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Li S, Zhou Z, Gao M, Liao Z, He K, Qu W, Li J, Kamel IR, Chu Q, Zhang Q, Li Z. Incremental value of automatically segmented perirenal adipose tissue for pathological grading of clear cell renal cell carcinoma: a multicenter cohort study. Int J Surg 2024; 110:4221-4230. [PMID: 38573065 PMCID: PMC11254242 DOI: 10.1097/js9.0000000000001358] [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: 12/17/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Accurate preoperative prediction of the pathological grade of clear cell renal cell carcinoma (ccRCC) is crucial for optimal treatment planning and patient outcomes. This study aims to develop and validate a deep-learning (DL) algorithm to automatically segment renal tumours, kidneys, and perirenal adipose tissue (PRAT) from computed tomography (CT) images and extract radiomics features to predict the pathological grade of ccRCC. METHODS In this cross-ethnic retrospective study, a total of 614 patients were divided into a training set (383 patients from the local hospital), an internal validation set (88 patients from the local hospital), and an external validation set (143 patients from the public dataset). A two-dimensional TransUNet-based DL model combined with the train-while-annotation method was trained for automatic volumetric segmentation of renal tumours, kidneys, and visceral adipose tissue (VAT) on images from two groups of datasets. PRAT was extracted using a dilation algorithm by calculating voxels of VAT surrounding the kidneys. Radiomics features were subsequently extracted from three regions of interest of CT images, adopting multiple filtering strategies. The least absolute shrinkage and selection operator (LASSO) regression was used for feature selection, and the support vector machine (SVM) for developing the pathological grading model. Ensemble learning was used for imbalanced data classification. Performance evaluation included the Dice coefficient for segmentation and metrics such as accuracy and area under curve (AUC) for classification. The WHO/International Society of Urological Pathology (ISUP) grading models were finally interpreted and visualized using the SHapley Additive exPlanations (SHAP) method. RESULTS For automatic segmentation, the mean Dice coefficient achieved 0.836 for renal tumours and 0.967 for VAT on the internal validation dataset. For WHO/ISUP grading, a model built with features of PRAT achieved a moderate AUC of 0.711 (95% CI, 0.604-0.802) in the internal validation set, coupled with a sensitivity of 0.400 and a specificity of 0.781. While model built with combination features of the renal tumour, kidney, and PRAT showed an AUC of 0.814 (95% CI, 0.717-0.889) in the internal validation set, with a sensitivity of 0.800 and a specificity of 0.753, significantly higher than the model built with features solely from tumour lesion (0.760; 95% CI, 0.657-0.845), with a sensitivity of 0.533 and a specificity of 0.767. CONCLUSION Automated segmentation of kidneys and visceral adipose tissue (VAT) through TransUNet combined with a conventional image morphology processing algorithm offers a standardized approach to extract PRAT with high reproducibility. The radiomics features of PRAT and tumour lesions, along with machine learning, accurately predict the pathological grade of ccRCC and reveal the incremental significance of PRAT in this prediction.
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Affiliation(s)
- Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Ziling Zhou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Mengmeng Gao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Zhouyan Liao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Kangwen He
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Weinuo Qu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Jiali Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Ihab R Kamel
- Department of Radiology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Qingpeng Zhang
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, and the Musketeers Foundation Institute of Data Science, University of Hong Kong, Hong Kong, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
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Yazdian Anari P, Zahergivar A, Gopal N, Chaurasia A, Lay N, Ball MW, Turkbey B, Turkbey E, Jones EC, Linehan WM, Malayeri AA. Kidney scoring surveillance: predictive machine learning models for clear cell renal cell carcinoma growth using MRI. Abdom Radiol (NY) 2024; 49:1202-1209. [PMID: 38347265 DOI: 10.1007/s00261-023-04162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Classification of clear cell renal cell carcinoma (ccRCC) growth rates in patients with Von Hippel-Lindau (VHL) syndrome has several ramifications for tumor monitoring and surgical planning. Using two separate machine-learning algorithms, we sought to produce models to predict ccRCC growth rate classes based on qualitative MRI-derived characteristics. MATERIAL AND METHODS We used a prospectively maintained database of patients with VHL who underwent surgical resection for ccRCC between January 2015 and June 2022. We employed a threshold growth rate of 0.5 cm per year to categorize ccRCC tumors into two distinct groups-'slow-growing' and 'fast-growing'. Utilizing a questionnaire of qualitative imaging features, two radiologists assessed each lesion on different MRI sequences. Two machine-learning models, a stacked ensemble technique and a decision tree algorithm, were used to predict the tumor growth rate classes. Positive predictive value (PPV), sensitivity, and F1-score were used to evaluate the performance of the models. RESULTS This study comprises 55 patients with VHL with 128 ccRCC tumors. Patients' median age was 48 years, and 28 patients were males. Each patient had an average of two tumors, with a median size of 2.1 cm and a median growth rate of 0.35 cm/year. The overall performance of the stacked and DT model had 0.77 ± 0.05 and 0.71 ± 0.06 accuracies, respectively. The best stacked model achieved a PPV of 0.92, a sensitivity of 0.91, and an F1-score of 0.90. CONCLUSION This study provides valuable insight into the potential of machine-learning analysis for the determination of renal tumor growth rate in patients with VHL. This finding could be utilized as an assistive tool for the individualized screening and follow-up of this population.
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Affiliation(s)
- Pouria Yazdian Anari
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Aryan Zahergivar
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Nikhil Gopal
- Urology Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Aditi Chaurasia
- Urology Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Nathan Lay
- Artificial Intelligence Resource, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Mark W Ball
- Urology Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Baris Turkbey
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Evrim Turkbey
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Elizabeth C Jones
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - W Marston Linehan
- Urology Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA.
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA.
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Boynton D, Noyes SL, Murali A, Peabody H, Krumm A, Singh K, Lane BR. Simplified cardiovascular index may be the best comorbidity index for clinical use in prediction of mortality for renal cancer patients. Urol Oncol 2024; 42:72.e1-72.e8. [PMID: 38242826 DOI: 10.1016/j.urolonc.2024.01.004] [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: 09/05/2023] [Revised: 12/01/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVE Understanding the relationship between comorbidities and life expectancy is important in cancer patients who carry risks of cancer and noncancer-related mortality. Comorbidity indices (CI) are tools to provide an objective measure of competing risks of death. We sought to determine which CI might be best incorporated into clinical practice for patients with suspected renal cancer. MATERIALS AND METHODS 1572 patients diagnosed with renal masses (stage I-IV) between 1998 and 2016 were analyzed for this study. Patient data were gathered from a community-based health center. Comorbidities were evaluated individually, and with 1 of 4 CI: Charlson (CCI), updated CCI (uCCI), age-adjusted CCI (aCCI), and simplified cardiovascular index (CVI). Cox-proportional hazard analysis of all-cause mortality was performed using the four CI, adjusting for the 4 CI, adjusting for age, gender, race, tumor size, and tumor stage. RESULTS Univariable analyses revealed the four CI were significant predictors of mortality (P < 0.05), as were age, gender, tumor size, and stage. Comorbid conditions at diagnosis included hypertension (47.8%), diabetes mellitus (47.2%), coronary artery disease (41.1%), chronic kidney disease (31.8%), peripheral vascular disease (8.0%), congestive heart failure (5.7%), chronic obstructive pulmonary disease (5.7%), and cerebrovascular disease (2.0%). When analyzing the 4 CI in multivariable survival analyses accounting for factors available at diagnosis, and analyses incorporating pathologic and recurrence data, only CVI score and uCCI remained statistically significant (P < 0.05). Limitations of this work are the retrospective nature of data collection and data from a single institution, limiting the generalizability. CONCLUSION Increasing comorbidity, age, tumor size, and cM stage are predictors of ACM for suspected renal cancer patients. CVI appears to provide comparable information to various iterations of CCI (uCCI, aCCI) while being the simplest to use. Utilization of CVI may assist clinicians and patients when considering between interventional and noninterventional approaches for suspected renal cancer.
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Affiliation(s)
- Dennis Boynton
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI
| | | | - Adharsh Murali
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Henry Peabody
- Division of Urology, Corewell Health West, Grand Rapids, MI
| | - Andrew Krumm
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Karandeep Singh
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Brian R Lane
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI; Division of Urology, Corewell Health West, Grand Rapids, MI.
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Gopal N, Anari PY, Chaurasia A, Antony M, Wakim P, Linehan WM, Ball M, Turkbey E, Malayeri A. The kidney imaging surveillance scoring system (KISSS): using qualitative MRI features to predict growth rate of renal tumors in patients with von-Hippel Lindau (VHL) syndrome. Abdom Radiol (NY) 2024; 49:542-550. [PMID: 38010527 DOI: 10.1007/s00261-023-04087-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To determine the reliability of an MRI-based qualitative kidney imaging surveillance scoring system (KISSS) and assess which imaging features predict growth rate (GR) of renal tumors in patients with VHL. MATERIALS AND METHODS We identified 55 patients with VHL with 128 renal tumors who underwent intervention from 2015 to 2020 at the National Cancer Institute. All patients had 2 preoperative MRIs at least 3 months apart. Two fellowship-trained radiologists scored each tumor on location and MR-sequence-specific imaging parameters from the earlier MRI. Weighted kappa was used to determine the degree of agreement between radiologists for each parameter. GR was calculated as the difference in maximum tumor dimension over time (cm/year). Differences in mean growth rate (MGR) within categories of each imaging variable were assessed by ANOVA. RESULTS Apart from tumor margin and renal sinus, reliability was at least moderate (K > 0.40) for imaging parameters. Median initial tumor size was 2.1 cm, with average follow-up of 1.2 years. Tumor MGR was 0.42 cm/year. T2 hypointense, mixed/predominantly solid, and high restricted diffusion tumors grew faster. When comparing different combinations of these variables, the model with the lowest mean error among both radiologists utilized only solid/cystic and restricted diffusion features. CONCLUSIONS We demonstrate a novel MR-based scoring system (KISSS) that has good precision with minimal training and can be applied to other qualitative radiology studies. A subset of imaging variables (T2 intensity; restricted diffusion; and solid/cystic) were independently associated with growth rate in VHL renal tumors, with the combination of the latter two most optimal. Additional validation, including in sporadic RCC population, is warranted.
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Affiliation(s)
- Nikhil Gopal
- Urology Oncology Branch, National Cancer Institutes, National Institutes of Health, Bethesda, MD, USA
| | - Pouria Yazdian Anari
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Aditi Chaurasia
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Maria Antony
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Paul Wakim
- Center for the Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, USA
| | - W Marston Linehan
- Urology Oncology Branch, National Cancer Institutes, National Institutes of Health, Bethesda, MD, USA
| | - Mark Ball
- Urology Oncology Branch, National Cancer Institutes, National Institutes of Health, Bethesda, MD, USA
| | - Evrim Turkbey
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Ashkan Malayeri
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA.
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Klontzas ME, Kalarakis G, Koltsakis E, Papathomas T, Karantanas AH, Tzortzakakis A. Convolutional neural networks for the differentiation between benign and malignant renal tumors with a multicenter international computed tomography dataset. Insights Imaging 2024; 15:26. [PMID: 38270726 PMCID: PMC10811309 DOI: 10.1186/s13244-023-01601-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVES To use convolutional neural networks (CNNs) for the differentiation between benign and malignant renal tumors using contrast-enhanced CT images of a multi-institutional, multi-vendor, and multicenter CT dataset. METHODS A total of 264 histologically confirmed renal tumors were included, from US and Swedish centers. Images were augmented and divided randomly 70%:30% for algorithm training and testing. Three CNNs (InceptionV3, Inception-ResNetV2, VGG-16) were pretrained with transfer learning and fine-tuned with our dataset to distinguish between malignant and benign tumors. The ensemble consensus decision of the three networks was also recorded. Performance of each network was assessed with receiver operating characteristics (ROC) curves and their area under the curve (AUC-ROC). Saliency maps were created to demonstrate the attention of the highest performing CNN. RESULTS Inception-ResNetV2 achieved the highest AUC of 0.918 (95% CI 0.873-0.963), whereas VGG-16 achieved an AUC of 0.813 (95% CI 0.752-0.874). InceptionV3 and ensemble achieved the same performance with an AUC of 0.894 (95% CI 0.844-0.943). Saliency maps indicated that Inception-ResNetV2 decisions are based on the characteristics of the tumor while in most tumors considering the characteristics of the interface between the tumor and the surrounding renal parenchyma. CONCLUSION Deep learning based on a diverse multicenter international dataset can enable accurate differentiation between benign and malignant renal tumors. CRITICAL RELEVANCE STATEMENT Convolutional neural networks trained on a diverse CT dataset can accurately differentiate between benign and malignant renal tumors. KEY POINTS • Differentiation between benign and malignant tumors based on CT is extremely challenging. • Inception-ResNetV2 trained on a diverse dataset achieved excellent differentiation between tumor types. • Deep learning can be used to distinguish between benign and malignant renal tumors.
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Affiliation(s)
- Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Georgios Kalarakis
- Department of Diagnostic Radiology, Karolinska University Hospital, Stockholm, Sweden
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Emmanouil Koltsakis
- Department of Diagnostic Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Papathomas
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Clinical Pathology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Apostolos H Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Antonios Tzortzakakis
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
- Medical Radiation Physics and Nuclear Medicine, Section for Nuclear Medicine, Karolinska University Hospital, 14 186, Huddinge, Stockholm, Sweden.
