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Yang F, Jiang H, Gao X, Chen H, Zhao W, Zhu Y, Han L, Zeng L, Zhang L, Chen R. Multiorgan Transplant From a Donor With Solid Renal Masses: An Initial Experience and Clinical Considerations. Transplant Proc 2021; 53:2503-2508. [PMID: 34482997 DOI: 10.1016/j.transproceed.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/29/2021] [Accepted: 08/02/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with early-stage renal cell carcinoma (RCC) are considered to be eligible donors. Although preliminary experience in using kidneys of specific pathologic types, mainly those with small renal masses (SRMs), have been established, multiorgan utilization of the same donor with SRMs is limited. METHODS One deceased donor whose left-side kidney was diagnosed with Fuhrman grade I RCC was included. The tumor mass in the kidney was removed through partial nephrectomy according to the gold standard. Then, 3 transplant surgeries were performed, in which 1 recipient accepted kidney transplant after tumor exeresis, 1 simultaneous heart-kidney (the contralateral one) transplant, and 1 liver transplant. Recipients were followed up according to our standard protocol for renal cancers. (All allografts were allocated in compliance with the Declaration of Helsinki and the Declaration of Istanbul.) RESULTS: After 32 months, no radiographic findings showed any morphologic changes of the lesion, and all patients were in good condition, with neither tumor recurrence nor allograft rejection or infection. No complaints such as pain, oliguria, dyspnea, nausea, or fatigue were recorded. CONCLUSIONS To the best of knowledge, this initial work takes the lead in elaborating the organ utilization of multiorgan donors with SRMs. We hope the experience will provide support for cross discussion concerned with multiorgan transplant from tumor-affected donors in clinical practices, further expand the donor pool and address the donor shortage problem.
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Affiliation(s)
| | | | | | | | | | | | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Li Zeng
- Department of Organ Transplantation
| | | | - Rui Chen
- Department of Organ Transplantation.
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Papillary renal cell carcinoma: Review. Urol Oncol 2021; 39:327-337. [PMID: 34034966 DOI: 10.1016/j.urolonc.2021.04.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 01/20/2023]
Abstract
Kidney cancer is the 13th most common malignancy globally, and the incidence is rising. Papillary renal cell carcinoma is the second most common subtype, comprising 10-15% of renal cell carcinomas. Though the histologic features of this subtype were initially described in the 1990's, our understanding of the genetic and molecular characteristics of this disease have rapidly evolved over the past decade. In this review, we summarize the contemporary understanding of the clinical, morphologic, radiographic, and genetic characteristics of papillary renal cell carcinoma, as well as clinical considerations, current options for management, and prognosis.
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Abstract
It is estimated that up to 2% of renal cell cancer (RCC) clusters in families. Several forms of hereditary RCC have been characterized with specific clinical, histopathological, and genetic features. The most common of these is von Hippel-Lindau (VHL) disease caused by mutations in the VHL gene and predisposing to clear cell RCC. Predisposition to papillary RCC is present in hereditary leiomyomatosis and renal cell cancer (HLRCC) and hereditary papillary renal cell carcinoma (HPRC). Identification of the genetic defects causing these diseases has enlightened the molecular pathogenesis of RCC, and moreover, provided means to improve patient management. Genetic testing enables early diagnosis of the disease, after which individuals at-risk can be guided to regular surveillance. Screening facilitates detection of presymptomatic early tumors broadening treatment options and potentially improving prognosis. Thus, identification of individuals with inherited cancer susceptibility is important as special management of these patients improves disease outcome. The purpose of this review is to provide clues for identification and management of hereditary renal cancer patients in clinical practice.
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Affiliation(s)
- M Kiuru
- Department of Medical Genetics, University of Helsinki, Helsinki, Finland
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4
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Volpe A, Bollito E, Bozzola C, Di Domenico A, Bertolo R, Zegna L, Duregon E, Boldorini R, Porpiglia F, Terrone C. Classification of Histologic Patterns of Pseudocapsular Invasion in Organ-Confined Renal Cell Carcinoma. Clin Genitourin Cancer 2015; 14:69-75. [PMID: 26337654 DOI: 10.1016/j.clgc.2015.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/30/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED A standardized histologic definition and classification of the patterns of renal tumor pseudocapsular invasion (RTPI) in renal cell carcinoma (RCC) is not available. We classified RTPI into 2 main histologic patterns: expansive and infiltrative RTPI. Patients with organ-confined RCC and infiltrative RTPI had a greater risk of cancer-specific death and might require stricter postoperative surveillance strategies. INTRODUCTION A standardized histologic definition and classification of patterns of renal tumor pseudocapsular invasion (RTPI) in renal cell carcinoma (RCC) is not available. The aim of the present study was to propose a classification of RTPI patterns and assess their correlation with other pathologic features and prognosis. PATIENTS AND METHODS The renal tumor pseudocapsule was assessed by 2 expert genitourinary pathologists on the histologic slides of 190 specimens from radical nephrectomy performed for organ-confined (pT1-pT2) RCC. The histologic patterns of RTPI were classified and described. The association between the RTPI patterns and other pathologic features was assessed. The Kaplan-Meier method was used to calculate the survival functions, and Cox regression models were used to assess the predictors of cancer-specific survival. RESULTS RTPI was classified into 2 main histologic patterns (expansive and infiltrative). Expansive and infiltrative RTPI was observed in 39.5% and 51.6% of cases, respectively. A significant association between the RTPI pattern and Fuhrman grade (P = .006) and RCC histologic subtype (P = .034) was detected. Patients with infiltrative pseudocapsular invasion had significantly poorer 5- and 10-year cancer-specific survival rates than patients with expansive invasion or no invasion (93.6% vs. 98.9% and 84.9% vs. 93%, respectively; P = .039). The presence of infiltrative pseudocapsular invasion was a significant predictor of cancer-specific survival (hazard ratio 4.38, 95% confidence interval 1.04-20.27). CONCLUSION An expansive and an infiltrative RTPI pattern can be described. In our study, patients with organ-confined RCC and an infiltrative RTPI pattern had a greater risk of cancer-specific death and might require stricter postoperative surveillance strategies.
