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Lin BH, Chen SH, Ruan ZT, Gao RC, Qiu QRS, Chen YH, Zheng QS, Wei Y, Xue XY, Xu N. A Novel Classification System of Renal Hilar Tumors for Surgical Guidance: Technique, Outcome, and Safety. Ann Surg Oncol 2024:10.1245/s10434-024-15470-y. [PMID: 38824192 DOI: 10.1245/s10434-024-15470-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/29/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND This study was designed to develop an innovative classification and guidance system for renal hilar tumors and to assess the safety and effectiveness of robot-assisted partial nephrectomy (RAPN) for managing such tumors. METHODS A total of 179 patients undergoing RAPN for renal hilar tumors were retrospectively reviewed. A novel classification system with surgical techniques was introduced and the perioperative features, tumor characteristics, and the efficacy and safety of RAPN were compared within subgroups. RESULTS We classified the tumors according to our novel system as follows: 131 Type I, 35 Type II, and 13 Type III. However, Type III had higher median R.E.N.A.L., PADUA, and ROADS scores compared with the others (all p < 0.001), indicating increased operative complexity and higher estimated blood loss [180.00 (115.00-215.00) ml]. Operative outcomes revealed significant disparities between Type III and the others, with longer operative times [165.00 (145.00-200.50) min], warm ischemia times [24.00 (21.50-30.50) min], tumor resection times [13.00 (12.00-15.50) min], and incision closure times [22.00 (20.00-23.50) min] (all p < 0.005). Postoperative outcomes also showed significant differences, with longer durations of drain removal (77.08 ± 18.16 h) and hospitalization for Type III [5.00 (5.00-6.00) d] (all p < 0.05). Additionally, Type I had a larger tumor diameter than the others (p = 0.009) and pT stage differed significantly between the subtypes (p = 0.020). CONCLUSIONS The novel renal hilar tumor classification system is capable of differentiating the surgical difficulty of RAPN and further offers personalized surgical steps tailored to each specific classification. It provides a meaningful tool for clinical practice.
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Affiliation(s)
- Bo-Han Lin
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Urology, National Region Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shao-Hao Chen
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Urology, National Region Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhong-Tian Ruan
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Urology, National Region Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Rui-Cheng Gao
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Urology, National Region Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Qian-Ren-Shun Qiu
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Urology, National Region Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ye-Hui Chen
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Urology, National Region Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Qing-Shui Zheng
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Urology, National Region Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yong Wei
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Urology, National Region Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xue-Yi Xue
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
- Department of Urology, National Region Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
| | - Ning Xu
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
- Department of Urology, National Region Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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Powles T, Albiges L, Bex A, Comperat E, Grünwald V, Kanesvaran R, Kitamura H, McKay R, Porta C, Procopio G, Schmidinger M, Suarez C, Teoh J, de Velasco G, Young M, Gillessen S. Renal cell carcinoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2024:S0923-7534(24)00676-8. [PMID: 38788900 DOI: 10.1016/j.annonc.2024.05.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Affiliation(s)
- T Powles
- Barts Cancer Institute, Queen Mary University of London and Royal Free London NHS Foundation Trust, Department of Medical Oncology, London, UK
| | - L Albiges
- Université Paris Saclay, Institut Gustave Roussy, Villejuif, France
| | - A Bex
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London; Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - E Comperat
- Department of Pathology, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria
| | - V Grünwald
- Interdisciplinary Genitourinary Oncology, West German Cancer Center Clinic for Internal Medicine and Clinic for Urology, University Hospital Essen, Essen, Germany
| | - R Kanesvaran
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - H Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - R McKay
- Department of Medicine and Urology, University of California San Diego, La Jolla, USA
| | - C Porta
- Interdisciplinary Department of Medicine, University of Bari 'A. Moro', Bari; Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari
| | - G Procopio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - M Schmidinger
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - C Suarez
- Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - J Teoh
- S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - G de Velasco
- Instituto de Investigación i+12 and Departamento de Oncología Médica, Hospital University 12 de Octubre, Madrid, Spain
| | - M Young
- Barts Cancer Institute, Queen Mary University of London and Royal Free London NHS Foundation Trust, Department of Medical Oncology, London, UK; Barts Cancer Institute, Department of Experimental Cancer Medicine, Queen Mary University of London, London, UK
| | - S Gillessen
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona; Università della Svizzera Italiana, Lugano, Switzerland
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Rawal S, Ganpule A, Singh G, Shrivastava N, Kishore TA, Dubey D, Mavuduru RS, Kumar A, Gautam G, Pooleri GK, Keshavamurthy M, Ragavan N, Baxi H, Addla SK, Raghunath SK, Dahiya A, Gupta D, Sharma G. Perioperative and functional outcomes following robot-assisted partial nephrectomy: Descriptive analysis of Indian study group on partial nephrectomy database. Indian J Urol 2024; 40:121-126. [PMID: 38725898 PMCID: PMC11078450 DOI: 10.4103/iju.iju_443_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/16/2024] [Accepted: 03/03/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction There is an unmet need for high-quality data for Robot-assisted partial nephrectomy (RAPN) in the Indian population. Indian study group on partial nephrectomy (ISGPN) is a consortium of Indian centers contributing to the partial nephrectomy (PN) database. The current study is a descriptive analysis of perioperative and functional outcomes following RAPN. Methods For this study, the retrospective ISGPN database was reviewed, which included patients who underwent RAPN for renal masses at 14 centers across India from September 2010 to September 2022. Demographic, clinical, radiological, perioperative, and functional data were collected and analyzed. Ethics approval was obtained from each of the participating centers. Results In this study, 782 patients were included, and 69.7% were male. The median age was 53 years (interquartile range [IQR 44-62]), median operative time was 180 min (IQR 133-240), median estimated blood loss was 100 mL (IQR 50-200), mean warm ischemia time was 22.7 min and positive surgical margin rates were 2.5%. The complication rate was 16.2%, and most of them were of minor grade. Trifecta and pentafecta outcomes were attained in 61.4% and 60% of patients, respectively. Conclusions This is the largest Indian multi-centric study using the Indian Robotic PN Collaborative database to evaluate the outcomes of robot-assisted PN, and has proven its safety and efficacy in the management of renal masses.
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Affiliation(s)
- Sudhir Rawal
- Department of Genito Uro-Oncology Services, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Gurpremjit Singh
- Department of Uro-Oncology and Robotic Surgery, Medanta, Gurugram, Haryana, India
| | - Nikita Shrivastava
- Department of Urology, DKS Super Speciality Hospital and Postgraduate Institute, Raipur, Chhattisgarh, India
| | - T. A. Kishore
- Department of Urology, Aster Medicity, Kochi, Kerala, India
| | - Deepak Dubey
- Department of Urology, Manipal Hospital, Bengaluru, India
| | - Ravimohan S. Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anant Kumar
- Department of Urology and Renal Transplantation, Max Hospitals, Delhi, India
| | - Gagan Gautam
- Department of Uro-Oncology and Robotic Surgery, Max Institute of Cancer Care, New Delhi, India
| | - Ginil Kumar Pooleri
- Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | | | - Hemang Baxi
- Department of Urology, HCG Cancer Center, Ahmedabad, Gujarat, India
| | - Sanjai Kumar Addla
- Department of Uro Oncology, Apollo Hospital, Hyderabad, Telangana, India
| | | | - Akhil Dahiya
- Department of Clinical and Medical Affairs, Intuitive Surgical, California, USA
| | | | - Gopal Sharma
- Department of Urology, Medanta, Gurugram, Haryana, India
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Li P, Xu Q, Liu K, Ye J. CRYL1 is a Potential Prognostic Biomarker of Clear Cell Renal Cell Carcinoma Correlated with Immune Infiltration and Cuproptosis. Technol Cancer Res Treat 2024; 23:15330338241237439. [PMID: 38497139 PMCID: PMC10946081 DOI: 10.1177/15330338241237439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Clear cell renal cell carcinoma (ccRCC) is a widespread urogenital neoplasm. However, the therapeutic efficacy of these methods is unsatisfactory. In-depth screening of biomarkers could aid early diagnosis and therapy and predict patient prognosis. METHODS The GEO datasets were selected with specific criteria. Differentially expressed gene (DEG), weighted gene coexpression network analysis (WGCNA), protein-protein interaction, LASSO, random forest, and Cox regression analyses were applied to identify the independent prognostic biomarkers. Survival analysis, correlation with clinical features, gene set enrichment analysis (GSEA), GO enrichment, immune infiltration analysis, and correlation with cuproptosis-related genes were carried out to determine the prognostic value and possible molecular mechanisms of the TSVR. Wound healing assays, transwell assays, cell colony formation experiments, flow cytometry, and immunohistochemistry (IHC) analysis were used to validate the functional attributes of CRYL1. RESULTS Four GEO datasets were included to screen for hub genes. DEG combined with WGCNA showed a key module with 300 genes having the strongest correlation with "survival state" (R2 = -0.24 and P = 7e-8); six genes were identified by LASSO, random forest, and Cytoscape. Finally, CRYL1 (hazard ratio (HR) = 2.01, P < 0.001) was selected as an independent prognostic biomarker. The higher CRYL1 expression group had better DFS and overall survival (OS). GSEA demonstrated that the CRYL1-related DEGs were enriched mainly in the metabolism of sugar, fat, and amino acids. CRYL1 is positively correlated with FDX1 and the LIAS pathway, which are important molecule involved in cuproptosis. CRYL1 affects the infiltration abundance of four immune cells and can predict a positive OS. Wound healing, transwell, cell colony formation, and flow cytometry assays demonstrated that CRYL1 silencing enhances migration and proliferation and leads to a decreased apoptotic ratio. IHC analysis suggested that CRYL1 was highly expressed in adjacent tissues. CONCLUSIONS CRYL1 is a robust predictive marker for clinicopathological characteristics and survival status in ccRCC patients.
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Affiliation(s)
- Peng Li
- The 6th affiliated hospital of wenzhou medical university, Lishui city people's hospital, Lishui, Zhejiang, China
- Lishui city people's hospital, The first affiliated hospital of Lishui University, Lishui, Zhejiang, China
| | - Qiangqiang Xu
- The 6th affiliated hospital of wenzhou medical university, Lishui city people's hospital, Lishui, Zhejiang, China
- Lishui city people's hospital, The first affiliated hospital of Lishui University, Lishui, Zhejiang, China
| | - Ken Liu
- The 6th affiliated hospital of wenzhou medical university, Lishui city people's hospital, Lishui, Zhejiang, China
- Lishui city people's hospital, The first affiliated hospital of Lishui University, Lishui, Zhejiang, China
| | - Junjie Ye
- The 6th affiliated hospital of wenzhou medical university, Lishui city people's hospital, Lishui, Zhejiang, China
- Lishui city people's hospital, The first affiliated hospital of Lishui University, Lishui, Zhejiang, China
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Timm B, Thomson A, Bolton D, Pether M. Pre-gerotal fat patch-A novel alternative to haemostatic agents during partial nephrectomy. BJUI COMPASS 2023; 4:709-714. [PMID: 37818025 PMCID: PMC10560614 DOI: 10.1002/bco2.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/12/2023] [Accepted: 05/25/2023] [Indexed: 10/12/2023] Open
Abstract
Objective This study aimed to determine if using a pre-gerotal fat patch at open partial nephrectomy (PN) as a haemostatic bolster is a viable alternative to using synthetic haemostatic agents. Materials and methods Human Research Ethics Committee approval was obtained for audit of a prospectively kept database from July 2012 to July 2021, which followed outcomes of patients who received a low-tension pre-gerotal fat patch renorrhaphy at open PN. Patient demographics, intraoperative measures, histological outcomes and post-operative complications were analysed. Using a retroperitoneal approach, the peritoneum was mobilised and a vascularised pedicle of pre-gerotal fat was rotated in the direction of the kidney. Routine definition of the hilum, clamping of the hilar vessels and dissection of mass followed. After watertight closure and haemostasis, the harvested pre-gerotal fat patch was placed over the defect and secured using low-tension renorrhaphy. Two-layer closure of the abdominal wall with placement of a drain was routine. Results A total of 55 patients underwent open PN. Mean age was 60.4 (35-77) years. There were 38 men and 17 women, and 32 right and 23 left PNs. Mean mass size was 31.9 mm (10-95 mm) and collecting system was breached in 36.5% of cases. One patient (1.9%) suffered a Clavien-Dindo IIIb complication requiring return to theatre and transfusion due to a bleed from an intercostal artery. There were no renal bed bleeds, urine leaks or urine fistulas detected. Mean intraoperative blood loss was 355 mL (50-1500 mL) and mean post-operative creatinine increased by 10.7 μmol/L (51-172 μmol/L). Mean follow up was 40.2 (4-109) months. Conclusion Utilisation of an anatomical pre-gerotal fat patch to provide pressure at the renorrhaphy site during open PN is an effective technique to assist with surgical haemostasis. This simple technique avoids the costs of haemostatic agents, whilst adding minimal operating time to procedures.
