1
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Pallauf M, Ged Y, Singla N. Molecular differences in renal cell carcinoma between males and females. World J Urol 2023; 41:1727-1739. [PMID: 36905442 DOI: 10.1007/s00345-023-04347-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/23/2023] [Indexed: 03/12/2023] Open
Abstract
PURPOSE The disparity in renal cell carcinoma (RCC) risk and treatment outcome between males and females is well documented, but the underlying molecular mechanisms remain poorly elucidated. METHODS We performed a narrative review synthesizing contemporary evidence on sex-specific molecular differences in healthy kidney tissue and RCC. RESULTS In healthy kidney tissue, gene expression differs significantly between males and females, including autosomal and sex-chromosome-linked genes. The differences are most prominent for sex-chromosome-linked genes and attributable to Escape from X chromosome-linked inactivation and Y chromosome loss. The frequency distribution of RCC histologies varies between the sexes, particularly for papillary, chromophobe, and translocation RCC. In clear-cell and papillary RCC, sex-specific gene expressions are pronounced, and some of these genes are amenable to pharmacotherapy. However, for many, the impact on tumorigenesis remains poorly understood. In clear-cell RCC, molecular subtypes and gene expression pathways have distinct sex-specific trends, which also apply to the expression of genes implicated in tumor progression. CONCLUSION Current evidence suggests meaningful genomic differences between male and female RCC, highlighting the need for sex-specific RCC research and personalized sex-specific treatment approaches.
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Affiliation(s)
- Maximilian Pallauf
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD, 21287, USA
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Yasser Ged
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nirmish Singla
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD, 21287, USA.
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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2
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Gaas MY, Kaprin AD, Vorobyev NV, Rapoport LM, Korolev DO, Kalpinsky AS. Markers of local kidney cancer recurrence: A surgeon's mistake or a pattern? Review. Urologia 2022:3915603221140964. [PMID: 36515572 DOI: 10.1177/03915603221140964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The influence of various morphological, anatomical, genetic and other factors on the local recurrence-free survival of patients who have undergone different renal cell cancer (RCC) treatment is still a rather complex, ambiguous and controversial issue for practicing oncourologists. This review evaluates the effect of several factors on both recurrence-free survival and local recurrence-free survival. The review includes articles, clinical cases, literature reviews, and meta-analyses highlighting the analysis of independent and interrelated predisposing factors for developing local recurrence of RCC from 1984 to 2020. The PubMed, Web of Science, and Scopus databases were searched in English, Spanish, and German. A review of the literature showed the role of the following indices in the local recurrence RCC: microvascular invasion (p = 0.001), tumor necrosis (p = 0.0001), high malignancy (Fuhrman III or IV) (HR = 38.3, 95% CI 3.1-467, p = 0.004) as histological factors, tumor size as an anatomical factor. Thus, the authors state that every centimeter of the tumor increases the risk of local recurrence (p < 0.05). A group from the Mayo Clinic showed the equivalence of different treatment methods in local RCC recurrence. Thus, in the group of patients with cT1a stage kidney cancer, the 5-year local recurrence-free survival rates were 97.7% (96.7-98.6), 95.9% (92.3-99.6), and 95.9% (92.3-99.6) for renal resection, RFA, and cryoablation, respectively. Surgical margin status is the most studied and controversial marker of local renal cell carcinoma recurrence. Researchers found a direct effect of PSM on the risk of local RCC recurrence (p < 0.01). The personalized approach with the search and evaluation of predisposing factors for the local recurrence, as well as further selection of the most optimal treatment, will allow oncourologists to improve both the effectiveness of primary treatment and the recurrence-free survival of patients.
