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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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Neves JB, Vanaclocha Saiz L, Abu-Ghanem Y, Marchetti M, Tran-Dang MA, El-Sheikh S, Barod R, Beisland C, Capitanio U, Cullen D, Klatte T, Ljungberg B, Mumtaz F, Patki P, Stewart GD, Dabestani S, Tran MGB, Bex A. Pattern, timing and predictors of recurrence after surgical resection of chromophobe renal cell carcinoma. World J Urol 2021; 39:3823-3831. [PMID: 33851271 DOI: 10.1007/s00345-021-03683-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/24/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Currently there are no specific guidelines for the post-operative follow-up of chromophobe renal cell carcinoma (chRCC). We aimed to evaluate the pattern, location and timing of recurrence after surgery for non-metastatic chRCC and establish predictors of recurrence and cancer-specific death. METHODS Retrospective analysis of consecutive surgically treated non-metastatic chRCC cases from the Royal Free London NHS Foundation Trust (UK, 2015-2019) and the international collaborative database RECUR (15 institutes, 2006-2011). Kaplan-Meier curves were plotted. The association between variables of interest and outcomes were analysed using univariate and multivariate Cox proportional hazards regression models with shared frailty for data source. RESULTS 295 patients were identified. Median follow-up was 58 months. The five and ten-year recurrence-free survival rates were 94.3% and 89.2%. Seventeen patients (5.7%) developed recurrent disease, 13 (76.5%) with distant metastases. 54% of metastatic disease diagnoses involved a single organ, most commonly the bone. Early recurrence (< 24 months) was observed in 8 cases, all staged ≥ pT2b. 30 deaths occurred, of which 11 were attributed to chRCC. Sarcomatoid differentiation was rare (n = 4) but associated with recurrence and cancer-specific death on univariate analysis. On multivariate analysis, UICC/AJCC T-stage ≥ pT2b, presence of coagulative necrosis, and positive surgical margins were predictors of recurrence and cancer-specific death. CONCLUSION Recurrence and death after surgically resected chRCC are rare. For completely excised lesions ≤ pT2a without coagulative necrosis or sarcomatoid features, prognosis is excellent. These patients should be reassured and follow-up intensity curtailed.
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Affiliation(s)
- Joana B Neves
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | | | - Yasmin Abu-Ghanem
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Marta Marchetti
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - My-Anh Tran-Dang
- Department of Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Soha El-Sheikh
- Department of Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Ravi Barod
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Christian Beisland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - David Cullen
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Faiz Mumtaz
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Prasad Patki
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Saeed Dabestani
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Maxine G B Tran
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Axel Bex
- Division of Surgery and Interventional Science, University College London, London, UK.
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK.
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Sali AP, Bahirwade GK, Bakshi G, Prakash G, Joshi A, Desai SB, Menon S. Application and comparison of Fuhrman nuclear grading system with the novel tumor grading system for chromophobe renal cell carcinoma and its correlation with disease-specific events. Indian J Urol 2021; 37:147-152. [PMID: 34103797 PMCID: PMC8173929 DOI: 10.4103/iju.iju_633_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/01/2021] [Accepted: 03/14/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction The grading system of chromophobe renal cell carcinoma (ChRCC) is not well established. In this study, we aimed to compare the application of Fuhrman nuclear grade (FNG) with the novel chromophobe tumor grade (CTG). We also evaluated the correlation of these two grading systems with the clinical outcome. Materials and Methods Consecutive cases of ChRCC diagnosed on nephrectomy during 2005-2014 were identified. The clinical details of the patients were retrieved. Histopathology slides were reviewed and the nuclear grading was assigned using standard FNG and the CTG system. The CTG and FNG gradings were correlated with clinical outcome. Results A total of 80 cases were retrieved. Distribution of FNG was as follows: FNG-1, 1 (1.3%); FNG-2, 23 (28.3%); FNG-3, 44 (55.0%); and FNG-4, 12 (15%). CTG distribution was as follows: CTG-1, 48 (60.0%); CTG-2, 20 (25.0%); and CTG-3 12 (15.0%). Follow-up data was available in 46 cases; the median follow-up was 23.9 months (range 1-96.4 months). The median time to recurrence/metastasis was 17.2 months (range 3.2-31.2 months). Mean disease-free survival (DFS) was 68.5 months. Both CTG (P < 0.001) and FNG (P = 0.001) correlated with DFS; however, only CTG retained this significance when only the nonsarcomatous cases were analyzed. On receiver operating characteristics curve analysis, CTG had higher predictive accuracy for DFS for the entire group, while FNG lost the statistical significance when the nonsarcomatous cases were analyzed. CTG (P = 0.001) but not FNG (P = 0.106) correlated with the disease-specific adverse events in non-sarcomatous cases. Conclusions It is possible to apply CTG in ChRCC. It is a better predictor of DFS and disease-specific adverse events. CTG is more appropriate and applicable than the FNG in grading ChRCC.
