1
|
Jin DD, Lin JH, Li SH, Zhuang BW, Xie XY, Xie XH, Wang Y. Ultrasound findings and clinical characteristics in differentiating renal urothelial carcinoma from endophytic clear cell renal cell carcinoma. Clin Hemorheol Microcirc 2024:CH242119. [PMID: 38995769 DOI: 10.3233/ch-242119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
OBJECTIVE This study aimed to evaluate the clinical characteristics and features of conventional ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) in differentiating between renal urothelial carcinomas (RUC) and endophytic clear cell renal cell carcinomas (EccRCC). METHODS A total of 72 RUCs and 120 EccRCCs confirmed by pathology were assessed retrospectively. Both CUS and CEUS were performed within 4 weeks before the surgery. Logistic regression analyses were used to select statistically significant variables of clinical, CUS, and CEUS features for the differentiation of RUC and EccRCC. Sensitivity (SEN), specificity (SPE), and the area under the receiver-operating characteristic curve (AUC) were assessed for diagnostic performance. Inter- and intra-observer agreements of CUS and CEUS features were evaluated using the intra-class correlation coefficient(ICC). RESULTS Multiple logistic regression analysis demonstrated that clinical (age >50 years old and hematuria), CUS (size <4.0 cm, hypo-echogenicity, irregular shape, hydronephrosis) and CEUS (absence of non-enhancement area, iso- /hypo-enhancement in cortical phase and absence of rim-like enhancement) features were independent factors for RUC diagnosis. When combining clinical characters with CUS and CEUS features into an integrated diagnostic criterion, the AUC reached 0.917 (95% CI 0.873-0.961), with a sensitivity of 95.8% and specificity of 87.5%. ICC ranged from 0.756 to 0.907 for inter-observer agreement and 0.791 to 0.934 for intra-observer agreement for CUS and CEUSfeatures. CONCLUSIONS The combination of clinical features of age and hematuria with imaging features of CUS and CEUS can be useful for the differentiation between RUC and EccRCC.
Collapse
Affiliation(s)
- Dong-Dong Jin
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jin-Hua Lin
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shi-Hui Li
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bo-Wen Zhuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Hua Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yan Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
2
|
Bing X, Wang N, Li Y, Sun H, Yao J, Li R, Li Z, Ouyang A. The Value of Dual-Energy Computed Tomography-Based Radiomics in the Evaluation of Interstitial Fibers of Clear Cell Renal Carcinoma. Technol Cancer Res Treat 2024; 23:15330338241235554. [PMID: 38404055 PMCID: PMC10896050 DOI: 10.1177/15330338241235554] [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: 08/17/2023] [Revised: 12/27/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVE We investigated the potential of dual-energy computed tomography (DECT) radiomics in assessing cancer-associated fibroblasts in clear cell renal carcinoma (ccRCC). METHODS A retrospective analysis was conducted on 132 patients with ccRCC. The arterial and venous phase iodine-based material decomposition images (IMDIs), virtual non-contrast images, 70 keV, 100 keV, and 150 keV virtual monoenergetic images, and mixed energy images (MEIs) were obtained from the DECT datasets. On the Radcloud platform, radiomics feature extraction, feature selection, and model establishment were performed. Seven radiomics models were established using the support vector machine. The predictive performance was evaluated by utilizing receiver operating characteristic and the area under the curve (AUC) was calculated. Nomograms were constructed. RESULTS The combined model demonstrated high efficiency in evaluating pseudocapsule thickness with AUC, specificity, and sensitivity of 0.833, 0.870, and 0.750, respectively in the validation set, surpassing those of other models. The precision, F1-score, and Youden index were also higher for the combined model. For evaluating the number of collagen fibers, the combined model exhibited the highest AUC (0.741) among all models, with a specificity of 0.830 and a sensitivity of 0.330. The AUC in the 150 kv model and IMDI model were slightly lower than those in the combined model (0.728 and 0.710, respectively), with corresponding sensitivity and specificity of 0.560/0.780 and 0.670/0.830. The nomogram exhibited that Rad-score had good prediction efficiency. CONCLUSION DECT radiomics features have significant value in evaluating the interstitial fibers of ccRCC. The combined model of IMDI + MEI exhibits superior performance in assessing the thickness of the pseudocapsule, while the combined, 150 keV, and IMDI models demonstrate higher efficacy in evaluating collagen fiber number. Radiomics, combined with imaging features and clinical features, has excellent predictive performance. These findings offer crucial support for the clinical diagnosis, treatment, and prognosis of ccRCC and provide valuable insights into the application of DECT.