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Kinnear N, Kucheria A, Ogbechie C, Adam S, Haidar O, Cotter Fonseca P, Brodie A, Pullar B, Adshead J. Concordance between renal tumour biopsy and robotic-assisted partial and radical nephrectomy histology: a 10-year experience. J Robot Surg 2024; 18:45. [PMID: 38240940 DOI: 10.1007/s11701-024-01821-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
We aimed to assess concordance between renal tumour biopsy (RTB) and surgical pathology from robotic-assisted partial nephrectomy (RAPN) or robotic-assisted radical nephrectomy (RARN). Patients with preoperative RTB undergoing RAPN or RARN for suspected malignancy (9 September 2013-9 September 2023) were enrolled retrospectively from three sites. Patients were excluded if the tumour had prior cryotherapy or if biopsy or nephrectomy histology were unavailable or inconclusive. The primary outcome was concordance with the presence/absence of malignancy. Secondary outcomes were concordance with tumour subtype, World Health Organisation nuclear grade (patients with RTB clear cell or papillary RCC only), false-negative rate, false-positive rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). In the enrolment period, 332 and 132 patients underwent RAPN and RARN, respectively. Of these, 160 received preoperative RTB, with nine patients excluded, leaving 151 eligible patients. Median age was 63 years, and 49 (32%) were female. On surgical specimens, 144 patients had malignant histology. RTB was highly concordant with presence/absence of malignancy (147/151, 97%). Concordance with tumour subtype occurred in 141 patients (93%), while concordance with nuclear grade was seen in 42/66 patients (64%, RTB grade missing in 53 patients). False-negative rate, false-positive rate, sensitivity, specificity, PPV, and NPV were 2%, 14%, 98%, 86%, 99%, and 67%, respectively. Limitations include absence of complication data and exclusion of patients biopsied without surgery. In patients undergoing RAPN or RARN, preoperative RTB has high concordance with surgical pathology, both in the presence of malignancy and RCC subtype.
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Affiliation(s)
- Ned Kinnear
- Lister Hospital, Stevenage, SG1 4AB, UK.
- University of Adelaide, Adelaide, Australia.
| | | | | | - Sana Adam
- Lister Hospital, Stevenage, SG1 4AB, UK
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Conroy S, Catto JWF, Bex A, Brown JE, Cartledge J, Fielding A, Jones RJ, Khoo V, Nicol D, Stewart GD, Sullivan M, Tran MGB, Woodward R, Cumberbatch MG. Diagnosis, treatment, and survival from kidney cancer: real-world National Health Service England data between 2013 and 2019. BJU Int 2023; 132:541-553. [PMID: 37436368 DOI: 10.1111/bju.16128] [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: 07/13/2023]
Abstract
OBJECTIVES To report the NHS Digital (NHSD) data for patients diagnosed with kidney cancer (KC) in England. We explore the incidence, route to diagnosis (RTD), treatment, and survival patterns from 2013 to 2019. MATERIALS AND METHODS Data was extracted from the Cancer Data NHSD portal for International Classification of Diseases, 10th edition coded KC; this included Cancer Registry data, Hospital Episode Statistics, and cancer waiting times data. RESULTS Registrations included 66 696 individuals with KC. Incidence of new KC diagnoses increased (8998 in 2013, to 10 232 in 2019), but the age-standardised rates were stable (18.7-19.4/100 000 population). Almost half of patients (30 340 [45.5%]) were aged 0-70 years and the cohort were most frequently diagnosed with Stage 1-2 KC (n = 26 297 [39.4%]). Most patients were diagnosed through non-urgent general practitioner referrals (n = 16 814 [30.4%]), followed by 2-week-wait (n = 15 472 [28.0%]) and emergency routes (n = 11 796 [21.3%]), with older patients (aged ≥70 years), Stage 4 KCs, and patients with non-specified renal cell carcinoma being significantly more likely to present through the emergency route (all P < 0.001). Invasive treatment (surgery or ablation), radiotherapy, or systemic anti-cancer therapy use varied with disease stage, patient factors, and treatment network (Cancer Alliance). Survival outcomes differed by Stage, histological subtype, and social deprivation class (P < 0.001). Age-standardised mortality rates did not change over the study duration, although immunotherapy usage is likely not captured in this study timeline. CONCLUSION The NHSD resource provides useful insight about the incidence, diagnostic pathways, treatment, and survival of patients with KC in England and a useful benchmark for the upcoming commissioned National Kidney Cancer Audit. The RTD data may be limited by incidental diagnoses, which could confound the high proportion of 'emergency' diagnoses. Importantly, survival outcomes remained relatively unchanged.
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Affiliation(s)
- Samantha Conroy
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Urology, Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - James W F Catto
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Urology, Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Axel Bex
- Royal Free NHS Foundation Trust, Specialist Centre for Kidney Cancer, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Janet E Brown
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Alison Fielding
- Bladder and Renal Cancer Clinical Studies Group, National Cancer Research Institute, London, UK
| | - Rob J Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Vincent Khoo
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - David Nicol
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Mark Sullivan
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- University of Oxford, Oxford, UK
| | - Maxine G B Tran
- Royal Free NHS Foundation Trust, Specialist Centre for Kidney Cancer, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rose Woodward
- Action Kidney Cancer, Manchester, UK
- International Kidney Cancer Coalition, UK
| | - Marcus G Cumberbatch
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Urology, Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
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Demirci A, Hamidi N, Uzel T, Başar H. The 5-Factor Modified Frailty Index is effective in treatment decision and the determination of perioperative complications in patients with localized prostate cancer. Support Care Cancer 2023; 31:603. [PMID: 37779118 DOI: 10.1007/s00520-023-08078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To determine the active treatment option and perioperative complications using the 5-Factor Modified Frailty Index (mFI-5) in localized prostate cancer patients. MATERIAL AND METHODS Patients diagnosed with localized prostate cancer in our clinic between January 2018 and October 2022 were evaluated. The patients were separated according to the mFI-5 scores as Group 1 (score = 0, n = 74), Group 2 (score = 1, n = 41), and Group 3 (score ≥ 2, n = 69). Factors affecting the determination of treatment selection, oncological results, and surgical complications were identified with regression analysis. RESULTS The mean age of the patients in Group 1 was lower than in Group 2 and Group 3 (63.09 ± 7.25 years vs. 67.56 ± 7.98 years and 69.2 ± 6.77 years, p < 0.001, respectively). In Group 1, more patients were treated with retropubic radical prostatectomy (RRP), and in Group 3 with radiotherapy (RT) and active surveillance (AS) (62.2%, 53.6%, and 17.4%, p = 0.001, respectively). The rate of Clavien-Dindo grade 3 and 4 complication rates were higher in Group 3 than in Group 1 (50% vs. 8.7%, p < 0.001, respectively). Frailty was found to be an independent risk factor for overall survival (HR: 10.68, p = 0.02), the presence of Clavien-Dindo ≥ 3 complication (HR: 4.9, p = 0.02) and determination of RT/AS as the active treatment option (HR: 2.45, p = 0.04). CONCLUSION In patients with frailty according to the mFI-5, the complication rate after RRP in localized prostate cancer increased. When selecting the treatment to be applied in these patients, it will be useful to also evaluate the frailty status.
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Affiliation(s)
- Aykut Demirci
- Department of Urology, University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Mehmet Akif Ersoy Mah. Vatan Cad. No: 91, 06200, Ankara, Turkey.
| | - Nurullah Hamidi
- Department of Urology, University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Mehmet Akif Ersoy Mah. Vatan Cad. No: 91, 06200, Ankara, Turkey
| | - Tuncel Uzel
- Department of Urology, University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Mehmet Akif Ersoy Mah. Vatan Cad. No: 91, 06200, Ankara, Turkey
| | - Halil Başar
- Department of Urology, University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Mehmet Akif Ersoy Mah. Vatan Cad. No: 91, 06200, Ankara, Turkey
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Patel AK, Butaney M, Lane BR, Wilder S, Johnson A, Qi J, Wang Y, DiBianco J, Herrel L, Maatman T, Peabody J, Rosenberg B, Seifman B, Semerjian A, Shetty S, Schervish E, Collins J, Tandogdu Z, Rogers CG. Building a Roadmap for Surveillance of Renal Masses Using a Modified Delphi Method to Help Achieve Consensus. Urology 2023; 180:168-175. [PMID: 37353086 DOI: 10.1016/j.urology.2023.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To establish a consensus for initial evaluation and follow-up of patients on active surveillance (AS) for T1 renal masses (T1RM). METHODS A modified Delphi method was used to gather information about AS of T1RM, with a focus on patient selection, timing/type of imaging modality, and triggers for intervention. A consensus panel of Michigan Urological Surgery Improvement Collaborative-affiliated urologists who routinely manage renal masses was formed. Areas of consensus (defined >80% agreement) about T1RM AS were established iteratively via 3 rounds of online questionnaires. RESULTS Twenty-six Michigan Urological Surgery Improvement Collaborative urologists formed the panel. Consensus was achieved for 321/587 scenarios (54.7%) administered through 124 questions. Life expectancy, age, comorbidity, and renal function were most important for patient selection, with life expectancy ranking first. All tumors <3 cm and all patients with life expectancy <1 year were considered appropriate for AS. Appropriateness also increased with elevated perioperative risk, increasing tumor complexity, and/or declining renal function. Consensus was for multiphasic axial imaging initially (contrast CT for GFR >60 or MRI for GFR >30) with first repeat imaging at 3-6 months and subsequent imaging timing determined by tumor size. Consensus was for chest imaging for tumors >3 cm initially and >5 cm at follow up. Renal biopsy was not felt to be a requirement for entering AS, but useful in several scenarios. Consensus indicated rapid tumor growth as an appropriate trigger for intervention. CONCLUSION Our consensus panel was able to achieve areas of consensus to help define a clinically useful and specific roadmap for AS of T1RM and areas for further discussion where consensus was not achieved.
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Affiliation(s)
| | | | - Brian R Lane
- Spectrum Health Hospital System, Grand Rapids, MI; Michigan State University College of Human Medicine, Grand Rapids, MI
| | | | - Anna Johnson
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Ji Qi
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | | | - John DiBianco
- University of Florida, Department of Urology, Gainesville, FL
| | - Lindsey Herrel
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Thomas Maatman
- Michigan Urological Clinic, University of Michigan/West, Grand Rapids, MI
| | | | - Bradley Rosenberg
- Oakland University William Beaumont School of Medicine, Auburn Hills, MI
| | | | | | - Sugandh Shetty
- Comprehensive Urology, Royal Oak, MI; Wayne State University School of Medicine, Detroit, MI
| | | | - Justin Collins
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - Zafer Tandogdu
- Department of Urology, University College London Hospital, London, UK
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10
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Cheung DC, Martin LJ, Komisarenko M, McAlpine K, Alibhai SMH, Finelli A. A Matched Analysis of Active Surveillance Versus Nephrectomy for T1a Small Renal Masses. Eur Urol Oncol 2023; 6:535-539. [PMID: 36746730 DOI: 10.1016/j.euo.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 02/08/2023]
Abstract
While patients with a small renal mass (SRM) on active surveillance (AS) experience excellent metastasis-free survival (MFS) and cancer-specific survival (CSS), differences in overall survival (OS) observed may be explained by selection of older/comorbid patients for AS. Few studies have evaluated AS versus primary intervention in clinically balanced groups. We identified patients aged 55-75 yr with an SRM (≤4 cm, T1a) in our institutional database (2000-2020). Patients from AS and nephrectomy subgroups were matched exactly for age, sex, Eastern Cooperative Oncology Group (ECOG) performance status, biopsy status, and histology. The primary outcomes were OS and an event-free survival (EFS) composite that included OS, CSS, MFS, progression, or systemic therapy, which we tested in Cox proportional-hazards models. We identified 377 patients (205 AS, 172 nephrectomy). The cohort was balanced after matching (n = 110; mean age 64 yr, 77% male, and 75% ECOG score 0). In each arm, 47% were biopsied (predominantly clear-cell histology). The predicted 5-yr OS was 96% for the nephrectomy group and 95% for the AS group (hazard ratio for nephrectomy vs AS [HR] 0.83, 95% confidence interval [CI] 0.13-5.32; p = 0.8), with corresponding 5-yr EFS rates of 93% and 96% (HR 1.88, 95% CI 0.35-10.15; p = 0.5). Among SRM cases well matched for age and overall health status, we observed higher 5-yr OS and EFS rates for AS than previously reported; the rates were not significantly different from those after nephrectomy. The matched characteristics of our population are similar to those for treatment arms in contemporary cohorts and the results support the safety of AS in younger, healthier patients. PATIENT SUMMARY: While it has been shown that active surveillance for small kidney tumors is safe in older and more frail patients, its safety in younger, healthier patients has not been confirmed. We compared outcomes for patients aged 55-75 yr who were managed with surgery or active surveillance, and were similar in age and overall health. The probability of death after 5 years was low overall and not significantly different between the groups, suggesting that active surveillance is safe in routine clinical practice.
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Affiliation(s)
- Douglas C Cheung
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Lisa J Martin
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, Canada
| | - Maria Komisarenko
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, Canada
| | - Kristen McAlpine
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada; Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, Canada.