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Affiliation(s)
- Alessandro Volpe
- Divisions of Urology and Pathology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy.
| | - Enrico Bollito
- Divisions of Urology and Pathology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Cristina Bozzola
- Divisions of Urology and Pathology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Antonia Di Domenico
- Divisions of Urology and Pathology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Riccardo Bertolo
- Divisions of Urology and Pathology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Luisa Zegna
- Divisions of Urology and Pathology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Eleonora Duregon
- Divisions of Urology and Pathology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Renzo Boldorini
- Divisions of Urology and Pathology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Francesco Porpiglia
- Divisions of Urology and Pathology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Carlo Terrone
- Divisions of Urology and Pathology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
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The subclassification of papillary renal cell carcinoma does not affect oncological outcomes after nephron sparing surgery. World J Urol 2015; 34:347-52. [DOI: 10.1007/s00345-015-1634-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 06/29/2015] [Indexed: 01/20/2023] Open
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Tsili AC, Argyropoulou MI. Advances of multidetector computed tomography in the characterization and staging of renal cell carcinoma. World J Radiol 2015; 7:110-127. [PMID: 26120380 PMCID: PMC4473304 DOI: 10.4329/wjr.v7.i6.110] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/18/2015] [Accepted: 04/29/2015] [Indexed: 02/06/2023] Open
Abstract
Renal cell carcinoma (RCC) accounts for approximately 90%-95% of kidney tumors. With the widespread use of cross-sectional imaging modalities, more than half of RCCs are detected incidentally, often diagnosed at an early stage. This may allow the planning of more conservative treatment strategies. Computed tomography (CT) is considered the examination of choice for the detection and staging of RCC. Multidetector CT (MDCT) with the improvement of spatial resolution and the ability to obtain multiphase imaging, multiplanar and three-dimensional reconstructions in any desired plane brought about further improvement in the evaluation of RCC. Differentiation of RCC from benign renal tumors based on MDCT features is improved. Tumor enhancement characteristics on MDCT have been found closely to correlate with the histologic subtype of RCC, the nuclear grade and the cytogenetic characteristics of clear cell RCC. Important information, including tumor size, localization, and organ involvement, presence and extent of venous thrombus, possible invasion of adjacent organs or lymph nodes, and presence of distant metastases are provided by MDCT examination. The preoperative evaluation of patients with RCC was improved by depicting the presence or absence of renal pseudocapsule and by assessing the possible neoplastic infiltration of the perirenal fat tissue and/or renal sinus fat compartment.
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Ramaswamy K, Kheterpal E, Pham H, Mohan S, Stifelman M, Taneja S, Huang WC. Significance of Pathologic T3a Upstaging in Clinical T1 Renal Masses Undergoing Nephrectomy. Clin Genitourin Cancer 2015; 13:344-349. [PMID: 25680295 DOI: 10.1016/j.clgc.2015.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/04/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND The objectives of the present study were to report the incidence of pathologic T3a upstaging in a contemporary cohort of patients with clinical stage T1 (cT1) renal tumors treated with partial or radical nephrectomy; investigate the clinical outcomes; and identify the predictors associated with pathologic upstaging. MATERIALS AND METHODS From a single-institution, institutional review board-approved renal tumor database of 945 patients, we identified 610 patients who had undergone surgery for a cT1 renal mass. Data for 494 patients were available for analysis. Of these, 66 lesions had been pathologically upstaged to T3a after surgery and 428 had not. The oncologic follow-up data and clinical and pathologic features were recorded, and multivariable logistic regression analysis was performed to identify the risk factors for pT3a upstaging, controlling for age, gender, body mass index, and nephrectomy type. RESULTS The cT1 tumors of 66 patients (13.3%) were upstaged to pT3a after surgery. Of these 66 patients, 44 (66.7%) had undergone partial and 22 (33.3%) radical nephrectomy. The median follow-up period was 50 months. No patient with upstaging developed recurrence, and all were disease free at their last follow-up visit. On multivariable analysis, tumor size > 4 cm (odds ratio [OR], 3.766; 95% confidence interval [CI], 1.417-10.011; P < .008), clear cell histologic features (OR, 4.461; 95% CI, 1.498-13.461; P < .007), and positive surgical margins (hazard ratio, 5.118; 95% CI, 2.088-12.547; P < .0001) were associated with upstaging. CONCLUSION Of the cT1 lesions in 66 patients, 13% were pathologically upstaged after surgery. The patients with larger tumors, clear cell histologic features, and positive surgical margins were at the greatest risk of upstaging. However, after an intermediate follow-up period, pathologic upstaging did not appear to result in worsened oncologic outcomes.
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Affiliation(s)
- Krishna Ramaswamy
- Department of Urology, New York University School of Medicine, New York, NY.
| | - Emil Kheterpal
- Department of Urology, New York University School of Medicine, New York, NY
| | - Hai Pham
- University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Sanjay Mohan
- New York University School of Medicine, New York, NY
| | - Michael Stifelman
- Department of Urology, New York University School of Medicine, New York, NY
| | - Samir Taneja
- Department of Urology, New York University School of Medicine, New York, NY
| | - William C Huang
- Department of Urology, New York University School of Medicine, New York, NY
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8
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Minervini A, Raspollini MR, Tuccio A, Di Cristofano C, Siena G, Salvi M, Vittori G, Sebastianelli A, Lapini A, Serni S, Carini M. Pathological characteristics and prognostic effect of peritumoral capsule penetration in renal cell carcinoma after tumor enucleation. Urol Oncol 2014; 32:50.e15-22. [DOI: 10.1016/j.urolonc.2013.07.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
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10
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Tsili AC, Argyropoulou MI, Gousia A, Kalef-Ezra J, Sofikitis N, Malamou-Mitsi V, Tsampoulas K. Renal cell carcinoma: value of multiphase MDCT with multiplanar reformations in the detection of pseudocapsule. AJR Am J Roentgenol 2012; 199:379-86. [PMID: 22826400 DOI: 10.2214/ajr.11.7747] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the diagnostic performance of four-phase (unenhanced, arterial, portal, and nephrographic-excretory) MDCT with multiplanar reformations in the detection of pseudocapsule of renal cell carcinoma (RCC). MATERIALS AND METHODS In a retrospective study of 29 histologically proven RCCs in 29 patients (17 men, 12 women; mean age, 59 years), examinations were performed with a 16-MDCT scanner. The protocol included unenhanced and three-phase (arterial, portal, and nephrographic-excretory) contrast-enhanced CT. The data were analyzed by two reviewers blinded to the histopathologic results. Any discrepancy was resolved by consensus. The presence of a regular, high- or low-attenuation halo surrounding a renal neoplasm was considered to represent renal pseudocapsule. The accuracy of MDCT in the detection of pseudocapsule with the histopathologic results as the standard of reference was evaluated. Unenhanced transverse images and multiplanar reformations in the transverse, coronal, and sagittal planes of each contrast-enhanced phase were separately analyzed. The chi-square two-way test was used to compare each CT phase and multiplanar reformation with histologic results. RESULTS The mean diameter of RCCs on CT scans was 5.6 cm (range, 2.8-15 cm), in accordance with the pathologic result. MDCT enabled detection of renal pseudocapsule in 20 of 29 RCCs with 83% sensitivity, 80% specificity, 95% positive predictive value, 50% negative predictive value, and 83% overall accuracy. Imaging in the portal and nephrographic phases with coronal and sagittal reformations proved more accurate in the detection of pseudocapsule (p < 0.05). CONCLUSION Multiphase MDCT with multiplanar reformations had satisfactory results in the detection of renal pseudocapsule in RCC.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, University Hospital of Ioannina, Leoforos S. Niarchou, 45500, Pl Pargis, 2, 45332, Ioannina, Greece.