Collapse
Affiliation(s)
- Xue Bing
- Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, P.R. China
| | - Ning Wang
- Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, P.R. China
| | - Yuhan Li
- Department of Radiology, Longkou Traditional Chinese Medicine Hospital, Yantai, P.R. China
| | - Haitao Sun
- Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, P.R. China
| | - Jian Yao
- Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, P.R. China
| | - Ruobing Li
- Department of Radiology, Shandong First Medical University, Jinan, P.R. China
| | - Zhongyuan Li
- School of Medical Imaging, Weifang Medical University, Weifang, P.R. China
| | - Aimei Ouyang
- Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, P.R. China
| |
Collapse
|
3
|
Dong X, Pan S, Zhou X, Ma W, Guo H, Gan W. Characteristics of peritumoral pseudocapsule in small renal cell carcinoma and its influencing factors. Cancer Med 2023; 12:1260-1268. [PMID: 35766142 PMCID: PMC9883584 DOI: 10.1002/cam4.4991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/21/2022] [Accepted: 06/13/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the peritumoral pseudocapsule (PC) status and identify the factors influencing PC status in small renal cell carcinoma (RCCs). METHODS A total of 147 patients with small RCC (≤4 cm) who had undergone tumor enucleation (TE) were assigned into three groups according to PC status: complete PC, PC absence, and PC invasion. Computed tomography (CT) imaging and clinicopathological features were compared among the three groups. Univariate and multivariate analyses were performed to identify factors associated with incomplete PC. RESULTS The number of patients with complete PC, PC absence, and PC invasion was 87 (59%), 20 (14%), and 40 (27%), respectively. Compared with the other two groups, tumors with complete PC were most common in clear cell RCC (CCRCC) and showed a hyperenhancement pattern (92%) and clear boundary (63%) on CT scanning images (p < 0.001). PC absence was most common in female patients (50%), whereas PC invasion was more common in male patients (85%) (p = 0.017). The tumor diameter in the PC absence group (2.24 ± 0.93 cm) was shorter compared with that of the complete PC group (2.88 ± 0.76 cm) and PC invasion group (3.16 ± 0.64 cm) (p < 0.001). Univariate and multivariate analysis showed that hypoenhancement pattern, unclear boundary, and non-CCRCC subtype were independent risk factors of incomplete PC. CONCLUSIONS Hypoenhancement pattern, unclear boundary, and non-CCRCC subtype were significant predictors of incomplete PC in small RCCs. It remains to be established whether TE is an appropriate procedure for patients with incomplete PC.
Collapse
Affiliation(s)
- Xiang Dong
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Sheng Pan
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaodie Zhou
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Wenliang Ma
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weidong Gan
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Urology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| |
Collapse
|
4
|
Xi W, Hou Y, Hu X, Xia Y, Jiang S, Wang H, Bai Q, Hou J, Guo J. Prognostic significance of pseudocapsule status in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors. Transl Androl Urol 2022; 10:4132-4141. [PMID: 34984179 PMCID: PMC8661261 DOI: 10.21037/tau-21-429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/22/2021] [Indexed: 11/06/2022] Open
Abstract
Background We sought to determine whether pseudocapsule (PS) features have prognostic implications in patients with metastatic renal cell carcinoma (mRCC). Methods We retrospectively reviewed 231 patients diagnosed with mRCC and treated with tyrosine kinase inhibitors; 188 patients with data available regarding the tumor-parenchyma interfacial PS of the primary tumor were enrolled for analysis. PS status was evaluated as intact (grade 0), merely involved (grade 1), penetrated (grade 2), and absent (grade 3). We applied the Kaplan-Meier method and Cox regression model to assess the survival impact. Results Of the 188 patients, 19 (10.1%), 61 (32.4%), 96 (51.1%) and 12 (6.4%) had grade 0, 1, 2 and 3 PS, respectively. PS status was significantly associated with histology (P=0.0206), venous tumor embolus (P=0.0511), microvascular invasion (P=0.0108) and microsatellite formation (P=0.0097). Patients without a PS had the worst overall survival (OS), with a 3-year OS rate of 12.7%, whereas the OS rates for grades 0, 1 and 2 were 78.8%, 50.8% and 43.6%, respectively. Adjusted by other variables, grade 3 and grade 2 PS gave rise to a much higher risk of death across the cohort [hazard ratio (HR) =5.217, P=0.0182; HR =3.765, P=0.0281, respectively]. Sarcomatoid change was also an independent factor for OS (HR =2.932, P=0.0075). In contrast, microsatellite formation was not associated with survival in the cohort. Conclusions PS status has prognostic implications for OS in metastatic renal cancer. The absence of the PS and sarcomatoid change are two pathological features related to an extremely poor prognosis.
