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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; 35:692-706. [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] [MESH Headings] [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, Department of Medical Oncology, Queen Mary University of London and Royal Free London NHS Foundation Trust, 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, 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, Department of Medical Oncology, Queen Mary University of London and Royal Free London NHS Foundation Trust, 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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Zhao X, Liu Z, Chen JY, Guo W, Zhang HX, Tian XJ, Wang GL, Liu C, Ma LL, Zhang SD. Influence of tumor thrombus morphology on the surgical complexity in renal cell carcinoma with inferior vena cava tumor thrombus: a single-center, large-sample study from China. World J Urol 2024; 42:454. [PMID: 39073634 PMCID: PMC11286623 DOI: 10.1007/s00345-024-05170-3] [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: 03/01/2023] [Accepted: 07/09/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The morphology of tumor thrombus varies from person to person and it may affect surgical methods and tumor prognosis. However, studies on the morphology of tumor thrombus are limited. The purpose of our study was to evaluate the impact of tumor thrombus morphology on surgical complexity. METHODS We retrospectively reviewed the clinical data of 229 patients with renal cell carcinoma combined with inferior vena cava (IVC) tumor thrombus who underwent surgical treatment at Peking University Third Hospital between January 2014 and December 2021. The patients were divided into floating morphology (107 patients) and filled morphology (122 patients) tumor thrombi groups. Chi-square and Mann-Whitney U tests were used for categorical and continuous variables, respectively. Postoperative complications were evaluated using the Clavien-Dindo surgical complication classification method. RESULTS Patients with filled morphology tumor thrombus required more surgical techniques than those with floating morphology tumor thrombus, which was reflected in more open surgeries (P < 0.001), more IVC interruptions (P <0.001), lesser use of the delayed occlusion of the proximal inferior vena cava (DOPI) technique (P < 0.001), and a greater need for cut-off of the short hepatic vein (P < 0.001) and liver dissociation (P = 0.001). Filled morphology significantly increased the difficulty of surgery in patients with renal cell carcinoma with tumor thrombus, reflected in longer operation time (P < 0.001), more surgical blood loss (P <0.001), more intra-operative blood transfusion (P < 0.001), and longer postoperative hospital stay (P < 0.001). Filled morphology tumor thrombus also led to more postoperative complications (53% vs. 20%; P < 0.001). CONCLUSION Compared with floating morphology thrombus, filled morphology thrombus significantly increased the difficulty of surgery in patients with renal cell carcinoma with IVC tumor thrombus.
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Affiliation(s)
- Xun Zhao
- Department of Urology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Ji-Yuan Chen
- Department of Urology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Wei Guo
- Department of Urology, Yan'an Hospital of Traditional Chinese Medicine, 26 Xuanyuan Road, Bridge Ditch Street, Baota District, Yan'an, Shanxi Province, 716000, China
| | - Hong-Xian Zhang
- Department of Urology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Xiao-Jun Tian
- Department of Urology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Guo-Liang Wang
- Department of Urology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Lu-Lin Ma
- Department of Urology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
| | - Shu-Dong Zhang
- Department of Urology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
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Hanquiez P, Neuville P, Robin J, Ruffion A, Fiard G, Rossello N, Decaussin-Petrucci M, Paparel P. Outcomes after radical nephrectomy with vena cava thrombectomy using multidisciplinary approach: A single center experience. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102657. [PMID: 38821382 DOI: 10.1016/j.fjurol.2024.102657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 05/09/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION To describe the perioperative outcomes in patients treated with radical nephrectomy with cava thrombectomy at all thrombi levels using a multidisciplinary approach, with or without extracorporeal circulation (ECC), and to identify factors associated with perioperative morbidity. METHODS We retrospectively identified 42 patients who were diagnosed with renal cell carcinoma (RCC) and a vena cava thrombus and treated with radical nephrectomy and cava thrombectomy by a double surgical team at Lyon University Hospital from 2008 through 2021. The surgeons operated in the cardiothoracic operating theater to proceed with median sternotomy or ECC, if necessary. The primary endpoint of this study was perioperative morbidity and mortality assessed using the Clavien-Dindo scale. Complications were recorded until 90 days after surgery, and those classified as grade IIIa or higher were considered high-grade complications. RESULTS Overall, 32 (76%) patients required ECC. No intraoperative mortality occurred; however, two patients (5%) died within 30 days. Complications occurred within 30 days in 30 patients (72%), with severe complications observed in 10 patients (24%). No further complications occurred between 30 and 90 days. Multivariate analysis revealed that age, thrombus level, ECC, American Society of Anesthesiologists physical status, symptoms, and metastasis at presentation were not significantly associated with high-grade complications (P>0.05). CONCLUSIONS Multidisciplinary approach is essential and frequent use of ECC, when achieved by a trained team, may facilitate surgery, and is associated with low perioperative morbidity, especially for patients with high-level thrombi. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Paul Hanquiez
- Department of Urology, Lyon Sud Hospital, Lyon, France.
| | - Paul Neuville
- Department of Urology, Lyon Sud Hospital, Lyon, France; Claude-Bernard University Lyon 1, Lyon, France.
| | - Jacques Robin
- Claude-Bernard University Lyon 1, Lyon, France; Department of Cardiac Surgery, "Louis-Pradel" Cardiologic Hospital, Lyon, France.
| | - Alain Ruffion
- Department of Urology, Lyon Sud Hospital, Lyon, France; Claude-Bernard University Lyon 1, Lyon, France.
| | - Gaëlle Fiard
- Department of Urology, Grenoble University Hospital, Grenoble, France.
| | - Noémie Rossello
- Department of Public health, Edouard Herriot Hospital, Lyon, France.
| | - Myriam Decaussin-Petrucci
- Claude-Bernard University Lyon 1, Lyon, France; Department of Pathology, Lyon-Sud Hospital, Lyon, France.
| | - Philippe Paparel
- Department of Urology, Lyon Sud Hospital, Lyon, France; Claude-Bernard University Lyon 1, Lyon, France.
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4
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Barashi NS, Friedman D, Shiang A, Pickersgill N, Vetter J, Suresh T, Ippolito JE, Smith ZL. Growth kinetics of venous tumor thrombus in patients with renal cell carcinoma. Urol Oncol 2024; 42:31.e17-31.e23. [PMID: 38160126 DOI: 10.1016/j.urolonc.2023.12.001] [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: 08/18/2023] [Revised: 11/11/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Some patients with renal cell carcinoma (RCC) present with venous tumor thrombus (VTT). The extent of the VTT is related to survival, so prompt surgical care is recommended. However, studies evaluating the natural history of VTT in patients with RCC are rare. We sought to evaluate the growth kinetics of VTT in patients with RCC using preoperative cross-sectional images. MATERIALS AND METHODS We identified patients who underwent radical nephrectomy and venous tumor thrombectomy at our institution from 01/2009 to 02/2022. We included those with a minimum of 2 adequate preoperative imaging studies (contrast-enhanced Computerized Tomography (CT), noncontrast Magnetic resonance imaging (MRI), or contrast-enhanced MRI), at least 14 days apart. We measured VTT in each study to calculate growth rate, and evaluated predictors of faster growth (demographics, histology, laterality, tumor diameter, and staging). To assess the relation between clinical variables and VTT growth, we used the Wilcoxon Rank-Sum, Kruskal-Wallis, and Spearman correlation tests. RESULTS A total of 30 patients were included in the analysis. The median time interval between studies was 33 days. Patients were mostly Caucasian and Males (90% and 70%, respectively). Most patients underwent a CT scan as their initial imaging study (66%), followed with an MRI as second study (73%). The mean venous tumor thrombus growth rate was 0.3 mm/d (standard deviation of 0.5mm), and only rhabdoid/sarcomatoid differentiation showed an association with tumor thrombus growth rate (0.3 vs. 0.63 mm/d, P = 0.038). CONCLUSIONS To the best of our knowledge, this is the first study evaluating the natural growth rate of venous tumor thrombus in patients with renal cell carcinoma. We found that tumor thrombi grew an average of 0.3 mm/d (1.0 cm/month) and that those with sarcomatoid and/or rhabdoid differentiation grew faster (0.63 mm/d). Further studies are needed to validate these results and provide a better understanding of tumor thrombus kinetics.
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Affiliation(s)
- Nimrod S Barashi
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, MO.
| | - Daniel Friedman
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Alex Shiang
- Washington University in St. Louis School of medicine. St. Louis, MO
| | - Nicholas Pickersgill
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, MO
| | - Joel Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, MO
| | - Tara Suresh
- Washington University in St. Louis School of medicine. St. Louis, MO
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Zachary L Smith
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, MO
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5
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Filomena GB, Marino F, Scarciglia E, Russo P, Fantasia F, Bientinesi R, Ragonese M, Foschi N, Gulino G, Sacco E, Racioppi M. Simultaneous surgical management of renal cancer with atrial thrombotic extension and severe chronic coronary artery disease: a case report. J Med Case Rep 2023; 17:543. [PMID: 38087378 PMCID: PMC10717298 DOI: 10.1186/s13256-023-04292-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Renal cell carcinoma accounts for 2-3% of all malignant cancers in adults and is characterized by the potential development of venous tumor thrombus. CASE PRESENTATION We present a rare case of a 62-year-old Caucasian man who arrived in the emergency department for monosymptomatic hematuria. Further investigation revealed a right renal cell carcinoma with 16 cm intravascular extension through the renal vein into the inferior vena cava and right atrium associated with significant coronary artery disease based on the computed tomography scan and coronary angiography. To the best of our knowledge, after an extensive literature review, only one similar case has been reported with involvement of the contralateral kidney. Therefore, there are no applicable management recommendations. After performing coronary artery bypass graft surgery, we proceeded with an open right radical nephrectomy and inferior vena cava and right atrium thrombectomy under cardiopulmonary bypass and while the patient's heart was still beating. The postoperative course went without complications, and the patient was discharged from the hospital on the 10th postoperative day. CONCLUSIONS Radical nephrectomy and thrombectomy with reconstruction of the inferior vena cava combined with coronary artery bypass graft can be performed safely and effectively in selected patients with renal cell carcinoma and significant coronary artery disease. Multidisciplinary teamwork and careful patient selection are essential for optimal outcomes.
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Affiliation(s)
- Giovanni Battista Filomena
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eros Scarciglia
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabrizio Fantasia
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nazario Foschi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Gulino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Zhang X, Zhang J, Zhang G, Xu L, Bai X, Zhang J, Chen L, Peng Q, Jin Z, Sun H. The feasibility of contrast-enhanced CT to identify the adhesive renal venous tumor thrombus of renal cell carcinoma. Eur Radiol 2023; 33:7429-7437. [PMID: 37314475 DOI: 10.1007/s00330-023-09776-w] [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: 02/06/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To identify adhesive renal venous tumor thrombus (RVTT) of renal cell carcinoma (RCC) by contrast-enhancement CT (CECT). MATERIALS AND METHODS Our retrospective study included 53 patients who underwent preoperative CECT and pathologically confirmed RCC combined with RVTT. They were divided into two groups based on the intra-operative findings of RVTT adhesion to the venous wall, with 26 cases in the adhesive RVTT group (ARVTT) and 27 cases in the non-adhesive group (NRVTT). The location, maximum diameter (MD) and CT values of tumors, the maximum length (ML) and width (MW) of RVTT, and length of inferior vena cava tumor thrombus were compared between the two groups. The presence of renal venous wall involvement, renal venous wall inflammation, and enlarged retroperitoneal lymph node was compared between the two groups. A receiver operating characteristic curve was used to analyze the diagnostic performance. RESULTS The MD of RCC and the ML and MW of the RVTT were all larger in the ARVTT group than in the NRVTT group (p = 0.042, p < 0.001, and p = 0.002). The proportion of renal vein wall involvement and renal vein wall inflammation were higher in the ARVTT group than in NRVTT groups (both p < 0.001). The multivariable model including ML and vascular wall inflammation to predict ARVTT could achieve the best diagnostic performance with the area under the curve, sensitivity, specificity, and accuracy of 0.91, 88.5%, 96.3%, and 92.5%, respectively. CONCLUSION The multivariable model acquired by CECT images could be used to predict RVTT adhesion. CLINICAL RELEVANCE STATEMENT For RCC patients with tumor thrombus, contrast-enhanced CT could noninvasively predict the adhesion of tumor thrombus, thus predicting the difficulty of surgery and contributing to the selection of an appropriate treatment plan. KEY POINTS • The length and width of the tumor thrombus could be used to predict its adhesion to the vessel wall. • Adhesion of the tumor thrombus can be reflected by inflammation of the renal vein wall. • The multivariable model from CECT can well predict whether the tumor thrombus adhered to the vein wall.
