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Mansour H, Tran-Dang MA, Walkden M, Boleti E, Barod R, Patki P, Mumtaz F, Tran MGB, Bex A, El Sheikh S. Renal mass biopsy - a practical and clinicopathologically relevant approach to diagnosis. Nat Rev Urol 2024:10.1038/s41585-024-00897-5. [PMID: 38907039 DOI: 10.1038/s41585-024-00897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/23/2024]
Abstract
Advancements in imaging modalities have increased the frequency of renal mass discovery. Imaging has typically been considered sufficient to guide management for a large proportion of these tumours, but renal mass biopsies (RMBs) have an increasing role in determining malignancy and can be a valuable tool for preventing unnecessary surgery in patients with benign tumours. A structured approach should be used to help to navigate the expanding repertoire of renal tumours, many of which are molecularly defined. In terms of tumour subtyping, the pathologist's strategy should focus on stratifying patients into clinically different prognostic groups according to our current knowledge of tumour behaviour, including benign, low-grade or indolent, intermediate malignant or highly aggressive. Crucial pathological features and morphological mimicry of tumours can alter the tumour's prognostic group. Thus, pathologists and urologists can use RMB to select patients with tumours at a reduced risk of progression, which can be safely managed with active surveillance within a tailored imaging schedule, versus tumours for which ablation or surgical intervention is indicated. RMB is also crucial in the oncological setting to distinguish between different high-grade tumours and guide tailored management strategies.
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Affiliation(s)
- Hussein Mansour
- Research Department of Pathology, UCL Cancer Institute, London, UK
| | - My-Anh Tran-Dang
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
| | - Miles Walkden
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Ekaterini Boleti
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
| | - Ravi Barod
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Prasad Patki
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Faiz Mumtaz
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Maxine G B Tran
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Axel Bex
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Soha El Sheikh
- Research Department of Pathology, UCL Cancer Institute, London, UK.
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK.
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Xing Z, Xu H, Ai K, Deng H, Hong Y, Deng P, Wang J, Xiong W, Li Z, Zhu L, Li Y. Gross Hematuria Does not Affect the Selection of Nephrectomy Types for Clinical Stage 1 Clear Cell Renal Cell Carcinoma: A Multicenter, Retrospective Cohort Study. Ann Surg Oncol 2024; 31:3531-3543. [PMID: 38329657 DOI: 10.1245/s10434-024-14958-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE This study aimed to discuss the correlation between gross hematuria and postoperative upstaging (from T1 to T3a) in patients with cT1 clear cell renal cell carcinoma (ccRCC) and to compare oncologic outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in patients with gross hematuria. METHODS A total of 2145 patients who met the criteria were enrolled in the study (including 363 patients with gross hematuria). The least absolute selection and shrinkage operator logistic regression was used to evaluate the risk factor of postoperative pathological upstaging. The propensity score matching (PSM) and stable inverse probability of treatment weighting (IPTW) analysis were used to balance the confounding factors. The Kaplan-Meier analysis and multivariate Cox proportional risk regression model were used to assess the prognosis. RESULTS Gross hematuria was a risk factor of postoperative pathological upstaging (odds ratio [OR] = 3.96; 95% confidence interval [CI] 2.44-6.42; P < 0.001). After PSM and stable IPTW adjustment, the characteristics were similar in corresponding patients in the PN and RN groups. In the PSM cohort, PN did not have a statistically significant impact on recurrence-free survival (hazard ratio [HR] = 1.48; 95% CI 0.25-8.88; P = 0.67), metastasis-free survival (HR = 1.24; 95% CI 0.33-4.66; P = 0.75), and overall survival (HR = 1.46; 95% CI 0.31-6.73; P = 0.63) compared with RN. The results were confirmed in sensitivity analyses. CONCLUSIONS Although gross hematuria was associated with postoperative pathological upstaging in patients with cT1 ccRCC, PN should still be the preferred treatment for such patients.
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Affiliation(s)
- Zhuo Xing
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Haozhe Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kai Ai
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Haitao Deng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yulong Hong
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Piye Deng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Wang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Wei Xiong
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhi Li
- Department of Urology, The Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, Hunan, China
| | - Lingfei Zhu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yuan Li
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Kondo T. Editorial Comment to Outcomes and predictors of clinical T1 renal mass (cT1) upstaged to pathological T3a (pT3a) after partial nephrectomy: A single-center experience. Int J Urol 2024; 31:257-258. [PMID: 38151956 DOI: 10.1111/iju.15374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
- Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
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Kröger Dahlin BI, Hlodan J, Ghaffarpour R, Ljungberg B. Multiple factors influence decision making for the surgical treatment in patients with renal cell carcinoma. Scand J Urol 2024; 59:26-30. [PMID: 38358280 DOI: 10.2340/sju.v59.25517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Surgical strategy in renal cell carcinoma (RCC) is considered based on the renal function. Partial nephrectomy (PN) preserves kidney function better than radical nephrectomy (RN), lowering risk of chronic kidney disease (CKD). The aim was to evaluate whether renal function and other clinical variables were important for surgical treatment selection. METHODS Patients with RCC, surgically treated between 1994 and 2018 were included. There were 663 patients in all stages, 265 women and 398 men, mean age 66 years. CLINICAL DATA estimated glomerular filtration rate (eGFR), WHO performance status (WHO-PS), Charlson comorbidity index (CCI), surgery, T-stage, M-stage, RCC type, tumor size, age, and gender were extracted from the medical records. Statistical analysis included Mann-Whitney U, X2-test, and logistic regression analysis. RESULTS Of 663 patients, 455 were treated with RN and 208 with PN. In all patients, preoperative eGFR was significantly higher in PN (80.8) than in RN (77.1, p = 0.015). Using logistic regression tumor size (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.95-0.98, T-stage (OR: 0.46; 95% CI: 0.33-0.65), WHO-PS (OR: 0.39; 95% CI: 0.04-0.57), and CCI (OR: 1.23; 95% CI: 1.05-1.44), associated to treatment selection, while eGFR, M-stage, age, and gender did not. In cTa subgroup, eGFR was also higher in PN (84.6) than in RN (75.0, p = 0.007). Using logistic regression, tumor size (OR: 0.93; 95% CI: 0.83-0.98) and WHO-PS (OR: 0.36; 95% CI: 0.20-0.66) associated to treatment selection, while eGFR, CCI, age, and gender did not. CONCLUSION Tumor size, CCI scores, T-stage, and WHO-PS, all had an impact on the surgical strategy for all RCC patients. In patients with T1a RCC, tumor size and WHO-PS associated independently with treatment decision. After adjusted analysis, renal function lost its independent association with the treatment strategy in RCC patients.
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Affiliation(s)
- Britt-Inger Kröger Dahlin
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Jan Hlodan
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Ramin Ghaffarpour
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
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Xu H, Xing Z, Ai K, Wang J, Lv Z, Deng H, Li K, Wang Y, Li Y. Patients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity score. World J Surg Oncol 2024; 22:24. [PMID: 38254091 PMCID: PMC10804783 DOI: 10.1186/s12957-024-03302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Partial nephrectomy (PN) is usually recommended for T1 stage clear cell renal cell carcinoma (ccRCC) regardless of the nuclear grades. However, the question remains unresolved as to whether PN is non-inferior to RN in patients with T1-ccRCC at higher risk of recurrence. In fact, we found that patients with high nuclear grades treated with PN had poorer prognosis compared with those treated with radical nephrectomy (RN). Therefore, this study was designed to evaluate the associations of PN and RN in the four nuclear grade subsets with oncologic outcomes. METHODS A retrospective study was conducted in three Chinese urological centers that included 1,714 patients who underwent PN or RN for sporadic, unilateral, pT1, N0, and M0 ccRCC without positive surgical margins and neoadjuvant therapy between 2010 and 2019. Associations of nephrectomy type with local ipsilateral recurrence, distant metastases, and all-cause mortality (ACM) were evaluated using the Kaplan-Meier method and multivariable Cox proportional hazards regression models after overlap weighting (OW). RESULTS A total of 1675 patients entered the OW cohort. After OW, in comparison to PN, RN associated with a reduced risk of local ipsilateral recurrence in the G2 subset (HR = 0.148, 95% CI 0.046-0.474; p < 0.05), G3 subset (HR = 0.097, 95% CI 0.021-0.455; p < 0.05), and G4 subset (HR = 0.091, 95% CI 0.011-0.736; p < 0.05), and resulting in increased five-year local recurrence-free survival rates of 7.0%, 17.9%, and 36.2%, respectively. An association between RN and a reduced risk of distant metastases in the G4 subset (HR = 0.071, 95% CI 0.016-0.325; p < 0.05), with the five-year distant metastases-free survival rate increasing by 33.1% was also observed. No significant difference in ACM between PN and RN was identified. CONCLUSIONS Our findings substantiate that opting for RN, as opposed to PN, is more advantageous for local recurrence-free survival and distant metastases-free survival in patients with high nuclear grade (especially G4) pT1-ccRCC. We recommend placing a heightened emphasis on enhancing preoperative nuclear grade assessment, as it can significantly influence the choice of surgical plan. TRIAL REGISTRATION This study was registered at Chinese Clinical Trial Registry (ID: ChiCTR2200063333).
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Affiliation(s)
- Haozhe Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Zhuo Xing
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Kai Ai
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Jie Wang
- Department of Oncology, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Zhengtong Lv
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Haitao Deng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Ke Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yang Wang
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Yuan Li
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
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Fateri C, Peta A, Limfueco L, Bui TL, Kar N, Glavis-Bloom J, Roth B, Landman J, Houshyar R. Novel Retroperitoneal Neovascularity Scoring System in Renal Cell Carcinoma Tumor Staging. J Endourol 2023; 37:367-373. [PMID: 36367194 DOI: 10.1089/end.2022.0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Renal cell carcinoma (RCC) is the most common type of kidney cancer worldwide. Although radiologists assess enhancement patterns of renal tumors to predict tumor pathology report, to our knowledge, no formal scoring system has been created and validated to assess the level of neovascularity in RCC, despite its critical role in cancer metastases. In this study, we characterized and analyzed the level of angiogenesis in tumor-burdened kidneys and their benign counterparts. We then created and validated a scoring scale for neovascularity that can help predict tumor staging for RCC. Methods: After Institutional Review Board approval, the charts of patients who had undergone operation for RCC between January 13, 2014 and February 4, 2020 were retrospectively reviewed for inclusion in this study. Inclusion criteria were a diagnosis of RCC, simple/radical nephrectomy, preoperative contrast-enhanced CT scans, and complete pathology reports. Neovascularity was scored on a scale of 0-4 where 0 = no neovascularity detected, 1 = a single vessel <3 mm wide, 2 = a single vessel ≥3 mm wide, 3 = multiple vessels <3 mm wide, and 4 = multiple vessels ≥3 mm wide. Results: A total of 227 patients were included in this study. Most of the tumor pathology reports were clear cell carcinoma, regardless of tumor staging. The average neovascularity score was 1.07 for pT1x tumors, 2.83 for pT2x tumors, and 3.04 for pT3x tumors. There was a significant difference in neovascularity score between pT1x and pT2x tumors (p = 0.0046), pT1x and pT3x tumors (p < 0.0001), and benign kidneys and kidneys with RCC (p < 0.0001). Conclusion: Our novel vascular scoring system for RCC demonstrates significant correlation with RCC pathological tumor staging. This scoring system may be utilized as part of a comprehensive radiological assessment of renal tumors, potentially improving tumor characterization and clinical decision making.