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[Open partial nephrectomy: standard of minimal invasive surgery]. Prog Urol 2011; 21:917-24. [PMID: 22118356 DOI: 10.1016/j.purol.2011.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 06/30/2011] [Accepted: 07/20/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Partial nephrectomy is now recognized as the standard treatment for tumors less than 7cm. The oncological results are comparable to those obtained by total nephrectomy, while preserving kidney function. Our objective was to describe our experience and research factors associated with complications, recurrence and death. PATIENTS AND METHODS Partial nephrectomy performed in our center by June 1996 to December 2008 were reviewed retrospectively. Demographic and tumors characteristics, postoperative complications and patient outcomes were identified. Factors associated with complications and survival were investigated by regression tests. RESULTS Of the 96 patients enrolled (mean age 61.4 years±12.8), 13 had renal insufficiency (serum creatinine 120 to 212μmol/L). The mean tumor size was 32mm (±13.9) and 57 (79.2%) corresponded to clear cell carcinoma. The overall rate of postoperative complications was 26%, including 8.3% of hemorrhagic complications and 3.1% of urinary complications. None of the analyzed variables were associated with the occurrence of complications. With a mean of 2 years and 9 months follow-up (±28months), eight patients (11.1%) had tumor recurrence. Multifocal tumors as well as postoperative complications were associated with risk of recurrence. Three patients with positive tumor margins were monitored with no evidence of progression (with 71, 42 and 12 months of follow-up). CONCLUSION Our single-center retrospective study of partial nephrectomy for renal tumor showed medium-term oncological results similar to those reported in the total nephrectomy with the advantage of nephron preservation. The results of studies by conventional surgery such as that we report should be a benchmark for laparoscopic surgery.
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Minervini A, Ficarra V, Rocco F, Antonelli A, Bertini R, Carmignani G, Cosciani Cunico S, Fontana D, Longo N, Martorana G, Mirone V, Morgia G, Novara G, Roscigno M, Schiavina R, Serni S, Simeone C, Simonato A, Siracusano S, Volpe A, Zattoni F, Zucchi A, Carini M. Simple Enucleation is Equivalent to Traditional Partial Nephrectomy for Renal Cell Carcinoma: Results of a Nonrandomized, Retrospective, Comparative Study. J Urol 2011; 185:1604-10. [DOI: 10.1016/j.juro.2010.12.048] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Marco Roscigno
- Vita-Salute University San Raffaele HSR Milan, Milan, Italy
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Deturmeny J, Larre S, Vidal F, Delaporte V, Lechevallier E, Coulange C. [Partial nephrectomy for cancer and percutaneous biopsy: Oncologic results]. Prog Urol 2011; 21:177-83. [PMID: 21354035 DOI: 10.1016/j.purol.2010.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 04/23/2010] [Accepted: 06/22/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the results of partial nephrectomy (NP) for cancer in 60 patients selected by the biopsy of the tumor by analyzing the information, oncologic follow-up. PATIENTS It was a cohort study unicenter retrospective from 1994 to 2006. The biopsy was systematically done for patients who were candidates for elective NP. The criteria for elective indications NP tumors were less than 4cm, low grade Fuhrman (I and II). The tubulopapillary tumors (TBP) on biopsy were excluded from the elective indications. The parameters studied were the biopsy data, overall survival, disease-free survival. RESULTS The median age was 59 years (32-79 years) and 69% of tumor were fortuitous discovery. Indications of need accounted for 30% of cases (single kidney, bilateral tumors and chronic renal failure [CRF]). Biopsy allowed a diagnosis in 89% of cases. There was one death in specific postoperative immediately. A final histology was 75% of clear cell carcinoma, 13.3% of chromophobe and 11.7% of TBP, 96.6% of T1a including 86.6% of low grade and no surgical margin. The median follow-up was 49 months with 98.5% of specific survival at 5 years, one local recurrence and no general recurrence. CONCLUSION The study has shown that the selection of patients by biopsy gives satisfactory carcinologic results with 98.5% specific survival at the end of follow-up; it is between 89 and 100% in the literature.
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Affiliation(s)
- J Deturmeny
- Service d'urologie, hôpital La conception, 105, boulevard Baille, 13005 Marseille, France.
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Rodriguez R, Cizman Z, Hong K, Koliatsos A, Georgiades C. Prospective analysis of the safety and efficacy of percutaneous cryoablation for pT1NxMx biopsy-proven renal cell carcinoma. Cardiovasc Intervent Radiol 2010; 34:573-8. [PMID: 20628879 DOI: 10.1007/s00270-010-9934-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 06/17/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Our objective was to determine the efficacy and safety of image-guided, percutaneous cryoablation for American Joint Committee on Cancer pT1ANxMx and pT1BNxMx biopsy-proven renal cell carcinoma (RCC). MATERIALS AND METHODS Computed tomography (CT)-guided, percutaneous cryoablation was used to treat 117 renal lesions in 113 consecutive patients with pT1NxMx RCC. All 117 ablations were included in the safety analysis, and complications were categorized according to Common Terminology Criteria for Adverse Events version 3.0 (CTCAE v3.0). Eighty-one lesions were biopsy-proven RCC and were included in the efficacy analysis. Technical success was defined as the "ice-ball" covering the entire lesion plus a minimum 5-mm margin. Efficacy was defined as complete lack of enhancement and continuous decrease in size on subsequent follow-up imaging studies. RESULTS Technical success was 100%, with 15% of ablations requiring air or saline injection to prevent nontarget ablation. We recorded a 7% rate of clinically significant complications (CTCAE category≥2) and 0% mortality. Renal function was not adversely affected. Seventy percent of patients were discharged to home on the same day. Efficacy was 98.7% for a median follow-up of 67 weeks (range 7-172). For the subgroup of patients that reached a median follow-up of 2 (n=59) and 3 years (n=13), efficacy was 98.3 and 92.3%, respectively. Cancer specific survival was 100%. CONCLUSIONS CT-guided, percutaneous cryoablation has an excellent safety and efficacy profile for stage T1A and T1B RCC; however, longer follow-up is needed to compare it with other nephron-sparing surgical treatments. It is a great option for nonsurgical patients, those in whom renal function cannot be further sacrificed, and those at risk for metachronous lesions.
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Affiliation(s)
- Ronald Rodriguez
- Department of Urology, Johns Hopkins Hospital, Marburg 205A, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Kesik V, Yalçin B, Akçören Z, Senocak ME, Talim B, Büyükpamukçu M. A rare type of renal cell carcinoma in a girl: hybrid renal cell carcinoma. Pediatr Hematol Oncol 2010; 27:228-32. [PMID: 20367266 DOI: 10.3109/08880010903447383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hybrid renal cell carcinoma (HRCN) is a rare type of renal tumor with characteristic pathologic features, including oncocytic and chromophobe cellular content, and shows more favorable prognosis than renal cell carcinoma. The early-stage tumors show favorable outcome, and postoperative regular clinical and radiological follow-up is adequate in most cases. However, close follow-up is mandatory for tumors with histopathologically coexistence of squamous, papillary, and/or eosinophilic RCC component. This report describes a 12-year-old girl with a stage I HRCN who was closely followed after nephrectomy with no further treatment.
