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Bodard S, Dariane C, Bibault JE, Boudhabhay I, Delavaud C, Timsit MO, Verkarre V, Méjean A, Hélénon O, Guinebert S, Correas JM. [Nephron sparing in the management of localized solid renal mass]. Bull Cancer 2024; 111:720-732. [PMID: 37169604 DOI: 10.1016/j.bulcan.2023.04.005] [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: 01/28/2023] [Revised: 03/30/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023]
Abstract
Managing a malignant renal tumor requires, first of all, a reflection on the necessity of its treatment. It must consider the renal function, altered at the time of diagnosis in 50% of cases. The treatment method chosen depends on many factors, in particular, the predicted residual renal function, the risk of chronic kidney disease, the need for temporary or long-term dialysis, and overall long-term survival. Other factors include the size, position, and number of tumors and a hereditary tumor background. When a renal-sparing management alternative is available, total nephrectomy should no longer be performed in patients with small malignant renal masses (cT1a). This may consist of surgery (partial nephrectomy or lumpectomy), percutaneous thermo-ablation (by radiofrequency, microwave, or cryotherapy). In patients with limited life expectancy, imaging-based surveillance may be proposed to suggest treatment in case of local progression. Good coordination between urologist, radiologist, nephrologist, and sometimes radiotherapist should allow optimal management of patients with a malignant renal tumor with or without underlying renal failure.
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Affiliation(s)
- Sylvain Bodard
- AP-HP, hôpital Necker-Enfants-Malades, service d'imagerie adulte, 75015 Paris, France; Université de Paris-Cité, 75006 Paris, France; Sorbonne université, laboratoire d'imagerie biomédicale, CNRS, Inserm, Paris, France; Groupe de recherche interdisciplinaire francophone en onco-néphrologie (GRIFON), Paris, France.
| | - Charles Dariane
- Université de Paris-Cité, 75006 Paris, France; AP-HP, hôpital européen Georges-Pompidou, service d'urologie, 75015 Paris, France
| | - Jean-Emmanuel Bibault
- Université de Paris-Cité, 75006 Paris, France; AP-HP, hôpital européen Georges-Pompidou, service de radiothérapie, 75015 Paris, France
| | - Idris Boudhabhay
- Université de Paris-Cité, 75006 Paris, France; AP-HP, hôpital Necker-Enfants-Malades, service de néphrologie et transplantation rénale adulte, 75015 Paris, France
| | - Christophe Delavaud
- AP-HP, hôpital Necker-Enfants-Malades, service d'imagerie adulte, 75015 Paris, France
| | - Marc-Olivier Timsit
- Université de Paris-Cité, 75006 Paris, France; AP-HP, hôpital européen Georges-Pompidou, service d'urologie, 75015 Paris, France
| | - Virginie Verkarre
- Université de Paris-Cité, 75006 Paris, France; AP-HP, hôpital européen Georges-Pompidou, service d'anatomie pathologie, 75015 Paris, France
| | - Arnaud Méjean
- Université de Paris-Cité, 75006 Paris, France; AP-HP, hôpital européen Georges-Pompidou, service d'urologie, 75015 Paris, France
| | - Olivier Hélénon
- AP-HP, hôpital Necker-Enfants-Malades, service d'imagerie adulte, 75015 Paris, France; Université de Paris-Cité, 75006 Paris, France
| | - Sylvain Guinebert
- AP-HP, hôpital Necker-Enfants-Malades, service d'imagerie adulte, 75015 Paris, France; Université de Paris-Cité, 75006 Paris, France
| | - Jean-Michel Correas
- AP-HP, hôpital Necker-Enfants-Malades, service d'imagerie adulte, 75015 Paris, France; Université de Paris-Cité, 75006 Paris, France; Sorbonne université, laboratoire d'imagerie biomédicale, CNRS, Inserm, Paris, France
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2
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Dev R, Chauhan U, Nandolia KK. Multifaceted Imaging of Renal Lesions With an Emphasis on Cross-Sectional Imaging. Cureus 2024; 16:e59956. [PMID: 38854236 PMCID: PMC11161908 DOI: 10.7759/cureus.59956] [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] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Renal lesions are common findings encountered in cross-sectional imaging. Ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) are available modalities for evaluating renal lesions. The Bosniak classification system aids in classifying a renal lesion into a particular category based on various imaging characteristics on contrast-enhanced CT (CECT). Materials and methods The CT report archives were searched for the keyword 'Bosniak' lesions, and six illustrative cases were selected to be included in the review. Results Six cases under Bosniak categories I to IV were included in the review. Operative follow-ups were added in cases where patients underwent surgery. Discussion We have reviewed the imaging features of various renal lesions with cross-sectional modalities, namely CT and MRI, with special emphasis on the Bosniak classification system, including its amendments. Conclusion The Bosniak system is widely used to classify and characterize renal lesions. The authors have presented a scoping review of the features of renal lesions and the Bosniak system.
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Affiliation(s)
- Rahul Dev
- Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Udit Chauhan
- Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Khanak K Nandolia
- Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, IND
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Wang K, Wang G, Liu Y, Dong L, Niu Y, Li G. Tumor margin irregularity degree is an important preoperative predictor of adverse pathology for clinical T1/2 renal cell carcinoma and the construction of predictive model. World J Urol 2024; 42:64. [PMID: 38289390 DOI: 10.1007/s00345-023-04698-0] [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: 01/23/2023] [Accepted: 10/30/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE To explore the critical role of the tumor margin irregularity degree (TMID) of renal tumors in predicting adverse pathology of patients with clinical T1/2 (cT1/2) renal cell carcinoma (RCC). METHODS A total of 821 patients with cT1/2 RCC undergoing nephrectomy in the Second Hospital of Tianjin Medical University between January 2017 and December 2020 were reviewed. The tumor margin irregularity (TMI) was classified into renal mass with locally raised protrusion and smooth margin called 'lobular', sharply and unsmooth nodular margin called 'spiculation', blurred margins between tumor and renal parenchyma or a completely irregular and non-elliptical shape. The ratio between the number of irregular cross-sections (X) and the number of total cross-sections from top to bottom occupied (Y) was defined as TMID (X/Y). The logistic regression was performed to determine the independent predictors of adverse pathology, and the Kaplan-Meier curve and log-rank test were used to analyze the survival outcomes. RESULTS Among 821 cT1/2 RCC patients, 245 (29.8%) had adverse pathology. The results of the univariate and multivariate logistic regressions showed that the age, tumor size, hemoglobin, and TMID were the independent predictors of adverse pathology. Incorporation of TMID could increase the discrimination of the predictive model with the area under curve (AUC) of ROC curves increasing from 0.725 to 0.808. Patients with adverse pathology or higher TMID both had significantly shorter recurrence-free survival (RFS). CONCLUSION The nomogram model incorporated with TMID for predicting adverse pathology could increase its discrimination, calibration, and clinical application values, compared with the models without TMID.
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Affiliation(s)
- Keruo Wang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Guixin Wang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yaru Liu
- Department of Emergency, The Second Hospital of Tianjin Medical University, Tianjin Medical University, Tianjin, 300211, China
| | - Liang Dong
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yuanjie Niu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
| | - Gang Li
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
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Benmeziani R, Royer M, Aubert C, Rolley C, Le Corre V, Culty T, Nedelcu C, Zidane M, Lebdai S, Bigot P. [Impact of delay before partial nephrectomy of a localized kidney tumor]. Bull Cancer 2023; 110:160-167. [PMID: 36379731 DOI: 10.1016/j.bulcan.2022.08.006] [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: 04/20/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Partial nephrectomy is the treatment of choice for small localized renal tumors. In case of doubt, a biopsy can confirm the diagnosis. The aim of this study was to evaluate the impact of a delayed time to partial nephrectomy on cancer development. MATERIALS AND METHODS Our single center study enrolled localized renal tumor patients who underwent a partial nephrectomy between 2015 and 2020; the collected data were included in the uroCCR prospective database. The histopathological stage of the tumors and the recurrence rate in patients treated with surgery >90 days after diagnosis were investigated. The impact a preoperative biopsy on was also explored. Statistical significance was tested using Student's t-test and Chi-squared test (SPSS software). RESULTS The cohort consisted of 179 patients, among which 41 (23 %) received a preoperative biopsy. 89 patients (50 %) were treated surgically >3 months after diagnosis. The median time to nephrectomy was 86 days (13-1 037). A delayed time to surgery did not lead to significantly higher recurrence rates (P=0.66). Preoperative biopsy led to a doubling time to surgery (P<0.001) but was neither correlated to a more severe tumor stage (P=0.944) nor to a higher recurrence rate (P=0.08). Tumor growth was not significantly different with or without the presence of a biopsy (P=0.122). CONCLUSION Our data evidence that a substantial delayed time to partial nephrectomy does not result in a negative impact on cancer prognosis in localized renal tumor patients.
