langenhuijsen
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, Netherlands
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands.
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Beksac AT, Corrigan D, Abou Zeinab M, Ferguson E, Kaviani A, Schwen ZR, Kaouk JH. Long-term comparative outcomes of partial nephrectomy and cryoablation in patients with solitary kidneys: a single-center analysis. Minerva Urol Nephrol 2022; 74:722-729. [PMID: 35622349 DOI: 10.23736/s2724-6051.22.04840-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients with solitary kidneys are amenable to postoperative acute kidney injury (AKI) after PN. We compared the functional and oncological outcomes of cryoablation (CA) and PN in patients with a solitary kidney and a cT1a renal mass. METHODS From a single-institution series, we analyzed 74 patients (31 PN, 43 CA) with a solitary kidney who underwent treatment for a cT1a renal mass. The functional outcomes were AKI and estimated glomerular filtration rate (eGFR) preservation. Oncological outcomes were recurrence and death. Linear mixed-effects and logistic regression models were used for functional outcomes analysis, whereas oncological outcomes were analyzed using the Kaplan-Meier method. RESULTS Median follow-up was 63.9 months. PN group had lower median age (59 years vs. 68, P<0.001) and larger median tumor size (2.80 cm vs. 2.0, p =0.003). AKI was more common in the PN group on postoperative day 1 (58% vs. 2.8%, P<0.001). However, only one patient in the PN group required temporary dialysis in the perioperative period. eGFR preservation was similar at postoperative 3 months (89% vs. 90%, P=0.083), or 12 months (85% vs. 94%, P=0.2) follow-up. CA group had higher recurrence rate (29% vs. 3.2%, P=0.005), and worse recurrence-free survival (P=0.027). Overall survival (OS) was comparable (P=0.31). CONCLUSIONS In a solitary kidney setting, CA is associated with a lower risk of AKI at postoperative day 1 compared to PN. Functional outcome is comparable upon longer follow-up. The local recurrence rates are significantly higher in the CA group with no significant difference in OS.
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Affiliation(s)
- Alp T Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Dillon Corrigan
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mahmoud Abou Zeinab
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ethan Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Aaron Kaviani
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Zeyad R Schwen
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA -
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Papa M, Biondetti P, Colombo R, Ierardi AM, Angileri SA, Lucignani G, Boeri L, Montanari E, Cardone G, Scagnelli P, Carrafiello G. sABLATE: a simplified ABLATE score for prediction of complications and outcome in percutaneous thermal ablation of renal lesions. Med Oncol 2021; 38:126. [PMID: 34495438 DOI: 10.1007/s12032-021-01542-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/23/2021] [Indexed: 11/28/2022]
Abstract
The aim of the study is to evaluate the performance of a simplified ABLATE score (sABLATE) in predicting complications and outcome with respect to RENAL, mRENAL, and ABLATE scores. This study included 136 renal lesions in 113 patients (M:F ratio = 2.5; mean age 70.8 years). 98 tumors underwent cryoablation at San Raffaele hospital between 01/2015 and 03/2020, while 37 underwent microwave ablation at San Paolo or Policlinico hospitals between 07/2016 and 03/2020. RENAL, mRENAL, ABLATE, and sABLATE scores were calculated using pre-procedural imaging. Data regarding complications and follow-up were registered. Mann-Whitney U test, ROC analyses, and logistic regression analyses were used for complications. Cox-regression analyses were performed for outcome. Mean tumor diameter was 23.2 mm. Mean and median RENAL, mRENAL, ABLATE, and sABLATE scores were 6.8 and 7, 6.9 and 7, 5.3, and 5, and 3.5 and 3, respectively. During a mean follow-up of 21.9 months (range 1-73), we registered 7 complications, 3 cases of residual disease, and 10 local tumor progressions. Mann-Whitney U test p values for complications for RENAL, mRENAL, ABLATE, and sABLATE were 0.51, 0.49, 0.66, and 0.056, respectively. ROC analyses for complications showed an AUC for RENAL, mRENAL, ABLATE, and sABLATE of 0.57, 0.57, 0.55, and 0.71, respectively. Regarding outcome, HR and p values of Cox-regression analyses were 1.30 and 0.36 for RENAL, 1.33 and 0.35 for mRENAL, 2.16 and 0.01 for ABLATE, 2.29 and 0.004 for sABLATE. sABLATE was the only score close to significance for complications, representing a progress even if not definitive. Regarding outcome, ABLATE confirmed its value, and sABLATE maintained validity despite being a simplification.