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Affiliation(s)
- Margarita Y Gaas
- Department Urology and Operative Nephrology with the Course of Oncourology of Medical Institute of Peoples' Friendship University of Russia, Moscow, Russian Federation
| | - Andrey D Kaprin
- Department Urology and Operative Nephrology with the Course of Oncourology of Medical Institute of Peoples' Friendship University of Russia, Moscow, Russian Federation
| | - Nikolay V Vorobyev
- Department of Oncology, Radiotherapy and Plastic Surgery of I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.,P.A. Hertsen Moscow Oncology Research Center, A Branch of FSBI NMRRC of the Ministry of Health of Russia, Moscow, Russian Federation
| | - Leonid M Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Dmitry O Korolev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Alexey S Kalpinsky
- Department of Tumors of the Reproductive and Urinary Organs, Moscow Research Oncological Institute, P. A. Herzen, Branch of the Federal State Budgetary Institution "National Research Center of Radiology," Moscow, Russian Federation
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3
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Yang J, Xia JD, Xue JX, Song NH, Liang C, Xi D, Wang YM, Wang ZJ. Robotic-assisted partial nephrectomy with sequential clamping of segmental renal arteries for multiple ipsilateral renal tumors: initial outcomes. BMC Urol 2019; 19:31. [PMID: 31053126 PMCID: PMC6500028 DOI: 10.1186/s12894-019-0451-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/24/2019] [Indexed: 01/20/2023] Open
Abstract
Background To assess the technical feasibility and outcomes of robotic-assisted partial nephrectomy (RPN) with sequential segmental renal artery (SRA) clamping for multiple ipsilateral renal tumors (MIRTs). Methods From April 2016 to February 2018, consecutive eleven cases successfully underwent RPN with sequential SRA clamping under the guidance of dual-source computed tomography (DSCT). Results Ten cases had two lesions and two cases had three at the ipsilateral kidneys. The mean size and the mean R.E.N.A.L score for the dominant lesion of single case were 3.3 cm and 5.7, respectively. Twenty-two lesions (84.6%) had one target SRA and four (15.4%) had two target SRAs. Satisfactory ischemic areas were achieved by sequentially clamping two (81.8%) or three (18.2%) target SRAs with mean clamping time of 18.8 (15.0–27.0) min for single lesion, and the mean of total clamping time for single case was 37.5 (32.0–52.0) min. Only the complications of grade 1–2 were found and no positive surgical margin was discovered. The mean follow-up time was 5.4 months and no local recurrence or metastasis was found. The mean postoperative eGFR was 71.2 ml/minute/1.73m2 that was only an insignificant reduction (9.3%) compared with the preoperative baseline. Conclusion This novel nephron-sparing technique, RPN with sequential SRA clamping, represents a good alternative for selected patients with MIRTs. With the guidance of DSCT and skilled robotic experience, this technique is feasible and can maximize renal function preservation. Large-scale multicenter clinical studies are still needed to further prove these initial outcomes. Electronic supplementary material The online version of this article (10.1186/s12894-019-0451-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jie Yang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Jia-Dong Xia
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Jian-Xin Xue
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Ning-Hong Song
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Chao Liang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Di Xi
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Ya-Min Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Zeng-Jun Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
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4
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Bu K, Shi Z, Lu Y, Zhao J, Li B. An occult urothelial carcinoma with wide multiorgan metastases and its genetic alteration profiling: Case report and literature review. Medicine (Baltimore) 2019; 98:e15245. [PMID: 31008958 PMCID: PMC6494344 DOI: 10.1097/md.0000000000015245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Urothelial carcinoma, also named transitional cell carcinoma, is the most frequent occurring malignancy in the urinary system. It mainly invades the surrounding tissues and metastasizes to distant organs in later stages. PATIENT CONCERNS Here, we presented an unusual case of occult urothelial carcinoma primarily manifested as a multiorgan metastatic cancer in a 59-year-old man. The patient complained of pain on the left thigh root for a month. The imaging and histopathological examination revealed multiple malignancies in lung, bone, and liver. DIAGNOSES The histological evaluation and the immunohistochemistry (IHC) profile of liver, lung, and bone were consistent with the diagnosis of metastases from the original urothelial cancer, while imaging examination was not able to detect a primary lesion in the urinary system. INTERVENTIONS Based on the mutation of STK11 M51Ifs*106 detected by next generation sequencing (NGS), we started targeted therapy with everolimus. OUTCOMES The patient deteriorated after 3 months of treatment and passed away. LESSONS In this initial report of occult urothelial carcinoma, we obtained information on genetic variations of tumor tissue which could provide important information for subsequent studies on this kind of disease.