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Affiliation(s)
- Akash Pramod Sali
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Pathology, Homi Bhabha Cancer Hospital (A Unit of Tata Memorial Centre), Sangrur, Punjab, India
| | - Ganesh K Bahirwade
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ganesh Bakshi
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gagan Prakash
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Joshi
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sangeeta B Desai
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Long-term Outcomes of Follow-up for Initially Localised Clear Cell Renal Cell Carcinoma: RECUR Database Analysis. Eur Urol Focus 2019. [DOI: 10.1016/j.euf.2018.02.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dabestani S, Beisland C, Stewart GD, Bensalah K, Gudmundsson E, Lam TB, Gietzmann W, Zakikhani P, Marconi L, Fernandéz-Pello S, Monagas S, Williams SP, Powles T, Van Werkhoven E, Meijer R, Volpe A, Staehler M, Ljungberg B, Bex A. Increased use of cross-sectional imaging for follow-up does not improve post-recurrence survival of surgically treated initially localized R.C.C.: results from a European multicenter database (R.E.C.U.R.). Scand J Urol 2019; 53:14-20. [DOI: 10.1080/21681805.2019.1588919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Saeed Dabestani
- Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Grant D. Stewart
- Department of Surgery, Academic Urology Group, University of Cambridge, Cambridge, United Kingdom
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | | | - Thomas B. Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - William Gietzmann
- Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Paimaun Zakikhani
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | | | - Serenella Monagas
- Department of Urology, San Agustin University Hospital, Aviles, Spain
| | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Erik Van Werkhoven
- Department of Bioinformatics and Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard Meijer
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Novara, Italy
| | - Michael Staehler
- Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Axel Bex
- Division of Surgical Oncology, Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Szabados B, Foller S, Schulz GB, Staehler M, Grimm MO, Stief CG, Casuscelli J. [Follow-up of renal cell carcinoma in a nonmetastatic stage]. Urologe A 2019; 58:65-76. [PMID: 30627750 DOI: 10.1007/s00120-018-0823-z] [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] [Indexed: 11/25/2022]
Abstract
Postoperative follow-up care after curative surgery or ablative treatment is the standard of care in patients with nonmetastatic renal cell carcinoma. The goal is to identify and treat postoperative complications and local recurrences early on. Follow-up investigations and their relevance are widely acknowledged and validated and patients undergoing follow-up seem to benefit from a longer survival in nonmetastatic renal cell carcinoma. Hence there is no consensus on a standardized follow-up strategy. The most disputed question is around the frequency of the investigations and the duration of the follow-up. Without an evidence-based follow-up protocol, urologists should carry out an individualized, potentially lifelong follow-up regimen, which also includes the patients' needs and perspectives.
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Affiliation(s)
- B Szabados
- Barts Cancer Institute, Queen Mary University of London, London, Großbritannien
| | - S Foller
- Klinik für Urologie, Universitätsklinikum Jena, Jena, Deutschland
| | - G B Schulz
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - M Staehler
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - M-O Grimm
- Klinik für Urologie, Universitätsklinikum Jena, Jena, Deutschland
| | - C G Stief
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - J Casuscelli
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
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Merrill SB, Sohl BS, Hamirani A, Lehman EB, Lehman KK, Kaag MG, Raman JD. Capturing Renal Cell Carcinoma Recurrences When Asymptomatic Improves Patient Survival. Clin Genitourin Cancer 2018; 17:132-138. [PMID: 30563753 DOI: 10.1016/j.clgc.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/08/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The purpose of this study was to explore whether the practice of postoperative renal cell carcinoma (RCC) surveillance affords a survival benefit by investigating whether detection of RCC recurrences in an asymptomatic versus symptomatic manner influences mortality. PATIENTS AND METHODS We identified 737 patients who underwent partial or radical nephrectomy for M0 RCC between 1998 and 2016. Overall survival and disease-specific survival stratified by the type of recurrence detection (asymptomatic vs. symptomatic) was estimated using Kaplan-Meier probabilities both from the time of surgery and from the time of recurrence. Cox proportional hazard regression models were used to evaluate the impact of the type of recurrence detection on mortality. RESULTS A total of 78 patients (10.6%) experienced recurrence after surgery, of whom 63 (80.8%) were asymptomatic (detected using routine surveillance) and 15 (19.2%) were symptomatic. The median postoperative follow-up was 47.2 months (interquartile range, 26.3-89.4 months). Five- and 10-year overall survival, from time of surgery, among patients with asymptomatic versus symptomatic recurrences was 57% and 39% versus 24% and 8%, respectively (P = .0002). As compared with asymptomatic recurrences, patients with symptomatic recurrences had an increased risk of overall (OD) and disease-specific death (DSD) both when examined from the time of surgery (OD: hazard ratio [HR], 3.16; 95% confidence interval [CI], 1.33-7.49; P = .0091 and DSD: HR, 3.44; 95% CI, 1.38-8.57; P = .0079) and from the time of recurrence (OD: HR, 2.93; 95% CI, 1.24-6.93; P = .0143 and DSD: HR, 3.62; 95% CI, 1.45-9.01; P = .0058). CONCLUSIONS Capturing RCC recurrences in an asymptomatic manner during routine surveillance is associated with improved patient survival.