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Affiliation(s)
- Vural Kesik
- Hacettepe University, Faculty of Medicine, Department of Pediatric Oncology, Sihhiye, Ankara, Turkey.
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Bigot P, Bernhard JC, Crepel M, Bensalah K, Azzouzi AR, de la Taille A, Salomon L, Tostain J, Ficarra V, Pantuck AJ, Belldegrun AS, Méjean A, Ferrière JM, Pfister C, Albouy B, Colombel M, Zini L, Villers A, Montorsi F, Shariat S, Rioux-Leclercq N, Patard JJ. [How radical nephrectomy compares to partial nephrectomy for the treatment of pT1a papillary renal cell carcinomas?]. Prog Urol 2010; 20:350-5. [PMID: 20471579 DOI: 10.1016/j.purol.2010.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 12/22/2009] [Accepted: 01/19/2010] [Indexed: 01/20/2023]
Abstract
PURPOSE Our objective was to compare oncologic results of nephron sparing surgery (NSS) versus radical nephrectomy (RN) in T1aN0-x M0 papillary renal cell carcinoma (PRCC). PATIENTS AND METHODS We retrospectively reviewed 277 patients treated for a pT1aN0M0 PRCC selected from an academic database from 12 centres. We compared the clinico-pathological features by using Chi-square and Student statistical analyses. Survivals analyses using Kaplan-Meier and Log-rank models were performed. RESULTS The two groups were composed by 186 patients treated by NSS and 91 by RN. The TNM stage was fixed and the two groups were, in terms of age and Fuhrman grade, comparable. Median age at diagnosis was 59 years (27-85). Median tumor size was 2.7 cm (0.4-4). The average follow-up was 49 months (1-246). Very few events arose in both groups: two local recurrences were observed in the NSS group (1.07%), three patients died of cancer in the NSS treated group (1.6%) and five in the RN treated group (5.5%). The five and 10 cancer-specific survival rate were comparable in the two groups (98% vs. 100% and 98% vs. 97%). The specific survival curves were perfectly similar for both groups (log rank test, p=0.25). CONCLUSION NSS is equivalent to RN as far as oncologic control of pT1aN0M0 PRCC is concerned.
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Affiliation(s)
- P Bigot
- UMR 60-61 CNRS, service d'urologie, CHU de Rennes, université Rennes 1, 2 rue Henri-Le-Guilloux, Rennes, France
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Haferkamp A, Kurosch M, Pritsch M, Hatiboglu G, Macher-Goeppinger S, Pfitzenmaier J, Pahernik S, Wagener N, Hohenfellner M. Prognostic Factors Influencing Long-Term Survival of Patients Undergoing Nephron-Sparing Surgery for Nonmetastatic Renal-Cell Carcinoma (RCC) with Imperative Indications. Ann Surg Oncol 2009; 17:544-51. [DOI: 10.1245/s10434-009-0812-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Indexed: 11/18/2022]
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Crépel M, Isbarn H, Capitanio U, Liberman D, Jeldres C, Sun M, Shariat SF, Widmer H, Arjane P, Graefen M, Montorsi F, Patard JJ, Perrotte P, Karakiewicz PI. Does Histologic Subtype Affect Oncologic Outcomes After Nephron-sparing Surgery? Urology 2009; 74:842-5. [DOI: 10.1016/j.urology.2009.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 02/05/2009] [Accepted: 02/04/2009] [Indexed: 01/20/2023]
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Berdjis N, Hakenberg OW, Novotny V, Manseck A, Oehlschläger S, Wirth MP. Nephron-sparing surgery for renal cell carcinoma in the solitary kidney. ACTA ACUST UNITED AC 2009; 41:10-3. [PMID: 17366096 DOI: 10.1080/00365590600911225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Partial nephrectomy in solitary kidneys carries the risk of tumour progression as well as loss of renal function. We evaluated complications and outcome in patients with renal cell cancer in solitary kidneys who were treated by means of nephron-sparing surgery. MATERIAL AND METHODS Between 1993 and 2003, 38 patients with renal cell carcinoma in a solitary kidney underwent nephron-sparing surgery (partial nephrectomy, n = 37; work-bench resection, n = 1). Of these patients, 21 had asynchronous and eight had synchronous bilateral tumours and underwent contralateral radical nephrectomy. The variables examined were tumour size, disease progression, pre- and postoperative renal function and early (within 30 days of nephron-sparing surgery) and late complications. RESULTS After a mean follow-up period of 41.7 months (range 8-93 months) the mean serum creatinine level had increased from 1.25 mg/dl preoperatively to 1.62 mg/dl postoperatively. Seventeen patients retained normal renal function and 21 developed some degree of renal insufficiency. New-onset chronic renal insufficiency after nephron-sparing surgery with creatinine levels >2 mg/dl was the only late complication observed, occurring in 10 cases. None of the patients required dialysis. Transient urinary leakage was the most frequent early complication, occurring in four cases. Recurrence and/or progression were seen in six patients: four with local recurrence (three of whom also had distant metastases) and two with pure metastatic progression. Nephron-sparing surgery was repeated for the patient with isolated local tumour recurrence. The mean tumour size was 3.8 cm (range 0.7-9.9 cm). Tumour size was markedly greater in patients who developed disease progression (6.2 vs 3.5 cm) and in those who developed renal insufficiency (5.2 vs 3.3 cm). CONCLUSIONS Nephron-sparing surgery for renal cell carcinoma involving a solitary kidney provides effective curative treatment for small tumours, with preservation of renal function. However, patients who undergo partial nephrectomy for locally extensive tumours are at high risk of disease progression.
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Affiliation(s)
- Navid Berdjis
- Department of Urology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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Abstract
The diagnosis and treatment of renal cell carcinoma (RCC) has been the subject of major changes since the late 1980s. Initially, surgery was the only treatment available, but more recently, systemic therapies have been developed, and their introduction has modified some of the surgical indications for rcc. In addition, refinements in surgical technique and the introduction of minimally invasive approaches have revolutionized patient care and bear the promise of even more improvements to come. This paper provides an up-to-date overview of recent developments in the surgical treatment of RCC.
