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Matsuura T, Ito A, Moriguchi M, Ikarashi D, Tamura D, Kato R, Maekawa S, Kato Y, Kanehira M, Takata R, Sugimura J, Abe T, Obara W. Influence of robot-assisted partial nephrectomy on long-term renal function as assessed using DTPA renal scintigraphy. J Endourol 2021; 36:641-646. [PMID: 34913764 DOI: 10.1089/end.2021.0243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The long-term split renal function after robot-assisted partial nephrectomy (RAPN) is yet to be elucidate. This study aimed to assess long-term renal function RAPN, using renal scintigraphy, and to identify clinical factors related to deterioration of renal function on the affected side of the kidney. PATIENTS AND METHODS RAPN for small tumors was performed, and split renal function was evaluated using DTPA renal scintigraphy before and 1 year after surgery. Clinical factors (age, sex, body mass index, tumor side, presence of urinary protein, diabetes, hypertension, and dyslipidemia), perioperative factors (renal nephrectomy score [RNS], tumor diameter, overall surgery duration, console time, warm ischemic time, amount of bleeding), and renal function (estimated glomerular filtration rate (eGFR) and glomerular filtration rate (GFR) measured using scintigraphy on both the affected and contralateral kidneys) were analyzed. RESULTS Sixty-six patients were included in the study. The median eGFR decreased from 71.9 ml/min to 63.9 ml/min after 1 year (p<.001), accounting for a mean loss of 10.1%. In scintigraphy examination, the median GFR on the affected kidney side decreased from 41.1 ml/min to 33.7 ml/min after 1 year (p<.001), accounting for a mean loss of 16.8%. RNS was significantly associated with renal function. Among RNS factors, the N factor is associated with renal function after RAPN. CONCLUSION RNS, particularly the N factor, possibly influences the long-term deterioration of renal function after RAPN.
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Affiliation(s)
- Tomohiko Matsuura
- Iwate Medical University, 12833, Urology, idaidori, 1-1, Yahaba-cho, Iwate, Japan, 028-3695;
| | - Ayato Ito
- Iwate Medical University, 12833, Urology, Yahaba-cho, Iwate, Japan;
| | - Mariko Moriguchi
- Iwate Medical University, 12833, Urology, Yahaba-cho, Iwate, Japan;
| | | | - Daichi Tamura
- Iwate Medical University, 12833, Urology, Morioka, Iwate, Japan;
| | - Renpei Kato
- Iwate Medical University, 12833, Morioka, Iwate, Japan;
| | - Shigekatsu Maekawa
- Iwate Medical University, 12833, Urology, 2-1-1 Idai-Dori, Yahaba, Shiwa, Iwate, Japan, 028-3695;
| | - Yoichiro Kato
- Iwate Medical University, 12833, Urology, Morioka, Iwate, Japan;
| | | | - Ryo Takata
- Iwate Medical University, 12833, Urology, 19-1 Uchimaru, Morioka, Iwate, Japan, 020-8505;
| | - Jun Sugimura
- Iwate Medical University, 12833, Urology, Yahaba-cho, Iwate, Japan;
| | - Takaya Abe
- Iwate Medical University, 12833, Urology, Morioka, Iwate, Japan;
| | - Wataru Obara
- Iwate Medical University, 12833, Urology, Yahaba-cho, Iwate, Japan;
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Zhao J, Li Q, Feng ZX, Zhang J, Wu S, Jin L, Gallie BL. Tylectomy Safety in Salvage of Eyes with Retinoblastoma. Cancers (Basel) 2021; 13:cancers13225862. [PMID: 34831013 PMCID: PMC8616183 DOI: 10.3390/cancers13225862] [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: 10/27/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary The role of organ-conserving surgery has not been explored in retinoblastoma as it has been in other cancers, such as breast cancer lumpectomy, partial nephrectomy for kidney cancer, and partial orchiectomy for testis cancer. This is largely accounted for by the high mortality of extraocular retinoblastoma compared to intraocular retinoblastoma, and fear of iatrogenic tumor spread with intraocular surgery. We propose the little-known word “tylectomy” (“tulos”, Greek for “lump”) to describe the surgical resection of retinoblastoma. Through review of consecutive patients treated by our team between 2012–2014, we compared survival of patients with eye salvage, including tylectomy, to those who had eye salvage without tylectomy or primary enucleation. We found that patients who had tylectomy had superior survival compared to those who had eye salvage without tylectomy (96% vs. 90%), and comparable survival to those with primary enucleation (96% vs. 95%). Our study supports tylectomy as a safe contribution to retinoblastoma management. Abstract Intraocular surgery is tabooed in retinoblastoma management, due to the concern of lethal extraocular spread. We reviewed the outcomes of consecutive children with intraocular retinoblastoma diagnosed at 29 Chinese centers between 2012–2014. We compared the outcomes of three categories of treatment: eye salvage including tylectomy (Group I), eye salvage without tylectomy (Group II), and primary enucleation (Group III). A total of 960 patients (1243 eyes) were diagnosed: 256 in Group I, 370 in Group II, and 293 in Group III; 41 patients abandoned treatment upfront. The estimated 5-year overall survivals (OS) were, for Group I, 94%, for Group II 89%, and for Group III 95%. The estimated 5-year disease-specific survivals (DSS) were, for Group I, 96%, for Group II 90%, and for Group III 95%. Patients in Group I had a significantly higher 5-year DSS than patients in Group II (p = 0.003) and not significantly different than patients in Group III (p = 0.367). Overall survival was not compromised by the inclusion of tylectomy in eye salvage therapy compared to eye salvage without tylectomy or primary enucleation. Disease-specific survival was better when tylectomy was included in eye salvage treatments. Tylectomy as part of multimodal treatment may contribute to the care of retinoblastoma patients with chemotherapy-resistant tumor, eyes with concomitant ocular complications, or at the risk of treatment abandonment.