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Affiliation(s)
- Racha Benmeziani
- CH Angoulême, service d'urologie, rond-point de Girac, 16959 Angoulême, France.
| | - Matthias Royer
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Cécile Aubert
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Cyrielle Rolley
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Vincent Le Corre
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Thibaut Culty
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Cosmina Nedelcu
- CHU de Angers, service de radiologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Merzouka Zidane
- CHU de Angers; service d'anatomopathologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Souhil Lebdai
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Pierre Bigot
- CHU de Angers, service d'urologie, 4, rue Larrey, 49933 Angers cedex 9, France
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French AFU Cancer Committee Guidelines - Update 2022-2024: management of kidney cancer. Prog Urol 2022; 32:1195-1274. [DOI: 10.1016/j.purol.2022.07.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
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Vijay V, Vokshi FH, Smigelski M, Nagpal S, Huang WC. Incidence of benign renal masses in a contemporary cohort of patients receiving partial nephrectomy for presumed renal cell carcinoma. Clin Genitourin Cancer 2022; 21:e114-e118. [DOI: 10.1016/j.clgc.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
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Wenzel M, Hoeh B, Rührup J, Gambetta H, Nocera L, Würnschimmel C, Tian Z, Karakiewicz PI, Briganti A, Chun FK, Roos FC, Becker A, Krimphove MJ. An external validation of the nocera nomogram: Predicting non-organ confined stage of ≥pT3 in cT1 clear cell renal cell carcinoma. Front Oncol 2022; 12:1019057. [PMID: 36300101 PMCID: PMC9589884 DOI: 10.3389/fonc.2022.1019057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background Only one previously published study by Nocera et al. addressed the risk of upstaging to ≥pT3 in cT1 clear cell renal cell carcinoma (ccRCC) by using characteristics of the R.E.N.A.L and PADUA score (age, tumor size, rim location, exophytic rate, polar involvement) developing an accurate nomogram. However, this nomogram has never been externally validated yet. Material and methods The study cohort consisted of 288 patients with cT1a-b ccRCC, diagnosed between 2008-2021 at the University Hospital Frankfurt, Germany. Analyses addressed clinical, tumor and radiographic characteristics. The external validation of the nomogram relied on accuracy calculations derived from the area under the curve of the receiver operator characteristic analysis. Results Overall, 11.8% (n=34) patients harbored ≥pT3 ccRCC. Median radiographic tumor size (3.6 vs. 5.3cm), R.E.N.A.L. (8 vs. 9 points) and PADUA score (9 vs. 11 points), as well as proportions of renal sinus involvement (82.4% vs. 51.6%), renal hilus involvement (44.1 vs. 13.0%), and medial rim location significantly differed between the pT1-2 and ≥pT3 group (all p ≤ 0.01). In subgroup analyses of small renal mass ccRCC patients (<4cm, cT1a), only 3.8% (n=6) patients had ≥pT3 pathology. Upstaged patients were significantly older and more frequently had endophytic tumor than pT1-2 counterparts (p<0.05). The external validation of the Nocera nomogram showed a good accuracy of 76.6%. Using the suggested cut-off of 21%, 26.5% of patients exhibited ≥pT3 ccRCC. Conversely, within patients below cut-off, 5.9% patients exhibited ≥pT3 ccRCC. Conclusion We reported the first external validation of the nomogram addressing the risk of ≥pT3 in cT1 ccRCC patients, demonstrating a good accuracy, with a low false-negative rate. Therefore, the nomogram can accurately be used for patients’ counselling and treatment decision making.
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
- *Correspondence: Mike Wenzel,
| | - Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Jessica Rührup
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Hanna Gambetta
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Luigi Nocera
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
- Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Christoph Würnschimmel
- Department of Urology, Luzerner Kantonspital, Lucerne, Switzerland
- Department of Health Science and Medicine, Univerity of Lucerne, Lucerne, Switzerland
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Felix K.H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Frederik C. Roos
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Marieke J. Krimphove
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
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Stewart GD, Klatte T, Cosmai L, Bex A, Lamb BW, Moch H, Sala E, Siva S, Porta C, Gallieni M. The multispeciality approach to the management of localised kidney cancer. Lancet 2022; 400:523-534. [PMID: 35868329 DOI: 10.1016/s0140-6736(22)01059-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 12/12/2022]
Abstract
Historically, kidney cancer was approached in a siloed single-speciality way, with urological surgeons managing the localised stages of the disease and medical oncologists caring for patients if metastases developed. However, improvements in the management of localised kidney cancer have occurred rapidly over the past two decades with greater understanding of the disease biology, diagnostic options, and innovations in curative treatments. These developments are favourable for patients but provide a substantially more complex landscape for patients and clinicians to navigate, with associated challenging decisions about who to treat, how, and when. As such, the skill sets needed to manage the various aspects of the disease and guide patients appropriately outstrips the capabilities of one particular specialist, and the evolution of a multispeciality approach to the management of kidney cancer is now essential. In this Review, we summarise the current best multispeciality practice for the management of localised kidney cancer and the areas in need of further research and development.
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Affiliation(s)
- Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; CRUK Cambridge Centre, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Laura Cosmai
- Division of Nephrology and Dialysis, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Axel Bex
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Benjamin W Lamb
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; School of Allied Health, Anglia Ruskin University, Cambridge, UK
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Evis Sala
- CRUK Cambridge Centre, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Camillo Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy; Division of Medical Oncology, AOU Consorziale Policlinico di Bari, Bari, Italy
| | - Maurizio Gallieni
- Division of Nephrology and Dialysis, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy; Department of Clinical and Biomedical Sciences, Università di Milano, Milan, Italy
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Purysko AS, Nikolaidis P, Khatri G, Auron M, De Leon AD, Ganeshan D, Gore JL, Gupta RT, Shek-Man Lo S, Lyshchik A, Savage SJ, Smith AD, Taffel MT, Yoo DC, Lockhart ME. ACR Appropriateness Criteria® Post-Treatment Follow-up and Active Surveillance of Clinically Localized Renal Cell Carcinoma: 2021 Update. J Am Coll Radiol 2022; 19:S156-S174. [PMID: 35550799 DOI: 10.1016/j.jacr.2022.02.015] [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: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 11/30/2022]
Abstract
Renal cell carcinoma (RCC) accounts for most malignant renal tumors and is considered the most lethal of all urologic cancers. For follow-up of patients with treated or untreated RCC and those with neoplasms suspected to represent RCC, radiologic imaging is the most valuable component of surveillance, as most relapses and cases of disease progression are identified when patients are asymptomatic. Understanding the strengths and limitations of the various imaging modalities for the detection of disease, recurrence, or progression is essential when planning follow-up regimens. This document addresses the appropriate imaging examinations for asymptomatic patients who have been treated for RCC with radical or partial nephrectomy or ablative therapies. It also discusses the appropriate imaging examinations for asymptomatic patients with localized biopsy-proven or suspected RCC undergoing active surveillance. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Paul Nikolaidis
- Panel Chair, Vice Chair, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Gaurav Khatri
- Panel Vice-Chair, Division Chief, Body MRI; Associate Division Chief, Abdominal Imaging; Program Director, Body MRI Fellowship, UT Southwestern Medical Center, Dallas, Texas
| | - Moises Auron
- Medical Director Blood Management; Quality and Patient Safety Officer, Department of Hospital Medicine; Member, Board of Governors, Cleveland Clinic, Cleveland, Ohio; Primary care physician-Internal medicine
| | | | | | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina; and Chair, ACR Meetings Subcommittee, Commission on Publications and Lifelong Learning
| | - Simon Shek-Man Lo
- Vice Chair for Strategic Planning, Director of SBRT, and Co-chair of Appointment and Promotion Committee of Department of Radiation of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington; and Immediate Past President of CARROS of ACR, Fellowship Committee Chair of CARROS of ACR, ACR Assistant Councilor (on behalf of American Radium Society), Chair of the Committee for ACR Practice Parameter for Radiation Oncology
| | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Stephen J Savage
- Professor and Vice Chairman of Urology, Medical University of South Carolina, Charleston, South Carolina; American Urological Association
| | - Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Myles T Taffel
- Associate Section Head Abdominal Imaging, New York University Langone Medical Center, New York, New York
| | - Don C Yoo
- Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama; and Chair, ACR Appropriateness Committee
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Numakura K, Nakai Y, Kojima T, Osawa T, Narita S, Nakayama M, Kitamura H, Nishiyama H, Shinohara N. Overview of clinical management for older patients with renal cell carcinoma. Jpn J Clin Oncol 2022; 52:665-681. [PMID: 35397166 DOI: 10.1093/jjco/hyac047] [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] [Received: 11/24/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
The rapidly increasing pool of older patients being diagnosed with and surviving their cancer is creating many challenges. Regarding localized renal cell carcinoma, surgery is considered as gold standard treatment options even in older men, whereas active surveillance and ablation therapy are alternative options for a proportion of these patients. With regard to advanced disease, anti-vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) and immune check point inhibitor are standard treatment modalities, although treatment choice from multiple regimens and prevention of adverse events need to be considered. Better assessment techniques, such as comprehensive geriatric assessment to meet the unique needs of older patients, are a central focus in the delivery of high-quality geriatric oncology care. Through this process, shared decision-making should be adopted in clinical care to achieve optimal goals of care that reflect patient and caregiver hopes, needs and preferences. It is necessary to continue investigating oncological outcomes and complications associated with treatment in this population to ensure appropriate cancer care. In this narrative review, we completed a literature review of the various treatments for renal cell carcinoma in older patients that aimed to identify the current evidence related to the full range of the treatments including active surveillance, surgery, ablation therapy and systemic therapy. Prospectively designed studies and studies regarding geriatric assessment were preferentially added as references. Our goals were to summarize the real-world evidence and provide a decision framework that guides better cancer practices for older patients with renal cell carcinoma.