Collapse
Affiliation(s)
- Wei Xi
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyi Hu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu Xia
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuai Jiang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hang Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Bai
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
5
|
Ma Y, Xu X, Pang P, Wen Y. A CT-Based Tumoral and Mini-Peritumoral Radiomics Approach: Differentiate Fat-Poor Angiomyolipoma from Clear Cell Renal Cell Carcinoma. Cancer Manag Res 2021; 13:1417-1425. [PMID: 33603485 PMCID: PMC7886092 DOI: 10.2147/cmar.s297094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/20/2021] [Indexed: 01/13/2023] Open
Abstract
Objective This study aimed to evaluate the role of tumor and mini-peritumor in the context of CT-based radiomics analysis to differentiate fat-poor angiomyolipoma (fp-AML) from clear cell renal cell carcinoma (ccRCC). Methods A total of 58 fp-AMLs and 172 ccRCCs were enrolled. The volume of interest (VOI) was manually delineated in the standardized CT images and radiomics features were automatically calculated with software. After methods of feature selection, the CT-based logistic models including tumoral model (Ra-tumor), mini-peritumoral model (Ra-peritumor), perirenal model (Ra-Pr), perifat model (Ra-Pf), and tumoral+perirenal model (Ra-tumor+Pr) were constructed. The area under curves (AUCs) were calculated by DeLong test to evaluate the efficiency of logistic models. Results The AUCs of Ra-peritumor of nephrographic phase (NP) were slightly higher than those of corticomedullary phase (CMP). Furthermore, the Ra-Pr showed significant higher efficiency than the Ra-Pf, and relative more optimal radiomics features were selected in the Ra-Pr than Ra-Pf. The Ra-tumor+Pr combined tumoral and perirenal radiomics analysis was of most significant in distinction compared with Ra-tumor and Ra-peritumor. Conclusion The validity of NP to differentiate fp-AML from ccRCC was slightly higher than that of CMP. To the NP analysis, the Ra-Pr was superior to the Ra-Pf in distinction, and the lesions invaded to the perirenal tissue more severely than to the perifat tissue. It is important to the individual therapeutic surgeries according to the different lesion location. The pooled tumoral and perirenal radiomics analysis was the most promising approach in distinguishing fp-AML and ccRCC.