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Affiliation(s)
- Cameron Fateri
- Department of Radiology and School of Medicine, University of California, Irvine, Orange, California, USA
| | - Akhil Peta
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California, USA
| | - Luke Limfueco
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California, USA
| | - Thanh-Lan Bui
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California, USA
| | - Nina Kar
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California, USA
| | - Justin Glavis-Bloom
- Department of Radiology and School of Medicine, University of California, Irvine, Orange, California, USA
| | - Bradley Roth
- Department of Radiology and School of Medicine, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Radiology and School of Medicine, University of California, Irvine, Orange, California, USA.,Department of Urology, School of Medicine, University of California, Irvine, Orange, California, USA
| | - Roozbeh Houshyar
- Department of Radiology and School of Medicine, University of California, Irvine, Orange, California, USA
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Kalfazade N, Özlü DN, Şam E, Akkaş F, Gürbüz N. Factors associated with pathological tumor stage and T3a upstage in clinical T1-2 renal cell carcinoma. Prog Urol 2023; 33:135-144. [PMID: 36604246 DOI: 10.1016/j.purol.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/16/2022] [Accepted: 12/10/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Considering the oncological outcomes, understanding the preoperative factors associated with and predicting advanced stage and T3a upstage will help in risk assessment and selection of the right treatment. MATERIAL AND METHOD Patients with postoperative pathology of Renal Cell Carcinoma (RCC) and stage T1-2 N0M0 were included in the study. Demographic and pathological characteristics of the patients, Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis- the ratio of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were recorded. Patients were classified according to T stage (T1-2 vs T3-4) and T3a upstage (T3a upstaged vs non-T3a upstaged). RESULTS A total of 289 patients participated in the study when inclusion and exclusion criteria were applied. No difference was found between the groups in terms of age, gender, body mass index, laterality, ABO blood group, Rh positivity and comorbidities. According to multivariate analysis, PLR, AST/ALT, Fuhrman grade, open radical nephrectomy (RN) and Clear Cell pathological subtype were found to be significant-independent factors in predicting advanced stage (T3-4) and T3a upstage (P<0.05). CONCLUSION It was found that higher PLR and AST/ALT ratios were associated with more advanced stage and postoperative T3a upstage in RCC patients. In addition, these patients more frequently had open RN and had higher Fuhrman grades, while the clear cell subtype was less common.
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Affiliation(s)
- N Kalfazade
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
| | - D N Özlü
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
| | - E Şam
- Department of Urology, University of Health Sciences Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - F Akkaş
- Department of Urology, University of Health Sciences Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - N Gürbüz
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
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Tanaka H, Fukuda S, Kimura K, Fukawa Y, Yamamoto K, Fukushima H, Moriyama S, Yasuda Y, Uehara S, Waseda Y, Yoshida S, Yokoyama M, Matsuoka Y, Saito K, Tateishi U, Campbell SC, Fujii Y. Defining Tumour Shape Irregularity for Preoperative Risk Stratification of Clinically Localised Renal Cell Carcinoma. EUR UROL SUPPL 2022; 48:36-43. [PMID: 36743398 PMCID: PMC9895768 DOI: 10.1016/j.euros.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/26/2022] Open
Abstract
Background Unexpected adverse pathology is a major concern in surgical management of clinically localised renal cell carcinoma (RCC). Further studies are needed to improve preoperative risk stratification. Objective To define and classify tumour shape irregularity (TSI) based on preoperative imaging, and to investigate its effect on pathological and oncological outcomes in clinically localised RCC. Design setting and participants We retrospectively analysed 474 patients with cT1-2N0M0 RCC managed by partial or radical nephrectomy. Preoperative dynamic computed tomography was used to define and classify TSI, graded as 1 (completely elliptical shape), 2 (elliptical shape with minor and focal protrusions), or 3 (nonelliptical shape presenting with major and/or extensive protrusions). Intervention Partial or radical nephrectomy. Outcome measurements and statistical analysis A logistic regression analysis evaluated the risk factors for pT3a upstaging and Fuhrman grade 3-4. A Cox proportional hazard analysis assessed preoperative variables for recurrence-free survival (RFS). Results and limitations The median tumour size was 3.5 cm, and 94 patients (20%) had (R)adius (tumour size as maximal diameter), (E)xophytic/endophytic properties of tumour, (N)earness of tumour deepest portion to collecting system or sinus, (A)nterior (a)/posterior (p) descriptor, and (L)ocation relative to polar lines (RENAL) score ≥10. TSI was graded as 1, 2, and 3 in 214 (45%), 151 (32%), and 109 (23%) patients, respectively. Higher TSI was significantly associated with a larger tumour size and a higher RENAL score. Overall, pT3a upstaging and Fuhrman grade 3-4 were observed in 45 (9.5%) and 116 patients (31% in 380 clear cell RCC cases), respectively. The incidence of pT3a upstaging and Fuhrman grade 3-4 was significantly higher in patients with higher TSI (0.5%, 8.6%, and 28% for pT3a upstaging and 12%, 33%, and 60% for Fuhrman grade 3-4 in TSI 1, 2, and 3 groups, respectively). In multivariable analyses, higher TSI was independently associated with adverse pathological outcomes. During the median follow-up of 6.0 yr, 49 patients (10%) developed recurrence. Multivariable analyses demonstrated that older age and higher TSI were independent risk factors for worse RFS. The limitations include the retrospective design. Conclusions TSI may be a useful adjunct in preoperative risk stratification for adverse pathology and recurrence after surgery in clinically localised RCC. Patient summary Tumour shape irregularity is significantly associated with unfavourable pathological outcomes, that is, locally advanced stage or high-grade cancer, and with a higher recurrence rate after surgery in patients with clinically localised renal cell carcinoma. Preoperative evaluation of the tumour shape may help in patient counselling and treatment decisions.
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Affiliation(s)
- Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan,Corresponding author. Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. Tel. +81-3-5803-5295; Fax: +81-3-5803-5295.
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichiro Kimura
- Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Fukawa
- Department of Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kouhei Yamamoto
- Department of Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Fukushima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shingo Moriyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yosuke Yasuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Steven C. Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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French AFU Cancer Committee Guidelines - Update 2022-2024: management of kidney cancer. Prog Urol 2022; 32:1195-1274. [DOI: 10.1016/j.purol.2022.07.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
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10
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Morrone A, Bentellis I, Bernhard JC, Bensalah K, Champy C, Bruyere F, Doumerc N, Olivier J, Audenet F, Parier B, Brenier M, Long JA, Nouhaud FX, Branger N, Lang H, Charles T, Xylinas E, Waeckel T, Gomez F, Boissier R, Rouget B, Shaikh A, Chevallier D, Ambrosetti D, Durand M. Positive surgical margin's impact on short-term oncological prognosis after robot-assisted partial nephrectomy (MARGINS study: UroCCR no 96). Sci Rep 2022; 12:18342. [PMID: 36316438 PMCID: PMC9622828 DOI: 10.1038/s41598-022-23146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
The oncological impact of positive surgical margins (PSM) after robot-assisted partial nephrectomy (RAPN) is still under debate. We compared PSM and Negative Surgical Margins (NSM) in terms of recurrence-free survival (RFS), metastasis-free survival (MFS) and overall survival (OS) after RAPN, and we identified predictive factors of PSM. Multi-institutional study using the UroCCR database, which prospectively included 2166 RAPN between April 2010 and February 2021 (CNIL DR 2013-206; NCT03293563). Two groups were retrospectively compared: PSM versus NSM. Prognostic factors were assessed using Kaplan-Meyer curves with log-Rank test, cox hazard proportional risk model and logistic regression after univariate comparison. 136 patients had PSM (6.3%) and 2030 (93.7%) had NSM. During a median follow-up of 19 (9-36) months after RAPN, 160 (7.4%) recurrences were reported. Kaplan-Meier curves and analysis suggested that RFS, MFS and OS were not affected by a PSM (p = 0.68; 0.71; 0.88, respectively). In multivariate analysis predictors of PSM were a lower RENAL score (p = 0.001), longer warm ischemia time (WIT) (p = 0.003) and Chromophobe Renal Cell Carcinoma (chrRCC) (p = 0.043). This study found no impact of PSM on RFS, MFS or OS, and predictors of PSM were the RENAL score, WIT and chrRCC.
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Affiliation(s)
- Arnoult Morrone
- grid.410528.a0000 0001 2322 4179Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, Nice University Hospital, Nice, France ,grid.410528.a0000 0001 2322 4179Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, Nice University Hospital, 30 voie Romaine, 06000 Nice, France
| | - Imad Bentellis
- grid.410528.a0000 0001 2322 4179Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, Nice University Hospital, Nice, France
| | - Jean-Christophe Bernhard
- grid.42399.350000 0004 0593 7118Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Karim Bensalah
- grid.411154.40000 0001 2175 0984Department of Urology, Rennes University Hospital, Rennes, France
| | - Cécile Champy
- grid.50550.350000 0001 2175 4109Department of Urology, Henri Mondor University Hospital, APHP, Paris, France
| | - Franck Bruyere
- grid.12366.300000 0001 2182 6141Department of Urology, Tours University and Regional Hospital, Tours, France
| | - Nicolas Doumerc
- grid.411175.70000 0001 1457 2980Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
| | - Jonathan Olivier
- grid.503422.20000 0001 2242 6780Department of Urology, Lille University and Regional Hospital, Lille, France
| | - François Audenet
- grid.508487.60000 0004 7885 7602Department of Urology, AP-HP Centre, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Bastien Parier
- grid.413784.d0000 0001 2181 7253Department of Urology, Hôpital Bicêtre, Université Paris Saclay, APHP, Le Kremlin-Bicêtre, France
| | - Martin Brenier
- Department of Urology, Paris Saint-Joseph Hospital Group, Paris, France
| | - Jean-Alexandre Long
- grid.410529.b0000 0001 0792 4829Department of Urology, Grenoble University Hospital, Grenoble, France
| | - François-Xavier Nouhaud
- grid.41724.340000 0001 2296 5231Department of Urology, Rouen University Hospital, Rouen, France
| | - Nicolas Branger
- grid.418443.e0000 0004 0598 4440Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - Hervé Lang
- grid.11843.3f0000 0001 2157 9291Department of Urology, Strasbourg University and Regional Hospital, Strasbourg, France
| | - Thomas Charles
- grid.411162.10000 0000 9336 4276Department of Urology, Poitiers University Hospital, Poitiers, France
| | - Evanguelos Xylinas
- grid.508487.60000 0004 7885 7602Department of Urology, Bichat-Claude Bernard Hospital, APHP, Paris Descartes University, Paris, France
| | - Thibaut Waeckel
- grid.411149.80000 0004 0472 0160Department of Urology, Caen University Hospital, Caen, France
| | - Florie Gomez
- grid.50550.350000 0001 2175 4109Department of Urology, Tenon Hospital, APHP, Paris, France
| | - Romain Boissier
- grid.414336.70000 0001 0407 1584Department of Urology and Renal transplantation, La Conception University Hospital, Aix-Marseille University, APHM, Marseille, France
| | | | - Aysha Shaikh
- grid.410528.a0000 0001 2322 4179Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, Nice University Hospital, Nice, France
| | - Daniel Chevallier
- grid.410528.a0000 0001 2322 4179Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, Nice University Hospital, Nice, France
| | - Damien Ambrosetti
- grid.410528.a0000 0001 2322 4179Central Laboratory of Pathology, Nice University Hospital, Nice, France ,grid.460782.f0000 0004 4910 6551INSERM U1081 - CNRS UMR 7284, Nice University Côte d’Azur, Nice, France
| | - Matthieu Durand
- grid.410528.a0000 0001 2322 4179Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, Nice University Hospital, Nice, France ,grid.460782.f0000 0004 4910 6551INSERM U1081 - CNRS UMR 7284, Nice University Côte d’Azur, Nice, France
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11
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Cao C, Kang X, Shang B, Shou J, Shi H, Jiang W, Xie R, Zhang J, Zhang L, Zheng S, Bi X, Li C, Ma J. A novel nomogram can predict pathological T3a upstaged from clinical T1a in localized renal cell carcinoma. Int Braz J Urol 2022; 48:784-794. [PMID: 35838503 PMCID: PMC9388175 DOI: 10.1590/s1677-5538.ibju.2021.0859] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/06/2022] [Indexed: 12/24/2022] Open
Abstract
HYPOTHESIS Nomogram can be built to predict the pathological T3a upstaging from clinical T1a in patients with localized renal cell carcinoma before surgery. PURPOSE Renal cell carcinoma (RCC) patients with clinical T1a (cT1a) disease who are upstaged to pathological T3a (pT3a) have reduced survivals after partial nephrectomy. We aimed to develop a nomogram-based model predicting pT3a upstaging in RCC patients with preoperative cT1a based on multiple preoperative blood indexes and oncological characteristics. MATERIALS AND METHODS Between 2010 and 2019, 510 patients with cT1a RCC were individually matched according to pT3a upstaging and pathological T1a (pT1a) at a 1:4 ratio using clinicopathologic features. Least absolute shrinkage and selection operator regression analysis was used to identify the most important risk factor from 40 peripheral blood indicators, and a predictive model was established. Multivariate logistic regression analysis was performed with the screened blood parameters and clinical data to identify significant variables. Harrell's concordance index (C-index) was applied to evaluate the accuracy of the model for predicting pT3a upstaging in patients with cT1a RCC. RESULTS Out of 40 blood indexes, the top ranked predictor was fibrinogen (FIB). Age, the ratio of the tumor maximum and minimum diameter (ROD), FIB, and tumor size were all independent risk factors for pT3a upstaging in multivariate analysis. A predictive ARFS model (Age, ROD, FIB, tumor Size) was established, and the C-index was 0.756 (95% CI, 0.681-0.831) and 0.712 (95% CI, 0.638-0.785) in the training and validation cohorts, respectively. CONCLUSIONS Older age, higher ROD, increased FIB level, and larger tumor size were independent risk factors for upstaging. The ARFS model has a high prediction efficiency for pT3a upstaging in patients with cT1a RCC.