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Affiliation(s)
- Kunpeng Bu
- Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning
| | - Zeyan Shi
- Department of Hematology, First Hospital Affiliated to Guangxi Medical University, Guangxi
| | - Yang Lu
- Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning
| | | | - Bixun Li
- Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning
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Tsivian M, Abern MR, Tsivian E, Sze C, Jibara G, Rampersaud EN, Polascik TJ. Effect of blood transfusions on oncological outcomes of surgically treated localized renal cell carcinoma. Urol Oncol 2018; 36:362.e1-362.e7. [DOI: 10.1016/j.urolonc.2018.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/18/2018] [Accepted: 04/24/2018] [Indexed: 10/16/2022]
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6
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Yerram NK, Dagenais J, Bryk DJ, Nandanan N, Maurice MJ, Mouracade P, Kara O, Kaouk JH. Trifecta Outcomes in Multifocal Tumors: A Comparison Between Robotic and Open Partial Nephrectomy. J Endourol 2018; 32:615-620. [PMID: 29790375 DOI: 10.1089/end.2018.0134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To report a comparative analysis of outcomes in patients who underwent multiple excisions for unilateral synchronous multifocal renal tumors using both open and robotic approaches. METHODS We retrospectively reviewed 110 patients who underwent robotic and open partial nephrectomy and had multiple tumor excisions in an ipsilateral kidney. "Trifecta" was defined as negative surgical margins, no urologic complications, and a glomerular filtration rate (GFR) preservation of ≥90% at last follow-up. Inverse probability of treatment weighting (IPTW) was applied to equilibrate treatment groups, minimize selection bias, and optimize inference on the basis of each patient's clinicodemographic characteristics. RESULTS Sixty-eight robotic and 42 open patient approaches had sufficient data for IPTW. After weighting, there were no statistical differences in baseline characteristics between the two groups. On adjusted analyses, robotic partial nephrectomy achieved equivalent rates of trifecta to open surgery (16.3% vs 16.5%, p = 0.99), which persisted on subgroup analyses of patients with two (20.1% vs 23.7%, p = 0.82) or more than two tumors (6.8% vs 7.4%, p = 0.95). There were no differences between robotic and open cohorts for negative margin rates, absence of complications, or GFR ≥90%. The robotic cohort had a shorter mean length of stay (3.4 vs 4.9 days, p < 0.001). CONCLUSIONS Surgical resection remains the mainstay for patients with unilateral, synchronous, and multifocal renal tumors. Our analysis found that both open and robotic approaches to partial nephrectomy are equally likely to achieve the "trifecta" outcome in an equilibrated high-risk group of patients. The robotic approach for these complex patients may be safe and feasible for a carefully selected group of patients.
