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Lucignani G, De Lorenzis E, Ierardi AM, Silvani C, Marmiroli A, Nizzardo M, Albo G, Carrafiello G, Montanari E, Boeri L. Perioperative and Survival Outcomes of Patients Treated With Robot-Assisted Partial Nephrectomy and Percutaneous Microwave Ablation for Small Renal Masses: A Single Center Experience. Clin Genitourin Cancer 2024; 22:237-243. [PMID: 38065718 DOI: 10.1016/j.clgc.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Robot assisted partial nephrectomy (RAPN) and microwave ablation (MWA) are 2 of the most advanced techniques for the management of localized small renal masses. PURPOSE To compare the perioperative, functional and oncological results of RAPN and MWA. MATERIALS AND METHODS Data from 171 consecutive patients undergoing either RAPN or MWA for a localized small renal mass at a single academic center was retrospectively collected. Baseline features included patients' demographics and masses' characteristics. Procedures were compared in terms of perioperative outcomes and renal function variation Progression of a persistent lesion or local recurrence after a complete treatment defined local tumor progression. Descriptive statistics and survival analysis tested the association between predictors and local tumor progression. RESULTS Of all, 109 and 62 patients underwent RAPN and MWA. Patients in the MWA group were older (P = .002) had higher Charlson Comorbidity Index (CCI) (P < .001) and higher frequency of preoperative chronic kidney disease (P < .001). MWA led to a shorter postoperative hospitalization time (P < .001) and lower incidence of medical complications (6.5% vs. 22.9%, P = .02) than RAPN. GFR decline was similar between groups both at discharge (P = .39) and at the time of last follow up (P = 1.00). A lower rate of secondary interventions (11.7% vs. 2.8%, P = .037) and a better disease-free survival (83.2% vs. 96.5%, P = .027) were reported after RAPN. Conversely, cancer specific and overall survival were comparable (P > .05). At univariate regression analysis, MWA was associated with local tumor progression (HR 3.46, P = .040). CONCLUSION MWA displayed a lower perioperative impact, while functional outcomes were similar after each intervention. RAPN resulted superior in terms of tumor eradication, but no difference was noted regarding cancer specific survival. Thus, MWA represents a valid alternative in frail patients, though less radical than RAPN.
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Affiliation(s)
- Gianpaolo Lucignani
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Maria Ierardi
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Silvani
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Marmiroli
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Nizzardo
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Qiu J, Deng R, Zhao Z, Tian P, Zhou J. The long-term outcomes of local tumor destruction versus partial nephrectomy for cT1a non-clear cell renal cell carcinoma and development of prognostic nomograms. J Cancer Res Clin Oncol 2024; 150:122. [PMID: 38472549 PMCID: PMC10933168 DOI: 10.1007/s00432-023-05571-8] [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: 10/24/2023] [Accepted: 11/25/2023] [Indexed: 03/14/2024]
Abstract
PURPOSE There is a lack of authoritative opinions on local tumor destruction (LTD) for clinical T1a (cT1a) non-clear cell renal cell carcinoma (nccRCC). We aim to compare the outcomes of cT1a nccRCC after partial nephrectomy (PN) or LTD and explore prognostic factors. METHODS Patients diagnosed with cT1a nccRCC receiving LTD or PN between 2000 and 2020 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. A 1:1 propensity score matching (PSM) was performed for patients receiving LTD and PN. Kaplan-Meier survival analysis, Cox regression analysis, competing risk regression models, and subgroup analysis were used to compare outcomes and identify prognostic factors. Prognostic nomograms were established and evaluated based on the multivariate models. RESULTS A total of 3664 cT1a nccRCC patients were included. The LTD group had poorer overall survival (OS) and similar cancer-specific survival (CSS) compared with the PN group before and after PSM (p < 0.05), while the other-cause mortality rate of the LTD group was higher than that of the PN group. Age, marital status, household income, prior tumor history, interval between diagnosis and treatment, treatments, and tumor size were identified as independent predictive factors for OS. Age, tumor size, prior tumor history, and histological type were identified as independent predictive factors for CSS. Then the nomograms predicting OS and CSS were constructed based on these prognostic factors, which showed excellent performance in risk stratification and accuracy. CONCLUSION LTD could achieve comparable cancer-control effects as PN among cT1a nccRCC patients. The OS and CSS nomograms worked effectively for prognosis assessment.