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Affiliation(s)
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | | | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Masashi Nakayama
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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Cui HW, Sullivan ME. Surveillance for low-risk kidney cancer: a narrative review of contemporary worldwide practices. Transl Androl Urol 2021; 10:2762-2786. [PMID: 34295761 PMCID: PMC8261444 DOI: 10.21037/tau-20-1295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/04/2021] [Indexed: 11/09/2022] Open
Abstract
The management trend of low-risk kidney cancer over the last decade has been from treatment with radical nephrectomy, to use of nephron sparing procedures of partial nephrectomy and ablation, as well as the option of active surveillance (AS). This narrative review aims to summarise the available guidelines related to AS and review the published descriptions of regional practices on the management of low-risk kidney cancer worldwide. A search of PubMed, Google Scholar and Cochrane Library databases for studies published 2010 to June 2020 identified 15 studies, performed between 2000 and 2019, which investigated 13 different cohorts of low-risk kidney cancer patients on AS. Although international guidelines show a level of agreement in their recommendation on how AS is conducted, in terms of patient selection, surveillance strategy and triggers for intervention, cohort studies show distinct differences in worldwide practice of AS. Prospective studies showed general agreement in their predefined selection criteria for entry into AS. Retrospective studies showed that patients who were older, with greater comorbidities, worse performance status and smaller tumours were more likely to be managed with AS. The rate of percutaneous renal mass biopsy varied between studies from 2% to 56%. The surveillance protocol was different across all studies in terms of recommended modality and frequency of imaging. Of the 6 studies which had set indications for intervention, these were broadly in agreement. Despite clear criteria for intervention, patient or surgeon preference was still the reason in 11–71% of cases of delayed intervention across 5 studies. This review shows that AS is being applied in a variety of centres worldwide and that key areas of patient selection criteria and surveillance strategy have large similarities. However, the rate of renal mass biopsy and of delayed intervention varies significantly between studies, suggesting the process of diagnosing malignant SRM and decision making whilst on AS are varying in practice. Further research is needed on the diagnosis and characterisation of incidentally found small renal masses (SRM), using imaging and histology, and the natural history of these SRM in order to develop evidence-based active surveillance protocols.
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Affiliation(s)
- Helen Wei Cui
- Urology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark Edward Sullivan
- Urology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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12
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Chan VWS, Tan WS, Leow JJ, Tan WP, Ong WLK, Chiu PKF, Gurung P, Pirola GM, Orecchia L, Liew MPC, Lee HY, Wang Y, Chen IHA, Castellani D, Wroclawski ML, Mayor N, Sathianathen NJ, Braga I, Liu Z, Moon D, Tikkinen K, Kamat A, Meng M, Ficarra V, Giannarini G, Teoh JYC. Delayed surgery for localised and metastatic renal cell carcinoma: a systematic review and meta-analysis for the COVID-19 pandemic. World J Urol 2021; 39:4295-4303. [PMID: 34031748 PMCID: PMC8143063 DOI: 10.1007/s00345-021-03734-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/13/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose The COVID-19 pandemic has led to the cancellation or deferment of many elective cancer surgeries. We performed a systematic review on the oncological effects of delayed surgery for patients with localised or metastatic renal cell carcinoma (RCC) in the targeted therapy (TT) era. Method The protocol of this review is registered on PROSPERO(CRD42020190882). A comprehensive literature search was performed on Medline, Embase and Cochrane CENTRAL using MeSH terms and keywords for randomised controlled trials and observational studies on the topic. Risks of biases were assessed using the Cochrane RoB tool and the Newcastle–Ottawa Scale. For localised RCC, immediate surgery [including partial nephrectomy (PN) and radical nephrectomy (RN)] and delayed surgery [including active surveillance (AS) and delayed intervention (DI)] were compared. For metastatic RCC, upfront versus deferred cytoreductive nephrectomy (CN) were compared. Results Eleven studies were included for quantitative analysis. Delayed surgery was significantly associated with worse cancer-specific survival (HR 1.67, 95% CI 1.23–2.27, p < 0.01) in T1a RCC, but no significant difference was noted for overall survival. For localised ≥ T1b RCC, there were insufficient data for meta-analysis and the results from the individual reports were contradictory. For metastatic RCC, upfront TT followed by deferred CN was associated with better overall survival when compared to upfront CN followed by deferred TT (HR 0.61, 95% CI 0.43–0.86, p < 0.001). Conclusion Noting potential selection bias, there is insufficient evidence to support the notion that delayed surgery is safe in localised RCC. For metastatic RCC, upfront TT followed by deferred CN should be considered. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03734-1.
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Affiliation(s)
- Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Wei Shen Tan
- Department of Urology, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Urology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Wei Phin Tan
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | | | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Pratik Gurung
- Department of Urology, University of Rochester Medical Center, New York, USA
| | | | - Luca Orecchia
- Urology Unit, Policlinico Tor Vergata Foundation, Rome, Italy
| | | | - Hsiang-Ying Lee
- Urology Department, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Yuding Wang
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Canada
| | - I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Nikhil Mayor
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | - Isaac Braga
- Department of Urology, Instituto Portugues de Oncologia, Porto, Portugal
| | - Zhenbang Liu
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Dora Moon
- Department of Urology, East Lancashire Hospitals NHS Foundation Trust, Blackburn, UK
| | - Kari Tikkinen
- Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashish Kamat
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Max Meng
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia Academic Medical Centre, Udine, Italy
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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13
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Bensalah K, Bigot P, Albiges L, Bernhard J, Bodin T, Boissier R, Correas J, Gimel P, Hetet J, Long J, Nouhaud F, Ouzaïd I, Rioux-Leclercq N, Méjean A. Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : prise en charge du cancer du rein. Prog Urol 2020; 30:S2-S51. [DOI: 10.1016/s1166-7087(20)30749-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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14
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Klein G, Wang H, Elshabrawy A, Nashawi M, Gourley E, Liss M, Kaushik D, Wu S, Rodriguez R, Mansour AM. Analyzing National Incidences and Predictors of Open Conversion During Minimally Invasive Partial Nephrectomy for cT1 Renal Masses. J Endourol 2020; 35:30-38. [PMID: 32434388 DOI: 10.1089/end.2020.0161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives: To analyze predictors of open conversion during minimally invasive partial nephrectomy (MIPN) for cT1 renal masses. Methods: The National Cancer Database (NCDB) was investigated for kidney cancer patients who underwent partial nephrectomy (PN) between 2010 and 2015. Patients who underwent MIPN were stratified into converted and nonconverted groups. Sociodemographics, facility characteristics, and surgical outcomes were compared between the two groups, and multivariate logistic regression model was fitted to identify independent predictors of open conversion. Results: In total, 54,246 patients underwent PN for kidney cancer during the 6-year period. Of those, 18,994 (35%) were open partial nephrectomies (OPNs) and 35,252 (64%) were MIPN. Overall, 1010 (2.87%) of MIPNs were converted to OPN. There was an increasing utilization of MIPN from 50.35% in 2010 to 74.73% in 2015. Patients who had open conversion had more 30-day readmissions (5.95% vs 3.31%, p < 0.01). On multivariate analysis; high-volume facility (>30 MIPNs/year), year of surgery (2015 vs 2010), and robotic approach predicted a lower likelihood of conversion (odds ratio [OR] 0.52, confidence interval [CI] 0.44-0.62; OR 0.59, CI 0.47-0.73; and OR 0.31, CI 0.27-0.35; respectively, p < 0.001 for all). Conversely, Medicaid (vs private insurance; OR 1.75, CI 1.39-2.19, p < 0.001) and male sex (OR 1.26, CI 1.11-1.44, p < 0.001) were independent predictors of conversion. Conclusions: Open conversion in MIPN occurred in 2.87% of cases. There was an increasing utilization of MIPN associated with decreased conversion rates. Higher volume hospitals and progressing year of surgery were associated with less likelihood of conversion.