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Affiliation(s)
- Maurizio Papa
- Azienda Socio Sanitaria Territoriale (ASST) Lodi, Complex Unit of Radiology, Department of Diagnostic and Interventional Radiology, Viale Savoia 4, 26900, Lodi, Italy.
| | - Pierpaolo Biondetti
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Roberta Colombo
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Salvatore Alessio Angileri
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Gianpaolo Lucignani
- Urology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Luca Boeri
- Urology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Emanuele Montanari
- Urology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Gianpiero Cardone
- Diagnostic and Interventional Radiology Department, IRCCS Ospedale San Raffaele-Turro, Università Vita-Salute San Raffaele, Milan, Italy
| | - Paola Scagnelli
- Azienda Socio Sanitaria Territoriale (ASST) Lodi, Complex Unit of Radiology, Department of Diagnostic and Interventional Radiology, Viale Savoia 4, 26900, Lodi, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
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Stacul F, Sachs C, Giudici F, Bertolotto M, Rizzo M, Pavan N, Balestreri L, Lenardon O, Pinzani A, Pola L, Cicero C, Celia A, Cova MA. Cryoablation of renal tumors: long-term follow-up from a multicenter experience. Abdom Radiol (NY) 2021; 46:4476-4488. [PMID: 33912986 PMCID: PMC8346457 DOI: 10.1007/s00261-021-03082-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/16/2022]
Abstract
Purpose To retrospectively investigate long-term outcomes of renal cryoablation from a multicenter database. Methods 338 patients with 363 renal tumors underwent cryoablation in 4 centers in North-Eastern Italy. 340/363 tumors (93.7%) were percutaneously treated with CT guidance. 234 (68.8%) were treated after conscious sedation, 76 (22.3%) under local lidocaine anesthesia only and 30 (8.8%) under general anesthesia. Treatment efficacy and complication rate considered all procedures. Oncologic outcomes considered a subset of 159 patients with 159 biopsy proven renal cell carcinoma. Results Mean tumor size was 2.53 cm. Technical success was achieved in 355/363 (97.8%) treatments. Treatment efficacy after the first treatment was achieved in 348/363 (95.9%) tumors. Statistical analysis revealed a significant lower treatment efficacy for ASA score >3, Padua score >8, tumor size >2.5 cm, use of >2 cryoprobes, presence of one single kidney. In the subset of 159 patients, recurrence-free survival rates were 90.5% (95% CI 83.0%, 94.9%) at 3 years and 82.4% (95% CI 72.0%, 89.4%) at 5 years; overall survival rates were 96.0% (95% CI 90.6%, 98.3%) at 3 years and 91.0% (95% CI 81.7%, 95.7%) at 5 years; no patient in this subset developed metastatic disease. Clavien-Dindo >1 complications were recorded in 14/369 procedures (3.8%) and were related to age >70 years, tumor size >4 cm and use of >2 cryoprobes. Conclusion Cryoablation performed across four different centers in a large cohort of predominantly small renal tumors showed that this technique provides good recurrence-free survival rates and overall survival rates at three- and five-year with very low major complications rate. Electronic supplementary material The online version of this article (10.1007/s00261-021-03082-z) contains supplementary material, which is available to authorized users.
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Papillary renal cell carcinoma: Review. Urol Oncol 2021; 39:327-337. [PMID: 34034966 DOI: 10.1016/j.urolonc.2021.04.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 01/20/2023]
Abstract
Kidney cancer is the 13th most common malignancy globally, and the incidence is rising. Papillary renal cell carcinoma is the second most common subtype, comprising 10-15% of renal cell carcinomas. Though the histologic features of this subtype were initially described in the 1990's, our understanding of the genetic and molecular characteristics of this disease have rapidly evolved over the past decade. In this review, we summarize the contemporary understanding of the clinical, morphologic, radiographic, and genetic characteristics of papillary renal cell carcinoma, as well as clinical considerations, current options for management, and prognosis.