Collapse
Affiliation(s)
- Yanqing Ma
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310000, People's Republic of China
| | - Xiren Xu
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310000, People's Republic of China
| | - Peipei Pang
- Department of Pharmaceuticals Diagnosis, GE Healthcare, Hangzhou, 310000, People's Republic of China
| | - Yang Wen
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310000, People's Republic of China
| |
Collapse
|
6
|
Ficarra V, Caloggero S, Rossanese M, Giannarini G, Crestani A, Ascenti G, Novara G, Porpiglia F. Computed tomography features predicting aggressiveness of malignant parenchymal renal tumors suitable for partial nephrectomy. Minerva Urol Nephrol 2020; 73:17-31. [PMID: 33200903 DOI: 10.23736/s2724-6051.20.04073-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The aim of this study was to identify and standardize computed tomography (CT) features having a potential role in predicting aggressiveness of malignant parenchymal renal tumors suitable for partial nephrectomy (PN). We performed a non-systematic review of the recent literature to evaluate the potential impact of CT variables proposed by the Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma in predicting aggressiveness of newly diagnosed malignant parenchymal renal tumors. The analyzed variables were clinical tumor size, tumor growth rate, enhancement characteristics, amount of cystic component, polar and capsular location, tumor margins and distance between tumor and renal sinus. Unfavorable behavior was defined as: 1) renal cell carcinoma (RCC) with stage ≥pT3; 2) nuclear grade 3 or 4; 3) presence of sarcomatoid de-differentiation; or 4) non-clear cell subtypes with unfavorable prognosis (type 2 papillary RCC, collecting duct or renal medullary carcinoma, unclassified RCC). Beyond clinical tumor size, tumor growth rate, enhancement characteristics, amount of cystic component, tumor margins and distance between tumor and renal sinus are highly relevant features predicting an unfavorable behavior. Moreover, several studies supported the role of necrosis as preoperative predictor of tumor aggressiveness. Peritumoral and intratumoral vasculature as well as capsule status are emerging variables that need to be further evaluated. Tumor size, enhancement characteristics, tumor margins and distance to the renal sinus are highly relevant CT features predicting biological aggressiveness of malignant parenchymal renal tumors. Combination of these parameters might be useful to generate tools to predict the unfavorable behavior of renal tumors suitable for PN.
Collapse
Affiliation(s)
- Vincenzo Ficarra
- Unit of Urology, Department of Human and Pediatric Pathology "Gaetano Barresi", G. Martino University Hospital, University of Messina, Messina, Italy -
| | | | - Marta Rossanese
- Unit of Urology, Department of Human and Pediatric Pathology "Gaetano Barresi", G. Martino University Hospital, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Unit of Urology, Academic Medical Center "Santa Maria della Misericordia", Udine, Italy
| | | | - Giorgio Ascenti
- Department of Radiology, University of Messina, Messina, Italy
| | - Giacomo Novara
- Unit of Urology, Department of Oncological, Surgical and Gastrointestinal Sciences, University of Padua, Padua, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| |
Collapse
|
7
|
Multiphoton Microscopic Study of the Renal Cell Carcinoma Pseudocapsule: Implications for Tumour Enucleation. Urology 2020; 144:249-254. [PMID: 32681916 DOI: 10.1016/j.urology.2020.06.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/12/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To utilize Multiphoton Microscopy (MPM) as a novel imaging technique to characterize and quantify collagen at the Renal Cell Carcinoma Pseudocapsule, to assess for both intra-tumoral and inter-tumoral variation of collagen characteristics. MPM combines Second Harmonic Generation and Two Photon Excitation Fluorescence to image extracellular matrix architecture. METHODS Twenty partial nephrectomy specimen tissues were retrieved, cut into 5-micron sections, mounted on slides and deparaffinized. The pseudocapsules (PCs) were imaged with 2X and 20X objective at selected Regions of Interest. Corresponding clinical information was retrieved. PC thickness was determined. Collagen parameters measured included quantification by the Collagen Area Ratio, and qualitative measurements by the Collagen Fiber Density and Collagen Reticulation Index. RESULTS The boundaries between tumor, PC and normal renal parenchyma were distinguished by MPM without need for staining. In the thickest areas of the PC, collagen content and density were quantitatively higher compared to the thinnest areas. Median Collagen Area Ratio was higher in the thickest compared to the thinnest areas of the PC (P = .01). Clear Cell RCC specimens had a consistently higher Collagen Fiber Density in both the thickest and thinnest areas compared to non-Clear Cell RCC specimens (P = .02). CONCLUSIONS We demonstrated the ability of MPM to quantify collagen characteristics of PCs without fluorescent labeling. Tumor enucleation for Renal Cell Carcinoma along its PC remains debatable with regards to oncological safety. Even with a complete and intact PC, the PC is not a homogenous structure, and varies in its thickness and its collagen characteristics within, and between tumors.