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Affiliation(s)
- Xiaoxiao Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Jincai Zhang
- Department of Radiology, Linyi Central Hospital, Linyi, Shandong Province, China
| | - Gumuyang Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Lili Xu
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Xin Bai
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Jiahui Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Li Chen
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Qianyu Peng
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Zhengyu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
- National Center for Quality Control of Radiology, Beijing, 100730, China.
| | - Hao Sun
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
- National Center for Quality Control of Radiology, Beijing, 100730, China.
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Zhou S, Zheng J, Zhai W, Chen Y. Spatio-temporal heterogeneity in cancer evolution and tumor microenvironment of renal cell carcinoma with tumor thrombus. Cancer Lett 2023; 572:216350. [PMID: 37574183 DOI: 10.1016/j.canlet.2023.216350] [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: 06/12/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
Metastasis is the most fatal aspect of cancer, often preceded by a tumor thrombus (TT) which forms within the vascular system. Renal cell carcinoma (RCC), the predominant form of kidney cancer, witnesses a venous system invasion in 4-10% of cases, resulting in venous tumor thrombus (RCC-TT). This variant represents a formidable clinical challenge due to its escalated surgical complexity, heightened risk of progression and metastasis, and an adverse prognosis. However, recent trials addressing RCC-TT face significant barriers stemming from the profound inter- and intra-tumoral heterogeneity, patient-specific treatment variations, and distinct therapeutic resistance patterns between the primary tumor (PT) and the TT. This review delves into the unique evolutionary pathway of RCC-TT, the relationship between the staging and grading of RCC-TT invasion patterns, and the spatial molecular profiling of RCC-TT. Additionally, we assess the temporal heterogeneity among TT, PT, and distant metastases, as well as the functional phenotypes of TME components. An outlook for future research on RCC-TT is also provided.
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Affiliation(s)
- Sian Zhou
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Junhua Zheng
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Wei Zhai
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China; Department of Urology, State Key Laboratory of Oncogenes and Related Genes, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
| | - Yonghui Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
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8
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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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Acuña Pais B, Casais R, Lugo J, Piñón MÁ, Legarra JJ. Surgical management of tumor thrombus into the right atrium. J Cardiovasc Thorac Res 2023; 15:121-126. [PMID: 37654816 PMCID: PMC10466468 DOI: 10.34172/jcvtr.2023.31597] [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: 07/09/2022] [Accepted: 03/27/2023] [Indexed: 09/02/2023] Open
Abstract
Renal cell carcinoma represents 3% of solid tumors. In 4-10% of patients, venous tumor thrombosis is present, and 1% reaches the right atrium. Other tumors can be associated with tumor thrombosis. The natural history of venous tumor thrombosis implies a mean survival of 5 months. Between 2001 and 2021, 4 patients underwent resection of tumor thrombi into the right atrium, requiring cardiopulmonary bypass. None of the patients died within 30 days postoperatively. Mean follow-up time was 30.9 months (2.4- 96.1). Two patients are still alive and two died due to disease progression. Died patient's follow-up was 7.5 and 17.4 months, surpassing life expectancy of those without surgery. We present a series of patients who underwent lumpectomy and IVC thrombectomy. IVC tumor thrombosis has an ominous prognosis, however surgical treatment has an important role by improving the survival of these patients. The multidisciplinary approach is necessary to obtain good postoperative results.
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Affiliation(s)
- Beatriz Acuña Pais
- Cardiovascular Surgery Service, Álvaro Cunqueiro Hospital, Carretera de Clara Campoamor, Vigo, Spain
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10
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Dason S, Mohebali J, Blute ML, Salari K. Surgical Management of Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus. Urol Clin North Am 2023; 50:261-284. [PMID: 36948671 DOI: 10.1016/j.ucl.2023.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Most kidney cancers are primary renal cell carcinomas (RCC) of clear cell histology. RCC is unique in its ability to invade into contiguous veins - a phenomenon terms venous tumor thrombus. Surgical resection is indicated for most patients with RCC and an inferior vena cava (IVC) thrombus in the absence of metastatic disease. Resection also has an important role in selected patients with metastatic disease. In this review, we discuss the comprehensive management of the patient with RCC with IVC tumor thrombus, emphasizing a multidisciplinary approach to the surgical techniques and perioperative management.
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Affiliation(s)
- Shawn Dason
- Department of Urology, Ohio State University, 915 Olentangy River Road, Ste 3100, Columbus, OH 43212, USA
| | - Jahan Mohebali
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Michael L Blute
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Keyan Salari
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA.
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11
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Drăgan A, Sinescu I. AKI3-Risk Predictors and Scores in Radical Nephrectomy with High Thrombectomy under Extracorporeal Circulation for Renal Cell Carcinoma with Supradiaphragmatic Inferior Vena Cava/Right Atrial Thrombus: A Single-Centre Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020386. [PMID: 36837587 PMCID: PMC9962973 DOI: 10.3390/medicina59020386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023]
Abstract
Background and Objectives: The recommended therapeutic management in renal cell carcinoma (RCC) with supradiaphragmatic inferior vena cava/right atrial thrombus (IVC/RA) is surgery. Extracorporeal circulation is required. Acute kidney injury (AKI), a frequent complication after nephrectomy and cardiac surgery is associated with long-term kidney disease. This study aims to identify the risk factors involved in the occurrence of the severe postoperative AKI (AKI3) and to analyse various preoperative validated risk scores from cardiac and noncardiac surgery in predicting this endpoint. Materials and Methods: The medical data of all patients with RCC with supradiaphragmatic IVC/RA thrombus who underwent radical nephrectomy with high thrombectomy, using extracorporeal circulation, between 2004-2018 in the Prof. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, were retrospectively analysed. The patients who died intraoperatively were excluded from the study. The predefined study endpoint was the postoperative AKI3. Preoperative, intraoperative and postoperative data were collected according to the stratification of study population in two subgroups: AKI3-present and AKI3- absent patients. EuroSCORE, EuroSCORE II, Logistic EuroSCORE, NSQIP any-complications and NSQIP serious-complications were analysed. Results: We reviewed 30 patients who underwent this complex surgery between 2004-2018 in our institute. Two patients died intraoperatively. Nine patients (32.14%) presented postoperative AKI3. Age (OR 1.151, CI 95%: 1.009-1.312), preoperative creatinine clearance (OR 1.066, CI 95%: 1.010-1.123) and intraoperative arterial hypotension (OR 13.125, CI 95%: 1.924-89.515) were risk factors for AKI3 (univariable analysis). Intraoperative arterial hypotension emerged as the only independent risk factor in multivariable analysis (OR 11.66, CI 95%: 1.400-97.190). Logistic EuroSCORE (ROC analysis: AUC = 0.813, p = 0.008, CI 95%: 0.633-0.993) best predicted the endpoint. Conclusions: An integrated team effort is essential to avoid intraoperative arterial hypotension, the only independent risk factor of AKI3 in this highly complex surgery. Some risk scores can predict this complication. Further studies are needed.
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Affiliation(s)
- Anca Drăgan
- Department of Cardiovascular Anaesthesiology and Intensive Care, Prof. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, 258 Fundeni Road, 022328 Bucharest, Romania
- Correspondence:
| | - Ioanel Sinescu
- Department of Urological Surgery, Dialysis and Kidney Transplantation, Fundeni Clinical Institute, 258 Fundeni Road, 022328 Bucharest, Romania
- Department of Uronephrology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
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12
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Zacek P, Brodak M, Gofus J, Dominik J, Moravek P, Louda M, Podhola M, Vojacek J. Renal cell carcinoma with intracardiac tumor thrombus extension: Radical surgery yields 2 years of postoperative survival in a single-center study over a period of 30 years. Front Oncol 2023; 13:1137804. [PMID: 36816971 PMCID: PMC9931241 DOI: 10.3389/fonc.2023.1137804] [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: 01/04/2023] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
Background Renal cell carcinoma (RCC) with tumor thrombus extension into the right atrium (level IV) is a rare life-threatening clinical condition that can only be managed by means of a combined urological and cardiac surgical approach. The early and late outcomes of this radical treatment were analyzed in a large single-institution series over a period of 30 years. Methods In 37 patients with RCC and intracardiac tumor thrombus extension, nephrectomy was performed followed by the extraction of the intracaval and intracardiac tumor thrombus under direct visual control during deep hypothermic circulatory arrest (DHCA). Recently, in 13 patients, selective aortic arch perfusion (SAAP) was instituted during DHCA. Results In all patients, precise removal of the tumor thrombus was accomplished in a bloodless field. The mean duration of isolated DHCA was 15 ± 6 min, and 31.5 ± 10.2 min in the case of DHCA + SAAP, at a mean hypothermia of 22.7 ± 4°C. In-hospital mortality was 7.9% (3 patients). In Kaplan-Meier analysis, the estimated median survival was 26.4 months whereas the 5-year cancer-related survival rate was 51%. Conclusions Despite its complexity, this extensive procedure can be performed safely with a generally uneventful postoperative course. The use of cardiopulmonary bypass with DHCA, with the advantage of SAAP, allows for a safe, precise, and complete extirpation of intracaval and intracardiac tumor mass. Late outcomes after radical surgical treatment in patients with RCC and tumor thrombus reaching up in the right atrium in our series justify this extensive procedure.