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Affiliation(s)
- Geraldine Klein
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Hanzhang Wang
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Ahmed Elshabrawy
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Mouhamed Nashawi
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Eric Gourley
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Michael Liss
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Dharam Kaushik
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Shenghui Wu
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, Texas, USA
| | - Ronald Rodriguez
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Ahmed M Mansour
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA.,Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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15
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Mauri G, Rossi D, Bonomo G, Camisassi N, Della Vigna P, Maiettini D, Varano GM, Monfardini L, Mascagni L, Orsi F. Image-guided thermal ablation of central renal tumors with retrograde cold pyeloperfusion technique: a monocentric experience. Int J Hyperthermia 2020; 37:660-667. [PMID: 32552069 DOI: 10.1080/02656736.2020.1778801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose: To evaluate feasibility, safety and efficacy of image-guided thermal ablations associated with retrograde pyeloperfusion in patients with centrally located renal tumors.Materials and methods: 48 patients (15 women, 33 men, mean age 69.1 ± 11.8) were treated with image-guided thermal ablation associated with pyeloperfusion for 58 centrally located renal tumors (mean diameter 32.3 ± 7.32 mm). 7 patients had a single kidney. Microwave and radiofrequency ablation were used. All treatments were performed with ultrasound, CT, or fusion imaging guidance under general anesthesia and simultaneous retrograde cold pyeloperfusion technique.Results: Procedure was feasible in all cases. Technical success and primary technical efficacy were reached in 51/58 (88%) and 45/54 tumors (83%). With a second ablation performed in 5 tumors, secondary technical efficacy was achieved in 50/50 (100%) tumors. Minor and major complications occurred in 8/58 (13%) and 5/58 (8%) tumors. No significative change in renal function occurred after treatment.During follow-up, 5 recurrences occurred, that were retreated with a second ablation. At last follow up (mean 32.2 ± 22.0 months), 41/48 (85%) treated patients were free from disease. The median TTP and PFS were 27.0 (range, 2.3-80.0) and 26.5 months (range, 2.3-80.0), respectively.Conclusion: Image-guided thermal ablation associated with protective pyeloperfusion is a feasible, safe, and effective treatment option for patients with central renal tumors with a minimal impact on renal function and relevant potential to avoid nephrectomy.
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Affiliation(s)
- Giovanni Mauri
- Department of Oncology and Hematology-Oncology, Università Degli Studi di Milano, Milan, Italy.,Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Duccio Rossi
- Postgraduate School of Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| | - Guido Bonomo
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Nicola Camisassi
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Della Vigna
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Daniele Maiettini
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianluca Maria Varano
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Monfardini
- Dipartimento di Radiologia, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Luca Mascagni
- Radiology Residency, School of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Franco Orsi
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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16
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Wośkowiak P, Lewicka K, Bureta A, Salagierski M. Active surveillance and focal ablation for small renal masses: a better solution for comorbid patients. Arch Med Sci 2020; 16:1111-1118. [PMID: 32864000 PMCID: PMC7444719 DOI: 10.5114/aoms.2019.86190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/01/2018] [Indexed: 01/04/2023] Open
Abstract
The natural history of small renal masses (SRM) is still not well understood and they are frequently incidentally diagnosed in elderly patients. Therefore, there is a need for less invasive options sparing the patient from the side-effects related to conventional surgical treatment. PubMed and Medline database search was performed to look for new findings on active surveillance and focal therapy for SRM. Sixty-one articles published between 2002 and 2018 were selected for the purpose of the review. There is growing evidence confirming the safety of active surveillance in patients at surgical risk and there appears to be a satisfactory intermediate-term outcome of focal treatment of SRM. In the group of elderly patients with a decreased life expectancy active surveillance appears to be the most appropriate approach. The future of minimally invasive therapy appears bright, especially with the improvement of new imaging modalities.
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Affiliation(s)
- Piotr Wośkowiak
- The Faculty of Medicine and Health Sciences, University of Zielona Gora, Zielona Gora, Poland
| | - Katarzyna Lewicka
- The Faculty of Medicine and Health Sciences, University of Zielona Gora, Zielona Gora, Poland
| | - Adrianna Bureta
- The Faculty of Medicine and Health Sciences, University of Zielona Gora, Zielona Gora, Poland
| | - Maciej Salagierski
- The Faculty of Medicine and Health Sciences, University of Zielona Gora, Zielona Gora, Poland
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17
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Kadomoto S, Makino T, Izumi K, Mizokami A. An important step in establishing a treatment strategy for small renal masses of clear cell renal cell carcinoma based on the significance of adverse histopathologic features on tumor needle biopsy. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S374. [PMID: 32016092 DOI: 10.21037/atm.2019.12.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Suguru Kadomoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Tomoyuki Makino
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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18
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Purysko AS, Nikolaidis P, Dogra VS, Ganeshan D, Gore JL, Gupta RT, Heilbrun ME, Khatri G, Kishan AU, Lyshchik A, Savage SJ, Smith AD, Wang ZJ, Wolfman DJ, Wong-You-Cheong JJ, Yoo DC, Lockhart ME. ACR Appropriateness Criteria® Post-Treatment Follow-up and Active Surveillance of Clinically Localized Renal Cell Cancer. J Am Coll Radiol 2019; 16:S399-S416. [DOI: 10.1016/j.jacr.2019.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 01/03/2023]
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19
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Guo RQ, Li XG. Comparison of survival benefits of nephron-sparing intervention or active surveillance for patients with localized renal masses: a systematic review and meta-analysis. BMC Urol 2019; 19:74. [PMID: 31382939 PMCID: PMC6683559 DOI: 10.1186/s12894-019-0503-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Strong evidence comparing effectiveness between nephron-sparing intervention (NSI) and active surveillance (AS) is lacking. Thus, we aim to compare the outcomes of survival, including cancer-specific survival (CSS), overall survival (OS), and cardiovascular-specific survival (CVSS), in patients with renal masses who underwent NSI or AS. Methods A systematic literature search of PubMed, Web of Science, and EMBASE was performed for citations published prior to September 2018 that described NSI, partial nephrectomy and thermal ablation included, and AS for patients with renal masses and a standard meta-analysis on survival outcomes was then conducted. Results The meta-analysis included seven studies containing 5809 patients. The results comparing NSI with AS were as follows: CSS (hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.46–0.89, P < 0.001), OS (HR = 0.46, 95%CI: 0.39–0.53, P < 0.001), and CVSS (HR = 0.37, 95%CI: 0.24–0.57, P < 0.001). Conclusions This systematic review and meta-analysis indicates that NSI is associated with better OS, CSS and CVSS when compared with AS for patients with renal masses. Further better prospective cohort studies are needed to make definitive statements about these different treatment methods.
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Affiliation(s)
- Run-Qi Guo
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, No.1 Dongdan Dahua Street, Beijing, 100370, People's Republic of China
| | - Xiao-Guang Li
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, No.1 Dongdan Dahua Street, Beijing, 100370, People's Republic of China.