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Affiliation(s)
- Junyang Zhao
- Department of Ophthalmology, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou 545001, China; (J.Z.); (J.Z.)
- Pediatric Oncology Center, Beijing Children’s Hospital, Beijing 100045, China
| | - Qiyan Li
- Department of Ophthalmology, Beijing Tongren Hospital, Beijing 100730, China;
| | - Zhao Xun Feng
- Department of Ophthalmology, University of Ottawa, Ottawa, ON K1L 8L6, Canada;
| | - Jianping Zhang
- Department of Ophthalmology, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou 545001, China; (J.Z.); (J.Z.)
| | - Songyi Wu
- Quanzhou Aier Eye Hospital, Quanzhou 362017, China; (S.W.); (L.J.)
| | - Liwen Jin
- Quanzhou Aier Eye Hospital, Quanzhou 362017, China; (S.W.); (L.J.)
| | - Brenda L. Gallie
- Department of Ophthalmology and Vision Science, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Krembil Research Institute and Techna Institutes, University Health Network, Toronto, ON M5T 2S8, Canada
- Departments of Ophthalmology and Vision Science, Molecular Genetics, and Medical Biophysics, University of Toronto, Toronto, ON M5T 3A9, Canada
- Correspondence: ; Tel.: +1-416-294-9729
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Cosmai L, Porta C, Foramitti M, Perrone V, Mollica L, Gallieni M, Capasso G. Preventive strategies for acute kidney injury in cancer patients. Clin Kidney J 2020; 14:70-83. [PMID: 33564407 PMCID: PMC7857811 DOI: 10.1093/ckj/sfaa127] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Indexed: 12/13/2022] Open
Abstract
Acute kidney injury (AKI) is a common complication of cancer that occurs in up to 50% of neoplastic patients during the natural history of their disease; furthermore, it has a huge impact on key outcomes such as overall prognosis, length of hospitalization and costs. AKI in cancer patients has different causes, either patient-, tumour- or treatment-related. Patient-related risk factors for AKI are the same as in the general population, whereas tumour-related risk factors are represented by compression, obstruction, direct kidney infiltration from the tumour as well by precipitation, aggregation, crystallization or misfolding of paraprotein (as in the case of multiple myeloma). Finally, treatment-related risk factors are the most common observed in clinical practice and may present also with the feature of tumour lysis syndrome or thrombotic microangiopathies. In the absence of validated biomarkers, a multidisciplinary clinical approach that incorporates adequate assessment, use of appropriate preventive measures and early intervention is essential to reduce the incidence of this life-threatening condition in cancer patients.
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Affiliation(s)
- Laura Cosmai
- Onco-Nephrology Outpatient Clinic, Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Camillo Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari 'A. Moro', Bari, Italy.,Division of Medical Oncology, AOU Consorziale Policlinico di Bari, Bari
| | | | - Valentina Perrone
- Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Ludovica Mollica
- Division of Medical Oncology, AOU Consorziale Policlinico di Bari, Bari.,Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Maurizio Gallieni
- Department of Clinical and Biomedical Sciences 'Luigi Sacco', University of Milano, Milan, Italy.,Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy.,Biogem Research Institute, Ariano Irpino, Italy
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Larcher A, Wallis CJ, Pavan N, Porpiglia F, Takagi T, Tanabe K, Rha KH, Raheem AA, Yang B, Zang C, Perdonà S, Quarto G, Maurer T, Amiel T, Schips L, Castellucci R, Crivellaro S, Dobbs R, Baiamonte G, Celia A, De Concilio B, Furlan M, Lima E, Linares E, Micali S, Amparore D, De Naeyer G, Trombetta C, Hampton LJ, Tracey A, Bindayi A, Antonelli A, Derweesh I, Mir C, Montorsi F, Mottrie A, Autorino R, Capitanio U. Outcomes of minimally invasive partial nephrectomy among very elderly patients: report from the RESURGE collaborative international database. Cent European J Urol 2020; 73:273-279. [PMID: 33133653 PMCID: PMC7587491 DOI: 10.5173/ceju.2020.0179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 01/20/2023] Open
Abstract
The aim of the study was to perform a comprehensive investigation of clinical outcomes of robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in elderly patients presenting with a renal mass. The REnal SURGery in Elderly (RESURGE) collaborative database was queried to identify patients aged 75 or older diagnosed with cT1-2 renal mass and treated with RAPN or LPN. Study outcomes were: overall complications (OC); warm ischemia time (WIT) and 6-month estimated glomerular filtration rate (eGFR); positive surgical margins (PSM), disease recurrence (REC), cancer-specific mortality (CSM) and other-cause mortality (OCM). Descriptive statistics, Kaplan-Meier, smoothed Poisson plots and logistic and linear regression models (MVA) were used. Overall, 216 patients were included in this analysis. OC rate was 34%, most of them being of low Clavien grade. Median WIT was 17 minutes and median 6-month eGFR was 54 ml/min/1.73 m2. PSM rate was 5%. After a median follow-up of 20 months, the 5-year rates of REC, CSM and OCM were 4, 4 and 5%, respectively. At MVA predicting perioperative morbidity, RAPN relative to LPN (odds ratio [OR] 0.33; p <0.0001) was associated with lower OC rate. At MVA predicting functional outcomes, RAPN relative to LPN was associated with shorter WIT (estimate [EST] -4.09; p <0.0001), and with higher 6-month eGFR (EST 6.03; p = 0.01). In appropriately selected patients with small renal masses, minimally-invasive PN is associated with acceptable perioperative outcomes. The use of a robotic approach over a standard laparoscopic approach can be advantageous with respect to clinically relevant outcomes, and it should be preferred when available.