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Affiliation(s)
- Brennan Timm
- Bunbury Regional HospitalBunburyWestern AustraliaAustralia
| | | | | | - Michael Pether
- Bunbury Regional HospitalBunburyWestern AustraliaAustralia
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Yang H, Wu K, Liu H, Wu P, Yuan Y, Wang L, Liu Y, Zeng H, Li J, Liu W, Wu S. An automated surgical decision-making framework for partial or radical nephrectomy based on 3D-CT multi-level anatomical features in renal cell carcinoma. Eur Radiol 2023; 33:7532-7541. [PMID: 37289245 PMCID: PMC10598088 DOI: 10.1007/s00330-023-09812-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine whether 3D-CT multi-level anatomical features can provide a more accurate prediction of surgical decision-making for partial or radical nephrectomy in renal cell carcinoma. METHODS This is a retrospective study based on multi-center cohorts. A total of 473 participants with pathologically proved renal cell carcinoma were split into the internal training and the external testing set. The training set contains 412 cases from five open-source cohorts and two local hospitals. The external testing set includes 61 participants from another local hospital. The proposed automatic analytic framework contains the following modules: a 3D kidney and tumor segmentation model constructed by 3D-UNet, a multi-level feature extractor based on the region of interest, and a partial or radical nephrectomy prediction classifier by XGBoost. The fivefold cross-validation strategy was used to get a robust model. A quantitative model interpretation method called the Shapley Additive Explanations was conducted to explore the contribution of each feature. RESULTS In the prediction of partial versus radical nephrectomy, the combination of multi-level features achieved better performance than any single-level feature. For the internal validation, the AUROC was 0.93 ± 0.1, 0.94 ± 0.1, 0.93 ± 0.1, 0.93 ± 0.1, and 0.93 ± 0.1, respectively, as determined by the fivefold cross-validation. The AUROC from the optimal model was 0.82 ± 0.1 in the external testing set. The tumor shape Maximum 3D Diameter plays the most vital role in the model decision. CONCLUSIONS The automated surgical decision framework for partial or radical nephrectomy based on 3D-CT multi-level anatomical features exhibits robust performance in renal cell carcinoma. The framework points the way towards guiding surgery through medical images and machine learning. CLINICAL RELEVANCE STATEMENT We proposed an automated analytic framework that can assist surgeons in partial or radical nephrectomy decision-making. The framework points the way towards guiding surgery through medical images and machine learning. KEY POINTS • The 3D-CT multi-level anatomical features provide a more accurate prediction of surgical decision-making for partial or radical nephrectomy in renal cell carcinoma. • The data from multicenter study and a strict fivefold cross-validation strategy, both internal validation set and external testing set, can be easily transferred to different tasks of new datasets. • The quantitative decomposition of the prediction model was conducted to explore the contribution of each extracted feature.
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Affiliation(s)
- Huancheng Yang
- Teaching Center of Shenzhen Luohu Hospital, Shantou University Medical College, Shantou, 515000, China
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
- Shantou University Medical College, Shantou University, Shantou, 515000, China
- Shenzhen Following Precision Medical Research Institute, Luohu Hospital Group, Shenzhen, 51800, China
| | - Kai Wu
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
- Shenzhen Following Precision Medical Research Institute, Luohu Hospital Group, Shenzhen, 51800, China
| | - Hanlin Liu
- Department of Radiology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
| | - Peng Wu
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
- Shenzhen Following Precision Medical Research Institute, Luohu Hospital Group, Shenzhen, 51800, China
| | - Yangguang Yuan
- Department of Radiology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
| | - Lei Wang
- Department of Radiology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
| | - Yaru Liu
- Department of Radiology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
| | - Haoyang Zeng
- Teaching Center of Shenzhen Luohu Hospital, Shantou University Medical College, Shantou, 515000, China
- Shantou University Medical College, Shantou University, Shantou, 515000, China
| | - Junkai Li
- Teaching Center of Shenzhen Luohu Hospital, Shantou University Medical College, Shantou, 515000, China
- Shantou University Medical College, Shantou University, Shantou, 515000, China
| | - Weihao Liu
- Teaching Center of Shenzhen Luohu Hospital, Shantou University Medical College, Shantou, 515000, China
- Shantou University Medical College, Shantou University, Shantou, 515000, China
| | - Song Wu
- Teaching Center of Shenzhen Luohu Hospital, Shantou University Medical College, Shantou, 515000, China.
- Shenzhen Following Precision Medical Research Institute, Luohu Hospital Group, Shenzhen, 51800, China.
- Department of Urology, South China Hospital, Health Science Center, Shenzhen University, Shenzhen, 518116, China.
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Nakayama Y, Sakano S, Shinohara Y, Nishijima J, Ban Y, Hidaka Y, Fukuda M, Shiraishi K. The effect of antiplatelet therapy on outcomes in patients who underwent laparoscopic radical nephrectomy: A Japanese single-center study. Asian J Endosc Surg 2023; 16:679-686. [PMID: 37340623 DOI: 10.1111/ases.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES The number of patients receiving antiplatelet therapy (APT) who have undergone laparoscopic radical nephrectomy is increasing. However, it is unclear whether APT affects the outcomes of patients undergoing radical nephrectomy. We investigated the perioperative outcomes of radical nephrectomy in patients with and without APT. METHODS We retrospectively collected data from 89 Japanese patients who underwent laparoscopic radical nephrectomy for clinically diagnosed renal cell carcinoma (RCC) at Kokura Memorial Hospital between March 2013 and March 2022. We analyzed information related to APT. We divided the patients into two groups: the APT group (patients receiving APT) and the N-APT group (patients not receiving APT). Moreover, the APT group was further divided into the C-APT group (patients with continuous APT) and the I-APT group (patients with interrupted APT). We compared the surgical outcomes of these groups. RESULTS Among 89 patients eligible for the study, 25 received APT and 10 continued APT. Even though the patients who received APT had a high American Society of Anesthesiologists physical status and many complications, including smoking, diabetes, hypertension, and chronic heart failure, no significant difference in the intra- or postoperative outcomes, including bleeding complications, was observed regardless of whether the patients received APT or continued APT. CONCLUSIONS We concluded that in laparoscopic radical nephrectomy, continuation of APT is an acceptable strategy for patients with thromboembolic risk caused by interruption of APT.
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Affiliation(s)
- Yuki Nakayama
- Department of Urology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Shigeru Sakano
- Department of Urology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yota Shinohara
- Department of Urology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Jun Nishijima
- Department of Urology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yoshimasa Ban
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Yukihiro Hidaka
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Masashi Fukuda
- Department of Urology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Koji Shiraishi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
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Okhawere KE, Pandav K, Grauer R, Wilson MP, Saini I, Korn TG, Meilika KN, Badani KK. Trends in the surgical management of kidney cancer by tumor stage, treatment modality, facility type, and location. J Robot Surg 2023; 17:2451-2460. [PMID: 37470910 DOI: 10.1007/s11701-023-01664-1] [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: 05/26/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
Partial nephrectomy (PN) is an alternative to radical nephrectomy (RN) in the appropriate localized renal tumor. The scope of PN has expanded over time and, since the advent and proliferation of minimally invasive surgery, more surgeons have access to and have been trained in laparoscopic and robotic technology. Amid the changing surgical landscape, we sought to characterize the trends in management by cancer stage, institution type, and geographic location using the National Cancer Database (NCDB). We queried the NCDB for patients with kidney cancer from 2004 to 2019. Overall, 241,311 patients who underwent PN or RN were included in the study. The nephrectomy approach was categorized as robotic partial (RPN), robotic radical (RRN), laparoscopic partial (LPN), laparoscopic radical (LRN), open or unspecified partial (OPN), and open or unspecified radical (ORN). The categorical variables were presented as frequency and percentages. Overall, there was an increase in the utilization of robotic approaches from 2010 to 2019. For cT1 tumors, the use of RPN and RRN increased from 14.27 to 33.06% and 5.24% to 19.63%, respectively. The use of ORN for cT2 and cT3 tumors declined, with rates dropping from 54.71 to 10.76% and 64.71 to 46.64%, respectively. Conversely, the utilization of RRN rose during this period. However, ORN remained the most common approach for cT3 tumors. The use of RPN increased across different facility types, with the highest utilization observed in academic/research programs. The use of ORN for cT2 and cT3 tumors declined across facility types, although it remained most prevalent in community cancer programs. The use of robot-assisted surgery to treat localized renal cancer increased in the US between 2010 and 2019 across all stages of disease. RPN became the most used approach for cT1 disease, while LRN was preferred for cT2 disease. ORN remained the approach of choice for cT3 disease throughout the study period. Trends in facility type and geographic location largely mirrored the overall trends.
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Affiliation(s)
- Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Krunal Pandav
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Michael P Wilson
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Indu Saini
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Talia G Korn
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Kirolos N Meilika
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA.
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9
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Lv Z, Chen G, Chen X, Li Y, Bao E, Hu K, Yu X. Open versus robot-assisted partial nephrectomy for highly complex renal masses: a meta-analysis of perioperitive and functional outcomes. J Robot Surg 2023; 17:1955-1965. [PMID: 37415066 DOI: 10.1007/s11701-023-01652-5] [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: 04/20/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023]
Abstract
Robot-assisted partial nephrectomy (RAPN) is increasingly being used for the complex surgical management of renal masses. The comparison of RAPN with open partial nephrectomy (OPN) has not yet led to a unified conclusion with regard to perioperative outcomes. To conduct a systematic review and meta-analysis of the literature on the perioperative outcomes of RAPN compared with OPN. We performed a systematic search in PubMed, Embase, Web of Science, and Cochrane Library database for randomized control trials (RCTs) and non-RCTs that compare OPN to RAPN. The primary outcomes included perioperative, functional and oncologic. The odds ratio (OR) and weighted mean difference (WMD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CIs). Five studies, comprising 936 patients, were included in the meta-analysis. Our findings indicated that there were no significant differences in blood loss, minor complication rate, eGFR decline from baseline, positive surgical margin, and ischemia time between OPN and RAPN. However, RAPN was associated with a shorter hospital stay (WMD 1.64 days, 95% CI - 1.17 to 2.11; p < 0.00001), lower overall complication rate (OR 1.72, 95% CI 1.21-2.45; p < 0.002), lower transfusion rate (OR 2.64, 95% CI 1.39-5.02; p = 0.003) and lower major complication rate (OR 1.76, 95% CI 1.11-2.79; p < 0.02) compared to OPN. Additionally, the operation time for OPN was shorter than that for RAPN (WMD - 10.77 min, 95% CI - 18.49 to - 3.05, p = 0.006). In comparison with OPN, RAPN exhibits better results in terms of hospital stay, overall complications, blood transfusion rate, and major complications, with no significant difference in intraoperative blood loss, minor complications, PSM, ischemia time, and short-term postoperative eGFR decline. However, the operation time of OPN is slightly shorter than that of RAPN.
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Affiliation(s)
- ZongYing Lv
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - GuiYuan Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - XiaoBin Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yugen Li
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - ErHao Bao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ke Hu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - XiaoDong Yu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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10
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Chen S, Fan S, Guan H, Yang K, Li Z, Xiong S, Wang X, Li Z, Shen C, Zhou L, Li X. The application of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy with a new robotic system KangDuo Surgical Robot-01: Initial experience. Asian J Urol 2023; 10:482-487. [PMID: 38024439 PMCID: PMC10659978 DOI: 10.1016/j.ajur.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/21/2023] [Accepted: 03/15/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To assess the feasibility of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy (rRAPN) with a new robotic platform called KangDuo Surgical Robot-01 (KD-SR-01) system (Suzhou KangDuo Robot Co., Ltd., Suzhou, China) and discuss its surgical technique. Methods A 44-year-old male patient was admitted with a 2.5 cm tumor on dorsolateral upper pole of the left kidney. The R.E.N.A.L. nephrometry score of this patient was 4x. This patient underwent rRAPN with KD-SR-01. The perinephric fat between the tumor and Gerota's fascia was preserved, which was used for internal suspension traction during tumor resection. Postoperative follow-up data were collected. Results The surgery was successfully carried out with a duration of 127 min, in which the docking time was 6 min 25 s and console time was 60 min. The warm ischemia time was 19 min 53 s, and the estimated blood loss was 0 mL. The pathological histology showed a pathological tumor stage 1a clear cell renal cell carcinoma, with a negative surgical margin. The World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade of this patient was Grade 2. No recurrence was observed during the 6-month follow-up. Conclusion Internal suspension in rRAPN is feasible and effective with use of the new robotic system KD-SR-01.
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Affiliation(s)
| | | | | | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Xiang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Zhenyu Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
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11
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MacLennan S, Wintner LM, Beyer K, Lawlor A, Tripathee S, Dabestani S, Marconi L, Giles RH, Woodward R, Van Hemelrijck M, Bex A, Zondervan P. A protocol for the development of core outcome sets for effectiveness trials and clinical audits in renal cell cancer (R-COS). BJUI COMPASS 2023; 4:504-512. [PMID: 37636213 PMCID: PMC10447209 DOI: 10.1002/bco2.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/17/2023] [Accepted: 06/04/2023] [Indexed: 08/29/2023] Open
Abstract
Background There is inconsistency in outcomes collected in renal cell cancer (RCC) intervention effectiveness studies and variability in their definitions. This makes critical summaries of the evidence base difficult and sub-optimally informative for clinical practice guidelines and decision-making by patients and healthcare professionals. A solution is to develop a core outcome set (COS), an agreed minimum set of outcomes to be reported in all trials in a clinical area. Objectives To develop three COS for (a) localised, (b) locally advanced and (c) metastatic. RCC study design participants and methods The methods are the same for each of our three COS and are structured in two phases. Phase 1 identifies potentially relevant outcomes by conducting both a systematic literature review and patient interviews (N ~ 30 patients). Qualitative data will be analysed using framework analysis. In phase 2, all outcomes identified in phase 1 will be entered in a modified eDelphi, whereby patients and healthcare professionals (50 of each) will score each outcome's importance (Likert scale from 1 [not important] to 9 [critically important]). Outcomes scored in the 7-9 range by ≥70% and 1-3 by ≤15% will be regarded as 'consensus in', and the vice versa of this will constitute 'consensus out'. All other combinations will be regarded as equivocal and discussed at consensus meetings (including 10 patients and 10 healthcare professionals) in order to vote on them and ratify the results of the eDelphi. Discussion The R-COS will reduce outcome reporting heterogeneity and improve the evidence base for RCC. Study registration The study is registered with the COMET initiative: https://www.comet-initiative.org/studies/details/1406.