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Affiliation(s)
- Suzanne B Merrill
- Division of Urology, Department of Surgery, Penn State College of Medicine, Hershey, PA.
| | - Brian S Sohl
- Pennsylvania State University, College of Medicine, Hershey, PA
| | - Ashiya Hamirani
- Pennsylvania State University, College of Medicine, Hershey, PA
| | - Erik B Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Kathleen K Lehman
- Division of Urology, Department of Surgery, Penn State College of Medicine, Hershey, PA
| | - Matthew G Kaag
- Division of Urology, Department of Surgery, Penn State College of Medicine, Hershey, PA
| | - Jay D Raman
- Division of Urology, Department of Surgery, Penn State College of Medicine, Hershey, PA
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Kassouf W, Monteiro LL, Drachenberg DE, Fairey AS, Finelli A, Kapoor A, Lattouf JB, Leveridge MJ, Power NE, Pouliot F, Rendon RA, Sabbagh R, So AI, Tanguay S, Breau RH. Canadian Urological Association guideline for followup of patients after treatment of non-metastatic renal cell carcinoma. Can Urol Assoc J 2018; 12:231-238. [PMID: 30139427 DOI: 10.5489/cuaj.5462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Wassim Kassouf
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Adrian S Fairey
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Robert Sabbagh
- Division of Urology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Simon Tanguay
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
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Dabestani S, Marconi L, Kuusk T, Bex A. Follow-up after curative treatment of localised renal cell carcinoma. World J Urol 2018; 36:1953-1959. [DOI: 10.1007/s00345-018-2338-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 05/11/2018] [Indexed: 12/30/2022] Open
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Potentially curable recurrent disease after surgically managed non-metastatic renal cell carcinoma in low-, intermediate- and high-risk patients. World J Urol 2016; 34:1073-9. [DOI: 10.1007/s00345-016-1822-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/31/2016] [Indexed: 11/27/2022] Open
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Use of MRI in Differentiation of Papillary Renal Cell Carcinoma Subtypes: Qualitative and Quantitative Analysis. AJR Am J Roentgenol 2016; 206:566-72. [DOI: 10.2214/ajr.15.15004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Canvasser NE, Stouder K, Lay AH, Gahan JC, Lotan Y, Margulis V, Raj GV, Sagalowsky AI, Cadeddu JA. The Usefulness of Chest X-Rays for T1a Renal Cell Carcinoma Surveillance. J Urol 2016; 196:321-6. [PMID: 26880407 DOI: 10.1016/j.juro.2016.02.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The overall incidence of pulmonary metastasis of T1 renal cell carcinoma is low. We evaluated the usefulness of chest x-rays based on the current AUA (American Urological Association) guidelines and NCCN Guidelines® for T1a renal cell carcinoma surveillance. MATERIALS AND METHODS Between 2006 and 2012, 258 patients with T1a renal cell carcinoma were treated with partial nephrectomy, radical nephrectomy or radio frequency ablation with surveillance followup at our institution. A retrospective chart review was performed to identify demographics, pathological findings and surveillance records. The primary outcome was the incidence of asymptomatic pulmonary recurrences diagnosed by chest x-ray in cases of T1a disease. Our secondary outcome was a comparison of diagnoses by treatment modality (partial nephrectomy, radical nephrectomy or radio frequency ablation). RESULTS Pulmonary metastases developed in 3 of 258 patients (1.2%) but only 1 (0.4%) was diagnosed by standard chest x-ray surveillance. Median followup in the entire cohort was 36 months (range 6 to 152) and 193 of 258 patients (75%) had greater than 24 months of followup. A mean of 3.3 surveillance chest x-rays were completed per patient. When assessed by treatment type, there was no significant difference in the recurrence rate for partial nephrectomy (0 of 191 cases), radical nephrectomy (0 of 22) or radio frequency ablation (1 of 45 or 2.2%) (p = 0.09). CONCLUSIONS Chest x-rays are a low yield diagnostic tool for detecting pulmonary metastasis in patients treated for T1a renal cel carcinoma. Treatment mode does not appear to influence the need for chest x-ray surveillance.