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Affiliation(s)
- Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | | | - Nicola Pavan
- Department of Urology, University of Trieste, Trieste, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Toshio Takagi
- Department of Urology, Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Women's Medical University, Tokyo, Japan
| | - Koon H. Rha
- Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ali Abdel Raheem
- Department of Urology, Tanta University, Tanta, Egypt; Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bo Yang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Chao Zang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Sisto Perdonà
- Division of Urology, IRCCS Fondazione G.Pascale, Naples, Italy
| | - Giuseppe Quarto
- Division of Urology, IRCCS Fondazione G.Pascale, Naples, Italy
| | - Tobias Maurer
- Department of Urology, Technical University, Munich, Germany
| | - Thomas Amiel
- Department of Urology, Technical University, Munich, Germany
| | - Luigi Schips
- Department Of Urology, Annunziata Hospital, G. D’Annunzio University, Chieti, Italy
| | - Roberto Castellucci
- Department Of Urology, Annunziata Hospital, G. D’Annunzio University, Chieti, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Ryan Dobbs
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Gianfranco Baiamonte
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | - Maria Furlan
- Department of Urology, Spedali Civili Hospital University of Brescia, Brescia, Italy
| | - Estevão Lima
- Department of CUF Urology and Service of Urology, Hospital of Braga, Braga, Portugal
| | | | - Salvatore Micali
- University of Modena and Reggio Emilia, Department of Urology, Modena, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Carlo Trombetta
- Department of Urology, University of Trieste, Trieste, Italy
| | | | | | - Ahmet Bindayi
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | - Alessandro Antonelli
- Department of Urology, Spedali Civili Hospital University of Brescia, Brescia, Italy
| | - Ithaar Derweesh
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | - Carme Mir
- Instituto Valenciano de Oncologia Foundation, Valencia, Spain
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
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5
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Achieving the "trifecta" with open versus minimally invasive partial nephrectomy. World J Urol 2020; 39:1569-1575. [PMID: 32656670 DOI: 10.1007/s00345-020-03349-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/07/2020] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The "trifecta" is a summary measure of outcome after partial nephrectomy (PN) that encompasses three parameters: negative surgical margin, ≤ 10% decrease in post-operative estimated glomerular filtration rate (eGFR) and absence of urological complications. We assessed trifecta rates in patients undergoing open (OPN), laparoscopic (LPN), and robotic PN (RPN) for a clinical T1 renal mass (≤ 7 cm). METHODS Clinical and pathologic parameters were extracted from the prospectively maintained Canadian Kidney Cancer Information System for patients treated between January 2011 and October 2018. Comparisons between groups were made using Kruskal-Wallis test for continuous variables and Chi-squared independence test for categorical variables. Multivariable analysis was performed to identify predictors of each component of the trifecta and the trifecta itself. RESULTS Of 1708 total patients, 746 underwent OPN, 678 LPN, and 284 RPN for a T1 renal mass. A 'trifecta' was achieved in 53% OPN, 52% LPN and 47% RPN (p = 0.194). On multivariable analysis, OPN and LPN were associated with less frequent post-operative decline in eGFR and more frequent trifecta when compared to RPN, but there was no difference between OPN and LPN. OPN also predicted a higher rate of negative margins compared to RPN but not LPN. CONCLUSION After correction for confounding variables, OPN and LPN were more likely than RPN to achieve the trifecta, which appeared to be due primarily to loss of renal function. No difference was observed between OPN and LPN. Analyses were limited by the lack of nephrometry score.