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Affiliation(s)
- Chuanzhen Cao
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeCancer HospitalNational Clinical Research Center for CancerBeijingChinaDepartment of Urology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;
| | - Xiangpeng Kang
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeCancer HospitalNational Clinical Research Center for CancerBeijingChinaDepartment of Urology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;
| | - Bingqing Shang
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeCancer HospitalNational Clinical Research Center for CancerBeijingChinaDepartment of Urology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;
| | - Jianzhong Shou
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeCancer HospitalNational Clinical Research Center for CancerBeijingChinaDepartment of Urology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;
| | - Hongzhe Shi
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeCancer HospitalNational Clinical Research Center for CancerBeijingChinaDepartment of Urology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;
| | - Weixing Jiang
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeCancer HospitalNational Clinical Research Center for CancerBeijingChinaDepartment of Urology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;
| | - Ruiyang Xie
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeCancer HospitalNational Clinical Research Center for CancerBeijingChinaDepartment of Urology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;
| | - Jin Zhang
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeCancer HospitalNational Clinical Research Center for CancerBeijingChinaDepartment of Imaging, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China;
| | - Lianyu Zhang
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeCancer HospitalNational Clinical Research Center for CancerBeijingChinaDepartment of Imaging, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China;
| | - Shan Zheng
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeCancer HospitalNational Clinical Research Center for CancerBeijingChinaDepartment of Pathology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
| | - Xingang Bi
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeCancer HospitalNational Clinical Research Center for CancerBeijingChinaDepartment of Urology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;
| | - Changling Li
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeCancer HospitalNational Clinical Research Center for CancerBeijingChinaDepartment of Urology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;
| | - Jianhui Ma
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeCancer HospitalNational Clinical Research Center for CancerBeijingChinaDepartment of Urology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;
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12
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Shimada W, Kimura K, Tanaka H, Fukuda S, Yoshida S, Fujii Y. Significance of tumor shape irregularity: Radiomics analysis based on dynamic computed tomography for predicting pT3a upstaging in cT1b‐2N0M0 renal cell carcinoma. Int J Urol 2022. [DOI: 10.1111/iju.14982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Wataru Shimada
- Department of Urology Tokyo Medical and Dental University Tokyo Japan
| | - Koichiro Kimura
- Department of Diagnostic Radiology Tokyo Medical and Dental University Tokyo Japan
| | - Hajime Tanaka
- Department of Urology Tokyo Medical and Dental University Tokyo Japan
| | - Shohei Fukuda
- Department of Urology Tokyo Medical and Dental University Tokyo Japan
| | - Soichiro Yoshida
- Department of Urology Tokyo Medical and Dental University Tokyo Japan
| | - Yasuhisa Fujii
- Department of Urology Tokyo Medical and Dental University Tokyo Japan
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13
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Xu P, Zhang S, Cao B, Li Y, Huang J, Lin W, Cheng J, Li H, Chen W, Zhu Y, Jiang S, Hu X, Wu J, Wu Z, Zhou J, Guo J, Wang H. Predictive value of renal tumor contour irregularity score in pathological T3a upstaging of clinical T1 renal cell carcinoma: A multi-institutional study. Urol Oncol 2022; 40:199.e1-199.e8. [PMID: 35365414 DOI: 10.1016/j.urolonc.2022.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To explore the predictive value of renal tumor contour irregular degree (CID) in pathological T3a upstaging of clinical T1 renal cell carcinoma (RCC). MATERIALS AND METHODS We performed a retrospective multi-institutional review of 1,487 patients with clinical T1N0M0 RCC between January 2009 and June 2019. Kaplan-Meier survival curve and Cox regressions were used to analyze the prognostic factors of disease-free survival (DFS). Logistic regressions were performed to determine predictors of pathological T3a upstaging in clinical T1 RCC. RESULTS Among 1,487 patients with cT1 RCC, 96 (6.5%) were pathological T3a upstaging. Multivariable logistic regression analysis showed that age (odds ratio [OR] = 1.022, 95% confidence interval [CI] = 1.001-1.042, P = 0.036), tumor maximum diameter(OR = 1.242, 95% CI = 1.042--1.480, P = 0.015) and CID (OR = 1.067, 95% CI = 1.051-1.083, P < 0.001) were independent predictors of pathological T3a upstaging. The area under the curve (AUC) of the prediction model that included the CID was 0.846, while the AUC of the prediction model that did not include CID was only 0.741, the difference was statistically significant (P < 0.001). Kaplan-Meier survival curve showed that patients with pathological T3a upstaging had significantly worse DFS than patients without pathological T3a upstaging (P < 0.001). Multivariable Cox analysis showed that pathological T3a upstaging (HR = 1.836, 95% CI = 1.013-3.329, P = 0.002) is an independent prognostic factor for DFS in patients with cT1N0M0 RCC. CONCLUSIONS The predictive model of CID combined with tumor maximum diameter and age significantly improved the ability to predict pathological T3a upstaging in clinical T1 RCC, compared with the prediction model of tumor maximum diameter combined with age. The predictive model of CID combined with tumor maximum diameter and age may be applicable to patients considering partial vs. radical nephrectomy.
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Affiliation(s)
- Peirong Xu
- Department of Urology, Xuhui Hospital, Fudan University, Shanghai, China; Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sihong Zhang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bohong Cao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yaohui Li
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiaqi Huang
- Department of Urology, Minhang Hospital, Fudan University, Shanghai, China
| | - Wenyao Lin
- Department of Urology, Xuhui Hospital, Fudan University, Shanghai, China
| | - Jie Cheng
- Department of Urology, Xuhui Hospital, Fudan University, Shanghai, China
| | - Huifeng Li
- Department of Urology, Qingpu Hospital, Fudan University, Shanghai, China
| | - Weijie Chen
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanjun Zhu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuai Jiang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyi Hu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiawen Wu
- Department of Urology, Minhang Hospital, Fudan University, Shanghai, China
| | - Zhenqi Wu
- Department of Urology, Qingpu Hospital, Fudan University, Shanghai, China
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianming Guo
- Department of Urology, Xuhui Hospital, Fudan University, Shanghai, China; Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Urology, Qingpu Hospital, Fudan University, Shanghai, China.
| | - Hang Wang
- Department of Urology, Xuhui Hospital, Fudan University, Shanghai, China; Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Urology, Minhang Hospital, Fudan University, Shanghai, China.
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14
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Tian J, Zeng X, Wan J, Gan J, Ke C, Guan W, Hu Z, Yang C. Partial and Radical Nephrectomy Provides Equivalent Oncologic Outcomes in pT3a Renal Cell Carcinoma: A Population-Based Study. Front Oncol 2022; 11:819098. [PMID: 35155208 PMCID: PMC8826755 DOI: 10.3389/fonc.2021.819098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To compare the cause-specific survival (CSS) and overall survival (OS) of patients with localized T3a renal cell carcinoma (RCC) after partial nephrectomy (PN) or radical nephrectomy (RN). Methods We obtained the demographic and clinicopathological data of 7,127 patients with localized T3a RCC and who underwent PN or RN from the Surveillance, Epidemiology, and End Results (SEER) database. These patients were divided into fat invasion cohort and venous invasion cohort for subsequent analysis. Kaplan–Meier analysis (KMA) and univariate and multivariate Cox proportional hazards regression analyses were used to evaluate the effects of PN or RN on OS and CSS. Meanwhile, 65 cases with clinical T1 (cT1) RCC upstaged to pathological T3a (pT3a) who were treated in Tongji Hospital (TJH) from 2011 to 2020 and underwent PN or RN were identified. Results In the study cohort, 2,085 (29.3%) patients died during the 1–172 months’ follow-up, of whom 1,155 (16.2%) died of RCC. In the two cohorts of fat invasion and venous invasion, KMA indicated that the PN group had favorable survival (p < 0.001). However, after propensity score matching (PSM), univariate and multivariate Cox regression analyses showed that the PN and RN groups had comparable CSS in the fat invasion cohort (p = 0.075) and the venous invasion cohort (p = 0.190). During 1–104 months of follow-up, 9 cases in the Tongji cohort had disease recurrence. There was no significant difference in recurrence-free survival between the RN group and the PN group (p = 0.170). Conclusions Our analysis showed that after balancing these factors, patients with localized pT3a RCC receiving PN or RN can achieve comparable oncologic outcomes. PN is safe for selected T3a patients.
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Affiliation(s)
- Jihua Tian
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Xing Zeng
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Jie Wan
- Department of Pathology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiahua Gan
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Chunjin Ke
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Wei Guan
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Chunguang Yang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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15
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Li X, Liu B, Cui P, Zhao X, Liu Z, Qi Y, Zhang G. Integrative Analysis of Peripheral Blood Indices for the Renal Sinus Invasion Prediction of T1 Renal Cell Carcinoma: An Ensemble Study Using Machine Learning-Assisted Decision-Support Models. Cancer Manag Res 2022; 14:577-588. [PMID: 35210855 PMCID: PMC8857979 DOI: 10.2147/cmar.s348694] [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: 11/10/2021] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Renal sinus invasion is an attributive factor affecting the prognosis of renal cell carcinoma (RCC). This study aimed to construct a risk prediction model that could stratify patients with RCC and predict renal sinus invasion with the help of a machine learning (ML) algorithm. Patients and Methods We retrospectively recruited 1229 patients diagnosed with T1 stage RCC at the Baotou Cancer Hospital between November 2013 and August 2021. Iterative analysis was used to screen out predictors related to renal sinus invasion, after which ML-based models were developed to predict renal sinus invasion in patients with T1 stage RCC. The receiver operating characteristic curve (ROC), decision curve analysis (DCA), and clinical impact curve (CIC) were performed to evaluate the robustness and clinical practicability of each model. Results A total of 21 candidate variables were shortlisted for model building. Iterative analysis screened that neutrophil to albumin ratio (NAR), hemoglobin level * albumin level * lymphocyte count/platelet count ratio (HALP), prognostic nutrition index (PNI), body mass index*serum albumin/neutrophil-lymphocyte ratio (AKI), NAR, and fibrinogen (FIB) concentration (NARFIB), platelet to lymphocyte ratio (PLR), and R.E.N.A.L score was related to renal sinus invasion and contributed significantly to ML-based algorithm. The areas under the ROC curve (AUCs) of the random forest classifier (RFC) model, support vector machine (SVM), eXtreme gradient boosting (XGBoost), artificial neural network (ANN), and decision tree (DT) ranged from 0.797 to 0.924. The optimal risk probability of renal sinus invasion predicted was RFC (AUC = 0.924, 95% confidence interval [CI]: 0.414–1.434), which showed robust discrimination for identifying high-risk patients. Conclusion We successfully develop practical models for renal sinus invasion prediction, particularly the RFC, which could contribute to early detection via integrating systemic inflammatory factors and nutritional parameters.