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Affiliation(s)
- Noah E Canvasser
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kylee Stouder
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aaron H Lay
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey C Gahan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ganesh V Raj
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Arthur I Sagalowsky
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Stewart-Merrill SB, Thompson RH, Boorjian SA, Psutka SP, Lohse CM, Cheville JC, Leibovich BC, Frank I. Oncologic Surveillance After Surgical Resection for Renal Cell Carcinoma: A Novel Risk-Based Approach. J Clin Oncol 2015; 33:4151-7. [DOI: 10.1200/jco.2015.61.8009] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The appropriate duration of surveillance for renal cell carcinoma (RCC) after radical or partial nephrectomy remains unknown, and evidence to support current guidelines are lacking. Herein, we provide an approach to surveillance that balances the risk of recurrence versus the risk of non-RCC death. Patients and Methods We identified 2,511 patients who underwent surgery for M0 RCC between 1990 and 2008. Patients were stratified for analysis by pathologic stage (pT1Nx-0, pT2Nx-0, pT3/4Nx-0, and pTanyN1), relapse location (abdomen, chest, bone, and other), age (< 50, 50 to 59, 60 to 69, 70-79 and ≥ 80 years), and Charlson comorbidity index (CCI; ≤ 1 and ≥ 2). Risks of disease recurrence and non-RCC death were estimated by using parametric models for time-to-failure with Weibull distributions. Surveillance duration was estimated at the point when the risk of non-RCC death exceeded the risk of recurrence. Results At a median follow-up of 9.0 years (interquartile range, 6.4 to 12.7 years), a total of 676 patients developed recurrence. By using a competing-risk model, vastly different surveillance durations were appreciated. Specifically, among patients with pT1Nx-0 disease and a CCI ≤ 1, risk of non-RCC death exceeded that of abdominal recurrence risk at 6 months in patients age 80 years and older but failed to do so for greater than 20 years in patients younger than age 50 years. For patients with pT1Nx-0 disease but a CCI ≥ 2, the risk of non-RCC death exceeded that of abdominal recurrence risk already at 30 days after surgery, regardless of patient age. Conclusion We present an individualized approach to RCC surveillance that bases the duration of follow-up on the interplay between competing risk factors of recurrence and non-RCC death. This strategy may improve the balance between the derived benefit from surveillance and medical resource allocation.
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Postoperative surveillance imaging for patients undergoing nephrectomy for renal cell carcinoma. Urol Oncol 2015; 33:499-502. [PMID: 26411549 DOI: 10.1016/j.urolonc.2015.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/13/2015] [Accepted: 08/17/2015] [Indexed: 12/18/2022]
Abstract
The American Urological Association and the National Comprehensive Cancer Network guidelines regarding postoperative surveillance for renal cell carcinoma (RCC) have provided a standardized framework for imaging following nephrectomy. These stage-stratified recommendations are based on retrospective studies that identified the timeline and location of RCC recurrences. However, the simplified and generalizable protocols offered by the American Urological Association and the National Comprehensive Cancer Network are not without limitations. Studies have found that RCC recurrences continue to be missed even with perfect compliance to these protocols and that RCC recurrences occur not infrequently after the required surveillance window of 5 years. Furthermore, recent studies evaluating the use of adjuvant systemic therapy in patients who are at a high risk for RCC recurrence or metastasis after nephrectomy have yielded disappointing results. This calls into question what interventions we can offer patients to improve survival once RCC recurrences are detected during postoperative surveillance; an effective surveillance strategy requires effective treatment options. The future of personalized medicine with genetic profiling of patients with RCC may offer a potential solution by providing better risk stratification to determine the intensity of surveillance imaging as well as to determine which patients will actually derive survival benefit from intervention on recurrent disease.
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Araki H, Tsuzuki T, Kimura T, Tanaka K, Yamada S, Sassa N, Yoshino Y, Hattori R, Gotoh M. Relationship of pathologic factors to efficacy of sorafenib treatment in patients with metastatic clear cell renal cell carcinoma. Am J Clin Pathol 2015; 143:492-9. [PMID: 25780000 DOI: 10.1309/ajcpm8rj2ecawogq] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To evaluate the predictive value of growth patterns in patients undergoing sorafenib treatment for metastatic clear cell renal cell carcinomas (CCRCCs). METHODS Forty-eight patients were analyzed, each of whom underwent nephrectomy and received sorafenib treatment for metastatic CCRCC. Progression-free survival (PFS) was predicted using pathologic parameters, including pathologic stage, Fuhrman nuclear grade (FNG), the presence of a sarcomatoid component, lymphovascular invasion, tumor necrosis, and growth pattern. RESULTS Three (6%) patients showed partial response, 20 (42%) patients showed stable disease, and 25 (52%) patients showed progressive disease. Univariate analyses demonstrated that FNG, the presence of a sarcomatoid component, tumor necrosis, and growth pattern were significantly associated with PFS. In the multivariate analysis, growth pattern was the only parameter that was significantly and independently predictive of PFS. CONCLUSIONS As a novel histologic prognostic parameter, growth pattern may be useful for predicting response to sorafenib treatment.