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Percutaneous CT-Guided Renal Cryoablation: Technical Aspects, Safety, and Long-Term Oncological Outcomes in a Single Center. ACTA ACUST UNITED AC 2021; 57:medicina57030291. [PMID: 33804740 PMCID: PMC8003936 DOI: 10.3390/medicina57030291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/18/2021] [Indexed: 12/15/2022]
Abstract
Background and objectives: Cryoablation is emerging as a safe and effective therapeutic option for treating renal cell carcinoma. This study analyzed the safety and long-term oncological outcomes of cryoablation in our center. Materials and methods: Patients who underwent computed tomography (CT)-guided percutaneous cryoablation between February 2011 and June 2020 for one or more clinically localized renal tumors were identified. Technical success and treatment efficacy were assessed. Post-procedural complications were classified according to the Clavien-Dindo system. Recurrence-free survival was determined for biopsy-proven malignant renal tumors. Results: A total of 174 renal tumors, 78 of which were biopsy-proven malignant carcinomas, were treated in 138 patients (97 males and 41 females, mean age: 73 years, range: 43-89 years). Mean tumor size was 2.25 cm and 54.6% of the lesions required a complex approach. Technical success was achieved in 171 out of 174 tumors (98.3%). Primary treatment efficacy was 95.3% and increased to 98.2% when retreats were taken into account. The overall complication rate was 29.8%. No complications of Clavien-Dindo grade III or more were encountered. Median follow-up was 21.92 months (range: 0.02-99.87). Recurrence-free survival was 100% at 1 year, 95.3% (95% CI: 82.1%-98.8%) at 3 years, and 88.6% (95% CI: 71.8%-95.7%) at 5 years. Conclusions: Cryoablation is a safe and effective technique for the treatment of small renal lesions, with no major complications when performed by expert interventional radiologists. The multidisciplinary discussion is essential, especially considering the high number of histologically undetermined lesions. Our long-term oncological outcomes are encouraging and in line with the literature.
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Cazzato RL, De Marini P, Leonard-Lorant I, Leclerc L, Auloge P, Tricard T, Dalili D, Garnon J, Lang H, Gangi A. Safety and Oncologic Outcomes of Magnetic Resonance Imaging-Guided Cryoablation of Renal Cell Carcinoma: A 10-Year Single-Center Experience. Invest Radiol 2021; 56:153-162. [PMID: 32897930 DOI: 10.1097/rli.0000000000000719] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Magnetic resonance imaging guidance has been sporadically reported for renal tumor cryoablation (CA); therefore, clinical experience with this modality is still limited.The aim of this study is to retrospectively analyze our 10-year experience with renal tumor CA performed on a 1.5 T magnetic resonance imaging unit with the intent of reporting procedural safety and oncologic outcomes. MATERIALS AND METHODS We included 143 patients (102 men; 41 women; median age, 73 years; range, 34-91 years) with 149 tumors (median size, 2.6 cm; range, 0.6-6.0 cm), treated between 2009 and 2019. Patient, tumor, procedure, and follow-up data were collected and analyzed. The Kaplan-Meier method was used to estimate local recurrence-free (LRFS), metastasis-free (MFS), disease-free (DFS), cancer-specific, and overall (OS) survival. Univariate and multivariate models were used to identify factors associated with complications, LRFS, MFS, DFS, and OS. RESULTS The overall complication rate was 10.7% (16/149 tumors), with 1 major (1/149 [0.7%]; 95% confidence interval, 0.0%-3.7%) hemorrhagic complication. Other minor complications (15/149 [10.1%]; 95% confidence interval, 0.6%-16.1%) did not include any cases of injury to nearby organs. There were no factors associated with complications.Five-year estimates of LRFS (primary/secondary), MFS, DFS, cancer-specific survival, and OS were 82.8%/91.5%, 91.1%, 75.1%, 98.2%, and 89.6%, respectively. Increasing tumor size (hazard radio [HR], 1.8; P = 0.02) and intraparenchymal tumor location (HR, 5.6; P < 0.01) were associated with lower LRFS; increasing patient's age (HR, 0.5; P = 0.01), high tumor grade (HR, 23.3; P < 0.01) and non-clear-cell/nonpapillary histology (HR, 20.1; P < 0.01) with metastatic disease; and high tumor grade (HR, 3.2; P = 0.04) with lower DFS. CONCLUSION Magnetic resonance imaging-guided CA of renal tumors is associated with acceptable morbidity and high survival estimates at 5-year follow-up. Given the absence of complications resulting from injuries to nearby organs, further studies are required to evaluate whether the potential reduced incidence of these adverse events justifies large-scale implementation of this interventional modality.