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Affiliation(s)
- Xin Li
- Department of Thoracic Oncology, Baotou Cancer Hospital, Baotou, Inner Mongolia, People’s Republic of China
| | - Bo Liu
- Department of Thoracic Oncology, Baotou Cancer Hospital, Baotou, Inner Mongolia, People’s Republic of China
| | - Peng Cui
- Department of Thoracic Oncology, Baotou Cancer Hospital, Baotou, Inner Mongolia, People’s Republic of China
| | - Xingxing Zhao
- Department of Thoracic Oncology, Baotou Cancer Hospital, Baotou, Inner Mongolia, People’s Republic of China
| | - Zhao Liu
- Department of Thoracic Oncology, Baotou Cancer Hospital, Baotou, Inner Mongolia, People’s Republic of China
| | - Yanxiang Qi
- Department of Thoracic Oncology, Baotou Cancer Hospital, Baotou, Inner Mongolia, People’s Republic of China
| | - Gangling Zhang
- Department of Thoracic Oncology, Baotou Cancer Hospital, Baotou, Inner Mongolia, People’s Republic of China
- Correspondence: Gangling Zhang, Department of Thoracic Oncology, Baotou Cancer Hospital, Baotou, Inner Mongolia, 014030, People’s Republic of China, Tel +86-138-4827-8198, Email
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16
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Liu S, Feng C, Liu C, Wang Z. Comparison of prognosis between patients undergoing radical nephrectomy versus partial nephrectomy for renal cell carcinoma ≤7 cm T3aN0/xM0: Survival benefit is biased toward partial nephrectomy. Cancer Med 2021; 10:8909-8923. [PMID: 34779154 PMCID: PMC8683550 DOI: 10.1002/cam4.4412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND There is limited and controversial evidence on the prognosis of partial nephrectomy (PN) versus radical nephrectomy (RN) in patients with T3aN0/xM0 renal cell carcinoma (RCC) upstaged from clinical T1 RCC. In this study, we aimed to assess the prognosis difference following PN versus RN in patients with ≤7 cm T3aN0/xM0 RCC. METHODS From the Surveillance, Epidemiology, and End Results database, a total of 3196 patients receiving treatment of PN/RN for ≤7 cm T3aN0/xM0 RCC with only extrarenal fat extension in 2010-2017 were identified. An inverse probability of treatment weighting (IPTW)-adjusted cause-specific Cox model with hazard ratio (HR) and 95% confidence interval (CI) was used for overall survival (OS) and cancer-specific survival (CSS) analyses. Sensitivity analysis was based on the propensity score matching of PN and RN groups and from the dataset of 2010-2013. RESULTS A total of 872 patients underwent PN, compared with 2324 undergoing RN. After IPTW adjustment, there was no significant difference in preoperative baseline characteristics between the PN and RN cohorts. Patients who underwent RN had worse OS (HRIPTW-adjusted , 1.46; 95% CI, 1.16-1.84; p = 0.001) and comparable CSS (HRIPTW-adjusted , 1.03; 95% CI, 0.64-1.66; p = 0.890) than those receiving PN in all cohorts and subgroups with T3a RCC of ≤4 cm and perinephric fat extension. Further, in patients with 4-7 cm T3a RCC with perinephric-fat invasion and all sizes of T3a RCC with sinus/perisinus fat extension, PN led to comparable OS and CSS. Sensitivity analyses validated these results. CONCLUSION PN provides comparable CSS and OS or even better OS than RN for patients with RCC ≤7 cm T3aN0/xM0. Although our study has some limitations, our results indicated that PN might oncologically safe for clinical T1 RCC, even confirmed a pathologically T3a upstaging post-PN.
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Affiliation(s)
- Shiliang Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunxiang Feng
- Department of Pathogenic Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang Liu
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhixian Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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17
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[Risk factors of renal sinus invasion in clinical T1 renal cell carcinoma patients undergoing nephrectomy]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53. [PMID: 34393224 PMCID: PMC8365066 DOI: 10.19723/j.issn.1671-167x.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To summarize the clinicoradiological characteristics of clinical T1 renal cell carcinoma patients and to investigate the risk factors of renal sinus invasion in cT1 renal cell carcinoma patients undergoing nephrectomy. METHODS A retrospective study was conducted in cT1 renal cell carcinoma patients from January 2016 to August 2019 in Department of Urology, Peking University Third Hospital, who underwent partial or radical nephrectomy by analyzing clinicopathological and radiological data. The influencing factors of renal sinus invasion for cT1 renal cell carcinoma were determined by χ2 test, Mann-Whitney U test and Logistic regression analysis. RESULTS A total of 507 patients were enrolled, including 354 males (69.8%) and 153 females (30.2%). The median age was 59 years and the median body mass index (BMI) was 25.5 kg/m2. Eighteen patients (3.6%) had gross hematuria preoperatively. The median tumor diameter was 3.5 cm. Three hundred twenty-two patients (63.5%) were staged clinical T1a and 165 cases (36.5%) were staged clinical T1b. The median R.E.N.A.L. score was 8. Three hundred fifty-nine patients (70.8%) had regular tumor border and 148 (29.2%) irregular. All the patients underwent surgical treatment, including 186 (36.7%) partial nephrectomy and 321 (63.3%) radical nephrectomy. Postoperative pathology showed seventy-five patients (14.8%) had renal sinus invasion, including 18 in cT1a (5.6%) and 57 in cT1b (30.8%). Univariate analysis showed that age (P=0.020), R.E.N.A.L. score (R value, E value, N value, P < 0.001) and tumor border (P < 0.001) were associated risk factors for cT1 renal cell carcinoma with renal sinus invasion. On multivariate binary Logistic analysis, R.E.N.A.L. score (P≤0.020) and irregular tumor border (P=0.001) were independent risk factors. CONCLUSION For cT1 renal cell carcinoma patients undergoing nephrectomy, about 15% had renal sinus invasion postoperatively. High R.E.N.A.L. score and irre-gular tumor border help predicting cT1 renal cell carcinoma renal sinus invasion.
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18
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Kishida T. Editorial Comment to Predictors of postoperative recurrence in patients with non-metastatic pT3a renal cell carcinoma. Int J Urol 2021; 28:1067. [PMID: 34390054 DOI: 10.1111/iju.14670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Takeshi Kishida
- Department of Urology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
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19
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Abreu D, Carvalhal G, Gueglio G, Tobia I, Garcia P, Zuñiga A, Meza L, Bengió R, Scorticati C, Castillejos R, Rodriguez F, Autran AM, Gonzales C, Gadu J, Nolazco A, Ameri C, Zampolli H, Langenhin R, Muguruza D, Machado MT, Mingote P, Yandian J, Clavijo J, Nogueira L, Clark O, Secin F, Rovegno A, Vilas A, Barrios E, Decia R, Guimarães G, Glina S, Pal SK, Rodriguez O, Palou J, Spiess P, Lara PN, Linehan WM, Pastore AL, Zequi SC. Prognostic Factors in De Novo Metastatic Renal Cell Carcinoma: A Report From the Latin American Renal Cancer Group. JCO Glob Oncol 2021; 7:671-685. [PMID: 33974442 PMCID: PMC8162501 DOI: 10.1200/go.20.00621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the effect of clinical and pathological variables on cancer-specific and overall survival (OS) in de novo metastatic patients from a collaborative of primarily Latin American countries. PATIENTS AND METHODS Of 4,060 patients with renal cell carcinoma diagnosed between 1990 and 2015, a total of 530 (14.5%) had metastasis at clinical presentation. Relationships between clinical and pathological parameters and treatment-related outcomes were analyzed by Cox regression and the log-rank method. RESULTS Of 530 patients, 184 (90.6%) had died of renal cell carcinoma. The median OS of the entire cohort was 24 months. American Society of Anesthesiology classification 3-4 (hazard ratio [HR]: 1.64), perirenal fat invasion (HR: 2.02), and ≥ 2 metastatic organ sites (HR: 2.19) were independent prognostic factors for 5-year OS in multivariable analyses. We created a risk group stratification with these variables: no adverse risk factors (favorable group), median OS not reached; one adverse factor (intermediate group), median OS 33 months (HR: 2.04); and two or three adverse factors (poor risk group), median OS 14 months (HR: 3.58). CONCLUSION Our study defines novel prognostic factors that are relevant to a Latin American cohort. With external validation, these easily discerned clinical variables can be used to offer prognostic information across low- and middle-income countries.
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Affiliation(s)
- Diego Abreu
- Servicio de Urología, Hospital Pasteur, Montevideo, Uruguay
| | | | | | | | | | | | - Luis Meza
- Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | | | | | - Ricardo Castillejos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCNSZ), Ciudad de México, Mexico
| | - Francisco Rodriguez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCNSZ), Ciudad de México, Mexico
| | | | | | - Jose Gadu
- Hospital Militar, Ciudad de México, Mexico
| | | | | | | | - Raúl Langenhin
- Coperativa Médica de Paysandú (COMEPA), Paysandú, Uruguay
| | - Diego Muguruza
- Coperativa Médica de Paysandú (COMEPA), Paysandú, Uruguay
| | | | | | | | | | | | | | - Fernando Secin
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Agustín Rovegno
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Ana Vilas
- Departamento de Patología, Hospital Pasteur, Montevideo, Uruguay
| | - Enrique Barrios
- Departamento de Métodos Cuantitativos, Facultad de Medicina, Montevideo, Uruguay
| | - Ricardo Decia
- Servicio de Urología, Hospital Pasteur, Montevideo, Uruguay
| | | | | | | | | | | | | | - Primo N Lara
- The University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | | | - Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
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Guo P, Wang Y, Han Y, Wei D, Zhao J, Li M, Jiang Y, Luo Y. Oncological Outcomes of Patients With Different Pathological Features of pT3a Renal Tumor: A Systematic Review and Quantitative Synthesis. Front Oncol 2021; 11:678459. [PMID: 34150642 PMCID: PMC8209473 DOI: 10.3389/fonc.2021.678459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To identify the differences in oncological outcomes for patients with different pT3a renal tumor invasion patterns and pathological features. Methods The protocol of this study was registered on PROSPERO (CRD42021234475). Relevant studies were identified by searching the PubMed, Cochrane library, Embase, and Web of Science databases. Cancer-specific survival (CSS) was selected as the endpoint. Pooled hazard ratio (HR) and 95% confidence interval (CI) extracted from multivariate Cox models were evaluated to identify the hazard association. Results A total of 22 studies, which enrolled 12384 patients were included for quantitative synthesis. Sinus fat invasion (SFI) + perinephric fat invasion (PFI) was associated with inferior CSS compared to SFI only (p = 0.02). Comparable CSS was observed between SFI and PFI (p = 0.57). SFI ± PFI showed inferior CSS compared to PFI only (p = 0.0002). The presence of pelvicalyceal system invasion significantly increased the risk of cancer-specific mortality (p = 0.0005). Renal vein invasion (RVI) indicated poor oncological outcomes in terms of CSS (p = 0.002). The concomitant RVI and fat invasion (FI) significantly increased the risk of deterioration of CSS compared to RVI or FI (p < 0.0001). Multiple invasion patterns translated into a significantly decreased CSS (p < 0.0001). Aggressive tumor behavior, including lymph node involvement (p = 0.006), distant metastases (p < 0.00001), sarcomatoid differentiation (p < 0.0001), necrosis (p < 0.0001), Fuhrman grade III or IV (p < 0.0001), positive margin (p < 0.0001), and tumor size >7cm (p < 0.0001) were the predictors of inferior CSS. The lymphovascular invasion (p = 0.67) was indolent in terms of CSS. Conclusion This study confirmed the heterogenicity of pT3a renal tumors. Multiple invasion patterns could translate into a significantly decreased CSS, and SFI should not be merged in the SFI + PFI group. The presence of PSI or RVI could significantly increase the risk of cancer-specific mortality. Lymph node involvement, distant metastases, sarcomatoid differentiation, necrosis, high Fuhrman grade, positive margin, and size >7cm were the predictors of inferior CSS. A precise-risk grade of CSS for different invasion patterns including comprehensive combinations may be useful for the further refinements of the TNM system. Systematic Review Registration The current study was registered on PROSPERO, and the registration numbers is CRD42021234475.
