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Ebrahimi P, Karami M, Hosseini-Berneti SH, Lashkarbolouki AH, Keshtegar S, Ghezel MA, Nikbakht HA. Examining the trend of mortality of genitourinary system cancers in Babol, North Iran (2013-2021). BMC Urol 2024; 24:161. [PMID: 39080636 PMCID: PMC11289959 DOI: 10.1186/s12894-024-01523-7] [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: 03/07/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Cancers of the genitourinary system, particularly prostate, bladder, and kidney cancer, exhibit a high prevalence. Consequently, predicting the morbidity and mortality of genitourinary cancers holds great significance for future planning and implementation. This study aimed to examine the crude and age-standardized rates of mortality and the trend of genitourinary cancers over nine years in northern Iran. METHODS This cross-sectional study used data on the number of deaths attributed to genitourinary cancers recorded in Babol City between 2013 and 2021 through the cause of death registration and classification system. Population estimates were derived from the latest census reports. Subsequently, crude and age-standardized rates, as well as trends for genitourinary cancers, were calculated. RESULTS A total of 307 deaths occurred, with an average age of 75.6 ± 14.3 years due to genitourinary cancers. The crude and age-standardized rates of genitourinary cancers increased from 2.7 and 1.9 per hundred thousand people in 2013 to 7.7 and 5.9 per hundred thousand people in 2021, respectively. Over the study period, death rates significantly rose for men (P < 0.001) and remained constant for women (P = 0.444). Examination of genitourinary cancers revealed an upward trend for bladder (P = 0.012) and prostate (P = 0.012) cancers, while a stable trend was observed for kidney (P = 0.070) and testicular (P = 0.139) cancers. CONCLUSIONS The age-standardized rate and trend of genitourinary cancers are rising. Consequently, this study emphasizes the importance of prevention through screening programs, raising awareness, and utilizing appropriate diagnostic methods.
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Affiliation(s)
- Pouyan Ebrahimi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mohsen Karami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Department of Parasitology and Mycology, Babol University of Medical Sciences, Babol, Iran
| | | | | | - Sana Keshtegar
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | | | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, 47176-47745, Iran.
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A Comparison of Functional and Oncologic Outcomes between Partial Nephrectomy and Radiofrequency Ablation in Patients with Chronic Kidney Disease after Propensity Score Matching. Diagnostics (Basel) 2022; 12:diagnostics12102292. [PMID: 36291981 PMCID: PMC9600482 DOI: 10.3390/diagnostics12102292] [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: 08/12/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose: This study aimed to compare functional and oncological outcomes between partial nephrectomy (PN) and radiofrequency ablation (RFA) for a small renal mass (SRM, ≤4 cm) in patients with chronic kidney disease (CKD). Materials and Methods: Patients with CKD who underwent either PN or RFA for SRM between 2005 and 2019 were included. Patients were stratified into two categories: CKD stage 2 and CKD stage 3 or higher. We performed propensity score matching (PSM) analysis in patients with CKD stage 2 and CKD stage 3 or higher. We compared the functional and oncological outcomes between two groups according to CKD stage before and after PSM. Results: Among 1332 patients, 1195 patients were CKD stage 2 and 137 patients were CKD stage 3 or higher. After PSM analysis using age, pre-treatment eGFR, and clinical tumor size as matching variables, the PN and RFA groups had 270 and 135 CKD stage 2 patients, respectively, and both had 53 patients each with CKD stage 3 or higher. There were no significant differences in percent change in eGFR at 1 year post-operation between groups in patients with CKD stage 2 and stage 3 or higher. Among all patients with tissue-proven malignancy, the 5-year recurrence-free survival (RFS), cancer-specific survival, and overall survival were significantly higher in the PN group. However, only the 5-year RFS was significantly higher in the PN group after matching. Conclusion: Mortality is low in patients with SRM, and functional outcomes were not significantly different between the two treatments. RFA could be an alternative treatment modality in patients who are poor candidates for surgery.
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Peddada AV, Anderson D, Blasi OC, McCollough K, Jennings SB, Monroe AT. Nephron-Sparing Robotic Radiosurgical Therapy for Primary Renal Cell Carcinoma: Single-Institution Experience and Review of the Literature. Adv Radiat Oncol 2020; 5:204-211. [PMID: 32280820 PMCID: PMC7136638 DOI: 10.1016/j.adro.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/28/2019] [Accepted: 10/06/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE We report our single-institution stereotactic body radiation therapy (SBRT) experience on stage I renal cancer with prospectively collected toxicity and efficacy data. METHODS AND MATERIALS A total of 21 patients with solitary renal tumors, including 14 surgical candidates who refused surgery (66%), were treated with SBRT. Histologic confirmation was obtained on all patients before treatment; 2 had transitional cell carcinoma and 19 had renal cell carcinoma. The median age was 71 years (range, 58-88). Nearly all patients received 48 Gy in 3 fractions. RESULTS The median follow-up was 78 months (range, 5-107). At 5 years post treatment, the local tumor control rate was 100%. Tumor size decreased by a median value of 5.3% at 1 year post treatment, 15.6% at 2 years post treatment, and 15.4% at 5 years post treatment. Glomerular filtration rate had decreased by a median value of 1.5% at 1 year post treatment, 7.0% at 2 years post treatment, and 14.2% at 5 years post treatment. Three patients experienced grade 1 toxicity; no other treatment-related adverse effects were reported. CONCLUSIONS SBRT is a promising noninvasive treatment in the management of primary renal cell carcinoma, with evolving clinical evidence demonstrating encouraging results with respect to local control and toxicity.
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Affiliation(s)
| | | | - Olivier C. Blasi
- Colorado Associates in Medical Physics, Penrose Cancer Center, Colorado Springs, Colorado
| | - Kiernan McCollough
- Colorado Associates in Medical Physics, Penrose Cancer Center, Colorado Springs, Colorado
| | - Scott B. Jennings
- Department of Urology, DaVita Medical Group, Colorado Springs, Colorado
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Abstract
Renal cell carcinomas (RCCs) are a diverse set of malignancies that have recently been shown to harbour mutations in a number of chromatin modifier genes - including PBRM1, SETD2, BAP1, KDM5C, KDM6A, and MLL2 - through high-throughput sequencing efforts. Current research focuses on understanding the biological activities that chromatin modifiers employ to suppress tumorigenesis and on developing clinical approaches that take advantage of this knowledge. Unsurprisingly, several common themes unify the functions of these epigenetic modifiers, particularly regulation of histone post-translational modifications and nucleosome organization. Furthermore, chromatin modifiers also govern processes crucial for DNA repair and maintenance of genomic integrity as well as the regulation of splicing and other key processes. Many chromatin modifiers have additional non-canonical roles in cytoskeletal regulation, which further contribute to genomic stability, expanding the repertoire of functions that might be essential in tumorigenesis. Our understanding of how mutations in chromatin modifiers contribute to tumorigenesis in RCC is improving but remains an area of intense investigation. Importantly, elucidating the activities of chromatin modifiers offers intriguing opportunities for the development of new therapeutic interventions in RCC.
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Affiliation(s)
- Aguirre A de Cubas
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - W Kimryn Rathmell
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Kang HW, Seo SP, Kim WT, Yun SJ, Lee SC, Kim WJ, Hwang EC, Kang SH, Hong SH, Chung J, Kwon TG, Kim HH, Kwak C, Byun SS, Kim YJ. Trends in clinical, operative, and pathologic characteristics of surgically treated renal mass in a Korean center: A surgical series from 1988 through 2015. Investig Clin Urol 2019; 60:184-194. [PMID: 31098426 PMCID: PMC6495035 DOI: 10.4111/icu.2019.60.3.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/19/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose To analyze trends over a period of 28 years in the clinical, operative, and pathologic characteristics of patients with a renal mass who underwent surgical resection in Korea. Materials and Methods Consecutive patients (n=6,231) with a renal mass who underwent surgical resection at eight Korean institutions between 1988 and 2015 were reviewed. Patients were assigned to one of three groups according to the date of surgery: group 1, 1988-1999; group 2, 2000-2009; and group 3, 2010-2015. Results Age at the time of surgery, body mass index, smoking status, incidence of diabetes and hypertension, and the number of incidentally identified renal masses increased significantly over time. The proportion of patients undergoing partial nephrectomy (PN) or minimally invasive surgery (MIS) increased sharply during the last two time periods. From 2010, the rate of robot-assisted nephrectomy rose sharply, occurring in 37.8% of MIS cases. Benign pathology was identified in 1.8% and 5.2% of cases in the middle and last periods, respectively; angiomyolipoma was the most common pathology. In later years, tumors were more often localized, although tumor grade increased. Sub-group analysis of small renal masses ≤4 cm revealed similar trends in operative and pathologic characteristics over time. Conclusions Between 1988 and 2015, there was a substantial change in the clinical, operative, and histological characteristics of patients who underwent resection of a renal mass in Korea. The most notable changes were stage migration towards localized disease and widespread use of PN and MIS.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sung Pil Seo
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Won Tae Kim
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seok Joong Yun
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang-Cheol Lee
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Wun-Jae Kim
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jinsoo Chung
- Department of Urology, National Cancer Center, Goyang, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University College of Medicine, Daegu, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong-June Kim
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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Current Status of Immunotherapy for Localized and Locally Advanced Renal Cell Carcinoma. JOURNAL OF ONCOLOGY 2019; 2019:7309205. [PMID: 31057615 PMCID: PMC6463563 DOI: 10.1155/2019/7309205] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/26/2019] [Accepted: 03/11/2019] [Indexed: 01/05/2023]
Abstract
Systemic therapy strategies in the setting of localized and locally advanced renal cell carcinoma (RCC) have continued to evolve in two directions: as adjuvant therapy (to reduce risk of recurrence or progression in high risk localized groups), or as neoadjuvant therapy as a strategy to render primary renal tumors amenable to planned surgical resection in settings where radical resection or nephron-sparing surgery was not thought to be safe or feasible. In the realm of adjuvant therapy, the results of phase III randomized clinical trials have been mixed and contradictory; nonetheless based on the findings of the landmark S-TRAC study, the tyrosine kinase inhibitor Sunitinib has been approved as an adjuvant agent in the United States. In the realm of neoadjuvant therapy, presurgical tumor reduction has been demonstrated in a number of phase II studies utilizing targeted molecular agents. The advent of immunomodulation through checkpoint inhibition as first line therapy for metastatic RCC represents an exciting horizon for adjuvant and neoadjuvant strategies. This article reviews the current status and future prospects of adjuvant and neoadjuvant immunotherapy in localized and locally advanced RCC.
