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Khondker A, Kwong JCC, Chua ME, Kim JK, Chan JYH, Zappitelli M, Brzezinski J, Cost NG, Rickard M, Lorenzo AJ. Nephron-sparing surgery for renal cell carcinoma in children and young adults: A systematic review. Urol Oncol 2023; 41:137-144. [PMID: 36428167 DOI: 10.1016/j.urolonc.2022.09.015] [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: 04/24/2022] [Revised: 07/08/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the patient characteristics and role of nephron-sparing surgery (NSS) in the treatment of children and young adults with renal cell carcinoma (RCC). METHODS A systematic search of Embase, MEDLINE, and Scopus databases was conducted in December 2021 according to Cochrane collaboration recommendations. All included manuscripts were assessed for patient characteristics and all reported outcomes for patients undergoing partial nephrectomy (PN), and radical nephrectomy (RN) outcomes were abstracted as a comparison group. Primary outcomes included surgical outcomes, overall survival, kidney outcomes. Outcomes were pooled with weighted mean and ranges. Meta-analysis was not performed given study quality. This systematic review was prospectively registered on PROSPERO (CRD42022300261). RESULTS We found a total of 16 studies describing 119 and 559 unique patients undergoing PN and RN, respectively, with a mean age of 12.2 years and mean follow-up of 59.1 months. The mean tumor size for patients undergoing PN was 3.5 cm. Of the 113 patients undergoing PN with available data, 109 were alive at follow-up (98%). No studies reported long-term kidney outcomes, and four studies reported surgical outcomes. All studies had at least moderate risk of bias. CONCLUSIONS The use of NSS in children and young adults with RCC is feasible in selected patients. However, small sample sizes, confounding, and low study quality limit clinical recommendation on NSS in this population. There are significant opportunities for future research on the use of NSS in RCC, especially with systematic reporting of oncological, kidney, and surgical outcomes.
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Affiliation(s)
- Adree Khondker
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jethro C C Kwong
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jin K Kim
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Justin Y H Chan
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Michael Zappitelli
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jack Brzezinski
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nicholas G Cost
- Division of Urology, Department of Surgery, Surgical Oncology Program at Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
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Weisbach L, Aziz A, Fisch M, Riechardt S. [Renal cell carcinomas in childhood]. Urologe A 2017; 56:900-904. [PMID: 28600591 DOI: 10.1007/s00120-017-0420-6] [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] [Indexed: 11/30/2022]
Abstract
BACKGROUND Renal cell carcinoma is a rare childhood disease. However, it should be considered in the differential diagnosis in the detection of a renal mass. OBJECTIVES Incidence and mortality of renal cell carcinomas in childhood. Presentation of clinical symptoms, diagnostics, histology, therapy and course of the disease. PATIENTS AND METHODS Evaluation of our own prospective data of a small patient population of 8 patients, as well as discussion of the current literature on this tumor entity. RESULTS The average follow-up period was 27 months. Preoperative staging studies showed no metastases. The histologically primary predominant subtype was papillary renal cell carcinoma. Tumor stage and lymph node status were the most important prognostic factors in our study. CONCLUSIONS Renal cell carcinoma in childhood is a rare disease whose treatment is challenging and should be performed in an interdisciplinary team. Typical clinical symptoms, as in adults, are absent. The partial nephrectomy should be, if practicable, the surgical treatment of choice. The most important risk factors for survival are tumor stage and lymph node status. Data on adjuvant target therapy for metastatic disease in childhood are lacking. Further prospective, multicenter studies are necessary to generate more information on the biology and course of this disease and to obtain adjuvant treatment options in locally advanced disease.