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Affiliation(s)
- Steven MacLennan
- Academic Urology Unit, Institute of Applied Health SciencesUniversity of AberdeenAberdeenUK
| | - Lisa M. Wintner
- University Hospital of Psychiatry IIMedical University of InnsbruckAustria
| | - Katharina Beyer
- Translational Oncology and Urology Research (TOUR)King's College LondonLondonUK
| | - Ailbhe Lawlor
- Translational Oncology and Urology Research (TOUR)King's College LondonLondonUK
| | - Sheela Tripathee
- Academic Urology Unit, Institute of Applied Health SciencesUniversity of AberdeenAberdeenUK
| | - Saeed Dabestani
- Department of Translational Medicine, Division of Urological CancersLund UniversityLundSweden
- Department of UrologyKristianstad Central Hospital, Region SkaneKristianstadSweden
| | - Lorenzo Marconi
- Department of UrologyCoimbra University HospitalCoimbraPortugal
| | - Rachel H. Giles
- International Kidney Cancer CoalitionDuivendrechtThe Netherlands
| | | | | | - Axel Bex
- Department of UrologyAmsterdam University Medical CentersAmsterdamThe Netherlands
- Specialist Centre for Kidney CancerRoyal Free HospitalLondonUK
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
| | - Patricia Zondervan
- Department of UrologyAmsterdam University Medical CentersAmsterdamThe Netherlands
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12
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Lee CU, Alabbasi M, Chung JH, Kang M, Seo SI. How far has robot-assisted partial nephrectomy reached? Investig Clin Urol 2023; 64:435-447. [PMID: 37668199 PMCID: PMC10482664 DOI: 10.4111/icu.20230121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 09/06/2023] Open
Abstract
Nephron-sparing surgery is the standard treatment for small renal mass (SRM). Nephron-sparing surgery has evolved from an open to a minimally invasive technique. Robot-assisted partial nephrectomy (RAPN) is the latest technique in this field and is reported to be safe and feasible, showing oncologically and functionally superior or compatible results compared with open and laparoscopic partial nephrectomy for SRM. This is not limited to only SRM but also applies to large and complex renal masses and other challenging situations. RAPN showed good oncological and functional outcomes for ≥clinical T2 renal tumors, complex renal masses (PADUA score ≥10, RENAL score ≥10), hilar renal tumors, and multiple renal tumors. In addition, the outcomes of RAPN in these challenging cases were not inferior to those in conventional cases. RAPN could also be applied to a number of challenging cases in which the open technique was considered first. RAPN showed good results in patients with a solitary kidney, horseshoe kidney, and in repeat surgeries. Furthermore, RAPN could be safely performed on obese, elderly, and pediatric patients. Finally, this review evaluates efficiency and utility of RAPN based on the results of challenging cases of renal masses and to project the future of RAPN.
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Affiliation(s)
- Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mahmood Alabbasi
- Bahrain Defence Force Royal Medical Services, Riffa, Southern, Bahrain
| | - Jae Hoon Chung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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13
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Méndez-Vidal MJ, Lázaro Quintela M, Lainez-Milagro N, Perez-Valderrama B, Suárez Rodriguez C, Arranz Arija JÁ, Peláez Fernández I, Gallardo Díaz E, Lambea Sorrosal J, González-del-Alba A. SEOM SOGUG clinical guideline for treatment of kidney cancer (2022). Clin Transl Oncol 2023; 25:2732-2748. [PMID: 37556095 PMCID: PMC10425490 DOI: 10.1007/s12094-023-03276-5] [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: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 08/10/2023]
Abstract
Renal cancer is the seventh most common cancer in men and the tenth in women. The aim of this article is to review the diagnosis, treatment, and follow-up of renal carcinoma accompanied by recommendations with new evidence and treatment algorithms. A new pathologic classification of RCC by the World Health Organization (WHO) was published in 2022 and this classification would be considered a "bridge" to a future molecular classification. For patients with localized disease, surgery is the treatment of choice with nephron-sparing surgery recommended when feasible. Adjuvant treatment with pembrolizumab is an option for intermediate-or high-risk cases, as well as patients after complete resection of metastatic disease. More data are needed in the future, including positive overall survival data. Clinical prognostic classification, preferably IMDC, should be used for treatment decision making in mRCC. Cytoreductive nephrectomy should not be deemed mandatory in individuals with intermediate-poor IMDC/MSKCC risk who require systemic therapy. Metastasectomy can be contemplated in selected subjects with a limited number of metastases or long metachronous disease-free interval. For the population of patients with metastatic ccRCC as a whole, the combination of pembrolizumab-axitinib, nivolumab-cabozantinib, or pembrolizumab-lenvatinib can be considered as the first option based on the benefit obtained in OS versus sunitinib. In cases that have an intermediate IMDC and poor prognosis, the combination of ipilimumab and nivolumab has demonstrated superior OS compared to sunitinib. As for individuals with advanced RCC previously treated with one or two antiangiogenic tyrosine-kinase inhibitors, nivolumab and cabozantinib are the options of choice. When there is progression following initial immunotherapy-based treatment, we recommend treatment with an antiangiogenic tyrosine-kinase inhibitor. While no clear sequence can be advocated, medical oncologists and patients should be aware of the recent advances and new strategies that improve survival and quality of life in the setting of metastatic RC.
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Affiliation(s)
- María José Méndez-Vidal
- Medical Oncology Department, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Martin Lázaro Quintela
- Medical Oncology Department, Hospital Alvaro Cunqueiro-Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain
| | - Nuria Lainez-Milagro
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Pamplona, Spain
| | | | | | | | | | | | - Julio Lambea Sorrosal
- Medical Oncology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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14
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Hu X, Wang Y, Shao Y, Wu K, Tang Y, Ren S, Li X. Radical versus partial nephrectomy for T1 non-clear cell renal cell carcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1519-1523. [PMID: 36958950 DOI: 10.1016/j.ejso.2023.03.212] [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: 11/24/2022] [Revised: 01/22/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Nephron-sparing surgery is the recommended surgical management of T1 renal cell carcinoma (RCC). However, non-clear cell RCC (nccRCC) is heterogeneous and included many histological types. Therefore, the present study was performed to compare radical nephrectomy (RN) versus partial nephrectomy (PN) in nccRCC. MATERIALS AND METHODS Within the Surveillance, Epidemiology, and End Results registry (2000-2019), the patients with nccRCC were identified. Kaplan-Meier survival curve and the log-rank test were conducted. Univariate analysis and multivariate Cox regression analysis were performed to explore the prognostic factors. RESULTS A total of 7575 patients with nccRCC were included, of which papillary RCC (n = 5219) is the major histology. Kaplan-Meier plots and log-rank tests showed that nccRCC patients who underwent RN had significantly worse overall survival (OS) and cancer-specific survival (CSS) than those who received PN (all P < 0.05). Multivariate analysis also revealed that RN was significantly associated with poor OS and CSS in nccRCC patients. Stratified by histological types, the multivariate analysis also revealed that RN was significantly associated with poor OS in papillary and chromophobe (all P < 0.05). Besides, the multivariable analysis indicated that RN was associated with poor CSS in papillary RCC (P < 0.05). For other histology, the patients who received RN had a comparable survival to those who received PN. CONCLUSION For patients with T1 nccRCC, our findings revealed that PN was not inferior to RN in OS and CSS. PN may be also the preferred option for T1 nccRCC, but more prospective studies are required to validate this finding.
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Affiliation(s)
- Xu Hu
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Yaohui Wang
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Yanxiang Shao
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Kang Wu
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Yaxiong Tang
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Shangqing Ren
- Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China.
| | - Xiang Li
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, China.
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15
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Andrade WS, Tang FHF, Mariotti ACH, Mancini MW, Duarte IX, Singer EA, Weiss RE, Pasqualini R, Arap W, Arap MA. Preclinical optimization of a diode laser-based clamp-free partial nephrectomy in a large animal model. Sci Rep 2023; 13:9237. [PMID: 37286592 DOI: 10.1038/s41598-023-35891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
Kidney cancer is a common urologic malignancy with either laparoscopic (LPN) or robotic partial nephrectomy as therapeutic options of choice for localized tumors. However, renal resection and suturing are challenging steps of the procedure that can lead to complications such as prolonged warm ischemia, bleeding, and urinary fistulas. LPN with a diode laser is an efficient technique due to its cutting and/or coagulation attributes. Surprisingly, key laser features such as wavelength and power remain undefined. Using a large porcine model, we evaluated the laser range of wavelength and power in a clamp-free LPN and compared it to the established gold-standard LPN technique (i.e., cold-cutting and suturing). By analyzing surgery duration, bleeding, presence of urine leak, tissue damage related to the resected renal fragment and the remaining organ, hemoglobin levels, and renal function, we show that an optimized experimental diode laser clamp-free LPN (wavelength, 980 nm; power, 15 W) had shorter surgery time with less bleeding, and better postoperative renal function recovery when compared to the well-established technique. Together, our data indicate that partial nephrectomy with a diode laser clamp-free LPN technique is an improved alternative to the gold-standard technique. Therefore, translational clinical trials towards human patient applications are readily feasible.
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Affiliation(s)
| | - Fenny H F Tang
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
- Division of Cancer Biology, Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Marilia W Mancini
- Research and Education Center for Phototherapy in Health Sciences (NUPEN), São Carlos, SP, Brazil
| | | | - Eric A Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Section of Urologic Oncology, Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Robert E Weiss
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
- Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Renata Pasqualini
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
- Division of Cancer Biology, Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Wadih Arap
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA.
- Division of Hematology/Oncology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Marco A Arap
- Hospital Sírio-Libanês, São Paulo, SP, Brazil.
- Department of Urology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
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16
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Crettenand F, Assayed-Leonardi N, Rohrer F, Martinez Carrique S, Roth B. Is Continuous Wound Infiltration a Better Option for Postoperative Pain Management after Open Nephrectomy Compared to Thoracic Epidural Analgesia? J Clin Med 2023; 12:jcm12082974. [PMID: 37109313 PMCID: PMC10143069 DOI: 10.3390/jcm12082974] [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: 03/02/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Despite increasingly advanced minimally invasive percutaneous ablation techniques, surgery remains the only evidence-based therapy in curative intent for larger (>3-4 cm) renal tumors. Although minimally invasive surgery using (robotic-assisted) laparoscopic or retroperitoneoscopic approaches has gained popularity, open nephrectomy (ON) is still performed in 25% of cases, especially in tumors with central localization (partial ON) or large tumors with/without cava thrombus (total ON). As postoperative pain is one of the drawbacks of ON, our study aims to assess recovery and post-operative pain management using continuous wound infiltration (CWI) compared to thoracic epidural analgesia (TEA). METHODS Since 2012, all patients undergoing ON at our tertiary cancer center at CHUV have been included in our prospective ERAS® (enhanced recovery after surgery) registry that is centrally stored in ERAS® Interactive Audit System (EIAS) secured server. This study represents an analysis of all patients operated on with partial or total ON at our center between 2012 and 2022. An additional analysis was performed for the estimations of the total cost of CWI and TEA, based on the diagnosis-related group method. RESULTS 92 patients were included and analyzed in this analysis (n = 64 (70%) with CWI; n = 28 (30%) with TEA). Adequate oral pain control was earlier achieved in the CWI group compared to the TEA group (median 3 vs. 4 days; p = 0.001), whereas immediate postoperative pain relief was better in the TEA group (p = 0.002). Consequently, opioid use was higher in the CWI group (p = 0.004). Still, reported nausea was lower in the CWI group (p = 0.002). Median time to bowel recovery was similar in both groups (p = 0.03). A shorter LOS (0.5 days) was observed in patients managed with CWI, although this was not statistically significant (p = 0.06). The use of CWI has reduced total hospital costs by nearly 40%. CONCLUSIONS TEA has better results in terms of postoperative pain management compared to CWI following ON. However, CWI is better tolerated, and causes less nausea and earlier recovery, which leads to a shorter length of stay. Given its simplicity and cost-effectiveness, CWI should be encouraged for ON.