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National trends and economic impact of surgical treatment for benign kidney tumors. Urol Oncol 2019; 37:183.e9-183.e15. [DOI: 10.1016/j.urolonc.2018.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/19/2018] [Accepted: 11/19/2018] [Indexed: 12/15/2022]
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Gallaway MS, Henley SJ, Steele CB, Momin B, Thomas CC, Jamal A, Trivers KF, Singh SD, Stewart SL. Surveillance for Cancers Associated with Tobacco Use - United States, 2010-2014. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2018; 67:1-42. [PMID: 30383737 PMCID: PMC6220819 DOI: 10.15585/mmwr.ss6712a1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PROBLEM/CONDITION Tobacco use is the leading preventable cause of cancer, contributing to at least 12 types of cancer, including acute myeloid leukemia (AML) and cancers of the oral cavity and pharynx; esophagus; stomach; colon and rectum; liver; pancreas; larynx; lung, bronchus, and trachea; kidney and renal pelvis; urinary bladder; and cervix. This report provides a comprehensive assessment of recent tobacco-associated cancer incidence for each cancer type by sex, age, race/ethnicity, metropolitan county classification, tumor characteristics, U.S. census region, and state. These data are important for initiation, monitoring, and evaluation of tobacco prevention and control measures. PERIOD COVERED 2010-2014. DESCRIPTION OF SYSTEM Cancer incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results program were used to calculate average annual age-adjusted incidence rates for 2010-2014 and trends in annual age-adjusted incidence rates for 2010-2014. These cancer incidence data cover approximately 99% of the U.S. POPULATION This report provides age-adjusted cancer incidence rates for each of the 12 cancer types known to be causally associated with tobacco use, including liver and colorectal cancer, which were deemed to be causally associated with tobacco use by the U.S. Surgeon General in 2014. Findings are reported by demographic and geographic characteristics, percentage distributions for tumor characteristics, and trends in cancer incidence by sex. RESULTS During 2010-2014, approximately 3.3 million new tobacco-associated cancer cases were reported in the United States, approximately 667,000 per year. Age-adjusted incidence rates ranged from 4.2 AML cases per 100,000 persons to 61.3 lung cancer cases per 100,000 persons. By cancer type, incidence rates were higher among men than women (excluding cervical cancer), higher among non-Hispanics than Hispanics (for all cancers except stomach, liver, kidney, and cervical), higher among persons in nonmetropolitan counties than those in metropolitan counties (for all cancers except stomach, liver, pancreatic, and AML), and lower in the West than in other U.S. census regions (all except stomach, liver, bladder, and AML). Compared with other racial/ethnic groups, certain cancer rates were highest among whites (oral cavity and pharyngeal, esophageal, bladder, and AML), blacks (colon and rectal, pancreatic, laryngeal, lung and bronchial, cervical, and kidney), and Asians/Pacific Islanders (stomach and liver). During 2010-2014, the rate of all tobacco-associated cancers combined decreased 1.2% per year, influenced largely by decreases in cancers of the larynx (3.0%), lung (2.2%), colon and rectum (2.1%), and bladder (1.3%). INTERPRETATION Although tobacco-associated cancer incidence decreased overall during 2010-2014, the incidence remains high in several states and subgroups, including among men, whites, blacks, non-Hispanics, and persons in nonmetropolitan counties. These disproportionately high rates of tobacco-related cancer incidence reflect overall demographic patterns of cancer incidence in the United States and also reflect patterns of tobacco use. PUBLIC HEALTH ACTION Tobacco-associated cancer incidence can be reduced through prevention and control of tobacco use and comprehensive cancer-control efforts focused on reducing cancer risk, detecting cancer early, and better assisting communities disproportionately affected by cancer. Ongoing surveillance to monitor cancer incidence can identify populations with a high incidence of tobacco-associated cancers and evaluate the effectiveness of tobacco control programs and policies. Implementation research can be conducted to achieve wider adoption of existing evidence-based cancer prevention and screening programs and tobacco control measures, especially to reach groups with the largest disparities in cancer rates.
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Affiliation(s)
- M. Shayne Gallaway
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
- Commissioned Corps, U.S. Public Health Service, Rockville, Maryland
| | - S. Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - C. Brooke Steele
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Behnoosh Momin
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Cheryll C. Thomas
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Ahmed Jamal
- Office on Smoking and Health, National Center for Chronic Disease and Prevention and Health Promotion, CDC
| | - Katrina F. Trivers
- Office on Smoking and Health, National Center for Chronic Disease and Prevention and Health Promotion, CDC
| | - Simple D. Singh
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Sherri L. Stewart
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Azer SA, Alghofaili MM, Alsultan RM, Alrumaih NS. Accuracy and Readability of Websites on Kidney and Bladder Cancers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:926-944. [PMID: 28281091 DOI: 10.1007/s13187-017-1181-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study was to assess the scientific accuracy and the readability level of websites on kidney and bladder cancers. The search engines Google™, Yahoo™ and Bing™ were searched independently by assessors in November 2014 using the following keywords: "bladder cancer", "kidney cancer", "patient bladder cancer", "patient kidney cancer" and "bladder and kidney cancer". Only English-language websites were selected on the bases of predetermined inclusion and exclusion criteria. Assessors independently reviewed the findings and evaluated the accuracy and quality of each website by using the DISCERN and the LIDA instruments. The readability of the websites was calculated using the Flesch-Kincaid Grade Level Index and the Coleman-Liau Readability Index. Sixty-two websites were finally included in the study. The overall accuracy scores varied; for the DISCERN, the range was 28 to 76; out of 80 (mean ± SD, 47.1 ± 12.1; median = 46.0, interquartile range (IQR) = 19.2), and for the LIDA, the range was 52 to 125; out of 144 (mean ± SD, 101.9 ± 15.2; median, 103; IQR, 16.5). The creators of these websites were universities and research centres (n = 25, 40%), foundations and associations (n = 10, 16%), commercial and pharmaceutical companies (n = 13, 21%), charities and volunteer work (n = 4, 6%) and non-university educational bodies (n = 10, 16%). The readability scores (mean ± SD) were 11.2 ± 2.2 for the Flesch-Kincaid Grade Level Index and 11.2 ± 1.6 for the Coleman-Liau Readability Index. The accuracy and the quality of the websites on kidney and bladder cancers varied. In most websites, there were deficiencies in clarity of aims, presenting symptoms, investigations and treatment options. The readability matched grades 10-11 literacy levels-a level above the public readability level. The study highlights the needs for further improvement of the online information created for public and patients with kidney and bladder cancers.
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Affiliation(s)
- Samy A Azer
- Curriculum Development and Research Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- Curriculum Development and Research Unit, Medical Education Department, College of Medicine, King Saud University, PO Box 2925, Riyadh, 11461, Saudi Arabia.
- Australian Professional Teaching, Melbourne, 3106, Australia.
| | - Maha M Alghofaili
- Curriculum Development and Research Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rana M Alsultan
- Curriculum Development and Research Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Najla S Alrumaih
- Curriculum Development and Research Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Bahler CD, Monn MF, Flack CK, Gramm AR, Gardner TA, Sundaram CP. Assessing Cost of Robotic Utilization in Partial Nephrectomy with Increasing Utilization. J Endourol 2018; 32:710-716. [DOI: 10.1089/end.2018.0170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Chandra K. Flack
- Department of Urology, Indiana University, Indianapolis, Indiana
| | - Alec R. Gramm
- Department of Urology, Indiana University, Indianapolis, Indiana
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11
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Radiofrequency ablation of small renal masses in comorbid patients. Wideochir Inne Tech Maloinwazyjne 2018; 13:212-214. [PMID: 30002753 PMCID: PMC6041583 DOI: 10.5114/wiitm.2018.74462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/20/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Over the recent years, the progress in imaging techniques has led to increased detection of small renal masses (SRMs), including in elderly and high-risk patients. Partial nephrectomy (nephron-sparing surgery - NSS), the current standard of care in T1a kidney tumours, has some limitations in patients who are poor candidates for surgery, as it is associated with potential perioperative complications and possible renal function loss. Radiofrequency ablation (RFA), a minimally invasive method that can be performed percutaneously, is an option in such cases. Aim To present our experience in treatment of SRMs using RFA in comorbid patients. Material and methods In the years 2006-2012, 103 percutaneous, ultrasound-guided RFA procedures were performed in the Oncology Centre in Bydgoszcz in patients with an ASA score ≥ 3. Abdominal computed tomography and tumour biopsy were performed before the procedure. The average follow-up time was 46 months. Results The 1, 3 and 5-year overall survival rates were respectively 97%, 90% and 75%, while cancer-specific survival was 100%. No Clavien-Dindo grade ≥ 3 complications were observed. Conclusions Radiofrequency ablation performed percutaneously is a minimally invasive treatment and may be applied in patients who are, due to comorbidities, poor candidates for surgery. In comorbid patients, where other causes of death play an important role, the application of a minimally invasive treatment method with satisfactory oncological effectiveness is justified.
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Chang YH, Chang SW, Liu CY, Lin PH, Yu KJ, Pang ST, Chuang CK, Kan HC, Shao IH. Demographic characteristics and complications of open and minimally invasive surgeries for renal cell carcinoma: a population-based case-control study in Taiwan. Ther Clin Risk Manag 2018; 14:1235-1241. [PMID: 30038497 PMCID: PMC6049605 DOI: 10.2147/tcrm.s164592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Renal cell carcinoma (RCC) is one of the most lethal urological malignancies, and surgeries remain the mainstay for localized RCC. This study aimed to compare the selection of open surgery and minimally invasive kidney surgery for RCCs for the aspects of complication, medical costs, and patient preference. Materials and methods We conducted a population-based case-control study by using the National Health Insurance Research Database of Taiwan, which included data from 23 million Taiwanese residents. Patients newly diagnosed with RCC during 2006-2012 were included. We compared the general characteristics, underlying disease, complications, hospital stay, postoperative analgesic dosage, and medical costs between open group and minimally invasive group. Results A total of 3,172 patients who received radical nephrectomy (RN) or partial nephrectomy (PN) for RCC were included. The mean age was 61.1 years, with a male to female ratio of 1.88. In the minimally invasive groups, the mean hospital stay was significantly shorter than in open groups (12.4 days in open RN versus 10.3 days in minimally invasive RN, and 9.7 days in open PN versus 8.2 days in minimally invasive PN). There was no significant difference between the medical costs and the incidence of major bleeding complication between the open group and the minimally invasive group. Female patients and patients with higher monthly income were more likely to receive minimally invasive surgery. Conclusion During past decades, open RN has gradually been replaced by minimally invasive surgeries and PN. Compared to open surgeries, minimally invasive surgeries could lead to less postoperative pain and faster recovery. Economic status of the patients potentially hinders them from receiving minimally invasive surgeries, which may cost more.
