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Combinations of Anti-Angiogenic Agents and Immune Checkpoint Inhibitors in Renal Cell Carcinoma: Best Option? Cancers (Basel) 2023; 15:cancers15041048. [PMID: 36831392 PMCID: PMC9954176 DOI: 10.3390/cancers15041048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Over the past decade, major advances have been made in the treatment of advanced and metastatic renal cell carcinomas, specifically clear cell carcinomas. For many years the optimal approach was sequential; thus, monotherapies [principally tyrosine kinase inhibitors (TKIs)] targeting angiogenesis until toxicity or progressive disease developed. The rationale was the common mechanisms of action of the targeting agents and avoidance of the risk of overlapping toxicities. Immune checkpoint inhibitors (ICIs) are effective monotherapies, and combinations thereof with anti-angiogenic agents were thus later considered. Synergistic interactions were reported in vitro. Clinical efficacy was evident in three pivotal phase III trials with axitinib-pembrolizumab, cabozantinib-nivolumab, and lenvatinib-pembrolizumab combinations. Two other combinations showed interesting results but did not improve overall survival. However, the data aided our understanding of the new therapeutic approaches. A combination of the ICIs nivolumab and ipilimumab was the first to evidence better progression-free and overall survival compared to sunitinib in patients with intermediate or unfavourable prognoses as evaluated by the International mRCC Database Consortium (IMDC). Here we focus on the TKI-ICI combinations, emphasising the rationale of their use and the clinical results. To date, no biomarker facilitating the selection of an optimal treatment by disease and patient status has been reported.
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Sriram JD, van de Beek I, Johannesma PC, van Werkum MH, van der Wel TJWT, Wessels EM, Gille HJJP, Houweling AC, Postmus PE, Smit HJM. Birt-Hogg-Dubé syndrome in apparent primary spontaneous pneumothorax patients; results and recommendations for clinical practice. BMC Pulm Med 2022; 22:325. [PMID: 36028846 PMCID: PMC9414409 DOI: 10.1186/s12890-022-02107-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Birt-Hogg-Dubé syndrome (BHD) is an inherited disease caused by pathogenic variants in the FLCN gene. One of the characteristics is the increased risk for spontaneous pneumothorax, likely due to the presence of pulmonary cysts mainly distributed under the carina. Due to variable expression and lack of awareness, BHD is likely to be underdiagnosed. We aimed to examine the prevalence of BHD in patients presenting with an apparent primary spontaneous pneumothorax and to evaluate the contribution of chest CT in establishing the diagnosis. Methods Patients who presented with apparent primary spontaneous pneumothorax between 2004 and 2017 in a large Dutch teaching hospital were enrolled in this quantitative cross-sectional study. A questionnaire was sent to eligible patients. Patients who completed the questionnaire and consented to further participation were invited to visit the hospital for genetic testing and low dose, volumetric chest CT. Results Genetic testing was performed in 88 patients with apparent primary spontaneous pneumothorax. Three patients were found to have a pathogenic variant in the FLCN gene (3.4%). No variants of unknown significance were detected. Pulmonary cysts were detected in 14 out of 83 participants with an available chest CT, six had more than one cyst. All three patients with BHD had multiple pulmonary cysts. Conclusions Based on previous literature and the present study, we believe that performing a chest CT in every patient presenting with primary spontaneous pneumothorax is justified. Subsequent genetic testing of the FLCN gene should be considered when multiple pulmonary cysts are present. Trial registration The study was registered at clinicaltrials.gov with reference NCT02916992. Summary at a glance Three out of 88 patients with an apparent primary spontaneous pneumothorax were diagnosed with Birt-Hogg-Dubé syndrome in this study and all three had multiple pulmonary cysts. We believe that performing a chest CT in every patient with an apparent primary spontaneous pneumothorax is justified to identify underlying diseases.