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Affiliation(s)
- François Crettenand
- Department of Urology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Nady Assayed-Leonardi
- Department of Urology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Felix Rohrer
- Department of Anesthesiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Silvia Martinez Carrique
- Department of Urology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Beat Roth
- Department of Urology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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17
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The Role of CT Imaging in Characterization of Small Renal Masses. Diagnostics (Basel) 2023; 13:diagnostics13030334. [PMID: 36766439 PMCID: PMC9914376 DOI: 10.3390/diagnostics13030334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
Small renal masses (SRM) are increasingly detected incidentally during imaging. They vary widely in histology and aggressiveness, and include benign renal tumors and renal cell carcinomas that can be either indolent or aggressive. Imaging plays a key role in the characterization of these small renal masses. While a confident diagnosis can be made in many cases, some renal masses are indeterminate at imaging and can present as diagnostic dilemmas for both the radiologists and the referring clinicians. This review focuses on CT characterization of small renal masses, perhaps helping us understand small renal masses. The following aspects were considered for the review: (a) assessing the presence of fat, (b) assessing the enhancement, (c) differentiating renal tumor subtype, and (d) identifying valuable CT signs.
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18
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Nitsch A, Sander C, Eggers B, Weiss M, Egger E, Kramer FJ, Erb HHH, Mustea A, Stope MB. Pleiotropic Devitalization of Renal Cancer Cells by Non-Invasive Physical Plasma: Characterization of Molecular and Cellular Efficacy. Cancers (Basel) 2023; 15:cancers15020481. [PMID: 36672432 PMCID: PMC9856574 DOI: 10.3390/cancers15020481] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/01/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Renal cell carcinoma (RCC) is the third most common urological tumor and has an extremely poor prognosis after metastasis has occurred. Therapeutic options are highly restricted, primarily due to resistance to classical chemotherapeutics. The development of new, innovative therapeutic procedures is thus of great urgency. In the present study, the influence of non-invasive physical plasma (NIPP) on malignant and non-malignant renal cells is characterized. The biological efficacy of NIPP has been demonstrated in malignant renal cell lines (786-O, Caki-1) and non-malignant primary human renal epithelial cells (HREpC). The cell responses that were experimentally examined were cell growth (cell number determination, calculation of growth rate and doubling time), cell motility (scratch assay, invasiveness assay), membrane integrity (uptake of fluorescent dye, ATP release), and induction of apoptosis (TUNEL assay, caspase-3/7 assay, comet assay). A single NIPP treatment of the malignant cells significantly inhibited cell proliferation, invasiveness, and metastasis. This treatment has been attributed to the disruption of membrane functionality and the induction of apoptotic mechanisms. Comparison of NIPP sensitivity of malignant 786-O and Caki-1 cells with non-malignant HREpC cells showed significant differences. Our results suggest that renal cancer cells are significantly more sensitive to NIPP than non-malignant renal cells. Treatment with NIPP could represent a promising innovative option for the therapy of RCC and might supplement established treatment procedures. Of high clinical relevance would be the chemo-sensitizing properties of NIPP, which could potentially allow a combination of NIPP treatment with low-dose chemotherapy.
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Affiliation(s)
- Andreas Nitsch
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Caroline Sander
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Benedikt Eggers
- Department of Oral, Maxillofacial and Plastic Surgery, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany
| | - Martin Weiss
- Department of Women’s Health, Eberhard Karls Universität Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
| | - Eva Egger
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Franz-Josef Kramer
- Department of Oral, Maxillofacial and Plastic Surgery, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany
| | - Holger H. H. Erb
- Department of Urology, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Matthias B. Stope
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Correspondence: ; Tel.: +49-228-287-11361
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Lapierre A, Badet L, Rouviere O, Crehange G, Berthiller J, Paparel P, Chapet O. Safety and Efficacy of Stereotactic Ablative Radiation Therapy for Renal Cell Cancer: 24-Month Results of the RSR1 Phase 1 Dose Escalation Study. Pract Radiat Oncol 2023; 13:e73-e79. [PMID: 35842186 DOI: 10.1016/j.prro.2022.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) has become a new therapeutic option for primary renal cell carcinoma. However, treatment doses lack consistency in the literature. The primary objective of this study was to determine the maximum tolerated dose for renal cancer SBRT. METHODS AND MATERIALS This phase 1 multicentric dose-escalation study assessed 4 dose levels: 8 Gy × 4, 8 Gy × 5, 10 Gy × 4, and 12 Gy × 4. The primary objective of this study was to determine the maximal tolerated dose, defined by the occurrence of dose-limiting toxicity was defined as any acute side effect of grade ≥4 based on the Common Terminology Criteria for Averse Events, version 4.0. RESULTS From October 2010 to September 2017, 13 patients were enrolled. The median follow-up was 23 months. There was no dose-limiting toxicity in our study, and the highest dose was reached successfully. No acute or late toxic effects above grade 2 were seen. There was no significant alteration of renal function after treatment. At 24 months, 2 patients had partial response and the others had stable disease. CONCLUSIONS After 24 months of follow-up, no dose-limiting toxicity was seen at any of the prescribed dose levels in our study. The findings suggest that our last dose level of 48 Gy in 4 12-Gy fractions can be considered safe and can be used in further studies.
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Affiliation(s)
- Ariane Lapierre
- Département de Radiothérapie Oncologie, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France; Université de Lyon, Lyon, France
| | - Lionel Badet
- Service d'Urologie, Chirurgie de la Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Rouviere
- Service d'Imagerie Urinaire et Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Gilles Crehange
- Département de Radiothérapie Oncologique, Institut Curie, Paris, France
| | - Julien Berthiller
- Service de Recherche et d'Epidemiologie Clinique, Pole de Santé Publique, Hospices Civils de Lyon
| | | | - Olivier Chapet
- Département de Radiothérapie Oncologie, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France; Université de Lyon, Lyon, France.
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20
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Zhang F, Liang J, Lu Y, Tang Y, Liu S, Wu K, Zhang F, Lu Y, Liu Z, Wang X. Macrophage-Specific Cathepsin as a Marker Correlated with Prognosis and Tumor Microenvironmental Characteristics of Clear Cell Renal Cell Carcinoma. J Inflamm Res 2022; 15:6275-6292. [DOI: 10.2147/jir.s375250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022] Open
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21
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MacLennan S, Duncan E, Skolarus TA, Roobol MJ, Kasivisvanathan V, Gallagher K, Gandaglia G, Sakalis V, Smith EJ, Plass K, Ribal MJ, N'Dow J, Briganti A. Improving Guideline Adherence in Urology. Eur Urol Focus 2022; 8:1545-1552. [PMID: 34702647 DOI: 10.1016/j.euf.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 01/25/2023]
Abstract
CONTEXT Clinical practice guidelines (CPGs) distil an evidence base into recommendations. CPG adherence is associated with better patient outcomes. However, preparation and dissemination of CPGs are a costly task involving multiple skilled personnel. Furthermore, dissemination alone does not ensure CPG adherence. Reasons for nonadherence are often complex, but understanding practice variations and reasons for nonadherence is key to improving CPG adherence and harmonising clinically appropriate and cost-effective care. OBJECTIVE To overview approaches to improving guideline adherence, to provide urology-specific examples of knowledge-practice gaps, and to highlight potential solutions informed by implementation science. EVIDENCE ACQUISITION Three common approaches to implementation science (the Knowledge-To-Action framework, the Consolidated Framework for Implementation Research, and the Behaviour Change Wheel), are summarised. EVIDENCE SYNTHESIS Three implementation problems in urology are illustrated: underuse of single instillation of intravesical chemotherapy in non-muscle-invasive bladder cancer, overuse of androgen deprivation therapy in localised prostate cancer, and guideline-discordant imaging in prostate cancer. Research using implementation science approaches to address these implementation problems is discussed. CONCLUSIONS Urologists, patients, health care providers, funders, and other key stakeholders must commit to reliably capturing and reporting data on patient outcomes, practice variations, guideline adherence, and the impact of adherence on outcomes. Leverage of implementation science frameworks is a sound next step towards improving guideline adherence and the associated benefits of evidence-based care. PATIENT SUMMARY Clinical practice guideline documents are created by expert panels. These documents provide overviews of the evidence for the tests and treatments used in patient care. They also provide recommendations and it is expected that in most circumstances clinicians will follow these recommendations. Sometimes, health care professionals cannot or do not follow these recommendations and it is not always clear why. In this review article we look at some examples of research approaches to addressing this problem of nonadherence and we provide some examples specific to urology.
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Affiliation(s)
- Steven MacLennan
- Academic Urology Unit, Institute of Applied Health Sciences, The University of Aberdeen, Aberdeen, UK; European Association of Urology Guidelines Office and Methodology Committee, Arnhem, The Netherlands.
| | - Eilidh Duncan
- Health Services Research Unit, Institute of Applied Health Sciences, The University of Aberdeen, Aberdeen, UK
| | - Ted A Skolarus
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Kevin Gallagher
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Giorgio Gandaglia
- Department of Urology, University Vita e Salute-San Raffaele, Milan, Italy
| | - Vasileios Sakalis
- Department of Urology, General Hospital Agios Pavlos, Thessaloniki, Greece
| | - Emma Jane Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Karin Plass
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Maria J Ribal
- European Association of Urology Guidelines Office, Arnhem, The Netherlands; Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - James N'Dow
- Academic Urology Unit, Institute of Applied Health Sciences, The University of Aberdeen, Aberdeen, UK; European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Alberto Briganti
- Department of Urology, University Vita e Salute-San Raffaele, Milan, Italy; European Association of Urology Guidelines Office, Arnhem, The Netherlands
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22
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Percutaneous cryoablation combined with prior transcatheter arterial embolization for renal cell carcinomas of 3 cm or larger: a prospective study. Int J Clin Oncol 2022; 27:1589-1595. [PMID: 35945389 DOI: 10.1007/s10147-022-02224-7] [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: 02/15/2022] [Accepted: 04/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND We prospectively evaluated the safety and efficacy of percutaneous cryoablation combined with transcatheter renal arterial embolization for the treatment of tumors ≥ 3 cm in diameter. METHODS We included patients aged ≥ 20 years with histologically proven renal cell carcinoma with a tumor diameter ≥ 3 cm who were inoperable or refused surgery. Prior to ablation, transcatheter arterial embolization was performed using a mixture of absolute ethanol and iodized oil. All cryoablation procedures were performed percutaneously under computed tomography fluoroscopy guidance. The primary endpoint was safety, which was evaluated for adverse events using CTCAE version 4.0. The secondary endpoint was survival; overall survival, progression-free survival, and cancer-specific survival were calculated. RESULTS From October 2013 to March 2016, 19 patients (mean age, 75 ± 13 years; 5 women, 14 men) were prospectively enrolled. The mean tumor diameter was 3.9 ± 0.7 (range 3.1-5.3) cm. Four grade 3 hematologic adverse events occurred, while no symptomatic grade ≥ 3 events occurred. The median follow-up period was 68 (range 52-84) months. During the follow-up period, two patients developed local tumor progression at 3 and 42 months after the initial ablative procedure; no patient showed distant metastasis. Two patients died from causes other than RCC. Overall survival, progression-free survival, and cause-specific survival were 100%, 95%, and 100% at 3 years, and 95%, 84%, and 100% at 5 years, respectively. CONCLUSION Percutaneous cryoablation combined with prior TAE for the treatment of tumors ≥ 3 cm in diameter was safe and achieved favorable survival.
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Huang S, Luo Q, Huang J, Wei J, Wang S, Hong C, Qiu P, Li C. A Cluster of Metabolic-Related Genes Serve as Potential Prognostic Biomarkers for Renal Cell Carcinoma. Front Genet 2022; 13:902064. [PMID: 35873461 PMCID: PMC9301649 DOI: 10.3389/fgene.2022.902064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/07/2022] [Indexed: 12/03/2022] Open
Abstract
Renal cell carcinoma (RCC) is the most common type of renal cancer, characterized by the dysregulation of metabolic pathways. RCC is the second highest cause of death among patients with urologic cancers and those with cancer cell metastases have a 5-years survival rate of only 10–15%. Thus, reliable prognostic biomarkers are essential tools to predict RCC patient outcomes. This study identified differentially expressed genes (DEGs) in the gene expression omnibus (GEO) database that are associated with pre-and post-metastases in clear cell renal cell carcinoma (ccRCC) patients and intersected these with metabolism-related genes in the Kyoto encyclopedia of genes and genomes (KEGG) database to identify metabolism-related DEGs (DEMGs). GOplot and ggplot packages for gene ontology (GO) and KEGG pathway enrichment analysis of DEMGs with log (foldchange) (logFC) were used to identify metabolic pathways associated with DEMG. Upregulated risk genes and downregulated protective genes among the DEMGs and seven independent metabolic genes, RRM2, MTHFD2, AGXT2, ALDH6A1, GLDC, HOGA1, and ETNK2, were found using univariate and multivariate Cox regression analysis, intersection, and Lasso-Cox regression analysis to establish a metabolic risk score signature (MRSS). Kaplan-Meier survival curve of Overall Survival (OS) showed that the low-risk group had a significantly better prognosis than the high-risk group in both the training cohort (p < 0.001; HR = 2.73, 95% CI = 1.97–3.79) and the validation cohort (p = 0.001; HR = 2.84, 95% CI = 1.50–5.38). The nomogram combined with multiple clinical information and MRSS was more effective at predicting patient outcomes than a single independent prognostic factor. The impact of metabolism on ccRCC was also assessed, and seven metabolism-related genes were established and validated as biomarkers to predict patient outcomes effectively.