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Affiliation(s)
- J.B. Lattouf
- Correspondence to: Jean-Baptiste Lattouf, Department of Surgery–Urology, Centre Hospitalier de l’Université de Montréal, 1058 rue St-Denis, Montreal, Quebec H2X 3J4. E-mail:
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Masoom S, Venkataraman G, Jensen J, Flanigan RC, Wojcik EM. Renal FNA-based typing of renal masses remains a useful adjunctive modality: evaluation of 31 renal masses with correlative histology. Cytopathology 2009; 20:50-5. [DOI: 10.1111/j.1365-2303.2007.00515.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hagemann IS, Lewis JS. A retrospective comparison of 2 methods of intraoperative margin evaluation during partial nephrectomy. J Urol 2008; 181:500-5. [PMID: 19084870 DOI: 10.1016/j.juro.2008.10.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE Intraoperative pathological consultation is often used to achieve negative margins during partial nephrectomy. Commonly a tumor bed biopsy for frozen section is taken from the most suspicious area of the defect. Alternatively the pathologist may perform prosection of the intact partial nephrectomy specimen and prepare frozen sections of suspicious areas. We determined the sensitivity and specificity of these 2 methods and a combined method. MATERIALS AND METHODS Records of 251 cases performed at a single institution between 2005 and 2007 were retrospectively analyzed. RESULTS Of the patients 56% were male. Mean age was 58.8 years. Laparoscopic resection was performed in 76% of cases. Mean greatest tumor dimension was 2.9 cm. Tumor bed biopsy was done in 120 cases, of which 15 (12.5%) showed positive final margins. With permanent section as the gold standard, tumor bed biopsy was 25% sensitive (95% CI 6-46) and 100% specific (95% CI 96-100) for detecting positive margins. In contrast, gross intraoperative consultation with or without frozen section in 163 cases, including 112 with gross intraoperative consultation only and 51 with frozen section, revealed positive final margins in 16 (9.8%) and was 75% sensitive (95% CI 50-90) and 100% specific (95% CI 97-100). The combined method involving tumor bed biopsy plus gross intraoperative consultation was 100% sensitive (95% CI 60-100) and 100% specific (95% CI 89-100). CONCLUSIONS The data support the routine practice of combined gross pathological consultation and tumor bed biopsy. When the combined method is not used, gross intraoperative consultation is more diagnostically accurate than tumor bed biopsy. The data do not support the common practice of examining the tumor bed biopsy alone.
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Affiliation(s)
- Ian S Hagemann
- Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, St Louis, Missouri, USA
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Gao H, Dong B, Liu X, Xuan H, Huang Y, Lin D. Metabonomic profiling of renal cell carcinoma: high-resolution proton nuclear magnetic resonance spectroscopy of human serum with multivariate data analysis. Anal Chim Acta 2008; 624:269-77. [PMID: 18706333 DOI: 10.1016/j.aca.2008.06.051] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 06/21/2008] [Accepted: 06/26/2008] [Indexed: 01/23/2023]
Abstract
Metabonomic profiling using proton nuclear magnetic resonance ((1)H NMR) spectroscopy and multivariate data analysis of human serum samples was used to characterize metabolic profiles in renal cell carcinoma (RCC). We found distinct, easily detectable differences between (a) RCC patients and healthy humans, (b) RCC patients with metastases and without metastases, and (c) RCC patients before and after nephrectomy. Compared to healthy human serum, RCC serum had higher levels of lipid (mainly very low-density lipoproteins), isoleucine, leucine, lactate, alanine, N-acetylglycoproteins, pyruvate, glycerol, and unsaturated lipid, together with lower levels of acetoacetate, glutamine, phosphatidylcholine/choline, trimethylamine-N-oxide, and glucose. This pattern was somewhat reversed after nephrectomy. Altered metabolite concentrations are most likely the result of the cells switching to glycolysis to maintain energy homeostasis following the loss of ATP caused by impaired TCA cycle in RCC. Serum NMR spectra combined with principal component analysis techniques offer an efficient, convenient way of depicting tumour biochemistry and stratifying tumours under different pathophysiological conditions. It may be able to assist early diagnosis and postoperative surveillance of human malignant diseases using single blood samples.
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Affiliation(s)
- Hongchang Gao
- Analytical Chemistry Laboratory, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, PR China
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Algaba F, Arce Y, Santaularia JM, Villavicencio Mavrich H. [Frozen section in urological oncology]. Actas Urol Esp 2008; 31:945-56. [PMID: 18257364 DOI: 10.1016/s0210-4806(07)73758-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The indications of Frozen section diagnosis (FS) in surgery due to urologic neoplasia are quite specific, and this explains the fact that they amount to a mere 7.3% of the FSs performed in general hospitals. This also makes the knowledge of their usefulness necessary, and thus we are submitting the present review. Generally speaking, FS is not warranted to identify the nature of a tumoral mass, with the following exceptions: (1) Renal masses of a doubtf ul parenchymal origin, or in the urinary tract: (2) Intesticular neoplasias,when the possibility of a conservative treatment arises; (3) Determination of the presence of a prostate adenocarcinoma in an organ donor with high serum PSA; but even in these circumstances its need is widely controversial. Intraoperative determination of surgical margins is particularly useful in: (1) Partial nephrectomies (it may be limited to inspection after dyeing the margin with Indian ink--bed freezing is very seldom needed); (2) Urethral margins in women with total cystectomies and orthotopic substitution; (3) In partial penectomies (always studying the urethral margin and the cavernosal and spongIosal corpora margins). The study of the nodes is a widely debated issue, and except for those cases in which unexpectedly increased node size is found, systematic FS is indicated neither of the bladder nor of the prostate. The situation regarding penis carcinoma is different, as in the groups with intermediate and high risk of node metastasis, even though there is around 16%-18% of false negatives FS is recommended, particularly of radioisotope-marked sentinel nodes.
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Affiliation(s)
- F Algaba
- Sección de Patología, Fundación Puigvert, Barcelona.
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Lane BR, Gill IS. 5-Year outcomes of laparoscopic partial nephrectomy. J Urol 2007; 177:70-4; discussion 74. [PMID: 17162003 DOI: 10.1016/j.juro.2006.08.093] [Citation(s) in RCA: 268] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE Laparoscopic partial nephrectomy is increasingly a definitive therapeutic option in patients with a small renal mass. Intermediate term oncological outcomes after laparoscopic partial nephrectomy are excellent up to a mean followup of 3 years. We present outcomes in 56 patients, each of whom has now completed a minimum of 5 years of followup after laparoscopic partial nephrectomy. MATERIALS AND METHODS Of the 557 laparoscopic partial nephrectomies performed at our institution 58 patients with a localized tumor have completed more than 5 years since surgery. Clinical and renal functional data on 56 patients (97%) were obtained from medical records, radiographic reports and patient contact via telephone. RESULTS Average patient age was 64 years and 9% were symptomatic at presentation. Average tumor size was 2.9 cm. On histopathology renal cell carcinoma was confirmed in 37 cases (66%) and pathological tumor stage was pT1a in 32 (86%). Final surgical margin was positive for cancer in 1 patient. Median serum creatinine preoperatively and postoperatively was 0.9 and 1.0 mg/dl, respectively. No patient with normal baseline serum creatinine undergoing elective laparoscopic partial nephrectomy had postoperative chronic renal insufficiency (serum creatinine more than 2 mg/dl). At a median followup of 5.7 years (range 5.0 to 6.9) no distant recurrence (0%) and a single local recurrence (2.7%) were detected. Overall and cancer specific survival was 86% and 100%, respectively, at 5 years. CONCLUSIONS To our knowledge this is the initial report in the literature of oncological and renal functional outcomes 5 years after laparoscopic partial nephrectomy with excellent results comparable to those of open nephron sparing surgery. At our center laparoscopic partial nephrectomy is an established alternative to open partial nephrectomy.