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Affiliation(s)
- Jincey D Sriram
- Department of Pulmonology, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands.
| | - Irma van de Beek
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Paul C Johannesma
- Department of Pulmonology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.,Department of Surgery, Gelderse Vallei Ziekenhuis, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
| | - Michiel H van Werkum
- Department of Radiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Tijmen J W T van der Wel
- Department of Pulmonology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Elise M Wessels
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Hans J J P Gille
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Arjan C Houweling
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Pieter E Postmus
- Department of Pulmonology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Hans J M Smit
- Department of Pulmonology, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
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Garg H, Nayak B, Kumar A, Singh P, Nayyar R, Kaul A, Seth A. Survival analysis and predictors of long-term outcomes following radical nephrectomy with inferior vena cava (IVC) thrombectomy in renal cell carcinoma. Indian J Cancer 2022; 0:348195. [PMID: 36861688 DOI: 10.4103/ijc.ijc_5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Renal cell carcinoma (RCC) presents with inferior vena cava (IVC) thrombus in 10%-30% cases and surgical management forms the mainstay of the treatment. The objective of this study is to assess the outcomes of the patients undergoing radical nephrectomy with IVC thrombectomy. Methods A retrospective analysis of patients undergoing open radical nephrectomy with IVC thrombectomy between 2006 till 2018 was done. Results A total of 56 patients were included. The mean (±standard deviation) age was 57.1 (±12.2) years. The number of patients with levels I, II, III, and IV thrombus were 4, 29,10, and 13, respectively. The mean blood loss was 1851.8 mL, and the mean operative time was 303.3 minutes. Overall, the complication rate was 51.7%, while the perioperative mortality rate was 8.9%. The mean duration of hospital stay was 10.6 ± 6.4 days. The majority of the patients had clear cell carcinoma (87.5%). There was a significant association between grade and stage of thrombus (P = 0.011). Using Kaplan-Meier survival analysis, the median overall survival (OS) was 75 (95% confidence interval [CI] = 43.5-106.5) months, and the median recurrence-free survival (RFS) was 48 (95% CI = 33.1-62.3) months. Age (P = 0.03), presence of systemic symptoms (P = 0.01), radiological size (P = 0.04), histopathological grade (P = 0.01), level of thrombus (P = 0.04), and invasion of thrombus into IVC wall (P = 0.01) were found to be significant predictors of OS. Conclusion The management of RCC with IVC thrombus poses a major surgical challenge. Experience of a center along with high-volume and multidisciplinary facility particularly cardiothoracic facility provides better perioperative outcome. Though surgically challenging, it offers good overall-survival and recurrence-free survival.
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Affiliation(s)
- Harshit Garg
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Aashir Kaul
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Dursun F, Patel RS, Hui D, Wang H, Mansour AM, Pruthi DK, Alonzo DG, Jayakumar L, Rodriguez R, Svatek RS, Liss MA, Kaushik D. The Latinx Disparity in Surgery for Kidney Cancer: Data from The South Texas Region. KIDNEY CANCER JOURNAL : OFFICIAL JOURNAL OF THE KIDNEY CANCER ASSOCIATION 2022; 20:6-13. [PMID: 35646227 PMCID: PMC9137392 DOI: 10.52733/kcj20n1-a1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The South Texas region, with a predominantly Latinx population, has a very high incidence of renal cell carcinoma (RCC), including those with tumor extending into the major blood vessels called venous tumor thrombus (VTT). There is currently no data on outcomes of Latinx patients with VTT as most published studies are from predominantly Caucasian population. Therefore, we performed this study to fill an urgent, unmet need. We reviewed patients who underwent radical nephrectomy with removal of VTT (called tumor thrombectomy) between 2015 and 2020. We collected data on demographics, clinical, pathological characteristics and outcomes of patients. Univariate and multivariate Cox regression analyses were used to evaluate the associations between ethnicity and disease progression or survival. We identified 112 patients, of which 67 (62%) were Latinx, and 41 (38%) were non-Latinx. Approximately 60% of patients had Level II-IV VTT; Latinx presented with a higher level of tumor thrombus (p=0.046). Latinx patients had a higher rate of no insurance (11% vs. 27%, p=0.04) and were more likely to lost to follow-up after surgery (22.4% vs. 13.3%, p=0.23) compared to non-Latinx. Fewer Latinx received systemic therapy (28% vs. 42%; p=0.13). Ninety-day mortality for the entire cohort was 3.8%. The Latinx population in the South Texas region present late, with advanced thrombus level, and do not have access to systemic therapy. Given symptomatic disease, surgical treatment, if feasible, is their only option. Our results highlight disparate treatment patterns which require further investigation and health-care policy changes.