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Zhang XP, Huang ZX, Yu LP, Zhang XW, Li Q, Liu SJ, Xu T. [Clinical and pathological analysis of small renal cell carcinoma]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:623-627. [PMID: 31420611 DOI: 10.19723/j.issn.1671-167x.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To analyze the clinical and pathological features of small renal cell carcinoma (RCC), especially of those with diameter less than 4 cm and to understand the characteristics and factors related to recurrence and progression. METHODS A total of 200 patients with RCC were stratifiedly selected for retrospective analysis. Their baseline demographic features, tumor-specific clinical features, pathological features of renal lesions, especially microscopic features were collected. The patients were divided according to the largest diameter of renal tumor lesions. Univariate analysis was used to compare the differences between tumor staging and microscopic pathological features between the groups. Binary multivariate Logistic regression was used to investigate factors related to tumor progression and prognosis in the patients with small RCC. RESULTS The tumor diameters of 127 RCC patients were less than 4 cm and most of them had clear cell renal cell carcinoma (ccRCC). The increase in tumor diameter resulted in significantly higher T stage (P<0.01), higher WHO/International Society of Urological Pathology (ISUP) grade (P<0.05) and increasing chance of lymph node metastasis (P<0.01). Even when the tumor diameter was less than 4 cm, the patients might still have perirenal fat invasion, renal sinus invasion and greater elevated tumor grade (greater than grade 3) and synchronous lung metastasis. The incidences of intravascular thrombus (9.3% vs. 0) and tumor necrosis (27.8% vs. 5.5%) in the patients with RCC between 4-7 cm were significantly higher than those with RCC less than 4 cm (P<0.01). Sub-group analysis of small RCC (less than 4 cm) indicated that the patients with RCC between 2-4 cm were more likely to have intratumoral hemorrhage (44.7% vs. 23%, P<0.05) and necrosis than those with RCC less than 2 cm (8.2% vs. 0, P=0.095). Logistic regression analysis of small RCC showed that the incidence of tumor invasion to renal capsule was higher in ccRCC (OR=5.15, 95%CI: 1.36-19.52). Necrosis was closely related to the formation of peritumor pseudocapsule in small RCC (OR=14.90, 95%CI: 1.41-157.50). Increase in the tumor diameter was related to higher tumor grade (greater than grade 3) (OR=3.49, 95%CI: 1.11- 10.93). CONCLUSION The tumor stage and grade of small RCC (less than 4 cm) are low, but extra-renal invasion and synchronous distant metastasis may occur. Internal hemorrhage and necrosis in tumor, ccRCC subtype, along with microscopic features, such as the renal capsule invasion and perirenal pseudocapsule formation are relevant factors of malignant behavior of small RCC and could be considered in prognosis evaluation.
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Affiliation(s)
- X P Zhang
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - Z X Huang
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - L P Yu
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - X W Zhang
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - Q Li
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - S J Liu
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - T Xu
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
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Ding Y, Tan Q, Mao W, Dai C, Hu X, Hou J, Zeng M, Zhou J. Differentiating between malignant and benign renal tumors: do IVIM and diffusion kurtosis imaging perform better than DWI? Eur Radiol 2019; 29:6930-6939. [PMID: 31161315 DOI: 10.1007/s00330-019-06240-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/08/2019] [Accepted: 04/16/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To quantitatively compare the diagnostic values of conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) in differentiating between malignant and benign renal tumors. METHODS Multiple b value DWIs and DKIs were performed in 180 patients with renal tumors, which were divided into clear cell renal cell carcinoma (ccRCC), non-ccRCC, and benign renal tumor group. The apparent diffusion coefficient (ADC), true diffusivity (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), mean kurtosis (MK), and mean diffusivity (MD) maps were calculated. The diagnostic efficacy of various diffusion parameters for predicting malignant renal tumors was compared. RESULTS The ADC, D, and MD values of ccRCCs were higher, while D*, f, and MK values were lower than those of benign renal tumors (all p < 0.025). The D* and f values of non-ccRCCs were lower than those of benign renal tumors (p = 0.002 and p < 0.001, respectively). The difference of ADC, D, MD, and MK values between non-ccRCCs and benign renal tumors was not statistically significant (p > 0.05). The ADC, D, MD, and f values of ccRCCs were higher, while MK values were lower than those of non-ccRCCs (all p < 0.001). The AUC values of ADC, D, D*, f, MK, and MD were 0.849, 0.891, 0.708, 0.656, 0.862, and 0.838 for differentiating ccRCCs from benign renal tumors, respectively. The AUC values of D* and f were 0.772 and 0.866 for discrimination between non-ccRCCs and benign renal tumors, respectively. CONCLUSION IVIM parameters are the best, while DWI and DKI parameters have similar performance in differentiating malignant and benign renal tumors. KEY POINTS • The D value is the best parameter for differentiating ccRCC from benign renal tumors. • The f value is the best parameter for differentiating non-ccRCC from benign renal tumors. • Conventional DWI and DKI have similar performance in differentiating malignant and benign renal tumors.