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Affiliation(s)
- Pavel Zacek
- Department of Cardiac Surgery, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
| | - Milos Brodak
- Department of Urology, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
| | - Jan Gofus
- Department of Cardiac Surgery, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia,*Correspondence: Jan Gofus,
| | - Jan Dominik
- Department of Cardiac Surgery, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
| | - Petr Moravek
- Department of Urology, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
| | - Miroslav Louda
- Department of Urology, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
| | - Miroslav Podhola
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
| | - Jan Vojacek
- Department of Cardiac Surgery, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
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Gu Y, Fu Y, Pan X, Zhou Y, Ji C, Zhao T, Miao H, Lv H, Da J, Ge J, Wang L, Qu L, Ge S, Guo H, Zhou W. Prognostic value of systemic immune-inflammation index in non-metastatic clear cell renal cell carcinoma with tumor thrombus. Front Oncol 2023; 13:1117595. [PMID: 36776325 PMCID: PMC9909392 DOI: 10.3389/fonc.2023.1117595] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
This study aims to determine the prognostic value of SII for non-metastatic clear cell renal cell carcinoma (ccRCC) patients with venous tumor thrombus (VTT). We retrospectively collected and analyzed 328 non-metastatic ccRCC patients with VTT who underwent radical nephrectomy and thrombectomy from 3 tertiary centers in China between 2011 to 2021. Kaplan-Meier analyses and Cox proportional hazard analyses were used to determine its prognostic value for overall survival (OS) and disease free survival (DFS). The Harrell concordance index (C-index), receiver operating characteristic curve (ROC) analysis, and decision curve analysis (DCA) were used to evaluate its role in the improvement of prognostic accuracy of the existing models. Nomogram models containing the SII were then developed and evaluated by R. Patients were divided into low-SII and high-SII groups based on the SII optimal cut-off value 912 calculated by the Youden index in all patients. Higher SII was correlated with more symptoms, longer surgical time, higher WHO/ISUP grade, and longer tumor diameter. Kaplan-Meier analyses revealed significant differences in OS and DFS between two groups. Multivariate analyses revealed that SII was an independent prognostic factor for OS (HR:2.220, p=0.002) and DFS (HR:1.846, p=0.002). Compared with other indicators, SII had a superior accuracy (c-index=0.630 for OS and 0.595 for DFS). It also improved the performance of models for predicting OS and DFS (all p <0.01). Based on the results of LASSO Cox regression analysis, we constructed a nomogram to predict OS and it performed well on both the training cohort (AUC=0.805) and the validation cohort (AUC=0.795). Risk stratification based on nomogram can distinguish patients with different risks (all p <0.001). Preoperative SII is an independent predictive factor for OS and DFS of non-metastatic ccRCC patients with VTT. It can be used to improve the performance of current risk models.
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Affiliation(s)
- Yufeng Gu
- Department of Urology, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Yao Fu
- Department of Pathology, Drum Tower Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Xin Pan
- Department of Urology, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Yulin Zhou
- Department of Urology, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Changwei Ji
- Department of Urology, Drum Tower Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Tangliang Zhao
- Department of Urology, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - He Miao
- Department of Urology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huichen Lv
- Department of Urology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jianping Da
- Department of Urology, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Jingping Ge
- Department of Urology, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Le Qu
- Department of Urology, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Silun Ge
- Department of Urology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, China,*Correspondence: Wenquan Zhou, ; Hongqian Guo, ; Silun Ge,
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China,*Correspondence: Wenquan Zhou, ; Hongqian Guo, ; Silun Ge,
| | - Wenquan Zhou
- Department of Urology, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China,*Correspondence: Wenquan Zhou, ; Hongqian Guo, ; Silun Ge,
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14
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Current Approaches in Surgical and Immunotherapy-Based Management of Renal Cell Carcinoma with Tumor Thrombus. Biomedicines 2023; 11:biomedicines11010204. [PMID: 36672712 PMCID: PMC9855836 DOI: 10.3390/biomedicines11010204] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Renal cell carcinoma (RCC) accounts for 2-3% of all malignant disease in adults, with 30% of RCC diagnosed at locally advanced or metastatic stages of disease. A form of locally advanced disease is the tumor thrombus (TT), which commonly grows from the intrarenal veins, through the main renal vein, and up the inferior vena cava (IVC), and rarely, into the right cardiac chambers. Advances in all areas of medicine have allowed increased understanding of the underlying biology of these tumors and improved preoperative staging. Although the development of several novel system agents, including several clinical trials utilizing immune checkpoint inhibitors and combination therapies, has been shown to lower perioperative morbidity and increase post-operative recurrence-free and progression-free survival, surgery remains the mainstay of therapy to achieve a cure. In this review, we provide a description of specific surgical approaches and techniques used to minimize intra- and post-operative complications during radical nephrectomy and tumor thrombectomy of RCC with TT extension of various levels. Additionally, we provide an in-depth review of the major developments in neoadjuvant and adjuvant immunotherapy-based treatment and the impact of ongoing and recently completed clinical trials on the surgical treatment of advanced RCC.
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15
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Garg H, Nayak B, Kumar A, Singh P, Nayyar R, Kaul A, Seth A. Survival analysis and predictors of long-term outcomes following radical nephrectomy with inferior vena cava (IVC) thrombectomy in renal cell carcinoma. Indian J Cancer 2022; 0:348195. [PMID: 36861688 DOI: 10.4103/ijc.ijc_5_20] [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: 11/05/2022]
Abstract
Background Renal cell carcinoma (RCC) presents with inferior vena cava (IVC) thrombus in 10%-30% cases and surgical management forms the mainstay of the treatment. The objective of this study is to assess the outcomes of the patients undergoing radical nephrectomy with IVC thrombectomy. Methods A retrospective analysis of patients undergoing open radical nephrectomy with IVC thrombectomy between 2006 till 2018 was done. Results A total of 56 patients were included. The mean (±standard deviation) age was 57.1 (±12.2) years. The number of patients with levels I, II, III, and IV thrombus were 4, 29,10, and 13, respectively. The mean blood loss was 1851.8 mL, and the mean operative time was 303.3 minutes. Overall, the complication rate was 51.7%, while the perioperative mortality rate was 8.9%. The mean duration of hospital stay was 10.6 ± 6.4 days. The majority of the patients had clear cell carcinoma (87.5%). There was a significant association between grade and stage of thrombus (P = 0.011). Using Kaplan-Meier survival analysis, the median overall survival (OS) was 75 (95% confidence interval [CI] = 43.5-106.5) months, and the median recurrence-free survival (RFS) was 48 (95% CI = 33.1-62.3) months. Age (P = 0.03), presence of systemic symptoms (P = 0.01), radiological size (P = 0.04), histopathological grade (P = 0.01), level of thrombus (P = 0.04), and invasion of thrombus into IVC wall (P = 0.01) were found to be significant predictors of OS. Conclusion The management of RCC with IVC thrombus poses a major surgical challenge. Experience of a center along with high-volume and multidisciplinary facility particularly cardiothoracic facility provides better perioperative outcome. Though surgically challenging, it offers good overall-survival and recurrence-free survival.
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Affiliation(s)
- Harshit Garg
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Aashir Kaul
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Nisen H, Erkkilä K, Ettala O, Ronkainen H, Isotalo T, Nykopp T, Seikkula H, Seppänen M, Tramberg M, Palmberg C, Kilponen A, Pogodin-Hannolainen D, Mustonen S, Veitonmäki T. Intraoperative complications in kidney tumor surgery: critical grading for the European Association of Urology intraoperative adverse incident classification. Scand J Urol 2022; 56:293-300. [PMID: 35730592 DOI: 10.1080/21681805.2022.2089228] [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: 10/17/2022]
Abstract
INTRODUCTION The European Association of Urology committee in 2020 suggested a new classification, intraoperative adverse incident classification (EAUiaiC), to grade intraoperative adverse events (IAE) in urology. AIMS We applied and validated EAUiaiC, for kidney tumor surgery. PATIENTS AND METHODS A retrospective multicenter study was conducted based on chart review. The study group comprised 749 radical nephrectomies (RN) and 531 partial nephrectomies (PN) performed in 12 hospitals in Finland during 2016-2017. All IAEs were centrally graded for EAUiaiC. The classification was adapted to kidney tumor surgery by the inclusion of global bleeding as a transfusion of ≥3 units of blood (Grade 2) or as ≥5 units (Grade 3), and also by the exclusion of preemptive conversions. RESULTS A total of 110 IAEs were recorded in 13.8% of patients undergoing RN, and 40 IAEs in 6.4% of patients with PN. Overall, bleeding injuries in major vessels, unspecified origin and parenchymal organs accounted for 29.3, 24.0, and 16.0% of all IEAs, respectively. Bowel (n = 10) and ureter (n = 3) injuries were rare. There was no intraoperative mortality. IAEs were associated with increased tumor size, tumor extent, age, comorbidity scores, surgical approach and indication, postoperative Clavien-Dindo (CD) complications and longer stay in hospital. 48% of conversions were reactive with more CD-complications after reactive than preemptive conversion (43 vs. 25%). CONCLUSIONS The associations between IAEs and preoperative variables and postoperative outcome indicate good construct validity for EAUiaiC. Bleeding is the most important IAE in kidney tumor surgery and the inclusion of transfusions could provide increased objectivity.
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Affiliation(s)
- Harry Nisen
- Department of Urology, Abdominal Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Kaisa Erkkilä
- Department of Surgery, Porvoo Hospital, Porvoo, Finland
| | - Otto Ettala
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Hanna Ronkainen
- Department of Urology, Oulu University Hospital, Oulu, Finland
| | - Taina Isotalo
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Timo Nykopp
- Department of Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Heikki Seikkula
- Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Marjo Seppänen
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - Margus Tramberg
- Department of Surgery, Kymenlaakso Central Hospital, Kotka, Finland
| | | | - Ansa Kilponen
- Department of Surgery, Kainuu Central Hospital, Kajaani, Finland
| | | | | | - Thea Veitonmäki
- Deparment of Urology, Tampere University Hospital and University of Tampere, Tampere, Finland
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Campi R, Barzaghi P, Pecoraro A, Gallo ML, Stracci D, Mariotti A, Giancane S, Agostini S, Li Marzi V, Sebastianelli A, Spatafora P, Gacci M, Vignolini G, Sessa F, Muiesan P, Serni S. Contemporary techniques and outcomes of surgery for locally advanced renal cell carcinoma with focus on inferior vena cava thrombectomy: the value of a multidisciplinary team. Asian J Urol 2022; 9:272-281. [PMID: 36035338 PMCID: PMC9399529 DOI: 10.1016/j.ajur.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/31/2022] [Accepted: 05/23/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To report the outcomes of surgery for a contemporary series of patients with locally advanced non-metastatic renal cell carcinoma (RCC) treated at a referral academic centre, focusing on technical nuances and on the value of a multidisciplinary team. Methods We queried our prospective institutional database to identify patients undergoing surgical treatment for locally advanced (cT3-T4 N0-1 M0) renal masses suspected of RCC at our centre between January 2017 and December 2020. Results Overall, 32 patients were included in the analytic cohort. Of these, 12 (37.5%) tumours were staged as cT3a, 8 (25.0%) as cT3b, 5 (15.6%) as cT3c, and 7 (21.9%) as cT4; 6 (18.8%) patients had preoperative evidence of lymph node involvement. Nine (28.1%) patients underwent nephron-sparing surgery while 23 (71.9%) received radical nephrectomy. A template-based lymphadenectomy was performed in 12 cases, with evidence of disease in 3 (25.0%) at definitive histopathological analysis. Four cases of RCC with level IV inferior vena cava thrombosis were successfully treated using liver transplant techniques without the need for extracorporeal circulation. While intraoperative complications were recorded in 3 (9.4%) patients, no postoperative major complications (Clavien-Dindo ≥3) were observed. At histopathological analysis, 2 (6.2%) patients who underwent partial nephrectomy harboured oncocytoma, while the most common malignant histotype was clear cell RCC (62.5%), with a median Leibovich score of 6 (interquartile range 5–7). Conclusion Locally advanced RCC is a complex and heterogenous disease posing several challenges to surgical teams. Our experience confirms that provided careful patient selection, surgery in experienced hands can achieve favourable perioperative, oncological, and functional outcomes.