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Affiliation(s)
- Furkan Dursun
- Department of Urology, University of Texas Health San Antonio, TX, USA
| | - Rahul S. Patel
- Department of Urology, University of Texas Health San Antonio, TX, USA
| | - Dawn Hui
- Department of Cardiothoracic Surgery, University of Texas Health San Antonio, TX, USA
| | - Hanzhang Wang
- Department of Urology, University of Texas Health San Antonio, TX, USA
| | - Ahmed M. Mansour
- Department of Urology, University of Texas Health San Antonio, TX, USA
- UT Health San Antonio/ MD Anderson Mays Cancer Center, TX, USA
| | - Deepak K. Pruthi
- Department of Urology, University of Texas Health San Antonio, TX, USA
- Department of Urology, University of Texas Rio Grande Valley, TX, USA
| | - David G. Alonzo
- Department of Urology, University of Texas Rio Grande Valley, TX, USA
| | - Lalithapriya Jayakumar
- Department of Surgery, Division of Vascular & Endovascular Surgery, University of Texas Health San Antonio, TX, USA
| | - Ronald Rodriguez
- Department of Urology, University of Texas Health San Antonio, TX, USA
- UT Health San Antonio/ MD Anderson Mays Cancer Center, TX, USA
| | - Robert S. Svatek
- Department of Urology, University of Texas Health San Antonio, TX, USA
- UT Health San Antonio/ MD Anderson Mays Cancer Center, TX, USA
| | - Michael A. Liss
- Department of Urology, University of Texas Health San Antonio, TX, USA
- UT Health San Antonio/ MD Anderson Mays Cancer Center, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas Health San Antonio, TX, USA
- UT Health San Antonio/ MD Anderson Mays Cancer Center, TX, USA
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Kumar S, Akif S, Parmar K, Singh P, Thummala Y, Panda I, Gupta K. Metachronous isolated inferior vena cava tumour thrombus in renal cell cancer: a rare aftermath. Ann R Coll Surg Engl 2021; 104:e139-e142. [PMID: 34941460 DOI: 10.1308/rcsann.2021.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Renal cell cancer (RCC) accounts for 3% of all solid malignancies. Synchronous tumour thrombus in the renal vein or inferior vena cava is reported in 4-10% cases and is a surgical challenge. Contemporary imaging modalities that are used to define the presence and extent of venous thrombus include colour Doppler, contrast-enhanced computed tomography and magnetic resonance venography. Surgical management depends upon the degree of tumour thrombus. We report isolated recurrence of RCC in the inferior vena cava 2 years after radical nephrectomy, and discuss its pathophysiology and management.
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Affiliation(s)
- S Kumar
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - S Akif
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K Parmar
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - P Singh
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Y Thummala
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - I Panda
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K Gupta
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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6
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Tselis N, Chatzikonstantinou G. Radiation Therapy in Renal Cell Carcinoma. Radiat Oncol 2018. [DOI: 10.1007/978-3-319-52619-5_38-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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7
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Quencer KB, Friedman T, Sheth R, Oklu R. Tumor thrombus: incidence, imaging, prognosis and treatment. Cardiovasc Diagn Ther 2017; 7:S165-S177. [PMID: 29399520 PMCID: PMC5778532 DOI: 10.21037/cdt.2017.09.16] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/12/2017] [Indexed: 12/11/2022]
Abstract
Intravascular tumor extension, also known as tumor thrombus, can occur in many different types of cancer. Those with the highest proclivity include Wilm's tumor, renal cell carcinoma (RCC), adrenal cortical carcinoma (ACC) and hepatocellular carcinoma (HCC). The presence of tumor thrombus markedly worsens prognosis and impacts treatment approach. Imaging plays a key role in its diagnosis. Endovascular methods also play a large role in treatment.
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Affiliation(s)
| | - Tamir Friedman
- Division of Interventional Radiology, Department of Radiology, Cornell University, New York, NY, USA
| | - Rahul Sheth
- Division of Interventional Radiology, Department of Radiology, MD Anderson Cancer, Houston, TX, USA
| | - Rahmi Oklu
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic-Arizona, Phoenix, AZ, USA
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8
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Kim JH, Park YH, Kim YJ, Kang SH, Byun SS, Hong SH. Is there a difference in clinicopathological outcomes of renal tumor between young and old patients? A multicenter matched-pair analysis. Scand J Urol 2016; 50:387-91. [PMID: 27415972 DOI: 10.1080/21681805.2016.1204621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the influence of age at diagnosis on tumor characteristics and cancer-specific survival (CSS) in renal cell carcinoma (RCC). MATERIALS AND METHODS Data of patients who underwent radical or partial nephrectomy for renal tumor between 2003 and 2011 at multiple institutions were collected. Patients were divided into two groups according to age at diagnosis: 20-39 years and 40-79 years. To adjust for potential baseline confounders, propensity score matching was performed. RESULTS All included data showed that young RCC patients presented with renal tumors that had a more favorable histological subtype, were localized, smaller in size, and had a lower Fuhrman nuclear grade. The 5 year CSS rates were 95.5% and 90.5% in the young and old patient groups, respectively (log rank p = 0.019). After matching on the propensity score, the two groups with RCC had 302 patients each. Because the groups were matched on covariates, there were no significant differences in the pathological proportion, tumor size, Fuhrman nuclear grade and clinical T stage. The 5 year CSS rates were 95.5% and 94.7% in the young and old patient groups, respectively (log rank p = 0.184). CONCLUSION After adjusting for potential biases, there was no significant difference in prognosis between young and old patients with RCC.