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Affiliation(s)
- Yuqin Ding
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Qinxuan Tan
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Wei Mao
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Chenchen Dai
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Xiaoyi Hu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jun Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
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8
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White VM, Marco DJT, Bolton D, Papa N, Neale RE, Coory M, Davis ID, Wood S, Giles GG, Jordan SJ. Age at diagnosis and the surgical management of small renal carcinomas: findings from a cross-sectional population-based study. BJU Int 2018; 122 Suppl 5:50-61. [PMID: 30307688 DOI: 10.1111/bju.14585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To describe the use of partial nephrectomy (PN) for patients with stage T1a renal cell carcinoma (RCC) by age group (<65 and ≥65 years) in two Australian states. MATERIALS AND METHODS All adults diagnosed with RCC in 2012 and 2013 were identified through population-based cancer registries in the Australian states of Queensland and Victoria. For each patient, research assistants extracted patient, tumour and treatment data from medical records. Percentages of patients treated by PN were determined for the two age groups. Multivariable logistic regression analyses examined factors associated with PN. Clinicians treating RCC were sent surveys to assess attitudes towards PN. RESULTS Data were collected on 956 patients (Victoria: n = 548; Queensland: n = 404) with stage T1a RCC. Of those undergoing surgery (n = 865), PN was more common for those aged <65 years (61%) than for those aged ≥65 years (44%), with this difference significant after adjusting for patient, tumour (odds ratio 0.50, 95% confidence interval 0.36-0.70). There were significant interactions between age and treatment centre volume (P < 0.05) and residential state (P < 0.05). PN was less likely for younger patients treated at lower-volume hospitals (<24 patients a year) but hospital volume was not associated with PN for older patients. PN was less likely for older patients in Queensland than Victoria. In multivariable analyses, age was not related to laparoscopic surgery. Queensland clinicians were less likely than those from Victoria to agree that PN was the treatment of choice for most T1aN0M0 tumours (P < 0.001). CONCLUSIONS In Australia, patients aged > 65 years with small renal cancers were less likely to be treated by PN than younger patients. The variation in the surgical procedure used to treat older T1a RCC patients by state and hospital volume indicates that better evidence is needed to direct practice in this area.
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Affiliation(s)
- Victoria M White
- Deakin University, Burwood, Vic., Australia.,Cancer Council Victoria, Melbourne, Vic., Australia
| | - David J T Marco
- Centre for Palliative Care, St Vincent's Hospital, Fitzroy, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia
| | | | | | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia.,School of Public Health, The University of Queensland, Brisbane, Qld, Australia
| | | | - Ian D Davis
- Eastern Health Clinical School, Monash University, Box Hill, Vic, Australia.,Eastern Health, Box Hill, Vic, Australia
| | - Simon Wood
- Centre for Kidney Disease Research, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Qld, Australia.,Translational Research Institute, Brisbane, Qld, Australia
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia.,School of Public Health, The University of Queensland, Brisbane, Qld, Australia
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Ahn T, Ellis RJ, White VM, Bolton DM, Coory MD, Davis ID, Francis RS, Giles GG, Gobe GC, Hawley CM, Johnson DW, Marco DJT, McStea M, Neale RE, Pascoe EM, Wood ST, Jordan SJ. Predictors of new-onset chronic kidney disease in patients managed surgically for T1a renal cell carcinoma: An Australian population-based analysis. J Surg Oncol 2018; 117:1597-1610. [PMID: 29790163 DOI: 10.1002/jso.25037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/09/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND New-onset chronic kidney disease (CKD) following surgical management of kidney tumors is common. This study evaluated risk factors for new-onset CKD after nephrectomy for T1a renal cell carcinoma (RCC) in an Australian population-based cohort. METHODS There were 551 RCC patients from the Australian states of Queensland and Victoria included in this study. The primary outcome was new-onset CKD (eGFR <60 mL/min per 1.73 m2 ) and the secondary outcome was new-onset moderate-severe CKD (<45 mL/min per 1.73 m2 ). Multivariable logistic regression was used to evaluate associations between patient, tumor and health-service characteristics and these outcomes. RESULTS Forty percent (219/551) of patients developed new-onset CKD, and 12% (68/551) experienced new-onset moderate-severe CKD. Risk factors for new-onset CKD were age, lower preoperative eGFR, tumor size >20 mm, radical nephrectomy, lower hospital caseloads (<20 cases/year), and rural place of residence. The associations between rural place of residence and low center volume were a consequence of higher radical nephrectomy rates. CONCLUSION Risk factors for CKD after nephrectomy generally relate to worse baseline health, or likelihood of undergoing radical nephrectomy. Surgeons in rural centres and hospitals with low caseloads may benefit from formalized integration with specialist centers for continued professional development and case-conferencing, to assist in management decisions.