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Affiliation(s)
- Ying-Hsu Chang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chung-Yi Liu
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Po-Hung Lin
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Kai-Jie Yu
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - See-Tong Pang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Cheng-Keng Chuang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Hung-Cheng Kan
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - I-Hung Shao
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
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Lee H, Lee CU, Yoo JH, Sung HH, Jeong BC, Jeon SS, Lee HM, Choi HY, Jeong CW, Kwak C, Seo SI. Comparisons of oncological outcomes and perioperative complications between laparoscopic and open radical nephrectomies in patients with clinical T2 renal cell carcinoma (≥7cm). PLoS One 2018; 13:e0191786. [PMID: 29364958 PMCID: PMC5783406 DOI: 10.1371/journal.pone.0191786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/04/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose Although minimal invasive techniques have been widely accepted in contemporary urology, the perioperative outcomes of laparoscopy in patients with clinical T2 renal cell carcinoma (RCC) have not been clearly evaluated. We aimed to compare the outcomes of laparoscopic radical nephrectomy (LRN) with those of open radical nephrectomy (ORN) in patients with clinical T2 RCC. Methods We retrospectively analyzed the data of 835 patients who underwent radical nephrectomy for localized clinical T2 RCC (≥7 cm). The survival rates and postoperative complications were compared between the LRN and ORN groups. Multivariate Cox regression tests were performed to identify the independent predictors of each survival outcome. Results There were 578 (69.2%) subjects in ORN group and 257 (30.8%) in LRN group, respectively. The LRN group showed a significant male predominance (p = 0.013), higher pathological stage (p = 0.02), and higher cellular grade (p = 0.010) compared with the ORN group. No significant differences in progression-free (p = 0.070), cancer-specific (p = 0.472), or overall survival (p = 0.249) were found between the two groups. In the multivariate analysis, the type of surgery did not show any significant associations with all three survival outcomes (all p > 0.2). Furthermore, there was no significant difference in postoperative complication rate between the two groups (p = 0.595). In the subgroup analysis according to tumor histology, no significant relationships were observed between survival outcome and surgery type. Conclusion The LRN and ORN groups showed similar oncological outcomes in patients with clinical T2 RCC. Early postoperative complications were also comparable between LRN and ORN.
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Affiliation(s)
- Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Ho Yoo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Han-Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail: (SI); (CWJ)
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: (SI); (CWJ)
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Morris CR, Lara PN, Parikh-Patel A, Kizer KW. Kidney Cancer Incidence in California: End of the Trend? KIDNEY CANCER 2017; 1:71-81. [PMID: 30334007 PMCID: PMC6179112 DOI: 10.3233/kca-170005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background and Objective: Since the 1990s, multiple studies have reported on an increased incidence of renal cell carcinomas (RCC), which has been considered incidental to the high use of abdominal diagnostic imaging. This population-based study used data from the California Cancer Registry to (i) update trends in RCC incidence and mortality by several tumor and demographic characteristics after reports of decreased use of diagnostic imaging in recent years, and (ii) examine changes in surgical treatment for early-stage RCC. Methods: Records of patients diagnosed with RCC from 1988 through 2013 and mortality data from the same period were examined. Joinpoint regression was used to estimate annual percent changes in age-adjusted RCC incidence and mortality rates, stratified by sex, race/ethnicity, stage at diagnosis, grade, and tumor size. Trends in the proportion of partial or total/radical nephrectomies were evaluated by Cochran-Armitage tests. Results: A total of 77,363 incident cases of RCC and 28,590 deaths were evaluated. While mortality rates significantly decreased, the incidence of small localized RCC increased in virtually all groups examined after the mid-1990s until 2008-2009, when incidence trends stabilized in all groups concomitant with a decrease in imaging. The proportion of partial nephrectomies among patients with small localized tumors increased from 13.8% in 1988 to 74.6% in 2013. Conclusions: Earlier trends in RCC were consistent with the incidental discovery of small tumors. In parallel with the increase in early-stage RCC, the use of partial nephrectomies increased markedly. Following the decreased use of advanced diagnostic imaging, the trend of increasing RCC incidence appears to have ended in California.
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Affiliation(s)
- Cyllene R Morris
- California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, Institute for Population Health Improvement, University of California Davis Health System, Sacramento, CA, USA
| | - Primo N Lara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Arti Parikh-Patel
- California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, Institute for Population Health Improvement, University of California Davis Health System, Sacramento, CA, USA
| | - Kenneth W Kizer
- California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, Institute for Population Health Improvement, University of California Davis Health System, Sacramento, CA, USA
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15
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Dy GW, Gore JL, Forouzanfar MH, Naghavi M, Fitzmaurice C. Global Burden of Urologic Cancers, 1990–2013. Eur Urol 2017; 71:437-446. [DOI: 10.1016/j.eururo.2016.10.008] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 10/05/2016] [Indexed: 12/13/2022]
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16
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Noone AM, Cronin KA, Altekruse SF, Howlader N, Lewis DR, Petkov VI, Penberthy L. Cancer Incidence and Survival Trends by Subtype Using Data from the Surveillance Epidemiology and End Results Program, 1992-2013. Cancer Epidemiol Biomarkers Prev 2016; 26:632-641. [PMID: 27956436 DOI: 10.1158/1055-9965.epi-16-0520] [Citation(s) in RCA: 263] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 12/12/2022] Open
Abstract
Background: Cancers are heterogeneous, comprising distinct tumor subtypes. Therefore, presenting the burden of cancer in the population and trends over time by these tumor subtypes is important to identify patterns and differences in the occurrence of these subtypes, especially to generalize findings to the U.S. general population.Methods: Using SEER Cancer Registry Data, we present incidence rates according to subtypes for diagnosis years (1992-2013) among men and women for five major cancer sites: breast (female only), esophagus, kidney and renal pelvis, lung and bronchus, and thyroid. We also describe estimates of 5-year relative survival according to subtypes and diagnosis year (1992-2008). We used Joinpoint models to identify years when incidence rate trends changed slope. Finally, recent 5-year age-adjusted incidence rates (2009-2013) are presented for each subtype by race and age.Results: Hormone receptor-positive and HER2-negative was the most common subtype (about 74%) of breast cancers. Adenocarcinoma made up about 69% of esophagus cases among men. Adenocarcinoma also is the most common lung subtype (43% in men and 52% in women). Ninety percent of thyroid subtypes were papillary. Distinct incidence and survival patterns emerged by these subtypes over time among men and women.Conclusions: Histologic or molecular subtype revealed different incidence and/or survival trends that are masked when cancer is considered as a single disease on the basis of anatomic site.Impact: Presenting incidence and survival trends by subtype, whenever possible, is critical to provide more detailed and meaningful data to patients, providers, and the public. Cancer Epidemiol Biomarkers Prev; 26(4); 632-41. ©2016 AACR.
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Affiliation(s)
- Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland.
| | - Kathleen A Cronin
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland
| | - Sean F Altekruse
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland
| | - Nadia Howlader
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland
| | - Denise R Lewis
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland
| | - Valentina I Petkov
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland
| | - Lynne Penberthy
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland
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17
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Okhunov Z, Chamberlin J, Moreira DM, George A, Babaian K, Shah P, Youssef R, Kaler KS, Lobko II, Kavoussi L, Landman J. Salvage Percutaneous Cryoablation for Locally Recurrent Renal-Cell Carcinoma After Primary Cryoablation. J Endourol 2016; 30:632-7. [PMID: 27009377 DOI: 10.1089/end.2016.0088] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The management of locally recurrent renal-cell carcinoma (RCC) following cryoablation remains a clinical dilemma. There is limited data regarding the management of locally recurrent disease in the setting of patients who have failed initial percutaneous cryoablation (PCA). We evaluate and report our experience with salvage PCA for local recurrence following renal cryoablation failure. PATIENTS AND METHODS We reviewed our experience with patients who underwent salvage PCA for local biopsy proven RCC recurrence following primary cryoablation procedures. Complications and oncologic outcomes were evaluated. Recurrence-free survival after primary and repeat cryoablation was plotted using the Kaplan-Meier curves. RESULTS A total 250 patients underwent primary cryoablation for RCC and 20 (8%) patients were identified who underwent repeat PCA for 21 locally recurrent tumors. The mean tumor size was 2.4 cm. Biopsy revealed clear cell in 14 patients, three papillary and four chromophobe RCC. All repeat cryoablation procedures were completed successfully, with no treatment failures on postprocedure imaging. There were no complications or deaths. With the median follow-up of 30 months (range 7-63), 3 (15%) patients experienced local recurrence. One patient had an enhancing lesion at 13 months following repeat PCA and underwent a third PCA. Two patients had recurrence at 6 and 35 months respectively and underwent successful laparoscopic partial nephrectomy. Local recurrence-free, metastasis-free and cancer-specific survival rates were 85%, 100%, and 100% respectively. Limitations include retrospective design and small number of patients. CONCLUSIONS Repeat PCA after primary cryoablation failure is feasible, has a low complication rate, and acceptable short-term oncologic outcomes. Further studies with durable follow-up are required.
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Affiliation(s)
- Zhamshid Okhunov
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Joshua Chamberlin
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Daniel M Moreira
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Arvin George
- 2 The Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine , New Hyde Park, New York
| | - Kara Babaian
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Paras Shah
- 2 The Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine , New Hyde Park, New York
| | - Ramy Youssef
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Kamaljot S Kaler
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Igor I Lobko
- 2 The Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine , New Hyde Park, New York
| | - Louis Kavoussi
- 2 The Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine , New Hyde Park, New York
| | - Jaime Landman
- 1 Department of Urology, University of California , Irvine, Orange, California
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18
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Schwartz K, Ruterbusch JJ, Colt JS, Miller DC, Chow WH, Purdue MP. Racial disparities in overall survival among renal cell carcinoma patients with young age and small tumors. Cancer Med 2015; 5:200-8. [PMID: 26710924 PMCID: PMC4735764 DOI: 10.1002/cam4.578] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 08/07/2015] [Accepted: 08/10/2015] [Indexed: 12/22/2022] Open
Abstract
We examined the overall survival of a population‐based cohort of black and white patients with renal cell carcinoma (RCC) to better understand the paradox of poorer RCC survival despite more frequent diagnosis at lower stage among blacks. Renal cell carcinoma patients (699 white, 252 black) diagnosed between 2002 and 2007 in metropolitan Detroit were followed for vital status in the Detroit Surveillance, Epidemiology and End Results (SEER) registry. Hazard ratios (HR) of death for black versus white race and 95% confidence intervals (CIs) were calculated using Cox proportional hazard models stratified by demographic and prognostic factors, and in models successively adjusted for clinical factors, comorbidities, and socioeconomic factors. Mean follow‐up time was 88.4 months for white patients and 89.6 months for black patients (P = 0.49), with 202 white deaths and 89 black deaths (P = 0.06). While black race was weakly associated with poorer overall survival (P = 0.053), black patients <65 years at diagnosis or with tumors <4 cm in size had significantly poorer survival than their white counterparts (HR = 1.46, 95% CI 1.06–2.01 and HR = 2.15, 95% CI 1.51–3.06, respectively). The racial disparities within these two subgroups were minimally affected by adjustment for clinical/treatment factors (HR = 1.49, 95% CI 1.01–2.19 and HR = 1.95, 95% CI 1.27–2.99), but were substantially reduced when renal‐relevant comorbidities were added (HR = 1.30, 95% CI 0.89–1.91 and HR = 1.76, 95% CI 1.16–2.66). After further adjustment for socioeconomic factors, the survival disparities were essentially null (HR = 1.14, 95% CI 0.71–1.85 and HR = 1.15, 95% CI 0.67–1.98). In this population‐based sample of RCC patients, younger black patients and those with small tumors had poorer overall survival than whites. The disparity was explained primarily by racial differences in renal‐relevant comorbidities, particularly chronic renal failure, and socioeconomic deprivation. Future research should focus on younger patients and those with smaller tumors to better understand how these factors may contribute to the survival disparity.