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Affiliation(s)
- L Weisbach
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - A Aziz
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - M Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - S Riechardt
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
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Kim JH, Seo SI, Song C, Chung J, Kwak C, Hong SH. Clinicohistological characteristics of renal cell carcinoma in children: A multicentre study. Can Urol Assoc J 2015; 9:E705-8. [PMID: 26664504 DOI: 10.5489/cuaj.2855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION In this retrospective multicentre study, we compared the clinicohistological characteristics of renal cell carcinoma (RCC) between pediatric and adult patients. METHODS Data for patients who underwent radical or partial nephrectomy for RCC between 1988 and 2014 at multiple institutions were collected. Patients were divided into 2 groups according to age at diagnosis: pediatric patients (age ≤18 years) and adult patients (age ≥40 years). The groups were compared for clinical and pathologic variables, and survival analysis was performed. RESULTS The median follow-up period was 64 (range: 30-91) months for pediatric patients versus 44 (range: 19-59) months for adult patients (p = 0.026). Pediatric patients were mostly female (p = 0.003), had symptoms at presentation (p < 0.001), and had a high-stage tumour (p = 0.014) than adult patients. Among the symptomatic patients, gross hematuria was the most common symptom. The median tumour size was not different between groups. Regarding histologic types, pediatric patients had more papillary tumours (p < 0.001), more unclassified tumours (p < 0.001), and fewer clear cell carcinomas (p < 0.001). Five-year cancer-specific survival rates were 85% and 87.4% in pediatric and adult patients, respectively (log rank p = 0.901). Recurrence-free survival was better in adult patients, although this did not reach statistical significance (log rank p = 0.272). This study has several limitations, including its retrospective nature and the relatively small number of pediatric RCC cases. CONCLUSION RCC in children is rare and is characterized by features that differ from those in adult RCC. Prognosis did not differ between groups.
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Affiliation(s)
- Jeong Ho Kim
- Department of Urology, Dongnam Institute of Radiological & Medical Sciences Cancer center, Busan, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinsoo Chung
- Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Rialon KL, Gulack BC, Englum BR, Routh JC, Rice HE. Factors impacting survival in children with renal cell carcinoma. J Pediatr Surg 2015; 50:1014-8. [PMID: 25805005 PMCID: PMC4439356 DOI: 10.1016/j.jpedsurg.2015.03.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/10/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Renal cell carcinoma (RCC) is an uncommon tumor in the pediatric population. We examined a large national cancer database to determine outcomes for children with RCC and to identify variables affecting long-term survival. METHODS The National Cancer Data Base (NCDB) was queried for patients age 0 to 17 years diagnosed with RCC from 1998-2011. Patient demographics, tumor stage and characteristics, management, and outcomes were evaluated. RESULTS A total of 304 children met inclusion criteria. Overall, 39% of children had stage I disease, 16% stage II, 33% stage III, and 12% stage IV. One-year and five-year survival for all children was 87% and 70%, respectively. Eighty-six percent of patients underwent surgical resection. In comparison to children who underwent complete nephrectomy, patients undergoing partial nephrectomy had smaller tumors and were of lower clinical stages. Survival following partial resection was 100% at one and five years. Age and gender had no significant impact on survival. Survival was negatively impacted by increasing tumor size (P<0.001), positive nodal status (P=0.001), and higher pathologic stage (P<0.001). CONCLUSION Children with renal cell carcinoma who undergo surgical resection have excellent one-year and five-year survival. Overall survival is significantly affected by pathologic stage, tumor size, and nodal status.