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Affiliation(s)
- Jianhui Qiu
- Department of Urology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Ruiyi Deng
- Department of Urology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Zihou Zhao
- Department of Urology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Peidong Tian
- Department of Urology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Jingcheng Zhou
- Department of Urology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China.
- Institute of Urology, Peking University, Beijing, China.
- National Urological Cancer Center, Beijing, China.
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Lehrer R, Cornelis F, Bernhard JC, Bigot P, Champy C, Bruyère F, Rouprêt M, Doumerc N, Bensalah CK, Olivier J, Audenet F, Tricard T, Parier B, Durand X, Durand M, Charles T, Branger N, Surlemont L, Xylinas E, Beauval JB, Barral M. Minimally invasive nephron-sparing treatments for T1 renal cell cancer in patients over 75 years: a comparison of outcomes after robot-assisted partial nephrectomy and percutaneous ablation. Eur Radiol 2023; 33:8426-8435. [PMID: 37466710 DOI: 10.1007/s00330-023-09975-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To compare the oncological and perioperative outcomes of robot-assisted partial nephrectomy (RPN) and percutaneous thermal ablation (PTA) for treatment of T1 renal cell cancer (RCC) in patients older than 75 years. MATERIALS AND METHODS Retrospective national multicenter study included all patients older than 75 years treated for a T1 RCC by RPN or PTA between January 2010 and January 2021. Patients' characteristics, tumor data, and perioperative and oncological outcomes were compared. RESULTS A total of 205 patients for 209 procedures (143 RPN and 66 PTA) were included. In the PTA group, patients were older (80.4 ± 3.7 vs. 79 ± 3.7 years (p = 0.01)); frailer (ASA score (2.43 ± 0.6 vs. 2.17 ± 0.6 (p < 0.01)); and more frequently had a history of kidney surgery (16.7% [11/66] vs. 5.6% [8/143] (p = 0.01)) than in the RPN group. Tumors were larger in the RPN group (2.7 ± 0.7 vs. 3.2 ± 0.9 cm (p < 0.01)). Operation time, length of hospital stay, and increase of creatinine serum level were higher in RPN (respectively 92.1 ± 42.7 vs. 150.7 ± 61.3 min (p < 0.01); 1.7 ± 1.4 vs. 4.2 ± 3.4 days (p < 0.01); 1.9 ± 19.3% vs. 10.1 ± 23.7 (p = 0.03)). Disease-free survival and time to progression were similar (respectively, HR 2.2; 95% CI 0.88-5.5; p = 0.09; HR 2.1; 95% CI 0.86-5.2; p = 0.1). Overall survival was shorter for PTA that disappeared after Cox adjusting model (HR 3.3; 95% CI 0.87-12.72; p = 0.08). CONCLUSION Similar oncological outcomes are observed after PTA and RPN for T1 RCC in elderly patients. CLINICAL RELEVANCE STATEMENT Robot-assisted partial nephrectomy and percutaneous thermal ablation have similar oncological outcomes for T1a kidney cancer in patients over 75 years; however, operative time, decrease in renal function, and length of hospital stay were lower with ablation. KEY POINTS • After adjusting model for age and ASA score, similar oncological outcomes are observed after percutaneous thermal ablation and robot-assisted partial nephrectomy for T1 renal cell cancer in elderly patients. • Operation time, length of hospital stay, and increase of creatinine serum level were higher in the robot-assisted partial nephrectomy group.