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Affiliation(s)
- Kendra Schwartz
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Julie J Ruterbusch
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan.,Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Joanne S Colt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - David C Miller
- Department of Urology, University of Michigan Medicine School, Ann Arbor, Michigan
| | - Wong-Ho Chow
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Mark P Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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19
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Weinberg AC, Woldu SL, Wen T, Deibert CM, Korets R, Badani KK. Utilization and perioperative complications of laparoscopic cryoablation vs. robotic partial nephrectomy for localized renal tumors. Int Braz J Urol 2015. [PMID: 26200540 PMCID: PMC4752140 DOI: 10.1590/s1677-5538.ibju.2014.0294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Objective: To compare the utilization, perioperative complications and predictors of LCA versus RPN in the treatment of localized renal tumors. Methods: From the Nationwide Inpatient Sample we identified patients undergoing RPN or LCA for the treatment of localized renal tumors from October 2008 through 2010. Patient and hospital-specific factors which predict postoperative complications and use of LCA were investigated. Results: 14,275 patients with localized renal tumors were identified: 70.3% had RPN and 29.7% had LCA. LCA was more common in older patient and at hospitals without robotic consoles. No difference was identified in perioperative complications (0.2% vs. 0.2%), transfusion (5.1% vs. 6.2%), length of stay (2.9 vs. 3.0 days) or median cost ($41,753 vs. $44,618) between the groups, LCA vs. RPN. On multivariate analysis sicker patients were more likely to have LCA (OR 1.34, p=0.048) and sicker patients had greater postoperative complications (OR 3.30, p<0.001); LCA did not predict more complications (OR 1.63, p=0.138) and LCA was performed at hospitals without RCs (OR 0.02, p<0.001). Limitations include observational study design, inability to assess disease severity, operative time, or body mass index, which may affect patient selection and outcomes. Conclusions: More patients had RPN vs. LCA; surgical technique was not predictive of postoperative complications. As technology develops to treat localized renal tumors, it will be important to continue to track outcomes and costs for procedures including RPN and LCA.
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Affiliation(s)
- Aaron C Weinberg
- Department of Urology, Columbia University College of Physicians and Surgeons, New York NY, USA
| | - Solomon L Woldu
- Department of Urology, Columbia University College of Physicians and Surgeons, New York NY, USA
| | - Timothy Wen
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Christopher M Deibert
- Department of Urology, Columbia University College of Physicians and Surgeons, New York NY, USA
| | - Ruslan Korets
- Department of Urology, Columbia University College of Physicians and Surgeons, New York NY, USA
| | - Ketan K Badani
- Department of Urology, Mount Saini Medical Center, New York, NY, USA
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20
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Yin X, Cui L, Li F, Qi S, Yin Z, Gao J. Radiofrequency Ablation Versus Partial Nephrectomy in Treating Small Renal Tumors: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2015; 94:e2255. [PMID: 26683944 PMCID: PMC5058916 DOI: 10.1097/md.0000000000002255] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Radiofrequency ablation (RFA) has emerged as an alternative treatment to surgical partial nephrectomy (PN) in the treatment of small renal tumors (SRTs). But its safety and oncological efficacy are still controversial. We conducted this systematic review and meta-analysis to compare the peritoperative and oncological outcomes of RFA and PN in the treatment of SRTs. Pubmed, EMBASE, Cochrane CENTRAL, and Web of Science were searched to identify eligible studies that compared the RFA and PN in the treatment of SRTs. Twelve retrospective studies that compared RFA with PN in the treatment of SRTs met our selection criterion and were included in this meta-analysis. The pooled results indicated that the local recurrence rate (4.14% vs 4.10%, RR: 1.18, 95% CI: 0.68, 2.07, P = 0.550) and distant metastases rate (2.76% vs 1.89%, RR: 1.31, 95% CI: 0.70, 2.46, P = 0.686) were not significantly different between the RFA group and the PN group. In terms of perioperative outcomes, RFA was associated with shorter length of stay (LOS) (WMD: -2.02 days, 95% CI: -2.77, -1.27, P < 0.001), lower eGFR decline after treatment (WMD: -3.90, 95% CI: -6.660, -1.140, P = 0.006). However, the overall perioperative complication rate (7.5% vs 6.2%, RR:1.10, 95% CI: 0.64, 1.87, P = 0.740) and the major complication rate (3.7% vs 4.4%, RR: 0.83, 95% CI: 0.43, 1.60, P = 0.579) were both similar between RFA and PN groups. Compared with PN, RFA achieves an equal oncological outcome for SRTs with similar local recurrence rate and distant metastases rate. Additionally, RFA is associated with a similar perioperative complication rate, lower decline of eGFR, and shorter LOS. Therefore, RFA is an effective option in the treatment of SRTs for selected patients.
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Affiliation(s)
- Xiaotao Yin
- From the Department of Urology, Chinese PLA General Hospital (XY, FL, SQ, ZY); Department of Urology, General Hospital of Civil Aviation of China (LC); and Department of Urology, The First Affiliated Hospital of PLA General Hospital, Beijing, China (JG)
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21
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Pan XW, Cui XM, Huang H, Huang Y, Li L, Wang ZJ, Qu FJ, Gao Y, Cui XG, Xu DF. Radiofrequency ablation versus partial nephrectomy for treatment of renal masses: A systematic review and meta-analysis. Kaohsiung J Med Sci 2015; 31:649-58. [PMID: 26709228 DOI: 10.1016/j.kjms.2015.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/11/2015] [Accepted: 09/18/2015] [Indexed: 01/20/2023] Open
Abstract
Our study was to collect the data available in the literature on radiofrequency ablation (RFA) and partial nephrectomy (PN) and conduct a cumulative analysis on perioperative outcomes, renal function outcomes, and survival to evaluate the overall safety and efficacy of RFA versus PN for small renal cell cancer (SRCC). A literature search was carried out using various electronic databases. Data including age, tumor size, comorbid disease, operation duration, hospital stay, pre- and postoperative estimated glomerular filtration rate (eGFR), major and minor complications, and local tumor recurrence and metastasis were collected for meta-analysis. Sixteen studies were included for this meta-analysis. The age of patients treated with RFA was significantly older than that of patients treated with PN [weighted mean difference (WMD) = 5.07 years]. There were more patients with cardiovascular disease in RFA group as compared with PN group [odds ratio (OR) = 4.24] before treatment. RFA was associated with a shorter length of hospital stay compared with PN (WMD = -2.02 days). No significant difference was found in major and minor complications between the two groups (major: OR = 0.74; minor: OR = 0.45). Preoperative eGFR and eGFR decline in RFA patients was significantly lower than that in PN patients (WMD = -7.27 and -4.82, respectively), whereas there was no significant difference in postoperative eGFR (WMD = -1.18). The local tumor recurrence rate in RFA group was higher than that in PN group (OR = 1.81). However, the distant metastasis rate was no statistical difference between the two groups (OR = 1.63). RFA is a suitable therapeutic option for older patients and those at high risk for SRCC because of a low risk of operation and better preservation of renal function.
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Affiliation(s)
- Xiu-Wu Pan
- Department of Urologic Surgery, Changzheng Hospital of the Second Military Medical University, Shanghai, China; Department of Urologic Surgery, Third Affiliated Hospital of the Second Military Medical University, Shanghai, China
| | - Xin-Ming Cui
- Department of EENT and Plastic and Maxillofacial Surgery, Nangang Branch of Heilongjiang Provincial Hospital, Heilongjiang Province, China
| | - Hai Huang
- Department of Urologic Surgery, Changzheng Hospital of the Second Military Medical University, Shanghai, China
| | - Yi Huang
- Department of Urologic Surgery, Changzheng Hospital of the Second Military Medical University, Shanghai, China
| | - Lin Li
- Department of Urologic Surgery, Changzheng Hospital of the Second Military Medical University, Shanghai, China
| | - Zhi-Jun Wang
- Department of Urologic Surgery, Changzheng Hospital of the Second Military Medical University, Shanghai, China
| | - Fa-Jun Qu
- Department of Urologic Surgery, Changzheng Hospital of the Second Military Medical University, Shanghai, China
| | - Yi Gao
- Department of Urologic Surgery, Changzheng Hospital of the Second Military Medical University, Shanghai, China
| | - Xin-Gang Cui
- Department of Urologic Surgery, Third Affiliated Hospital of the Second Military Medical University, Shanghai, China.