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11
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Monda SM, Lui HT, Pratsinis MA, Chandrasekar T, Evans CP, Dall'Era MA. The Metastatic Risk of Renal Cell Carcinoma by Primary Tumor Size and Subtype. EUR UROL SUPPL 2023; 52:137-144. [PMID: 37284045 PMCID: PMC10240521 DOI: 10.1016/j.euros.2023.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/08/2023] Open
Abstract
Background Current data on the association between tumor size, subtype, and metastases, and thresholds for intervention, for renal cell carcinoma (RCC), are largely based on single-center nephrectomy registries that may under-represent those presenting with metastatic disease. Objective We sought to assess tumor size and histologic subtype in relation to metastatic status at presentation for patients with RCC. Design setting and participants Using Surveillance, Epidemiology and End Results cancer registry data, we identified patients with a diagnosis of RCC made between 2004 and 2019, and a known size of primary tumor. We used nodal and metastatic TNM staging to assess metastatic disease at presentation. Outcome measurements and statistical analysis We report the proportion of metastatic disease across varying tumor sizes for clear cell (ccRCC), papillary (pRCC), and chromophobe (chRCC) RCC. We also examine sarcomatoid RCC and RCC with sarcomatoid features (sarcRCC). Logistic regression models were used to model the likelihood of metastatic disease for each histologic subtype. Results and limitations Of 181 096 RCC patients included, 23 829 had metastatic disease. For any RCC, metastatic rates of 3.6%, 13.1%, 30.3%, and 45.1% were observed for tumors ≤4, 4-≤7, 7-≤10, and >10 cm, respectively. Metastatic rates of chRCC were low at even large sizes, 11.0% at >10 cm. In contrast, sarcRCC had high metastatic rates at all sizes, 27.1% at ≤4 cm. Metastatic rates for ccRCC and pRCC increased steadily above 3 cm. For any RCC and each evaluated subtype, tumor size was found to be associated with metastatic disease on logistic regression (p < 0.001). Conclusions The likelihood of a renal mass being metastatic varies greatly with both its subtype and size. We report higher likelihoods of metastatic disease across tumor sizes compared with what has been reported previously. These results may help clinicians pick appropriate thresholds for intervention and candidates for active surveillance. Patient summary We find that the metastatic probability of renal cell carcinoma varies greatly with subtype and increases with tumor size.
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Affiliation(s)
- Steven M. Monda
- Department of Urologic Surgery, University of California Davis, Davis, CA, USA
| | - Hansen T. Lui
- Department of Urologic Surgery, University of California Davis, Davis, CA, USA
| | - Manolis A. Pratsinis
- Department of Urologic Surgery, University of California Davis, Davis, CA, USA
- Department of Urology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | | | | | - Marc A. Dall'Era
- Department of Urologic Surgery, University of California Davis, Davis, CA, USA
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12
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Yasuda Y, Zhang JH, Attawettayanon W, Rathi N, Wilkins L, Roversi G, Zhang A, Accioly JPE, Shah S, Munoz-Lopez C, Palacios DA, Hofmann M, Campbell RA, Kaouk J, Haber GP, Eltemamy M, Krishnamurthi V, Abouassaly R, Martin C, Li J, Weight C, Campbell SC. Comprehensive Management of Renal Masses in Solitary Kidneys. Eur Urol Oncol 2023; 6:84-94. [PMID: 36517406 DOI: 10.1016/j.euo.2022.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/20/2022] [Accepted: 11/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND A renal mass in a solitary kidney (RMSK) has traditionally been managed with partial nephrectomy (PN), although radical nephrectomy (RN) is occasionally required. Most RMSK studies have focused on patients for whom PN was achieved. OBJECTIVE To provide a comprehensive analysis of the management strategies/outcomes for an RMSK and address knowledge deficits regarding this challenging disorder. DESIGN, SETTING, AND PARTICIPANTS A total of 1024 patients diagnosed with an RMSK (1975-2022) were retrospectively evaluated. Baseline characteristics and pathologic/functional/survival outcomes were analyzed. INTERVENTION PN/RN/cryoablation (CA)/active surveillance (AS). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Functional outcomes, perioperative morbidity/mortality, and 5-yr recurrence-free survival (RFS) were evaluated. Kruskal-Wallis and chi-square tests were used to compare cohorts, and log-rank test and Cox proportional hazard model were used for survival analysis. RESULTS AND LIMITATIONS Of 1024 patients, 842 underwent PN (82%), 102 CA (10%), 54 RN (5%), and 26 AS (3%). The median tumor size and RENAL([R]adius [tumor size as maximal diameter], [E]xophytic/endophytic properties of tumor, [N]earness of tumor deepest portion to collecting system or sinus, [A]nterior [a]/posterior [p] descriptor, and [L]ocation relative to polar lines) score were 3.7 cm and 8, respectively. The median follow-up was 53 mo. For PN, 95% were clamped, and the median warm and cold ischemia times were 22 and 45 min, respectively. For PN, the median preoperative glomerular filtration rate (GFR) was 57 ml/min/1.73 m2, and the median new baseline and 5-yr GFRs were 47 and 48 ml/min/1.73 m2, respectively. Dialysis-free survival for PN was 97% at 5 yr. Twenty-two (2.1%) patients with clear-cell renal cell carcinoma and RENAL score ≥10 (median = 11) received tyrosine kinase inhibitors (TKIs) to facilitate PN, leading to 57% median decrease of tumor volume; PN was accomplished in 20 (91%). Forty-one patients had planned RN (4.0%), most often due to severe pre-existing chronic kidney disease (CKD), and 13 were converted from PN to RN (1.5%). Clavien III-V perioperative complications were observed in 80 (8%) patients and 90-d mortality was 0.6%. Five-year RFS for PN, CA, and RN were 83%, 80%, and 72%, respectively (p = 0.03 for PN vs RN). CONCLUSIONS Nephron-sparing approaches are feasible and successful in most RMSK patients. PN for an RMSK is often challenging but can be facilitated by selective use of TKIs. RN is occasionally required due to severe CKD, over-riding oncologic concerns, or conversion from PN. This is the first large RMSK study to provide a comprehensive analysis of all management strategies/outcomes. PATIENT SUMMARY Kidney cancer in a solitary kidney is a major challenge for achieving cancer-free status and avoiding dialysis. Although partial nephrectomy is the principal treatment for a renal mass in a solitary kidney, other options are occasionally required to optimize outcomes.
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Affiliation(s)
- Yosuke Yasuda
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | - Jj H Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Institute of Urologic Oncology, Department of Urology, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Worapat Attawettayanon
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Nityam Rathi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lamont Wilkins
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gustavo Roversi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ao Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Snehi Shah
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Martin Hofmann
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Mohamad Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Robert Abouassaly
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Charles Martin
- Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Jianbo Li
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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13
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Benmeziani R, Royer M, Aubert C, Rolley C, Le Corre V, Culty T, Nedelcu C, Zidane M, Lebdai S, Bigot P. [Impact of delay before partial nephrectomy of a localized kidney tumor]. Bull Cancer 2023; 110:160-167. [PMID: 36379731 DOI: 10.1016/j.bulcan.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Partial nephrectomy is the treatment of choice for small localized renal tumors. In case of doubt, a biopsy can confirm the diagnosis. The aim of this study was to evaluate the impact of a delayed time to partial nephrectomy on cancer development. MATERIALS AND METHODS Our single center study enrolled localized renal tumor patients who underwent a partial nephrectomy between 2015 and 2020; the collected data were included in the uroCCR prospective database. The histopathological stage of the tumors and the recurrence rate in patients treated with surgery >90 days after diagnosis were investigated. The impact a preoperative biopsy on was also explored. Statistical significance was tested using Student's t-test and Chi-squared test (SPSS software). RESULTS The cohort consisted of 179 patients, among which 41 (23 %) received a preoperative biopsy. 89 patients (50 %) were treated surgically >3 months after diagnosis. The median time to nephrectomy was 86 days (13-1 037). A delayed time to surgery did not lead to significantly higher recurrence rates (P=0.66). Preoperative biopsy led to a doubling time to surgery (P<0.001) but was neither correlated to a more severe tumor stage (P=0.944) nor to a higher recurrence rate (P=0.08). Tumor growth was not significantly different with or without the presence of a biopsy (P=0.122). CONCLUSION Our data evidence that a substantial delayed time to partial nephrectomy does not result in a negative impact on cancer prognosis in localized renal tumor patients.
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Affiliation(s)
- Racha Benmeziani
- CH Angoulême, service d'urologie, rond-point de Girac, 16959 Angoulême, France.
| | - Matthias Royer
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Cécile Aubert
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Cyrielle Rolley
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Vincent Le Corre
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Thibaut Culty
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Cosmina Nedelcu
- CHU de Angers, service de radiologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Merzouka Zidane
- CHU de Angers; service d'anatomopathologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Souhil Lebdai
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Pierre Bigot
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
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14
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Impact of COVID-19 on Uro-Oncological Patients: A Comprehensive Review of the Literature. Microorganisms 2023; 11:microorganisms11010176. [PMID: 36677468 PMCID: PMC9865028 DOI: 10.3390/microorganisms11010176] [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: 12/12/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
Background: The aim of this paper is to discuss the impact of COVID-19 on patients with urological malignancies (prostate cancer, bladder and upper tract urothelial cancer, kidney cancer, penile and testicular cancer) and to review the available recommendations reported in the literature. Methods: A review was performed, through the PubMed database, regarding available recommendations reported in the literature, to identify studies examining the impact of COVID-19 on treatment and clinical outcomes (including upstaging, recurrence, and mortality) for uro-oncological patients. Results: The COVID-19 pandemic dramatically changed the urological guidelines and patients' access to screening programs and follow-up visits. Great efforts were undertaken to guarantee treatments to high-risk patients although follow up was not always possible due to recurrent surges, and patients with lower risk cancers had to wait for therapies. Conclusions: Physically and mentally, uro-oncological patients paid a heavy price during the COVID-19 pandemic. Long term data on the "costs" of clinical decisions made during the COVID-19 pandemic are still to be revealed and analyzed.
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15
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Aragon-Ching JB, Uzzo R. Multidisciplinary treatment (MDT) perspectives in renal cell carcinoma. Ther Adv Urol 2023; 15:17562872231182216. [PMID: 37359736 PMCID: PMC10286529 DOI: 10.1177/17562872231182216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Affiliation(s)
| | - Robert Uzzo
- Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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16
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Urine Molecular Biomarkers for Detection and Follow-Up of Small Renal Masses. Int J Mol Sci 2022; 23:ijms232416110. [PMID: 36555747 PMCID: PMC9785854 DOI: 10.3390/ijms232416110] [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: 11/15/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Active surveillance (AS) is the best strategy for small renal masses (SRMs) management; however, reliable methods for early detection and disease aggressiveness prediction are urgently needed. The aim of the present study was to validate DNA methylation biomarkers for non-invasive SRM detection and prognosis. The levels of methylated genes TFAP2B, TAC1, PCDH8, ZNF677, FLRT2, and FBN2 were evaluated in 165 serial urine samples prospectively collected from 39 patients diagnosed with SRM, specifically renal cell carcinoma (RCC), before and during the AS via quantitative methylation-specific polymerase chain reaction. Voided urine samples from 92 asymptomatic volunteers were used as the control. Significantly higher methylated TFAP2B, TAC1, PCDH8, ZNF677, and FLRT2 levels and/or frequencies were detected in SRM patients' urine samples as compared to the control. The highest diagnostic power (AUC = 0.74) was observed for the four biomarkers panel with 92% sensitivity and 52% specificity. Methylated PCDH8 level positively correlated with SRM size at diagnosis, while TFAP2B had the opposite effect and was related to SRM progression. To sum up, SRMs contribute significantly to the amount of methylated DNA detectable in urine, which might be used for very early RCC detection. Moreover, PCDH8 and TFAP2B methylation have the potential to be prognostic biomarkers for SRMs.
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17
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Ratajczak JM, Gawrońska A, Fischer M, Hladun T, Marczak M. Can We Identify Patients in Danger of Delayed Treatment? Management of COVID-19 Pandemic Backlog in Urology Care in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16547. [PMID: 36554427 PMCID: PMC9779168 DOI: 10.3390/ijerph192416547] [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: 11/18/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic had a tremendous impact on healthcare systems around the world. This study aims to research the course of surgical treatment in urology during the pandemic in 2020, evaluate the volume of deferred treatment in urology in Poland, and indicate groups of patients that are especially vulnerable to a delay in the delivery of healthcare services. The National Health Found statistics (NHF) database was searched for information on procedures completed in urology departments from 2015 to 2020. Changes in hospital discharges of adults from 2019 to 2021 were investigated using monthly reports of NHF on patient billing groups. Statistics of PSA, testosterone, and creatinine testing were extracted from NHF reports. Annual changes in the number of surgeries were calculated. Then, the estimation of the expected quantity of procedures without the occurrence of the pandemic was performed using linear regression based on data from 2015 to 2020. The estimation was assumed reliable at R2 > 0.8. The difference between collected and estimated data was analysed. In 2020, the volume of radical prostatectomies, cystectomies, and kidney surgeries noted downturns following lockdowns in March and November. All analysed procedures, except radical cystectomy, noted a reduction in the entire year. The declines reached -34% in shockwave lithotripsy, -13% in ureterorenoscopic lithotripsy, -22% in cystolithotripsy, -28% in percutaneous lithotripsy, -12% in transurethral resection of a bladder tumour (TURBT), -31% in transurethral resection of the prostate, -15% in nephrectomy and kidney tumorectomy, and -10% in radical prostatectomy. Among the analysed procedures, only radical cystectomy rates increased 5%. Prostate-specific antigen and creatinine tests fell -17%, and testosterone testing was down -18%. In conclusion, the patients most vulnerable to delayed treatment due to the post-pandemic backlog are those requiring TURBT, kidney cancer operations, and radical prostatectomies. Solving backlogs in urology should prioritise cancer patients and thus requires improved access to cystoscopy, TURBT, diagnoses and surgery of prostate and kidney tumours. Addressing the needs of patients suffering from benign diseases demands appropriate measures to increase the surgical productivity of urology departments.