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Affiliation(s)
- Hidemori Araki
- Department of Urology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Toyonori Tsuzuki
- Department of Pathology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Tohru Kimura
- Department of Urology, Shakaihoken Chukyo Hospital, Nagoya, Japan
| | - Kuniaki Tanaka
- Department of Urology, Kariya Toyota General Hospital, Kariya, Japan
| | - Shin Yamada
- Department of Urology, Okazaki Municipal Hospital, Okazaki, Japan
| | - Naoto Sassa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Yoshino
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryohei Hattori
- Department of Urology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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ITO KEIICHI, SEGUCHI KENJI, SHIMAZAKI HIDEYUKI, TAKAHASHI EIJI, TASAKI SHINSUKE, KURODA KENJI, SATO AKINORI, ASAKUMA JUNICHI, HORIGUCHI AKIO, ASANO TOMOHIKO. Tumor necrosis is a strong predictor for recurrence in patients with pathological T1a renal cell carcinoma. Oncol Lett 2015; 9:125-130. [PMID: 25435945 PMCID: PMC4246637 DOI: 10.3892/ol.2014.2670] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 10/15/2014] [Indexed: 11/05/2022] Open
Abstract
Patients with pT1aN0M0 renal cell carcinoma (RCC) generally have good prognosis, and recurrence is rare. However, metastasis develops postoperatively in a small number of patients with pT1aN0M0 RCC. The present study was undertaken to identify predictors for recurrence in patients with pT1aN0M0 RCC. We reviewed the clinicopathological factors of 133 patients with pT1aN0M0 RCC who underwent radical or partial nephrectomy at the Department of Urology, National Defense Medical College (Saitama, Japan). Clinicopathological factors, including age, gender, tumor size, histological subtype, tumor grade, microvascular invasion, histological tumor necrosis, C-reactive protein levels and performance status were reviewed. These factors were compared between patients with and without postoperative recurrence. Recurrence-free survival (RFS) and cause-specific survival (CSS) rates were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to determine independent factors predicting recurrence in patients with pT1aN0M0 RCC. The 5-year RFS and CSS rates were 97.2 and 99.1%, respectively. When clinicopathological factors were compared between patients with and without recurrence, tumor size (P=0.0390) and percentage of tumor necrosis (P<0.0001) were significantly different between groups. All patients with recurrence had primary lesions ≥3 cm. By univariate analysis, tumor size (P=0.0379) and the presence of tumor necrosis (P=0.0319) were significant predictors for recurrence; tumor necrosis was also an independent predictor for recurrence (P=0.0143). In patients with pT1b tumors ≤5 cm (recurrence rate, 16.8%; n=48), the percentage of tumor necrosis was significantly higher in patients with recurrence compared with those without (P=0.0261). This suggests that tumor necrosis may be an important predictor for recurrence in small RCCs. Although recurrence is rare in pT1a RCC, the presence of tumor necrosis may be an important predictor for recurrence. Particularly, patients presenting with pT1a RCC with histological tumor necrosis should undergo careful follow-up.
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Affiliation(s)
- KEIICHI ITO
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - KENJI SEGUCHI
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - HIDEYUKI SHIMAZAKI
- Department of Laboratory Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - EIJI TAKAHASHI
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - SHINSUKE TASAKI
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - KENJI KURODA
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - AKINORI SATO
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - JUNICHI ASAKUMA
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - AKIO HORIGUCHI
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - TOMOHIKO ASANO
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
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Stewart SB, Thompson RH, Psutka SP, Cheville JC, Lohse CM, Boorjian SA, Leibovich BC. Evaluation of the National Comprehensive Cancer Network and American Urological Association renal cell carcinoma surveillance guidelines. J Clin Oncol 2014; 32:4059-65. [PMID: 25403213 DOI: 10.1200/jco.2014.56.5416] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The National Comprehensive Cancer Network (NCCN) and American Urological Association (AUA) provide guidelines for surveillance after surgery for renal cell carcinoma (RCC). Herein, we assess the ability of the guidelines to capture RCC recurrences and determine the duration of surveillance required to capture 90%, 95%, and 100% of recurrences. PATIENTS AND METHODS We evaluated 3,651 patients who underwent surgery for M0 RCC between 1970 and 2008. Patients were stratified as AUA low risk (pT1Nx-0) after partial (LR-partial) or radical nephrectomy (LR-radical) or as moderate/high risk (M/HR; pT2-4Nx-0/pTanyN1). Guidelines were assessed by calculating the percentage of recurrences detected when following the 2013 and 2014 NCCN and AUA recommendations, and associated Medicare costs were compared. RESULTS At a median follow-up of 9.0 years (interquartile range, 5.7 to 14.4 years), a total of 1,088 patients (29.8%) experienced a recurrence. Of these, 390 recurrences (35.9%) were detected using 2013 NCCN recommendations, 742 recurrences (68.2%) were detected using 2014 NCCN recommendations, and 728 recurrences (66.9%) were detected using AUA recommendations. All protocols missed the greatest amount of recurrences in the abdomen and among pT1Nx-0 patients. To capture 95% of recurrences, surveillance was required for 15 years for LR-partial, 21 years for LR-radical, and 14 years for M/HR patients. Medicare surveillance costs for one LR-partial patient were $1,228.79 using 2013 NCCN, $2,131.52 using 2014 NCCN, and $1,738.31 using AUA guidelines. However, if 95% of LR-partial recurrences were captured, costs would total $9,856.82. CONCLUSION If strictly followed, the 2014 NCCN and AUA guidelines will miss approximately one third of RCC recurrences. Improved surveillance algorithms, which balance patient benefits and health care costs, are needed.