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Affiliation(s)
- Pengju Guo
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongxing Wang
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yili Han
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dechao Wei
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiahui Zhao
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mingchuan Li
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongguang Jiang
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yong Luo
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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21
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Liu H, Wang Z, Peng E, Chen Z, Tang K, Xia D. Added Value of Systemic Inflammation Markers in Predicting Clinical Stage T1 Renal Cell Carcinoma Pathologically Upstaged to T3a. Front Oncol 2021; 11:679536. [PMID: 34136403 PMCID: PMC8202414 DOI: 10.3389/fonc.2021.679536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/03/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives We aimed to determine preoperative risk factors associated with pathologic T3a (pT3a) upstaging of clinical T1 (cT1) renal cell carcinomas (RCCs) and develop a novel model capable of accurately identifying those patients at high risk of harboring occult pT3a characteristics. Methods A retrospective analysis of 1324 cT1 RCC patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) was performed. The study cohort was divided into training and testing datasets in a 70:30 ratio for further analysis. Univariable and multivariable logistic regression analyses were performed to identify predictors associated with cT1 to pT3a upstaging and subsequently, those significant risk factors were used to construct models. We used the area under the curve (AUC) to determine the model with the highest discrimination power. Decision curve analyses (DCAs) were applied to evaluate clinical net benefit associated with using the predictive models. Results The rates of upstaging were 6.1% (n = 81), 5.8% (n = 54) and 6.8% (n = 27) in the total population, training cohort and validation cohort, respectively. Tumor size, clinical T stage, R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior) nephrometry score, lymphocyte to monocyte ratio (LMR), prognostic nutrition index (PNI) and albumin to globulin ratio (AGR) were significantly associated with pT3a upstaging. The model that consisted of R.E.N.A.L. score, LMR, AGR and PNI achieved the highest AUC of 0.70 in the validation cohort and yielded the highest net benefit. In the subpopulation with complete serum lipid profile, the inclusion of low-density lipoprotein cholesterol (LDL-C) and Castelli risk index-I (CRI-I) significantly improved the discrimination of model (AUC = 0.86). Conclusions Our finding highlights the importance of systemic inflammation response markers and serum lipid parameters in predicting pT3a upstaging. Our model had relatively good discrimination in predicting occult pT3a disease among patients with cT1 renal lesions, and the use of the model may be greatly beneficial to urologists in risk stratification and management decisions.
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Affiliation(s)
- Hailang Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhixian Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ejun Peng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ding Xia
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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22
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Deng H, Fan Y, Yuan F, Wang L, Hong Z, Zhan J, Zhang W. Partial nephrectomy provides equivalent oncologic outcomes and better renal function preservation than radical nephrectomy for pathological T3a renal cell carcinoma: A meta-analysis. Int Braz J Urol 2021; 47:46-60. [PMID: 32271510 PMCID: PMC7712695 DOI: 10.1590/s1677-5538.ibju.2020.0167] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose: Radical nephrectomy (RN) is the standard surgical type for pathological stage T3a (pT3a) renal cell carcinoma (RCC). Recently, some studies have suggested equivalence between partial nephrectomy (PN) and RN for oncologic control and have shown the benefits of PN for better renal function. We conducted this meta-analysis to assess oncologic outcomes, perioperative outcomes and renal function between two groups among patients with pT3a RCC. Materials and methods: PubMed, Scopus, Web of Science, Science Direct, Ovid MEDLINE, The Cochrane Library, Embase and Google Scholar were searched for eligible articles. The endpoints of the final analysis included overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), surgical complications, operative time, estimated blood loss (EBL), serum creatinine and estimated glomerular filtration rate (eGFR). Results: Twelve studies of moderate to high quality, including 14.152 patients, were examined. PN showed superiority for renal functional preservation, providing higher eGFR (WMD=12.48mL/min; 95%CI: 10.28 to 14.67; P <0.00001) and lower serum creatinine (WMD=-0.31mg/dL; 95%CI: −0.40 to −0.21; P <0.00001). There were no significant differences between PN and RN regarding operative time, EBL, surgical complications, OS, RFS and CSS. Despite inherent selection bias, most pooled estimates were consistent in sensitivity analysis and subgroup analysis. More positive margins were found in the PN group (RR=2.42; 95%CI: 1.25-4.68; P=0.009). Conclusions: PN may be more suitable for treating pT3a RCC than RN because it provides a similar survival time (OS or RFS) and superior renal function. Nevertheless, this result is still disputed, and more high-quality studies are required.
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Affiliation(s)
- Huan Deng
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yan Fan
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Feifei Yuan
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Li Wang
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Zhengdong Hong
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jinfeng Zhan
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Hussain MA, Hamarneh G, Garbi R. Learnable image histograms-based deep radiomics for renal cell carcinoma grading and staging. Comput Med Imaging Graph 2021; 90:101924. [PMID: 33895621 DOI: 10.1016/j.compmedimag.2021.101924] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/07/2021] [Accepted: 04/05/2021] [Indexed: 12/11/2022]
Abstract
Fuhrman cancer grading and tumor-node-metastasis (TNM) cancer staging systems are typically used by clinicians in the treatment planning of renal cell carcinoma (RCC), a common cancer in men and women worldwide. Pathologists typically use percutaneous renal biopsy for RCC grading, while staging is performed by volumetric medical image analysis before renal surgery. Recent studies suggest that clinicians can effectively perform these classification tasks non-invasively by analyzing image texture features of RCC from computed tomography (CT) data. However, image feature identification for RCC grading and staging often relies on laborious manual processes, which is error prone and time-intensive. To address this challenge, this paper proposes a learnable image histogram in the deep neural network framework that can learn task-specific image histograms with variable bin centers and widths. The proposed approach enables learning statistical context features from raw medical data, which cannot be performed by a conventional convolutional neural network (CNN). The linear basis function of our learnable image histogram is piece-wise differentiable, enabling back-propagating errors to update the variable bin centers and widths during training. This novel approach can segregate the CT textures of an RCC in different intensity spectra, which enables efficient Fuhrman low (I/II) and high (III/IV) grading as well as RCC low (I/II) and high (III/IV) staging. The proposed method is validated on a clinical CT dataset of 159 patients from The Cancer Imaging Archive (TCIA) database, and it demonstrates 80% and 83% accuracy in RCC grading and staging, respectively.
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Affiliation(s)
| | - Ghassan Hamarneh
- Medical Image Analysis Lab, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
| | - Rafeef Garbi
- BiSICL, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
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24
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Palacios DA, Zabor EC, Munoz-Lopez C, Roversi G, Mahmood F, Abramczyk E, Kelly M, Wilson B, Abouassaly R, Campbell SC. Does Reduced Renal Function Predispose to Cancer-specific Mortality from Renal Cell Carcinoma? Eur Urol 2021; 79:774-780. [PMID: 33678521 DOI: 10.1016/j.eururo.2021.02.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/18/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent publications have reported an association between increased renal cancer-specific mortality (CSM) and reduced renal function "below safety limits," and advocated for partial nephrectomy (PN) even for potentially aggressive/complex tumors. We hypothesize that this association may be related to confounding factors rather than a consequence of functional differences. OBJECTIVE To assess whether there is an independent association between preoperative estimated glomerular filtration rate (eGFR) or new baseline eGFR (NB-GFR) and CSM in patients undergoing PN or radical nephrectomy (RN). DESIGN, SETTING, AND PARTICIPANTS A single-center retrospective review was performed. All clinically and pathologically confirmed T1-T3a/N0/M0 renal cancer patients undergoing PN/RN (1999-2008, n = 1605) with adequate functional/oncological data were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was CSM. Secondary endpoints were cancer recurrence (CR) and all-cause mortality (ACM). Cox regression analyses investigated endpoints and predictive factors. RESULTS AND LIMITATIONS The median age was 60 yr and 64% of patients were male. Comorbidities included hypertension (60%), cardiovascular disease (19%), diabetes (21%), and chronic kidney disease (22%). PN was performed in 954 patients (59%). The median preoperative eGFR and NB-GFR were 80 and 60 ml/min/1.73 m2, respectively. Median tumor diameter was 3.6 cm (interquartile range [IQR] = 2.4, 5.5); 70% of tumors were clear cell and 40% were of high grade. Pathology revealed pT1-2/N0/M0 and pT3a/N0/M0 in 81% and 19%, respectively. The median follow-up among survivors was 11.5 yr (IQR = 4, 14). Cancer-specific survival, recurrence-free survival, and overall survival were 94%, 88%, and 73% at 10 yr, respectively. On multivariable analysis, increased age (hazard ratio [HR] = 1.03, p = 0.04), increased tumor size (HR = 1.24, p < 0.01), tumor grade 3/4 (HR = 3.17, p < 0.01), and clear-cell histology (HR = 2.92, p < 0.01) were associated with increased hazard of CSM. Neither preoperative eGFR nor NB-GFR was significantly associated with CSM or CR (all p > 0.1), while an increased preoperative eGFR was associated with reduced hazard of ACM (HR = 0.87, p < 0.01). Limitations include retrospective design and a potential selection bias. CONCLUSIONS Our data do not support oncological protection of greater preservation of renal function and confirm that unfavorable oncological outcomes for localized RCC are mostly associated with aggressive tumor characteristics. PATIENT SUMMARY We did not find an association between greater preservation of renal function and oncological outcomes for kidney cancer.
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Affiliation(s)
- Diego Aguilar Palacios
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Emily C Zabor
- Department of Quantitative Health Sciences & Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Gustavo Roversi
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Furman Mahmood
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Emily Abramczyk
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Maureen Kelly
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Brigid Wilson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Louis Stokes Veteran's Affairs Medical Center, Cleveland, OH, USA
| | - Robert Abouassaly
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Louis Stokes Veteran's Affairs Medical Center, Cleveland, OH, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
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25
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Chung DY, Kang DH, Kim JW, Kim DK, Lee JY, Cho KS. Comparison of oncologic outcomes between partial nephrectomy and radical nephrectomy in patients who were upstaged from cT1 renal tumor to pT3a renal cell carcinoma: an updated systematic review and meta-analysis. Ther Adv Urol 2020; 12:1756287220981508. [PMID: 33488775 PMCID: PMC7768328 DOI: 10.1177/1756287220981508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/26/2020] [Indexed: 12/18/2022] Open
Abstract
Aim Owing to the limited ability of current imaging modalities, several clinical T1 renal cell carcinomas (cT1 RCCa) can be pathologically upstaged to T3a (pT3a) after surgery. There have been some controversies regarding the oncological safety of partial nephrectomy (PNx) compared with radical nephrectomy (RNx) in these patients. We compared oncological outcomes of PNx and RNx in patients with upstaged pT3a RCCa. Methods A systematic review was performed following the PRISMA guideline. PubMed, MEDLINE, Embase were searched. Oncological outcomes [recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS)] between PNx and RNx were compared. The GRADE approach was used to rate the certainty of evidence. Results A total of 7406 patients in 12 articles related to upstaged pT3a RCCa were included. In adjusted analysis, no difference was observed in RFS [hazard ratios (HR) 0.87; 95% confidence intervals (CI), 0.57-0.95; p = 0.88] and CSS (HR, 0.78; 95% CI, 0.59-1.04; p = 0.09) for PNx and RNx. Meanwhile, PNx was significantly associated with favorable OS compared with RNx (HR, 0.74; 95% CI, 0.57-0.95; p = 0.02). Conclusions Our meta-analysis shows that patients treated with PNx have better or at least similar oncological outcomes compared with RNx in patients with upstaged pT3a RCCa from cT1. In particular, patients who had undergone PNx show a significantly improved OS. If PNx is available, we recommend performing PNx for all cT1 RCCa, even in patients with upstaging potential. However, due to the low level of evidence, large-scale randomized trials are required.