| | - Dan-Feng Xu
- Department of Urologic Surgery, Changzheng Hospital of the Second Military Medical University, Shanghai, China
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22
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Fossati N, Larcher A, Gadda GM, Sjoberg DD, Mistretta FA, Dell'Oglio P, Lista G, Carenzi C, Lughezzani G, Lazzeri M, Montorsi F, Vickers AJ, Guazzoni G, Buffi NM. Minimally Invasive Partial Nephrectomy Versus Laparoscopic Cryoablation for Patients Newly Diagnosed with a Single Small Renal Mass. Eur Urol Focus 2015; 1:66-72. [PMID: 28723359 DOI: 10.1016/j.euf.2015.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 01/19/2015] [Accepted: 02/04/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Minimally invasive partial nephrectomy (MIPN) and laparoscopic renal cryoablation (LRC) are two treatment options increasingly used for small renal masses. OBJECTIVE To compare perioperative, oncologic, and functional outcomes after MIPN and LRC. DESIGN, SETTING, AND PARTICIPANTS We included 372 consecutive patients newly diagnosed with a single small renal mass and treated with either MIPN or LRC at a single institution. INTERVENTION MIPN and LRC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Regression models were used to evaluate the impact of surgical treatment (MIPN vs LRC) on perioperative, oncologic, and functional outcomes. RESULTS AND LIMITATIONS Overall, 206 patients (55%) underwent MIPN and 166 (45%) were treated with LRC. In multivariate analysis, the rate of postoperative complications was significantly lower in the MIPN compared to the LRC group (20% vs 28%; adjusted difference -11%; p=0.02) after adjusting for age at surgery, American Society of Anesthesiologists score (1 vs 2 vs 3), and tumor size. The median follow-up was similar in the two groups (43 and 39 mo for MIPN and LRC, respectively). In univariate Cox regression analysis, treatment type was not significantly associated with disease-free survival (hazard ratio 1.06, 95% confidence interval [CI] 0.45-2.52; p=0.9). The disease-free survival rate at 5 yr was 92% in MIPN and 93% in LRC patients. In multivariate linear regression analysis, LRC was significantly associated with a higher estimated glomerular filtration rate (eGFR) at 6 mo compared to MIPN (coefficient 4.68, 95% CI 0.06-9.30; p=0.047) after adjusting for age at surgery, tumor size, and preoperative eGFR. There was no significant association between surgical treatment and postoperative eGFR at 3 yr after surgery (coefficient -2.36, 95% CI -7.55 to 2.83; p=0.4). Limitations include the retrospective study design and selection bias. CONCLUSIONS MIPN and LRC provided similar cancer control and comparable renal function at intermediate-term follow-up. Both surgical techniques emerged as viable treatment options for patient newly diagnosed with a single small renal mass. Further multi-institutional studies with longer follow-up and nephrometry scores are needed to corroborate our findings. PATIENT SUMMARY In patients newly diagnosed with a single small renal mass, minimally invasive partial nephrectomy and laparoscopic renal cryoablation provided similar cancer control and comparable renal function at intermediate-term follow-up.
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Affiliation(s)
- Nicola Fossati
- Division of Oncology / Unit of Urology, URI, IRCCS Ospedale San Raffaele - Ville Turro, Milan, Italy; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| | - Alessandro Larcher
- Division of Oncology / Unit of Urology, URI, IRCCS Ospedale San Raffaele - Ville Turro, Milan, Italy
| | - Giulio M Gadda
- Division of Oncology / Unit of Urology, URI, IRCCS Ospedale San Raffaele - Ville Turro, Milan, Italy
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Francesco A Mistretta
- Division of Oncology / Unit of Urology, URI, IRCCS Ospedale San Raffaele - Ville Turro, Milan, Italy
| | - Paolo Dell'Oglio
- Division of Oncology / Unit of Urology, URI, IRCCS Ospedale San Raffaele - Ville Turro, Milan, Italy
| | - Giuliana Lista
- Division of Oncology / Unit of Urology, URI, IRCCS Ospedale San Raffaele - Ville Turro, Milan, Italy
| | - Cristina Carenzi
- Division of Oncology / Unit of Urology, URI, IRCCS Ospedale San Raffaele - Ville Turro, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, Humanitas Clinical and Research Center, Humanitas University, Milan - Italy
| | - Massimo Lazzeri
- Department of Urology, Humanitas Clinical and Research Center, Humanitas University, Milan - Italy
| | - Francesco Montorsi
- Division of Oncology / Unit of Urology, URI, IRCCS Ospedale San Raffaele - Ville Turro, Milan, Italy
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Giorgio Guazzoni
- Department of Urology, Humanitas Clinical and Research Center, Humanitas University, Milan - Italy
| | - Nicolò Maria Buffi
- Department of Urology, Humanitas Clinical and Research Center, Humanitas University, Milan - Italy
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Lang EK, Zhang KK, Nguyen Q, Myers L, Allaf M, Colon I. Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities: Outcome study in 70 patients. Can Urol Assoc J 2015; 9:E256-61. [PMID: 26029291 DOI: 10.5489/cuaj.2597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of this study was to establish the efficacy of cryoablation for incidentally discovered small renal cell carcinomas in older patients with medical comorbidities. METHODS We carried out a retrospective chart analysis of outcomes of 70 patients treated by cryoablation. The inclusion criteria were age >56 years, medical comorbidities (Charlson class I-III), and suitability for cryoablation established by urologists and interventional radiologists. In total, 43 patients were male, 27 female, and the age range was 56 to 89. The lesions measured 1.5 to 4 cm; 29 were high-grade Fuhrman and 41 were low grade. All lesions were treated by 2 10-minute freezing cycles separated by an 8-minute thawing period. One to seven cryoprobes were inserted according to a preoperative, 3D computed tomography (CT)-based plan. RESULTS Results were assessed on follow-up CTs (at 8-9 months). Of the 70 patients, 68 were treated by cryoablations and surgical salvage procedures; these patients were free of disease for 23 to 72 months (mean 39). One patient experienced recurrence and the other was lost to follow-up. One or two cryoablations rendered 66 patients tumour-free and additional surgery rendered another 2 patients tumour-free. The location and configuration of the lesion affected outcomes. Of the 27 posterior lesions, there was 1 failure; of the postero-lateral lesions, there were 4 failures; of the anterior lesions, there were 5 lesions; finally of the 32 central or deep seated lesions, there were 9 failures. Implants with one and two cryoprobes had a high recurrence rate. Three major complications were managed by minor interventions. The mean hospitalization was 1.3 days and the procedure times were variable. CONCLUSION Percutaneous cryoablation is recommended as a minimally invasive nephron-sparing treatment for amenable lesions in older patients with medical comorbidities.
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Affiliation(s)
| | - Kan Karl Zhang
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
| | | | | | | | - Ivan Colon
- SUNY Downstate Medical Center, Brooklyn, NY
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Pan X, Huang H, Huang Y, Liu B, Cui X, Gan S, Ye J, Xu D, Chen L, Zhou Q, Li L, Hong Y. Sunitinib dosing schedule 2/1 improves tolerability, efficacy, and health-related quality of life in Chinese patients with metastatic renal cell carcinoma. Urol Oncol 2015; 33:268.e9-15. [PMID: 25863944 DOI: 10.1016/j.urolonc.2015.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 03/06/2015] [Accepted: 03/07/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the efficacy and tolerability of sunitinib dosing schedule of 2 weeks on and 1 week off (schedule 2/1) vs. the traditional schedule of 4 weeks on and 2 week off (schedule 4/2) and its influence on health-related quality of life (HRQoL) in Chinese patients with metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS A retrospective analysis of 108 patients with mRCC who were treated with sunitinib regimens (50mg daily) between January 2009 and July 2013 was undertaken. Overall, 3 groups of patients were studied according to the dosing schedule they received: schedule 4/2 (n = 50), transitional schedule 2/1 (T2/1; patients switched from schedule 4/2 to 2/1; n = 26), and initial schedule 2/1 (I2/1; n = 32). The tumor response, progression-free survival (PFS) time, adverse events, and HRQoL were assessed and compared among the groups. RESULTS The incidences of diarrhea, fatigue, hand-foot syndrome, and neutropenia induced by the treatment of sunitinib were all significantly less common with schedule I2/1 and T2/1 than with schedule 4/2 (P<0.05). Although there was no statistically significant difference in the tumor response among the 3 groups, the median PFS time was significantly longer with schedule I2/1 than with schedules T2/1 and 4/2 (11.2 vs. 9.4 and 9.5mo, respectively, P = 0.030), and HRQoL (as determined by 19-item Functional Assessment of Cancer Therapy Kidney Symptom Index scores) was better. CONCLUSIONS Treatment with sunitinib 50mg daily using a 2/1 dosing schedule can provide better tolerability and a longer PFS with better HRQoL in Chinese patients with mRCC than the traditional schedule 4/2.
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Affiliation(s)
- Xiuwu Pan
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hai Huang
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Urinary Surgery of Lihuili Hospital, Ningbo, China
| | - Yi Huang
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bing Liu
- Department of Urinary Surgery of Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xingang Cui
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Sishun Gan
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Jianqing Ye
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Danfeng Xu
- Urology Research Center of the Chinese People׳s Liberation Army, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lu Chen
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qiwei Zhou
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lin Li
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yi Hong
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, Shanghai, China
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Kim HK, Pyun JH, Kim JY, Kim SB, Cho S, Kang SG, Lee JG, Kim JJ, Cheon J, Kang SH. Renal cryoablation of small renal masses: a Korea University experience. Korean J Urol 2015; 56:117-24. [PMID: 25685298 PMCID: PMC4325115 DOI: 10.4111/kju.2015.56.2.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/29/2014] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the perioperative, functional, and oncological outcomes of renal cryoablation (RC) of small renal masses (SRMs) performed in Korea University Hospital. Materials and Methods We reviewed an Institutional Review Board-approved database of 70 patients who underwent RC and were followed up for a minimum of 3 months by a single surgeon in Korea University Hospital from August 2007 to May 2014. Among these patients, 68 patients (79 renal masses) were enrolled in our research. We evaluated perioperative, functional, and oncologic outcomes of RC. Results A total of 68 patients (79 renal masses) underwent RC in our institution. The mean age of the patients was 62.0 years. The mean tumor size was 2.25 cm. Among the 59 patients who underwent laparoscopic surgery, only 1 patient (1.47%) was converted to open surgery. No other perioperative complications occurred. The mean preoperative and 1-month postoperative estimated glomerular filtration ratio (eGFR) were 71.8 and 68.3 mL/min/1.73 m2, respectively (p=0.19). The mean 1-year postoperative eGFR was 65.0 mL/min/1.73 m2 (p=0.25). The mean follow-up period was 59.76 months (range, 3-119 months). Local tumor recurrence occurred in eight tumors (15.4%; a total of 52 renal cell carcinomas). Concerning treatment in the patients with recurrence, five patients underwent re-treatment and three patients are under active surveillance. None of the eight patients who experienced local recurrence had additional recurrence or tumor progression during the follow-up period. In our study, the recurrence-free rate was 83.0% and the cancer-specific survival rate was 100%. Moreover, the 5- and 10-year overall survival rates were both 100%. Conclusions Long-term experience with RC in our institution demonstrates that RC is a safe and effective treatment for patients with SRMs.