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Tatenuma T, Ito H, Muraoka K, Ito Y, Hasumi H, Hayashi N, Kondo K, Nakaigawa N, Makiyama K. Roughness of the renal tumor surface could predict the surgical difficulty of robot-assisted partial nephrectomy. Asian J Endosc Surg 2022; 15:591-598. [PMID: 35315223 PMCID: PMC9311271 DOI: 10.1111/ases.13058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Preoperative prediction of surgical difficulty of partial nephrectomy (PN) is essential to minimize the perioperative complications and to achieve a good surgical outcome. Recently, various scoring systems have been used to evaluate the difficulty of PN including R.E.N.A.L (Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location) nephrometry score. There were no scoring systems evaluating the roughness of the renal tumor surface and we hypothesized that the roughness of the renal tumor surface might affect the surgical difficulty of robot-assisted partial nephrectomy (RAPN). This study aimed to evaluate the impact of roughness of the renal tumor surface on the surgical outcome of RAPN. METHODS Overall, 161 patients underwent RAPN performed by the same surgeon between May 2016 and April 2019. We divided those tumors into two groups, like "roughness positive (tumor with roughness of tumor surface)" and "roughness negative (tumor without roughness of tumor surface)" according to the roughness of the endophytic region on preoperative computed tomography images. Clinical and pathological outcomes were compared between the two groups. RESULTS Eighty-five and 78 tumors were identified roughness negative and positive, respectively. Cases with roughness positive showed a significantly longer operative time, console time, and ischemia time and had greater blood loss than those with roughness negative. Significant and independent predictors of ischemia time and estimated glomerular filtration rate (eGFR) decrease were roughness of tumor surface, tumor size (not for eGFR decrease), and N score of the R.E.N.A.L nephrometry score. CONCLUSION Roughness of renal tumor surface was significantly and positively associated with ischemia time and the eGFR decrease rate.
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Affiliation(s)
| | - Hiroki Ito
- Department of UrologyYokohama City University HospitalYokohamaJapan
| | - Kentaro Muraoka
- Department of UrologyYokohama City University HospitalYokohamaJapan
| | - Yusuke Ito
- Department of UrologyYokohama City University HospitalYokohamaJapan
| | - Hisashi Hasumi
- Department of UrologyYokohama City University HospitalYokohamaJapan
| | - Narihiko Hayashi
- Department of UrologyYokohama City University HospitalYokohamaJapan
| | - Keiichi Kondo
- Department of UrologyYokohama City University HospitalYokohamaJapan
| | - Noboru Nakaigawa
- Department of UrologyYokohama City University HospitalYokohamaJapan
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Hong P, Du H, Tong M, Cao Q, Hu D, Ma J, Jin Y, Li Z, Huang W, Tong G. A Novel M7G-Related MicroRNAs Risk Signature Predicts the Prognosis and Tumor Microenvironment of Kidney Renal Clear Cell Carcinoma. Front Genet 2022; 13:922358. [PMID: 35812727 PMCID: PMC9263547 DOI: 10.3389/fgene.2022.922358] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/07/2022] [Indexed: 12/29/2022] Open
Abstract
Background: M7G modification is extremely vital for the development of many cancers, especially tumor immunity. M7G modification is a novel functional regulator of miRNA, and the researches on m7G-related miRNAs in kidney renal clear cell carcinoma (KIRC) are still insufficient. This research aims to establish a risk signature on the foundation of m7G-associated miRNAs, which can precisely forecast the prognosis of KIRC patients. Methods: Transcriptome data and clinical data used in this study come from The Cancer Genome Atlas database. Our team utilized univariable Cox, Lasso and multivariable Cox analyses to construct a m7G-associated miRNAs risk signature that can forecast the prognosis of KIRC patients. Kaplan-Meier method, time-dependent receiver operating characteristic (ROC) curve, and the independent analysis of risk signatures were employed to verify the predictability and accuracy of the risk signature. Subsequently, based on CIBERSORT, ESTIMATE and ssGSEA algorithms, we speculated the potential impact of the proposed risk signature on tumor immune microenvironment. Ultimately, by virtue of the risk signature and tumor immunity, the hub genes affecting the prognosis of KIRC patients were screened out. Results: Our team established and verified a prognostic signature comprising 7 m7G-associated miRNAs (miR-342-3p, miR-221-3p, miR-222-3p, miR-1277-3p, miR-6718-5p, miR-1251-5p, and miR-486-5p). The results of the Kaplan-Meier survival analysis revealed that the prognosis of KIRC sufferers in the high-risk group was often unsatisfactory. The accuracy of the prediction ability of the risk signature was verified by calculating the area under the ROC curve. Univariate-multivariate Cox analyses further showed that this risk signature could be utilized as an independent prognosis-related biomarker for KIRC sufferers. The results of the immune analysis revealed that remarkable diversities existed in immune status and tumor microenvironment between high-risk and low-risk groups. On the foundation of the proposed risk signature and other clinical factors, a nomogram was established to quantitatively forecast the survival of KIRC sufferers at 1, 3 and 5 years. Conclusion: Based on m7G-related miRNAs, a risk signature was successfully constructed, which could precisely forecast the prognosis of sufferers and guide personalized immunotherapy for KIRC patients.
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Affiliation(s)
- Peng Hong
- Department of Urology, The First Hospital of Jinzhou Medical University, Jinzhou Medical University, Jinzhou, China
| | - Huifang Du
- Affiliated First Hospital, Nanchang University, Nanchang, China
| | - Ming Tong
- Department of Urology, The First Hospital of Jinzhou Medical University, Jinzhou Medical University, Jinzhou, China
- *Correspondence: Ming Tong, ; Qingfei Cao,
| | - Qingfei Cao
- Department of Urology, The First Hospital of Jinzhou Medical University, Jinzhou Medical University, Jinzhou, China
- *Correspondence: Ming Tong, ; Qingfei Cao,
| | - Ding Hu
- Department of Urology, The First Hospital of Jinzhou Medical University, Jinzhou Medical University, Jinzhou, China
| | - Jiaji Ma
- Department of Urology, The First Hospital of Jinzhou Medical University, Jinzhou Medical University, Jinzhou, China
| | - Yanyang Jin
- Department of Urology, The First Hospital of Jinzhou Medical University, Jinzhou Medical University, Jinzhou, China
| | - Zizhi Li
- Department of Urology, The First Hospital of Jinzhou Medical University, Jinzhou Medical University, Jinzhou, China
| | - Weichao Huang
- Department of Urology, The First Hospital of Jinzhou Medical University, Jinzhou Medical University, Jinzhou, China
| | - Guangquan Tong
- Department of Urology, The First Hospital of Jinzhou Medical University, Jinzhou Medical University, Jinzhou, China
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Zhang XM, Xu JD, Lv JM, Pan XW, Cao JW, Chu J, Cui XG. “Zero ischemia” laparoscopic partial nephrectomy by high-power GreenLight laser enucleation for renal carcinoma: A single-center experience. World J Clin Cases 2022; 10:5646-5654. [PMID: 35979100 PMCID: PMC9258349 DOI: 10.12998/wjcc.v10.i17.5646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic partial nephrectomy has been widely used in renal cell carcinoma treatment. The efficacy of GreenLight laser on Laparoscopic partial nephrectomy is still unknown.
AIM To present the first series of laparoscopic partial nephrectomy (LPN) by GreenLight laser enucleation without renal artery clamping. Due to the excellent coagulation and hemostatic properties of the laser, laser-assisted LPN (LLPN) makes it possible to perform a “zero ischemia” resection.
METHODS Fifteen patients with T1a exogenous renal tumors who received high-power GreenLight laser non-ischemic LPN in our hospital were retrospectively analyzed. All clinical information, surgical and post-operative data, complications, pathological and functional outcomes were analyzed.
RESULTS Surgery was successfully completed in all patients, and no open or radical nephrectomy was performed. The renal artery was not clamped, leading to no ischemic time. No blood transfusions were required, the average hemoglobin level ranged from 96.0 to 132.0 g/L and no postoperative complications occurred. The mean operation time was 104.3 ± 8.2 min. The postoperative removal of negative pressure drainage time ranged from 5.0 to 7.0 d, and the mean postoperative hospital stay was 6.5 ± 0.7 d. No serious complications occurred. Postoperative pathological results showed clear cell carcinoma in 12 patients, papillary renal cell carcinoma in 2 patients, and hamartoma in 1 patient. The mean creatinine level was 75.0 ± 0.8 μmol/L (range 61.0-90.4 μmol/L) at 1 mo after surgery, and there were no statistically significant differences compared with pre-operation (P > 0.05). The glomerular filtration rate ranged from 45.1 to 60.8 mL/min, with an average of 54.0 ± 5.0 mL/min, and these levels were not significantly different from those before surgery (P > 0.05).
CONCLUSION GreenLight laser has extraordinary cutting and sealing advantages when used for small renal tumors (exogenous tumors of stage T1a) during LPN. However, use of this technique can lead to the generation of excessive smoke.
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Affiliation(s)
- Xiang-Min Zhang
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200092, China
- Department of Urology, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Ji-Dong Xu
- Department of Urology, Gongli Hospital of The Second Military Medical University, Shanghai 200135, China
| | - Jian-Min Lv
- Department of Urology, Shanghai The Seventh People's Hospital, Shanghai 200137, China
| | - Xiu-Wu Pan
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200092, China
| | - Jian-Wei Cao
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200092, China
| | - Jian Chu
- Department of Urology, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Xin-Gang Cui
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200092, China
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Almdalal T, Sundqvist P, Harmenberg U, Hellström M, Lindskog M, Lindblad P, Lundstam S, Ljungberg B. Clinical T1a Renal Cell Carcinoma, Not Always a Harmless Disease—A National Register Study. EUR UROL SUPPL 2022; 39:22-28. [PMID: 35528783 PMCID: PMC9068725 DOI: 10.1016/j.euros.2022.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background T1a renal cell carcinoma (RCC) is typically considered a curable disease, irrespective of the choice of local treatment modality. Objective To identify factors associated with the risk of local and distant recurrence, and overall survival (OS) in patients with primary nonmetastatic clinical T1a RCC. Design, setting, and participants A population-based nationwide register study of all 1935 patients with cT1a RCC, diagnosed during 2005–2012, identified through The National Swedish Kidney Cancer Register, was conducted. Outcome measurements and statistical analysis Outcome variables were recurrence (local or distant) and OS. Possible explanatory variables included tumor size, RCC type, T stage, surgical technique, age, and gender. Associations with disease recurrence and OS were evaluated by multivariable regression and Cox multivariate analyses, respectively. Results and limitations Among 1935 patients, 938 were treated with radical nephrectomy, 738 with partial nephrectomy, and 169 with ablative treatments, while 90 patients had no surgery. Seventy-eight (4%) patients were upstaged to pT3. Local or metastatic recurrences occurred in 145 (7.5%) patients, significantly more often after ablation (17.8%). The risk of recurrence was associated with tumor size, upstaging, and ablation. Larger tumor size, disease recurrence, and older age adversely affected OS, whereas partial nephrectomy and chromophobe RCC (chRCC) were associated with improved survival. Limitations include register design and a lack of comorbidity or performance status data. Conclusions Upstaging and recurrence occurred, respectively, in 4.0% and 7.5% of patients with nonmetastatic RCCs ≤4 cm. Tumor size upstaging and ablation were associated with the risk for recurrence, while tumor size and recurrence were associated with decreased OS. Patients with chRCC and partial nephrectomy had prolonged OS in a real-world setting. Patient summary We studied factors that may influence the risk of disease recurrence and overall survival, in a large nationwide patient cohort having nonmetastatic renal cell carcinoma ≤4 cm. Tumor size, tumor type, and treatment were associated with the risk of recurrence and overall death. Partial nephrectomy prolonged overall survival.
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Affiliation(s)
- Tarik Almdalal
- Department of Surgery and Urology, Eskilstuna Country Hospital, Eskilstuna, Sweden
| | - Pernilla Sundqvist
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ulrika Harmenberg
- Department of Oncology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Mikael Hellström
- Department of Radiology, Sahlgrenska Academy/Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden
| | - Magnus Lindskog
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Per Lindblad
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Svan Lundstam
- Department of Urology and Oncology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
- Corresponding author. Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå 901 85, Sweden. Tel. +46703227690; Fax: +4690125396.
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Liu Z, Zhang X, Lv P, Wu B, Bai S. Functional, oncological outcomes and safety of laparoscopic partial nephrectomy versus open partial nephrectomy in localized renal cell carcinoma patients with high anatomical complexity. Surg Endosc 2022; 36:7629-7637. [PMID: 35411462 DOI: 10.1007/s00464-022-09225-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/26/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Partial nephrectomy (PN) is the main treatment strategy for localized renal cell carcinoma (RCC). However, for RCC with high anatomical complexity, PN remains a challenge for urologists. Therefore, this study aimed to evaluate the functional oncological outcomes and safety of laparoscopic partial nephrectomy (LPN) versus open partial nephrectomy (OPN) in localized RCC patients with highly anatomical complexity (R.E.N.A.L. score ≥ 10). PATIENTS AND METHODS We retrospectively studied 575 patients who underwent PN at our center between January 2007 and December 2017. After propensity score-matching (PSM), 137 patients treated with LPN and 54 patients treated with OPN were balanced into 97 and 44 pairs. Patient demographics, and extensive perioperative and prognostic data were recorded and compared. RESULTS In the matched group, the OPN group had significantly less eGFR loss than the LPN group (2.57 ml/min/1.73 m2 vs. 31.59 ml/min/1.73 m2, P < 0.001). The recurrence-free survival (P = 0.287), overall survival (P = 0.296), cancer-specific survival (P = 0.664), and cardiocerebrovascular disease-specific survival (P = 0.341) were equivalent between groups. The rates of minor (P = 0.621) and major (P = 0.647) complications were also similar between groups. CONCLUSIONS This PSM cohort study showed that OPN resulted in better renal function preservation than LPN in localized RCC patients with high anatomical complexity, and had comparable oncological and safety outcomes after long-term follow-up. These findings may help improve clinical decision-making for localized RCC patients with high anatomical complexity.