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Henderickx MMEL, Baldew SV, Marconi L, van Dijk MD, van Etten-Jamaludin FS, Lagerveld BW, Bex A, Zondervan PJ. Surgical margins after partial nephrectomy as prognostic factor for the risk of local recurrence in pT1 RCC: a systematic review and narrative synthesis. World J Urol 2022; 40:2169-2179. [PMID: 35503118 PMCID: PMC9427912 DOI: 10.1007/s00345-022-04016-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/08/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To systematically review the published literature on surgical margins as a risk factor for local recurrence (LR) in patients undergoing partial nephrectomy (PN) for pT1 renal cell carcinomas (RCC). Evidence acquisition A systematic literature search of relevant databases (MEDLINE, Embase and the Cochrane Library) was performed according to the PRISMA criteria up to February 2022. The hypothesis was developed using the PPO method (Patients = patients with pT1 RCC undergoing PN, Prognostic factor = positive surgical margins (PSM) detected on final pathology versus negative surgical margins (NSM) and Outcome = LR diagnosed on follow-up imaging). The primary outcome was the rate of PSM and LR. The risk of bias was assessed by the QUIPS tool. Evidence synthesis After assessing 1525 abstracts and 409 full-text articles, eight studies met the inclusion criteria. The percentage of PSM ranged between 0 and 34.3%. In these patients with PSM, LR varied between 0 and 9.1%, whereas only 0–1.5% of LR were found in the NSM-group. The calculated odds ratio (95% confident intervals) varied between 0.04 [0.00–0.79] and 0.27 [0.01–4.76] and was statistically significant in two studies (0.14 [0.02–0.80] and 0.04 [0.00–0.79]). The quality analysis of the included studies resulted in an overall intermediate to high risk of bias and the level of evidence was overall very low. A meta-analysis was considered unsuitable due to the high heterogeneity between the included studies. Conclusion PSM after PN in patients with pT1 RCC is associated with a higher risk of LR. However, the evidence has significant limitations and caution should be taken with the interpretation of this data. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-04016-0.
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Affiliation(s)
- Michaël M. E. L. Henderickx
- Department of Urology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Suraj V. Baldew
- Department of Urology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Marcel D. van Dijk
- Faculty of Medicine (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Faridi S. van Etten-Jamaludin
- Research Support, Medical Library, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | | | - Axel Bex
- The Royal Free London NHS Foundation Trust and UCL Division of Surgery and Interventional Science, London, UK
- Department of Urology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Patricia J. Zondervan
- Department of Urology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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19
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Oncologic Outcomes of Renal Cell Carcinoma Patients Undergoing Radical Nephrectomy and Venous Thrombectomy: Prospective Follow-Up from a Single Center. JOURNAL OF ONCOLOGY 2022; 2022:9191659. [PMID: 35342403 PMCID: PMC8947865 DOI: 10.1155/2022/9191659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/18/2022] [Indexed: 12/31/2022]
Abstract
Purpose To evaluate the long-term oncologic outcomes of renal cell carcinoma (RCC) patients with venous thrombus after radical nephrectomy and venous thrombectomy (RN-VT) and to determine the prognostic factors. Methods and Materials We reported our follow-up data of RCC patients with venous thrombus from January 2014 to September 2020. We used the Kaplan-Meier method to assess the overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). The Cox proportional hazards regression model and competing risk model were used. Results After a median follow-up of 31 mon, eight-five patients (31.5%) died, and cancer-specific deaths occurred in 60 patients (22.2%). The 1 yr and 3 yr CSS were 89.3% and 72.7%, respectively. The median OS was 56.0 mon (95% CI 47.6-64.3 mon), and the 1 yr, 3 yr, and 5 yr OS were 87.0%, 62.1%, and 44.8%, respectively. For M1 patients, the median OS was 27.0 mon (95% CI 22.0-42.0 mon), and the 1 yr, 3 yr, and 5 yr OS were 78.0%, 41.5%, and 23.3%, respectively. For M0 patients, the median RFS was 38.0 mon (95% CI 32.5-43.5 mon), and the 1 yr and 3 yr RFS were 81.2% and 52.3%, respectively. Multivariate analyses showed that papillary RCC (HR 2.95, 95% CI 1.80-4.82, P < 0.001) or other RCC (HR 3.88, 95% CI 2.03-7.41, P < 0.001), perinephric fat invasion (HR 1.53, 95% CI 1.03-2.26, P = 0.04), sarcomatoid differentiation (HR 2.85, 95% CI 1.64-4.95, P < 0.001), Fuhrman grade 3 (HR 2.10, 95% CI 1.28-3.44, P = 0.003) or 4 (HR 3.55, 95% CI 2.09-6.03, P < 0.001), and distant metastasis (HR 1.76, 95% CI 1.18-2.63, P = 0.006) were associated with a worse CSS. Adjuvant therapy (HR 0.63, 95% CI 0.43-0.92, P = 0.02) was associated with a better CSS. Conclusions RCC patients can have an acceptable long-term survival after RN-VT. Prognostic factors influencing CSS included nonclear cell RCC histology, higher Fuhrman grade, sarcomatoid differentiation, perinephric fat invasion, distant metastasis, and adjuvant therapy.
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Zhang Y, Tian X, Bi H, Yan Y, Liu Z, Liu C, Zhang S, Ma L. A Nomogram Predicting the Progression-Free Survival of Nonmetastatic Renal Cell Carcinoma Patients With Venous Thrombus After Surgery. Front Oncol 2022; 12:765092. [PMID: 35402218 PMCID: PMC8988056 DOI: 10.3389/fonc.2022.765092] [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: 08/26/2021] [Accepted: 02/24/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives To demonstrate the progression-free survival (PFS) of nonmetastatic renal cell carcinoma (RCC) patients with venous thrombus after radical nephrectomy and venous thrombectomy (RN-VT) and to develop and validate a nomogram to predict the PFS of patients after RN-VT. Materials and Methods We reported our prospective follow-up data of RCC patients with venous thrombus from January 2014 to September 2020 (n = 199). We used the Kaplan–Meier method to assess the PFS. The Cox proportional hazards regression model was used to determine the predictors. Nomograms predicting the PFS was established, and external validation was performed. Calibration curves and decision curves were generated to assess the predictive efficacy and clinical benefit. Results After a median follow-up of 32 months, 79 patients (39.7%) had disease progression and the median PFS was 41.0 months (95% CI 34.8–53.2 months). The 1-year, 3-year, and 5-year PFS rates were 78.4%, 45.4%, and 30.0%, respectively. Multivariate analysis showed that Fuhrman grade [grade 4: hazard ratio (HR) 1.92, 95% CI 1.10–3.34, P = 0.02], pathological type (papillary RCC: HR 3.02, 95% CI 1.79–5.10, P < 0.001), perinephric fat invasion (HR 1.54, 95% CI 1.12–2.10, P = 0.007), sarcomatoid differentiation (HR 2.97, 95% CI 1.24–7.13, P = 0.02) were associated with a worse PFS, and adjuvant therapy (HR 0.32, 95% CI 0.18–0.59, P < 0.001) could lead to a better PFS. A nomogram based on the predictors was externally validated to have good discrimination and calibration, and it could improve PFS prediction to obtain a clinical benefit. Conclusions We constructed and validated a nomogram to predict the 1-year, 3-year, and 5-year PFS of M0 RCC patients with venous thrombus after surgery. The model can help identify patients who can benefit the most from surgery and develop the criteria for clinical trial enrollment.
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Affiliation(s)
| | | | | | | | | | | | | | - LuLin Ma
- *Correspondence: LuLin Ma, ; ShuDong Zhang,
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Ishiyama Y, Kondo T, Yoshida K, Iizuka J, Tanabe K, Takagi T. “Thrombus‐first” or “thrombus‐last” approach for surgical management of renal cell carcinoma with inferior vena cava thrombus. Int J Urol 2022; 29:559-565. [DOI: 10.1111/iju.14846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/09/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Yudai Ishiyama
- Department of Urology Tokyo Women’s Medical University Adachi Medical Center Tokyo Japan
- Department of Urology Tokyo Women’s Medical University Tokyo Japan
| | - Tsunenori Kondo
- Department of Urology Tokyo Women’s Medical University Adachi Medical Center Tokyo Japan
| | - Kazuhiko Yoshida
- Department of Urology Tokyo Women’s Medical University Tokyo Japan
| | - Junpei Iizuka
- Department of Urology Tokyo Women’s Medical University Tokyo Japan
| | - Kazunari Tanabe
- Department of Urology Tokyo Women’s Medical University Tokyo Japan
| | - Toshio Takagi
- Department of Urology Tokyo Women’s Medical University Tokyo Japan
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Zhao X, Yan Y, Dong JH, Liu Z, Zhang HX, Liu C, Ma LL. Influence of Deep Invasive Tumor Thrombus on the Surgical Complexity and Prognosis of Patients With Non-Metastatic Renal Cell Carcinoma Combined With Venous Tumor Thrombus. Front Oncol 2022; 12:833780. [PMID: 35223514 PMCID: PMC8865079 DOI: 10.3389/fonc.2022.833780] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/03/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To evaluate the impact of deep invasive tumor thrombus (DITT) on the surgical complexity and prognosis of patients with renal cell carcinoma with venous tumor thrombus. METHODS We retrospectively reviewed clinical data of 138 patients with non-metastatic renal cell carcinoma combined with venous tumor thrombus, who underwent surgical treatment in Peking University Third Hospital from January 2015 to June 2020. Patients were divided into the DITT group (84 patients) and non-invasive tumor thrombus (NITT) group (54 patients). Chi-square, t-test and Mann-Whitney U test were used for categorical and continuous variables, respectively. Kaplan-Meier plots were performed to evaluate the influence of DITT. Univariable and multivariable Cox regressions were conducted to determine independent prognostic factors and then assembled to make a nomogram to predict the survival. The performance of the nomogram was evaluated by Harrell's consistency index (C-index) and calibration plot. RESULTS Deep invasive tumor thrombus significantly increased the difficulty of surgery for patients with renal cell carcinoma with venous tumor thrombus, which is mainly reflected in longer operation time (p < 0.001), more surgical bleeding (p < 0.001), a higher proportion of perioperative blood transfusion (p = 0.006), a higher proportion of open surgery (p = 0.001), a longer postoperative hospital stay (p = 0.003), and a higher proportion of postoperative complications (p = 0.001). DITT (hazard ratio [HR] = 2.781, p = 0.040) was one of the independent risk factors for worse prognosis. Multivariate analysis showed that sarcoma-like differentiation (p = 0.040), tumor thrombus invasion (p = 0.040), low hemoglobin (p = 0.003), and pathological type (p < 0.001) were independent prognostic factors. The nomogram, combining all these predictors, showed powerful prognostic ability with a C-index of 78.8% (CI: 71.2%-86.4%). The predicted risk closely matches the observed recurrence probability. CONCLUSION Deep invasive tumor thrombus significantly increased the difficulty of surgeries for patients of renal cell carcinoma with venous tumor thrombus, and may lead to poor prognosis.