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Affiliation(s)
- Hyung Keun Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jong Hyun Pyun
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jae Yoon Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Seung Bin Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Seok Cho
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jeong Gu Lee
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Je Jong Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jun Cheon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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26
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Polymorphisms of the receptor for advanced glycation end-products and glyoxalase I in patients with renal cancer. Tumour Biol 2014; 36:2121-6. [DOI: 10.1007/s13277-014-2821-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022] Open
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27
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Antitumor activity of irradiated riboflavin on human renal carcinoma cell line 786-O. Tumour Biol 2014; 36:595-604. [DOI: 10.1007/s13277-014-2675-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 09/24/2014] [Indexed: 01/20/2023] Open
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28
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Grivas N, Kafarakis V, Tsimaris I, Raptis P, Hastazeris K, Stavropoulos NE. Clinico-pathological prognostic factors of renal cell carcinoma: A 15-year review from a single center in Greece. Urol Ann 2014; 6:116-21. [PMID: 24833821 PMCID: PMC4021649 DOI: 10.4103/0974-7796.130552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 02/10/2013] [Indexed: 01/22/2023] Open
Abstract
Aim: To investigate the prognostic significance of certain clinical and pathological factors of renal cell cancer. Materials and Methods: One hundred and fourteen patients who underwent radical nephrectomy between 1996 and 2011 in our hospital were examined. Parameters including age, gender, mode of presentation, hematological and pathological parameters were evaluated for their role as predictors of disease-free and overall survival. Results: Median follow-up was 69 months. Predominant histological type, pathological stage, and nuclear grade were clear cell carcinoma, pT1, and Fuhrman II, respectively. Five-year overall and disease-free survival were 86% and 82%, respectively. Only nuclear grade (P = 0.02) and preoperative anemia (P < 0.01) were correlated with overall survival, while pathological stage, nuclear grade, anemia, and neutrophil-to-lymphocyte ratio of 2.7 or greater were associated with disease-free survival (P = 0.02, P = 0.038, P < 0.01, P = 0.049, respectively). In the multivariate setting, anemia (P = 0.04) and pathological stage (P = 0.026) were the only independent statistically significant predictors of disease-free survival, while anemia (P = 0.018) and neutrophil to lymphocyte ratio (P = 0.034) were the only factors correlated with overall survival. Conclusions: Due to the wide application of various imaging studies, patients with kidney cancer are diagnosed more often with localized disease and favorable pathological features. Fuhrman nuclear grade, pathological stage, preoperative anemia, and neutrophil to lymphocyte ratio are strongly associated with survival. In localized disease, such information could be used to guide the intensity of follow-up and identify high-risk patients who can be targeted for adjuvant therapy trials.
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Affiliation(s)
- Nikolaos Grivas
- Department of Urology, G. Hatzikosta General Hospital, 45001, Ioannina, Greece
| | - Vasilios Kafarakis
- Department of Urology, G. Hatzikosta General Hospital, 45001, Ioannina, Greece
| | - Ioannis Tsimaris
- Department of Urology, G. Hatzikosta General Hospital, 45001, Ioannina, Greece
| | - Pavlos Raptis
- Department of Urology, G. Hatzikosta General Hospital, 45001, Ioannina, Greece
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Klatte T, Shariat SF, Remzi M. Systematic Review and Meta-Analysis of Perioperative and Oncologic Outcomes of Laparoscopic Cryoablation Versus Laparoscopic Partial Nephrectomy for the Treatment of Small Renal Tumors. J Urol 2014; 191:1209-17. [DOI: 10.1016/j.juro.2013.11.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2013] [Indexed: 11/15/2022]
Affiliation(s)
- Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Mesut Remzi
- Department of Urology, Landesklinikum, Korneuburg, Austria
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Laguna MP, Algaba F, Cadeddu J, Clayman R, Gill I, Gueglio G, Hohenfellner M, Joyce A, Landman J, Lee B, van Poppel H. Current patterns of presentation and treatment of renal masses: a clinical research office of the endourological society prospective study. J Endourol 2014; 28:861-70. [PMID: 24555480 DOI: 10.1089/end.2013.0724] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To assess epidemiologic characteristics, clinical and pathologic patterns of presentation, and treatment strategies in a contemporary population with renal masses (RMs). METHODS The Clinical Research Office of the Endourological Society collected prospective epidemiologic, clinical, and pathologic data on consecutive patients with RMs who were treated during a 1-year period in 98 centers worldwide. Preoperative assessment and treatment were performed according to local clinical practice guidelines. RESULTS From January 2010 to February 2012, 4288 patients (4355 cases, 4815 tumors) were treated for a RM. The mean age of the cohort was 61.5 years, and the ratio male:female 1.8:1. Caucasians represented 75% of the population, and the median body mass index was 27. The cohort exhibited a high rate of comorbidity (65.6%), including a 48.5% rate of hypertension; one-third of patients had a combination of two or more comorbidities. One-third of patients (36%) had risk factors for renal-cell carcinoma (RCC), of which smoking and obesity were the most common. Diagnosis was incidental in 67% of cases, and 22.2% of cases had chronic kidney disease stage ≥III at presentation. Median radiologic size was 44 mm (range 2-300 mm) and 68% were cT1. Radical nephrectomy and nephron-sparing surgery (NSS) including ablation were performed in 52% and 46% of cases, respectively, while 3.6% of cases were actively surveyed. Median pathologic size was 43 mm (range 2-300 mm) and 63% of the RCCs were pT1. CONCLUSIONS Current patterns of presentation of RMs are consistent with the decreasing trends in age and clinical or pathologic size and increasing incidental diagnosis. Patients exhibit a considerable basal comorbidity and presence of risk factors for RCC. Half of the cases are treated by a nephron-sparing modality with an increase in the penetration of NSS techniques in the contemporary urologic practice.
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Affiliation(s)
- M Pilar Laguna
- 1 Department of Urology, AMC University of Amsterdam , Amsterdam, The Netherlands
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31
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Rini BI, Quinn DI, Baum M, Wood LS, Tarazi J, Rosbrook B, Arruda LS, Cisar L, Roberts WG, Kim S, Motzer RJ. Hypertension among patients with renal cell carcinoma receiving axitinib or sorafenib: analysis from the randomized phase III AXIS trial. Target Oncol 2014; 10:45-53. [PMID: 24595903 PMCID: PMC4363524 DOI: 10.1007/s11523-014-0307-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/18/2014] [Indexed: 11/30/2022]
Abstract
Inhibitors of the vascular endothelial growth factor (VEGF) pathway frequently induce hypertension when used to treat patients with advanced renal cell carcinoma (RCC). This analysis characterizes hypertension and hypertension-related events in patients treated with the VEGF pathway inhibitors axitinib or sorafenib in the AXIS trial. AXIS was a randomized phase III study of axitinib versus sorafenib in patients with metastatic RCC following failure of one prior systemic regimen. Patients with uncontrolled hypertension were excluded, but patients with hypertension controlled with antihypertensive medication were allowed to participate. Guidelines for hypertension management included adjustment or addition of antihypertensive medications and/or axitinib or sorafenib dose reductions, interruptions, or discontinuations. Treatment-emergent all-causality hypertension occurred in 145 (40.4 %) axitinib-treated patients (N = 359) and 103 (29.0 %) sorafenib-treated patients (N = 355), with grade 3 hypertension reported in 55 (15.3 %) and 38 (10.7 %) patients, respectively, and grade 4 hypertension reported in one (0.3 %) patient in each arm. Hypertension-related events led to axitinib dose interruptions (n = 46; 12.8 %), dose reductions (n = 16; 4.5 %), or discontinuations (n = 1; 0.3 %). Approximately 50 % of axitinib-treated patients with grade 3 or 4 hypertension continued treatment for ≥ 9 months. Hypertension-related sequelae occurred in <1 % of axitinib-treated patients. Hypertension was more frequently observed during treatment with axitinib than sorafenib in patients with RCC, but axitinib-induced hypertension rarely led to treatment discontinuation or cardiovascular sequelae. Recommendations for monitoring blood pressure and managing hypertension during axitinib therapy are presented.
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Affiliation(s)
- Brian I Rini
- Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic Main Campus, Mail Code R35, 9500 Euclid Avenue, Cleveland, 44195, OH, USA,
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Tanagho YS, Bhayani SB, Kim EH, Figenshau RS. Renal Cryoablation Versus Robot-Assisted Partial Nephrectomy: Washington University Long-Term Experience. J Endourol 2013; 27:1477-86. [DOI: 10.1089/end.2013.0192] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Youssef S. Tanagho
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sam B. Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Eric H. Kim
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - R. Sherburne Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Renal cell carcinoma initially presenting as an arteriovenous malformation: a case presentation and a review of the literature. Case Rep Urol 2013; 2013:356819. [PMID: 24251063 PMCID: PMC3819914 DOI: 10.1155/2013/356819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 09/08/2013] [Indexed: 01/10/2023] Open
Abstract
We describe a case of a patient who presented with hematuria and was diagnosed with a renal arteriovenous malformation (AVM). Transcatheter arterial embolization subsequently was performed on this lesion multiple times. Follow-up imaging demonstrated that the AVM was masking an underlying, rapidly growing renal cell carcinoma (RCC). We describe the pathological and radiographic characteristics of AVMs and RCC. We describe the strengths and weaknesses of computed tomography (CT) and magnetic resonance imaging (MRI) to detect and characterize RCC and AVM. We recommend initial and follow-up MR imaging in patients with an AVM to establish a baseline, monitor treatment response, and survey lesions for underlying and obscured malignancy.
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Hammett J, Ko J, Byrd N, Crispen PL, Krupski TL. Patterns of care for renal surgery: Underutilization of nephron-sparing procedures. Can Urol Assoc J 2013; 7:E386-92. [PMID: 23826049 DOI: 10.5489/cuaj.12066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/14/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nephron-sparing procedures are well-described, provide similar oncologic outcomes to nephrectomy, and potentially decrease morbidity as compared to nephrectomy. METHODS We analyzed academic and community health system data from Virginia and Kentucky to evaluate the utilization and cost of nephron-sparing procedures. Primary International Classification of Disease (ICD-9) diagnosis and procedure codes were employed to target subjects of interest. RESULTS In total, we analyzed 3809 subjects from Virginia and 3163 subjects from Kentucky between 2004 and 2009 who underwent treatment of a malignant renal mass. There has been a 6.1% and 14.8% decrease in nephrectomy utilization in Virginia and Kentucky, respectively, since 2004. In 2009, 71.4% and 68.8% of all procedures for the treatment of renal masses were radical nephrectomies. The proportion of nephron-sparing procedures has increased in academic (20%) and community (15%) health systems since 2004. The difference in cost between nephrectomy, partial nephrectomy and ablative therapy in Virginia and Kentucky hospitals was negligible (p > 0.05). CONCLUSIONS Nephron-sparing procedures have been increasingly employed over the last 6 years, but are still underutilized. There does not appear to be a significant cost difference in the treatment of renal masses with nephrectomy, partial nephrectomy or ablative therapies.