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Affiliation(s)
- Jakub Marek Ratajczak
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-647 Lodz, Poland
| | - Anna Gawrońska
- Łukasiewicz Research Network, Poznań Institute of Technology, 61-755 Poznań, Poland
| | - Margaret Fischer
- Faculty of Pharmacy, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Taras Hladun
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland
| | - Michał Marczak
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-647 Lodz, Poland
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18
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Minghinelli FE, Recalde RJ, Prost DM, Cutuli HJ, Giovannini SJM, Zaninovich RS. Which biological pathways are responsible for the late appearance of brain metastases in renal cell carcinoma? Analysis of eight cases. Surg Neurol Int 2022; 13:466. [PMID: 36324953 PMCID: PMC9610221 DOI: 10.25259/sni_713_2022] [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: 08/08/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Renal cell carcinoma (RCC) represents 1% of all cancers and its brain metastases amount to 8.1% of all metastatic tumors. Late brain metastases are defined as tumors that appear 10 years after diagnosis of the primary lesion. The objective of this work is to discuss which biological pathways are responsible for the late appearance of these metastases analyzing eight cases. Case Description: We report here eight cases of late brain metastases of RCC treated between 2018 and 2021. Patients consulted for different clinical complaints. Brain magnetic resonance imaging and computed tomography scan were performed on all patients. They were treated by complete surgical resection plus radiosurgery or by radiosurgery alone. The histology of most metastases showed clear cell RCC. Conclusion: In the presence of a patient with an intracranial tumor and a history of RCC with more than 10 years of evolution, the presence of late metastasis should always be considered. There are many theories described in the literature that try to explain the late appearance of brain metastases from RCC (low mitotic index, impaired immune system, cross talk, self-seeding, and among others).
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Affiliation(s)
- Federico E. Minghinelli
- Department of Neurosurgery, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
| | - Rodolfo José Recalde
- Department of Neurosurgery, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
| | - Diego Martín Prost
- Department of Neurosurgery, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
| | - Hernán Javier Cutuli
- Ángel H. Roffo Institute of Oncology, University of Buenos Aires, School of Medicine, Buenos Aires, Argentina
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Tzortzakakis A, Papathomas T, Gustafsson O, Gabrielson S, Trpkov K, Ekström-Ehn L, Arvanitis A, Holstensson M, Karlsson M, Kokaraki G, Axelsson R. 99mTc-Sestamibi SPECT/CT and histopathological features of oncocytic renal neoplasia. Scand J Urol 2022; 56:375-382. [PMID: 36065481 DOI: 10.1080/21681805.2022.2119273] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND 99mTc-Sestamibi Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) contributes to the non-invasive differentiation of renal oncocytoma (RO) from renal cell carcinoma (RCC) by characterising renal tumours as Sestamibi positive or Sestamibi negative regarding their 99mTc-Sestamibi uptake compared to the non-tumoral renal parenchyma. PURPOSE To determine whether 99mTc- Sestamibi uptake in renal tumour and the non-tumoral renal parenchyma measured using Standard Uptake Value (SUV) SPECT, has a beneficial role in differentiating RO from RCC. MATERIAL AND METHODS Fifty-seven renal tumours from 52 patients were evaluated. In addition to visual evaluation of 99mTc-Sestamibi uptake, SUVmax measurements were performed in the renal tumour and the ipsilateral non-tumoral renal parenchyma. Analysis of the area under the receiver operating characteristic curve identified an optimal cut-off value for detecting RO, based on the relative ratio of 99mTc- Sestamibi uptake. RESULTS Semiquantitative evaluation of 99mTc-Sestamibi uptake did not improve the performance of 99mTc- Sestamibi SPECT/CT in detecting RO. 99mTc- Sestamibi SPECT/CT identifies a group of mostly indolent Sestamibi-positive tumours with low malignant potential containing RO, Low-Grade Oncocytic Tumours, Hybrid Oncocytic Tumours, and a subset of chromophobe RCCs. CONCLUSION The imaging limitations for accurate differentiation of Sestamibi-positive renal tumours mirror the recognised diagnostic complexities of the histopathologic evaluation of oncocytic neoplasia. Patients with Sestamibi-positive renal tumours could be better suited for biopsy and follow-up, according to the current active surveillance protocols.
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Affiliation(s)
- Antonios Tzortzakakis
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden.,Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - Thomas Papathomas
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
| | - Ove Gustafsson
- Division of Urology, Karolinska University Hospital, Huddinge, Sweden
| | - Stefan Gabrielson
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden.,Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Alberta Precision Labs, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Alexandros Arvanitis
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Maria Holstensson
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden.,Division of Function and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet
| | - Mattias Karlsson
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - Georgia Kokaraki
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden.,Department of Clinical Pathology and Cytology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Rimma Axelsson
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden.,Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden
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20
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Azadikhah A, Varghese BA, Lei X, Martin-King C, Cen SY, Duddalwar VA. Radiomics quality score in renal masses: a systematic assessment on current literature. Br J Radiol 2022; 95:20211211. [PMID: 35671097 PMCID: PMC10996962 DOI: 10.1259/bjr.20211211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To perform a systematic assessment and analyze the quality of radiomics methodology in current literature in the evaluation of renal masses using the Radiomics Quality Score (RQS) approach. METHODS We systematically reviewed recent radiomics literature in renal masses published in PubMed, EMBASE, Elsevier, and Web of Science. Two reviewers blinded by each other's scores evaluated the quality of radiomics methodology in studies published from 2015 to August 2021 using the RQS approach. Owing to the diversity in the imaging modalities and radiomics applications, a meta-analysis could not be performed. RESULTS Based on our inclusion/exclusion criteria, a total of 87 published studies were included in our study. The highest RQS was noted in three categories: reporting of clinical utility, gold standard, and feature reduction. The average RQS of the two reviewers ranged from 5 ≤ RQS≤19, with the maximum attainable RQS being 36. Very few (7/87 i.e., 8%) studies received an average RQS that ranged from 17 < RQS≤19, which represents studies with the highest RQS in our study. Many (39/87 i.e., 45%) studies received an average RQS that ranged from 13 < RQS≤15. No significant interreviewer scoring differences were observed. CONCLUSIONS We report that the overall scientific quality and reporting of radiomics studies in renal masses is suboptimal, and subsequent studies should bolster current deficiencies to improve reporting of radiomics methodologies. ADVANCES IN KNOWLEDGE The RQS approach is a meaningful quantitative scoring system to assess radiomics methodology quality and supports a comprehensive evaluation of the radiomics approach before its incorporation into clinical practice.
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Affiliation(s)
- Afshin Azadikhah
- USC Radiomics Laboratory, Department of Radiology, Keck School
of Medicine, University of Southern California,
Los Angeles, United States
| | - Bino Abel Varghese
- USC Radiomics Laboratory, Department of Radiology, Keck School
of Medicine, University of Southern California,
Los Angeles, United States
| | - Xiaomeng Lei
- USC Radiomics Laboratory, Department of Radiology, Keck School
of Medicine, University of Southern California,
Los Angeles, United States
| | - Chloe Martin-King
- USC Radiomics Laboratory, Department of Radiology, Keck School
of Medicine, University of Southern California,
Los Angeles, United States
| | - Steven Yong Cen
- USC Radiomics Laboratory, Department of Radiology, Keck School
of Medicine, University of Southern California,
Los Angeles, United States
| | - Vinay Anant Duddalwar
- USC Radiomics Laboratory, Department of Radiology, Keck School
of Medicine, University of Southern California,
Los Angeles, United States
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21
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Magee DE, Wong JK, Correa AF. Stereotactic Ablative Body Radiotherapy: An Emerging Weapon in the Treatment Armamentarium for Renal Cell Carcinoma or a Potential Avenue for Overtreatment? Eur Urol 2022; 82:623-624. [DOI: 10.1016/j.eururo.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/21/2022] [Indexed: 11/04/2022]
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22
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HIGH RISK DISEASE AND POOR FOLLOWUP: THE IMPORTANCE OF RENAL MASS BIOPSY IN A COHORT OF VETERANS. Urology 2022; 167:152-157. [PMID: 35588788 DOI: 10.1016/j.urology.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the clinical utility of RMB in our multi-state system. Renal mass biopsy (RMB) is useful in the management of masses ≤ 4 cm (T1a), but evaluation of RMB in the uniquely vulnerable Veteran population is lacking. METHODS 136 RMB in 130 patients performed between 06/2015 and 11/2020 were identified in this Quality Improvement analysis. Demographics, size, pathology, treatment, and biopsy complications were analyzed. Of 101 T1a masses, 89 were either diagnostic or not decompressed cysts and 77 met inclusion criteria for follow-up imaging compliance analysis. RESULTS The median age was 66 years. The diagnostic rate was 94.1% (128/136) for all masses and 94.1% (95/101) for T1a renal masses, with a complication rate of 2.2%. Among solid T1a masses, unexpectedly aggressive lesions (Fuhrman Grade 4, Type 2 papillary or sarcomatoid features) were identified in 8/89 (9.0%). 57 (64%) patients were treated with cryoablation or surgery and 32 (36%) patients elected active surveillance (AS). A neoplastic finding (oncocytoma or RCC) was present in 16 patients choosing AS (50%) compared to 52 patients choosing treatment (91%). Compliance with NCCN-recommended imaging was 50% and 47% for AS and treatment groups, respectively. CONCLUSIONS In this VA cohort, we found a significant incidence of high-risk lesions and poor compliance with follow-up imaging. Aggressive biopsy protocols with high consideration of treatment may be appropriate to limit risk in those lost to follow-up. Given that 9% of our small renal masses were highly aggressive, biopsy may be critical in the selection of AS candidates.
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23
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Numakura K, Nakai Y, Kojima T, Osawa T, Narita S, Nakayama M, Kitamura H, Nishiyama H, Shinohara N. Overview of clinical management for older patients with renal cell carcinoma. Jpn J Clin Oncol 2022; 52:665-681. [PMID: 35397166 DOI: 10.1093/jjco/hyac047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
The rapidly increasing pool of older patients being diagnosed with and surviving their cancer is creating many challenges. Regarding localized renal cell carcinoma, surgery is considered as gold standard treatment options even in older men, whereas active surveillance and ablation therapy are alternative options for a proportion of these patients. With regard to advanced disease, anti-vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) and immune check point inhibitor are standard treatment modalities, although treatment choice from multiple regimens and prevention of adverse events need to be considered. Better assessment techniques, such as comprehensive geriatric assessment to meet the unique needs of older patients, are a central focus in the delivery of high-quality geriatric oncology care. Through this process, shared decision-making should be adopted in clinical care to achieve optimal goals of care that reflect patient and caregiver hopes, needs and preferences. It is necessary to continue investigating oncological outcomes and complications associated with treatment in this population to ensure appropriate cancer care. In this narrative review, we completed a literature review of the various treatments for renal cell carcinoma in older patients that aimed to identify the current evidence related to the full range of the treatments including active surveillance, surgery, ablation therapy and systemic therapy. Prospectively designed studies and studies regarding geriatric assessment were preferentially added as references. Our goals were to summarize the real-world evidence and provide a decision framework that guides better cancer practices for older patients with renal cell carcinoma.
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Affiliation(s)
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | | | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Masashi Nakayama
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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24
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Current perspectives on active surveillance for patients with small renal masses. Asian J Urol 2022; 9:204-205. [PMID: 36035339 PMCID: PMC9399542 DOI: 10.1016/j.ajur.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Indexed: 11/21/2022] Open
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25
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Growth Kinetics and Progression Rate of Bosniak Classification, Version 2019 III and IV Cystic Renal Masses on Imaging Surveillance. AJR Am J Roentgenol 2022; 219:244-253. [PMID: 35293234 DOI: 10.2214/ajr.22.27400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Active surveillance is increasingly used as first-line management for localized renal masses. Triggers for intervention primarily reflect growth kinetics, which are poorly investigated for cystic masses defined by Bosniak classification version 2019 (v2019). Objective: To determine growth kinetics and incidence rates of progression of class III and IV cystic renal masses, as defined by Bosniak classification v2019. Methods: This retrospective study included 105 patients (68 men, 37 women; median age, 67 years) with 112 Bosniak v2019 class III or IV cystic renal masses on baseline renal-mass protocol CT or MRI examinations from January 2005 to September 2021. Mass dimensions were measured. Progression was defined as any of: linear growth rate (LGR) ≥5 mm per year (representing clinical guideline threshold for intervention), volume doubling time <1 year, T category increase, or N1 or M1 disease. Class III and IV masses were compared. Time-to-progression was estimated using Kaplan-Meier curve analysis. Results: At baseline, 58 masses were class III and 54 were class IV. Median follow-up was 406 days. Median LGR was for class III masses 0.0 mm per year [interquartile range (IQR) -1.3 to 1.8] and for class IV masses 2.3 mm per year (IQR 0.0¬¬-5.7) (p<.001). LGR exceeded 5 mm per year in 4 (7%) class 3 masses and 15 (28%) class IV masses (p=.005). Two patients, both with class IV masses, developed distant metastases. Incidence rate of progression was for class III masses 11.0 (95% CI 4.5-22.8) and for class IV masses 73.6 (95% CI 47.8-108.7) per 100,000 person-days of follow-up. Median time-to-progression was undefined for class III mases given small number of progression events and 710 days for class IV masses. Hazard ratio of progression for class IV relative to class III masses was 5.1 (95% CI 2.5-10.8) (p<.001). Conclusion: During active surveillance of cystic masses evaluated using Bosniak classification v2019, class IV masses grew faster and were more likely to progress than class III masses. Clinical Impact: In comparison with current active surveillance guidelines that treat class III and IV masses similarly, future iterations may incorporate relatively more intensive surveillance for class IV masses.