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Affiliation(s)
- Xun Zhao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Ye Yan
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Jing-Han Dong
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Hong-Xian Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lu-Lin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Grosso AA, Di Maida F, Giudici S, Mari A, Muiesan P, Taddei A, Campi R, Minervini A. Robotic surgery for renal tumors with inferior vena cava thrombosis: Indications and technical nuances. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2021.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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24
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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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25
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Takahara K, Shiroki R. Editorial Comment to Robot‐assisted radical nephrectomy and inferior vena cava tumor thrombectomy: Initial experience in Japan. IJU Case Rep 2022; 5:148. [PMID: 35509783 PMCID: PMC9057740 DOI: 10.1002/iju5.12425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kiyoshi Takahara
- Department of Urology School of Medicine Fujita Health University Toyoake Aichi Japan
| | - Ryoichi Shiroki
- Department of Urology School of Medicine Fujita Health University Toyoake Aichi Japan
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Muselaers S, Mulders P, Bertolo R, Erdem S, Ingels A, Marandino L, Roussel E, Marchioni M, Amparore D, Campi R. Inferior vena cava involvement in renal cell carcinoma: if you fail to plan, you're planning to fail. Minerva Urol Nephrol 2022; 73:854-857. [PMID: 35144370 DOI: 10.23736/s2724-6051.21.04811-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Stijn Muselaers
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands - .,European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands -
| | - Peter Mulders
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Riccardo Bertolo
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands.,Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | - Selcuk Erdem
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands.,Division of Urologic Oncology, Department of Urology, Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Alexandre Ingels
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands.,Department of Urology, Henri Mondor University Hospital, Créteil, France.,Biomaps, UMR1281, INSERM, CNRS, CEA, Paris Saclay University, Villejuif, France
| | - Laura Marandino
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands.,Department of Medical Oncology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Eduard Roussel
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands.,Department of Urology, University Hospital of Leuven, Leuven, Belgium
| | - Michele Marchioni
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands.,Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, G. D'Annunzio University, Chieti, Chieti-Pescara, Italy.,Department of Urology, SS Annunziata Hospital, G. D'Annunzio University, Chieti, Chieti-Pescara, Italy
| | - Daniele Amparore
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands.,Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Riccardo Campi
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands.,Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Shang B, Guo L, Shen R, Cao C, Xie R, Jiang W, Wen L, Bi X, Shi H, Zheng S, Li C, Ma J, Zhang K, Feng L, Shou J. Prognostic Significance of NLR About NETosis and Lymphocytes Perturbations in Localized Renal Cell Carcinoma With Tumor Thrombus. Front Oncol 2021; 11:771545. [PMID: 34993135 PMCID: PMC8724023 DOI: 10.3389/fonc.2021.771545] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/25/2021] [Indexed: 01/21/2023] Open
Abstract
BackgroundNon-metastatic renal cell carcinoma (RCC) with tumor thrombus showed a greater tendency for developing metastases after surgery. Early identification of patients with high risk of poor prognosis is especially important to explore adjuvant treatment of improving outcomes. Neutrophil-to-lymphocyte ratio (NLR) was a systemic inflammation marker and outcome predictor in RCC, reflecting the chaos in systemic immune status in cancer as myeloid cell expansion and lymphatic cell suppression. Neutrophil extracellular traps (NET) formation (NETosis) is the process of neutrophils generating an extracellular DNA net-like structure. NETosis in tumor was demonstrated to conduce to the subsequent metastases of tumor. However, the role of NLR for systemic immune status and tumor local immune infiltration, especially for neutrophil-associated NETs, in non-metastatic RCC with thrombus remains unclear.Patients and MethodsIn our clinical cohort, we enrolled the clinical, pathologic, and preoperative laboratory parameters of 214 RCC patients with tumor thrombus who were treated surgically. The clinical endpoint was defined as cancer-specific survival (CSS). In our basic research cohort, RNA-seq, TCR-seq, and scRNA-seq data were analyzed. Patients who reached the endpoint as recurrence-free survival (RFS) were defined as the “High-risk” group. Otherwise, they were separated into the “Low-risk” group.ResultsIn the clinical cohort, NLR≥4 was an independent risk factor for 203 localized RCC with tumor thrombus. In the basic research cohort, tumor thrombi were separated into NETosis-thrombi belonging to the “High-risk” group and non-NETosis-thrombi to the “Low-risk” group. NETs induced by tumor-derived G-CSF in tumor thrombus has a mechanistic role in unfavorable prognosis. Besides, NETs-score from single sample GSEA (ssGSEA) algorithm was an independent prognostic factor validated in the TCGA data. Apart from the neutrophils-associated NETosis, systemic immune perturbations of lymphocytes occurred in the “High-risk” group, represented with decreased TCR diversity and increasingly high proportion of CD4-positive effector memory T (Tem) cells, which indirectly represented the state of lymphopenia.ConclusionsOur findings firstly demonstrated that neutrophils-associated NETosis and systemic lymphocytes perturbations were considered as tumor progression in patients of localized RCC with tumor thrombus, which reflected NLR≥4 as an independent risk factor for patients.
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Affiliation(s)
- Bingqing Shang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liping Guo
- Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Rongfang Shen
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuanzhen Cao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruiyang Xie
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weixing Jiang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li Wen
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xingang Bi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhe Shi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shan Zheng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changling Li
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianhui Ma
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kaitai Zhang
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Kaitai Zhang, ; Lin Feng, ; Jianzhong Shou,
| | - Lin Feng
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Kaitai Zhang, ; Lin Feng, ; Jianzhong Shou,
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Kaitai Zhang, ; Lin Feng, ; Jianzhong Shou,
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Duda A, Hanak C, Wirtz P, Lipscomb A, Mitiek M. Single-stage resection with intraoperative filter placement for right renal carcinoma with vena cava extension. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:691-693. [PMID: 34746532 PMCID: PMC8556488 DOI: 10.1016/j.jvscit.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
Abstract
A unique feature of renal cell carcinoma is the extension of tumor into the inferior vena cava (IVC). We present the case of a 67-year-old man with a right renal mass, renal vein and IVC tumor thrombus, and acute occlusion of the common iliac veins. He underwent right radical nephrectomy, caval thrombectomy, bilateral iliofemoral vein thrombectomies, and intraoperative placement of an infrahepatic IVC filter. Intraoperative IVC filter placement should be considered a viable option for patients undergoing radical nephrectomy with thrombectomy for tumor invasion into the IVC with known lower extremity thrombosis.
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Affiliation(s)
- Amber Duda
- Department of Graduate Medical Education, Mercy Health - The Jewish Hospital, Cincinnati, Ohio
| | - Courtney Hanak
- Department of Graduate Medical Education, Mercy Health - The Jewish Hospital, Cincinnati, Ohio
| | - Patrick Wirtz
- Department of Graduate Medical Education, Mercy Health - The Jewish Hospital, Cincinnati, Ohio
| | - Amy Lipscomb
- Department of Graduate Medical Education, Mercy Health - The Jewish Hospital, Cincinnati, Ohio
| | - Mohi Mitiek
- Department of Graduate Medical Education, Mercy Health - The Jewish Hospital, Cincinnati, Ohio
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Staehler M, Rodler S, Schott M, Casuscelli J, Stief C, Spek A, Schlenker B. Polyethylene glycol-coated collagen patch (hemopatch ®) in open partial nephrectomy. World J Urol 2021; 40:127-132. [PMID: 34480235 PMCID: PMC8813698 DOI: 10.1007/s00345-021-03827-x] [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: 06/26/2019] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To describe the results of a polyethylene glycol-coated collagen patch, Hemopatch® on blood loss, surgical time and renal function in partial nephrectomy (PN) for renal cell carcinoma (RCC). METHODS Out of a single surgeon cohort of n = 565 patients undergoing conventional open PN (CPN) between 01/2015 and 12/2017 at the University of Munich a consecutive subgroup (n = 42) was operated on using a polyethylene glycol-coated collagen-based sealant Hemopatch® (Baxter International Inc., Deerfield, IL, USA) (HPN). RESULTS Median age was 65.2 years (range 12.7-95.2) with median follow-up of 9.43 months (0.03-49.15). Baseline renal function (CKD-EPI) was 78.56 ml/min/1.73 m2 (range 20.38-143.09) with a non-significant decline to 74.78 ml/min/1.73 m2 (range 3.75-167.74) at follow-up. In CPN 46% had low complexity, 33% moderate complexity and 20% high complexity lesions with 33% low, 40% moderate and 27% high complexity masses in HPN. Median tumor size was 4.3 cm (range 1-38 cm) in CPN with 4.8 cm (range 3.8-18.3 cm) with HPN, p = 0.293. Median blood loss and duration of surgery was significantly lower in the HPN group vs. CPN (146 ml ± 195 vs. 114 ml ± 159 ml; p = 0.021; 43 min ± 27 for HPN vs. 53 min ± 49; p = 0.035) with no difference in clamping time (12.6 min ± 8.6 for HPN vs. 12.0 min ± 9.5; p = 0.701). CONCLUSIONS Hemopatch® supported renoraphy shows promising results compared to standard renoraphy in PN. No side effects were seen. Further studies should evaluate the prevention of arterio-venous or urinary fistulas. In complex partial nephrectomies Hemopatch® supported renoraphy should be considered.
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Affiliation(s)
- Michael Staehler
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany. .,Multidisciplinary Center On Renal Tumors, Department of Urology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - S Rodler
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - M Schott
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - J Casuscelli
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - C Stief
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - A Spek
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - B Schlenker
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
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[Influence of deep invasive tumor thrombus on the surgical treatment and prognosis of patients with non-metastatic renal cell carcinoma complicated with venous tumor thrombus]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021. [PMID: 34393225 PMCID: PMC8365059 DOI: 10.19723/j.issn.1671-167x.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the impact of deep invasive tumor thrombus on the surgical complexity and prognosis of patients with renal cell carcinoma complicated with inferior vena cava tumor thrombus. METHODS We retrospectively reviewed the clinical data of 94 patients with non-metastatic renal cell carcinoma complicated with inferior vena cava tumor thrombus, who underwent surgical treatment in Peking University Third Hospital from January 2017 to June 2020. The patient's general condition, clinicopathological characteristics, surgery and survival information were collected. The patients were divided into two groups based on the intra-operative findings of tumor thrombus adhesion to the venous wall, of which 64 cases were in the deep invasive tumor thrombus (DITT) group and 30 cases were in the non-invasive tumor thrombus (NITT) group. Chi-square, t test and Mann-Whitney U test were used for categorical and continuous variables respectively. Kaplan-Meier plots and multivariable Cox regressions were performed to evaluate the influence of DITT on the prognosis of the patients with renal cell carcinoma with inferior vena cava tumor thrombus. RESULTS DITT significantly increase the difficulty of surgery for the patients with renal cell carcinoma with venous tumor thrombus, which was mainly reflected in the longer operation time (362.5 vs. 307.5 min, P=0.010), more surgical bleeding (1 200 vs. 450 mL, P=0.006), more surgical blood transfusion (800 vs. 0 mL, P=0.021), more plasma transfusion (200 vs. 0 mL, P=0.001), a higher proportion of open surgery (70.3% vs. 36.7%, P=0.002), a longer post-operative hospital stay (9.5 vs. 8 days, P=0.036), and a higher proportion of post-operative complications (46.9% vs. 13.8%, P=0.002). DITT was associated with worse overall survival of the patients with renal cell carcinoma with inferior vena cava tumor thrombus (P=0.022). Even in the multivariate analysis, DITT was still a poor prognostic factor for the overall survival of these patients [HR: 4.635 (1.017-21.116), P=0.047]. CONCLUSION For patients with non-metastatic renal cell carcinoma with inferior vena cava tumor thrombus, DITT will significantly increase the difficulty of surgery, and may lead to poor prognosis.
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Storey B, Grant A, Tiu A. Radical nephrectomy and vena caval thrombectomy with the use of cardiopulmonary bypass and hypothermic circulatory arrest: Experience at a large tertiary institution. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211039147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study aimed to review the experience at a large regional tertiary centre of open radical nephrectomy (RN) with vena caval thrombectomy with cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA) for the management of renal masses. Method: Data on patients with renal masses who had undergone RN and vena caval thrombectomy with CPB and HCA had been prospectively collected at two centres over a 19-year period (2000–2019). Twenty-three consecutive patients were identified and retrospectively analysed for operative and tumour characteristics and for postoperative outcome. Kaplan–Meier survival analysis was performed to compare patient outcomes based on tumour characteristics. Results: Median operating time was 358 minutes (interquartile range (IQR)=94 minutes), median bypass time was 117 minutes (IQR=28.5 minutes) and median circulation arrest time was 25 minutes (IQR=18.5 minutes). The median hospital length of stay was 11 days (IQR=5.3 days). Total complication rate was 52% ( n=12), consisting of four minor and eight major complications (Clavien–Dindo score >IIIa), including one intraoperative death. The overall five-year survival rate was 73% (11/15), with a median follow-up time of 53.1 months. Eleven (48%) patients were surgically cured, with a median follow-up time of 60.1 months (IQR=71.8 months). Disease recurrence was seen in eight (35%) patients, of whom four died. Patients who died survived for a median of 46.5 months. Median survival after the diagnosis of metastatic disease was seven months. Conclusions: We report the largest Australian cohort of RN with vena caval thrombectomy with CPB and HCA. We demonstrate outcomes comparable to major overseas centres, with an overall five-year survival rate of 73%. This suggests that even patients with extensive venal caval thrombus from renal masses can experience long-term survival benefit from RN and venal caval thrombectomy. Level of evidence: Level 3.