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Affiliation(s)
- Brian R Lane
- Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Duvdevani M, Mor Y, Kastin A, Laufer M, Nadu A, Golomb J, Zilberman D, Nativ O, Ramon J. Renal artery occlusion during nephron-sparing surgery: retrospective review of 301 cases. Urology 2006; 68:960-3. [PMID: 17113887 DOI: 10.1016/j.urology.2006.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 04/19/2006] [Accepted: 05/30/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Temporary occlusion of the renal artery during nephron-sparing surgery may facilitate complete tumor resection and reduce operative bleeding. However, it may also entail a greater risk of ischemic kidney damage. In contrast, when vascular occlusion is not applied, the risk of bleeding, as well as the risk of positive margins, may be increased. To study these issues, we retrospectively evaluated our results with nephron-sparing surgery for kidney masses using renal artery occlusion compared with patients in whom vascular occlusion was not applied. METHODS From 1988 to 2003, 301 consecutive patients underwent nephron-sparing surgery for a kidney mass at our institutions. At the surgeons' discretion, the renal artery was temporarily occluded in 181 patients (60%) and was not in 120 (40%). RESULTS No statistically significant differences were found between the two groups regarding blood loss, transfusion rates, and overall complication rates. The loss of the renal unit because of ischemia was noted in 2 patients (1.2%) after renal artery occlusion and in none of the nonoccluded group. Positive tumor margins were found in 5 patients (4.2%) in the nonoccluded group and in 1 patient (0.6%) in the vascular occlusion group. CONCLUSIONS Our results suggest that although vascular occlusion during nephron-sparing surgery may increase the risk of permanent kidney damage, patients with no vascular occlusion may have a greater risk of positive tumor margins after surgery. These two factors should be taken into consideration and could be discussed with the patient when attaining informed consent.
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Affiliation(s)
- Mordechai Duvdevani
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
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Carini M, Minervini A, Masieri L, Lapini A, Serni S. Simple Enucleation for the Treatment of PT1a Renal Cell Carcinoma: Our 20-Year Experience. Eur Urol 2006; 50:1263-8; discussion 1269-71. [DOI: 10.1016/j.eururo.2006.05.022] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 05/15/2006] [Indexed: 01/15/2023]
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Majhail NS, Wood L, Elson P, Finke J, Olencki T, Bukowski RM. Adjuvant subcutaneous interleukin-2 in patients with resected renal cell carcinoma: a pilot study. Clin Genitourin Cancer 2006; 5:50-6. [PMID: 16859579 DOI: 10.3816/cgc.2006.n.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A pilot study was conducted to investigate the toxicity and tolerance to low-dose subcutaneous interleukin-2 (IL-2) for patients with resected renal cell carcinoma (RCC) at high risk for recurrent disease (TNM stages III and IV resected distant metastases). PATIENTS AND METHODS Patients with surgically resected locally advanced (T3-4 or N1-2) or metastatic RCC were randomly assigned to 1 of 4 treatment groups that received different dose levels and schedules of subcutaneous IL-2 as follows: dose level 1, 4 MIU/m2 per day, every other week for 24 weeks (n = 10); dose level 2, 8 MIU/m2 per day, every other week for 24 weeks (n = 9); dose level 3, 4 MIU/m2 per day, weeks 1-4, 9-12, and 17-20 (n = 11); and dose level 4, 8 MIU/m2 per day, weeks 1-4, 9-12, and 17-20 (n = 10). Interleukin-2 was administered in 2 daily doses on days 1-5 of each week indicated. A dose level was considered tolerable if no more than 2 patients experienced grade 3/4 toxicity. RESULTS Forty-one patients were entered in the study and 40 were evaluable for toxicity. Therapy was well tolerated at all dose levels and schedules, with most patients (98%) experiencing mild-to-moderate constitutional symptoms. Grade 3/4 toxicity was seen in 8 patients (20%). Interleukin-2 dose reductions were required in 7 patients, and no patient discontinued therapy secondary to toxicity. Of 39 patients evaluable for efficacy, 31 have experienced relapse (79%), and 15 have died (38%). Median survival was 1.4 years, and the 3-year disease-free survival rate was 33%. Median overall survival has not been reached; however, the 3-year survival rate was 70%. There was no statistically significant difference between any of the treatment arms with respect to disease-free survival or 3-year survival (P > 0.54 and P >or= 0.09 for all pairwise comparisons), schedules (dose level 1/2 vs. 3/4; P = 0.46 and P = 0.5), or dose of IL-2 administered (dose level 1/3 vs. 2/4; P = 0.99 and P = 0.1). CONCLUSION Subcutaneous IL-2 was well tolerated for 6 months in patients with surgically resected RCC at high risk of recurrence. Future adjuvant trials in this setting are not likely to include IL-2 in view of the clinical efficacy and favorable toxicity profiles of selected multitargeted kinase inhibitors.
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Affiliation(s)
- Navneet S Majhail
- Oncology and Transplantation, University of Minnesota, Minneapolis, USA
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Silverman SG, Gan YU, Mortele KJ, Tuncali K, Cibas ES. Renal Masses in the Adult Patient: The Role of Percutaneous Biopsy. Radiology 2006; 240:6-22. [PMID: 16709793 DOI: 10.1148/radiol.2401050061] [Citation(s) in RCA: 212] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although percutaneous renal mass biopsy with cross-sectional imaging guidance has long been considered to be safe and accurate, there have been recent advances in imaging, interventional, and cytologic techniques that have increased the role of percutaneous biopsy in the diagnosis of renal masses. Today, biopsy plays a fundamental role in the care of patients with a renal mass. Biopsy results are used to confirm the diagnosis of renal cancers, metastases, and infections, and there is increasing evidence to suggest that biopsy can help subtype and grade many primary renal cancers. Because a considerable fraction of small solid renal masses are benign and do not need treatment, there is an increasing need to diagnose them. Biopsy after a full imaging work-up can help prevent unnecessary and potentially morbid surgical and ablation procedures in a substantial number of patients. Although more data are needed to understand the overall accuracy of biopsy for the diagnosis of benign lesions, many can be diagnosed with the aid of biopsy findings. This article reviews reported experience with percutaneous renal mass biopsy, discusses the technical factors that contribute to results, and details seven specific clinical settings that should prompt the clinician to consider percutaneous biopsy when encountering a renal mass.