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Affiliation(s)
- Kristy L. Rialon
- Department of Surgery, Division of General Surgery, Duke University Medical Center, Durham, NC, 27710, USA
| | - Brian C. Gulack
- Department of Surgery, Division of General Surgery, Duke University Medical Center, Durham, NC, 27710, USA
| | - Brian R. Englum
- Department of Surgery, Division of General Surgery, Duke University Medical Center, Durham, NC, 27710, USA
| | - Jonathan C. Routh
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Henry E. Rice
- Department of Surgery, Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, 27710, USA,Corresponding author at: Duke University Medical Center, Division of Pediatric Surgery, Box 3815, Durham, NC 27710, USA. Tel.: +1 919 681 5077. (H.E. Rice)
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Kieran K. Editorial comment. J Urol 2015; 193:1341. [PMID: 25553852 DOI: 10.1016/j.juro.2014.10.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kathleen Kieran
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Song HC, Sun N, Zhang WP, He L, Fu L, Huang C. Biological characteristics of pediatric renal cell carcinoma associated with Xp11.2 translocations/TFE3 gene fusions. J Pediatr Surg 2014; 49:539-42. [PMID: 24726108 DOI: 10.1016/j.jpedsurg.2013.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 10/09/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the clinical features of pediatric Xp11.2 translocation renal cell carcinoma (RCC). METHODS A retrospective review of 22 cases over 35 years. RESULTS Xp11.2 translocation RCCs were identified in 13 boys and 9 girls with a median age of 10.5 years (range: 2.5-16 years). RCC presented with hematuria in 17, abdominal mass in 1, abdominal masses with hematuria in 2, abdominal pain with hematuria in 1, and as an incidental finding in 1 patient. Ten patients were classified stage I, 10 were stage III, and two were stage IV. Of the 10 patients with stage I RCCs, 3 patients with tumor measuring less than 7 cm had nephron-sparing surgery (NSS) and 17 patients underwent simple nephrectomy. A 15-cm tumor was incompletely removed in one patient and another patient with a 25-cm × 18-cm × 15-cm tumor had gross residual. Of the 15 patients followed up between 6 months and 35 years, 13 were still living and 2 had died after surgery. CONCLUSIONS Xp11.2 translocation RCC is the predominant form of pediatric RCC, associated with advanced stage at presentation. Nephrectomy is the usual treatment for RCC but NSS is an option for patients with tumors measuring<7 cm. Patients with N+M0 maintained a favorable prognosis following surgery alone.
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Affiliation(s)
- Hong Cheng Song
- Department of Urology, Beijing Children's Hospital of Capital Medical University, Beijing 100045, China
| | - Ning Sun
- Department of Urology, Beijing Children's Hospital of Capital Medical University, Beijing 100045, China.
| | - Wei Ping Zhang
- Department of Urology, Beijing Children's Hospital of Capital Medical University, Beijing 100045, China
| | - LeJian He
- Department of Pathology, Beijing Children's Hospital of Capital Medical University, Beijing 100045, China
| | - Libing Fu
- Department of Pathology, Beijing Children's Hospital of Capital Medical University, Beijing 100045, China
| | - ChengRu Huang
- Department of Urology, Beijing Children's Hospital of Capital Medical University, Beijing 100045, China
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Downey RT, Dillman JR, Ladino-Torres MF, McHugh JB, Ehrlich PF, Strouse PJ. CT and MRI appearances and radiologic staging of pediatric renal cell carcinoma. Pediatr Radiol 2012; 42:410-7; quiz 513-4. [PMID: 22249598 DOI: 10.1007/s00247-011-2319-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 11/14/2011] [Accepted: 11/18/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Renal cell carcinoma (RCC) is an uncommon but noteworthy primary pediatric renal malignancy. There is a paucity of published data regarding the CT/MRI appearances and accuracy of pretreatment radiologic staging of this form of cancer in children. OBJECTIVE To review the various CT/MRI appearances of pediatric RCC and assess the accuracy of pretreatment radiologic staging using these imaging modalities. MATERIALS AND METHODS Institutional Departments of Pathology and Radiology records were searched from 1995 through 2010 for children (younger than 18 years of age) with RCC. Available pretreatment contrast-enhanced abdominopelvic CT and MRI examinations were reviewed by two radiologists. Pertinent imaging findings were documented by consensus, and correlation was made between radiologic and surgicopathological TNM staging. RESULTS Pretreatment imaging studies from 10 RCCs in nine children (four girls and five boys; mean age 12.9 years) were reviewed. The mean size of the primary tumor was 6.2 cm (range, 1.5-12.6 cm). Ninety percent of RCCs demonstrated heterogeneous postcontrast enhancement. Fifty percent of masses had associated hemorrhage, while 40% contained internal calcification. Regarding TNM staging, N staging was correct for 10 of 10 tumors, while M staging was correct for 10 of 10 tumors. Imaging correctly staged only 4 of 10 tumors with respect to T stage. Radiologic and surgicopathological overall staging were concordant for 8 of 10 tumors. CONCLUSION Pediatric RCCs typically present as large, heterogeneous masses, and they commonly hemorrhage and contain internal calcification. Radiologic and surgicopathological overall TNM staging are frequently concordant, although radiologic T staging is often incorrect.