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Affiliation(s)
- Doo Yong Chung
- Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Dong Hyuk Kang
- Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Jong Won Kim
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, Korea
| | - Do Kyung Kim
- Department of Urology, Soonchunhyang University Medical College, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
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Li L, Shi L, Zhang J, Fan Y, Li Q. The critical impact of tumor size in predicting cancer special survival for T3aM0M0 renal cell carcinoma: A proposal of an alternative T3aN0M0 stage. Cancer Med 2020; 10:605-614. [PMID: 33280246 PMCID: PMC7877365 DOI: 10.1002/cam4.3629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Based on the eighth TNM staging system, T3a renal cell carcinoma (RCC) is identified as an anatomical extrarenal invasion and does not consider the size of the tumor; however, it may not fully predict the prognosis of the patient. The objective of this study was to evaluate the prognostic value of tumor size effects on prognosis in T3a RCC and propose an alternative tumor stage system combined with T1-2. METHODS Data relating to T1-3aN0M0 RCC (n = 49586) were obtained from the Surveillance, Epidemiology, and End Results database (2004-2015). Survival analyses were conducted by Cox regression and Fine and Gray regression. Harrell's concordance index (c-index) was used to assess the discriminatory ability of the prognostic factors. RESULTS A 1-cm increase in T3a RCC resulted in an 8% increase in all-cause mortality (hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 1.06-1.10, p < 0.001) and 14% increase in the risk of RCC-specific mortality (sub-distribution HR [sHR]: 1.14; 95% CI: 1.11-1.16, p < 0.001). T3a tumor size stratified by the cutoff of 4 cm and 7 cm showed a better prediction of RCC-special survival (c-index: 0.644), compared with a cutoff just by 4 cm (c-index: 0.571) or by 7 cm (c-index: 0.602). Compared with T1b tumors, T3a RCC ≤4 cm showed no differences in terms of all-cause mortality (HR: 0.93; 95% CI: 0.79-1.09; p = 0.37) and mortality caused by RCC (sHR: 0.91; 95% CI: 0.70-1.19; p = 0.50). Last, the alternative T-staging system (T1a, a combination of T1b and T3a [≤4 cm], T2a, T2b, T3a [4-7 cm], and T3a [>7] cm) demonstrated good RCC-special survival predictive accuracy (c-index: 0.729), which was higher than that shown by the current eighth edition T-staging system (c-index: 0.720). CONCLUSION Tumor size should be taken into consideration for T3aN0M0 RCC rather than based on anatomical features alone.
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Affiliation(s)
- Luping Li
- Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Lei Shi
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Junjie Zhang
- Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yingzhong Fan
- Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Qi Li
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
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Association of Tumor Size with Risk of Lymph Node Metastasis in Clear Cell Renal Cell Carcinoma: A Population-Based Study. JOURNAL OF ONCOLOGY 2020; 2020:8887782. [PMID: 33178275 PMCID: PMC7648693 DOI: 10.1155/2020/8887782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 12/18/2022]
Abstract
The purpose of this article was to explore the association of tumor size with lymph node metastases (LNM) risk in patients with clear cell renal cell carcinoma (ccRCC). Based on the Surveillance, Epidemiology, and End Result (SEER) database, patients diagnosed with ccRCC from 1988 to 2015 were included in this study. For each patient, personal characteristics, clinicopathological data, and survival outcomes were, respectively, collected. Subsequently, the odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to investigate the potential risk factors for LNM in ccRCC. Finally, Kaplan-Meier (KM) survival plots of overall survival (OS) and ccRCC-specific survival (CSS) were evaluated on the basis of different tumor sizes. A total of 8,292 patients were finally enrolled in the study, 1,170 of whom (14.11%) had LNM. According to the heatmap, we could intuitively interpret that larger tumor size was related to an increased risk of LNM obviously. The risk of LNM was evidently greater for larger tumor size (4-7 cm: OR = 2.415, 95% CI = 1.708–3.415; 7–10 cm: OR = 3.746, 95% CI = 2.677–5.242; and >10 cm: OR = 4.617, 95% CI = 3.302–6.457) compared with smaller tumor size (≤4 cm). According to the KM survival plots of OS and CSS, we observed a gradual decline in survival with increasing tumor size, while the smallest tumor size had the best survival outcomes. These results indicated the positive relationship of tumor size with risk of LNM in ccRCC. And we also noticed continual decrease survival rates of OS and CSS with increasing tumor size.
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Bensalah K, Bigot P, Albiges L, Bernhard J, Bodin T, Boissier R, Correas J, Gimel P, Hetet J, Long J, Nouhaud F, Ouzaïd I, Rioux-Leclercq N, Méjean A. Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : prise en charge du cancer du rein. Prog Urol 2020; 30:S2-S51. [DOI: 10.1016/s1166-7087(20)30749-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Chen H, Yang S, Qian C. Effectiveness of Nephron Sparing Surgery and Radical Nephrectomy in the Management of Unilateral Wilms Tumor: A Meta-Analysis. Front Oncol 2020; 10:1248. [PMID: 33014769 PMCID: PMC7498664 DOI: 10.3389/fonc.2020.01248] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/17/2020] [Indexed: 01/15/2023] Open
Abstract
Background: Unilateral Wilms tumor is the most common renal malignancy in the pediatric population. Although the onset of surgical intervention like radical nephrectomy has substantially reduced the mortality rate, recent evidence has raised concerns regarding several postoperative complications associated with this procedure. Nephron sparing surgery has been reported to avoid such postoperative complications and have high technical success rate. However, no attempt to date has been made to synthesize the evidence comparing the efficacy of radical nephrectomy and nephron sparing surgery for managing unilateral Wilms tumor. Methods and Results: To metastatistically compare the efficiency of radical nephrectomy with nephron sparing surgery for managing unilateral Wilms tumor, a systematic identification of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. A meta-analysis comparing renal function (estimated glomerular filtration rate), survival rate, and rate of relapse was performed to compare the efficacy of radical nephrectomy and nephron sparing surgery. Out of 1,283 records, 20 articles including 5,246 children (mean age, 4.3 ± 3.0 years) were included in this review. Radical nephrectomy was performed on 11 of the included studies, whereas nephron sparing surgery was performed on five studies. Two studies compared the efficacy of both interventions. The meta-analysis reveals the beneficial effects of nephron sparing surgery (Hedge's g, 0.76) as compared to radical nephrectomy (-0.16) for the estimated glomerular filtration rate for children with unilateral Wilms tumor. Moreover, higher survivability (0.59) and lesser occurrence of relapse were (-1.0) also reported for cases operated with nephron sparing surgery. Conclusion: The current meta-analysis recommends the use of nephron sparing surgery for unilateral Wilms tumor. The procedure accounts for higher survivability and postoperative renal function and lesser incidence of relapse as compared to radical nephrectomy.
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Affiliation(s)
- Hongkun Chen
- Department of Pediatric Surgery, Zaozhuang Municipal Hospital, Zaozhuang, China
| | - Shuqing Yang
- Zaozhuang Hospital of Traditional Chinese Medicine, Zaozhuang, China
| | - Cheng Qian
- Department of Pediatric Surgery, Zaozhuang Municipal Hospital, Zaozhuang, China
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Kondo T. Editorial Comment from Dr Kondo to Partial nephrectomy preserves renal function without increasing the risk of complications compared with radical nephrectomy for renal cell carcinomas of stages pT2-3a. Int J Urol 2020; 27:915. [PMID: 32783217 DOI: 10.1111/iju.14347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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Mühlbauer J, Kowalewski KF, Walach MT, Porubsky S, Wessels F, Nuhn P, Wagener N, Kriegmair MC. Partial nephrectomy preserves renal function without increasing the risk of complications compared with radical nephrectomy for renal cell carcinomas of stages pT2-3a. Int J Urol 2020; 27:906-913. [PMID: 32783245 DOI: 10.1111/iju.14326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/19/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To compare the operative and functional result of partial and radical nephrectomy in renal cell carcinomas of stages pT2-3a. METHODS Consecutive patients with renal cell carcinoma of stages pT2-3a, cN0 and cM0, who underwent partial or radical nephrectomy between January 2005 and October 2019 at a tertiary care center were included. Data were collected retrospectively. End-points included severe postoperative complications (Clavien-Dindo classification ≥3), acute and chronic renal function impairment, and overall survival. Uni- and multivariable outcome analyses were based on logistic regression. RESULTS A total of 158 patients were included (110 radical nephrectomy and 48 partial nephrectomy). Over time, partial nephrectomy was increasingly used. A RENAL score ≥10 was the only independent predictor influencing the surgical approach (radical nephrectomy vs partial nephrectomy, odds ratio 8.62, 95% confidence interval 3.32-22.37, P < 0.001). No significant differences in complications for radical nephrectomy versus partial nephrectomy were found (12.7% vs 8.3%, P = 0.424). Renal function was better preserved in the partial nephrectomy group (the latest chronic kidney disease stage ≥3: radical nephrectomy 73% vs partial nephrectomy 41%, P = 0.005). The surgical approach was a significant factor for chronic kidney disease (odds ratio 51.07, 95% confidence interval 3.57-730.59, P = 0.004). Overall survival did not significantly differ between radical nephrectomy and partial nephrectomy (mean overall survival 85.86 months, 95% confidence interval 3.83-78.36 vs 81.28 months, 95% confidence interval 4.59-72.29, P = 0.702). CONCLUSIONS In selected patients, partial nephrectomy can be used in large or locally advanced renal cell carcinoma. Compared with radical nephrectomy, it allows better preservation of renal function without harboring an increased risk of severe postoperative complications.
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Affiliation(s)
- Julia Mühlbauer
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Karl-Friedrich Kowalewski
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Margarete T Walach
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan Porubsky
- Department of, Pathology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Frederik Wessels
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Philipp Nuhn
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Nina Wagener
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Maximilian C Kriegmair
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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Teishima J, Hayashi T, Kitano H, Sadahide K, Sekino Y, Goto K, Inoue S, Honda Y, Sentani K, Awai K, Yasui W, Matsubara A. Impact of radiological morphology of clinical T1 renal cell carcinoma on the prediction of upstaging to pathological T3. Jpn J Clin Oncol 2020; 50:473-478. [PMID: 32100866 DOI: 10.1093/jjco/hyz154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/04/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Previous studies have reported that cases with clinical T1 renal cell cancer upstaging to pathological T3 are a risk factor to predicting postoperative recurrence after partial nephrectomy. The aim of our study was to investigate the impact of the radiological morphology of the enhanced CT scan of clinical T1 renal cell cancer on predicting upstaging to pathological T3. METHODS Three hundred sixty-seven cases with clinical T1 renal cell cancer diagnosed from enhanced CT scans were enrolled in this study. Based on the findings from the enhanced CT scan, the cases were classified into 'round', the margins of which were smooth and round; 'lobular', one or more findings of smooth dent and no spiky dent were identified on the margin of the tumor; and 'irregular', one or more spiky dent were identified on the margin of the tumor. The association of postoperative upstaging with these radiological morphology and other clinical characteristics of each case was analyzed. RESULTS Eighteen cases (4.9%) pathologically upstaged to T3a. Two round case (0.7%), 3 lobular cases (10.0%) and 13 irregular cases (22.0%) pathologically upstaged (P < 0.001, round + lobular versus irregular). Four of 17 cases (23.5%) with hilar tumors pathologically upstaged, while 14 of 350 cases (4%) with tumors pathologically upstaged in other sites (P < 0.001). Multivariate analysis revealed that irregular case was an independent factor in predicting upstaging to pathological T3a (P < 0.001). CONCLUSIONS Evaluation of the radiological morphology of clinical T1 renal cell cancer based on enhanced CT scans is useful for predicting pathological upstaging.