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20
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Liao X, Qiu S, Wang W, Zheng X, Jin K, Zhang S, Bao Y, Yang L, Wei Q. Partial nephrectomy vs cryoablation for T1a renal cell carcinoma: A comparison of survival benefit stratified by tumour size. Cancer Epidemiol 2019; 59:221-226. [PMID: 30836219 DOI: 10.1016/j.canep.2019.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We compared the impact on survival outcomes of partial nephrectomy (PN) and cryoablation (CA) for patients diagnosed with T1a renal cell carcinoma (RCC). PATIENTS AND METHODS Among patients diagnosed between 2004 and 2014 in the Surveillance, Epidemiology and End Results program, we identified histologically confirmed T1aN0M0 RCC treated with PN (n = 17644) or CA (n = 868). Propensity score matching (PSM) was performed. Kaplan-Meier method, Cox proportional hazards model were used to calculate cancer specific mortality (CSM) and overall mortality (OM) in the unmatched and matched cohort, and in subgroups based on tumour size (< 2 cm, 2-3 cm, 3-4 cm). Sensitivity analyses were performed. RESULTS A total of 18512 patients were identified: PN (93.88%) and CA (6.12%). In the propensity-score matched cohort, for tumours ≤ 2 cm, the CA and PN groups had similar CSM (HR: 1.41, 95% CI: 0.32-6.31, p = 0.65) and OM (HR 0.97, 95%CI: 0.47-2.01, p = 0.93). For tumours 2-3 cm, CA was associated with similar CSM (HR 1.64, 95%CI: 0.67-4.03, p = 0.28) but higher OM (HR 2.05, 95%CI: 1.35-3.11, p < 0.001), compared with PN. For tumours 3-4 cm, CA was associated with increased CSM (HR: 3.76, 95% CI: 1.62-8.69, p = 0.002) and OM (HR 2.17, 95%CI: 1.48-3.18, p < 0.001). CONCLUSION For RCC ≤ 2 cm, PN and CA are equal in survival outcomes. For RCC 2-4 cm, PN may have a possible advantage over CA.
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Affiliation(s)
- Xinyang Liao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China; Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Wanyu Wang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Xiaonan Zheng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Kun Jin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Shiyu Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Yige Bao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
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21
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Marcq G, Hénon F, Ouzaid I, Fantoni JC, Hermieu JF, Xylinas E. Active surveillance for non-muscle invasive bladder cancer. Transl Androl Urol 2019; 8:54-60. [PMID: 30976569 PMCID: PMC6414342 DOI: 10.21037/tau.2018.10.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 10/22/2018] [Indexed: 12/24/2022] Open
Abstract
Most of low grade (LG) bladder tumors will experience disease recurrence and very few of them (<2%) will experience disease progression. Therefore active surveillance (AS) for LG non-muscle invasive bladder cancer (NMIBC) has emerged. The goal of our study was to provide a literature review of AS for LG NMIBC including inclusion criteria, modalities and oncological outcomes. We conducted a systematic review (registered in PROSPERO: CRD42018102935) using MEDLINE and EMBASE between June 2018 and August 2018 with the following terms: LG, NMIBC, AS, urothelial neoplasm. Overall, 6 studies that reached our scope of review were included cumulating 403 patients with 2 prospective trials. Inclusion criteria were: recurrent LG (G1 and G2) Ta or T1 NMIBC, with a negative cytology, a low volume (<10 mm) and low number (<5) of tumors. Cystoscopy every 3 months during the first 2 years and every 6 months afterwards were required. AS dropout criteria were presence of tumor-related symptoms, a positive cytology, a modification of tumor morphology or size and patient's request. Pooled data showed an overall 65% reclassification rate where 15% of patients were reclassified based on grade and 10% on stage with a median follow-up of 32 months (IQR, 24-42 months). Only one study reported on progression to MIBC in 4 patients out of 186 (2%). Most of patients enrolled in an AS protocol for recurrent LG NMIBC will undergo a TURBT eventually. Many patients may be eligible to this therapeutic approach but current knowledge does not support its use in daily practice outside of a clinical trial.
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Affiliation(s)
| | | | - Idir Ouzaid
- Department of Urology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
| | | | - Jean-François Hermieu
- Department of Urology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
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22
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Bensalah K, Albiges L, Bernhard JC, Bigot P, Bodin T, Boissier R, Correas JM, Gimel P, Hetet JF, Long JA, Nouhaud FX, Ouzaïd I, Rioux-Leclercq N, Méjean A. Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : prise en charge du cancer du rein. Prog Urol 2018; 28 Suppl 1:R5-R33. [DOI: 10.1016/j.purol.2019.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 12/15/2022]
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23
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Breen DJ, King AJ, Patel N, Lockyer R, Hayes M. Image-guided Cryoablation for Sporadic Renal Cell Carcinoma: Three- and 5-year Outcomes in 220 Patients with Biopsy-proven Renal Cell Carcinoma. Radiology 2018; 289:554-561. [DOI: 10.1148/radiol.2018180249] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- David J. Breen
- From the Departments of Radiology (D.J.B., A.J.K., N.P.) and Urology (R.L., M.H.), University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, England
| | - Alexander J. King
- From the Departments of Radiology (D.J.B., A.J.K., N.P.) and Urology (R.L., M.H.), University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, England
| | - Nirav Patel
- From the Departments of Radiology (D.J.B., A.J.K., N.P.) and Urology (R.L., M.H.), University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, England
| | - Richard Lockyer
- From the Departments of Radiology (D.J.B., A.J.K., N.P.) and Urology (R.L., M.H.), University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, England
| | - Matthew Hayes
- From the Departments of Radiology (D.J.B., A.J.K., N.P.) and Urology (R.L., M.H.), University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, England
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Bensalah K, Albiges L, Bernhard JC, Bigot P, Bodin T, Boissier R, Correas JM, Gimel P, Hetet JF, Long JA, Nouhaud FX, Ouzaïd I, Rioux-Leclercq N, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : prise en charge du cancer du reinFrench ccAFU guidelines – Update 2018–2020: Management of kidney cancer. Prog Urol 2018; 28:S3-S31. [PMID: 30473002 DOI: 10.1016/j.purol.2018.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 12/15/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: DOI:10.1016/j.purol.2019.01.004.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the DOI:10.1016/j.purol.2019.01.004.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- K Bensalah
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033, Rennes cedex, France.
| | - L Albiges
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Département d'oncologie génito-urinaire, Gustave-Roussy, 94805, Villejuif cedex, France
| | - J-C Bernhard
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie et transplantation rénale, CHU de Bordeaux, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - P Bigot
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, CHU d'Angers, 4, rue Larrey, 49000, Angers, France
| | - T Bodin
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre d'urologie Prado-Louvain, 188, rue du Rouet, 13008, Marseille, France
| | - R Boissier
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie et transplantation rénale, CHU Conception, 147, boulevard Baille, 13005, Marseille, France
| | - J-M Correas
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'imagerie médicale (radiologie), hôpital universitaire Necker-Enfants-malades, 149, rue de Sèvres, 75015, Paris, France
| | - P Gimel
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre d'urologie, site Médipôle, 5, avenue Ambroise-Croizat, 66330, Cabestany, France
| | - J-F Hetet
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de chirurgie urologique, clinique Jules-Verne, 2-4, route de Paris, 44314, Nantes, France
| | - J-A Long
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de chirurgie urologique et de la transplantation rénale, hôpital Michallon, CHU Grenoble, boulevard de la Chantourne, 38700, La Tronche, France
| | - F-X Nouhaud
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, CHU de Rouen, 1, rue de Germont, 76000, Rouen, France
| | - I Ouzaïd
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Clinique urologique, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018, Paris, France
| | - N Rioux-Leclercq
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'anatomie et cytologie pathologiques, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033, Rennes cedex 9, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015, Paris, France
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Tang DH, Nawlo J, Chipollini J, Gilbert SM, Poch M, Pow-Sang JM, Sexton WJ, Spiess PE. Management of Renal Masses in an Octogenarian Cohort: Is There a Right Approach? Clin Genitourin Cancer 2017; 15:696-703. [DOI: 10.1016/j.clgc.2017.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/26/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022]
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Prins FM, Kerkmeijer LGW, Pronk AA, Vonken EJPA, Meijer RP, Bex A, Barendrecht MM. Renal Cell Carcinoma: Alternative Nephron-Sparing Treatment Options for Small Renal Masses, a Systematic Review. J Endourol 2017; 31:963-975. [PMID: 28741377 DOI: 10.1089/end.2017.0382] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The standard treatment of T1 renal cell carcinoma (RCC) is (partial) nephrectomy. For patients where surgery is not the treatment of choice, for example in the elderly, in case of severe comorbidity, inoperability, or refusal of surgery, alternative treatment options are available. These treatment options include active surveillance (AS), radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), or stereotactic body radiotherapy (SBRT). In the present overview, the efficacy, safety, and outcome of these different options are summarized, particularly focusing on recent developments. MATERIALS AND METHODS Databases of MEDLINE (through PubMed), EMBASE, and the Cochrane Library were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The search was performed in December 2016, and included a search period from 2010 to 2016. The terms and synonyms used were renal cell carcinoma, active surveillance, radiofrequency ablation, microwave ablation, cryoablation and stereotactic body radiotherapy. RESULTS The database search identified 2806 records, in total 73 articles were included to assess the rationale and clinical evidence of alternative treatment modalities for small renal masses. The methodological quality of the included articles varied between level 2b and level 4. CONCLUSION Alternative treatment modalities, such as AS, RFA, CA, MWA, and SBRT, are treatment options especially for those patients who are unfit to undergo an invasive treatment. There are no randomized controlled trials available comparing surgery and less invasive modalities, leading to a low quality on the reported articles. A case-controlled registry might be an alternative to compare outcomes of noninvasive treatment modalities in the future.