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Affiliation(s)
- Thomas Ahn
- Princess Alexandra Hospital, Brisbane, Australia
| | - Robert J Ellis
- Princess Alexandra Hospital, Brisbane, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Victoria M White
- Cancer Council Victoria, Melbourne, Australia.,Deakin University, Geelong, Australia
| | - Damien M Bolton
- Austin Health, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | | | - Ian D Davis
- Monash University, Melbourne, Australia.,Eastern Health, Melbourne, Australia
| | - Ross S Francis
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Glenda C Gobe
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Carmel M Hawley
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | | | - Megan McStea
- University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Simon T Wood
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,University of Queensland, Brisbane, Australia
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10
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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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11
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Dragomir A, Aprikian A, Kapoor A, Finelli A, Pouliot F, Rendon R, Black PC, Moore R, Breau RH, Kawakami J, Drachenberg D, Lattouf JB, Tanguay S. Follow-up imaging after nephrectomy for cancer in Canada: urologists' compliance with guidelines. An observational study. CMAJ Open 2017; 5:E834-E841. [PMID: 29229610 PMCID: PMC5741415 DOI: 10.9778/cmajo.20170005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Surgical tumour removal remains the preferred treatment for most patients with renal cell carcinoma, and many medical associations have proposed guidelines for the optimal surveillance of patients following surgery. This study evaluated the adherence of Canadian urologists to the follow-up guidelines proposed by the Canadian Urological Association (CUA) in 2009. METHODS The study cohort was identified from the Canadian Kidney Cancer Information System, a prospectively populated database from 15 academic institutions in 6 Canadian provinces: British Colombia, Alberta, Manitoba, Ontario, Quebec and Nova Scotia. A total of 1982 patients who underwent radical or partial nephrectomy for stage pT1-3N0M0 renal cancer between January 2011 and June 2016 were included in the cohort. Numbers of abdominal and chest imaging tests performed during the follow-up period were captured and compared with the 2009 CUA guidelines. The level of compliance was measured by means of weighted κ and Pearson correlation statistics. Multivariate logistic regression was used to evaluate factors associated with noncompliance (under- or overtesting) in the postoperative surveillance period. RESULTS Of the 1982 patients, 1380 had stage pT1 disease, 164 had stage pT2 disease, and 438 had stage pT3 disease. There was incongruent adherence to the CUA surveillance guidelines, with a ratio of observed to recommended tests of 0.71 and 2.27 for chest and abdominal imaging, respectively. Overall, moderate correlation between observed and recommended tests was observed, with the highest value found for abdominal imaging in the pT3 group (κ = 0.59 [95% confidence interval 0.52-0.66]). Patients who underwent radical nephrectomy and those who presented with a higher stage of the disease were less likely to receive fewer chest imaging tests than recommended, and those with stage pT2 disease, those with stage pT3 disease, those with conventional clear cell renal cell carcinoma and those with a low-risk histologic type had an increased risk of undertesting. INTERPRETATION In the 6 Canadian provinces, there are large differences between guidelines and clinical practice in imaging surveillance after nephrectomy for renal cell carcinoma. Better adherence to clinical guidelines could improve optimization of health care services.
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Affiliation(s)
- Alice Dragomir
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Armen Aprikian
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Anil Kapoor
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Antonio Finelli
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Frédéric Pouliot
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Ricardo Rendon
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Peter C Black
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Ronald Moore
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Rodney H Breau
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Jun Kawakami
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Darrell Drachenberg
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Jean-Baptiste Lattouf
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Simon Tanguay
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
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12
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Partial nephrectomy vs. radical nephrectomy for stage I renal cell carcinoma in the presence of predisposing systemic diseases for chronic kidney disease. Kaohsiung J Med Sci 2017; 33:339-343. [PMID: 28738974 DOI: 10.1016/j.kjms.2017.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 01/30/2023] Open
Abstract
Aim of this study is to compare the effects of partial nephrectomy (PN) and radical nephrectomy (RN) for stage I renal cell carcinoma (RCC) on renal functions in patients with diabetes mellitus (DM) and/or hypertension (HT). Charts of patients who underwent surgery for stage I RCC in our department were retrospectively reviewed and patients with DM and/or HT were enrolled. Preoperative and postoperative estimated glomerular filtration rates (eGFR) were calculated according to the Modification of Diet in Renal Disease (MDRD) formulation for both RN and PN groups. Groups were compared for patient demographics, preoperative eGFR, postoperative eGFR and ΔeGFR [(preoperative eGFR) - (postoperative eGFR)] which reflects the renal functional loss. There were 85 patients in the RN and 33 patients in the PN groups. Demographic data were similar but the patients in the PN group had smaller tumor size compared to RN group (32.2 ± 11.8 mm vs 47.1 ± 15.2 mm, p < 0.001). Preoperative eGFR did not differ between groups (75 ± 28.4 mL/min/1.73 m2 vs 75.5 ± 23.8 mL/min/1.73 m2 in RN and PN groups, p = 0.929). However, there were significant differences between groups in terms of postoperative eGFR (57.5 ± 21.7 mL/min/1.73 m2 vs 74 ± 27.5 mL/min/1.73 m2 in RN and PN groups, p < 0.001) and ΔeGFR (17.5 ± 4.2 mL/min/1.73 m2 vs 1.5 ± 0.4 mL/min/1.73 m2 in RN and PN groups, p < 0.001). Our findings favor the use of PN over RN for stage I RCC whenever feasible in patients with predisposing systemic diseases for chronic kidney disease for better preservation of renal functions.