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Affiliation(s)
- Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Kitano
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kousuke Sadahide
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yohei Sekino
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keisuke Goto
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Inoue
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukiko Honda
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhiro Sentani
- Department of Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Wataru Yasui
- Department of Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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de la Barra CC, González PG, Baeza MÁ, Pérez OP, Cruzat JD. A preoperative model to predict pT3 upstaging in clinically localized renal cell carcinoma. Cent European J Urol 2020; 73:173-177. [PMID: 32782837 PMCID: PMC7407775 DOI: 10.5173/ceju.2020.0005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/22/2020] [Accepted: 04/02/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction Patients upstaged to pT3 after partial nephrectomy (PN) may be at an increased risk of disease progression compared to those patients submitted to radical nephrectomy (RN). We sought to identify preoperative factors predicting pT3 upstaging in localized renal cell carcinoma. Material and methods Patients submitted to nephrectomy for clinically localized (cT1–cT2) renal cell carcinoma between 2011 and 2016 were identified from a prospective registry, those presenting with locally advanced or metastatic disease were excluded. Clinical factors, laboratory, and imaging using RENAL score, were analyzed. A multivariate analysis was performed looking for stage pT3a predictors. Results Two hundred and nine patients were included, 66% were men, with a mean age of 57 years. Mean tumor size was 49 ±31 mm. 19% were staged as pT3a. Of this group, 10% underwent a PN. Age, hypertension, presence of hematuria, creatinine levels, size and RENAL score were statistically associated with locally advanced stage. The variables of the RENAL score that were associated to pT3a stage were size, nearness to renal sinus/collector system and contact with main renal vessels. On the multivariate analysis, only age, size, and contact with renal vessels were found to predict upstaging. A model was developed which was able to predict stage pT3a with an area under the curve (AUC) of 0.864 in the ROC curve. Conclusions Upstaging to pT3a is fairly common in clinically localized tumors. A formula that includes tumor size, age and contact with the main vessels on imaging, can help predict it. This should be considered when deciding if the patient is a candidate for nephron sparing surgery.
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Takagi T, Yoshida K, Wada A, Kondo T, Fukuda H, Ishihara H, Kobayashi H, Iizuka J, Okumi M, Ishida H, Nagashima Y, Tanabe K. Predictive factors for recurrence after partial nephrectomy for clinical T1 renal cell carcinoma: a retrospective study of 1227 cases from a single institution. Int J Clin Oncol 2020; 25:892-898. [PMID: 32048086 DOI: 10.1007/s10147-020-01632-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/29/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Identifying the predictive factors for tumor recurrence after partial nephrectomy (PN) is useful to determine patients who require careful observation after surgery. Therefore, we investigated recurrence after partial nephrectomy (PN) in patients with clinical T1 renal cell carcinoma (RCC) and analyzed predictive factors for recurrence-free survival (RFS). METHODS This study included 1227 patients who underwent PN for clinical T1 RCC and retrospectively investigated patients' characteristics and tumor factors that are associated with tumor recurrence. RESULTS The median patient age was 59 years, and the median tumor size was 30 mm. Although 970 (74%) and 319 (26%) patients had clinical T1a and T1b RCCs, respectively, 20 patients (1.6%) were upstaged to pathological T3a. A positive surgical margin was found in 19 (1.5%) patients. The distribution of surgical approaches was open surgery in 428 (35%) patients and minimally invasive surgery in 799 (65%) patients. With a median follow-up of 35 months (Interquartile range 19-55 months), 39 (3.2%) patients, including ten with local recurrence, five with recurrence in the ipsilateral kidney, and 28 with other organs or lymph-nude, developed recurrence. The 3-year RFS was 99%, and the median recurrence time from PN was 19 months (interquartile range: 11-37 months). Multivariate analysis identified high grade tumor and upstaging to pT3a as significant predictors for worse RFS. CONCLUSION Patients with high grade tumors and tumors upstaged to pT3 had a high risk of worse RFS, which suggested that careful monitoring is required for such patients after PN, even if a good prognosis is achieved in patients with clinical T1 RCC.
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Affiliation(s)
- Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Arisa Wada
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masayoshi Okumi
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Hamilton ZA, Capitanio U, Pruthi D, Ghali F, Larcher A, Patel DN, Eldefrawy A, Patel S, Cotta BH, Bradshaw AW, Meagher MF, Miller NS, Carenzi C, Wan F, Liss MA, McGregor T, Montorsi F, Derweesh IH. Risk Factors for Upstaging, Recurrence, and Mortality in Clinical T1-2 Renal Cell Carcinoma Patients Upstaged to pT3a Disease: An International Analysis Utilizing the 8th Edition of the Tumor-Node-Metastasis Staging Criteria. Urology 2019; 138:60-68. [PMID: 31836465 DOI: 10.1016/j.urology.2019.11.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate risk factors for and outcomes in pathological T3a-upstaging in Renal Cell Carcinoma (RCC), as Tumor-Node-Metastasis staging for T3a RCC was recently revised. METHODS Multicenter retrospective analysis of patients with clinical T1-T2 RCC, stratified by occurrence of pathologic T3a-upstaging. Primary outcome was recurrence-free survival (RFS). Multivariable analyses (MVA) were conducted for upstaging and recurrence. Kaplan-Meier analysis (KMA) was utilized for RFS and overall survival (OS). RESULTS We analyzed 2573 patients (1223 RN/1350 PN). Upstaging occurred in 360 (14.0%). On MVA, higher clinical stage was associated with increasing risk of upstaging [cT1a (referent), odds ratio for cT1b, cT2a, and cT2b was 2.6, 6.5, and 14.1, P < .001]. Higher clinical stage at presentation correlated with increasing risk of recurrence in pT3a-upstaged RCC (cT1a upstaged-pT3a [referent], hazard ratio [HR] for cT1b, cT2a, and cT2b upstaged pT3a was 1.16 [P = .729], 3.02 [P = .013], and 4.5 [P = .003]). Perirenal fat (HR 1.6, P = .038) and renal vein (HR 2.2, P = .006) invasion were associated with increased risk of recurrence; type of surgery was not (P = .157). KMA for RFS and OS in pT3a-upstaged patients demonstrated differences based on initial clinical stage (5-year PFS for cT1a/b, and cT2 upstaged was 84.5%/72.8%, and 44.7%, P < .001; 5-year OS for cT1 and cT2 upstaged was 83.8% and 63.2%, P < .001). CONCLUSION Risk of pT3a-upstaging and recurrence in pT3a-upstaged RCC correlates with clinical stage at presentation. Renal vein and perinephric fat invasion were associated with increased risk of recurrence. PN did not increase risk of recurrence and potential of pT3a-upstaging should not deter consideration of PN.
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Affiliation(s)
- Zachary A Hamilton
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - Umberto Capitanio
- URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Deepak Pruthi
- Department of Urology, Queens University, Kingston, Ontario, Canada
| | - Fady Ghali
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - Alessandro Larcher
- URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Devin N Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - Ahmed Eldefrawy
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - Sunil Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - Brittney H Cotta
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - Aaron W Bradshaw
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - Margaret F Meagher
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - Nathan S Miller
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - Cristina Carenzi
- URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fang Wan
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - Michael A Liss
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - Thomas McGregor
- Department of Urology, Queens University, Kingston, Ontario, Canada
| | - Francesco Montorsi
- URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ithaar H Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California.
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Renal Cell Carcinoma Staging with Learnable Image Histogram-Based Deep Neural Network. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/978-3-030-32692-0_61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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Yoshida T, Ohe C, Tsuzuki T, Sugi M, Kinoshita H, Tsuta K, Matsuda T. Clinical impact of segmental renal vein invasion on recurrence in patients with clinical T1 renal cell carcinoma undergoing partial nephrectomy. Int J Clin Oncol 2019; 25:464-471. [DOI: 10.1007/s10147-019-01543-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/03/2019] [Indexed: 12/30/2022]
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Chen L, Deng W, Liu X, Wang G, Fu B. Impact of pathological T3a upstaging on oncological outcomes of clinical T1 renal cell carcinoma: a meta-analysis. J Cancer 2019; 10:4998-5006. [PMID: 31598172 PMCID: PMC6775504 DOI: 10.7150/jca.32859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 07/04/2019] [Indexed: 01/11/2023] Open
Abstract
Objective: The study aims to assess the prognostic impact of pathological T3a upstaging in clinical T1 renal cell carcinoma (RCC) on clinical outcomes. Methods: We performed a systematic literature search of PMC, Embase, Web of Science, and Cochrane library from inception to April 2019 for studies that investigated the prognostic significance of pathological T3a upstaging in clinical T1 RCC after surgery and conducted a standard meta-analysis on survival outcomes. Results: Overall, nine studies including 101,505 clinical T1 RCC patients were identified, in which 5,560 (5.5%) patients were upstaged to T3a after surgical treatment. Meta-analysis results showed that pT3a upstaging from clinical T1 RCC was significantly associated with poor recurrence-free survival (RFS; pooled hazard ratio [HR] 2.16, 95% confidence interval [CI] 1.70-2.75; P<0.001), overall survival (OS; pooled HR 1.36, 95% CI 1.24-1.50; P<0.001), and cancer-specific survival (CSS; pooled HR 2.11, 95% CI 1.58-2.83; P<0.001). Subgroup analyses by surgical type demonstrated that pT3a upstaging remains a significant prognostic factor for RFS and OS in RCC patients who underwent different surgical treatments. Conclusions: Current available evidence strongly supported that postoperative pT3a upstaging has a significant negative impact on RFS, OS, and CSS in clinical T1 RCC patients. Clinical T1 RCC patients with pT3a upstaging after surgery should be closely monitored by clinician and should receive close follow-up for their poor prognosis.
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Affiliation(s)
- Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Sugiyama Y, Yatsuda J, Murakami Y, Ito N, Yamasaki T, Mikami Y, Ogawa O, Kamba T. Impact of tumor size on patient survival after radical nephrectomy for pathological T3a renal cell carcinoma. Jpn J Clin Oncol 2019; 49:465-472. [PMID: 30793163 DOI: 10.1093/jjco/hyy200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/08/2018] [Accepted: 12/17/2018] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We recently reported the results from a multi-institutional retrospective outcome study involving 814 patients with renal cell carcinomas (RCCs) who had undergone radical surgery and whose diagnoses were confirmed via a central pathological review. This study aimed to clarify the impact of tumor size on survival outcomes in patients with pT3aN0M0 RCC after radical nephrectomy using this cohort. METHODS Using the Kaplan-Meier method, overall survival (OS), cancer-specific survival (CSS) and relapse-free survival (RFS) were estimated for 103 pT3aN0M0 patients. The differences in the OS, CSS and RFS according to tumor size were evaluated using the log-rank test. To identify independent prognostic factors that affected each survival outcome, clinicopathological factors were examined using univariate and multivariate analyses, and the Cox proportional hazards model. RESULTS The OS, CSS and RFS rates for 26 patients with pT3a RCCs ≤4 cm were significantly better than those for 77 patients with pT3a RCCs that were 4-7 cm or >7 cm (P = 0.0064, 0.0169 and 0.0001, respectively). Tumor size and venous invasion were independent prognosticators for OS, CSS and RFS. The OS and CSS for patients with pT3a tumors ≤4 cm were comparable with those for patients with pT1 RCCs, and the RFS for patients with pT3a RCCs ≤4 cm was similar to that for patients with pT1b RCCs. CONCLUSIONS Tumor size significantly influenced the prognosis for patients with pT3aN0M0 RCC. This study's results suggest that the postoperative management of pT3a RCCs could be individualized according to tumor size.