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Affiliation(s)
- Jeong Ho Kim
- a Department of Urology , Dongnam Institute of Radiological & Medical Sciences, Cancer Center , Busan , Republic of Korea
| | - Yong Hyun Park
- b Department of Urology , Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea , Seoul , Republic of Korea
| | - Yong June Kim
- c Department of Urology , Chungbuk National University College of Medicine , Cheongju , Republic of Korea
| | - Seok Ho Kang
- d Department of Urology , Korea University School of Medicine , Seoul , Republic of Korea
| | - Seok Soo Byun
- e Department of Urology , Seoul National University Bundang Hospital , Seongnam , Republic of Korea
| | - Sung-Hoo Hong
- b Department of Urology , Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea , Seoul , Republic of Korea
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9
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Kim DY, Wood CG, Karam JA. Treating the two extremes in renal cell carcinoma: management of small renal masses and cytoreductive nephrectomy in metastatic disease. Am Soc Clin Oncol Educ Book 2015:e214-21. [PMID: 24857105 DOI: 10.14694/edbook_am.2014.34.e214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The incidental renal mass represents a heterogeneous group that contains both benign and malignant pathologies. The majority of renal cell carcinomas are discovered incidentally, without the presence of symptoms directly related to the mass, and are closely associated with the term small renal masses because of the discovery before the onset of symptoms. In general, small renal masses are defined as 4 cm or smaller, and may account for greater than half of renal cell carcinoma diagnosis. The use of renal mass biopsy may offer additional pathological information but the clinician must be reminded of the technical and diagnostic limitations of renal mass biopsy. Patient-dependent factors, such as life expectancy and comorbidities, guide the management of small renal masses, which include active surveillance, partial nephrectomy, radical nephrectomy, and ablative techniques (cryoablation and radiofrequency ablation). Partial nephrectomy has demonstrated durable oncologic control for small renal masses while preserving renal function and, if feasible, is the current treatment of choice. In the other extreme of the renal cell carcinomas spectrum and in the presence of metastatic disease, the removal of the renal primary tumor is termed cytoreductive nephrectomy. Two randomized trials (SWOG 8949 and EORTC 30947) have demonstrated a survival benefit with cytoreductive nephrectomy before the initiation of immunotherapy. These two studies have also been the motivation to perform cytoreductive nephrectomy in the targeted therapy era. Currently, there are two ongoing randomized prospective trials accruing to investigate the timing and relevance of cytoreductive nephrectomy in the contemporary setting of targeted therapy.
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Affiliation(s)
- Dae Y Kim
- From the Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher G Wood
- From the Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jose A Karam
- From the Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Kim JH, Seo SI, Song C, Chung J, Kwak C, Hong SH. Clinicohistological characteristics of renal cell carcinoma in children: A multicentre study. Can Urol Assoc J 2015; 9:E705-8. [PMID: 26664504 DOI: 10.5489/cuaj.2855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION In this retrospective multicentre study, we compared the clinicohistological characteristics of renal cell carcinoma (RCC) between pediatric and adult patients. METHODS Data for patients who underwent radical or partial nephrectomy for RCC between 1988 and 2014 at multiple institutions were collected. Patients were divided into 2 groups according to age at diagnosis: pediatric patients (age ≤18 years) and adult patients (age ≥40 years). The groups were compared for clinical and pathologic variables, and survival analysis was performed. RESULTS The median follow-up period was 64 (range: 30-91) months for pediatric patients versus 44 (range: 19-59) months for adult patients (p = 0.026). Pediatric patients were mostly female (p = 0.003), had symptoms at presentation (p < 0.001), and had a high-stage tumour (p = 0.014) than adult patients. Among the symptomatic patients, gross hematuria was the most common symptom. The median tumour size was not different between groups. Regarding histologic types, pediatric patients had more papillary tumours (p < 0.001), more unclassified tumours (p < 0.001), and fewer clear cell carcinomas (p < 0.001). Five-year cancer-specific survival rates were 85% and 87.4% in pediatric and adult patients, respectively (log rank p = 0.901). Recurrence-free survival was better in adult patients, although this did not reach statistical significance (log rank p = 0.272). This study has several limitations, including its retrospective nature and the relatively small number of pediatric RCC cases. CONCLUSION RCC in children is rare and is characterized by features that differ from those in adult RCC. Prognosis did not differ between groups.