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13
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Mohapatra A, Potretzke AM, Weaver J, Anderson BG, Vetter J, Figenshau RS. Trends in the Management of Small Renal Masses: A Survey of Members of the Endourological Society. J Kidney Cancer VHL 2017; 4:10-19. [PMID: 28752023 PMCID: PMC5519769 DOI: 10.15586/jkcvhl.2017.82] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/27/2017] [Indexed: 01/20/2023] Open
Abstract
Treatment modalities for small renal masses (SRMs) include open or minimally invasive radical or partial nephrectomy, and laparoscopic or percutaneous ablations. Members of the Endourological Society were surveyed to evaluate how practitioner and clinical practice characteristics may be associated with the management of SRMs over time. The survey assessed characteristics of urologists (recency of residency and fellowship training, clinical practice type and location, and treatment modalities available) and their management of SRMs over the past year and over the course of the year 5 years prior. Of the 1495 surveys e-mailed, there were 129 respondents (8.6%). Comparing the past year to 5 years prior, there was increasing utilization of robotic partial nephrectomy (p < 0.001) and robotic radial nephrectomy (p = 0.031). In contrast, there was decreasing utilization of open partial nephrectomy (p < 0.001), open radical nephrectomy (p = 0.039), laparoscopic partial nephrectomy (p = 0.002), and laparoscopic radical nephrectomy (p = 0.041). Employment of laparoscopic ablation decreased (p = 0.001), but that of percutaneous ablation did not change significantly. For masses treated with image-guided therapy, there was increasing utilization of microwave ablation (p = 0.008) and decreasing usage of radiofrequency ablation (p = 0.002). Future studies should focus on the most effective treatment modalities based on provider, patient, and tumor characteristics.
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Affiliation(s)
| | | | - John Weaver
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Barrett G. Anderson
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Joel Vetter
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert S. Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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14
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White V, Marco DJ, Bolton D, Davis ID, Jefford M, Hill D, Prince HM, Millar JL, Winship IM, Coory M, Giles GG. Trends in the surgical management of stage 1 renal cell carcinoma: findings from a population-based study. BJU Int 2017; 120 Suppl 3:6-14. [DOI: 10.1111/bju.13889] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - David J.T. Marco
- Cancer Council Victoria; Melbourne Vic. Australia
- University of Melbourne; Parkville Vic. Australia
| | | | - Ian Douglas Davis
- Monash University Eastern Health Clinical School; Box Hill Vic. Australia
- Eastern Health; Box Hill Vic. Australia
| | - Michael Jefford
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Parkville Vic. Australia
- Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - David Hill
- Cancer Council Victoria; Melbourne Vic. Australia
- University of Melbourne; Parkville Vic. Australia
| | - Henry Miles Prince
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Parkville Vic. Australia
- Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | | | | | | | - Graham G. Giles
- Cancer Council Victoria; Melbourne Vic. Australia
- University of Melbourne; Parkville Vic. Australia
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15
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Fantin JPP, de Carvalho Neiva R, Gatti M, de Arruda PF, de Arruda JGF, Antoniassi T, Spessoto LCF, Mesquita JC, Castiglioni L, Fácio-Júnior FN. Risk factors for acute renal failure in nephrectomized patients treated in a university hospital. Transl Androl Urol 2017; 6:277-281. [PMID: 28540236 PMCID: PMC5422694 DOI: 10.21037/tau.2017.03.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background New surgical techniques for nephrectomy mainly related to early diagnosis made possible by advances in imaging studies have been developed in recent decades. However, postoperative renal dysfunction is a constant concern because of the major problems faced by healthcare services and by the patients themselves. To assess risk factors for developing acute renal failure (ARF) in patients submitted to nephrectomy in a university hospital. Methods Seventy-seven patients submitted to nephrectomy for benign and malignant diseases in a university hospital were evaluated in respect to preoperative and postoperative creatinine clearance. Demographic (gender, age), clinical (cancer, diabetes, high blood pressure, chronic kidney disease) and surgical (anesthesia time, open or laparoscopic surgery) variables were also analyzed. Results Of the 77 patients, 72 met the inclusion criteria. Of these, ten (13.8%) had a diagnosis of chronic renal failure (CRF), 30 (48%) had stage I ARF and one (16.1%) had stage II ARF. The anesthesia time, type of surgery (open or laparoscopy), total or partial nephrectomy, the side of the procedure, hypertension, diabetes, CRF, renal cancer, preoperative and postoperative creatinine concentrations were analyzed. Only the difference between preoperative and postoperative creatinine clearance was clinically significant (P<0.001). Conclusions An altered preoperative renal function is a risk factor for the development of ARF in nephrectomized patients.