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Affiliation(s)
- Benjamin Storey
- Department of Urology, Royal Newcastle Centre, Australia
- University of Newcastle, Australia
| | - Alexander Grant
- Department of Urology, Royal Newcastle Centre, Australia
- University of Newcastle, Australia
- Lake Macquarie Private Hospital, Australia
| | - Albert Tiu
- Department of Urology, Royal Newcastle Centre, Australia
- University of Newcastle, Australia
- Lake Macquarie Private Hospital, Australia
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Chen Z, Yang F, Ge L, Qiu M, Liu Z, Liu C, Tian X, Zhang S, Ma L. Outcomes of renal cell carcinoma with associated venous tumor thrombus: experience from a large cohort and short time span in a single center. BMC Cancer 2021; 21:766. [PMID: 34215223 PMCID: PMC8254310 DOI: 10.1186/s12885-021-08508-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background The surgical management and outcomes of renal cell carcinoma (RCC) with venous tumor thrombus (VTT) have been reported in limited sample size, and there remain discrepancies over the factors that influence oncologic outcomes after radical nephrectomy with thrombectomy (RNTE). The aim of the study was to analyze the outcomes of the patients with RCC with VTT in our institution and identify the independent prognostic factors. Methods Patients with RCC with VTT were enrolled for the study from February 2015 to December 2018. All patients underwent RNTE. Clinical data were compared using Mann-Whitney U test and the chi-square test for continuous and categorical variables respectively. Survival analysis was estimated using the Kaplan-Meier method. Univariable and multivariable survival analyses were performed using Cox regression model. Results 121 patients (91 men & 30 women) were identified with a median age of 60 years. VTT level was 0 in 25 patients, I in 20, II in 50, III in 12 and IV in 14. The median follow-up time was 24 months. During the follow-up period, 51 (42%) patients died and 69 (57%) patients experienced recurrence or metastasis. The 3-year and 5-year over-all survival (OS) were 58 and 39%. Among the several factors examined, positive lymph node (P = 0.016), metastasis at surgery (P = 0.034), tumor necrosis (P = 0.023) and sarcomatoid differentiation (P < 0.001) were demonstrated as independent significant risk factors on multivariable analysis. Conclusion The OS was poor for patients with RCC with VTT. Rather than VTT level, positive lymph node, metastasis at surgery, tumor necrosis and sarcomatoid differentiation were independent prognostic predictors.
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Affiliation(s)
- Zhigang Chen
- Peking University Health Science Centre, No.49 North Garden Road, Haidian District, Beijing, P. R. China.,Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Feilong Yang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China.,Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Liyuan Ge
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Min Qiu
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China.
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China.
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Caño Velasco J, Polanco Pujol L, Hernandez Cavieres J, González García F, Herranz Amo F, Ciancio G, Hernández Fernández C. Controversies in the diagnosis of renal cell carcinoma with tumor thrombus. Actas Urol Esp 2021; 45:257-263. [PMID: 33139067 DOI: 10.1016/j.acuro.2020.09.009] [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: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
Diagnosis and treatment of renal cell carcinoma with venous tumor thrombosis remains a challenge today, requiring multidisciplinary teams, mainly in tumor thrombus levels III-IV. Our objective is to present the various diagnostic techniques used and its controversies. A review of the most relevant related articles between January 2000 and August 2020 has been carried out in PubMed, EMBASE and Scielo. Continuous technological development has allowed progress in its detection, in the approximation of the histological subtype, and in the determination of tumor thrombus level. Regardless of the imaging technique used for its diagnosis (CT, MRI, TEE, ultrasound with contrast), the time elapsed until treatment is vitally important to reduce the risk of complications, some of them fatal, such as pulmonary thromboembolism.
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Xiao R, Xu C, Ge L, He W, Yang B, Liu L, Liu C, Ma L. Prognostic Value of Positive Lymph Nodes in Patients with Renal Cell Carcinoma and Tumor Thrombus Undergoing Nephrectomy and Thrombectomy. Urol Int 2021; 105:657-665. [PMID: 33882508 DOI: 10.1159/000514057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTIONS The objective of this study was to determine the prognostic value of positive lymph nodes (LNs) in patients with renal cell carcinoma (RCC) and tumor thrombus (TT) and to explore risk factors predicting LNs metastasis. METHODS We retrospectively analyzed 216 patients with RCC and TT treated at a single institution from January 2015 to December 2019. Overall survival (OS) and progression-free survival (PFS) was estimated using the Kaplan-Meier curves divided by pathological LN status. Associations between clinicopathological features and survival outcomes were evaluated using Cox regression models. Logistic regression model was performed to determine risk factors associated with LN metastasis. RESULTS We identified 216 patients with RCC and TT including 85 (39.4%) who did and 131 (60.6%) who did not undergo lymph node dissection. Pathologically positive LNs were found in 18 (8.3%) cases. pN1 had significant worse OS (median: 21 vs. 41 and 56 months, p < 0.001) and PFS (median:14 vs. 29 and 33 months, p < 0.001) than pN0 and pNx respectively. However, survival outcomes of OS and PFS were similar between pNx-0/M1 and pN1/M0 group and between 1- and ≥2-node-positive group. Non-CCRCC (p = 0.001), sarcomatoid differentiation (p < 0.001), and pathologically positive LNs (p = 0.025) were independent prognostic predictors predicting worse OS while distance metastasis (p = 0.009), non-CCRCC (p = 0.023), necrosis (p = 0.014), sarcomatoid differentiation (p = 0.003), and pathologically positive LNs (p = 0.007) were independent prognostic indicators predicting worse PFS. Clinically positive LNs (p = 0.014) and sarcomatoid differentiation (p = 0.009) were predictors of positive LNs. CONCLUSIONS LNs metastasis independently associated with worse survival outcomes in RCC and TT populations, with similar survival outcomes compared to distance metastasis. Therefore, more accurate risk stratification is warranted for guiding postoperative surveillance and adjuvant therapy.
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Affiliation(s)
- Ruotao Xiao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Chuxiao Xu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Liyuan Ge
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Wei He
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Bin Yang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lei Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Triple Retroaortic Renal Vein With Tumor Thrombus. Urology 2021; 154:e17-e18. [PMID: 33891926 DOI: 10.1016/j.urology.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 11/20/2022]
Abstract
A case report of a 51-year-old man with left renal tumor and level II vena cava tumor thrombus (thrombus extending >2 cm above the renal vein, but below the hepatic veins) in a rare anatomical variant of renal vein. In nonmetastatic patients, aggressive surgical resection is widely accepted as the standard management option, but some doubts about the best practice in these patients are relevant. Surgical approach on those patients is a challenge for the surgeons, and anatomical variants make the procedure even more difficulty. These patients should be referring to a tertiary center because of the potential perioperative complexity.
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Outcomes in Renal Cell Carcinoma with Inferior Vena Cava Thrombus Treated with Surgery. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:96-100. [PMID: 34211754 PMCID: PMC8200613 DOI: 10.12865/chsj.47.01.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/14/2021] [Indexed: 11/28/2022]
Abstract
Introduction. Renal cell carcinoma can invade through the renal vein into the inferior vena cava, and can extend intraluminally, with tumor-thrombus formation. Methods: Retrospective study from January 2003 to August 2016. Surgical outcomes were analyzed. Neves classification was used for patient categorization. Kaplan Meier and Log-Rank test were used for survival analysis. Results: A total of 134 patients were included, 69 males (51.4%) and 65 females (49%), M:F ratio 1.06:1. Tumor size, bleeding and surgical time were higher in level IV thrombi (mean 16.1cm, 3 064ml and 6.5hrs, respectively), compared to level I (8.5cm, 1033ml and 3.1hrs, respectively). A higher frequency of positive lymph nodes was observed in levels III and IV compared with levels I and II (49% vs. 17.7%, p=0.0001). Distant metastases were observed in 36 pts. (27%). Overall surgical mortality was 4.5%. 5-year overall survival was 63%. We observed a 5-year survival in patients with level I-II 82% and level III and IV 46%. Conclusions: Our results suggest the benefit for the patient of an aggressive surgical approach with an acceptable mortality and 5-year survival rate. The results obtained justify an aggressive surgical approach to these tumors.
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Galosi AB, Papaveri A, Castellani D, Agostini E, Burattini L, Dell'Atti L. Level IV tumor thrombus in non-metastatic renal cell cancer? No, thanks. Level II is better. Lessons learned from a case report. Urol Case Rep 2021; 37:101660. [PMID: 33868935 PMCID: PMC8044637 DOI: 10.1016/j.eucr.2021.101660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022] Open
Abstract
Up to 19% of patients with renal cell carcinoma present with a venous thrombus at diagnosis and 1% have a thrombus extending above the diaphragm. The higher the thrombus level, the more challenging the surgery. Cavoatrial tumor thrombus usually requires circulatory arrest and sometimes cardiopulmonary by-pass. We present a case of non-metastatic renal cell carcinoma with a cavoatrial tumor thrombus in a patient who was unfit for cardiac surgery. Eight months of targeted molecular therapy downsized the tumor thrombus to inferior vena cava and allowed us to perform a radical nephrectomy with minimal cavothomy for thrombus resection.
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Affiliation(s)
- Andrea Benedetto Galosi
- Department of Specialist Clinical Science and Odontostomatology, Urology Division, Università Politecnica delle Marche, Via conca 71, 60126, Ancona, Italy
| | - Alessio Papaveri
- Department of Specialist Clinical Science and Odontostomatology, Urology Division, Università Politecnica delle Marche, Via conca 71, 60126, Ancona, Italy
| | - Daniele Castellani
- Department of Specialist Clinical Science and Odontostomatology, Urology Division, Università Politecnica delle Marche, Via conca 71, 60126, Ancona, Italy
| | - Edoardo Agostini
- Department of Specialist Clinical Science and Odontostomatology, Urology Division, Università Politecnica delle Marche, Via conca 71, 60126, Ancona, Italy
| | - Luciano Burattini
- Department of Molecular and Clinical Science, Medical Oncology Division, Università Politecnica delle Marche, Via conca 71, 60126, Ancona, Italy
| | - Lucio Dell'Atti
- Department of Specialist Clinical Science and Odontostomatology, Urology Division, Università Politecnica delle Marche, Via conca 71, 60126, Ancona, Italy
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Gerosa G, Bagozzi L, Tessari C, Pittarello D, Zanella F, Mancini M, Prayer-Galetti T, Cillo U, Zattoni F, Tarzia V. Proof of Concept: Microinvasive AngioVac Approach in Renal Cell Carcinoma With Atrial Thrombosis. Ann Thorac Surg 2021; 112:e193-e196. [PMID: 33676906 DOI: 10.1016/j.athoracsur.2020.11.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022]
Abstract
The AngioVac system (AngioDynamics, Latham, NY) has already been described for treatment of thrombotic formations concerning the venous district and the tricuspid valve. We describe an innovative application of the AngioVac system to treat the inferior vena cava thrombosis associated with renal cell carcinoma. In a high surgical risk patient, we utilized a microinvasive and a modified venoarterial AngioVac circuit to remove the atrial thrombus, ensure temporary circulatory support during abdominal surgery, and prevent pulmonary embolism.