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Affiliation(s)
- Yutaka Sugiyama
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto
| | - Junji Yatsuda
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto
| | - Yoji Murakami
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto
| | - Noriyuki Ito
- Department of Urology, Japanese Red Cross Wakayama Medical Center, Wakayama
| | - Toshinari Yamasaki
- Department of Urology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto
| | - Tomomi Kamba
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto
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Fukui S, Miyake M, Iida K, Onishi K, Hori S, Morizawa Y, Kagebayashi Y, Fujimoto K. The Preoperative Predictive Factors for Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma. Diagnostics (Basel) 2019; 9:diagnostics9030076. [PMID: 31311108 PMCID: PMC6787604 DOI: 10.3390/diagnostics9030076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/13/2019] [Accepted: 07/14/2019] [Indexed: 12/15/2022] Open
Abstract
We aimed to determine the oncological outcomes of patients with clinical T1 renal cell carcinoma (RCC) upstaged to pathological T3a and to identify the preoperative predictive factors for upstaging. We retrospectively reviewed 272 patients with clinical T1 RCC who underwent surgical treatment. Thirty-three patients (12%) were upstaged to pathological T3a. These patients had a significantly larger tumor size on computed tomography (p < 0.0001), a higher aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (p = 0.037), and an elevated c-reactive protein (CRP) level (p = 0.014) preoperatively compared with those with pathological T1 RCC. On multivariate analysis, tumor diameter was the only significant preoperative predictive factor for upstaging [hazard ratio (HR), 3.61; 95% confidence interval (CI), 1.32-9.84; p = 0.01]. The AST/ALT ratio tended to be a preoperative predictive factor for upstaging, although it was not significant (HR, 2.14; 95% CI, 0.97-4.73; p = 0.06). Pathological T3a upstaging occurred in 25% of those with a tumor diameter ≥30 mm and a preoperative AST/ALT ratio ≥1.1. There was a significant correlation between pathological T3a upstaging and the number of preoperative risk factors (p = 0.0002). The preoperative tumor diameter and serum AST/ALT ratio can be predictive factors for pathological T3a upstaging in patients with clinical T1 RCC.
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Affiliation(s)
- Shinji Fukui
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara 634-8521, Japan.
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Kota Iida
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Kenta Onishi
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Yoriaki Kagebayashi
- Department of Urology, Nara Prefecture General Medical Center, 897-5, Shichijo-nishi machi 2 chome, Nara, Nara 630-8581, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840, Shijo-cho, Kashihara, Nara 634-8521, Japan
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Joseph JV, Brasacchio R, Fung C, Reeder J, Bylund K, Sahasrabudhe D, Yeh SY, Ghazi A, Fultz P, Rubens D, Wu G, Singer E, Schwarz E, Mohile S, Mohler J, Theodorescu D, Lee YF, Okunieff P, McConkey D, Rashid H, Chang C, Fradet Y, Guru K, Kukreja J, Sufrin G, Lotan Y, Bailey H, Noyes K, Schwartz S, Rideout K, Bratslavsky G, Campbell SC, Derweesh I, Abrahamsson PA, Soloway M, Gomella L, Golijanin D, Svatek R, Frye T, Lerner S, Palapattu G, Wilding G, Droller M, Trump D. A Festschrift in Honor of Edward M. Messing, MD, FACS. Bladder Cancer 2018; 4:S1-S43. [PMID: 30443561 PMCID: PMC6226303 DOI: 10.3233/blc-189037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/28/2018] [Indexed: 12/02/2022]
Affiliation(s)
- Jean V. Joseph
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Chunkit Fung
- University of Rochester Medical Center, Rochester, NY, USA
| | - Jay Reeder
- University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Bylund
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Shu Yuan Yeh
- University of Rochester Medical Center, Rochester, NY, USA
| | - Ahmed Ghazi
- University of Rochester Medical Center, Rochester, NY, USA
| | - Patrick Fultz
- University of Rochester Medical Center, Rochester, NY, USA
| | - Deborah Rubens
- University of Rochester Medical Center, Rochester, NY, USA
| | - Guan Wu
- University of Rochester Medical Center, Rochester, NY, USA
| | - Eric Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Edward Schwarz
- University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya Mohile
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Yi Fen Lee
- University of Rochester Medical Center, Rochester, NY, USA
| | - Paul Okunieff
- UF Health Proton Therapy Institute, Gainesville, FL, USA
| | - David McConkey
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA
| | - Hani Rashid
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Yves Fradet
- CHU de Quebec-Hotel-Dieu de Quebec, Quebec, QC, Canada
| | | | | | - Gerald Sufrin
- State University of New York at Buffalo, Buffalo, NY, USA
| | - Yair Lotan
- UT Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Howard Bailey
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Kathy Rideout
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Steven C. Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | - Leonard Gomella
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Robert Svatek
- UT Health Science Center San Antonio, San Antonio, TX, USA
| | - Thomas Frye
- University of Rochester Medical Center, Rochester, NY, USA
| | - Seth Lerner
- Baylor College of Medicine Medical Center, Houston, TX, USA
| | | | | | | | - Donald Trump
- Virginia Commonwealth University, Fairfax, VA, USA
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Re: Incidence of T3a Up-Staging and Survival after Partial Nephrectomy: Size-Stratified Rates and Implications for Prognosis. J Urol 2018; 200:695. [PMID: 30227577 DOI: 10.1016/j.juro.2018.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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43
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Derweesh IH, Ryan ST, Hamilton ZA. Partial nephrectomy for T1b and T2 renal masses: A subtle paradigm shift and a new synthesis. Cancer 2018; 124:3798-3801. [DOI: 10.1002/cncr.31579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 04/23/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Ithaar H. Derweesh
- Department of Urology, UC San Diego Moores Cancer Center; University of California San Diego School of Medicine; Louisiana Jolla, California Maryland
| | - Stephen T. Ryan
- Department of Urology, UC San Diego Moores Cancer Center; University of California San Diego School of Medicine; Louisiana Jolla, California Maryland
| | - Zachary A. Hamilton
- Department of Urology, UC San Diego Moores Cancer Center; University of California San Diego School of Medicine; Louisiana Jolla, California Maryland
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44
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Crane A, Suk-Ouichai C, Campbell JA, Caraballo ER, Aguilar Palacios D, Tanaka H, Campbell SC. Imprudent Utilization of Partial Nephrectomy. Urology 2018; 117:22-26. [DOI: 10.1016/j.urology.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/13/2017] [Accepted: 12/18/2017] [Indexed: 01/20/2023]
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45
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Russell CM, Lebastchi AH, Chipollini J, Niemann A, Mehra R, Morgan TM, Miller DC, Palapattu GS, Hafez KS, Sexton WJ, Spiess PE, Weizer AZ. Multi-institutional Survival Analysis of Incidental Pathologic T3a Upstaging in Clinical T1 Renal Cell Carcinoma Following Partial Nephrectomy. Urology 2018; 117:95-100. [PMID: 29678662 DOI: 10.1016/j.urology.2018.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/28/2018] [Accepted: 04/02/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate whether incidental pathologic T3a (pT3a) upstaging after partial nephrectomy (PN) for clinical T1 disease results in inferior oncologic outcomes compared to pT1a-b disease. MATERIALS AND METHODS Retrospective chart review was completed at the University of Michigan and Moffitt Cancer Center to identify patients undergoing PN for clinical T1 masses between 1995 and 2015. A total of 1955 patients were identified, of which 95 had pT3a upstaging. Median follow-up was 38.2 months. Patients with pT3a disease were individually matched by clinicopathologic features with patients undergoing PN with pT1a-b disease in a 1:2 ratio. Kaplan-Meier analysis and univariate and multivariable Cox proportional hazards regression analysis were performed. Primary endpoint was recurrence-free survival (RFS). Secondary endpoints were all-cause mortality, cancer-specific survival (CSS), and rates of local and distant recurrence. RESULTS Recurrence rates were significantly higher in pT3a disease compared to pT1a-b controls (P <.01). In those patients with pT3a upstaging, 3- and 5-year RFS were 81% and 58%, compared to 86% and 75% in pT1a-b controls (P = .01). CSS at 3 and 5 years were 91% and 90% in pT3a disease and 100% and 97% in pT1a-b controls (P <.01). All-cause mortality at 3 and 5 years were 82% and 71% in pT3a disease and 93% and 80% in pT1a-b controls (P = .04). Univariate and multivariable analysis of pT3a disease demonstrated no association between demographic or pathologic characteristics and RCC recurrence. CONCLUSION Patients with pT3a upstaging following PN experience a significantly reduced RFS and CSS when compared to pT1 disease.
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Affiliation(s)
| | | | - Juan Chipollini
- Department of Urologic Oncology, Moffitt Cancer Center, Tampa, FL
| | - Adam Niemann
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - Khaled S Hafez
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Wade J Sexton
- Department of Urologic Oncology, Moffitt Cancer Center, Tampa, FL
| | | | - Alon Z Weizer
- Department of Urology, University of Michigan, Ann Arbor, MI.
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46
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Liek E, Elsebach K, Göbel H, Krah X, Krautschick-Wilkens A, Schweiger J, Steiner G, Steiner T, Wunderlich H. The Overall Survival Benefit for Patients with T1 Renal Cell Carcinoma after Nephron-Sparing Surgery Depends on Gender and Age. Urol Int 2018; 100:309-316. [DOI: 10.1159/000486627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/03/2018] [Indexed: 11/19/2022]
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47
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Delto JC, Paulucci D, Helbig MW, Badani KK, Eun D, Porter J, Abaza R, Hemal AK, Bhandari A. Robot-assisted partial nephrectomy for large renal masses: a multi-institutional series. BJU Int 2018; 121:908-915. [DOI: 10.1111/bju.14139] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | | | - Michael W. Helbig
- Florida International University Herbert Wertheim College of Medicine; Miami FL USA
| | | | - Daniel Eun
- Lewis Katz School of Medicine at Temple University; Philadelphia PA USA
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48
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Incidence of T3a up-staging and survival after partial nephrectomy: Size-stratified rates and implications for prognosis. Urol Oncol 2018; 36:12.e7-12.e13. [DOI: 10.1016/j.urolonc.2017.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/09/2017] [Accepted: 09/05/2017] [Indexed: 12/21/2022]
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49
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Ghanie A, Formica MK, Wang D, Bratslavsky G, Stewart T. Pathological upstaging of clinical T1 renal cell carcinoma: an analysis of 115,835 patients from National Cancer Data Base, 2004–2013. Int Urol Nephrol 2017; 50:237-245. [DOI: 10.1007/s11255-017-1768-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
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50
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Reynolds CR, Delto JC, Paulucci DJ, Weinstein C, Badani K, Eun D, Abaza R, Porter J, Bhandari A, Hemal AK. Comparison of perioperative and functional outcomes of robotic partial nephrectomy for cT1a vs cT1b renal masses. BJU Int 2017; 120:842-847. [DOI: 10.1111/bju.13960] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | - Joan C. Delto
- Division of Urology; Columbia University at Mount Sinai; Miami Beach FL USA
| | - David J. Paulucci
- Department of Urology; Icahn School of Medicine at Mount Sinai Hospital; New York NY USA
| | - Corey Weinstein
- Division of Urology; Columbia University at Mount Sinai; Miami Beach FL USA
| | - Ketan Badani
- Department of Urology; Icahn School of Medicine at Mount Sinai Hospital; New York NY USA
| | - Daniel Eun
- Temple University School of Medicine; Philadelphia PA USA
| | - Ronney Abaza
- Robotic Urologic Surgery; OhioHealth Dublin Methodist Hospital; Columbus OH USA
| | | | - Akshay Bhandari
- Division of Urology; Columbia University at Mount Sinai; Miami Beach FL USA
| | - Ashok K. Hemal
- Department of Urology; Wake Forest School of Medicine; Winston-Salem NC USA
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