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Affiliation(s)
- Jeong Ho Kim
- Department of Urology, Dongnam Institute of Radiological & Medical Sciences Cancer center, Busan, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinsoo Chung
- Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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11
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Hofbauer SL, de Martino M, Seemann C, Zamani N, Lucca I, Haitel A, Shariat SF, Klatte T. Associations between presenting symptoms, clinicopathological parameters, and prognosis in a contemporary series of patients with renal cell carcinoma. Korean J Urol 2014; 55:505-10. [PMID: 25132943 PMCID: PMC4131077 DOI: 10.4111/kju.2014.55.8.505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/17/2014] [Indexed: 12/23/2022] Open
Abstract
Purpose To evaluate the impact of presenting symptoms on survival in a contemporary series of patients with renal cell carcinoma (RCC). Materials and Methods We prospectively recorded data on the presenting symptoms, pathology, and RCC-specific survival of 633 consecutive RCC patients who underwent surgery between 2003 and 2012. Results Four hundred thirty-three RCCs (68%) were incidental, 111 (18%) were associated with local symptoms, and 89 (14%) were associated with systemic symptoms. Among those with incidental RCC, 317 patients (73%) were completely asymptomatic and 116 patients (27%) presented with symptoms not related to the tumor. During a median follow-up interval of 40 months (interquartile range: 39 to 69 months), 77 patients died from RCC. In univariate analyses, symptom classification was significantly associated with RCC-specific survival (p<0.001). Patients with incidental RCC and unrelated symptoms tended to have worse prognosis than did patients who were completely asymptomatic, although this difference was not statistically significant (p=0.057). The symptom classification was associated with advanced TNM stages (p<0.001) and grade (p<0.001). Conclusions This study confirms that presenting symptoms are associated with tumor characteristics and survival. The majority of RCCs are diagnosed incidentally in patients without any symptoms or with symptoms not related to RCC. Patients in the latter group tend to have a worse prognosis than do patients who are completely asymptomatic. With the increasing number of incidentally diagnosed RCCs, substratification of patients with incidental tumors may be prognostically relevant.
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Affiliation(s)
- Sebastian L Hofbauer
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Michela de Martino
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Christoph Seemann
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Nura Zamani
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Ilaria Lucca
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. ; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Andrea Haitel
- Clinical Institute of Pathology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
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Rabjerg M, Mikkelsen MN, Walter S, Marcussen N. Incidental renal neoplasms: is there a need for routine screening? A Danish single-center epidemiological study. APMIS 2014; 122:708-14. [DOI: 10.1111/apm.12282] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 03/24/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Maj Rabjerg
- Department of Clinical Pathology; Odense University Hospital; Odense Denmark
| | | | - Steen Walter
- Department of Urology; Odense University Hospital; Odense Denmark
| | - Niels Marcussen
- Department of Clinical Pathology; Odense University Hospital; Odense Denmark
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13
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Lyrdal D, Aldenborg F, Holmberg E, Peeker R, Lundstam S. Kidney cancer in Sweden: a decrease in incidence and tumour stage, 1979 - 2001. Scand J Urol 2012; 47:302-10. [PMID: 23137102 DOI: 10.3109/00365599.2012.732608] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE In the Western world the incidence of renal cell carcinoma (RCC) has been increasing for several decades. In Sweden the incidence has decreased since 1980. This may reflect better health of the population. Another possible explanation could be a decrease in incidentally diagnosed RCC. Since these tumours are smaller, relatively more advanced tumours would then enter the cancer registry. The aim of this study was to compare methods of detection of RCC, tumour characteristics and survival from three periods over a timespan of more than 20 years. MATERIAL AND METHODS Adult patients (n = 515) with RCC were identified in a well-defined population-based area with the same incidence of RCC as the rest of Sweden. Patient data from three periods, 1979 - 1981 (A), 1989 - 1991 (B) and 1999 - 2001 (C), were collected for gender, age, tumour side, method of detection, tumour size, tumour type, metastasis, T stage and Fuhrman grade at the time of diagnosis. Using the Swedish Cause-of-Death Register, cause-specific survival was calculated. When available, tissue was reanalysed according to modern standards by an experienced pathologist. RESULTS The frequency of ultrasound and computed tomography increased and autopsy and intravenous pyelography decreased with time as the first detection method. There was a significant change towards smaller tumours and less severe stages and grades in more recent periods. Metastatic disease was most common in the first period. The distribution between the different histological tumour types did not change over time. Five-year cause-specific survival increased significantly from 41% to 63%. Subgroup analysis found significantly increased survival for patients with no metastases or with low-grade tumours. CONCLUSION The data support a true decrease in the incidence of RCC over time in Sweden with a migration towards lower tumour stages but no change in distribution between the different histological subtypes over time.