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Affiliation(s)
- Raphaël Lehrer
- Department of Radiology, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France
- Department of Interventional Radiology, Sorbonne Université, Paris, France
| | - Francois Cornelis
- Radiology Department, Memorial Sloan Kettering Cancer Center, New York, USA
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
| | - Jean-Christophe Bernhard
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Bigot
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Angers University Hospital, Angers, France
| | - Cécile Champy
- Department of Urology, University Hospital Henri Mondor, AP-HP, Créteil, France
- INSERM, U1430, Henri Mondor University Hospital, AP-HP, 94000, Creteil, France
| | - Franck Bruyère
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Tours University Hospital, Tours, France
| | - Morgan Rouprêt
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Pitié-Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, France
| | - Nicolas Doumerc
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, University Hospital Rangueil, Toulouse, France
| | - Charles-Karim Bensalah
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Rennes University Hospital, Rennes, France
| | | | - François Audenet
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | | | - Bastien Parier
- Department of Urology, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Xavier Durand
- Department of Urology, Paris Saint-Joseph Hospital, Paris, France
| | - Matthieu Durand
- Department of Urology, Hôpital Pasteur 2, Nice, France
- INSERM U1081 - CNRS, UMR 7284, Université de Nice Côte d'Azur, Nice, France
| | - Thomas Charles
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Poitiers University Hospital, Poitiers, France
| | - Nicolas Branger
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Louis Surlemont
- Department of Urology, Rouen University Hospital, Rouen, France
| | - Evanguelos Xylinas
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Jean-Baptiste Beauval
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Matthias Barral
- Department of Radiology, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France.
- Department of Interventional Radiology, Sorbonne Université, Paris, France.
- Service d'Imagerie Radiologiques et Interventionnelles Spécialisées, Hôpital Tenon, Sorbonne Université, AP-HP, 4 rue de la chine, 75020, Paris, France.
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Wu X, Uhlig J, Shuch BM, Uhlig A, Kim HS. Cost-effectiveness of minimally invasive partial nephrectomy and percutaneous cryoablation for cT1a renal cell carcinoma. Eur Radiol 2023; 33:1801-1811. [PMID: 36329348 DOI: 10.1007/s00330-022-09211-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/12/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is growing evidence that partial nephrectomy (PN) and percutaneous cryoablation (PCA) yield comparable outcomes for patients with cT1a renal cell carcinoma (RCC), although the cost-effectiveness of both treatments still needs to be assessed. PURPOSE To perform a cost-effectiveness analysis of PN and PCA for patients with cT1a RCC. MATERIALS AND METHODS A decision analysis was created over a 5-year span from a healthcare payer's perspective computing expected costs and outcomes of PN and PCA in terms of quality-adjusted life-years (QALYs) and incremental cost-effectiveness (ICER). After each treatment, the following states were modelled using data from the recent literature: procedural complications, no evidence of disease (NED), local recurrence, metastases, and death from RCC- or non-RCC-related causes. Probabilistic and deterministic sensitivity analyses were performed. RESULTS PCA and PN yielded health benefits of 3.68 QALY and 3.67 QALY. Overall expected costs were $20,491 and $26,478 for PCA and PN. On probabilistic sensitivity analysis, PCA was more cost-effective than PN in 84.78% of Monte Carlo simulations. PCA was more cost-effective until its complication risk was at least 38% higher than PN. PCA was more cost-effective than PN when (i) PCAs annual local recurrence risk was < 3.5% higher than that of PN in absolute values; (ii) PCAs annual metastatic risk was < 1.0% higher than that of PN; or (iii) PCAs annual cancer-specific mortality risk < 0.65% higher than that of PN. PCA remained cost-effective until its procedural cost is above $13,875. CONCLUSION PCA appears to be more cost-effective than PN for the treatment of cT1a RCC, although the currently available evidence is of limited quality. PCA may be the better treatment strategy in the majority of scenarios varying procedural complications, recurrence, metastatic risk, and RCC-mortality in clinically plausible ranges. KEY POINTS • For patients with cT1a RCCs, PCA yields a comparable health benefit at lower costs compared to PN, making PCA the dominant and therefore more cost-effective treatment strategy over PN. • PCA was more cost-effective than PN when (i) PCAs annual local recurrence risk was < 3.5% higher than PN in absolute values; (ii) PCAs annual metastatic risk was < 1.0% higher than PN; or (iii) PCAs annual cancer-specific mortality risk < 0.65% higher than PN. • PCA is more cost-effective than PN for the treatment of cT1a RCC, and it remained so in the majority of scenarios varying procedural complications, recurrence, metastatic risk, and RCC mortality.