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Affiliation(s)
- Stuart G Silverman
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
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Becker F, Siemer S, Humke U, Hack M, Ziegler M, Stöckle M. Elective nephron sparing surgery should become standard treatment for small unilateral renal cell carcinoma: Long-term survival data of 216 patients. Eur Urol 2005; 49:308-13. [PMID: 16359779 DOI: 10.1016/j.eururo.2005.10.020] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2005] [Accepted: 10/19/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Our experiences with elective nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) in a consecutive series of 216 patients are presented. Clinicopathological features and long-term oncological outcome is compared to patients treated with radical nephrectomy (RN). METHODS Between 1975 and 2002, NSS was performed in 488 patients; 311 of these patients had elective indications. Renal cell carcinoma was found in 241/311 patients (77.5%). Long-term follow up data could be obtained in 216/311 patients. Cancer-specific survival was estimated using the Kaplan-Meier method. Cox's regression analysis and log-rank tests were used to evaluate independent predictive values of different clinicopathological features. Survival data of the 216 patients after NSS surgery were compared to 369 patients with small RCC treated with RN. RESULTS After a mean follow up of 66 months (median 64 months) 29 (13.4%) of 216 patients treated with NSS had died, 4 of them (1.8%) tumour-related. Tumour recurrence was detected in 12 patients (5.6%). 204 patients (94.4%) were free of tumour at last follow-up. Cancer specific survival rates at 5 and 10 years for patients treated with NSS (RN) were 97.8% (95.5%) and 95.8% (84.4%). CONCLUSIONS Elective NSS surgery provides optimal long-term outcome in patients with small localized RCC. Compared to RN, renal parenchyma is preserved without any disadvantage in survival rates. Consequently elective NSS should be accepted as gold standard for small renal tumours.
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Affiliation(s)
- F Becker
- Department of Urology and Paediatric Urology, University of Saarland, Germany.
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Shet T, Desai S. Toluidine positivity in chromophobe renal cell carcinoma: use in intraoperative diagnosis. Histopathology 2005; 47:534-5. [PMID: 16242003 DOI: 10.1111/j.1365-2559.2005.02124.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jones TD, Eble JN, Wang M, MacLennan GT, Delahunt B, Brunelli M, Martignoni G, Lopez-Beltran A, Bonsib SM, Ulbright TM, Zhang S, Nigro K, Cheng L. Molecular Genetic Evidence for the Independent Origin of Multifocal Papillary Tumors in Patients with Papillary Renal Cell Carcinomas. Clin Cancer Res 2005; 11:7226-33. [PMID: 16243792 DOI: 10.1158/1078-0432.ccr-04-2597] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE In patients with papillary renal cell carcinoma, it is not uncommon to find two or more anatomically distinct and histologically similar tumors at radical nephrectomy. Whether these multiple papillary lesions result from intrarenal metastasis or arise independently is unknown. Previous studies have shown that multifocal clear cell renal cell carcinomas express identical allelic loss and shift patterns in the different tumors within the same kidney, consistent with a clonal origin. However, similar clonality assays for multifocal papillary renal cell neoplasia have not been done. Molecular analysis of microsatellite and chromosome alterations and X-chromosome inactivation status in separate tumors in the same patient can be used to study the genetic relationships among the coexisting multiple tumors. EXPERIMENTAL DESIGN We examined specimens from 21 patients who underwent radical nephrectomy for renal cell carcinoma. All patients had multiple separate papillary lesions (ranging from 2 to 5). Eighteen patients had multiple papillary renal cell carcinomas. Seven had one or more papillary renal cell carcinomas with coexisting papillary adenomas. Genomic DNA samples were prepared from formalin-fixed, paraffin-embedded tissue sections using laser-capture microdissection. Loss of heterozygosity assays were done for six microsatellite polymorphic markers for putative tumor suppressor genes on chromosomes 3p14 (D3S1285), 7q31 (D7S522), 9p21 (D9S171), 16q23 (D16S507), 17q21 (D17S1795), and 17p13 (TP53). X-chromosome inactivation analyses were done on the papillary kidney tumors from three female patients. Fluorescence in situ hybridization analysis was done on the tumors of selected patients showing allelic loss at loci on chromosome 7 and/or chromosome 17. RESULTS Twenty of 21 (95%) cases showed allelic loss in one or more of the papillary lesions in at least one of the six polymorphic markers analyzed. A concordant allelic loss pattern between each coexisting kidney tumor was seen in only 1 of 21 (5%) cases. A concordant pattern of nonrandom X-chromosome inactivation in the coexisting multiple papillary lesions was seen in two of three female patients. A discordant pattern of X-chromosome inactivation was seen in the tumors of the other female patient. Fluorescence in situ hybridization showed that the majority of tumors analyzed had gains of chromosomes 7 and 17. Two patients had one tumor with chromosomal gain and another separate tumor that did not. CONCLUSION Our data suggest that, unlike multifocal clear cell renal cell carcinomas, the multiple tumors in patients with papillary renal cell carcinoma arise independently. Thus, intrarenal metastasis does not seem to play an important role in the spread of papillary renal cell carcinoma, a finding that has surgical, therapeutic, and prognostic implications.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/pathology
- Chromosomes, Human, Pair 16/genetics
- Chromosomes, Human, Pair 17/genetics
- Chromosomes, Human, Pair 3/genetics
- Chromosomes, Human, Pair 7/genetics
- Chromosomes, Human, Pair 9/genetics
- Female
- Gene Frequency
- Humans
- In Situ Hybridization, Fluorescence
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Loss of Heterozygosity
- Male
- Microsatellite Repeats
- Middle Aged
- Models, Genetic
- Neoplasms, Multiple Primary/genetics
- Neoplasms, Multiple Primary/pathology
- Nephrectomy
- Trisomy
- X Chromosome Inactivation/genetics
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Affiliation(s)
- Timothy D Jones
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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Lapini A, Serni S, Minervini A, Masieri L, Carini M. PROGRESSION AND LONG-TERM SURVIVAL AFTER SIMPLE ENUCLEATION FOR THE ELECTIVE TREATMENT OF RENAL CELL CARCINOMA: EXPERIENCE IN 107 PATIENTS. J Urol 2005; 174:57-60; discussion 60. [PMID: 15947577 DOI: 10.1097/01.ju.0000162019.45820.53] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We present our findings in a series of T1a renal cell carcinoma treated with elective simple enucleation, specifically reporting the incidence of local recurrence, and progression-free and disease specific survival rates. MATERIALS AND METHODS A total of 107 patients who underwent elective nephron sparing surgery performed with simple enucleation from January 1989 to December 2000 were studied retrospectively. None of the patients had preoperative or intraoperative suspicion of positive nodes. All patients were free from distant metastases before surgery (M0). Patient status was last evaluated in July 2004. Mean (median, range) followup was 88.3 (84, 44 to 175) months. RESULTS Pathological review according to the 2002 TNM classification showed that 95% (102 of 107) of tumors were pT1a, 4% (4 of 107) pT1b and 1% (1 of 107) pT3a. Mean (SD, median, range) tumor greatest dimension was 2.7 (0.93, 2.5, 0.6 to 5) cm. None of the patients died in the immediate postoperative period (within the first 30 days). There were no major complications such as bleeding and urinary leakage/urinoma requiring reoperation. The 5 and 10-year cancer specific survival was 99% and 97.8%, respectively. The 5 and 10-year progression-free survival was 98.1% and 94.7%, respectively. Overall 3 patients had disease progression (2.8%) of whom 2 (1.9%) were local recurrence, 1 alone and 1 associated with distant metastases diagnosed 12 months earlier. CONCLUSIONS Simple tumor enucleation is a safe and acceptable approach for elective nephron sparing surgery. It provides excellent long-term progression-free and cancer specific survival rates, and is not associated with an increased risk of local recurrence compared with partial nephrectomy.