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26
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Tang Y, Liu F, Mao X, Li P, Mumin MA, Li J, Hou Y, Song H, Lin H, Tan L, Gui C, Zhang M, Fu L, Chen W, Huang Y, Luo J. The impact of tumor size on the survival of patients with small renal masses: A population-based study. Cancer Med 2022; 11:2377-2385. [PMID: 35229988 PMCID: PMC9189465 DOI: 10.1002/cam4.4595] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/09/2021] [Accepted: 12/18/2021] [Indexed: 12/11/2022] Open
Abstract
Background Active surveillance (AS) with delayed intervention has gained acceptance as a management strategy for small renal masses (SRMs). However, during AS, there is a risk of tumor growth. Thus, we aim to investigate whether tumor growth in patients with SRMs leads to tumor progress. Methods In this study, we enrolled 16,070 patients from the Surveillance, Epidemiology, and End Results database with T1a renal cell carcinoma (RCC) between 2004 and 2017. The 16,070 patients were divided into three groups: 10,526 in the partial nephrectomy (PN) group, 2768 in the local ablation (LA) group, and 2776 in the AS group. Associations of tumor size with all‐cause and cancer‐specific mortality were evaluated using Kaplan–Meier analyses and Cox regression models. Results Four tumor size categories were delineated (≤1, >1–2, >2–3, and > 3–4 cm in diameter), and 10‐year all‐cause and cancer‐specific mortality both significantly increased with increasing tumor size in the PN, LA, and AS groups (all p < 0.05). Tumors were substaged based on diameter: T1aA (≤2 cm) and T1aB (>2–4 cm). All‐cause and cancer‐specific mortality were significantly higher in T1aB tumors than T1aA tumors in each group (hazard ratio = 1.395 and 1.538, respectively; all p < 0.05). Conclusions Tumor growth relates to worse prognosis of T1a RCC, and 2 cm serves as a size threshold that is prognostically relevant for patients with T1a RCC. Because of the lack of accurate predictors of tumor growth rate, AS for patients with SRMs incurs a risk of tumor progression.
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Affiliation(s)
- Yiming Tang
- Department of Urology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.,Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fei Liu
- 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
| | - Xiaopeng Mao
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pengju Li
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mukhtar A Mumin
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiaying Li
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Hou
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongde Song
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haishan Lin
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lei Tan
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chengpeng Gui
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingxiao Zhang
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liangmin Fu
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong Huang
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Emergency, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junhang Luo
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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27
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Richard PO, Violette PD, Bhindi B, Breau RH, Kassouf W, Lavallée LT, Jewett M, Kachura JR, Kapoor A, Noel-Lamy M, Ordon M, Pautler SE, Pouliot F, So AI, Rendon RA, Tanguay S, Collins C, Kandi M, Shayegan B, Weller A, Finelli A, Kokorovic A, Nayak J. Canadian Urological Association guideline: Management of small renal masses - Full-text. Can Urol Assoc J 2022; 16:E61-E75. [PMID: 35133268 PMCID: PMC8932428 DOI: 10.5489/cuaj.7763] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Patrick O. Richard
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Philippe D. Violette
- Departments of Health Research Methods Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, ON, Canada
| | - Bimal Bhindi
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
| | - Rodney H. Breau
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Luke T. Lavallée
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Michael Jewett
- Department of Surgical Oncology, Division of Urology, Princess Margaret Hospital, Toronto, ON, Canada
| | - John R. Kachura
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anil Kapoor
- McMaster Institute of Urology, St. Joseph Healthcare, Hamilton, ON, Canada
| | - Maxime Noel-Lamy
- Department of Medical Imaging, Division of Interventional Radiology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Michael Ordon
- Department of Surgery, Division of Urology, St. Michael’s Hospital, Toronto, ON, Canada
| | - Stephen E. Pautler
- Department of Surgery, Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Frédéric Pouliot
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Québec, Quebec, QC, Canada
| | - Alan I. So
- Division of Urology, British Columbia Cancer Care, Vancouver, BC, Canada
| | - Ricardo A. Rendon
- Department of Surgery, Division of Urology, Capital Health - QEII, Halifax, NS, Canada
| | - Simon Tanguay
- Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Maryam Kandi
- Departments of Health Research Methods Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- McMaster Institute of Urology, St. Joseph Healthcare, Hamilton, ON, Canada
| | | | - Antonio Finelli
- Department of Surgical Oncology, Division of Urology, Princess Margaret Hospital, Toronto, ON, Canada
| | - Andrea Kokorovic
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Jay Nayak
- Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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28
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Bianchi L, Chessa F, Piazza P, Ercolino A, Mottaran A, Recenti D, Serra C, Gaudiano C, Cappelli A, Modestino F, Golfieri R, Bertaccini A, Marcelli E, Porreca A, Celia A, Schiavina R. Percutaneous ablation or minimally invasive partial nephrectomy for cT1a renal masses? A propensity score-matched analysis. Int J Urol 2021; 29:222-228. [PMID: 34894001 DOI: 10.1111/iju.14758] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/03/2021] [Accepted: 11/08/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Local tumor ablation to treat small renal mass is increasing. The aim of the present study was to compare oncologic outcomes among patients with T1 renal mass treated with partial nephrectomy and local tumor ablation. METHODS To reduce the inherent differences between patients undergoing laparoscopic or robot-assisted partial nephrectomy (n = 405) and local tumor ablation (n = 137), we used a 1:1 propensity score-matched analysis. Local tumor ablation consisted of radiofrequency ablation and cryoablation. Disease-free survival, overall survival and other causes mortality-free survival rates were estimated using the Kaplan-Meier method. Multivariable logistic regression and competing-risk regression models were used to identify predictors of complications, recurrence and other causes mortality, respectively. RESULTS Partial nephrectomy had higher disease-free survival estimates, as compared with local tumor ablation (92.8% vs 80.4% at 5 years, P = 0.02), with no significant difference between radiofrequency ablation and cryoablation (P = 0.9). Ablation showed comparable overall survival estimates to partial nephrectomy (91% vs 95.8% at 5 years, P = 0.6). The 5-year recurrence rates were 7.9% versus 23.8% for patients aged ≤70 years, and 2.5% versus 11.9% for patients aged >70 years treated with partial nephrectomy and ablation, respectively; the 5-year other causes mortality rates were 0% and 2.2% for patients treated with partial nephrectomy and ablation aged ≤70 years, and 3% versus 10.9% for patients aged >70 years treated with partial nephrectomy and ablation, respectively. At multivariable analysis, ablation was associated with fewer complications (odds ratio 0.41; P = 0.01). At competing risks analysis, age (hazard ratio 0.96) and ablation (hazard ratio 4.56) were independent predictors of disease recurrence (all P ≤ 0.008). CONCLUSIONS Local tumor ablation showed a higher risk of recurrence and lower risk of complications compared with partial nephrectomy, with comparable overall survival rates.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Mottaran
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Dario Recenti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carla Serra
- Interventional Ultrasound Unit, Department of Organ Failure and Transplantations, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Modestino
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Department of Experimental, Diagnostic and Specialty Medicine, Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Angelo Porreca
- Department of Urology, Veneto Institute of Oncology, Padua, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
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29
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Schieda N, Krishna S, Pedrosa I, Kaffenberger SD, Davenport MS, Silverman SG. Active Surveillance of Renal Masses: The Role of Radiology. Radiology 2021; 302:11-24. [PMID: 34812670 DOI: 10.1148/radiol.2021204227] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Active surveillance of renal masses, which includes serial imaging with the possibility of delayed treatment, has emerged as a viable alternative to immediate therapeutic intervention in selected patients. Active surveillance is supported by evidence that many benign masses are resected unnecessarily, and treatment of small cancers has not substantially reduced cancer-specific mortality. These data are a call to radiologists to improve the diagnosis of benign renal masses and differentiate cancers that are biologically aggressive (prompting treatment) from those that are indolent (allowing treatment deferral). Current evidence suggests that active surveillance results in comparable cancer-specific survival with a low risk of developing metastasis. Radiology is central in this. Imaging is used at the outset to estimate the probability of malignancy and degree of aggressiveness in malignant masses and to follow up masses for growth and morphologic change. Percutaneous biopsy is used to provide a more definitive histologic diagnosis and to guide treatment decisions, including whether active surveillance is appropriate. Emerging applications that may improve imaging assessment of renal masses include standardized assessment of cystic and solid masses and radiomic analysis. This article reviews the current and future role of radiology in the care of patients with renal masses undergoing active surveillance.
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Affiliation(s)
- Nicola Schieda
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Satheesh Krishna
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Ivan Pedrosa
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Samuel D Kaffenberger
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Matthew S Davenport
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Stuart G Silverman
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
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Disease Progression in Older Patients With Renal Tumor Assigned to an Active Surveillance Protocol. Clin Genitourin Cancer 2021; 20:e53-e60. [PMID: 34815184 DOI: 10.1016/j.clgc.2021.09.008] [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: 07/10/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Active surveillance (AS) is a validated option for the treatment of small renal masses (SMRs), especially in older patients. This study investigates the oncologic outcomes and competitive mortality of older patients prospectively assigned to AS. METHODS We conducted a monocentric study on patients ≥75 years treated between 2011 and 2016 for a SMR. Treatment modalities, biopsy data, survivals (overall, specific, cancer progression) and delayed interventions were analyzed. RESULTS Overall, 106 patients (median age 80.5 years) were included, of which 41 were managed by AS during a follow-up of 3.4 years [0-7.1]. Seven patients (17%) had a primary biopsy with 3 confirmed renal cell carcinomas. Fourteen patients (34.1%) presented with progression (29.2% local; 4.9% metastatic), 8 (19.5%) requiring delayed interventions (75% ablative therapy and 25% radical nephrectomy). Overall survival (OS) was 68.3% and cancer specific survival was 95.1% during the study period. Competitive mortality was higher (84.6%) than cancer specific mortality (15.4%), P = .001. CONCLUSION The growth rate of progression including 4.9% metastatic progression underlines the value of AS compared to simple watchful surveillance in the treatment of SMRs in older patients. Of note, the higher competitive mortality confirm that AS should be preferred to active intervention at the beginning of the management.
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Izadmehr S, Lundon DJ, Mohamed N, Katims A, Patel V, Eilender B, Mehrazin R, Badani KK, Sfakianos JP, Tsao CK, Wiklund P, Oh WK, Cordon-Cardo C, Tewari AK, Galsky MD, Kyprianou N. The Evolving Clinical Management of Genitourinary Cancers Amid the COVID-19 Pandemic. Front Oncol 2021; 11:734963. [PMID: 34646777 PMCID: PMC8504458 DOI: 10.3389/fonc.2021.734963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/31/2021] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19), a disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has become an unprecedented global health emergency, with fatal outcomes among adults of all ages throughout the world. There is a high incidence of infection and mortality among cancer patients with evidence to support that patients diagnosed with cancer and SARS-CoV-2 have an increased likelihood of a poor outcome. Clinically relevant changes imposed as a result of the pandemic, are either primary, due to changes in timing or therapeutic modality; or secondary, due to altered cooperative effects on disease progression or therapeutic outcomes. However, studies on the clinical management of patients with genitourinary cancers during the COVID-19 pandemic are limited and do little to differentiate primary or secondary impacts of COVID-19. Here, we provide a review of the epidemiology and biological consequences of SARS-CoV-2 infection in GU cancer patients as well as the impact of COVID-19 on the diagnosis and management of these patients, and the use and development of novel and innovative diagnostic tests, therapies, and technology. This article also discusses the biomedical advances to control the virus and evolving challenges in the management of prostate, bladder, kidney, testicular, and penile cancers at all stages of the patient journey during the first year of the COVID-19 pandemic.
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Affiliation(s)
- Sudeh Izadmehr
- Department of Medicine, Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Dara J. Lundon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nihal Mohamed
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew Katims
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Vaibhav Patel
- Department of Medicine, Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Benjamin Eilender
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Reza Mehrazin
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ketan K. Badani
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - John P. Sfakianos
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Che-Kai Tsao
- Department of Medicine, Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - William K. Oh
- Department of Medicine, Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Carlos Cordon-Cardo
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ashutosh K. Tewari
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Matthew D. Galsky
- Department of Medicine, Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Natasha Kyprianou
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Yang C, Shuch B, Kluger HM, Serrano M, Kibel AS, Humphrey PA, Adeniran AJ. Adverse Histopathologic Characteristics in Small Papillary Renal Cell Carcinomas Have Minimal Impact on Prognosis. Am J Clin Pathol 2021; 156:550-558. [PMID: 34424955 DOI: 10.1093/ajcp/aqab015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Tumor size has long been used in the management decision-making of patients with renal masses. Active surveillance had recently gained traction in selected patients with tumor size of 4 cm or less. Adverse histopathologic characteristics in papillary renal cell carcinoma (PRCC) have been shown to correlate with worse prognosis. We aimed to study whether such features in small PRCCs provide additional prognostic information. METHODS Nephrectomies from our institution were collected and reviewed to evaluate for adverse histopathologic features. Clinical follow-up information was collected for all cases. Relationships between the variables were examined by Wilcoxon test and logistic regression. RESULTS We identified 291 consecutive cases of PRCC. Adverse tumor histopathologic characteristics were significantly related to size. In PRCCs with size greater than 4 cm, there were more cases with high World Health Organization/International Society of Urological Pathology grade and necrosis. Adverse histologic features are less commonly seen in small PRCC and are not associated with lower disease-free survival or disease-specific survival. CONCLUSIONS Identification of these features in small PRCCs (≤4 cm) through needle core biopsy examination would not provide additional prognostic information in patients for whom active surveillance is considered. Clinical and radiologic follow-up in patients with small renal masses that have a known histologic diagnosis of PRCC should be sufficient.