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Affiliation(s)
- Zeqi Liu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Xuanyu Zhang
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Peng Lv
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China.
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Schoen G. Roboterassistierte organerhaltende Nierentumorchirurgie. Aktuelle Urol 2022; 53:188-200. [PMID: 35345015 DOI: 10.1055/a-1696-8097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Takahara K, Fukaya K, Nukaya T, Takenaka M, Zennami K, Ichino M, Sasaki H, Sumitomo M, Shiroki R. Perioperative and long-term functional outcomes of robot-assisted versus open partial nephrectomy: A single-center retrospective study of a Japanese cohort. Ann Med Surg (Lond) 2022; 75:103482. [PMID: 35386794 PMCID: PMC8978100 DOI: 10.1016/j.amsu.2022.103482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 12/01/2022] Open
Abstract
Objective This study aimed to compare the perioperative and long-term functional outcomes between robot-assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN) in Japanese patients. Methods We retrospectively analyzed 242 patients who underwent either RAPN or OPN between 2007 and 2017 at our hospital. Propensity score matching was carried out between the two groups at a ratio of 1:1. Perioperative outcomes and postoperative estimated glomerular filtration rates (eGFR) were compared at one and three years of follow-up. Results After propensity score matching, we evaluated 39 patients from each group. The ischemia duration of the RAPN group was significantly shorter than that of the OPN group (18 vs. 24, p < 0.001). Moreover, the estimated blood loss (EBL) was significantly lower in the RAPN group than in the OPN group (50 vs. 174, p < 0.001). However, there were no significant differences in the postoperative eGFR between the two groups at one or three years of follow-up (OPN 54.8 vs. RAPN 61.2, p = 0.109, and OPN 54.8 vs. RAPN 55.5, p = 0.262, respectively). Conclusion RAPN resulted in shorter ischemia durations and lower rates of EBL than did OPN; however, no differences in long-term renal function were observed between RAPN and OPN in our propensity-score matched Japanese cohort. This study aimed to compare the perioperative and long-term functional outcomes of RAPN and OPN in Japanese patients. RAPN resulted in shorter ischemia durations and lower rates of estimated blood loss than OPN. No differences in long-term renal function were observed between RAPN and OPN.
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European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update. Eur Urol 2022; 82:399-410. [DOI: 10.1016/j.eururo.2022.03.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 12/22/2022]
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Rosiello G, Larcher A, Fallara G, Giancristofaro C, Martini A, Re C, Cei F, Musso G, Tian Z, Karakiewicz PI, Mottrie A, Bertini R, Salonia A, Necchi A, Raggi D, Briganti A, Montorsi F, Capitanio U. Head-to-head comparison of all the prognostic models recommended by the European Association of Urology Guidelines to predict oncologic outcomes in patients with renal cell carcinoma. Urol Oncol 2022; 40:271.e19-271.e27. [PMID: 35140049 DOI: 10.1016/j.urolonc.2021.12.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES European Urology Association guidelines suggest the use of integrated prognostic systems to assess oncologic outcomes after surgery in patients with localized renal cell carcinoma (RCC). We performed a head-to-head comparison among all the EAU guidelines recommended prognostic models in RCC. METHODS The study included 2,014 patients treated with surgery for clinically localized RCC. Patients were classified into prognostic risk groups, based on each of the five EAU guidelines recommended prognostic model definition, namely UISS, Leibovich 2003, VENUSS, GRANT, and Leibovich 2018 score. Prognostic accuracy of each prognostic model to predict clinical progression or cancer-specific mortality (CSM) was assessed, and ROC curves were calculated, according to histological subtype, namely clear-cell, papillary, and chromophobe RCC. RESULTS Of 2,014 patients, 1,575 (78%) harboured clear-cell, 312 (16%) papillary, and 127 (6%) chromophobe RCC. Median follow-up was 66 months [Interquartile range (IQR): 29-120]. In clear-cell RCC, low-risk patients rates ranged from 21% to 64%, according prognostic model. The same phenomenon was observed for papillary and chromophobe RCC. In clear-cell RCC, Leibovich 2018 resulted the most accurate model in predicting clinical progression (88.1%) and CSM (86.8%). Conversely, VENUSS or UISS prognostic models predicting oncologic outcomes represented the most accurate in papillary (88.7% and 84.8%) or chromophobe (87.8% and 89.1%) RCC, respectively. CONCLUSIONS A non-negligible difference in terms of performance accuracy exists among the EAU guidelines recommended prognostic models. Thus, their adoption in RCC should be histology-specific and follow-up strategies based on prognostic risk class appear justified only if the appropriate model is used to stratify patients into prognostic risk groups.
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Affiliation(s)
- Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Fallara
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Giancristofaro
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Martini
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Re
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Cei
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Musso
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Roberto Bertini
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Salonia
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Necchi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Raggi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Analysis of Clinical Characteristics, Radiological Predictors, Pathological Features, and Perioperative Outcomes Associated with Perinephric Fat Adhesion Degree. JOURNAL OF ONCOLOGY 2022; 2021:9095469. [PMID: 34987581 PMCID: PMC8723850 DOI: 10.1155/2021/9095469] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/01/2021] [Indexed: 11/25/2022]
Abstract
Background To assess the clinical characteristics, radiological predictors, and pathological features of perinephric fat adhesion degree (PFAD) graded based on fixed criteria and to determine the impact of adherent perinephric fat (APF) on retroperitoneal laparoscopic partial nephrectomy (RLPN) outcomes. Methods 84 patients undergoing RLPN were included and graded into 4 groups based on PFAD. Univariate and multivariate analyses were performed for clinical characteristics and radiological predictors of PFAD. Perioperative data were compared between APF groups and non-APF groups. Masson staining determined collagen fibers. Immunohistochemistry detected CD45 immune cells and CD34 vessels. Results 20, 28, 18, and 18 patients were graded as normal perinephric fat (NPF), mild adherent perinephric fat (MiPF), moderate adherent perinephric fat (MoPF), and severe adherent perinephric fat (SPF), respectively. Multivariate analysis revealed that gender (p < 0.001), age (p = 0.003), and hypertension (p = 0.006) were significant clinical risk factors of PFAD, while radiological predictors included perinephric stranding (p = 0.001), posterior perinephric fat thickness (p = 0.009), and perinephric fat density (p = 0.02). APF was associated with drain output (p = 0.012) and accompanied by immune cells gathering in renal cortex near thickened renal capsule with many vessels. Conclusions Clinical characteristics and radiological predictors can evaluate PFAD and may assist to guide preoperative surgical option. Pathological features of APF reflect decapsulation and bleeding during kidney mobilization at RLPN.
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Jin M, Yuan S, Yuan Y, Yi L. Prognostic and Clinicopathological Significance of the Systemic Immune-Inflammation Index in Patients With Renal Cell Carcinoma: A Meta-Analysis. Front Oncol 2021; 11:735803. [PMID: 34950577 PMCID: PMC8689141 DOI: 10.3389/fonc.2021.735803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background The systemic immune-inflammation index (SII) is a hematological parameter based on neutrophil, platelet, and lymphocyte counts. Studies that have investigated the prognostic value of SII in patients with renal cell carcinoma (RCC) have reported controversial results. In this study, we systematically investigated the prognostic value of SII in patients with RCC. Methods We systematically searched English articles in the PubMed, Embase, Web of Science, and Cochrane Library databases up to October 2021. Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were used to obtain pooled results. Results The meta-analysis included 10 studies that enrolled 3,180 patients. A high SII was associated with poor overall survival (HR 1.75, 95% CI 1.33–2.30, p<0.001) in patients with RCC. However, a high SII was not shown to be a significant prognostic factor for progression-free survival/disease-free survival (HR 1.22, 95% CI 0.84–1.76, p=0.293) or poor cancer-specific survival (HR 1.46, 95% CI 0.68–3.12, p=0.332) in patients with RCC. A high SII was correlated with male sex (OR 1.51, 95% CI 1.11–2.04, p=0.008), Fuhrman grade G3–G4 (OR 1.80, 95% CI 1.08–3.00, p=0.024), and poor risk based on the International Metastatic Renal Cell Carcinoma Database Consortium criteria (OR 19.12, 95% CI 9.13–40.06, p<0.001). Conclusion A high SII was independently associated with poor survival outcomes in patients with RCC. Additionally, an elevated SII indicated more aggressive disease. The SII may serve as a useful cost-effective prognostic indicator in patients with RCC.
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Affiliation(s)
- Mingyu Jin
- Department of Andrology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Shaoying Yuan
- Department of Andrology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Yiming Yuan
- Andrology Center, Peking University First Hospital, Beijing, China
| | - Luqi Yi
- Department of Urology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
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Matsuura T, Ito A, Moriguchi M, Ikarashi D, Tamura D, Kato R, Maekawa S, Kato Y, Kanehira M, Takata R, Sugimura J, Abe T, Obara W. Influence of robot-assisted partial nephrectomy on long-term renal function as assessed using DTPA renal scintigraphy. J Endourol 2021; 36:641-646. [PMID: 34913764 DOI: 10.1089/end.2021.0243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The long-term split renal function after robot-assisted partial nephrectomy (RAPN) is yet to be elucidate. This study aimed to assess long-term renal function RAPN, using renal scintigraphy, and to identify clinical factors related to deterioration of renal function on the affected side of the kidney. PATIENTS AND METHODS RAPN for small tumors was performed, and split renal function was evaluated using DTPA renal scintigraphy before and 1 year after surgery. Clinical factors (age, sex, body mass index, tumor side, presence of urinary protein, diabetes, hypertension, and dyslipidemia), perioperative factors (renal nephrectomy score [RNS], tumor diameter, overall surgery duration, console time, warm ischemic time, amount of bleeding), and renal function (estimated glomerular filtration rate (eGFR) and glomerular filtration rate (GFR) measured using scintigraphy on both the affected and contralateral kidneys) were analyzed. RESULTS Sixty-six patients were included in the study. The median eGFR decreased from 71.9 ml/min to 63.9 ml/min after 1 year (p<.001), accounting for a mean loss of 10.1%. In scintigraphy examination, the median GFR on the affected kidney side decreased from 41.1 ml/min to 33.7 ml/min after 1 year (p<.001), accounting for a mean loss of 16.8%. RNS was significantly associated with renal function. Among RNS factors, the N factor is associated with renal function after RAPN. CONCLUSION RNS, particularly the N factor, possibly influences the long-term deterioration of renal function after RAPN.
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Affiliation(s)
- Tomohiko Matsuura
- Iwate Medical University, 12833, Urology, idaidori, 1-1, Yahaba-cho, Iwate, Japan, 028-3695;
| | - Ayato Ito
- Iwate Medical University, 12833, Urology, Yahaba-cho, Iwate, Japan;
| | - Mariko Moriguchi
- Iwate Medical University, 12833, Urology, Yahaba-cho, Iwate, Japan;
| | | | - Daichi Tamura
- Iwate Medical University, 12833, Urology, Morioka, Iwate, Japan;
| | - Renpei Kato
- Iwate Medical University, 12833, Morioka, Iwate, Japan;
| | - Shigekatsu Maekawa
- Iwate Medical University, 12833, Urology, 2-1-1 Idai-Dori, Yahaba, Shiwa, Iwate, Japan, 028-3695;
| | - Yoichiro Kato
- Iwate Medical University, 12833, Urology, Morioka, Iwate, Japan;
| | | | - Ryo Takata
- Iwate Medical University, 12833, Urology, 19-1 Uchimaru, Morioka, Iwate, Japan, 020-8505;
| | - Jun Sugimura
- Iwate Medical University, 12833, Urology, Yahaba-cho, Iwate, Japan;
| | - Takaya Abe
- Iwate Medical University, 12833, Urology, Morioka, Iwate, Japan;
| | - Wataru Obara
- Iwate Medical University, 12833, Urology, Yahaba-cho, Iwate, Japan;
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Zengul AG, Zengul FD, Ozaydin B, Oner N, Fiveash JB. Identifying research themes and trends in the top 20 cancer journals through textual analysis. J Cancer Policy 2021; 30:100313. [DOI: 10.1016/j.jcpo.2021.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 09/28/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
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Ahluwalia P, Mondal AK, Sahajpal NS, Rojiani MV, Kolhe R. Gene signatures with therapeutic value: emerging perspective for personalized immunotherapy in renal cancer. Immunotherapy 2021; 13:1535-1547. [PMID: 34753298 DOI: 10.2217/imt-2021-0187] [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: 11/21/2022] Open
Abstract
Renal cancer is one of the deadliest urogenital diseases. In recent years, the advent of immunotherapy has led to significant improvement in the management of patients with renal cancer. Although cancer immunotherapy and its combinations had benefited numerous patients, several challenges need to be addressed. Apart from the high costs of treatment, the lack of predictive biomarkers and toxic side-effects have impeded its wider applicability. To address these issues, new biomarkers are required to predict responsiveness and design personalized treatment strategies. Recent advances in the field of single-cell sequencing and multi-dimensional spatial transcriptomics have identified clinically relevant subtypes of renal cancer. Furthermore, there is emerging potential for gene signatures based on immune cells, non-coding RNAs, and pathways such as metabolism and RNA modification. In this review article, we have discussed recent progress in the identification of gene signatures with predictive and prognostic potential in renal cancer.