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Affiliation(s)
- Nitin K Yerram
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Julien Dagenais
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Darren J Bryk
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Naveen Nandanan
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.,2 Virginia Commonwealth University Health System , Urology, Richmond, Virginia
| | - Matthew J Maurice
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Pascal Mouracade
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Onder Kara
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.,3 Urology Department, Amasya University , Amasya, Turkey
| | - Jihad H Kaouk
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
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7
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Beaugerie A, Audenet F, Verkarre V, Delavaud C, Le Guilchet T, Hurel S, de Saint Aubert N, Correas JM, Fontaine E, Richard S, Méjean A, Timsit MO. Pathological heterogeneity in sporadic synchronous renal tumors: Is the histological concordance predictable? Urol Oncol 2017; 36:11.e7-11.e12. [PMID: 28993058 DOI: 10.1016/j.urolonc.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/31/2017] [Accepted: 09/05/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the pathological concordance rate of multiple synchronous renal masses (MSRM) presumed to be sporadic and to analyze predictive factors of concordance. MATERIAL AND METHODS We identified from our institutional database patients with sporadic MSRM treated at our center between January 2000 and December 2015. All tumors were reviewed by a dedicated uropathologist. Pathological concordance rate was analyzed regarding clinical characteristics and preoperative imaging. RESULTS We included 112 patients: 50 had unilateral synchronous renal masses and 62 bilateral synchronous renal masses. A total of 291 tumors were analyzed, with an average of 2.6 tumors per patient. Overall, the malignant concordance rate was 91.6%, the pathological concordance rate was 67.3% and the grade concordance rate was 62.5%. In univariate analysis, predictive factors of histological concordance were bilateral synchronous renal masses (odds ratio [OR] = 3.39; 95% CI: 1.06-10.8; P = 0.04), age<60 years (OR = 3.04; 95% CI: 1.2-7.7; P = 0.02) and ≥3 lesions (OR = 2.41; 95% CI: 1.03-5.68; P = 0.04). In multivariate analysis, age<60 remained significantly associated with histological concordance (OR = 3.84; 95% CI: 1.24-11.9; P = 0.02). CONCLUSIONS The histological concordance rate of MSRM is low. Age at diagnosis <60 years, bilateral lesions and ≥3 tumors are predictive factors of histological concordance, but the pathological diagnosis remains difficult to predict. This heterogeneity is important to take into account, particularly when choosing the treatment upon the renal biopsy results from a single lesion.
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Affiliation(s)
- Aurélien Beaugerie
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes University, Paris, France.
| | - François Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes University, Paris, France
| | - Virginie Verkarre
- Department of Pathology, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes University, Paris, France
| | - Christophe Delavaud
- Department of Radiology, Hôpital Necker-Enfants malades, AP-HP, Paris Descartes University, Paris, France
| | - Thomas Le Guilchet
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes University, Paris, France
| | - Sophie Hurel
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes University, Paris, France
| | - Nicolas de Saint Aubert
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes University, Paris, France
| | - Jean-Michel Correas
- Department of Radiology, Hôpital Necker-Enfants malades, AP-HP, Paris Descartes University, Paris, France
| | - Eric Fontaine
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes University, Paris, France
| | - Stéphane Richard
- Centre PREDIR, Hôpital de Bicêtre, AP-HP, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Arnaud Méjean
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes University, Paris, France
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes University, Paris, France
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8
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Histologic subtype needs to be considered after partial nephrectomy in patients with pathologic T1a renal cell carcinoma: papillary vs. clear cell renal cell carcinoma. J Cancer Res Clin Oncol 2017; 143:1845-1851. [PMID: 28451753 DOI: 10.1007/s00432-017-2430-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/18/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE We compared the oncological outcomes of papillary renal cell carcinoma (pRCC) with clear cell renal cell carcinoma (ccRCC) after partial nephrectomy (PN) in patients with pathologic T1a RCC. METHODS After excluding patients with synchronous multiple renal tumors, familial RCC, and pathologic stage T1b or above, 759 patients with ccRCC and 84 patients with pRCC were included. We assessed the impact of histologic subtypes on oncologic outcomes after PN in patients with pathologic T1a RCC (median follow-up duration, 67 months). RESULTS There was no difference in patient and tumor characteristics between the 2 groups, except Fuhrman grade (p = 0.006). Kaplan-Meier analysis identified 5-year recurrence-free survival of 98.7 and 95.6% in patients with ccRCC and pRCC, respectively. However, 10-year recurrence-free survival in patients with ccRCC and pRCC was 96.1 and 73.0%, respectively (p < 0.001). Recurrence ≥5 years post surgery was more common in patients with pRCC compared with those with ccRCC (0.3 vs. 4.8%; p < 0.001). In multivariate analysis, pRCC [hazard ratio (HR) 5.309; p = 0.001] was a significant risk factor for recurrence after PN in patients with pathologic T1a RCC, in addition to larger tumor size (HR 1.861; p = 0.038) and Fuhrman grade ≥3 (HR 5.176; p = 0.003). CONCLUSIONS In patients with pathologic T1a RCC, recurrence after PN occurred more commonly in pRCC compared with ccRCC. As over half of the recurrence cases in patients with pRCC occurred ≥5 years post surgery, a longer follow-up time is required, even for those with pathologic stage T1a disease.