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Affiliation(s)
- Chen Yang
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Brian Shuch
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Harriet M Kluger
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | | | - Adam S Kibel
- Department of Urology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Peter A Humphrey
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
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Dispagna MA, Daneshvar M, Bratslavsky G. Surgical Insights for the Management of Variant Histology in Renal Cell Carcinoma. Int Braz J Urol 2021; 47:935-942. [PMID: 33650834 PMCID: PMC8321463 DOI: 10.1590/s1677-5538.ibju.2020.0778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose: To review the current literature regarding variant (non-clear) histology of renal cell carcinoma (RCC) and the clinical management of these renal tumors. Material and Methods: A PubMed database search was performed in May 2020 focusing on variant RCC, its diagnosis and associated syndromes, tumor characteristics, and options for management. Results: A broad range of pathological, clinical and diagnostic characteristics amongst non-ccRCC variants were found to have an impact on the overall management of these tumors. The imaging modalities, frequency of surveillance, and timing for intervention were found to be dependent on the type of genetic alterations, type of histology, and tumor growth rates. The timing and type of surgery as well as the systemic therapy are tailored to the specific tumor type and patient. Conclusion: The findings of this review suggest that clinical management should be considered and adjusted for patients with non-ccRCC histological variants based on tumor subtype and genetic alterations.
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Affiliation(s)
| | - Michael Daneshvar
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Gennady Bratslavsky
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, United States
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Patel SH, Singla N, Pierorazio PM. Decision-making in active surveillance in kidney cancer: current trends and future urine and tissue markers. World J Urol 2021; 39:2869-2874. [PMID: 34370079 DOI: 10.1007/s00345-021-03786-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
Surveillance for small renal masses is a growing choice of management amongst physicians and patients. These decisions, however, can be difficult as patient factors and tumor factors may blur the line between continued surveillance and intervention. Currently, there are no biomarkers that are readily available to aid in the decision making for patients with known renal cell carcinoma; however, many show promise. We herein review the literature of the adjunct tools that are currently available for decision making in small renal masses, but also new potential biomarkers that can potentially be of use.
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Affiliation(s)
- Sunil H Patel
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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35
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Walach MT, Wunderle MF, Haertel N, Mühlbauer JK, Kowalewski KF, Wagener N, Rathmann N, Kriegmair MC. Frailty predicts outcome of partial nephrectomy and guides treatment decision towards active surveillance and tumor ablation. World J Urol 2021; 39:2843-2851. [PMID: 33515329 PMCID: PMC8405500 DOI: 10.1007/s00345-020-03556-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To examine frailty and comorbidity as predictors of outcome of nephron sparing surgery (NSS) and as decision tools for identifying candidates for active surveillance (AS) or tumor ablation (TA). METHODS Frailty and comorbidity were assessed using the modified frailty index of the Canadian Study of Health and Aging (11-CSHA) and the age-adjusted Charlson-Comorbidity Index (aaCCI) as well as albumin and the radiological skeletal-muscle-index (SMI) in a cohort of n = 447 patients with localized renal masses. Renal tumor anatomy was classified according to the RENAL nephrometry system. Regression analyses were performed to assess predictors of surgical outcome of patients undergoing NSS as well as to identify possible influencing factors of patients undergoing alternative therapies (AS/TA). RESULTS Overall 409 patient underwent NSS while 38 received AS or TA. Patients undergoing TA/AS were more likely to be frail or comorbid compared to patients undergoing NSS (aaCCI: p < 0.001, 11-CSHA: p < 0.001). Gender and tumor complexity did not vary between patients of different treatment approach. 11-CSHA and aaCCI were identified as independent predictors of major postoperative complications (11-CSHA ≥ 0.27: OR = 3.6, p = 0.001) and hospital re-admission (aaCCI ≥ 6: OR = 4.93, p = 0.003) in the NSS cohort. No impact was found for albumin levels and SMI. An aaCCI > 6 and/or 11-CSHA ≥ 0.27 (OR = 9.19, p < 0.001), a solitary kidney (OR = 5.43, p = 0.005) and hypoalbuminemia (OR = 4.6, p = 0.009), but not tumor complexity, were decisive factors to undergo AS or TA rather than NSS. CONCLUSION In patients with localized renal masses, frailty and comorbidity indices can be useful to predict surgical outcome and support decision-making towards AS or TA.
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Affiliation(s)
- M T Walach
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - M F Wunderle
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - N Haertel
- Department of Medicine II, University Medical Centre Mannheim, Theodor‑Kutzer‑Ufer 1-3, 68167, Mannheim, Germany
| | - J K Mühlbauer
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - K F Kowalewski
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - N Wagener
- Department of Urology, Asklepios Klinik Altona, Paul-Ehrlich-Strasse 1, 22763, Hamburg, Germany
| | - N Rathmann
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - M C Kriegmair
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Association of Clear Cell Likelihood Score on MRI and Growth Kinetics of Small Solid Renal Masses on Active Surveillance. AJR Am J Roentgenol 2021; 218:101-110. [PMID: 34286596 DOI: 10.2214/ajr.21.25979] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: The lack of validated imaging markers to characterize biologic aggressiveness of small renal masses (SRMs; cT1a, ≤4 cm) hinders medical decision making amongst available initial management strategies. Objective: To explore the association of the clear cell likelihood score (ccLS) on MRI with growth rates and progression of SRMs. Methods: This retrospective study included consecutive SRMs assigned a ccLS on clinical MRI examinations performed between June 2016 and November 2019 at an academic tertiary-care medical center or its affiliated safety net hospital system. The ccLS scores the likelihood that the SRM represents clear cell renal cell carcinoma (ccRCC) from 1 (very unlikely) to 5 (very likely). The ccLS was extracted from clinical reports. Tumor size measurements were extracted from available prior and follow-up cross-sectional imaging examinations, through June 2020. Serial tumor size measurements were fit to linear and exponential growth curves. Estimated growth rates were grouped by the assigned ccLS. Tumor progression was defined by development of large size (>4 cm in at least two measurements) and/or rapid growth (doubling of volume within 1 year). Differences among ccLS groups were evaluated using Kruskal-Wallis tests. Correlation between ccLS and growth rate were evaluated by Spearman correlation (ρ). Results: Growth rates of 386 SRMs (100 ccLS1-2, 75 ccLS3, and 211 ccLS4-5) from 339 patients (median age 65 years; 198 men, 141 women) were analyzed. Median follow-up was 1.16 years. The ccLS was correlated with growth rates by size (ρ=0.19, p<.001; ccLS4-5: 9%/year, ccLS1-2: 5%/year, p<.001) and by volume (ρ=0.136, p=.008; ccLS4-5: 29%/year, ccLS1-2: 16%/year, p<.001). Disease progression (observed in 49 SRMs) was not significantly associated with ccLS group (p=.61). Two patients (0.6%) developed metastases during active surveillance (AS): one ccLS1 that was a type 2 papillary renal cell carcinoma and one ccLS4 that was ccRCC. Conclusions: Growth is associated with ccLS in SRMs, with higher ccLS correlating with faster growth. Clinical Impact: The non-invasive clear cell likelihood score (ccLS), derived from MRI, correlates with growth rate of SRMs and may help guide personalized management. SRMs with lower ccLS may be considered for AS, whereas SRMs with higher ccLS may warrant earlier intervention.
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Srivastava A, Uzzo RN, Lee J, Cho E, Grieco A, Masic S, Handorf E, Chen DYT, Viterbo R, Greenberg RE, Smaldone MC, Kutikov A, Uzzo RG. Renal mass biopsy: A strategy to reduce associated costs and morbidity when managing localized renal masses. Urol Oncol 2021; 39:790.e9-790.e15. [PMID: 34301455 DOI: 10.1016/j.urolonc.2021.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/31/2021] [Accepted: 06/21/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Renal mass biopsy (RMB) has not been widely adopted in evaluating small renal mass due to concerns for safety, efficacy, and its perceived lack of consequence on management decisions. We assess the potential cost savings and morbidity avoidance of routine RMB on cT1 renal masses undergoing robotic-assisted partial nephrectomy (RAPN). METHODS We identified n = 920 consecutive RAPN pT1 renal masses and n = 429 consecutive RMBs for cT1 renal masses over 12 years. Using a novel pathological-based risk classification system for cT1 renal masses, we evaluated the morbidity and costs of our RAPN and RMB cohorts. We then define four clinical scenarios where RMB could potentially delay and/or avoid intervention in our pT1 RAPN cohort and model potential complications prevented and cost savings utilizing common clinical scenarios. RESULTS Using our risk stratification system in RAPN patients, final histology was classified as benign in n=174 (18.9%) cases, very low-risk (n = 62 [7%]), low-risk (n = 383 [42%]), and high-risk (n = 301 [33%]), respectively. We identified n = 116 (12.6%) Clavien graded peri-operative complications. In our RMB patients, 120 (27.9%), 17 (3.9%), 240 (55.9%), 52(12.1%) were benign, very low, low and high-risk tumors. The median total direct cost for RAPN was $6955/case compared to $1312/case for RMB. If we established a primary goal to avoid immediate extirpative surgery in benign renal tumors, in the elderly (>70 y) with very low-risk tumors and/or those with high renal functional risks (≥ CKD3b), or competing risks (ASA ≥ 3), RMB could have reduced direct costs by approximately 20% and avoided n = 39 Clavien graded complications, seven readmissions, three transfusions, and two returns to the OR. With the additional cost of performing RMB on those not initially biopsied, the net cost saving would be approximately $1.2 million with minimal added complications while still treating high-risk tumors. CONCLUSIONS Routine RMB before intervention results in cost-saving and complication avoidance. Given the limitations of biopsy, shared decision-making is mandatory. Biopsy should be considered prior to intervention in at-risk populations.
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Affiliation(s)
- Abhishek Srivastava
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA.
| | - Robert N Uzzo
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Jennifer Lee
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Eric Cho
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Alex Grieco
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Selma Masic
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Elizabeth Handorf
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - David Y T Chen
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Rosalia Viterbo
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Richard E Greenberg
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Marc C Smaldone
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Robert G Uzzo
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
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Ajami T, Sebastia C, Corominas D, Ribal MJ, Nicolau C, Alcaraz A, Musquera M. Clinical and radiological findings for small renal masses under active surveillance. Urol Oncol 2021; 39:499.e9-499.e14. [PMID: 34116937 DOI: 10.1016/j.urolonc.2021.04.010] [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: 11/12/2020] [Revised: 02/09/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze the experience performing active surveillance (AS) of small renal masses (SRMs) in our center and to correlate the evolution of SRMs under AS with clinical and radiological findings. METHODS Patients on AS between January 2012 until May 2020 for SRMs in our center have been included. Growth rate (GR) per year was analyzed and correlated with radiographic features. Patients with growth kinetics higher than 5mm/year during follow up were offered active treatment. RESULTS 73 patients were included in AS: the mean age was 75.7 years, a mean initial tumour size of 21.2 mm, and a mean growth rate of 2.05 mm/year. Around 60 % had an ASA score of 3. The tumor size did not change over time in 43% of cases; in 4% we noticed a regression in size and in 52% of cases growth during follow-up (38% 1-5mm/year and 14% more than 5 mm/year). Delayed active treatment was indicated in 16 (21%) of cases. Treatment applied was as following: 2 radiofrequency ablations, 6 radical and 8 partial nephrectomies. A weak correlation was found between initial size and growth rate (r = 0.38, P = 0.02). No significant association was detected regarding any of the analyzed radiological findings and GR. With a mean follow up time of 33 months none of the patients presented metastatic progression. CONCLUSION Active surveillance is a feasible option for management of SRMs in selected patients without jeopardizing oncological safety. In our series, no clinical or radiological characteristics for predicting tumour growth were found.
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Affiliation(s)
- Tarek Ajami
- Department of Urology, Hospital Clinic de Barcelona, Barcelona, ES
| | - Carmen Sebastia
- Department of Radiology- Genitourinary Section, Hospital Clinic de Barcelona, Barcelona, ES
| | - Daniel Corominas
- Department of Radiology- Genitourinary Section, Hospital Clinic de Barcelona, Barcelona, ES
| | - Maria Jose Ribal
- Department of Urology, Hospital Clinic de Barcelona, Barcelona, ES
| | - Carlos Nicolau
- Department of Radiology- Genitourinary Section, Hospital Clinic de Barcelona, Barcelona, ES
| | - Antonio Alcaraz
- Department of Urology, Hospital Clinic de Barcelona, Barcelona, ES
| | - Mireia Musquera
- Department of Urology, Hospital Clinic de Barcelona, Barcelona, ES.