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Affiliation(s)
- Xiao Wu
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Johannes Uhlig
- Department for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Brian M Shuch
- Section of Urology, University of California, Los Angeles, School of Medicine, Los Angeles, CA, USA
| | - Annemarie Uhlig
- Department for Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Hyun S Kim
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Imaging, University of Maryland School of Medicine, 22 South Greene Street, Suite G2K14, Baltimore, MD, 21201, USA. .,Division of Medical Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. .,University of Maryland Marlene and Stewart Greenbaum Comprehensive Cancer Center, Baltimore, MD, USA.
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5
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Sorce G, Hoeh B, Hohenhorst L, Panunzio A, Tappero S, Tian Z, Kokorovic A, Larcher A, Capitanio U, Tilki D, Terrone C, Chun FKH, Antonelli A, Saad F, Shariat SF, Montorsi F, Briganti A, Karakiewicz PI. Cancer-specific Mortality in T1a Renal Cell Carcinoma Treated with Local Tumor Destruction Versus Partial Nephrectomy. Eur Urol Focus 2023; 9:125-132. [PMID: 35918270 DOI: 10.1016/j.euf.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Large-scale analyses addressing cancer-specific mortality (CSM) in T1a renal cell carcinoma (RCC) patients treated with local tumor destruction (LTD), relative to partial nephrectomy (PN), are scarce. OBJECTIVE To compare CSM after LTD versus PN. DESIGN, SETTING, AND PARTICIPANTS Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2018), we identified patients with clinical T1a stage RCC treated with LTD or PN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES After 1:1 ratio propensity score matching (PSM) between patients treated with LTD versus PN, competing risks regression (CRR) models addressed CSM, after adjustment for other-cause mortality (OCM) and other covariates (age, tumor size, tumor grade, and histological subtype). RESULTS AND LIMITATIONS Relative to the 35 984 PN patients, 5936 LTD patients were older and more frequently harbored unknown RCC histological subtype or unknown grade. After 1:1 PSM that resulted in 5352 LTD versus 5352 PN patients, the 10-yr CSM rate was 8.7% versus 5.5%. In multivariable CRR models, LTD was associated with higher CSM, relative to PN (hazard ratio [HR]: 1.58, p < 0.001). Subgroup analyses revealed invariably higher CSM after LTD versus PN in patients with tumor size ≤3 cm (10-yr CSM 7.2% vs 5.3%, multivariable HR: 1.47, p < 0.001) and in patients with tumor size 3.1-4 cm (10-yr CSM 11.4% vs 6.1%, multivariable HR: 1.72, p < 0.001). Lack of information regarding earlier cancer controls, retreatment, tumor location within the kidney, and type of surgery represented limitations. CONCLUSIONS In T1a RCC patients, LTD is invariably associated with higher CSM relative to PN, even after adjustment for OCM and all available patient and tumor characteristics, and regardless of tumor size considerations. However, the magnitude of CSM disadvantage was more pronounced in LTD patients with tumor size 3.1-4 cm than in those with tumor size ≤3 cm. PATIENT SUMMARY In patients with small renal masses, we observed higher cancer-specific death rates for local tumor destruction (LTD) than for partial nephrectomy. The LTD disadvantage was more pronounced for patients with tumor size 3.1-4 cm, but was also present in those with tumor size ≤3 cm.
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Affiliation(s)
- Gabriele Sorce
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
| | - Benedikt Hoeh
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lukas Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Panunzio
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Stefano Tappero
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Andrea Kokorovic
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Instanbul, Turkey
| | - Carlo Terrone
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Departments of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Division of Urology, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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Chen Z, Meng L, Zhang J, Zhang X. Progress in the cryoablation and cryoimmunotherapy for tumor. Front Immunol 2023; 14:1094009. [PMID: 36761748 PMCID: PMC9907027 DOI: 10.3389/fimmu.2023.1094009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
With the rapid advancement of imaging equipment and minimally invasive technology, cryoablation technology is being used more frequently in minimally invasive treatment of tumors, primarily for patients with early tumors who voluntarily consent to ablation as well as those with advanced tumors that cannot be surgically removed or cannot be tolerated. Cryoablation is more effective and secure for target lesions than other thermal ablation methods like microwave and radiofrequency ablation (RFA). The study also discovered that cryoablation, in addition to causing tumor tissue necrosis and apoptosis, can facilitate the release of tumor-derived autoantigens into the bloodstream and activate the host immune system to elicit beneficial anti-tumor immunological responses against primary. This may result in regression of the primary tumor and distant metastasis. The additional effect called " Accompanying effects ". It is the basis of combined ablation and immunotherapy for tumor. At present, there is a lot of research on the mechanism of immune response induced by cryoablation. Trying to solve the question: how positively induce immune response. In this review, we focus on: 1. the immune effects induced by cryoablation. 2. the effect and mechanism of tumor immunotherapy combined with cryoablation. 3.The clinical research of this combination therapy in the treatment of tumors.