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Liu D, Fong DYT, Chan ACY, Poon RTP, Khong PL. Hepatocellular carcinoma: surveillance CT schedule after hepatectomy based on risk stratification. Radiology 2014; 274:133-40. [PMID: 25162308 DOI: 10.1148/radiol.14132343] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate alternative schedules for surveillance computed tomography (CT) for patients who underwent hepatectomy for hepatocellular carcinoma ( HCC hepatocellular carcinoma ) and to demonstrate an appropriate schedule on the basis of stratification for risk of recurrence. MATERIALS AND METHODS CT and pathologic reports for consecutive patients with HCC hepatocellular carcinoma who underwent hepatectomy at one institution were evaluated with institutional review board approval. Univariate and multivariate analyses were performed to identify risk factors for recurrence. Patients were categorized into risk groups on the basis of classification and regression tree analysis. Average recurrence detection rates ( RDR recurrence detection rate s) between consecutive CT scans were calculated for existing and alternative surveillance schedules for each risk group, and the difference in RDR recurrence detection rate was determined by using the Student t test. A P value of less than .05 was considered to indicate a significant difference. Expected delay in diagnosis was also computed for the alternative surveillance schedules for each risk group. RESULTS Two hundred sixty patients (216 men; mean age, 56.0 years ± 22.5) underwent 2705 CT studies. Independent risk factors for recurrence were microvascular invasion (P = .001), cirrhosis (P = .007), and tumor multiplicity (P = .001). Three risk groups (low, intermediate, and high) were identified. For low- and intermediate-risk groups, average RDR recurrence detection rate was not significantly different in the first 2 years after hepatectomy when the interval was extended from 3 months (3.3% and 4.6%, respectively) to 4 months (4.3% [expected delay, 16 days] and 6.1% [expected delay, 18 days], respectively) or for the subsequent 3 years when the interval was extended from 6 months (1.3% and 3.5%, respectively) to 12 months (2.5% [expected delay, 72 days] and 7.0% [expected delay, 103 days], respectively). This alternative schedule included five (35.7%) fewer CT scans than the 14 in the original schedule, and a reduction in radiation dose and cost during the 5-year follow-up period. CONCLUSION Posthepatectomy surveillance CT schedules may be tailored and optimized according to stratification by risk of recurrence to reduce the frequency of CT scans without compromising surveillance benefits.
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Affiliation(s)
- Dan Liu
- From the Departments of Diagnostic Radiology (D.L., P.L.K.) and Surgery (A.C.Y.C., R.T.P.P.), Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Rd, Hong Kong; and School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (D.Y.T.F.)
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Analysis and validation of tissue biomarkers for renal cell carcinoma using automated high-throughput evaluation of protein expression. Hum Pathol 2014; 45:1092-9. [PMID: 24746216 DOI: 10.1016/j.humpath.2014.01.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/02/2014] [Accepted: 01/08/2014] [Indexed: 11/23/2022]
Abstract
The objective of this study was to compare the predictive ability of potential tissue biomarkers to known prognostic factors that predict renal cell carcinoma (RCC) recurrence using an automated system of immunohistochemical analysis. After institutional review board approval, a tissue microarray was constructed using tissue from patients who had partial or radical nephrectomy for RCC. Patients with metastatic disease were excluded. Immunohistochemical staining of the tissue microarray for Ki-67, C-reactive protein, carbonic anhydrase 9, and hypoxia-inducible factors 1α and 2α was analyzed using automated image analysis. Univariable and multivariable analyses were performed to evaluate the association of putative biomarkers and known prognostic factors. Of 216 patients who met the entrance criteria, 34 (16%) patients developed metastatic recurrence within a median follow-up interval of 60.9 (interquartile range, 13.9-87.1) months. RCC morphotypes analyzed in this study include clear cell (n = 156), papillary (n = 38), chromophobe (n = 16), and collecting duct/unclassified (n = 6). Univariate analysis identified that only increased Ki-67 was predictive of RCC recurrence among the proteins evaluated, in addition to other known clinicopathological prognostic factors. After multivariate analysis, Ki-67 was identified as an independently predictive risk factor for RCC recurrence (hazard ratio [HR], 3.73 [confidence interval {CI}, 1.60-8.68]). Other independent predictors of RCC recurrence included tumor diameter (HR, 1.20 [CI, 1.02-1.41]) and perinephric fat invasion (HR, 4.49 [CI, 1.11-18.20]). We conclude that Ki-67 positivity is independently predictive of RCC recurrence after surgery in nonmetastatic patients. Automated analysis of tissue protein expression can facilitate a more objective and expedient investigation of tissue biomarkers for RCC.