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Kim SP, Campbell SC, Gill I, Lane BR, Van Poppel H, Smaldone MC, Volpe A, Kutikov A. Collaborative Review of Risk Benefit Trade-offs Between Partial and Radical Nephrectomy in the Management of Anatomically Complex Renal Masses. Eur Urol 2016; 72:64-75. [PMID: 27988238 DOI: 10.1016/j.eururo.2016.11.038] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/29/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND While partial nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear understanding of the potential risks and benefits of PN and radical nephrectomy (RN). OBJECTIVE To critically review the comparative effectiveness evidence of PN versus RN; to describe key trade-offs involved in this treatment decision; and to highlight gaps in the current literature. EVIDENCE ACQUISITION A collaborative critical review of the medical literature was conducted. EVIDENCE SYNTHESIS Patients who undergo PN for an anatomically complex or large mass may be exposed to perioperative and potential oncologic risks that could be avoided if RN were performed, while patients who undergo RN may forgo long-term benefits of renal preservation. Decision-making regarding the optimal treatment with PN or RN among patients with anatomically complex or large renal mass is highly nuanced and must balance the risks and benefits of each approach. Currently, high-quality evidence on comparative effectiveness is sparse. Retrospective comparisons are plagued by selection biases, while the one existing prospective randomized trial, albeit imperfect, suggests that nephron-sparing surgery may not benefit all patients. CONCLUSIONS For anatomically complex tumors, PN preserves renal parenchyma but may expose patients to higher perioperative risks than RN. The risks and benefits of each surgical approach must be better objectified for identification of patients most suitable for complex PN. A prospective randomized trial is warranted and would help in directing patient counseling. PATIENT SUMMARY Treatment decisions for complex renal masses require shared decision-making regarding the risk trade-offs between partial and radical nephrectomy.
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Affiliation(s)
- Simon P Kim
- University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Seidman Cancer Center, Urology Institute, Center of Healthcare Outcomes and Quality, Cleveland, OH, USA; Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Inderbir Gill
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Brian R Lane
- Spectrum Health Medical Group, Urology, Grand Rapids, MI, USA
| | - Hein Van Poppel
- Department of Urology, University Hospitals of Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marc C Smaldone
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Alessandro Volpe
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA.
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10
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Maurice MJ, Ramirez D, Nelson RJ, Caputo PA, Kara Ö, Malkoç E, Kaouk JH. Multiple Tumor Excisions in Ipsilateral Kidney Increase Complications After Partial Nephrectomy. J Endourol 2016; 30:1200-1206. [DOI: 10.1089/end.2016.0223] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Matthew J. Maurice
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Ramirez
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan J. Nelson
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Peter A. Caputo
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Önder Kara
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, Amasya University Medical School, Amasya, Turkey
| | - Ercan Malkoç
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H. Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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11
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Mano R, Kent M, Larish Y, Winer AG, Chevinsky MS, Hakimi AA, Sternberg IA, Sjoberg DD, Russo P. Partial and Radical Nephrectomy for Unilateral Synchronous Multifocal Renal Cortical Tumors. Urology 2015; 85:1404-10. [PMID: 25872696 DOI: 10.1016/j.urology.2015.02.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/01/2015] [Accepted: 02/27/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate clinicopathologic characteristics and treatment outcomes of patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN) for unilateral synchronous multifocal renal tumors. METHODS We retrospectively reviewed medical records for 128 patients with nonmetastatic, unilateral, synchronous, multifocal renal tumors who underwent surgical resection at our institution from 1995 to 2012. Five patients with hereditary renal cell carcinoma were excluded. Differences between patient and tumor characteristics from the 2 nephrectomy groups were evaluated. Outcomes in terms of recurrence-free survival, overall survival, and chronic kidney disease upstaging were estimated using Kaplan-Meier methods. The log-rank test was used for group comparisons. RESULTS The study cohort included 78 PN patients (63%) and 45 RN patients (37%); 17 of 95 planned PN (18%) were converted to RN. Tumor diameter and RENAL nephrometry scores were greater in RN patients (P <.0001 and P = .0002, respectively). Pathologic stage T3 was seen in 40% of RN patients and 10% of PN patients (P = .0002). Histologic concordance was apparent in 60 of 123 patients (49%). Median follow-up for patients alive without a recurrence was 4 years. Five-year recurrence-free survival was 98% for PN and 85% for RN. Five-year overall survival was 96% for PN and 86% for RN (P = .5). Five-year freedom from chronic kidney disease upstaging was 74% for PN and 55% for RN (P = .11). CONCLUSION Partial nephrectomy for the treatment of unilateral, synchronous, multifocal, renal tumors with favorable characteristics was associated with a low recurrence rate. These findings suggest PN is an appropriate management strategy for this group of carefully selected patients.