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Affiliation(s)
- Zenan Chen
- Department of Radiology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Liangliang Meng
- Department of Radiology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.,Department of Radiology, Chinese People's Armed Police (PAP) Force Hospital of Beijing, Beijing, China
| | - Jing Zhang
- Department of Radiology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiao Zhang
- Department of Radiology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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Manini C, Imaz I, de Larrinoa AF, López JI. Algorithm-Based Approach to the Histological Routine Diagnosis of Renal Oncocytic Tumors in Core Biopsy Specimens. Curr Urol Rep 2022; 23:327-333. [PMID: 36169870 DOI: 10.1007/s11934-022-01114-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW A growing number of tumor entities with badly defined limits are enlarging in the last years the family of oncocytic tumors in the kidney. RECENT FINDINGS Chromophobe renal cell carcinoma (ChRCC) and renal oncocytoma (RO) are classically well-known tumors, but the borderland between them, and their precise connection, remains a matter of debate. Aside from that, other emerging and provisional entities, like eosinophilic solid and cystic renal cell carcinoma (ESC RCC), eosinophilic vacuolated tumor (EVT), low-grade oncocytic tumor (LOT), and papillary renal neoplasm with reverse polarity (PRRP), have been recently described. This spectrum of tumors remains a diagnostic challenge in renal pathology, especially if the specimen obtained is scarce. This review focuses on practical diagnostic problems when managing core biopsies and proposes a diagnostic algorithm maximizing the information provided by both morphology and immunohistochemistry. So, a combination of morphologic features on hematoxylin-eosin and six antibodies (CK7, CD117, CK20, CD10, GATA-3, and cathepsin K) is advised to be used in a stepwise fashion.
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Affiliation(s)
- Claudia Manini
- Department of Pathology, San Giovanni Bosco Hospital, 10154, Turin, Italy.,Department of Sciences of Public Health and Pediatrics, University of Turin, 10124, Turin, Italy
| | - Igone Imaz
- Department of Pathology, Cruces University Hospital, 48903, Barakaldo, Spain
| | | | - José I López
- Biomarkers in Cancer Unit, Biocruces-Bizkaia Health Research Institute, Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia, Spain.
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8
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Muacevic A, Adler JR, Owens J, Hussain S. Cryoablation for the Treatment of Kidney Cancer: Comparison With Other Treatment Modalities and Review of Current Treatment. Cureus 2022; 14:e31195. [PMID: 36505146 PMCID: PMC9728501 DOI: 10.7759/cureus.31195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
With cancer among the leading causes of death worldwide and kidney cancer among the more common cancers in the United States, it has become increasingly important to ensure that first-line treatments remain validated and supported in recent literature. Surgical intervention has long remained the gold standard for intervention but with newer techniques and technology on the horizon, there must be a constant review of other options that may provide improved outcomes and reduction of associated risks. Ablative techniques have gained traction and are becoming a valuable intervention for multiple different types of cancers, kidney cancer included. Cryoablation, a newer ablative technique taking advantage of extreme cold to freeze and destroy abnormal tissue, provides a promising option for treatment. Currently, no review article, to our knowledge, compares all the different treatment options for kidney cancer. Additionally, while some literature has addressed cryoablation in comparison to other methods of management, there has not been an extensive review to combine our current understanding of these comparisons. In this review article, we provide an overview of each of the commonly used treatments for kidney cancer and summarize the current literature regarding the advantages and disadvantages of each intervention. Finally, we seek to compare cryoablation, a newer option for treatment, to each of the approaches with the goal of evaluating the best methods for management and determining cryoablation's role alongside these current interventions.