Collapse
|
8
|
Jiang YL, Peng CX, Wang HZ, Qian LJ. Comparison of the long-term follow-up and perioperative outcomes of partial nephrectomy and radical nephrectomy for 4 cm to 7 cm renal cell carcinoma: a systematic review and meta-analysis. BMC Urol 2019; 19:48. [PMID: 31174522 PMCID: PMC6554915 DOI: 10.1186/s12894-019-0480-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/27/2019] [Indexed: 01/25/2023] Open
Abstract
Background The efficacy of partial nephrectomy (PN) for T1b renal cell carcinoma (RCC) is controversial. The oncological outcomes, the change in postoperative renal function and the perioperative complications are unclear. Methods We searched PUBMED, EMBASE and the Cochrane Central Register for studies from March 1998 to March 2018 for studies comparing PN to radical nephrectomy (RN) for the treatment of T1b RCC. After data extraction and quality assessment, we used RevMan 5.2 to pool the data. Then, we used Stata 12.0 to perform sensitivity analyses and meta-regression. We used the GRADE profiler to evaluate the evidence according to the GRADE approach. Results A total of 16 studies involving 33,117 patients were included in our meta-analysis. No significant difference was found in the 5-year overall survival (OS), 10-year OS, 5-year recurrence-free survival (RFS) and 10-year RFS. The 5-year cancer-special survival (CSS) and 10-year CSS were better in RN compared to PN, respectively, at RR = 1.02, P < 0.05 and RR = 1.04, P < 0.05. PN was better than RN in the preservation of renal function (WMD = -9.15, 95% CI: − 10.30 to − 7.99, P < 0.05). The confidence level grading of the evidence was moderate for 5-year OS, 10-year OS, 5-year CSS, 10-year CSS, 5-year RFS, 10-year RFS, tumor recurrence, decline in eGFR, and postoperative complications. Conclusions PN may provide comparable outcomes in terms of RFS & OS, and better renal function preservation although CSS was worse. Electronic supplementary material The online version of this article (10.1186/s12894-019-0480-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yu-Li Jiang
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China. .,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China.
| | - Cheng-Xia Peng
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China
| | - Heng-Zi Wang
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China
| | - Lu-Jie Qian
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China
| |
Collapse
|
9
|
Lu Z, Zhou J, Yang C, Zhang L, Tai S, Yin Y, Liang C. The feasibility and safety of modified robot-assisted enucleation for highly complex renal tumors: research on a surgical technique. Transl Cancer Res 2019; 8:761-769. [PMID: 35116814 PMCID: PMC8798219 DOI: 10.21037/tcr.2019.04.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND To report the technical feasibility and oncological safety of modified robot-assisted enucleation for highly complex renal tumors using the combined retroperitoneoscopic and transperitoneoscopic accesses. METHODS The present research is a retrospective analysis of 166 cases of highly complex renal tumors that underwent a partial nephrectomy at a tertiary academic institution between September 2014 and August 2017. Consecutive consented patients were grouped into two cohorts. Seventy-two cases underwent conventional robot-assisted partial nephrectomy (C-RAPN), and 94 cases were treated with modified robot-assisted tumor enucleation (MRATE). The perioperative and oncological outcomes of both groups were reported. Furthermore, pathological examinations of 225 cases of highly complex renal tumors treated with radical nephrectomy were analyzed. RESULTS Although preoperative clinical data were similar between the two groups, the perioperative outcomes were distinctly different. Total renal function at postoperative day 1 was better (P<0.001), and the surgical margin width was narrower (P<0.001) in the MRATE group. In addition, the MRATE group presented less blood loss (143.29 and 90.76 mL; P<0.001) and lower 30-d complication rates (4.2% and 16.7%, respectively; P=0.033). Mean ischemia time and operative time was 3 and 14 minutes shorter in the MRATE group, respectively. Finally, histopathological analysis of 225 cases of renal tumors with high surgical complexity provided objective evidence for the feasibility of MRATE. CONCLUSIONS MRATE technique may offer an efficient and safe method to treat anatomically complex renal masses in referral centers. The long-term outcome of MRATE technique merits further investigation.