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Affiliation(s)
- Pankaj Ahluwalia
- Department of Pathology, Medical College of Georgia, Augusta University, GA 30912, USA
| | - Ashis K Mondal
- Department of Pathology, Medical College of Georgia, Augusta University, GA 30912, USA
| | - Nikhil S Sahajpal
- Department of Pathology, Medical College of Georgia, Augusta University, GA 30912, USA
| | - Mumtaz V Rojiani
- Department of Pharmacology, Penn State University College of Medicine, PA 17033, USA
| | - Ravindra Kolhe
- Department of Pathology, Medical College of Georgia, Augusta University, GA 30912, USA
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Mao C, Xu W, Ma W, Wang C, Guo Z, Yan J. Prognostic Value of Pretreatment Prognostic Nutritional Index in Patients With Renal Cell Carcinoma: A Meta-Analysis. Front Oncol 2021; 11:719941. [PMID: 34676162 PMCID: PMC8523954 DOI: 10.3389/fonc.2021.719941] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/10/2021] [Indexed: 01/11/2023] Open
Abstract
Background The pretreatment prognostic nutritional index (PNI) is correlated with poor prognosis in several malignancies. However, the prognostic role of PNI in patients with renal cell carcinoma (RCC) remains unclear. Therefore, we performed a meta-analysis to investigate the prognostic significance of PNI in patients with RCC. Methods We searched the PubMed, Web of Science, Embase, Scopus, and Cochrane Library databases up to February 2021. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were used to estimate correlation between PNI and survival endpoints in RCC. Results Ten studies with 4,908 patients were included in the meta-analysis. The pooled results indicated that a low PNI associated with poor overall survival (HR = 2.10, 95% CI = 1.67–2.64, p<0.001), shorter progression-free survival, disease-free survival, recurrence-free survival (HR = 1.99, 95% CI = 1.67–2.36, p<0.001), and poor cancer-specific survival (HR = 2.95, 95% CI = 1.61–5.39, p<0.001). Additionally, the prognostic ability of PNI was not affected by subgroup analysis factors. Conclusion The meta-analysis indicated that low PNI associated with shorter survival outcomes in patients with RCC. Therefore, PNI could be used as an effective prognostic indicator in RCC.
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Affiliation(s)
- Changqing Mao
- Department of Nephrology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Weixin Xu
- Department of Laboratory Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Weina Ma
- Department of Pharmacy, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Chun Wang
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Zhaojiao Guo
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jun Yan
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
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SREBP1 site 1 protease inhibitor PF-429242 suppresses renal cell carcinoma cell growth. Cell Death Dis 2021; 12:717. [PMID: 34285190 PMCID: PMC8292369 DOI: 10.1038/s41419-021-03999-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 12/13/2022]
Abstract
Renal cell carcinoma (RCC) cells have increased lipogenesis and cholesterol synthesis. Sterol regulatory element-binding protein-1 (SREBP1) is cleaved by site 1 protease (S1P) to release the transcriptionally active amino-terminal domain. PF-429242 is a potent and competitive S1P inhibitor. We here tested its activity in RCC cells. In established and primary human RCC cells, PF-429242 potently inhibited cell proliferation, migration, and invasion. The S1P inhibitor provoked apoptosis activation in RCC cells. Furthermore, shRNA-mediated S1P silencing or CRISPR/Cas9-induced S1P knockout led to RCC cell growth inhibition and apoptosis activation. Conversely, ectopic overexpression of SREBP1 or S1P augmented RCC cell proliferation and migration. Daily i.v. injection of a single dose of PF-429242 robustly inhibited RCC xenograft growth in severe combined immunodeficiency mice. Additionally, intratumoral injection of S1P shRNA lentivirus inhibited RCC xenograft growth in mice. SREBP1, S1P, and its target gene low density lipoprotein receptor (LDLR) were significantly elevated in human RCC tissues. These results suggest that targeting S1P by PF-429242 inhibited RCC cell growth in vitro and in vivo.
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Wakita N, Hinata N, Suzuki K, Bando Y, Okamura Y, Hara T, Terakawa T, Furukawa J, Harada K, Fujisawa M. Comparison of robot-assisted partial nephrectomy for complex (RENAL scores ≥10) and non-complex renal tumors: A single-center experience. Int J Urol 2021; 28:1054-1059. [PMID: 34279058 DOI: 10.1111/iju.14647] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/27/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To compare functional and surgical outcomes of robot-assisted partial nephrectomy for complex tumors with RENAL scores ≥10 and non-complex tumors at a single academic institution. METHODS We retrospectively analyzed the data of all patients who underwent robot-assisted partial nephrectomy at Kobe University Hospital (Kobe, Hyogo, Japan) from 2011 to 2020. Functional and surgical outcomes for complex tumors (RENAL score ≥10) were compared with those of patients with non-complex tumors (RENAL <10). Outcomes analyzed included blood loss, warm ischemia time, console time, perioperative complications, and preoperative and postoperative renal function. RESULTS A total of 348 patients were included in our present study, with a median follow-up time of 35.1 months. Of these, 299 patients (85.9%) had non-complex tumors and 49 patients (14.1%) had complex tumors. Warm ischemia time and console time were significantly longer in the complex tumors group. Major perioperative complications (Clavien-Dindo classification system ≥3) were significantly more frequent in the complex tumors group than the non-complex tumor group (16.3% vs 5.7%, P = 0.018). Postoperative preservation of estimated glomerular filtration rate and percentage of chronic kidney disease upstage by 1 year were significantly inferior in the complex tumors group. The positive surgical margin rate was 0% and 0.3% in the complex and non-complex tumor groups, respectively. There were no significant differences in recurrence-free survival between the two groups (P = 0.11). CONCLUSIONS Robot-assisted partial nephrectomy for complex renal tumors is safe, with no difference in oncological outcomes, although more postoperative complications and decreased renal function can be observed than non-complex tumors.
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Affiliation(s)
- Naoto Wakita
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Nobuyuki Hinata
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kotaro Suzuki
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yukari Bando
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yasuyoshi Okamura
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takuto Hara
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tomoaki Terakawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Junya Furukawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kenichi Harada
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Kim CS, Choi SJN, Kim SS, Suh SH, Bae EH, Ma SK, Kim SW. An anastomosing hemangioma mimicking a renal cell carcinoma in a kidney transplant recipient: a case report. BMC Nephrol 2021; 22:262. [PMID: 34256731 PMCID: PMC8278676 DOI: 10.1186/s12882-021-02467-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although anastomosing hemangiomas are very rare and benign vascular neoplasms, these tumors are more common among patients with end-stage kidney disease. Incidental finding of these tumors in the kidney or adrenal gland has been reported. Herein, we describe a case in which an anastomosing hemangioma was misdiagnosed as a renal cell carcinoma before kidney transplant. Case presentation A 35-year-old woman with lupus nephritis was admitted to our emergency department for suspected uremic symptoms of nausea and general weakness. She had received hemodialysis due to end-stage kidney disease, and a living-donor kidney transplantation from her father was planned. On pre-operative contrast-enhanced computed tomography and magnetic resonance imaging, a 1.7 cm renal cell carcinoma was observed in the right kidney. On staining after radical nephrectomy, irregularly shaped vascular spaces of various sizes were observed, with these spaces having an anastomosing pattern. As the findings of the anastomosing hemangioma are similar to those of a renal cell carcinoma on imaging, histology examination was necessary to confirm the diagnosis of anastomosing hemangioma and to prevent delay in listing for kidney transplantation. Good kidney function was achieved after transplantation, with no tumor recurrence. Conclusion Our case underlines the importance for prompt surgical resection of an enhancing renal mass to confirm diagnosis in patients scheduled for kidney transplantation to avoid any delay.
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Affiliation(s)
- Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Soo Jin Na Choi
- Department of Surgery, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung-Sun Kim
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, South Korea.
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Yin X, Wang Z, Wang J, Xu Y, Kong W, Zhang J. Development of a novel gene signature to predict prognosis and response to PD-1 blockade in clear cell renal cell carcinoma. Oncoimmunology 2021; 10:1933332. [PMID: 34262797 PMCID: PMC8253123 DOI: 10.1080/2162402x.2021.1933332] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is the most common kidney malignancy characterized by a poor prognosis. The treatment efficacy of immune checkpoint inhibitors (ICIs) also varies widely in advanced ccRCC. We aim to construct a robust gene signature to improve the prognostic discrimination and prediction of ICIs for ccRCC patients. In this study, adopting differentially expressed genes from seven ccRCC datasets in GEO (Gene Expression Omnibus), a novel signature (FOXM1&TOP2A) was constructed in TCGA (The Cancer Genome Atlas) database by LASSO and Cox regression. Survival and time-dependent ROC analysis revealed the strong predictive ability of our signature in discovery set, two online validation sets and one tissue microarray (TMA) from our institution. High-risk group based on the signature comprises more high-grade (G3&G4) and advanced pathologic stage (stageIII/IV) tumors and presents hyperactivation of cell cycle process according to the functional analysis. Meanwhile, high-risk tumors demonstrate an immunosuppressive phenotype with more infiltrations of regulatory T cells (Tregs), macrophages and high expressions of genes negatively regulating anti-tumor immunity. Low-risk tumors have an improved response to anti-PD-1 therapy and the predictive ability of our signature is better than other recognized biomarkers in ccRCC. A nomogram containing this signature showed a high predictive accuracy with AUCs of 0.90 and 0.84 at 3 and 5 years. Overall, this robust signature could predict prognosis, evaluate immune microenvironment and response to anti-PD-1 therapy in ccRCC, which is very promising in clinical promotion.
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Affiliation(s)
- Xiaomao Yin
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zaoyu Wang
- Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jianfeng Wang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yunze Xu
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wen Kong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jin Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Uemura T, Kato T, Nagahara A, Kawashima A, Hatano K, Ujike T, Ono Y, Higashihara H, Fujita K, Fukuhara S, Kiuchi H, Imamura R, Tomiyama N, Nonomura N, Uemura M. Therapeutic and Clinical Outcomes of Robot-assisted Partial Nephrectomy Versus Cryoablation for T1 Renal Cell Carcinoma. In Vivo 2021; 35:1573-1579. [PMID: 33910838 DOI: 10.21873/invivo.12413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND In cT1 renal cell carcinoma (RCC), very few studies have compared oncological outcomes and renal function preservation rates in nephron-sparing robot-assisted partial nephrectomy (RAPN) and percutaneous cryoablation (PCA). PATIENTS AND METHODS We retrospectively analysed 126 patients with cT1 RCC treated with RAPN (n=78) and computed tomography-guided PCA (n=48) between March 2016 and November 2019. Clinical data and outcomes were compared for the two groups. RESULTS There were no significant differences in the 3-year overall survival and relapse-free survival rates in the two groups (p=0.17 and p=0.093, respectively). The median percentage of estimated glomerular filtration rate preservation at 6 months after surgery was 91.8% and 91.4% in the RAPN and PCA groups, respectively (p=0.9). CONCLUSION In patients with cT1a RCC, oncological outcomes and renal function appear similar following RAPN and PCA.
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Affiliation(s)
- Toshihiro Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taigo Kato
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan;
| | - Akira Nagahara
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Atsunari Kawashima
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koji Hatano
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Ujike
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Ono
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Higashihara
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinichiro Fukuhara
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Kiuchi
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryoichi Imamura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
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Iatrogenic ureteric stricture post image guided renal cryoablation in a patient with von hippel-lindau syndrome. Radiol Case Rep 2021; 16:2057. [PMID: 34158894 PMCID: PMC8203560 DOI: 10.1016/j.radcr.2021.05.003] [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: 04/30/2021] [Accepted: 05/01/2021] [Indexed: 01/20/2023] Open
Abstract
A 53-year-old lady is known to have Von Hippel-Lindau syndrome with a long history of previous renal cell carcinomas (RCCs) in both kidneys. She was treated by partial nephrectomy for a right peripheral RCC and subsequently image guided radiofrequency ablation (RFA) of a left central RCC. She developed another de novo RCC adjacent to the right pelvic-ureteric junction (PUJ) 4 years after the initial RFA. Due to the close proximity to the PUJ and visibility of an ice ball with cryoablation (CRYO), the consensus from the MDT was that CRYO would be safer than RFA and she subsequently underwent percutaneous image guided CRYO to treat the small de novo RCC. Unfortunately, during the 1-month imaging follow up, she developed moderate hydronephrosis and a ureteric stricture needing long-term ureteric stent management. This case highlights the risk of ureteric injury caused by the thermal effect of the ice ball during image guided renal CRYO. Therefore, it is vital that all interventional radiologists adopt various manoeuvres to protect the ureter from the ice ball during CRYO in order to avoid the development of latent ureteric stricture.