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Affiliation(s)
- Jessica Hammett
- Department of Urology, University of Virginia, Charlottesville, VA
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35
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Luciani LG, Malossini G, Porpiglia F. Reply: To PMID 23608665. Urology 2013; 81:1244-5. [PMID: 23608664 DOI: 10.1016/j.urology.2012.12.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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[Renal cell carcinoma: A 12-year retrospective study of epidemiologic, therapeutic and follow-up data]. Prog Urol 2013; 23:15-21. [PMID: 23287479 DOI: 10.1016/j.purol.2012.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 07/30/2012] [Accepted: 08/06/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the evolution of epidemiology and management of renal cell carcinoma and their impact on overall and progression-free survivals. PATIENTS AND METHODS We reviewed the files of consecutive patients with renal cell carcinoma in our center between January 2000 and December 2011. Patients with confirmed diagnosis on histology who underwent radical nephrectomy, partial nephrectomy or thermoablation were included. Benign tumors were excluded. Epidemiologic and therapeutic data during the period of study were compared. Overall and progression-free survivals divided in three periods were compared by Kaplan-Meier curves. RESULTS Four hundred and forty-nine patients were included with a median age of 60 years old [21; 89], and median follow-up of 39 months. Tumor histology was clear cell carcinoma in 75.9% of cases. During the period of study, patients with ASA score upper than 3 increased from 20.4% to 47.8%, tumor size decreased from 58.4mm to 49.5mm and incidental tumor discovery increased from 59.1% to 71.6%. Nephron-sparing surgery increased from 19.7% to 44%. Overall survival and progression-free survival was not different during this period (P=0.071 and P=0.582). CONCLUSION The increase in early incidental discovery of renal cell carcinoma allowed nephron-sparing surgery in spite of patients with more comorbidities, with stable overall and progression-free survivals in our series.
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Schnoeller TJ, de Petriconi R, Hefty R, Jentzmik F, Al Ghazal A, Steinestel J, Mueller J, Zengerling F, Schrader M, Schrader AJ. [The use of Surgisis® optimizes and simplifies partial nephrectomy for large renal tumors]. Urologe A 2012. [PMID: 23178845 DOI: 10.1007/s00120-012-3050-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND With lower rates of postoperative renal failure, diabetes and cardiovascular disease, partial nephrectomy achieves longer overall survival and equally long tumor-specific survival. It is thus the current gold standard treatment for renal tumors and now also for those ≥ 4 cm in size. The main complications of nephron-sparing surgery, particularly for large and centrally located tumors, are postoperative parenchymal bleeding and urinary fistulas after opening the urinary collecting system (UCS). MATERIAL AND METHODS Between August 2003 and April 2012, 76 partial nephrectomies for tumors ≥ 4 cm in size were performed using porcine small intestinal submucosa (SIS, Surgisis®) to close the capsular, renal and in some cases, UCS defects. RESULTS The median tumor size was 5.0 cm (range 4.0-13.0 cm) and the intervention was performed with warm ischemia in 25 cases (32.8 %), with cold perfusion in 16 cases (21.2 %) and without ischemia in 35 cases (46.0 %). A total of 4 patients (5.5 %) developed postoperative urinary fistulas and 4 (5.5 %) required revision surgery because of significant postoperative bleeding. There were no local infections or allergic reactions to the foreign material. CONCLUSIONS Surgisis® enables a quick and technically uncomplicated closure of the renal defect after partial nephrectomy for tumors. It has the potential to further minimize postoperative bleeding and urinary fistulas and to facilitate the intervention to the extent that nephron-sparing surgery will gain broader acceptance even in patients with tumors ≥4 cm in size.
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Affiliation(s)
- T J Schnoeller
- Klink für Urologie, Universitätsklinikum Ulm, Prittwitzstraße 43, Ulm, Germany.
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Management of kidney cancer in Asia: resource-stratified guidelines from the Asian Oncology Summit 2012. Lancet Oncol 2012; 13:e482-91. [DOI: 10.1016/s1470-2045(12)70433-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chao CT, Kao CC, Lee SY, Ho SJ, Jhuang YJ, Li LHY, Kao TW. Renal cell carcinoma with secondary hemophagocytic syndrome: A case report. Can Urol Assoc J 2012; 6:E64-6. [PMID: 22511436 DOI: 10.5489/cuaj.10188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A patient with a suspected malignancy and pancytopenia warrants much consideration. Most clinicians would consider bone marrow infiltrative process, heralding a grave prognosis. However, rare occurrence of hemophagocytic lymphohistiocytosis is another diagnostic possibility we should keep in mind. The treatment choices and overall prognosis may differ from patients without hemophagocytosis. We present a case of incidentally found advanced renal cell carcinoma (RCC) concurrent with hemophagocytosis process in the bone marrow. We also discuss the importance of this finding.
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Affiliation(s)
- Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Tan HJ, Norton EC, Ye Z, Hafez KS, Gore JL, Miller DC. Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA 2012; 307:1629-35. [PMID: 22511691 PMCID: PMC3864575 DOI: 10.1001/jama.2012.475] [Citation(s) in RCA: 294] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
CONTEXT Although partial nephrectomy is the preferred treatment for many patients with early-stage kidney cancer, recent clinical trial data, which demonstrate better survival for patients treated with radical nephrectomy, have generated new uncertainty regarding the comparative effectiveness of these treatment options. OBJECTIVE To compare long-term survival after partial vs radical nephrectomy among a population-based patient cohort whose treatment reflects contemporary surgical practice. DESIGN, SETTING, AND PATIENTS We performed a retrospective cohort study of Medicare beneficiaries with clinical stage T1a kidney cancer treated with partial or radical nephrectomy from 1992 through 2007. Using an instrumental variable approach to account for measured and unmeasured differences between treatment groups, we fit a 2-stage residual inclusion model to estimate the treatment effect of partial nephrectomy on long-term survival. MAIN OUTCOME MEASURES Overall and kidney cancer-specific survival. RESULTS Among 7138 Medicare beneficiaries with early-stage kidney cancer, we identified 1925 patients (27.0%) treated with partial nephrectomy and 5213 patients (73.0%) treated with radical nephrectomy. During a median follow-up of 62 months, 487 (25.3%) and 2164 (41.5%) patients died following partial or radical nephrectomy, respectively. Kidney cancer was the cause of death for 37 patients (1.9%) treated with partial nephrectomy, and 222 patients (4.3%) treated with radical nephrectomy. Patients treated with partial nephrectomy had a significantly lower risk of death (hazard ratio [HR], 0.54; 95% CI, 0.34-0.85). This corresponded with a predicted survival increase with partial nephrectomy of 5.6 (95% CI, 1.9-9.3), 11.8 (95% CI, 3.9-19.7), and 15.5 (95% CI, 5.0-26.0) percentage points at 2, 5, and 8 years posttreatment (P < .001). No difference was noted in kidney cancer-specific survival (HR, 0.82; 95% CI, 0.19-3.49). CONCLUSION Among Medicare beneficiaries with early-stage kidney cancer who were candidates for either surgery, treatment with partial rather than radical nephrectomy was associated with improved survival.
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Affiliation(s)
- Hung-Jui Tan
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Edward C. Norton
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI
- Department of Economics, University of Michigan, Ann Arbor, MI
- National Bureau of Economic Research, Cambridge, MA
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | - Zaojun Ye
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Khaled S. Hafez
- Division of Urologic Oncology, Department of Urology, Ann Arbor, MI
| | - John L. Gore
- Department of Urology, University of Washington, Seattle, WA
| | - David C. Miller
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
- Division of Urologic Oncology, Department of Urology, Ann Arbor, MI
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Stroup SP, Palazzi KL, Chang DC, Ward NT, Parsons JK. Inpatient safety trends in laparoscopic and open nephrectomy for renal tumours. BJU Int 2012; 110:1808-13. [PMID: 22471427 DOI: 10.1111/j.1464-410x.2012.11071.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
UNLABELLED Study Type--Cohort study Level of Evidence 2b. What's known on the subject? and What does the study add? Laparoscopic radical nephrectomy for renal cancer provides equivalent long-term cancer control with shorter hospital stays, less postoperative pain, and faster resumption of normal activities, but it has diffused slowly into clinical practice, perhaps as a result of perceptions about safety. Patient safety outcomes for laparoscopic and open radical nephrectomy using validated measures remain incompletely characterized. This is the first study to investigate peri-operative outcomes of radical nephrectomy using validated patient safety measures. We found a 32% decreased probability of adverse patient safety events occurring in laparoscopic compared with open radical nephrectomy. The safety benefits of laparoscopy were attained only after 10% of cases were completed laparoscopically--a proportion some have proposed as the 'tipping point' for the adoption of surgical innovations. This observation could have implications for patient safety in the setting of diffusion of new surgical techniques. OBJECTIVE • To compare peri-operative adverse patient safety events occurring in laparoscopic radical nephrectomy (LRN) with those occurring in open radical nephrectomy (ORN). METHODS • We used the US Nationwide Inpatient Sample to identify patients undergoing kidney surgery for renal tumours from 1998 to 2008. • We used patient safety indicators (PSIs), which are validated measures of preventable adverse outcomes, and multivariate regression to analyse associations of surgery type with patient safety. RESULTS • Open radical nephrectomy accounted for 235,098 (89%) cases while 28,609 (11%) cases were LRN. • Compared with ORN, LRN patients were more likely to be male (P= 0.048), have lower Charlson comorbidity scores (P < 0.001), and to undergo surgery at urban (P < 0.001) and teaching (P < 0.001) hospitals. • PSIs occurred in 18,714 (8%) of ORN and 1434 (5%) of LRN cases (P < 0.001). • On multivariate analysis, LRN was associated with a 32% decreased probability of any PSI (adjusted odds ratio 0.68, 95% confidence interval: 0.6 to 0.77, P < 0.001). Stratification by year showed that this difference was initially manifested in 2003, when the proportion of LRN cases first exceeded 10%. CONCLUSIONS • We found that LRN was associated with substantially superior peri-operative patient safety outcomes compared with ORN, but only after the national prevalence of LRN exceeded 10%. • Further study is needed to explain these patterns and promote the safe diffusion of novel surgical therapies into broad practice.