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Affiliation(s)
- Ryan T Downey
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI 48109, USA
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Cloutier J, Aziz A, Inman B, Bolduc S. Bilateral renal cell carcinoma in a child. Urology 2012; 80:430-3. [PMID: 22386253 DOI: 10.1016/j.urology.2012.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 12/31/2011] [Accepted: 01/09/2012] [Indexed: 10/28/2022]
Abstract
Renal cell carcinoma is a rare renal tumor in the pediatric population with an incidence of 0.1-0.3%. We report on the first case of bilateral renal clear cell carcinoma that was treated by partial nephrectomies. We performed a complete genetic evaluation to exclude a family inheritance and we looked at the deletions associated with the possible histologic subtypes of renal cell carcinoma. The patient had no evidence of recurrence after 80-month follow-up and her renal function remained normal.
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Affiliation(s)
- Jonathan Cloutier
- Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Quebec, Canada
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Fall B, Diao B, Sow Y, Sarr A, Fall PA, Ndoye AK, Diagne BA. [Renal cell carcinoma in children: Report of a case with lymph node involvement]. Arch Pediatr 2011; 18:537-9. [PMID: 21458970 DOI: 10.1016/j.arcped.2011.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 03/19/2010] [Accepted: 02/15/2011] [Indexed: 10/28/2022]
Abstract
Renal cell carcinoma (RCC) in children is rare. This entity has different clinical and biological presentation characteristics from adult RCC. In contrast to Wilms tumor, the efficacy of chemotherapy and radiation therapy in pediatric RCC remains uncertain. Debate continues on the importance of lymph node dissection. The authors present a case of RCC with lymph node involvement in a 12-year-old boy. The treatment was radical nephrectomy and a limited lymphadenectomy. No adjuvant therapy was given. After 13 months of follow-up, there is no evidence of recurrence. This case shows that lymph node involvement (in the absence of distant metastases) is not associated with a poor prognosis in pediatric RCC and that lymphadenectomy in lymph node-positive cases is important.
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Affiliation(s)
- B Fall
- Service d'urologie-andrologie, CHU Aristide-Le-Dantec, avenue Pasteur, BP 35354 Dakar colobane, Sénégal
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Baek M, Jung JY, Kim JJ, Park KH, Ryu DS. Characteristics and clinical outcomes of renal cell carcinoma in children: A single center experience. Int J Urol 2010; 17:737-40. [DOI: 10.1111/j.1442-2042.2010.02588.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jurić I, Pogorelić Z, Kuzmić-Prusac I, Biocić M, Jakovljević G, Stepan J, Zupancić B, Culić S, Kruslin B. Expression and prognostic value of the Ki-67 in Wilms' tumor: experience with 48 cases. Pediatr Surg Int 2010; 26:487-93. [PMID: 20306058 DOI: 10.1007/s00383-010-2588-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE Ki-67, tumor proliferation marker, is an important prognostic factor in a variety of cancers. In the present study, we investigated the expression and the prognostic value of Ki-67 in nephroblastoma. METHODS Ki-67 expressions were investigated by immunohistochemistry on paraffin-embedded material in 48 children operated on because of nephroblastoma. Patients were treated according to SIOP protocol. The mean follow-up period was 5.4 years. A proliferation index was obtained by immunohistochemistry using anti-Ki-67 anti-body. RESULTS The mean Ki-67 proliferation index in the blastemal type was 12.3%, and in the epithelial type, 21.4%. In the anaplastic type, Ki-67 proliferation index was: in the blastemal component 20%, in the stromal 21%, and in the epithelial 31%. In the mixed tumor type, Ki-67 proliferation index was assessed as: in the blastemal component 10%, in the epithelial 33% and in the stromal 31.5%. Proliferation index for the epithelium was significantly higher than those found for the blastema (P = 0.001). A correlation between Ki-67 and tumor stage found proliferation index significantly higher in stages I and II (P = 0.002). CONCLUSION The results support the conclusion that Ki-67 is a relevant marker for assessing the proliferative activity and tumor cell dynamics of nephroblastoma, but it may not be a good clinical prognostic marker.
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Affiliation(s)
- Ivo Jurić
- Department of Pediatric Surgery, University Hospital Split and Split University School of Medicine, Spincićeva 1, 21 000, Split, Croatia
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