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Comparison of the Results of Therapy for cT1 Renal Carcinoma with Nephron-Sparing Surgery (NSS) vs. Percutaneous Thermal Ablation (TA). J Pers Med 2022; 12:jpm12030495. [PMID: 35330494 PMCID: PMC8956074 DOI: 10.3390/jpm12030495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 12/24/2022] Open
Abstract
Implementation of ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI) into abdominal cavity diagnostics enabled early detection of cT1 graded renal cancers. According to European Association of Urology (EAU) and Polish urological Association (PUA) recommended method of treatment is sparing resection of renal parenchyma with tumour—nephron-sparing surgery (NSS). In selected cases other methods such as thermal ablation (TA) or cryoablation can be introduced /1/. Objectives: To evaluate the results of treatment of cT1 renal tumours with the use of NSS and TA methods. Material and methods: 140 patients with cT1 renal carcinoma were treated in 2nd Department of Urology of Medical University of Lodz between 2014 and 2017. Neuron-sparing surgery was performed in 56 cases (40%), while percutane-ous thermal ablation (TA) in 84 cases (60%). Demographic data, clinical data (lab results, Charlson index), nephrometry data (tumour size, location, R.E.N.A.L. score) post-operative data (Clavien-Dindo classifica-tion) were investigated. Histopathology results, Fuhrman malignancy grading, as total three-year survival of patients were evaluated. The following methods were used for statistical evaluation: Chi2, Fisher, W Shapiro-Wilk, U Mann-Whitney tests, Kaplan-Meier’s curve and Cox model. The results were displayed in a form of median and upper and lower quartile values (25–75%). Results: No statistical differences in gender nor left/right kidney location were observed. Patients, who underwent TA were at average 10 years older and had multiple comorbidities (median age for TA was 79, for NSS 68; median Charlson index for TA was 5 and for NSS was 3). TA patients had lesser haematological values (Hb, Ht). R.E.N.A.L. scoring demonstrated comparable nephrometry in both groups. NSS procedure was open laparotomy without temporary clamping of renal vessels. Surgical margins of resected tumours were negative. TA was performed with Cool-Tip Covidienequipment with the use of Cluster electrode and was ultraso-nography-guided. Post-treatment complications evaluated with the use of Clavien-Dindo classification were slightly more frequent for NSS method. Patients after NSS were discharged at average after 8.5 days and after TA after 3 days. Histopathological type and Fuhrman malignancy grading were comparable in both groups. TA treated patients’ death risk was 9-fold of that observed in NSS treated patients. There was 1 death for each group in perioperative period. Conclusion: 1. NSS was associated with slightly higher side effect rate but resulted in prolonged survival. 2. TA was applied to elderly patients with comorbidities. Despite less invasive treatment this group had poorer/reduced survival. 3. Charlson Comorbidity Index (CCI) and the treatment method were relevant survival factors in patients treated due to cT1 renal cancer tumours.
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Morkos J, Porosnicu Rodriguez KA, Zhou A, Kolarich AR, Frangakis C, Rodriguez R, Georgiades CS. Percutaneous Cryoablation for Stage 1 Renal Cell Carcinoma: Outcomes from a 10-year Prospective Study and Comparison with Matched Cohorts from the National Cancer Database. Radiology 2020; 296:452-459. [PMID: 32515677 DOI: 10.1148/radiol.2020192325] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Percutaneous cryoablation (PCA) is an increasingly utilized treatment for stage I renal cell carcinoma (RCC), albeit without supportive level I evidence. Purpose Primary objective was to determine the 10-year oncologic outcomes of PCA for stage I RCC in a prospective manner. Secondary objectives were to compare outcomes after partial nephrectomy (PN) and radical nephrectomy (RN) from the National Cancer Database (NCDB), to determine long-term renal function, and to determine the risk of metachronous disease. Materials and Methods In this institutional review board-approved prospective observational study (2006-2013), study participants with single, sporadic, biopsy-proven RCC were included to calculate the 10-year