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A 25 year perspective on the evolution and advances in an understanding of the biology, evaluation and treatment of kidney cancer. Urol Oncol 2021; 39:548-560. [PMID: 34092483 DOI: 10.1016/j.urolonc.2021.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 01/20/2023]
Abstract
The diagnosis, evaluation and management of patients with renal cell carcinoma has transformed in the 21st century. Utilizing biological discoveries and technological advances, the field has moved from blunt surgical and largely ineffective medical treatments, to nuanced and fine-tuned approaches based on biology, extent of disease and patient preferences. In this review we will summarize the last 25 years of progress in kidney cancer.
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Cui HW, Sullivan ME. Surveillance for low-risk kidney cancer: a narrative review of contemporary worldwide practices. Transl Androl Urol 2021; 10:2762-2786. [PMID: 34295761 PMCID: PMC8261444 DOI: 10.21037/tau-20-1295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/04/2021] [Indexed: 11/09/2022] Open
Abstract
The management trend of low-risk kidney cancer over the last decade has been from treatment with radical nephrectomy, to use of nephron sparing procedures of partial nephrectomy and ablation, as well as the option of active surveillance (AS). This narrative review aims to summarise the available guidelines related to AS and review the published descriptions of regional practices on the management of low-risk kidney cancer worldwide. A search of PubMed, Google Scholar and Cochrane Library databases for studies published 2010 to June 2020 identified 15 studies, performed between 2000 and 2019, which investigated 13 different cohorts of low-risk kidney cancer patients on AS. Although international guidelines show a level of agreement in their recommendation on how AS is conducted, in terms of patient selection, surveillance strategy and triggers for intervention, cohort studies show distinct differences in worldwide practice of AS. Prospective studies showed general agreement in their predefined selection criteria for entry into AS. Retrospective studies showed that patients who were older, with greater comorbidities, worse performance status and smaller tumours were more likely to be managed with AS. The rate of percutaneous renal mass biopsy varied between studies from 2% to 56%. The surveillance protocol was different across all studies in terms of recommended modality and frequency of imaging. Of the 6 studies which had set indications for intervention, these were broadly in agreement. Despite clear criteria for intervention, patient or surgeon preference was still the reason in 11–71% of cases of delayed intervention across 5 studies. This review shows that AS is being applied in a variety of centres worldwide and that key areas of patient selection criteria and surveillance strategy have large similarities. However, the rate of renal mass biopsy and of delayed intervention varies significantly between studies, suggesting the process of diagnosing malignant SRM and decision making whilst on AS are varying in practice. Further research is needed on the diagnosis and characterisation of incidentally found small renal masses (SRM), using imaging and histology, and the natural history of these SRM in order to develop evidence-based active surveillance protocols.
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Affiliation(s)
- Helen Wei Cui
- Urology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark Edward Sullivan
- Urology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Klatte T, Berni A, Serni S, Campi R. Intermediate- and long-term oncological outcomes of active surveillance for localized renal masses: a systematic review and quantitative analysis. BJU Int 2021; 128:131-143. [PMID: 34060192 DOI: 10.1111/bju.15435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate intermediate- and long-term oncological outcomes of active surveillance (AS) for localized renal masses (LRMs). METHODS This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered on PROSPERO (CRD42021230416). Studies on AS for LRMs with at least 3 years' follow-up were eligible. Two review authors independently screened the literature, extracted data, and assessed risk of bias. The primary outcomes were metastasis rate, renal cell carcinoma (RCC)-specific mortality (RCC-SM) and all-cause mortality (ACM). Pooled estimates were obtained from random-effects models. Subgroup analyses were performed for small renal masses (SRMs; ≤4 cm) and non-SRMs (>4 cm). RESULTS We analysed 18 unique cohorts comprising 2066 patients. The pooled initial maximum tumour size was 2.8 cm (95% confidence interval [CI] 2.7-3.0) and the percutaneous biopsy rate was 28%. The pooled mean annual growth rate was 2.8 mm (95% CI 2.1-3.4). Within a pooled mean follow-up of 53 months, 2.1% (95% CI 1.0-3.6) of patients developed metastatic disease, 1.0% (95% CI 0.3-2.1) died from RCC and 22.6% (95% CI 15.8-30.2) died from any cause. For patients with SRMs (nine studies, n = 987), the pooled metastasis rate was 1.8% (95% CI 0.5-3.7), RCC-SM was 0.6% (95% CI 0-2.1), and ACM was 28.5% (95% CI 17.4-41.4). Across five studies reporting on outcomes of 239 patients with non-SRMs, the pooled metastasis rate was 5.1% (95% CI 0-17.3), RCC-SM was 2.1% (95% CI 0-8.9) and ACM was 29.1% (95% CI 13.6-47.3). This review is limited by non-standardized inclusion criteria, definitions and follow-up, data heterogeneity, limited patient numbers in sub-analyses and absence of high-quality studies. CONCLUSIONS Active surveillance is a safe intermediate- and long-term management option for well-selected patients with LRMs, especially those with SRMs. Limited data are available for non-SRMs, but current evidence would support further evaluation of this approach in selected patients. It is not possible to draw definitive conclusions until more high-quality data become available.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Dorset University Hospitals NHS Foundation Trust, Bournemouth, UK.,Department of Surgery, University of Cambridge, Cambridge, UK
| | - Alessandro Berni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- 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
| | - Riccardo Campi
- 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.,European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands
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Yamamoto T, Kawasaki Y, Umezawa R, Kadoya N, Matsushita H, Takeda K, Ishikawa Y, Takahashi N, Suzuki Y, Takeda K, Kawabata K, Ito A, Jingu K. Stereotactic body radiotherapy for kidney cancer: a 10-year experience from a single institute. JOURNAL OF RADIATION RESEARCH 2021; 62:533-539. [PMID: 33866363 PMCID: PMC8127673 DOI: 10.1093/jrr/rrab031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/09/2021] [Indexed: 06/12/2023]
Abstract
The purpose of this retrospective study was to investigate survival outcomes and irradiated tumor control (local control [LC]) and locoregional control (LRC) after stereotactic body radiotherapy (SBRT) for T1 or recurrent T1 (rT1) kidney cancer. Twenty-nine nonconsecutive patients with 30 tumors were included. SBRT doses of 70 Gy, 60 Gy or 50 Gy in 10 fractions were prescribed with a linear accelerator using daily image guidance. The Kaplan-Meier method was used to estimate time-to-event outcomes, and the log-rank test was used to compare survival curves between groups divided by each possible factor. The median follow-up periods for all patients and survivors were 57 months and 69.6 months, respectively. The five-year LC rate, LRC rate, progression-free survival (PFS) rate, disease-specific survival (DSS) rate and overall survival (OS) rate were 94%, 88%, 50%, 96% and 68%, respectively. No significant factor was related to OS and PFS. Three of 24 non-hemodialysis (HD) patients had new-onset-HD because of the progression of underlying kidney disease. Grade 3 or higher toxicities from SBRT did not occur. In conclusion, SBRT for kidney cancer provided a high rate of LC, LRC and DSS with minimal toxicities, but patient selection and indication for SBRT should be done carefully considering the relatively low OS rate.
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Affiliation(s)
- Takaya Yamamoto
- Corresponding author. Takaya Yamamoto, M.D., Ph.D., Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. Tel: +81-22-717-7312, Fax: +81-22-717-7316, E-mail:
| | - Yoshihide Kawasaki
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Kazuya Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Yu Suzuki
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Ken Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Kousei Kawabata
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
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Kuusk T, Cullen D, Neves JB, Campain N, Barod R, Boleti E, El-Sheihk S, Grant L, Kelly J, Marchetti M, Mumtaz F, Patki P, Ramachandran N, Silva P, Tran-Dang MA, Walkden M, Tran MGB, Powles T, Bex A. Impact of the first surge of the COVID-19 pandemic on a tertiary referral centre for kidney cancer. BJU Int 2021; 128:752-758. [PMID: 33964109 PMCID: PMC8239749 DOI: 10.1111/bju.15441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective To analyse the impact of the COVID‐19 pandemic on a centralized specialist kidney cancer care pathway. Materials and Methods We conducted a retrospective analysis of patient and pathway characteristics including prioritization strategies at the Specialist Centre for Kidney Cancer located at the Royal Free London NHS Foundation Trust (RFH) before and during the surge of COVID‐19. Results On 18 March 2020 all elective surgery was halted at RFH to redeploy resources and staff for the COVID‐19 surge. Prioritizing of patients according to European Association of Urology guidance was introduced. Clinics and the specialist multidisciplinary team (SMDT) meetings were maintained with physical distancing, kidney surgery was moved to a COVID‐protected site, and infection prevention measurements were enforced. During the 7 weeks of lockdown (23 March to 10 May 2020), 234 cases were discussed at the SMDT meetings, 53% compared to the 446 cases discussed in the 7 weeks pre‐lockdown. The reduction in referrals was more pronounced for small and asymptomatic renal masses. Of 62 low‐priority cancer patients, 27 (43.5%) were deferred. Only one (4%) COVID‐19 infection occurred postoperatively, and the patient made a full recovery. No increase in clinical or pathological upstaging could be detected in patients who underwent deferred surgery compared to pre‐COVID practice. Conclusion The first surge of the COVID‐19 pandemic severely impacted diagnosis, referral and treatment of kidney cancer at a tertiary referral centre. With a policy of prioritization and COVID‐protected pathways, capacity for time‐sensitive oncological interventions was maintained and no immediate clinical harm was observed.
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Affiliation(s)
- Teele Kuusk
- Department of Urology, Dartford and Gravesham NHS Trust, Darent Valley Hospital, Dartford, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - David Cullen
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Joana Briosa Neves
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.,UCL Division of Surgery and Interventional Science, London, UK
| | - Nicholas Campain
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Ravi Barod
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Ekaterini Boleti
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.,Department of Oncology, Royal Free London NHS Foundation Trust, London, UK
| | - Soha El-Sheihk
- Department of Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Lee Grant
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - John Kelly
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Marta Marchetti
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Faiz Mumtaz
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Prasad Patki
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Navin Ramachandran
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
| | - Pedro Silva
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - My-Anh Tran-Dang
- Department of Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Miles Walkden
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
| | - Maxine G B Tran
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.,UCL Division of Surgery and Interventional Science, London, UK
| | - Thomas Powles
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.,Barts Cancer Institute, London, UK
| | - Axel Bex
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.,UCL Division of Surgery and Interventional Science, London, UK
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Wang Z, Wang J, Zhu Y, Liu C, Li X, Zeng X. Cause-Specific Mortality Among Survivors From T1N0M0 Renal Cell Carcinoma: A Registry-Based Cohort Study. Front Oncol 2021; 11:604724. [PMID: 33777747 PMCID: PMC7988093 DOI: 10.3389/fonc.2021.604724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
Objective More T1N0M0 renal cell carcinoma (RCC) is detected and the prognosis has improved, but, the current focus on non-RCC-related mortality is superficial. We investigated cause-specific mortality and its temporal patterns after an RCC diagnosis. Methods In the Surveillance, Epidemiology, and End Results-18 database, patients with T1N0M0 RCC treated with partial nephrectomy (PN) or radical nephrectomy (RN) during 2000-15 were identified. Standardized mortality ratios (SMRs) for cause of death were calculated. Risk predictors for each cause-specific mortality were investigated using the Fine and Gray sub-distribution model. Results In all, 68,612 eligible patients were pooled. A total of 14,047 (20.5%) patients had died (cardiovascular disease [CVD], 28.3%; other non-cancer-related diseases, 20.3%; RCC, 18.7%; other cancer types, 16.3%; non-disease events, 16.1%) during follow-up. Heart disease, diabetes mellitus, and cerebrovascular disease were the primary causes of non-RCC-related mortality within 1 year after the diagnosis. The greatest proportion of death (39.0%) occurred within 1-5 years after the diagnosis, mostly due to RCC itself, followed by heart disease. However, >5 years after the diagnosis, heart disease became the leading cause of death. Compared with the general US population, a 21% (SMR, 1.21; 95%CI 1.19-1.23) increased risk of all-mortality was observed; RCC patients had a higher risk of heart disease-related death within 5-10 years (SMR, 1.10; 95%CI 1.04-1.17) and >10 years (1.12; 1.02-1.22) after the diagnosis. Older age and RN increased the death risk of CVD and RCC-specific mortality. Although a larger tumor diameter increased the risk of RCC-specific death, this was not a significant predictor for CVD. Moreover, for T1N0M0 RCC tumors of diameter >4 cm, there was no significant difference in CVD incidence for RN vs. PN. Conclusions RCC-specific mortality is a common challenge for the prognosis. Importantly, a large proportion and higher SMRs of other non-RCC-related diseases (especially CVD) should not be disregarded for the better holistic management of survivors of local RCC. Targeted prevention strategies for non-RCC-related death could lead to significant reductions in mortality for RCC survivors.