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Zhang HM, Wen DG, Wang Y, Bao YG, Yuan Y, Chen YT, Song B. Arterial Spin Labeling MRI for Predicting Microvascular Invasion of T1 Staging Renal Clear Cell Carcinoma Preoperatively. Front Oncol 2021; 11:644975. [PMID: 34084743 PMCID: PMC8168533 DOI: 10.3389/fonc.2021.644975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/09/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Microvascular invasion (MVI) is a valuable factor for T1 staging renal clear cell carcinoma (ccRCC) operation strategy decision, which is confirmed histopathologically post-operation. This study aimed to prospectively evaluate the performance of arterial spin labeling (ASL) MRI for predicting MVI of T1 staging ccRCC preoperatively. METHODS 16 volunteers and 39 consecutive patients were enrolled. MRI examinations consisted of ASL (three post label delays separately) of the kidney, followed by T1 and T2-weighted imaging. Two sessions of ASL were used to evaluate the reproducibility on volunteers. Renal blood flow of renal cortex, medulla, the entire and solid part of the tumor were measured on ASL images. Conventional imaging features were extracted. MVI and WHO/ISUP classification were evaluated histopathologically. A paired t-test was used to compare the renal cortex and medulla between ASL 1 and ASL 2. The reproducibility was assessed using the intraclass correlation. Differences in mean perfusion between the entire and the solid parts of tumors with or without MVI were assessed separately using Student's t test. The diagnostic performance was assessed. Logistic regression analysis was used to indicate the independent prediction index for MVI. RESULTS The two sessions of ASL showed no significant difference between the mean cortex values of RBF. The cortical RBF measurements demonstrated good agreement. 12 ccRCCs presented with MVI histopathologically. Mean perfusion of the solid part of tumors with MVI were 536.4 ± 154.8 ml/min/100 g (PLD1), 2912.5 ± 939.3 ml/min/100 g (PLD2), 3280.3 ± 901.2 ml/min/100 g (PLD3). Mean perfusion of the solid part of tumors without MVI were 453.5 ± 87.2 ml/min/100 g (PLD1), 1043.6 ± 695.8 ml/min/100 g (PLD2), 1577.6 ± 1085.8 ml/min/100 g (PLD3). These two groups have significant difference at all the PLDs (p < 0.05). The RBF of PLD1 of the solid part of tumor perfusion showed well diagnostic performance for predicting MVI: sensitivity 75%, specificity 100%, positive predictive value 66.7%, and negative predictive value 95.7%. The maximum diameter of the tumor, ill-defined margin, and the solid part of tumor perfusion were the independent prediction index for MVI. CONCLUSION ASL MR imaging has good reproducibility for renal cortex, and good diagnostic performance for predicting MVI for ccRCC.
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Affiliation(s)
- Han-Mei Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Da-Guang Wen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-Ge Bao
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Yuan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yun-Tian Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Liu T, Zhao Z, Feng B, Wang X, Li T, Xie S, Zhu W, Li X, Guo H, Yang R. Robotic-assisted laparoscopic tumor enucleation is a feasible technique for renal hilar tumors: A retrospective study. J Surg Oncol 2021; 124:135-142. [PMID: 33836093 DOI: 10.1002/jso.26479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/26/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE: This study aimed to evaluate the safety and efficacy of robot-assisted laparoscopic tumor enucleation (RAE) for the treatment of renal hilar tumors and to describe our experience with renorrhaphy-related surgical techniques. METHODS Retrospective data were collected from 173 consecutive patients who underwent RAE for localized renal tumors (cT1-cT2N0M0) at our hospital between September 2014 and November 2019. RESULTS Seventy-five patients had renal hilar tumors and 98 patients had nonhilar tumors. There were no statistical differences between the hilar and nonhilar groups in operation time (190 [115-390] vs. 190 [110-390] min, p = 0.889), warm ischemia time (26 [12-60] vs. 27 [17-41] min, p = 0.257), hospital stay duration (8 [3-16] vs. 7.5 [4-18] days, p = 0.386), renal function (estimated glomerular filtration rate, 102.5 [29.4-144] vs. 101.3 [64.2-134.7] ml/min/1.73 m2 , p = 0.631); creatinine level, (76 [43-169] vs. 78.5 [50-281.3] µmol/L, p = 0.673), perioperative complications rate, or surgical margin status. However, patients with hilar tumors lost significantly more blood than did those with nonhilar tumors (250 [50-1500] vs. 200 [20-1200] ml, p = 0.007). During the follow-up period (median, 30 months), three patients in each group experienced recurrence. The 5-year recurrence-free rates were 93.0% and 95.4% in the hilar and nonhilar tumor groups, respectively (p = 0.640). CONCLUSIONS For experienced robot laparoscopists, RAE is a safe, effective, and feasible procedure for renal hilar tumors, without increased risk of positive surgical margins or worse midterm oncologic outcomes compared with nonhilar tumors.
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Affiliation(s)
- Tianyao Liu
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zihan Zhao
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Baofu Feng
- Department of Urology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Xin Wang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tianhang Li
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shangxun Xie
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenjie Zhu
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaogong Li
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rong Yang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Inkiläinen A, Blomqvist L, Ljungberg B, Strigård K. Patient-reported outcome measures of abdominal wall morbidity after flank incision for open partial nephrectomy. BJU Int 2021; 128:497-503. [PMID: 33825298 DOI: 10.1111/bju.15420] [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: 11/26/2022]
Abstract
OBJECTIVE To compare patient-reported outcome measures in patients with and without abdominal wall complications after open partial nephrectomy (OPN) via flank incision. PATIENTS AND METHODS Patient-reported outcome measures were collected in 2017 from all patients operated on with OPN via flank incision between 2004 and 2016 in Västerbotten County, Sweden. Patients were mailed the ventral hernia pain questionnaire (VHPQ) and an abdominal wall asymmetry (AWA) questionnaire to evaluate postoperative AWA, attributed to bulge or incisional hernia. Demographic and follow-up data were retrieved from patient records. RESULTS A total of 198 patients were eligible for the study, and 146 questionnaires were returned (74%). Forty-five patients (31%) reported postoperative AWA and 27 (18%) reported ongoing pain. Three patients who reported AWA had a known incisional hernia. Pain and abdominal wall stiffness were more common in patients with AWA than in those without (P < 0.01 and P < 0.01, respectively). Of the 45 patients with AWA, 25 (56%) reported this as being negative cosmetically and 16 (36%) as negative regarding activities. Patients that reported AWA were younger and had a higher body mass index at surgery (P = 0.03 and 0.04, respectively). CONCLUSION Abdominal wall asymmetry is a common sequel of flank incision for OPN and is associated with a higher incidence of chronic pain and abdominal stiffness compared to absence of postoperative AWA. Some patients reported that the effect on daily activities and the cosmetic effect caused by AWA had a negative impact on their quality of life.
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Affiliation(s)
- Aapo Inkiläinen
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery (MMK), Karolinska Institutet, Stockholm, Sweden.,Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Carter N, Al-Shawi M, Royce P, O’Brien A, Clements W. A Hybrid Approach for Treating Recurrent Renal Cell Carcinoma (RCC) in a Single Kidney with a Tethered Ureter. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1723095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractThis case highlights a hybrid treatment model used successfully in a patient with complicated recurrent renal cell carcinoma (RCC), following partial nephrectomy, in the context of a single kidney. Scar tissue from previous surgery tethered the ureter to the margin of the lesion and combined with obesity, rendered simple percutaneous intervention challenging. The patient was ultimately successfully treated using a hybrid approach of open surgical access, ureterolysis, and intraoperative ultrasound-guided radiofrequency ablation. This approach optimized the volume of conserved normal renal parenchyma and eliminated the need for postoperative dialysis treatment, with no recurrence at 13 months follow-up.
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Affiliation(s)
- Nicole Carter
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Modher Al-Shawi
- Department of Urology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter Royce
- Department of Urology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - Andrew O’Brien
- Department of Urology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia
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Palacios DA, Zabor EC, Munoz-Lopez C, Roversi G, Mahmood F, Abramczyk E, Kelly M, Wilson B, Abouassaly R, Campbell SC. Does Reduced Renal Function Predispose to Cancer-specific Mortality from Renal Cell Carcinoma? Eur Urol 2021; 79:774-780. [PMID: 33678521 DOI: 10.1016/j.eururo.2021.02.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/18/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent publications have reported an association between increased renal cancer-specific mortality (CSM) and reduced renal function "below safety limits," and advocated for partial nephrectomy (PN) even for potentially aggressive/complex tumors. We hypothesize that this association may be related to confounding factors rather than a consequence of functional differences. OBJECTIVE To assess whether there is an independent association between preoperative estimated glomerular filtration rate (eGFR) or new baseline eGFR (NB-GFR) and CSM in patients undergoing PN or radical nephrectomy (RN). DESIGN, SETTING, AND PARTICIPANTS A single-center retrospective review was performed. All clinically and pathologically confirmed T1-T3a/N0/M0 renal cancer patients undergoing PN/RN (1999-2008, n = 1605) with adequate functional/oncological data were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was CSM. Secondary endpoints were cancer recurrence (CR) and all-cause mortality (ACM). Cox regression analyses investigated endpoints and predictive factors. RESULTS AND LIMITATIONS The median age was 60 yr and 64% of patients were male. Comorbidities included hypertension (60%), cardiovascular disease (19%), diabetes (21%), and chronic kidney disease (22%). PN was performed in 954 patients (59%). The median preoperative eGFR and NB-GFR were 80 and 60 ml/min/1.73 m2, respectively. Median tumor diameter was 3.6 cm (interquartile range [IQR] = 2.4, 5.5); 70% of tumors were clear cell and 40% were of high grade. Pathology revealed pT1-2/N0/M0 and pT3a/N0/M0 in 81% and 19%, respectively. The median follow-up among survivors was 11.5 yr (IQR = 4, 14). Cancer-specific survival, recurrence-free survival, and overall survival were 94%, 88%, and 73% at 10 yr, respectively. On multivariable analysis, increased age (hazard ratio [HR] = 1.03, p = 0.04), increased tumor size (HR = 1.24, p < 0.01), tumor grade 3/4 (HR = 3.17, p < 0.01), and clear-cell histology (HR = 2.92, p < 0.01) were associated with increased hazard of CSM. Neither preoperative eGFR nor NB-GFR was significantly associated with CSM or CR (all p > 0.1), while an increased preoperative eGFR was associated with reduced hazard of ACM (HR = 0.87, p < 0.01). Limitations include retrospective design and a potential selection bias. CONCLUSIONS Our data do not support oncological protection of greater preservation of renal function and confirm that unfavorable oncological outcomes for localized RCC are mostly associated with aggressive tumor characteristics. PATIENT SUMMARY We did not find an association between greater preservation of renal function and oncological outcomes for kidney cancer.
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Affiliation(s)
- Diego Aguilar Palacios
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Emily C Zabor
- Department of Quantitative Health Sciences & Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Gustavo Roversi
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Furman Mahmood
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Emily Abramczyk
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Maureen Kelly
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Brigid Wilson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Louis Stokes Veteran's Affairs Medical Center, Cleveland, OH, USA
| | - Robert Abouassaly
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Louis Stokes Veteran's Affairs Medical Center, Cleveland, OH, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Karabay E, Tosun Ç, Karsiyakali N, Kayar K, Aykan S, Aslan AR, Yucebas OE, Ozturk MI. Identifying the predictors of estimated glomerular filtration rate after partial nephrectomy with a nonlinear regression model. Int J Clin Pract 2021; 75:e13763. [PMID: 33064933 DOI: 10.1111/ijcp.13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the effect of partial nephrectomy on renal function and to identify predictors of estimated glomerular filtration rate (eGFR) at 6 months after partial nephrectomy. METHODS Medical data of 154 consecutive patients who underwent partial nephrectomy for a renal mass between January 2015 and March 2020 were retrospectively analysed. The primary outcome measure was eGFR at 6 months postoperatively. An ordinary least regression analysis using a restricted cubic spline for continuous variables was performed to examine the association between primary outcome measure and candidate predictors. RESULTS Of the patients, 66 (42.9%) were females and 88 (57.1%) were males with a median age of 60 (range, 50 to 67) years. The median baseline eGFR was 90.40 (range, 74.96 to 102.97) mL/min/1.73 m2 , while the median eGFR at 6 months was 77.12 (range, 61.06 to 91.93) mL/min/1.73 m2 (P < .001). Baseline eGFR (regression coefficient (β) = 22.7, 95%CI: 18.8 to 26.5, P < .001) was found to be most significant predictor with the postoperative eGFR levels at 6 months. In addition, advanced tumour size (β = -3.17, 95%CI: -5.33 to -1.01, P < .001) and presence of hypertension (β = -3.48, 95%CI: -6.96 to -0.003, P = .049) were also found to be inversely associated with the postoperative eGFR levels at 6 months. CONCLUSION Baseline eGFR values, tumour size, and presence of hypertension are significant predictors of eGFR values in the mid-term in patients undergoing partial nephrectomy.
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Affiliation(s)
- Emre Karabay
- Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Çağatay Tosun
- Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nejdet Karsiyakali
- Department of Urology, Altunizade Hospital, Acibadem M.A. Aydinlar University, Istanbul, Turkey
| | - Kemal Kayar
- Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serdar Aykan
- Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Ruknettin Aslan
- Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Omer Ergin Yucebas
- Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Metin Ishak Ozturk
- Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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