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Affiliation(s)
- Roy Mano
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew Kent
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yaniv Larish
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew G Winer
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael S Chevinsky
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Abraham Ari Hakimi
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Itay A Sternberg
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Russo
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY.
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12
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Yu N, Fu S, Fu Z, Meng J, Xu Z, Wang B, Zhang A. Allotransplanting donor kidneys after resection of a small renal cancer or contralateral healthy kidneys from cadaveric donors with unilateral renal cancer: a systematic review. Clin Transplant 2013; 28:8-15. [PMID: 24118586 DOI: 10.1111/ctr.12262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 12/25/2022]
Affiliation(s)
- Nengwang Yu
- Urology Department; General Hospital of Jinan Military Command; Jinan China
| | - Shuai Fu
- Department of Thoracic Medical Oncology; Beijing Cancer Hospital; Beijing China
| | - Zhihou Fu
- Orthopedics Department; General Hospital of Jinan Military Command; Jinan
| | - Jianzhong Meng
- Blood purification Department; General Hospital of Jinan Military Command; Jinan
| | | | - Baocheng Wang
- Oncology department; General Hospital of Jinan Military Command; Jinan China
| | - Aimin Zhang
- Urology Department; General Hospital of Jinan Military Command; Jinan China
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Sorbellini M, Bratslavsky G. Decreasing the indications for radical nephrectomy: a study of multifocal renal cell carcinoma. Front Oncol 2012; 2:84. [PMID: 22888474 PMCID: PMC3412268 DOI: 10.3389/fonc.2012.00084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/16/2012] [Indexed: 12/11/2022] Open
Abstract
Multifocal renal cell carcinoma (RCC) has been reported in 5-25% of cases worldwide. Although management of patients with multifocal RCC has not been clearly defined, presence of multifocal renal masses in one kidney and a normal contralateral kidney has often been considered a reason for performing radical nephrectomy. This study reviews the world literature to provide an accurate estimate of the prevalence of multifocal RCC and evaluates the oncologic outcomes of multifocal RCC after exclusion of patients with known hereditary and familial renal syndromes. A PubMed search of the literature was performed for articles in the English language using the following terms for the query: "multifocal RCC," "multifocality and RCC," "multicentric RCC," or "bilateral RCC." The references of the published articles were also reviewed for additional publications. Articles that did not specifically exclude patients with familial RCC or known hereditary RCC syndromes were excluded for estimation of multifocality prevalence and oncologic outcomes. After applying our exclusion criteria, nine articles were selected and form the basis of the current analysis. Weighted averages were used to calculate the prevalence of multifocality. Multifocal RCC was found in 6.8% of cases (373 of 5433 patients). Ipsilateral multifocality was found in 6.8% of cases. Bilateral multifocality was found in 11.7% of cases. Of all cases reported in this study, only 10% underwent partial nephrectomy. The rest of the study cohort underwent radical nephrectomy. The review of the literature showed that the use of nephron-sparing techniques in patients with multifocal disease did not compromise oncologic outcomes, despite the need for reoperation in certain cases. In conclusion, multifocal RCC remains a prevalent entity. Most clinicians still prefer to perform radical nephrectomies in these patients despite proven equivalent oncologic outcomes compared to nephron-sparing techniques. Urologists should be aware of these data when proposing treatment options to patients with multifocal RCC.