overall survival, recurrence-free survival, and disease-specific survival after PCA. Results were compared with matched PN and RN NCDB cohorts. Overall and recurrence-free survival probabilities were estimated by using nonparametric maximum likelihood estimator. Disease-specific survival was estimated by using the redistribution-to-right method. Age at diagnosis was stratified as a risk for survival. The effect on estimated glomerular filtration rate, serum creatinine level, and the risk for hemodialysis and metachronous disease were calculated. Results One hundred thirty-four patients (46% men) with single, sporadic, biopsy-proven RCC (median size ± standard deviation, 2.8 cm ± 1.4) were included. Overall survival was 86% (95% confidence interval [CI]: 80%, 93%) and 72% (95% CI: 62%, 83%), recurrence-free survival was 85% (95% CI: 79%, 91%) and 69% (95% CI: 59%, 79%) (improved over surgery), and disease-specific survival was 94% (95% CI: 90%, 98%) at both 5 years and 10 years (similar to surgery), respectively. The 10-year risk of hemodialysis was 2.3%. Risk of metachronous RCC was 6%. Charlson/Deyo Combined Comorbidity score analysis showed decreasing overall survival with increasing comorbidity index. The PCA cohort outperformed both RN- and PN-matched subgroups in all Charlson/Deyo Combined Comorbidity score categories. Conclusion Percutaneous cryoablation yielded a 10-year disease-specific survival of 94%, equivalent to that reported after radical or partial nephrectomy. Overall survival probability after percutaneous cryoablation at 5 years and 10 years was longer than for radical or partial nephrectomy, especially for patients at higher risk (Charlson/Deyo Combined Comorbidity score ≥2). © RSNA, 2020.
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Affiliation(s)
- John Morkos
- From the Department of Radiology (J.M., K.A.P.R., A.Z., A.R.K.), Department of Biostatistics (C.F.), and Department of Vascular and Interventional Radiology (C.S.G.), Johns Hopkins University, 1800 Orleans St, Zayed 7203, Baltimore, MD 21231; and Department of Urology, University of Texas Health Sciences Center, San Antonio, TX (R.R.)
| | - Kori A Porosnicu Rodriguez
- From the Department of Radiology (J.M., K.A.P.R., A.Z., A.R.K.), Department of Biostatistics (C.F.), and Department of Vascular and Interventional Radiology (C.S.G.), Johns Hopkins University, 1800 Orleans St, Zayed 7203, Baltimore, MD 21231; and Department of Urology, University of Texas Health Sciences Center, San Antonio, TX (R.R.)
| | - Alice Zhou
- From the Department of Radiology (J.M., K.A.P.R., A.Z., A.R.K.), Department of Biostatistics (C.F.), and Department of Vascular and Interventional Radiology (C.S.G.), Johns Hopkins University, 1800 Orleans St, Zayed 7203, Baltimore, MD 21231; and Department of Urology, University of Texas Health Sciences Center, San Antonio, TX (R.R.)
| | - Andrew R Kolarich
- From the Department of Radiology (J.M., K.A.P.R., A.Z., A.R.K.), Department of Biostatistics (C.F.), and Department of Vascular and Interventional Radiology (C.S.G.), Johns Hopkins University, 1800 Orleans St, Zayed 7203, Baltimore, MD 21231; and Department of Urology, University of Texas Health Sciences Center, San Antonio, TX (R.R.)
| | - Constantine Frangakis
- From the Department of Radiology (J.M., K.A.P.R., A.Z., A.R.K.), Department of Biostatistics (C.F.), and Department of Vascular and Interventional Radiology (C.S.G.), Johns Hopkins University, 1800 Orleans St, Zayed 7203, Baltimore, MD 21231; and Department of Urology, University of Texas Health Sciences Center, San Antonio, TX (R.R.)
| | - Ronald Rodriguez
- From the Department of Radiology (J.M., K.A.P.R., A.Z., A.R.K.), Department of Biostatistics (C.F.), and Department of Vascular and Interventional Radiology (C.S.G.), Johns Hopkins University, 1800 Orleans St, Zayed 7203, Baltimore, MD 21231; and Department of Urology, University of Texas Health Sciences Center, San Antonio, TX (R.R.)
| | - Christos S Georgiades
- From the Department of Radiology (J.M., K.A.P.R., A.Z., A.R.K.), Department of Biostatistics (C.F.), and Department of Vascular and Interventional Radiology (C.S.G.), Johns Hopkins University, 1800 Orleans St, Zayed 7203, Baltimore, MD 21231; and Department of Urology, University of Texas Health Sciences Center, San Antonio, TX (R.R.)
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