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Affiliation(s)
- David Lyrdal
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Göteborg, Sweden.
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Abstract
Clear cell renal cell carcinoma (RCC) represents the most common histological subtype of malignant kidney tumors. Based on symptoms alone, clear cell RCC is indistinguishable from other histological classes of RCC unless the tumor is present in the context of an RCC syndrome. Histopathological examination is, therefore, important to accurately identify clear cell RCC. Clear cell RCCs have characteristic morphological criteria; these tumors can be easily identified upon typical presentation, but diagnosis can be challenging when tumor cell pattern is unusual or when availability of tissue samples is limited. In this Review, the clinical, radiological and pathological characteristics of clear cell RCCs are described, as well as the potential tumors that can be confused with clear cell RCC and need to be considered in the differential diagnoses. Finally, the importance of an accurate diagnosis is highlighted in the context of the increasing use of preoperative tissue sampling and the prevalence of clear cell tumors associated with hereditary syndromes, which could have different therapeutic and prognostic implications for patients and their families.
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Affiliation(s)
- Vladimir A Valera
- Translational Surgical Pathology section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, MSC Room 2B44, Bethesda, MD 20892, USA
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Choi JB, Yoon BI, Kim SJ, Cho HJ, Hong SH, Choi YJ, Kim SW, Hwang TK, Lee JY. Changes in clinicopathological characteristics of renal cell carcinoma in the past 25 years: a single-center experience. Korean J Urol 2011; 52:110-4. [PMID: 21379427 PMCID: PMC3045715 DOI: 10.4111/kju.2011.52.2.110] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 01/04/2011] [Indexed: 01/14/2023] Open
Abstract
PURPOSE We examined changes in the clinicopathologic characteristics of renal cell carcinoma (RCC) in the past 25 years and aimed to obtain indicators for its diagnosis and treatment. MATERIALS AND METHODS The medical records of 563 patients with confirmed primary RCC after surgical treatment from 1985 to 2010 at Seoul St. Mary's Hospital were retrospectively reviewed. Patient and tumor characteristics were compared over 3 time periods (period 1: 1985-1994, period 2: 1995-2004, period 3: 2005-2010). RESULTS Period 1 included 65 patients, period 2 included 183 patients, and period 3 included 315 patients, showing an exponential growth in the number of patients. Frequency was highest in the late 50s age group. The review of clinical symptoms showed that incidental diagnosis increased significantly. The tumor size at diagnosis gradually decreased and the proportion of small tumors less than 4 cm increased remarkably. Concerning tumor spread, organ-confined tumors (T(1-2)N(0)M(0)) increased and distant metastasis decreased. Histologically, the clear cell type made up the greatest proportion, about 90% in each period, but subtypes besides the clear cell type increased over the study period. The rate of nephron-sparing surgery increased, and exophytic masses were the most common. CONCLUSIONS Our review of the recent 25 year's worth of data on RCC from Seoul St. Mary's Hospital showed that the incidental diagnosis of RCC increased over the study period in accordance with the development of screening tests. Tumor size decreased in accordance with the progress in imaging modalities. In the future, multicenter research will be needed to analyze the characteristics of whole renal cancer in Korea.
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Affiliation(s)
- Jin Bong Choi
- Department of Urology, The Catholic University of Korea, School of Medicine, Seoul, Korea
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