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Affiliation(s)
- Sean P Stroup
- UC San Diego Medical Center, Division of Urology VA San Diego Medical Center Moores UCSD Cancer Center, San Diego, CA 92103, USA
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Cote ML, Colt JS, Schwartz KL, Wacholder S, Ruterbusch JJ, Davis F, Purdue M, Graubard BI, Chow WH. Cigarette smoking and renal cell carcinoma risk among black and white Americans: effect modification by hypertension and obesity. Cancer Epidemiol Biomarkers Prev 2012; 21:770-9. [PMID: 22426145 DOI: 10.1158/1055-9965.epi-11-1109] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Incidence of kidney cancer has been increasing over the past three decades, with more rapid increases and higher incidence rates among blacks than whites in the United States. An association between cigarette smoking and renal cell carcinoma (RCC), the most common form of kidney cancer, has been reported for whites, but the association in blacks is less clear. METHODS The association between smoking and RCC was examined in 1,217 incident cases and 1,235 population controls frequency-matched on age, race, gender, and study site in the Kidney Cancer Study in Detroit, MI, and Chicago, IL. RESULTS In white individuals, increasing duration and number of pack-years of both were associated with increased risk of RCCs after adjusting for age, gender, education, study site, body mass index (BMI) and history of hypertension (P(trend) = 0.0002 and P(trend) = 0.002, respectively). Among black individuals, RCC risk increased with duration of smoking (P(trend) = 0.02) but not other measures. Compared with current smokers, RCC risk decreased with increasing years of smoking cessation among both whites and blacks (P(trend) = 0.01 and 0.02, respectively). When examining risk according to hypertension history, associations between smoking and RCC risk were observed only among individuals who reported never having been diagnosed with hypertension. Similarly, cigarette smoking was associated with increased risk of RCCs among nonobese individuals but not among those with BMI ≥ 30 kg/m(2). CONCLUSION Our observation that smoking is associated with RCC only in nonobese individuals and those with no history of hypertension are novel findings. IMPACT The complex relationships between RCCs, smoking, hypertension, and obesity require additional confirmation.
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Affiliation(s)
- Michele L Cote
- Wayne State University School of Medicine, Detroit, MI 48201, USA.
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Population based analysis of the increasing incidence of kidney cancer in the United States: evaluation of age specific trends from 1975 to 2006. J Urol 2011; 187:32-8. [PMID: 22088338 DOI: 10.1016/j.juro.2011.09.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE An increase in kidney cancer was reported in the United States but overall rates may obscure trends in age specific groups. We explored whether the increase in kidney cancer incidence differs across age groups. MATERIALS AND METHODS We ascertained the 63,843 incident renal cancer cases in SEER (Surveillance, Epidemiology and End Results) cancer registries for 1975 to 2006. Yearly incidence rates of renal cancer were calculated and stratified by age group. Age specific trends in cancer diagnosis were evaluated by Poisson regression. RESULTS From 1975 to 2006 the overall age adjusted renal cancer incidence increased 238% from 7.4/100,000 to 17.6/100,000 adults. From 1991 to 2006 the mean age at diagnosis decreased from 64.7 to 62.7 years and the proportion of patients diagnosed before age 65 years increased from 45.9% to 55.3%. Age specific incidence rates of renal cancer increased in all age groups from 1975 to 2006 (p <0.0001). However, the rates changed at different rates. Overall renal cancer diagnosis in the youngest age group (20 to 39 years) increased more quickly than all other age groups (p <0.0001). The renal cancer incidence in patients 60 to 69 and 70 to 79 years old increased more rapidly than in those 40 to 49 and 50 to 59 years old (p <0.01). CONCLUSIONS In the last 15 years mean age at diagnosis of renal cancer has decreased. During our study period the most rapidly increasing kidney cancer incidence was seen in those younger than 40 and 60 to 79 years old. The renal cancer increase in younger patients should direct attention toward further evaluation of renal cancer risk factors.
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Schnoeller TJ, de Petriconi R, Hefty R, Jentzmik F, Waalkes S, Zengerling F, Schrader M, Schrader AJ. Partial nephrectomy using porcine small intestinal submucosa. World J Surg Oncol 2011; 9:126. [PMID: 21992771 PMCID: PMC3233505 DOI: 10.1186/1477-7819-9-126] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 10/12/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whenever technically feasible and oncologically justified, nephron-sparing surgery is the current standard of care for localized renal cell carcinomas (RCC). The main complications of partial nephrectomy, especially for large and centrally located tumors, are urinary leakage and parenchymal bleeding. We prospectively evaluated the pros and cons of using porcine small intestinal submucosa (SIS, Surgisis®) to close the renal defect after nephron-sparing surgery. METHODS We used Surgisis® (Cook medical, Bloomington, IN, USA) to secure and compress the capsular defect after tumor resection in 123 patients submitted to 129 partial nephrectomies between August 2003 and February 2011. RESULTS The median tumor size was 3.7 cm (range 1.1-13.0 cm). Procedures were performed with cold ischemia in 24 cases (18.2%), with warm ischemia in 46 (35.6%), and without ischemia in 59 cases (44.8%). In the total group of patients, 4 (3.1%) developed urinary fistula, and only 2 (1.6%) required postoperative transfusions due to hemorrhage after the application of the small intestinal submucosa membrane. CONCLUSION Small intestinal submucosa is an easy-to-use biomaterial for preventing complications such as postoperative bleeding and urinary fistula in nephron-sparing surgery, especially in cases where tumor excision causes significant renal capsular and/or renal pelvic defects.
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Affiliation(s)
- Thomas J Schnoeller
- Department of Urology, Ulm University Medical Center, Prittwitzstrasse 43, D-89075 Ulm, Germany
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Weight CJ, Atwell TD, Fazzio RT, Kim SP, Kenny M, Lohse CM, Boorjian SA, Leibovich BC, Thompson RH. A Multidisciplinary Evaluation of Inter-Reviewer Agreement of the Nephrometry Score and the Prediction of Long-Term Outcomes. J Urol 2011; 186:1223-8. [DOI: 10.1016/j.juro.2011.05.052] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Indexed: 01/20/2023]
Affiliation(s)
| | | | | | - Simon P. Kim
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - McCabe Kenny
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Christine M. Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Lin L, Zhong K, Sun Z, Wu G, Ding G. Receptor for advanced glycation end products (RAGE) partially mediates HMGB1-ERKs activation in clear cell renal cell carcinoma. J Cancer Res Clin Oncol 2011; 138:11-22. [DOI: 10.1007/s00432-011-1067-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 09/06/2011] [Indexed: 11/24/2022]
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Klatte T, Grubmüller B, Waldert M, Weibl P, Remzi M. Laparoscopic Cryoablation Versus Partial Nephrectomy for the Treatment of Small Renal Masses: Systematic Review and Cumulative Analysis of Observational Studies. Eur Urol 2011; 60:435-43. [DOI: 10.1016/j.eururo.2011.05.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/02/2011] [Indexed: 02/07/2023]
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Ohno Y, Nakashima J, Ohori M, Hashimoto T, Iseki R, Hatano T, Tachibana M. Impact of tumor size on renal function and prediction of renal insufficiency after radical nephrectomy in patients with renal cell carcinoma. J Urol 2011; 186:1242-6. [PMID: 21849191 DOI: 10.1016/j.juro.2011.05.087] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Indexed: 01/30/2023]
Abstract
PURPOSE From the perspective of oncological and functional outcomes partial nephrectomy is considered standard surgery for small renal tumors 4 cm or less. However, radical nephrectomy is commonly done for small tumors. It is important to predict postoperative renal function in patients to choose the most optimal surgical procedure. MATERIALS AND METHODS We retrospectively reviewed the records of 271 patients treated with radical nephrectomy for renal cell carcinoma. Associations of tumor size and clinical variables with renal function were analyzed. RESULTS Preoperatively the mean ± SD glomerular filtration rate was 74.38 ± 17.70 ml per minute/1.73 m(2) and 56 patients (20%) had renal insufficiency (glomerular filtration rate less than 60 ml per minute/1.73 m(2)). The mean decrease in the glomerular filtration rate after radical nephrectomy was 24.2 ± 12.40 ml per minute/1.73 m(2) (31.5% ± 15%). Of 215 patients with a preoperative glomerular filtration rate of 60 ml per minute/1.73 m(2) or greater 165 (77%) had new onset renal insufficiency. Age, tumor size, preoperative glomerular filtration rate and hypertension were significantly associated with new onset renal insufficiency. Multivariate analysis revealed that age 60 years or greater, tumor size 7 cm or less and the preoperative glomerular filtration rate were independent risk factors for new onset renal insufficiency (p <0.05). Finally, we developed a predictive model for new onset renal insufficiency after radical nephrectomy. CONCLUSIONS Tumor size 7 cm or less, age 60 years or greater and a decreased preoperative glomerular filtration rate were significant risk factors for new onset renal insufficiency in patients treated with radical nephrectomy. Partial nephrectomy might be considered an option according to the risk of postoperative renal insufficiency, especially in elderly patients with a tumor of 7 cm or less.
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Affiliation(s)
- Yoshio Ohno
- Department of Urology, Tokyo Medical University, Tokyo, Japan.
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Steinberg PL, Munver R, Ghavamian R. Impact of repeated hilar clamping on renal function during laparoscopic and robot-assisted partial nephrectomy. J Endourol 2011; 25:1525-30. [PMID: 21815808 DOI: 10.1089/end.2010.0657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Conventional wisdom and small animal studies suggest repeated hilar clamping during partial nephrectomy is deleterious to renal function. We describe the impact of repeated renal hilar clamping during laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RPN) on the overall function of the operated kidney. PATIENTS AND METHODS A retrospective analysis of all patients undergoing RPN or LPN with repeated hilar clamping was performed. Patient and tumor characteristics were recorded. All patients had preoperative and postoperative mercaptoacetyltriglycine (MAG)3 renal scans, and the change in function was calculated. Change in glomerular filtration rate (GFR) was calculated with the modified Modification of Diet in Renal Disease equation as well. RESULTS Seven patients were studied with an average age of 60 and a body mass index of 32. Tumors averaged 3.6 cm, and there were four and three right- and left-sided tumors, respectively. The reasons for repeated clamping were bleeding in three patients and either gross or microscopic positive margins in four patients, all of whom had repeated resection. The average initial clamp time was 20 minutes, and the average reclamp time was 12 minutes. The average operative time was 185 minutes. and average blood loss was 171 mL. All renal units were functioning postoperatively. The average change in absolute renal function on the operated kidney was -4.9%, and the relative loss of function was -10%, both measured on MAG3 scan. The average GFR before surgery was 61.4 (mL/min/1.73m(2)); after surgery, the average GFR was 57.1 (mL/min/1.73m(2)), for an average loss of -7%. The range of change in GFR was from 0% to -23%. CONCLUSIONS Although not optimal, repeated clamping of the renal hilum during partial nephrectomy to control bleeding or to obtain a clear surgical margin is associated with minimal loss of renal function.
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Affiliation(s)
- Peter L Steinberg
- Department of Urology, Maine Medical Partners, South Portland, Maine 04101, USA.
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