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Affiliation(s)
- Fieke M Prins
- 1 Department of Radiation Oncology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Linda G W Kerkmeijer
- 1 Department of Radiation Oncology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Anne A Pronk
- 2 Department of Urology, Tergooi Hospital , Hilversum, The Netherlands
| | - Evert-Jan P A Vonken
- 3 Department of Radiology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Richard P Meijer
- 4 Department of Urology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Axel Bex
- 5 Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital , Amsterdam, The Netherlands
| | - Maurits M Barendrecht
- 6 Department of Urology, Tergooi Hospital, Hilversum and University Medical Center Utrecht , Utrecht, The Netherlands
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Delayed Intervention of Small Renal Masses on Active Surveillance. J Kidney Cancer VHL 2017; 4:24-30. [PMID: 28725541 PMCID: PMC5515897 DOI: 10.15586/jkcvhl.2017.75] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/10/2017] [Indexed: 01/17/2023] Open
Abstract
Although surgical excision is the standard of therapy for small renal masses (SRMs), there is a growing recognition of active surveillance as an option in select patients who are poor surgical candidates or who have shorter life expectancy. A number of patients on expectant management, however, subsequently advance to definitive therapy. In this study, we systematically reviewed the literature and performed a pooled analysis of active surveillance series to evaluate the rate and indications for definitive treatment after initiating a period of active surveillance. Fourteen clinical series (1245 patients; 1364 lesions) met our selection criteria. Mean lesion size at presentation was 2.30 ± 0.40 cm with a mean follow-up of 33.6 ± 16.9 months. Collectively, 34.0% of patients underwent delayed intervention, which ranged in individual series from 3.6% to 70.3%. Of patients undergoing delayed intervention, the average time on active surveillance prior to definitive treatment was 27.8 ± 10.6 months. A pooled analysis revealed that 41.0% of patients underwent therapy secondary to tumor growth rate and 51.9% secondary to patient or physician preference in the absence of clinical progression. Overall, 1.1% of all patients progressed to metastatic disease during the average follow-up period. Thus, active surveillance may be an appropriate option for carefully selected patients with SRMs. However, delayed treatment is pursued in a significant percentage of patients within 3 years. Prospective registries and clinical trials with standardized indications for delayed intervention are needed to establish true rates of disease progressions and recommendations for delayed intervention.
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Kunath F, Schmidt S, Krabbe L, Miernik A, Dahm P, Cleves A, Walther M, Kroeger N. Partial nephrectomy versus radical nephrectomy for clinical localised renal masses. Cochrane Database Syst Rev 2017; 5:CD012045. [PMID: 28485814 PMCID: PMC6481491 DOI: 10.1002/14651858.cd012045.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Partial nephrectomy and radical nephrectomy are the relevant surgical therapy options for localised renal cell carcinoma. However, debate regarding the effects of these surgical approaches continues and it is important to identify and summarise high-quality studies to make surgical treatment recommendations. OBJECTIVES To assess the effects of partial nephrectomy compared with radical nephrectomy for clinically localised renal cell carcinoma. SEARCH METHODS We searched CENTRAL, MEDLINE, PubMed, Embase, Web of Science, BIOSIS, LILACS, Scopus, two trial registries and abstracts from three major conferences to 24 February 2017, together with reference lists; and contacted selected experts in the field. SELECTION CRITERIA We included a randomised controlled trial comparing partial and radical nephrectomy for participants with small renal masses. DATA COLLECTION AND ANALYSIS One review author screened all of the titles and abstracts; only citations that were clearly irrelevant were excluded at this stage. Next, two review authors independently assessed full-text reports, identified relevant studies, evaluated the eligibility of the studies for inclusion, assessed trial quality and extracted data. The update of the literature search was performed by two independent review authors. We used Review Manager 5 for data synthesis and data analyses. MAIN RESULTS We identified one randomised controlled trial including 541 participants that compared partial nephrectomy to radical nephrectomy. The median follow-up was 9.3 years.Based on low quality evidence, we found that time-to-death of any cause was decreased using partial nephrectomy (HR 1.50, 95% CI 1.03 to 2.18). This corresponds to 79 more deaths (5 more to 173 more) per 1000. Also based on low quality evidence, we found no difference in serious adverse events (RR 2.04, 95% CI 0.19 to 22.34). Findings are consistent with 4 more surgery-related deaths (3 fewer to 78 more) per 1000.Based on low quality evidence, we found no difference in time-to-recurrence (HR 1.37, 95% CI 0.58 to 3.24). This corresponds to 12 more recurrences (14 fewer to 70 more) per 1000. Due to the nature of reporting, we were unable to analyse overall rates for immediate and long-term adverse events. We found no evidence on haemodialysis or quality of life.Reasons for downgrading related to study limitations (lack of blinding, cross-over), imprecision and indirectness (a substantial proportion of patients were ultimately found not to have a malignant tumour). Based on the finding of a single trial, we were unable to conduct any subgroup or sensitivity analyses. AUTHORS' CONCLUSIONS Partial nephrectomy may be associated with a decreased time-to-death of any cause. With regards to surgery-related mortality, cancer-specific survival and time-to-recurrence, partial nephrectomy appears to result in little to no difference.
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Affiliation(s)
- Frank Kunath
- University Hospital ErlangenDepartment of UrologyKrankenhausstrasse 12ErlangenGermany91054
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
| | | | - Laura‐Maria Krabbe
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
- University of Muenster Medical CenterDepartment of UrologyAlbert‐Schweitzer Campus 1, GB A1MuensterNRWGermany48149
| | - Arkadiusz Miernik
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
- Medical University Centre FreiburgDepartment of UrologyHugstetterstrasse 55FreiburgBaden‐WürttembergGermany79106
| | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
| | - Anne Cleves
- Cardiff University Library ServicesVelindre NHS TrustVelindre Cancer CentreCardiffWalesUKCF14 2TL
| | | | - Nils Kroeger
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
- University Hospital GreifswaldDepartment of Urology17489 GreifswaldGreifswaldGermany
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Finelli A, Ismaila N, Bro B, Durack J, Eggener S, Evans A, Gill I, Graham D, Huang W, Jewett MAS, Latcha S, Lowrance W, Rosner M, Shayegan B, Thompson RH, Uzzo R, Russo P. Management of Small Renal Masses: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2017; 35:668-680. [PMID: 28095147 DOI: 10.1200/jco.2016.69.9645] [Citation(s) in RCA: 230] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose To provide recommendations for the management options for patients with small renal masses (SRMs). Methods By using a literature search and prospectively defined study selection, we sought systematic reviews, meta-analyses, randomized clinical trials, prospective comparative observational studies, and retrospective studies published from 2000 through 2015. Outcomes included recurrence-free survival, disease-specific survival, and overall survival. Results Eighty-three studies, including 20 systematic reviews and 63 primary studies, met the eligibility criteria and form the evidentiary basis for the guideline recommendations. Recommendations On the basis of tumor-specific findings and competing risks of mortality, all patients with an SRM should be considered for a biopsy when the results may alter management. Active surveillance should be an initial management option for patients who have significant comorbidities and limited life expectancy. Partial nephrectomy (PN) for SRMs is the standard treatment that should be offered to all patients for whom an intervention is indicated and who possess a tumor that is amenable to this approach. Percutaneous thermal ablation should be considered an option if complete ablation can reliably be achieved. Radical nephrectomy for SRMs should only be reserved for patients who possess a tumor of significant complexity that is not amenable to PN or for whom PN may result in unacceptable morbidity even when performed at centers with expertise. Referral to a nephrologist should be considered if chronic kidney disease (estimated glomerular filtration rate < 45 mL/min/1.73 m2) or progressive chronic kidney disease occurs after treatment, especially if associated with proteinuria.