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Shuch B, Singer EA, Bratslavsky G. The Surgical Approach to Multifocal Renal Cancers: Hereditary Syndromes, Ipsilateral Multifocality, and Bilateral Tumors. Urol Clin North Am 2012; 39:133-48, v. [DOI: 10.1016/j.ucl.2012.01.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Chen XS, Zhang ZT, Du J, Bi XC, Sun G, Yao X. Optimal Surgical Margin in Nephron-sparing Surgery for T1b Renal Cell Carcinoma. Urology 2012; 79:836-9. [DOI: 10.1016/j.urology.2011.11.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 11/08/2011] [Accepted: 11/15/2011] [Indexed: 11/30/2022]
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Shuch B, Linehan WM, Bratslavsky G. Repeat partial nephrectomy: surgical, functional and oncological outcomes. Curr Opin Urol 2011; 21:368-75. [PMID: 21788903 PMCID: PMC3173810 DOI: 10.1097/mou.0b013e32834964ea] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW The greater utilization of partial nephrectomy and ablative procedures has increased the incidence of patients presenting with local renal recurrence. The choice to either perform a partial or radical nephrectomy in these situations can be a challenging decision. RECENT FINDINGS Repeat and salvage partial nephrectomy, while challenging and potentially associated with increased complications, offers patients the ability to maintain excellent renal functional outcomes and promising oncologic outcomes at intermediate follow-up. SUMMARY Surgeons should be familiar with the surgical complications and the functional and oncologic outcomes of reoperative nephron-sparing surgery (NSS). Recent data and outcome analysis support utilization of these procedures in patients presenting with either local recurrence or de-novo lesions in the ipsilateral kidney.
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Affiliation(s)
| | | | - Gennady Bratslavsky
- Correspondence: Gennady Bratslavsky, M.D., Senior Staff, Urologic Oncology Branch, National Cancer Institute National Institutes of Health, 10 Center Drive MSC 1107, Building 10, CRC, Room 2W-5942, Bethesda, Maryland 20892-1107, , Tel: (301) 496-6353, Fax:(301) 480-5626
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Current World Literature. Curr Opin Support Palliat Care 2011; 5:297-305. [DOI: 10.1097/spc.0b013e32834a76ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Laydner H, Autorino R, Spana G, Altunrende F, Yang B, Khanna R, White MA, Isac W, Hillyer S, Haber GP, Stein RJ, Kaouk JH. Robot-assisted partial nephrectomy for sporadic ipsilateral multifocal renal tumours. BJU Int 2011; 109:274-80. [DOI: 10.1111/j.1464-410x.2011.10319.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Gómez-Veiga F, Alcaraz-Asensio A, Burgos-Revilla J, Cózar-Olmo J. [Advances in uro-oncology "OncoForum": the best of 2010]. Actas Urol Esp 2011; 35:315-24. [PMID: 21453988 DOI: 10.1016/j.acuro.2011.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 02/07/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To highlight the most important issues of the 2010 annual meetings of the European Association of Urology, EAU), the American Urological Association, AUA, the American Society of Clinical Oncology, ASCO, and the American Society for Therapeutic Radiology and Oncology, ASTRO. METHODS A group of experts in oncological urology selected the most important summaries of the four congresses. Subsequently, the revisors assessed the findings in relation to their present and future impact on clinical practice. This document includes the summaries with the highest points. RESULTS The following messages were considered important. In pT3 prostate cancer, postoperative radiotherapy (RT) improves local control and biochemical progression-free survival, with no significant impact on distant metastasis and overall survival. In patients with bladder cancer without muscle invasion and with the risk of intermediate recurrence, maintenance chemotherapy does not increase recurrence-free survival after transurethral resection. There is no evidence of a synergist effect of the combination of Temsirolimus/ Bevacizumab in patients with metastatic kidney cell carcinoma without prior treatment. In the SWENOTECA V protocol for the treatment of seminomatous germ-cell testicular cancer, the adjuvant RT was interrupted because the concern regarding the induction of secondary cancers was greater than the reduction of relapses. CONCLUSIONS In 2010, new data was produced on the diagnosis and treatment in oncological urology, thanks to the interesting work of different trials.