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Affiliation(s)
- Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Lorenzo Bagozzi
- Cardiac Surgery Unit, Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Tessari
- Cardiac Surgery Unit, Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Demetrio Pittarello
- Cardiac Surgery Unit, Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Fabio Zanella
- Cardiac Surgery Unit, Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Mariangela Mancini
- Urology Unit, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Tommaso Prayer-Galetti
- Urology Unit, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Filiberto Zattoni
- Urology Unit, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Vincenzo Tarzia
- Cardiac Surgery Unit, Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy.
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Preoperative anaemia and thrombocytosis predict adverse prognosis in non-metastatic renal cell carcinoma with tumour thrombus. BMC Urol 2021; 21:31. [PMID: 33639914 PMCID: PMC7913427 DOI: 10.1186/s12894-021-00796-6] [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: 09/06/2020] [Accepted: 02/11/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND : This study aimed to determine the prognostic value of preoperative blood parameters in renal cell carcinoma (RCC) and tumour thrombus (TT) patients that were surgically treated. METHOD We retrospectively analysed clinicopathological data and blood parameters of 146 RCC and TT patients that were surgically treated. Univariate or multivariate Cox regression analyses were performed to determine the risk factors associated with progression-free survival (PFS) and overall survival (OS). Kaplan-Meier analysis and logistic regression were performed to study the risk factors. Receiver operating characteristic curves were applied to test improvements in the predictive accuracy of the established prognosis score. RESULTS On univariate and multivariate analysis, anaemia (HR 2.873, P = 0.008) and lymph node metastasis (HR 4.811, P = 0.015) were independent prognostic factors linked to OS. Besides, thrombocytosis (HR 2.324, P = 0.011), histologic subtype (HR 2.835, P = 0.004), nuclear grade (HR 2.069, P = 0.033), and lymph node metastasis (HR 5.739, P = 0.001) were independent prognostic factors associated with PFS. Kaplan-Meier curves revealed that patients with anaemia exhibited worse OS than those without it (P = 0.0033). Likewise, patients with thrombocytosis showed worse PFS than those without it (P < 0.0001). Adding the anaemia and thrombocytosis to the SSIGN score improved its predictive accuracy related to OS and PFS. Preoperative anaemia was linked to more symptom at presentation (OR 3.348, P = 0.006), longer surgical time (OR 1.005, P = 0.001), more blood loss (OR 1.000, P = 0.018), more transfusion (OR 2.734, P = 0.004), higher thrombus level (OR 4.750, P = 0.004) and higher nuclear grade (OR 3.449, P = 0.001) while thrombocytosis was associated with more symptom at presentation (OR 7.784, P = 0.007). CONCLUSIONS Preoperative anaemia and thrombocytosis were adverse prognostic factors in non-metastatic RCC patients with TT. Also, both preoperative anaemia and thrombocytosis can be clinically used for risk stratification of non-metastatic RCC and TT patients.
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Sakamoto S, Matsumura M, Tani K, Nemoto S, Tsuchida K, Koga F, Seyama Y. Jejunal limb obstruction by a tumor thrombus from pancreatic metastasis of renal cell carcinoma: a case report. Surg Case Rep 2021; 7:37. [PMID: 33534019 PMCID: PMC7859002 DOI: 10.1186/s40792-021-01122-w] [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: 01/04/2021] [Accepted: 01/27/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Renal cell carcinoma (RCC) is a primary tumor with the highest frequency of pancreatic metastasis. Although surgical resection can improve the prognosis of some patients with pancreatic metastasis of RCC (PM-RCC), the role of palliative surgery remains unclear. Herein, we described a case of jejunal limb occlusion caused by a tumor thrombus arising from a PM-RCC which was treated by surgical resection. CASE PRESENTATION A 75-year-old, male patient with metastatic RCC was admitted to our hospital with new-onset dysphagia and weight loss. Twenty years earlier he underwent a right nephrectomy with an adrenalectomy for the first surgical resection of RCC, and 12 years ago he underwent a left partial nephrectomy for metachronous primary RCC. Nine years later, multiple pancreatic metastases were detected. After discontinuing interferon therapy, he was followed up at his request without anticancer treatment. Multiple, pulmonary metastases developed 3 years ago, and resection of a brain metastasis was performed 6 months ago. He had also undergone a total gastrectomy with Roux-en Y reconstruction and splenectomy for gastric cancer 23 years ago. Computed tomography revealed a metastatic lesion in the pancreatic tail extending into the jejunal limb, which was obstructed by a tumor thrombus. Jejunal limb resection was performed concomitantly with a distal pancreatectomy as palliative surgery. The jejunal limb remnant was approximately 30 cm long and was re-anastomosed to the esophagus using a circular stapler. Blood perfusion at the anastomotic site was confirmed by indocyanine green fluorescence imaging. He was discharged on postoperative day 24 and was followed in the outpatient clinic. He achieved sufficient oral intake at 8 months postoperatively. CONCLUSIONS PM-RCC can invade the gastrointestinal tract and cause tumor thrombus formation resulting in bowel occlusion requiring surgical intervention.
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Affiliation(s)
- Shinya Sakamoto
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Masaru Matsumura
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Keigo Tani
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Satoshi Nemoto
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kazuhito Tsuchida
- Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yasuji Seyama
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
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Seetharam Bhat KR, Moschovas MC, Onol FF, Rogers T, Roof S, Patel VR, Schatloff O. Robotic renal and adrenal oncologic surgery: A contemporary review. Asian J Urol 2021; 8:89-99. [PMID: 33569275 PMCID: PMC7859360 DOI: 10.1016/j.ajur.2020.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/30/2020] [Accepted: 04/22/2020] [Indexed: 01/20/2023] Open
Abstract
Robot-assisted surgery has evolved over time. Radical nephrectomy with inferior vena cava thrombectomy is feasible and safe for level I, II and III thrombus in high volume centers. Though it is feasible for level IV thrombus, this procedure needs a multi-departmental co-operation. However, the safety of robot-assisted procedures in this subset is still unknown. Robot-assisted partial nephrectomy has been universally approved and found oncologically safe. Robotic adrenalectomy has been increasingly utilized for select cases, especially in bilateral tumors and for retroperitoneal adrenalectomy.
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Affiliation(s)
| | | | - Fikret Fatih Onol
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Travis Rogers
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Shannon Roof
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Vipul R. Patel
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Oscar Schatloff
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
- Sudmedica Health, Chile
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Kalapara AA, Frydenberg M. The role of open radical nephrectomy in contemporary management of renal cell carcinoma. Transl Androl Urol 2020; 9:3123-3139. [PMID: 33457285 PMCID: PMC7807349 DOI: 10.21037/tau-19-327] [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] [Indexed: 12/24/2022] Open
Abstract
Radical nephrectomy (RN) remains a cornerstone of the management of localised renal cell carcinoma (RCC). RN involves the en bloc removal of the kidney along with perinephric fat enclosed within Gerota's fascia. Key principles of open RN include appropriate incision for adequate exposure, dissection and visualisation of the renal hilum, and early ligation of the renal artery and subsequently renal vein. Regional lymph node dissection (LND) facilitates local staging but its therapeutic role remains controversial. LND is recommended in patients with high risk clinically localised disease, but its benefit in low risk node-negative and clinically node-positive patients is unclear. Concomitant adrenalectomy should be reserved for patients with large tumours with radiographic evidence of adrenal involvement. Despite a recent downtrend in utilisation of open RN due to nephron-sparing and minimally invasive alternatives, there remains a vital role for open RN in the management of RCC in three domains. Firstly, open RN is important to the management of large, complex tumours which would be at high risk of complications if treated with partial nephrectomy (PN). Secondly, open RN plays a crucial role in cytoreductive nephrectomy (CN) for metastatic RCC, in which the laparoscopic approach achieves similar results but is associated with a high reoperation rate. Finally, open RN is the current standard of care in the management of inferior vena caval (IVC) tumour thrombus. Management of tumour thrombus requires a multidisciplinary approach and varies with cranial extent of thrombus. Higher level thrombus may require hepatic mobilisation and circulatory support, whilst the presence of bland thrombus may warrant post-operative filter insertion or ligation of the IVC.
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Affiliation(s)
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Australia.,Cabrini Institute, Cabrini Health, Melbourne, Australia
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Ghoreifi A, Djaladat H. Surgical Tips for Inferior Vena Cava Thrombectomy. Curr Urol Rep 2020; 21:51. [PMID: 33090290 DOI: 10.1007/s11934-020-01007-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to describe the preoperative evaluation, surgical techniques, and postoperative management of patients with renal cell carcinoma (RCC) undergoing radical nephrectomy (RN) and inferior vena cava (IVC) thrombectomy. RECENT FINDINGS RN and IVC thrombectomy remains the standard management option in non-metastatic RCC patients with IVC thrombus. A comprehensive preoperative workup, including high-quality imaging, blood works, and appropriate consultations are required for all patients. The aim of the surgery is complete resection of all tumor burden, which requires a skillful surgical team for such a challenging procedure and is inherently associated with a high rate of perioperative morbidity and mortality. Preoperative CT or MRI is essential for surgical planning. The surgical approach is mainly determined by the level of the tumor thrombus. The open approach has been the standard, though minimally invasive and robotic techniques are emerging in selected cases by experienced surgeons.
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Affiliation(s)
- Alireza Ghoreifi
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave. Suite 7416, Los Angeles, CA, 90089, USA
| | - Hooman Djaladat
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave. Suite 7416, Los Angeles, CA, 90089, USA.
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Kapoor A, Kim J, Goucher G, Hoogenes J. Evolving Role of Urologists in the Management of Advanced Renal Cell Carcinoma. Urol Clin North Am 2020; 47:271-280. [PMID: 32600530 DOI: 10.1016/j.ucl.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Advanced renal cell carcinoma is not uncommon, but necessitates a multidisciplinary approach for optimal treatment. Targeted therapy has increased the likelihood of urologists managing patients in all disease stages. Neoadjuvant therapy is currently experimental. Systemic therapy for metastatic disease demonstrates survival benefits. The role of cytoreductive nephrectomy and adjuvant therapy is dependent on patient selection. Management of advanced renal cell carcinoma involves continued optimization of available agents and biomarker development. This article reviews the role of the urologist in medical and surgical therapies, including prognostication, management of locally advanced and metastatic disease, and provides the most recent clinical trial data.
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Affiliation(s)
- Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, McMaster Institute of Urology, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Room G334, Hamilton, Ontario L8N 4A6, Canada.
| | - Jaehoon Kim
- Division of Urology, Department of Surgery, McMaster University, McMaster Institute of Urology, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Room G334, Hamilton, Ontario L8N 4A6, Canada
| | - George Goucher
- Division of Urology, Department of Surgery, McMaster University, McMaster Institute of Urology, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Room G334, Hamilton, Ontario L8N 4A6, Canada
| | - Jen Hoogenes
- Division of Urology, Department of Surgery, McMaster University, McMaster Institute of Urology, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Room G334, Hamilton, Ontario L8N 4A6, Canada
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Darlington CD, Mammen RJ, Mammen KJ. COVID-19 and its impact on genitourinary malignancies. Indian J Urol 2020; 36:163-170. [PMID: 33082630 PMCID: PMC7531365 DOI: 10.4103/iju.iju_167_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/20/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 has emerged as an alarming disease since December 2019, claiming the lives of thousands across the world to date. This pandemic has burdened healthcare systems all over the world due to its heavy death toll. Researchers are actively working on effective treatment strategies, the scope of vaccination and the production of more medical equipment to tackle this crisis. However, it is important to note that the management of patients with malignancy also needs to be prioritized during such times. Some urological malignancies need early diagnosis and treatment while the diagnosis and treatment of several others can be safely delayed. Hence, we searched MEDLINE for evidence on the optimal management of urological cancers during the coronavirus disease (COVID-19) pandemic. Studies published from December 2019 to April 2020 were included in the review. Guidelines formulated by international and national urological societies were also included. This review aims to summarize the present evidence on effective triage and safe management of urological cancers amid COVID-19 pandemic to ensure efficient usage of healthcare resources during these unprecedented times.