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Affiliation(s)
- Antonio Finelli
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Nofisat Ismaila
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Bill Bro
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Jeremy Durack
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Scott Eggener
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Andrew Evans
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Inderbir Gill
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - David Graham
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - William Huang
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Michael A S Jewett
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Sheron Latcha
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - William Lowrance
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Mitchell Rosner
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Bobby Shayegan
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - R Houston Thompson
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Robert Uzzo
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Paul Russo
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
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Active surveillance for incidental renal mass in the octogenarian. World J Urol 2016; 35:1089-1094. [DOI: 10.1007/s00345-016-1961-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022] Open
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Effect of delayed resection after initial surveillance and tumor growth rate on final surgical pathology in patients with small renal masses (SRMs). Urol Oncol 2016; 34:486.e9-486.e15. [DOI: 10.1016/j.urolonc.2016.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/24/2016] [Accepted: 05/30/2016] [Indexed: 11/23/2022]
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Ambani SN, Morgan TM, Montgomery JS, Gadzinski AJ, Jacobs BL, Hawken S, Krishnan N, Caoili EM, Ellis JH, Kunju LP, Hafez KS, Miller DC, Palapattu GS, Weizer AZ, Wolf JS. Predictors of Delayed Intervention for Patients on Active Surveillance for Small Renal Masses: Does Renal Mass Biopsy Influence Our Decision? Urology 2016; 98:88-96. [PMID: 27450936 DOI: 10.1016/j.urology.2016.04.067] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To review our clinical T1a renal mass active surveillance (AS) cohort to determine whether renal mass biopsy was associated with maintenance of AS. MATERIALS AND METHODS From our prospectively maintained database we identified patients starting AS from June 2009 to December 2011 who had at least 5 months of radiologic follow-up, unless limited by unexpected death or delayed intervention. The primary outcome was delayed intervention. Clinical, radiologic, and pathologic variables were compared. We constructed Kaplan-Meier survival curves for maintenance of AS. Cox multivariable regression analysis was performed to assess predictors of delayed intervention. RESULTS We identified 118 patients who met criteria for inclusion with a median radiologic follow-up of 29.5 months. The delayed intervention group had greater initial mass size and faster growth rate compared to those who continued AS. Rate of renal mass biopsy was similar between the 2 groups. In the multivariable analysis, size >2 cm (hazard ratio [HR] 3.65, 95% confidence interval [CI] 1.28-10.38, P = .015), growth rate (continuous by mm/year: HR 1.26, 95% CI 1.12-1.41, P < .001), but not renal biopsy (HR 1.52, 95% CI 0.70-3.30, P = .29), were associated with increased risk of delayed intervention. Time-to-event curves also showed that size was closely associated with delayed intervention whereas renal mass biopsy was not. CONCLUSION At our institution, growth rate and initial tumor size appear to be more influential than renal mass biopsy results in determining delayed intervention after a period of AS. Further analysis is required to determine the role of renal biopsy in the management of patients being considered for AS.
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Affiliation(s)
- Sapan N Ambani
- Department of Urology, University of Michigan Health System, Ann Arbor, MI.
| | - Todd M Morgan
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | | | - Adam J Gadzinski
- Department of Urology, University of California-San Francisco, San Francisco, CA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Scott Hawken
- University of Michigan Medical School, Ann Arbor, MI
| | | | - Elaine M Caoili
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI
| | - James H Ellis
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI
| | - Lakshmi P Kunju
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI
| | - Khaled S Hafez
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - David C Miller
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Ganesh S Palapattu
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Alon Z Weizer
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - J Stuart Wolf
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
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The role of active surveillance of small renal masses. Int J Surg 2016; 36:518-524. [PMID: 27321381 DOI: 10.1016/j.ijsu.2016.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 05/29/2016] [Accepted: 06/04/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The use of modern abdominal imaging modalities have led in recent years to an increased incidental diagnosis of small renal masses (SRMs), especially in elderly patients. The natural history of SRMs has been historically poorly understood because most have been traditionally surgically removed soon after diagnosis. However, several studies of active surveillance (AS) of SRMs have been published in the last decade. METHODS A review of English-language publications on AS of SRMs was performed from 1995 to 2015 using the Medline, Embase and Web of Science databases. Fifty-six articles were selected based on their scientific relevance and critically analysed. RESULTS When followed conservatively with serial imaging, SRMs have variable growth rates with an average of 0.31 cm/year in the largest multicenter analysis. A significant number of SRMs have a slow growth and some have zero growth under surveillance. The risk of progression to metastatic disease during AS is rare (1-2%). Population-based analyses in older patient populations (>75 years) fail to show a benefit in cancer-specific mortality for surgical treatment of SRMs. DISCUSSION The standard of care for localized renal tumors is surgery. In elderly or unfit patients with decreased life expectancy, it is reasonable to propose an initial period of AS, with delayed intervention for those tumors which exhibit a fast growth during follow-up. At present AS is not recommended in younger and fit patients and for masses >4 cm at diagnosis outside clinical trials. Percutaneous needle biopsies of renal tumors have the potential to characterize histologically SRMs at diagnosis, thereby providing useful information for the selection of the best suited patients for AS. CONCLUSIONS Most SRMs are benign tumors or RCCs with a relatively indolent clinical behaviour. AS can be offered to patients with SRMs and decreased life expectancy. Prospective series of AS of histologically confirmed RCCs are needed to confirm the long term safety of this conservative approach.
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Ananthakrishnan L, Kapur P, Leyendecker JR. The spectrum of renal cell carcinoma in adults. Abdom Radiol (NY) 2016; 41:1052-65. [PMID: 27108133 DOI: 10.1007/s00261-016-0737-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The spectrum of renal cell carcinoma (RCC) includes many neoplasms with distinct cytogenetics, biologic behaviors, and imaging appearances. The advent of molecular therapies targeting different tumor types, new insights into the relative roles of biopsy and surveillance for small incidental tumors, and a growing array of nephron-sparing interventions have altered management of RCC. Similarly, the role of the radiologist is changing, and it is becoming increasingly important for radiologists to familiarize themselves with the various types of RCC. This article introduces the reader to the common and uncommon recognized types of renal cell carcinoma and discusses how these neoplasms differ in imaging appearance and behavior.
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Quiroga Matamoros W, Fernandez F, Citarella Otero D, Rangel J, Estrada Guerrero A, Patiño ID. Guía de manejo del carcinoma de células renales. Rev Urol 2016. [DOI: 10.1016/j.uroco.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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The growth rate of "clinically significant" renal cancer. SPRINGERPLUS 2015; 4:580. [PMID: 26543715 PMCID: PMC4628034 DOI: 10.1186/s40064-015-1385-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/27/2015] [Indexed: 12/27/2022]
Abstract
Surveillance studies of enhancing renal masses report on a mean tumor growth rate of about 0.3 cm/year. In most of these studies however, only small tumors in elderly patients were followed. In the current report, we attempt to evaluate the growth rate of “clinically significant” renal carcinomas defined as tumors that were treated immediately upon diagnosis. 46 patients (mean age 64 years SD 11 years) were treated for renal carcinoma. All had a cross-sectional imaging studies performed 6–60 months prior to diagnosis of kidney cancer demonstrating no tumor. Tumor growth rate was calculated by dividing tumor’s largest diameter by the time interval between the normal kidney imaging and diagnosis of renal cancer. Mean tumor diameter was 4.5 cm (SD 2.4 cm). Mean time period from the normal imaging to diagnosis of renal cancer was 33.6 months (SD 18 months). According to the proposed model, the average growth rate of “clinically significant” renal carcinomas was 2.13 cm/year (SD 1.45, range 0.2–6.5 cm/year). Tumor growth rate correlated inversely with patient’s age (p = 0.007). Patient gender or Fuhrman’s grade did not correlate however. The growth rate of “clinically significant” renal cancer appears to be higher than the rate reported in surveillance trials. Renal tumors tend to grow faster in young patients. As such, variable growth rate should be taken into account when considering active surveillance in young patients and when designing trials for evaluation of anti-cancer agents.