Collapse
Affiliation(s)
- Zhaoxiang Lu
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
- Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei 230022, China
- Department of Urology, the Chao Hu Hospital of Anhui Medical University, Hefei, China
| | - Jun Zhou
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
- Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei 230022, China
| | - Cheng Yang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
- Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei 230022, China
| | - Li Zhang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
- Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei 230022, China
| | - Sheng Tai
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
- Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei 230022, China
| | - Yu Yin
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
- Department of Pathology, Anhui Medical University, Hefei 230022, China
| | - Chaozhao Liang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
- Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei 230022, China
| |
Collapse
|
10
|
Chen FM, Hu RJ, Jiang XN, Zhong SW, Tang S. The correlation between affected renal function and affected renal residual volume: A retrospective outcome of laparoscopic nephron-sparing partial nephrectomy with segmental renal artery blocking-up for localized renal tumors. Medicine (Baltimore) 2019; 98:e13927. [PMID: 30633167 PMCID: PMC6336637 DOI: 10.1097/md.0000000000013927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Laparoscopic nephron-sparing partial nephrectomy with segmental renal artery blocking (SRPN) has been widely used in the treatment of localized renal tumors. However, the impact of ischemia-reperfusion injury (IRI) during SRPN remains controversial. This study aims to evaluate the correlation between affected renal function and affected renal volume after SRPN for localized renal tumor treatment, explore the effect of IRI on renal function after SRPN.A total of 39 patients who underwent SRPN for localized renal tumor from June 2009 to April 2012 were reviewed. These patients were followed-up for 5 years. The preoperative affected renal glomerular filtration rate (aGFRpre), postoperative affected renal glomerular filtration rate (aGFRpost), preoperative affected renal volume (aVolpre), and postoperative affected renal volume (aVolpost) were collected during the follow-up period. The correlation between aGFRpost/aGFRpre and aVolpost/aVolpre was compared.A total of 33 patients were successfully followed up. After 3, 6, 12, 24, and 60 months, aGFRpost was 34.6 ± 4.6, 34.7 ± 4.8, 34.9 ± 4.4, 35.1 ± 4.4, and 35.2 ± 4.2 mL/min. The correlation coefficients between aGFRpost/aGFRpre and aVolpost/aVolpre were 0.659 (P = .000), 0.667 (P = .000), 0.663 (P = .000), 0.629 (P = .000), and 0.604 (P = .000), respectively. The limitation of this study was the small cohort size.For the localized renal tumor, aGFRpost was associated with aVolpost, but was not associated with intraoperative factors, such as the time of clamping of the affected segmental renal artery. As a part of nephrons, the resected tumor tissue caused the lack of inherent nephrons, resulting in the loss of renal function. More nephrons should be maintained before resecting the tumor completely during SRPN.Trial registration: ChiCTR-RRC-17011418.
Collapse
Affiliation(s)
- Fang-Min Chen
- Department of Urology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cell; Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin
| | - Rui-Jie Hu
- The First People's Hospital of Jiujiang City, Jiujiang, Jiangxi
| | - Xi-Nan Jiang
- Department of Urology, Affliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Si-Wen Zhong
- Department of Urology, Affliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Shuai Tang
- Department of Urology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cell; Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin
| |
Collapse
|
11
|
Sidhaye VK, Nishida K, Martinez FJ. Precision medicine in COPD: where are we and where do we need to go? Eur Respir Rev 2018; 27:180022. [PMID: 30068688 PMCID: PMC6156790 DOI: 10.1183/16000617.0022-2018] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) was the fourth leading cause of death worldwide in 2015. Current treatments for patients ease discomfort and help decrease disease progression; however, none improve lung function or change mortality. COPD is heterogeneous in its molecular and clinical presentation, making it difficult to understand disease aetiology and define robust therapeutic strategies. Given the complexity of the disease we propose a precision medicine approach to understanding and better treating COPD. It is possible that multiOMICs can be used as a tool to integrate data from multiple fields. Moreover, analysis of electronic medical records could aid in the treatment of patients and in the predictions of outcomes. The Precision Medicine Initiative created in 2015 has made precision medicine approaches to treat disease a reality; one of these diseases being COPD.
Collapse
Affiliation(s)
- Venkataramana K. Sidhaye
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Dept of Environmental Health and Engineering, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Kristine Nishida
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| |
Collapse
|