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Affiliation(s)
- C. Danny Darlington
- Department of Urology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Rohan J. Mammen
- Department of Urology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Kim J. Mammen
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Zhao X, Liu Z, Zhang H, Li L, Tang S, Wang G, Zhang S, Wang S, Tian X, Ma L. PKUTHLP score: A comprehensive system to predict surgical approach in radical nephrectomy and thrombectomy. Oncol Lett 2020; 20:201-208. [PMID: 32565947 PMCID: PMC7285736 DOI: 10.3892/ol.2020.11571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/26/2020] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to develop an accurate preoperative scoring system to predict the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy. The clinical data of 123 patients with renal cell carcinoma with renal vein or inferior vena cava tumour thrombus admitted to the Department of Urology at Peking University Third Hospital between January 2015 and May 2018 were retrospectively analysed. Univariate and multivariate regression analyses were used to create the scoring system with an emphasis on the area improvement under the receiver operating characteristic curve. A total of 58 (47.2%) patients underwent complete laparoscopic surgery, 56 (45.5%) underwent complete open surgery and 9 (7.3%) underwent laparoscopic conversion to open surgery. The final multivariable model included the following three factors: Clinical node stage (P=0.030), Mayo classification (P<0.001) and tumour diameter (P=0.001). These three variables were then used to construct the score system named Peking University Third Hospital Laparoscopic Probability (PKUTHLP), which ranges from 0-5. The proportion of patients undergoing laparoscopic surgery for each level of the PKUTHLP score were as follows: 0 (n=20), 100%; 1 (n=34), 67.6%; 2 (n=21), 33.3%; 3 (n=21), 19.0%; 4 (n=23), 17.4%; and 5 (n=4), 0.0%. Overall, the PKUTHLP score accurately predicted the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy; however, prospective validation of the PKUTHLP scoring system is required.
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Affiliation(s)
- Xun Zhao
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Liwei Li
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Shiying Tang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Shumin Wang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
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Finlay B, Bednarz J, Dawson J. A Multidisciplinary Approach to Oncological Resections with Vascular Surgeons Improves Patient Outcomes. Eur J Vasc Endovasc Surg 2020; 60:293-299. [PMID: 32402805 DOI: 10.1016/j.ejvs.2020.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/12/2020] [Accepted: 04/08/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Oncological resections have become more radical in pursuit of disease free margins. Consequently, vascular structures may be injured inadvertently or purposely resected, with or without subsequent reconstruction. Thus, vascular surgeons have an increasing role in oncological surgery. The present authors sought to review their experience and examine the effect of timing of referral to a Vascular Surgeon (VS) on patient and surgical outcomes following tumour resection. METHODS A retrospective review was conducted of a prospectively maintained database at a public hospital network in Adelaide, Australia. All cases of collaboration between a VS and other surgeons for resection of cancer or non-malignant tumour were included. Medical records and operative, pathological, and transfusion data were reviewed, with particular attention to referring team, timing of VS referral (pre- or intra-operative), and the operative role of the VS. RESULTS Seventy-two cases were identified from January 2004 to June 2018. The most common collaborators were General Surgery and Urology. Of the cases, 86% were elective and 71% were referred to the VS pre-operatively. Pre-operative referral was associated with a predominant VS role of dissection and exposure. Pre-operative referral was associated with lower odds of vessel repair and reconstruction compared with intra-operative referral (adjusted OR = 0.20; 95% CI 0.04-0.93; p = .040) and a lower incidence of positive surgical margins (35% vs. 80%, p = .028). The rate of blood product units required was lower among pre-operative referrals relative to intra-operative referrals, but the effect of timing was not significant after adjustment for potential confounders (IRR = 0.80, 95% CI 0.26-2.44; p = .70). CONCLUSION Pre-operative planned involvement of vascular surgery in oncological operations can improve surgical outcomes, with additional expected benefits for surgical training and cross specialty collaboration.
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Affiliation(s)
- Ben Finlay
- Trauma & Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Jana Bednarz
- Adelaide Health Technology Assessment, University of Adelaide, Adelaide, South Australia, Australia
| | - Joe Dawson
- Trauma & Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Department of Vascular & Endovascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
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Yang JH, Song DH, Lee C, Kang DH, Jung JJ, Kim SH, Byun JH, Kim JW, Moon SH. Malignant pulmonary embolism associated with renal sarcoma: A case report. Medicine (Baltimore) 2020; 99:e19943. [PMID: 32384440 PMCID: PMC7220360 DOI: 10.1097/md.0000000000019943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
RATIONALE The preoperative diagnosis of massive pulmonary tumor embolism associated with renal neoplasms is relatively rare. In most cases, pulmonary tumor embolism is detected intraoperatively during renal tumor resection. Moreover, primary renal sarcoma is rare, and primary renal sarcoma complicated by pulmonary tumor embolism is extremely rare; accordingly, there is no optimal treatment for such cases. Herein, we report a case of renal sarcoma associated with pulmonary tumor embolism. PATIENT CONCERNS A 39-year-old man was admitted to the emergency room owing to the sudden onset of dyspnea and palpitation. DIAGNOSIS Contrast-enhanced computed tomography (CT) revealed a large mass in the right kidney involving the infrahepatic inferior vena cava, with massive pulmonary emboli in both the pulmonary arteries. INTERVENTIONS Emergency pulmonary embolectomy with radical nephrectomy was performed. OUTCOMES The patient experienced apparent remission of dyspnea, and resolution of right ventricle dysfunction. However, although remnant emboli were detected in the segmental arteries on postoperative CT, complete resolution of pulmonary embolism was observed after adjuvant chemotherapy. LESSONS Thus, concomitant cytoreductive nephrectomy with pulmonary embolectomy along with chemotherapy may be effective for patients with renal sarcoma with pulmonary tumor embolism.
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Affiliation(s)
- Jun Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Changwon
| | - Dae Hyun Song
- Gyeongsang National University School of Medicine
- Gyeongsang Institute of Health Science, Jinju
- Department of Pathology, Gyeongsang National University Changwon Hospital
| | - Chunwoo Lee
- Department of Urology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Dong Hoon Kang
- Department of Thoracic and Cardiovascular Surgery, Changwon
| | - Jae Jun Jung
- Department of Thoracic and Cardiovascular Surgery, Changwon
| | - Sung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Changwon
| | - Joung Hun Byun
- Department of Thoracic and Cardiovascular Surgery, Changwon
| | - Jong Woo Kim
- Department of Thoracic and Cardiovascular Surgery, Changwon
| | - Seong Ho Moon
- Department of Thoracic and Cardiovascular Surgery, Changwon
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Méjean A, Rouprêt M, Rozet F, Bensalah K, Murez T, Game X, Rebillard X, Mallet R, Faix A, Mongiat-Artus P, Fournier G, Neuzillet Y. [Recommendations CCAFU on the management of cancers of the urogenital system during an epidemic with Coronavirus COVID-19]. Prog Urol 2020; 30:221-231. [PMID: 32224294 PMCID: PMC7146722 DOI: 10.1016/j.purol.2020.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 12/16/2022]
Abstract
Objectif La population française est confrontée à la pandémie de COVID-19 et le système de santé a été réorienté en urgence pour la prise en charge des patients atteints du coronavirus. La prise en charge des cancers de l’appareil urinaire et génital masculin doit être adaptée à ce contexte. Matériel et méthode Un avis d’experts documenté par une revue de la littérature a été formulé par le Comité de Cancérologie de l’Association Française d’Urologie (CCAFU). Résultats La prise en charge médicale et chirurgicale des patients atteints de cancers de l’appareil urinaire et génital masculin doit être adaptée en modifiant les modalités de consultation, en priorisant les interventions en fonction du pronostic intrinsèque des cancers en tenant compte des comorbidités du patient. La protection des urologues vis-à-vis du COVID-19 doit être prise en considération. Conclusion Le CCAFU émet un avis d’experts quant aux mesures à prendre pour adapter la prise en charge des cancers de l’appareil urinaire et génital masculin au contexte de pandémie par COVID-19.
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Affiliation(s)
- A Méjean
- Comité de cancérologie de l'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - F Rozet
- Comité de cancérologie de l'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - K Bensalah
- Comité de cancérologie de l'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - T Murez
- Comité de cancérologie de l'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - X Game
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - X Rebillard
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - R Mallet
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - A Faix
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - P Mongiat-Artus
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - G Fournier
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - Y Neuzillet
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France.
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Yang B, Xia H, Xu C, Lu M, Zhang S, Wang G, Ma L. Impact of sarcomatoid differentiation and rhabdoid differentiation on prognosis for renal cell carcinoma with vena caval tumour thrombus treated surgically. BMC Urol 2020; 20:14. [PMID: 32070319 PMCID: PMC7029456 DOI: 10.1186/s12894-020-0584-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/31/2020] [Indexed: 01/24/2023] Open
Abstract
Background Sarcomatoid differentiation in renal cell carcinoma (RCC) with vena caval tumour thrombus has been shown to be associated with aggressive behaviours and poor prognosis; however, evidence of the impact of rhabdoid differentiation on prognosis is lacking. This study evaluated the impact of sarcomatoid differentiation and rhabdoid differentiation on oncological outcomes for RCC with vena caval tumour thrombus treated surgically. Methods We retrospectively analysed patients treated surgically for RCC with vena caval tumour thrombus at our institute from Jan 2015 to Nov 2018. Prognostic variables were evaluated for associations with progression-free survival (PFS) and cancer-specific survival (CSS) by Kaplan–Meier survival analysis and log-rank test. Univariate and multivariate analyses were performed to determine independent prognostic variables. Results We identified 125 patients with RCC and vena caval tumour thrombus, including 17 (13.6%) with sarcomatoid differentiation alone, 8 (6.4%) with rhabdoid differentiation alone and 3 (2.4%) with both sarcomatoid and rhabdoid differentiation. Compared to pure RCC, patients with sarcomatoid differentiation but not rhabdoid differentiation have worse PFS (p = 0.018 and p = 0.095, respectively). The univariate and multivariate analyses both showed sarcomatoid differentiation as a significant predictor of PFS. Compared to pure RCC, patients with sarcomatoid differentiation (p = 0.002) and rhabdoid differentiation (p = 0.001) both had significantly worse CSS. The univariate analysis showed sarcomatoid differentiation, rhabdoid differentiation, metastasis and blood transfusion as significant predictors of CSS (All, p < 0.05). In the multivariate analysis, sarcomatoid differentiation (HR 3.90, p = 0.008), rhabdoid differentiation (HR 3.01, p = 0.042), metastasis (HR 3.87, p = 0.004) and blood transfusion (HR 1.34, p = 0.041) all remained independent predictors of CSS. Conclusions Sarcomatoid differentiation and rhabdoid differentiation are both independent predictors of poor prognosis in RCC with vena caval tumour thrombus treated surgically.
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Affiliation(s)
- Bin Yang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Haizhui Xia
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Chuxiao Xu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Min Lu
- Department of Pathology, Peking University Health Science Center, Beijing, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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