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Blute ML, Drewry A, Abel EJ. Percutaneous biopsy for risk stratification of renal masses. Ther Adv Urol 2015; 7:265-74. [PMID: 26425141 DOI: 10.1177/1756287215585273] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The increased use of abdominal imaging has led to identification of more patients with incidental renal masses, and renal mass biopsy (RMB) has become a popular method to evaluate unknown renal masses prior to definitive treatment. Pathologic data obtained from biopsy may be used to guide decisions for treatment and may include the presence or absence of malignant tumor, renal cell cancer subtype, tumor grade and the presence of other aggressive pathologic features. However, prior to using RMB for risk stratification, it is important to understand whether RMB findings are equivalent to pathologic analysis of surgical specimens and to identify any potential limitations of this approach. This review outlines the advantages and limitations of the current studies that evaluate RMB as a guide for treatment decision in patients with unknown renal masses. In multiple series, RMB has demonstrated low morbidity and a theoretical reduction in cost, if patients with benign tumors are identified from biopsy and can avoid subsequent treatment. However, when considering the routine use of RMB for risk stratification, it is important to note that biopsy may underestimate risk in some patients by undergrading, understaging or failing to identify aggressive tumor features. Future studies should focus on developing treatment algorithms that integrate RMB to identify the optimal use in risk stratification of patients with unknown renal masses.
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Affiliation(s)
- Michael L Blute
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Anna Drewry
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Edwin Jason Abel
- Assistant Professor, Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705-2281, USA
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Miller AJ, Kurup AN, Schmit GD, Weisbrod AJ, Boorjian SA, Thompson RH, Lohse CM, Kor DJ, Callstrom MR, Atwell TD. Percutaneous Clinical T1a Renal Mass Ablation in the Octogenarian and Nonagenarian: Oncologic Outcomes and Morbidity. J Endourol 2015; 29:671-6. [DOI: 10.1089/end.2014.0733] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Christine M. Lohse
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Darryl J. Kor
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
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Silverman SG, Israel GM, Trinh QD. Incompletely Characterized Incidental Renal Masses: Emerging Data Support Conservative Management. Radiology 2015; 275:28-42. [DOI: 10.1148/radiol.14141144] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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The accuracy of renal tumor biopsy: analysis from a national prospective study. World J Urol 2014; 33:1205-11. [DOI: 10.1007/s00345-014-1432-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/23/2014] [Indexed: 12/27/2022] Open
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Rahbar H, Bhayani S, Stifelman M, Kaouk J, Allaf M, Marshall S, Zargar H, Ball MW, Larson J, Rogers C. Evaluation of Renal Mass Biopsy Risk Stratification Algorithm for Robotic Partial Nephrectomy—Could a Biopsy Have Guided Management? J Urol 2014; 192:1337-42. [DOI: 10.1016/j.juro.2014.06.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 01/20/2023]
Affiliation(s)
- Haider Rahbar
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Sam Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Michael Stifelman
- Department of Urology, New York University Langone Medical Center, New York, New York
| | - Jihad Kaouk
- The Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohamad Allaf
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Susan Marshall
- Department of Urology, New York University Langone Medical Center, New York, New York
| | - Homayoun Zargar
- The Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mark W. Ball
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jeffrey Larson
- Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
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Bhatt JR, Finelli A. Landmarks in the diagnosis and treatment of renal cell carcinoma. Nat Rev Urol 2014; 11:517-25. [PMID: 25112856 DOI: 10.1038/nrurol.2014.194] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The most common renal cancer is renal cell carcinoma (RCC), which arises from the renal parenchyma. The global incidence of RCC has increased over the past two decades by 2% per year. RCC is the most lethal of the common urological cancers: despite diagnostic advances, 20-30% of patients present with metastatic disease. A clearer understanding of the genetic basis of RCC has led to immune-based and targeted treatments for this chemoresistant cancer. Despite promising results in advanced disease, overall response rates and durable complete responses are rare. Surgery remains the main treatment modality, especially for organ-confined disease, with a selective role in advanced and metastatic disease. Smaller tumours are increasingly managed with biopsy, minimally invasive interventions and surveillance. The future promises multimodal, integrated and personalized care, with further understanding of the disease leading to new treatment options.
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Affiliation(s)
- Jaimin R Bhatt
- Princess Margaret Cancer Centre, University of Toronto, Division of Urology, 610 University Avenue 3-130, Toronto, ON M5G 2M9, Canada
| | - Antonio Finelli
- Princess Margaret Cancer Centre, University of Toronto, Division of Urology, 610 University Avenue 3-130, Toronto, ON M5G 2M9, Canada
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Millman AL, Pace KT, Ordon M, Lee JY. Surgeon-specific factors affecting treatment decisions among Canadian urologists in the management of pT1a renal tumours. Can Urol Assoc J 2014; 8:183-9. [PMID: 25024788 DOI: 10.5489/cuaj.1884] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The ubiquitous use of diagnostic imaging has resulted in an increased incidental detection of small renal masses (SRM). Patient- and tumour-related factors affect treatment decisions greatly; however, with multiple treatment options available, surgeon-specific characteristics and biases may also influence treatment recommendations. We determine the impact of surgeon-specific factors on treatment decisions in the management of SRM in Canada. METHODS An online survey study was conducted among Canadian urologists currently registered with the Canadian Urological Association. The questionnaire collected demographic information and recommended treatments for 6 SRM index cases involving theoretical patients of various ages (51-80 years) and comorbidities. RESULTS A total of 110 urologists responded (17% response rate) to the survey. Of these, 18% were over 65 years old and 45% were from academic centres. With increasing patient age and comorbidity, active surveillance and thermal ablative therapies were more the recommended treatment. Laparoscopic/robotic surgery was more commonly recommended by academic urologists and those under 65. Recommending surgery (radical nephrectomy or partial nephrectomy) for both elderly (about 80 years old) index patients correlated with surgeon age (surgeons over 65, p < 0.001), surgeons with no oncologic fellowship training (p = 0.021), surgeons with a non-academic practice (p = 0.003), surgeons with a personal history of cancer (p = 0.038) and surgeons with a family history of cancer death in the last 10 years (p = 0.022). CONCLUSIONS There are various factors that influence the management options offered to patients with SRMs. Our results suggest that surgeon age, personal history of cancer, practice-type and other surgeon-specific variables may affect treatments offered among urologists across Canada.
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Affiliation(s)
- Alexandra Leora Millman
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Kenneth T Pace
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Michael Ordon
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Jason Young Lee
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON
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Sahni VA, Silverman SG. Imaging management of incidentally detected small renal masses. Semin Intervent Radiol 2014; 31:9-19. [PMID: 24596435 DOI: 10.1055/s-0033-1363838] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Both imaging and intervention play an increasingly important role in the management of renal masses in general and renal cancer in particular. Indeed, radiologists are often the first to detect and diagnose renal cancer, and now with the burgeoning role of percutaneous ablation, they are often the treating physicians. Renal mass management begins with imaging, and although most can be diagnosed with a high degree of certainty using imaging, some remain indeterminate and require biopsy or observation, now referred to as active surveillance. Although active surveillance strategies have been employed for indeterminate renal masses that have a reasonable chance of being benign, recent data suggest that some renal cancers can undergo active surveillance safely. This article reviews the current imaging-based diagnostic evaluation of incidentally detected small renal masses, the burgeoning role of percutaneous biopsy, and how both imaging and biopsy are used to help select which patients need treatment and which can undergo active surveillance.
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Affiliation(s)
- V Anik Sahni
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stuart G Silverman
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Becker A, Roghmann F, Ravi P, Tian Z, Kluth LA, Gandaglia G, Noldus J, Dahlem R, Schlomm T, Graefen M, Karakiewicz PI, Trinh QD, Sun M. Delay in Nephrectomy and Cancer Control Outcomes in Elderly Patients with Small Renal Masses. Urol Int 2014; 92:455-61. [DOI: 10.1159/000356175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/04/2013] [Indexed: 11/19/2022]
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Shea MW. A proposal for a targeted screening program for renal cancer. Front Oncol 2013; 3:207. [PMID: 23971005 PMCID: PMC3747444 DOI: 10.3389/fonc.2013.00207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 07/30/2013] [Indexed: 01/09/2023] Open
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