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Affiliation(s)
- Alberto Lapini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
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Abstract
The pathologic features of RCC are the most valuable factors in predicting the prognosis and for planning surveillance and treatment protocols. Urologists and pathologists should optimize approaches in handling tumor-containing kidney specimens to allow for the best evaluation and reporting of such specimens. A pathologic report of a tumor-containing kidney specimen should include all established or potential prognostic factors, especially tumor types, size, grade, information for pathologic staging, and status of the surgical margin.
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Affiliation(s)
- Mingxin Che
- Department of Pathology, Harper University Hospital, Wayne State University/Detroit Medical Center, Detroit, MI 48201, USA.
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Abstract
Locally recurrent renal cell carcinoma (RCC) is 0-10% after nephron-sparing surgery, 2.5-4% after thermoablative interventions and 2-3% after (radical) nephrectomy. Risk-factors are: sporadic or hereditary origin, tumor size, multifocality, histologic phenotype and incomplete resection. To date, there are no significant differences in the incidence of locally recurrent tumors independently of whether open or laparoscopic techniques were preferred. Caution still has to be taken with the use of alternative tools for minimally invasive tumor ablation.Finally, no statistically proven standard therapy exists that would clearly provide a superior outcome for patients with an isolated local recurrence. However, meta-analyses strongly support the performance of a resection of the recurrence as the primary working principal.
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Affiliation(s)
- M Löhr
- Urologische Klinik, Klinikum Darmstadt
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Fleming S, Griffiths DFR. Best Practice No 180. Nephrectomy for renal tumour; dissection guide and dataset. J Clin Pathol 2005; 58:7-14. [PMID: 15623474 PMCID: PMC1770543 DOI: 10.1136/jcp.2003.014159] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Renal tumours constitute 2.5% of all malignancies and are among the 10 most common malignancies in the UK. Most of these are renal cell carcinomas (RCC) of various subtypes. Although historically RCC has been shown to be resistant to radiotherapy and chemotherapy, recent data suggest that the use of biological treatments, such as adjuvants, may be beneficial in patients with disease that has progressed at the time of presentation. The accurate diagnosis, staging, and grading of RCC is now a crucial element in optimal patient management. There are data to support the importance of histological type, tumour size, stage (especially patterns of extrarenal spread), and grade in determining outcome, and these data have been used to develop the published classification (Heidelberg/Rochester), staging (TNM), and grading (Fuhrman) systems. This article describes a dissection and histological sampling protocol that has been shown to increase the yield of staging information, a guide to histological classification and grading, and finally a minimum dataset for the completion of a satisfactory pathology report.
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Affiliation(s)
- S Fleming
- University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK.
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Duvdevani M, Laufer M, Kastin A, Mor Y, Nadu A, Hanani J, Nativ O, Ramon J. IS FROZEN SECTION ANALYSIS IN NEPHRON SPARING SURGERY NECESSARY? A CLINICOPATHOLOGICAL STUDY OF 301 CASES. J Urol 2005; 173:385-7. [PMID: 15643176 DOI: 10.1097/01.ju.0000149111.48445.73] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE One of the basic principles of nephron sparing surgery for renal cell carcinoma is resection of the tumor with normal tissue margins verified by frozen section analysis. In cases of positive tumor margins the surgeon is committed to complete the local resection or to perform radical nephrectomy. In this study we retrospectively evaluated the yield of frozen section analysis performed during nephron sparing surgeries, especially concerning compatibility with the final histological report and the long-term oncological outcome. MATERIALS AND METHODS Between 1988 and 2003, 172 men and 129 women with a mean age of 59 years (range 16 to 83) underwent nephron sparing surgery due to suspected renal tumors. Mean tumor size was 3.56 cm (range 1 to 12.5). Frozen section analysis was routinely performed during surgery. RESULTS Positive tumor margins in frozen section analysis were found in 2 cases (0.7%). In both cases the tumor was centrally located. Those 2 patients underwent immediate radical nephrectomy but no residual tumor was subsequently found in the radical nephrectomy specimens. Paraffin sections disclosed positive tumor margins in 4 other cases (1.3%) in whom the frozen section analysis had shown tumor negative margins. Of the 4 patients 1 underwent radical nephrectomy for tumor recurrence after 9 months. The other 3 patients showed no evidence of disease recurrence after 26, 59 and 120 months of followup. CONCLUSIONS Our results suggest that frozen section analysis during nephron sparing surgery has minimal clinical significance and hence routine incorporation in urological practice should be reconsidered.
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Affiliation(s)
- Mordechai Duvdevani
- Department of Urology, The Chaim Sheba Medical Center, Ramat-Gan, (affiliated with the Sackler School of Medicine, Tel-Aviv University), Israel
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Ficarra V, Novara G, Galfano A, Artibani W. Neoplasm Staging and Organ-Confined Renal Cell Carcinoma: A Systematic Review. Eur Urol 2004; 46:559-64. [PMID: 15474263 DOI: 10.1016/j.eururo.2004.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Several TNM staging system editions were published over the years for renal cell carcinoma (RCC). Using a search strategy similar to the one used by the TNM process Subcommittee for "literature watch", we searched MEDLINE with the intent to critically analyze literature concerning the different TNM editions and the data regarding the optimal breakpoints to substratify localized RCC. MATERIAL AND METHODS The electronic search was conducted as follows: "Neoplasm staging" [MeSH] AND "Carcinoma, Renal Cell" [MeSH]. At the end of a process of abstract analysis performed separately by three of the authors, 34 papers were included in the systematic review. RESULTS All the 34 selected papers were retrospective studies. According to the 1987 version of TNM classification, no paper showed statistically significant cancer-specific survival probability differences between stage I and stage II RCC. According to the 1997 TNM version, the results were controversial. While a few papers found significantly different cancer-specific survival rates between stage I and stage II RCC, several others failed to do so. With the aim to stratify patients with localized RCC, most of the papers proposed an ideal breakpoint ranging from 4.5 to 5.5 cm. CONCLUSION This literature review highlighted that a correct definition of the staging of organ-confined RCC was far from being achieved and provided an appropriate synopsis of the available data for further update of the TNM staging system.
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Affiliation(s)
- Vincenzo Ficarra
- Cattedra e Divisione Clinicizzata di Urologia, Università di Verona, Ospedale Policlinico, Piazzale Ludovico Scuro, 37134 Verona, Italy.
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