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Affiliation(s)
- João Paulo Pretti Fantin
- Resident in Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - Ronaldo de Carvalho Neiva
- Resident in Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - Marcio Gatti
- Department of Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - Pedro Ferraz de Arruda
- Department of Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | | | - Thiago Antoniassi
- Department of Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - Luís Cesar Fava Spessoto
- Department of Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - José Carlos Mesquita
- Department of Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - Lilian Castiglioni
- Department of Biostatistics, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - Fernando-Nestor Fácio-Júnior
- Department of Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
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16
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Speed JM, Trinh QD, Choueiri TK, Sun M. Recurrence in Localized Renal Cell Carcinoma: a Systematic Review of Contemporary Data. Curr Urol Rep 2017; 18:15. [PMID: 28213859 DOI: 10.1007/s11934-017-0661-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Patients with localized renal cell carcinoma (RCC) are at risk of recurrence. The purpose of this review was to characterize the literature on recurrence rates and risk factors after diagnosis of localized RCC. RECENT FINDINGS Our search revealed that existing data examining the prevalence of recurrence rates predominantly originates from cohorts of patients diagnosed and treated in the 1980s to 1990s, and may therefore not be as useful for counseling for current patients today. Many nomograms including the Cindolo Recurrence Risk Formula, the University of California-Los Angeles (UCLA) Integrated Scoring System (UISS), the SSIGN score, the Kattan nomogram, and the Karakiewicz nomogram have shown value in identifying patients at higher risk for recurrence. Biomarkers and gene assays have shown promise in augmenting the predictive accuracy of some of the aforementioned predictive models, especially when multiple gene markers are used in combination. However, more work is needed in not only developing a model but also validating it in other settings prior to clinical use. Adjuvant therapy is a promising new treatment strategy for patients with high-risk disease. Importantly, too many surveillance strategies exist. This may stem from the lack of a consensus in the urological community in how to follow these patients, as well as the variable guideline recommendations. In conclusion, contemporary recurrence rates are needed. Recurrence risk prediction models should be developed based on a series of more contemporary patients, and externally validated prior to routine clinical practice. Surveillance strategies following treatment of localized RCC need to be identified and standardized. Finally, there is a trend toward personalizing surveillance regimens to more appropriately screen patients at higher risk of recurrence.
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Affiliation(s)
- Jacqueline M Speed
- Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - Quoc-Dien Trinh
- Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, Dana 1230, 44 Binney St., Boston, MA, 02215, USA
| | - Maxine Sun
- Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA.
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17
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Wallis CJ, Garbens A, Chopra S, Gill IS, Satkunasivam R. Robotic Partial Nephrectomy: Expanding Utilization, Advancing Innovation. J Endourol 2017; 31:348-354. [DOI: 10.1089/end.2016.0639] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Christopher J.D. Wallis
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Alaina Garbens
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Sameer Chopra
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Inderbir S. Gill
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Raj Satkunasivam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
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18
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Mouracade P, Kara O, Maurice MJ, Dagenais J, Malkoc E, Nelson RJ, Kaouk JH. Patterns and Predictors of Recurrence after Partial Nephrectomy for Kidney Tumors. J Urol 2016; 197:1403-1409. [PMID: 27993666 DOI: 10.1016/j.juro.2016.12.046] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE We sought to identify patterns and predictors of recurrence in patients with clinically localized renal cell carcinoma managed by partial nephrectomy. MATERIALS AND METHODS We performed a retrospective study of 830 consecutive cases of partial nephrectomy done between 2007 and 2015 for clinically localized renal cell carcinoma at a single institution. Patient demographics and pathological characteristics were correlated with recurrence patterns (overall, local and distant) and overall survival using Kaplan-Meier and Cox regression analyses. Differences in the recurrence patterns were evaluated. RESULTS Median patient age was 61 years and median tumor size was 3.1 cm. Overall, 11.6% of tumors were stage pT3, 39.3% were high grade, 2.9% had lymphovascular invasion and 7.1% had positive margins. Higher grade, higher stage, positive surgical margins and increased R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of deepest tumor portion to collecting system or sinus, anterior/posterior and location relative to polar line) score were associated with shorter disease-free survival on Kaplan-Meier analysis. On multivariable regression pT (p <0.01), grade (p <0.01) and R.E.N.A.L. score (p = 0.03) remained independent predictors of disease-free survival. Predictors of metastasis were pT stage (HR 4.5) and grade (HR 3.9, both p <0.01), while R.E.N.A.L. score (HR 3.2, p = 0.03) was the single predictor of local recurrence. Five-year disease-free and overall survival probabilities were 91% and 94%, respectively. Local recurrence manifested and developed earlier than metastasis (median 13 vs 22 months, p <0.01). CONCLUSIONS High pT stage, high grade and high R.E.N.A.L. score increase the risk of disease recurrence after partial nephrectomy. The pT stage and grade are predictors of metastasis, while R.E.N.A.L. score predicts local recurrence. Because relapse features and risk factors differ between the 2 recurrence patterns, they should be studied separately in the future.
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Affiliation(s)
- Pascal Mouracade
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Onder Kara
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Matthew J Maurice
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Julien Dagenais
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ercan Malkoc
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan J Nelson
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
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