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Affiliation(s)
| | | | | | - Loïc Leclerc
- From the Departments of Interventional Radiology
| | | | | | | | | | - Hervé Lang
- Urology, University Hospital of Strasbourg, Strasbourg, France
| | - Afshin Gangi
- From the Departments of Interventional Radiology
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Cotta BH, Meagher MF, Bradshaw A, Ryan ST, Rivera-Sanfeliz G, Derweesh IH. Percutaneous renal mass biopsy: historical perspective, current status, and future considerations. Expert Rev Anticancer Ther 2019; 19:301-308. [DOI: 10.1080/14737140.2019.1571915] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Brittney H. Cotta
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret F. Meagher
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Aaron Bradshaw
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Stephen T. Ryan
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Gerant Rivera-Sanfeliz
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ithaar H. Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, USA
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11
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Haddad MM, Schmit GD, Kurup AN, Schmitz JJ, Boorjian SA, Geske J, Thompson RH, Callstrom MR, Atwell TD. Percutaneous Cryoablation of Solitary, Sporadic Renal Cell Carcinoma: Outcome Analysis Based on Clear-Cell versus Papillary Subtypes. J Vasc Interv Radiol 2018; 29:1122-1126. [DOI: 10.1016/j.jvir.2018.02.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/23/2018] [Accepted: 02/25/2018] [Indexed: 12/28/2022] Open
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12
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Bindayi A, Mcdonald ML, Beksac AT, Rivera-Sanfeliz G, Shabaik A, Hughes F, Aganovic L, Hansel DE, Derweesh IH. Can multiphase CT scan distinguish between papillary renal cell carcinoma type 1 and type 2? Turk J Urol 2018; 44:316-322. [PMID: 29932401 DOI: 10.5152/tud.2018.28938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/07/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the utility of multiphase computed tomography (CT) and percutaneous renal mass biopsy (PRMB) in differentiating between papillary renal cell carcinoma (pRCC)-Type 1 and -Type 2, as emerging data have suggested differential enhancement patterns in different renal tumor histologies. MATERIAL AND METHODS Retrospective analysis of 51 patients (23 pRCC-Type 1/28 pRCC-Type 2) who underwent multiphase CT followed by surgery from July 2011 to April 2016 was performed. Data were analyzed between subgroups based on histology. Multiphase CT was analyzed for tumor size, and attenuation [Hounsfield Units (HU)]. Change in HU (ΔHU) was calculated between noncontrast (NC), corticomedullary (CM), nephrographic (N), and delayed (D) phases. Subset analysis was carried out on patients who underwent PRMB prior to surgery. RESULTS There was no difference in median tumor size (pRCC-Type 1 2.8 vs. pRCC-Type 2 2.6 cm, p=0.832). In addition to tumor size being similar between groups, distribution of tumor stages between groups was also similar (p=0.651). Greater proportion of high-grade tumors (III/IV) was noted in pRCC-Type 2 (42.9% vs. 8.7%) (p=0.011). There was no difference in HU values for NC (p=0.961), CM (p=0.118), N (p=0.277), and D (p=0.256) phases, and in ΔHU between CM-NC (p=0.278), N-NC (p=0.316), and D-NC (p=0.103). Thirteen patients underwent percutaneous biopsy, 11 of whom had diagnostic samples. Examination of 10/11 (90.9%) samples accurately predicted correct histology, and of 6/11 (54.5%) samples correctly identified high-vs. low-grade histology. CONCLUSION Our findings suggest substantial overlap of CT findings, despite pRCC-Type 2 having greater proportion of high-grade tumors. Utility of CT is limited in the differentiation between pRCC subtypes. Patients with suggested pRCC on CT imaging being considered for a non-extirpative strategy should undergo PRMB for risk stratification.