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Evaluation of long-term outcome for patients with renal cell carcinoma after surgery: analysis of cancer deaths occurring more than 10 years after initial treatment. Int J Clin Oncol 2013; 19:146-51. [DOI: 10.1007/s10147-013-0533-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/22/2013] [Indexed: 11/29/2022]
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Lin YK, Gettle L, Raman JD. Significant variability in 10-year cumulative radiation exposure incurred on different surveillance regimens after surgery for pT1 renal cancers: yet another reason to standardize protocols? BJU Int 2013; 111:891-6. [DOI: 10.1111/j.1464-410x.2012.11531.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yu-Kuan Lin
- Division of Urology (Surgery); Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Lori Gettle
- Department of Radiology; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Jay D. Raman
- Division of Urology (Surgery); Penn State Milton S. Hershey Medical Center; Hershey PA USA
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Histologic variants of renal cell carcinoma: does tumor type influence outcome? Urol Clin North Am 2012; 39:119-32, v. [PMID: 22487756 DOI: 10.1016/j.ucl.2012.02.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Each histologic type of renal cell carcinoma (RCC) has different pathologic and clinical parameters; however, the independent role of histologic type in outcome prediction remains contested. Most studies show relevance for outcome of each histologic type when correlated with survival by univariate analysis, whereas few studies show differences in outcome once other key prognostic factors, such as stage and grade, are considered. These studies highlight the challenges to prove outcome relevance. Despite the contested independent value of type for outcome prediction, separation of RCC into types is well accepted and can be substantiated on clinical, pathologic, molecular, and general outcome differences.
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Kim SP, Weight CJ, Leibovich BC, Thompson RH, Costello BA, Cheville JC, Lohse CM, Boorjian SA. Outcomes and clinicopathologic variables associated with late recurrence after nephrectomy for localized renal cell carcinoma. Urology 2011; 78:1101-6. [PMID: 21903243 DOI: 10.1016/j.urology.2011.05.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 05/10/2011] [Accepted: 05/10/2011] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To characterize the incidence and clinicopathologic factors associated with late recurrence after surgical resection for renal cell carcinoma (RCC) because the recurrence patterns >5 years after nephrectomy have been poorly described. METHODS We identified 1454 patients treated with nephrectomy for localized RCC from 1970 to 2000 who had remained free of disease for 5 years. Subsequent tumor recurrence was classified as renal recurrence and distant metastasis. The incidence of recurrence >5 years from surgery was estimated using the Kaplan-Meier method. The associations of clinicopathologic variables with late recurrence were analyzed using Cox proportional hazard regression models. RESULTS With a median postoperative follow-up of 13.9 years (range 5.1-38.9), 63 patients (4.3%) experienced late renal recurrence at a median of 9.3 years (range 5.1-25.3), and 172 patients (11.8%) developed late distant metastases at a median of 9.6 years (range 5.1-26.6) after surgery. The estimated recurrence-free survival rate at 10 and 15 years was 97.3% and 95.2% for renal recurrence, and 93.1% and 85.9% for distant metastases, respectively. On multivariate analysis, increased tumor size (hazard ratio [HR] 1.12; P < .001) was associated with late renal tumor recurrence, and increased tumor size (HR 1.07; P = .018), clear cell or collecting duct histologic features (HR 3.76; P < .001), and tumor Stage pT1b (HR 2.8; P < .001), pT2a (HR 4.5; P < .001), pT2b (HR 3.4; P = .007), and pT3-pT4 (HR 5.1; P < .001) were associated with distant metastasis. CONCLUSION After an initial 5-year postoperative disease-free interval, approximately 5% and 15% of patients will develop renal recurrence and distant metastases, respectively, during the next decade. Therefore, long-term surveillance remains necessary after nephrectomy.