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Tsivian M, Moreira DM, Caso JR, Mouraviev V, Polascik TJ. Cigarette Smoking Is Associated With Advanced Renal Cell Carcinoma. J Clin Oncol 2011; 29:2027-31. [DOI: 10.1200/jco.2010.30.9484] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Cigarette smoking is a recognized risk factor for renal cell carcinoma (RCC), but little data are available on the association between smoking and RCC biology. We investigated the association between cigarette smoking and RCC stage in a large contemporary multiethnic surgical cohort. Patients and Methods We retrospectively reviewed the demographic, clinical, and pathologic data of patients undergoing surgery for RCC between 2000 and 2009. Advanced RCC was defined as metastatic disease, pathologic stage ≥ T3, and/or lymph node involvement. Self-reported smoking history included smoking status, duration, intensity, cumulative exposure, and cessation. Patient and tumor characteristics were compared between the groups in univariate and multivariate analyses. Results Of the 845 eligible patients, 19.4% and 29.1% were current and former smokers, respectively, and 207 patients (24.5%) had advanced disease. In both univariate and multivariate analyses, smoking was consistently associated with advanced RCC, and cessation reversed the risk. Current and former smokers had 1.5- and 1.6-fold increased odds of advanced disease, respectively. Heavier smoking (longer duration and exposure) was associated with increased risk of advanced RCC, whereas durable cessation reduced the odds of advanced disease. Conclusion Cigarette smoking is an independent risk factor for advanced RCC. Heavier smoking increases the likelihood of advanced disease. Durable smoking cessation attenuated the risk of advanced disease. Given that cigarette smoking is among the few modifiable risk factors for RCC, our results reinforce the importance of smoking cessation and encourage further investigation of the association between smoking and RCC biology.
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Tsivian A, Tsivian M, Benjamin S, Sidi AA. Laparoscopic partial nephrectomy for multiple tumours: feasibility and analysis of peri-operative outcomes. BJU Int 2010; 108:1330-4. [PMID: 21199286 DOI: 10.1111/j.1464-410x.2010.09995.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE • To describe our experience with laparoscopic partial nephrectomy (LPN) for multiple kidney tumours and compare the outcomes with LPN performed for single masses. PATIENTS AND METHODS • Retrospective analysis of medical records of patients undergoing LPN at our institution between 2005 and 2009 was performed. • The cohort was divided in two groups based on tumour focality: group 1, LPN for a single tumour (n= 99) and group 2, LPN for multiple ipsilateral tumours (n= 12). • The groups were compared with regards to demographic and peri-operative variables. RESULTS • Demographic variables were not different between the groups. Median dominant tumour size was 3.1 cm (interquartile range [IQR] 2.4-4.0) and 4.0 cm (2.3-5.9) in groups 1 and 2, respectively. • Median secondary tumour size in group 2 was 1.0 cm (1.0-1.8). • Operative times were longer in group 2 compared with group 1 (220 vs 160 min, P= 0.009). • Warm ischaemia times (WIT) (23 vs 22 min) and estimated blood loss (EBL) (100 vs 85 mL) were similar. CONCLUSIONS • LPN is a viable option for the treatment of multiple ipsilateral renal tumours. • Peri-operative outcomes are similar to standard LPN with the exception of longer operative time. • In experienced hands, the advantages of minimally invasive surgery may be extended to select patients with ipsilateral multifocal renal tumours.
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Affiliation(s)
- Alexander Tsivian
- Department of Urologic Surgery, the E. Wolfson Medical Center, Holon, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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