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Affiliation(s)
- Ahmet Bindayi
- Department of Urology, UC San Diego Health System, La Jolla, California, USA
| | - Michelle L Mcdonald
- Department of Urology, UC San Diego Health System, La Jolla, California, USA
| | - Alp T Beksac
- Department of Urology, UC San Diego Health System, La Jolla, California, USA
| | | | - Ahmed Shabaik
- Department of Pathology, UC San Diego Health System, La Jolla, California, USA
| | - Fiona Hughes
- Department of Radiology, UC San Diego Health System, La Jolla, California, USA
| | - Lejla Aganovic
- Department of Radiology, UC San Diego Health System, La Jolla, California, USA
| | - Donna E Hansel
- Department of Pathology, UC San Diego Health System, La Jolla, California, USA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego Health System, La Jolla, California, USA
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Correas JM, Delavaud C, Gregory J, Le Guilchet T, Lamhaut L, Timsit MO, Méjean A, Hélénon O. Ablative Therapies for Renal Tumors: Patient Selection, Treatment Planning, and Follow-Up. Semin Ultrasound CT MR 2017; 38:78-95. [DOI: 10.1053/j.sult.2016.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Hongo F, Yamada Y, Ueda T, Nakmura T, Naya Y, Kamoi K, Okihara K, Ichijo Y, Miki T, Yamada K, Ukimura O. Preoperative lipiodol marking and its role on survival and complication rates of CT-guided cryoablation for small renal masses. BMC Urol 2017; 17:10. [PMID: 28100214 PMCID: PMC5241976 DOI: 10.1186/s12894-017-0199-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/10/2017] [Indexed: 11/18/2022] Open
Abstract
Background Partial nephrectomy for small renal masses (SRM) may be useful for preserving renal function, but is technically more difficult than radical nephrectomy. Cryoablation may be performed under local anesthesia. The objective of the present study is to assess the safety and therapeutic efficacy of cryoablation with lipiodol marking for SRM. Methods Cryoablation therapy was performed on 42 patients under local anesthesia. Their median age was 74 years (31–91). The median tumor diameter was 21 mm (10–42). Responses to the treatment were evaluated using modified Response Evaluation Criteria in Solid Tumors (mRECIST) by contrast-enhanced CT. In six patients (14.3%) for whom it was not possible to use contrast medium, plain CT findings were assessed according to Response Evaluation Criteria in Solid Tumors (RECIST). Results Twenty-nine (69%) and five (12%) patients achieved complete responses (CR) and partial responses (PR), respectively, while four (10%) and four (10%) patients each had stable disease (SD) and progressive disease (PD) after the first course of therapy. A second course of cryoablation therapy with lipiodol marking was performed on three out of four patients with PD after the first course of therapy, and resulted in a total of 32 patients achieving CR (76%). Four (36.4%) out of 11 patients for whom lipiodol marking was not conducted had PD, whereas none of the 31 patients for whom lipiodol marking was conducted had PD. All grade complications were reported in 11 (24.4%) patients while grade 3 in two (4.4%) patients. 11 (24.4%) A significant difference was observed in postoperative hemorrhagic events in all grades (18% in patients undergoing cryoablation without lipiodol marking vs. 0% in patients undergoing cryoablation without lipiodol marking). Conclusions Although further studies involving more patients are needed in order to evaluate long-term results, cryoablation therapy appears to be a useful treatment option for SRM. Preoperative marking with lipiodol was helpful for improving complication and survival rates with cryoablation.
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Affiliation(s)
- Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Yasuhiro Yamada
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takashi Ueda
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Terukazu Nakmura
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yoshio Naya
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazumi Kamoi
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Koji Okihara
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yusuke Ichijo
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsuneharu Miki
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
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