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Affiliation(s)
- Zhixian Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yunpeng Zhu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang Liu
- Department of General Medical, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyong Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology of Hubei Province, Wuhan, China
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Adequacy of Unenhanced MRI for Surveillance of Small (Clinical T1a) Solid Renal Masses. AJR Am J Roentgenol 2021; 216:960-966. [PMID: 33594909 DOI: 10.2214/ajr.20.23458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE. The purpose of this study was to determine if contrast enhancement is necessary for MRI surveillance of clinical T1a (cT1a) solid renal masses. MATERIALS AND METHODS. With institutional review board approval, 36 patients who underwent two or more contrast-enhanced (CE) MRI examinations (median, four examinations; range, two to 10 examinations) for surveillance of 39 cT1a solid renal masses between 2009 and 2019 (median time between scans, 2 years; range, 1-7 years) were evaluated. Two radiologists independently measured renal mass size and assessed tumor stage in two sessions for baseline and follow-up examinations using T1-weighted nephrographic phase CE-MRI and unenhanced single-shot T2-weighted MRI in mixed order with a 4-week washout period. Comparisons were performed using the Wilcoxon sign-rank test and Pearson correlation. Bland-Altman and intraclass correlation determined interobserver agreement. RESULTS. Mean size ± SD of renal masses on CE-MRI and T2-weighted MRI were 18 ± 5 mm (range, 9-37 mm) and 18 ± 5 mm (range, 9-37 mm) for radiologist 1 and 19 ± 7 mm (range, 10-39 mm) and 19 ± 6 mm (range, 10-39 mm) for radiologist 2 with near perfect correlation (for radiologist 1, β = 0.9897; for radiologist 2, β = 0.9317; p < .001). Interob-server agreement for measurements comparing radiologist 1 and radiologist 2 on CEMRI and T2-weighted MRI and intraobserver agreement for measurements on CE-MRI and T2-weighted MRI were excellent. Mean growth rate of renal masses measured on CE-MRI and T2-weighted MRI were 2 ± 2 mm (range, -5 to 8 mm) and 2 ± 3 mm (range, -3 to 8 mm) for radiologist 1 and 3 ± 5 mm (range, -1 to 18 mm) and 3 ± 6 mm (range, -1 to 24 mm) for radiologist 2 with high correlation (for radiologist 1, β = 0.8313 [p < .001]; for radiologist 2, β = 0.848 [p = .002]). At baseline, all tumors were subjectively cT1a on CE-MRI and T2-weighted MRI (p > .99, intraclass correlation coefficient [ICC] = 1). During follow-up, one mass progressed to T3 on CE-MRI and T2-weighted MRI for radiologist 1 and radiologist 2 (p > .99, ICC = 1). CONCLUSION. In this study, size measurements on unenhanced T2-weighted MRI had near perfect correlation to measurements using CE-MRI in cT1a solid renal masses undergoing surveillance, with high agreement between and within observers. Clinical staging did not differ comparing T2-weighted MRI and CE-MRI, with near perfect agreement. Contrast enhancement is not necessary for follow-up size measurements in cT1a solid renal masses with MRI.
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Chandrasekar T, Boorjian SA, Capitanio U, Gershman B, Mir MC, Kutikov A. Collaborative Review: Factors Influencing Treatment Decisions for Patients with a Localized Solid Renal Mass. Eur Urol 2021; 80:575-588. [PMID: 33558091 DOI: 10.1016/j.eururo.2021.01.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT With the addition of active surveillance and thermal ablation (TA) to the urologist's established repertoire of partial (PN) and radical nephrectomy (RN) as first-line management options for localized renal cell carcinoma (RCC), appropriate treatment decision-making has become increasingly nuanced. OBJECTIVE To critically review the treatment options for localized, nonrecurrent RCC; to highlight the patient, renal function, tumor, and provider factors that influence treatment decisions; and to provide a framework to conceptualize that decision-making process. EVIDENCE ACQUISITION A collaborative critical review of the medical literature was conducted. EVIDENCE SYNTHESIS We identify three key decision points when managing localized RCC: (1) decision for surveillance versus treatment, (2) decision regarding treatment modality (TA, PN, or RN), and (3) decision on surgical approach (open vs minimally invasive). In evaluating factors that influence these treatment decisions, we elaborate on patient, renal function, tumor, and provider factors that either directly or indirectly impact each decision point. As current nomograms, based on preselected patient datasets, perform poorly in prospective settings, these tools should be used with caution. Patient decision aids are an underutilized tool in decision-making. CONCLUSIONS Localized RCC requires highly nuanced treatment decision-making, balancing patient- and tumor-specific clinical variables against indirect structural influences to provide optimal patient care. PATIENT SUMMARY With expanding treatment options for localized kidney cancer, treatment decision is highly nuanced and requires shared decision-making. Patient decision aids may be helpful in the treatment discussion.
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Affiliation(s)
- Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Maria Carmen Mir
- Department of Urology, Fundación Instituto Valenciano Oncologia, Valencia, Spain
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Contrast-enhanced ultrasound (CEUS) imaging for active surveillance of small renal masses. World J Urol 2021; 39:2853-2860. [PMID: 33495864 DOI: 10.1007/s00345-021-03589-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/05/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of contrast-enhanced ultrasound (CEUS) imaging for monitoring small (< 4 cm) renal masses (SRM) in patients undergoing active surveillance (AS). METHODS We retrospectively selected all consecutive patients with SRMs who underwent AS for at least 6 months at our Institution between January 2014 and December 2018. CEUS imaging was performed by two experienced genitourinary radiologists at established time points. The accuracy of CEUS for monitoring SRM size was compared with that of CT scan. For solid SRMs, four enhancement patterns (EP) were recorded. Radiological progression was defined as SRM growth rate ≥ 5 mm/year. RESULTS Overall, 158/1049 (15.1%) patients with SRMs underwent AS. At a median follow-up of 25 months (IQR 13-39), no patient died due to renal cell carcinoma (RCC). No patients experienced CEUS-related adverse events. There was a large variability in the pattern of growth of SRMs (overall median growth rate: 0.40 mm/year), with 9.5% of SRMs showing radiological progression. The median SRM size was comparable between CEUS and CT scan examinations at all time points. The vast majority (92.7%) of SRMs did not show a change in their EP over time; and there was no association between the SRM's EP and radiological progression or SRM size. Overall, 43 (27.2%) patients underwent delayed intervention (DI); median SRM size, and median growth rate were significantly higher in these patients as compared to those continuing AS. CONCLUSION In experienced hands, CEUS is a safe and effective strategy for active monitoring of SRMs in well-selected patients undergoing AS.
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Available active surveillance follow-up protocols for small renal mass: a systematic review. World J Urol 2021; 39:2875-2882. [PMID: 33452911 DOI: 10.1007/s00345-020-03581-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate follow-up strategies for active surveillance of renal masses and to assess contemporary data. METHODS We performed a comprehensive search of electronic databases (Embase, Medline, and Cochrane). A systematic review of the follow-up protocols was carried out. A total of 20 studies were included. RESULT Our analysis highlights that most of the series used different protocols of follow-up without consistent differences in the outcomes. Most common protocol consisted in imaging and clinical evaluation at 3, 6, and 12 months and yearly thereafter. Median length of follow-up was 42 months (range 1-137). Mean age was 74 years (range 67-83). Of 2243 patients 223 (10%) died during the follow-up and 19 patients died of kidney cancer (0.8%). The growth rate was the most used parameter to evaluate disease progression eventually triggering delayed intervention. Maximal axial diameter was the most common method to evaluate growth rate. CT scan is the most used, probably because it is usually more precise than kidney ultrasound and more accessible than MRI. Performing chest X-ray at every check does not seem to alter the clinical outcome during AS. CONCLUSION The minimal cancer-specific mortality does not seem to correlate with the follow-up scheme. Outside of growth rate and initial size, imaging features to predict outcome of RCC during AS are limited. Active surveillance of SRM is a well-established treatment option. However, standardized follow-up protocols are lacking. Prospective, randomized, trials to evaluate the best follow-up strategies are pending.
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Campi R, Sessa F, Corti F, Carrion DM, Mari A, Amparore D, Mir MC, Fiori C, Papalia R, Kutikov A, Volpe A, Capitanio U, Pierorazio PM, Scarpa RM, Porpiglia F, Minervini A, Serni S, Esperto F. Triggers for delayed intervention in patients with small renal masses undergoing active surveillance: a systematic review. MINERVA UROL NEFROL 2021; 72:389-407. [PMID: 32734748 DOI: 10.23736/s0393-2249.20.03870-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Patients with small renal masses (SRM) can be exposed to overdiagnosis and overtreatment. As such, active surveillance (AS) is recommended by all Guidelines for selected patients. However, it remains underutilized. One key reason is the lack of consensus on the factors prompting delayed intervention (DI). Herein we provide an updated overview of the triggers for DI in patients with SRMs initially undergoing AS. EVIDENCE ACQUISITION A systematic review of the English-language literature was performed according to the PRISMA statement recommendations using the MEDLINE, Cochrane Central Register of Controlled Trials and Web of Science databases. EVIDENCE SYNTHESIS Overall, 10 prospective studies including 1870 patients were included. Median patient age ranged between 64 and 75 years, while median tumor size between 1.7 cm to 2.3 cm. The proportion of cystic SRMs ranged from 0% to 30%. Baseline renal tumor biopsy was performed in 7-45.2% of patients. Among these, malignant histology was found in 28.5%-83.3% of cases. Overall, the median growth rate of SRMs ranged between 0.10 and 0.27 cm/year. The proportion of patients undergoing DI ranged between 7% and 44%, after a median AS period of 12-27 months. The most commonly performed type of DI was surgery. Of resected SRMs, 0% to 30% were benign. The actual triggers for DI were either tumor-related (renal mass growth, stage progression, development of local complications/symptoms) or patient-related (patient preference, improved medical conditions, or qualification for other surgical procedures). At a median follow-up of 21.7 - 57-6 months, the proportion of patients experiencing metastatic disease, cancer-specific and other-cause mortality was 0-3.1%, 0-4% and 0-45.6%, respectively. CONCLUSIONS The available evidence shows that both tumor-related and patient-related factors are ultimate triggers for DI in patients with SRMs undergoing AS. However, the level of evidence is still low and further research is needed to individualize AS strategies according to both tumor biology and patient-related characteristics and values.
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Affiliation(s)
- Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy - .,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy - .,European Society of Residents in Urology (ESRU), Arnhem, the Netherlands -
| | - Francesco Sessa
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Corti
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Diego M Carrion
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands.,Department of Urology, La Paz University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Maria C Mir
- Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Alexander Kutikov
- Division of Urology and Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Umberto Capitanio
- Division of Experimental Oncology, Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Phillip M Pierorazio
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Esperto
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands.,Department of Urology, Campus Bio-Medico University, Rome, Italy
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50
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Heller N, Isensee F, Maier-Hein KH, Hou X, Xie C, Li F, Nan Y, Mu G, Lin Z, Han M, Yao G, Gao Y, Zhang Y, Wang Y, Hou F, Yang J, Xiong G, Tian J, Zhong C, Ma J, Rickman J, Dean J, Stai B, Tejpaul R, Oestreich M, Blake P, Kaluzniak H, Raza S, Rosenberg J, Moore K, Walczak E, Rengel Z, Edgerton Z, Vasdev R, Peterson M, McSweeney S, Peterson S, Kalapara A, Sathianathen N, Papanikolopoulos N, Weight C. The state of the art in kidney and kidney tumor segmentation in contrast-enhanced CT imaging: Results of the KiTS19 challenge. Med Image Anal 2021; 67:101821. [PMID: 33049579 PMCID: PMC7734203 DOI: 10.1016/j.media.2020.101821] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 08/06/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022]
Abstract
There is a large body of literature linking anatomic and geometric characteristics of kidney tumors to perioperative and oncologic outcomes. Semantic segmentation of these tumors and their host kidneys is a promising tool for quantitatively characterizing these lesions, but its adoption is limited due to the manual effort required to produce high-quality 3D segmentations of these structures. Recently, methods based on deep learning have shown excellent results in automatic 3D segmentation, but they require large datasets for training, and there remains little consensus on which methods perform best. The 2019 Kidney and Kidney Tumor Segmentation challenge (KiTS19) was a competition held in conjunction with the 2019 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) which sought to address these issues and stimulate progress on this automatic segmentation problem. A training set of 210 cross sectional CT images with kidney tumors was publicly released with corresponding semantic segmentation masks. 106 teams from five continents used this data to develop automated systems to predict the true segmentation masks on a test set of 90 CT images for which the corresponding ground truth segmentations were kept private. These predictions were scored and ranked according to their average Sørensen-Dice coefficient between the kidney and tumor across all 90 cases. The winning team achieved a Dice of 0.974 for kidney and 0.851 for tumor, approaching the inter-annotator performance on kidney (0.983) but falling short on tumor (0.923). This challenge has now entered an "open leaderboard" phase where it serves as a challenging benchmark in 3D semantic segmentation.
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Affiliation(s)
| | - Fabian Isensee
- German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Heidelberg, Heidelberg, Germany
| | | | | | | | - Fengyi Li
- PingAn Technology Co., Ltd, Shanghai, China
| | - Yang Nan
- PingAn Technology Co., Ltd, Shanghai, China
| | - Guangrui Mu
- Shanghai United Imaging Intelligence Inc., Shanghai, China; Southern Medical University, Guangzhou, China
| | - Zhiyong Lin
- Peking University First Hospital, Beijing, China
| | - Miofei Han
- Shanghai United Imaging Intelligence Inc., Shanghai, China
| | - Guang Yao
- Shanghai United Imaging Intelligence Inc., Shanghai, China
| | - Yaozong Gao
- Shanghai United Imaging Intelligence Inc., Shanghai, China
| | - Yao Zhang
- Institute of Computing Technology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Yixin Wang
- Institute of Computing Technology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Feng Hou
- Institute of Computing Technology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | | | | | | | | | - Jun Ma
- School of Science, Nanjing University of Science and Technology, Nanjing, China
| | - Jack Rickman
- University of Minnesota, Minneapolis, United States
| | - Joshua Dean
- University of Minnesota, Minneapolis, United States
| | - Bethany Stai
- University of Minnesota, Minneapolis, United States
| | | | | | - Paul Blake
- University of Minnesota, Minneapolis, United States
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