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Affiliation(s)
- Simon P Kim
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Abel EJ, Culp SH, Meissner M, Matin SF, Tamboli P, Wood CG. Identifying the risk of disease progression after surgery for localized renal cell carcinoma. BJU Int 2010; 106:1277-83. [PMID: 20394619 DOI: 10.1111/j.1464-410x.2010.09337.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify factors in a large cohort of patients with pathologically localized renal cell carcinoma (RCC) that predicted disease progression after surgery, as RCC most commonly presents as a localized tumour which is treated with surgical excision. PATIENTS AND METHODS Using an institutional database, we identified all patients who underwent radical or partial nephrectomy and had pathologically confirmed pT1 or pT2 RCC. Multivariable stepwise logistic regression analysis was used to calculate an odds ratio corresponding to the odds of progression to metastatic disease during surveillance, based on several clinical and pathological variables. We defined those variables that remained significant on multivariable analysis as risk factors and, based on the number of risk factors, we assessed risk of disease progression. RESULTS In all, 925 patients were eligible for analysis with a median follow-up of 48.2 months. There was progression to metastatic disease in 53 (5.7%) patients; pT1 in 20/774 (2.6%), pT2 in 33/151 (21.9%). Risk factors included pT2 disease, male gender, symptoms at presentation (local or constitutional), presence of sarcomatoid de-differentiation, and macroscopic necrosis on final pathology. In 177 patients with no risk factors, none progressed; 20 of 618 (3.2%) with one or two risk factors had progression at a median of 37.1 months; 33 of 130 (25.4%) with three or more risk factors progressed at a median of 25.2 months. CONCLUSIONS We identified five risk factors that can help to predict those patients with pT1 or pT2 RCC at highest risk for disease progression after surgery. The potential for disease progression is exceedingly low in patients with no risk factors and surveillance can be minimized in this group.
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Affiliation(s)
- E Jason Abel
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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Current world literature. Curr Opin Urol 2010; 20:443-51. [PMID: 20679773 DOI: 10.1097/mou.0b013e32833dde0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Breau RH, Crispen PL, Jimenez RE, Lohse CM, Blute ML, Leibovich BC. Outcome of stage T2 or greater renal cell cancer treated with partial nephrectomy. J Urol 2010; 183:903-8. [PMID: 20083271 DOI: 10.1016/j.juro.2009.11.037] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Indexed: 12/22/2022]
Abstract
PURPOSE Partial nephrectomy for stage T1 renal cell carcinoma is oncologically efficacious and safe, and may have survival advantages. We describe our experience with partial nephrectomy for T2 or greater renal cell cancer. MATERIALS AND METHODS Between 1970 and 2008 approximately 2,300 partial nephrectomies were done at our institution, including 69 for sporadic unilateral advanced stage tumors (pT2 in 32, pT3a in 28 and pT3b in 9). We reviewed outcomes in these patients compared to those in 207 treated with radical nephrectomy matched 3:1 for stage, tumor size, baseline renal function, age and gender. RESULTS The risk of cancer specific (HR 0.80, 95% CI 0.43-1.50, p = 0.489) and overall (HR 1.11, 95% CI 0.72-1.71, p = 0.642) death was similar for partial nephrectomy. At a median of 3.2 years of followup 15 patients (22%) with partial nephrectomy had metastatic disease vs 69 (33%) with radical nephrectomy (HR 0.74, 95% CI 0.42-1.29, p = 0.29). Four patients (6%) with partial nephrectomy had isolated local recurrence vs 7 (3%) with radical nephrectomy (HR 2.11, 95% CI 0.62-7.22, p = 0.234). In the partial nephrectomy group 12 (17%) and 2 cases (3%) were complicated by urine leak and retroperitoneal bleeding requiring intervention, respectively. The median serum creatinine increase was 9.5% (IQR 0-22) vs 33% (IQR 20-47) for partial vs radical nephrectomy (p <0.001). CONCLUSIONS Partial nephrectomy for T2 or greater renal cell carcinoma preserves renal function and appears to achieve oncological outcomes similar to those of radical nephrectomy. The role of partial nephrectomy in patients with T2-3 tumors and a normal contralateral kidney deserves further consideration and study.
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Affiliation(s)
- Rodney H Breau
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55901, USA
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Breau RH, Cheville JC, Lohse CM, Kwon ED, Blute ML. Re: Presence of tumor necrosis is not a significant predictor of survival in clear cell renal cell carcinoma: higher prognostic accuracy of extent based rather than presence/absence classification. T. Klatte, J. W. Said, M. de Martino, J. Larochelle, B. Shuch, J. Y. Rao, G. V. Thomas, F. F. Kabbinavar, A. S. Belldegrun and A. J. Pantuck. J Urol 2009; 181: 1558-1564. J Urol 2009; 182:2979-80; author reply 2980-1. [PMID: 19846128 DOI: 10.1016/j.juro.2009.08.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Indexed: 12/01/2022]
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Klatte T. Editorial comment. J Urol 2009; 182:2136. [PMID: 19758634 DOI: 10.1016/j.juro.2009.07.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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