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Li G, Cao Z, Wang J, Zhang X, Zhang L, Dong J, Lu G. Mixed reality models based on low-dose computed tomography technology in nephron-sparing surgery are better than models based on normal-dose computed tomography. Quant Imaging Med Surg 2021; 11:2658-2668. [PMID: 34079731 DOI: 10.21037/qims-20-956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Nephron-sparing surgery has been widely applied in the treatment of renal tumors. Previous studies have confirmed the advantages of mixed reality technology in surgery. The study aimed to explore the optimization of mixed reality technology and its application value in nephron-sparing surgery. Methods In this prospective study of 150 patients with complex renal tumors (RENAL nephrometry score ≥7) who underwent nephron-sparing surgery, patients were randomly divided into Group A (the normal-dose mixed reality group, n=50), Group B (the low-dose mixed reality group, n=50), and Group C (the traditional computed tomography image group, n=50). Group A and Group C received the normal-dose computed tomography scan protocol: 120 kVp, 400 mA, and 350 mgI/mL, while Group B received the low-dose computed tomography scan protocol: 80 kVp, automatic tube current modulation, and 320 mgI/mL. All computed tomography data were transmitted to a three-dimensional visualization workstation and underwent modeling and mixed reality imaging. Two senior surgeons evaluated mixed reality quality. Objective indexes and perioperative indexes were calculated and compared. Results Compared with Group A, the radiation effective dose in Group B was decreased by 39.6%. The subjective scores of mixed reality quality in Group B were significantly higher than those of Group A (Z=-4.186, P<0.001). The inter-observer agreement between the two senior surgeons in mixed reality quality was excellent (K=0.840, P<0.001). The perioperative indexes showed that the mixed reality groups were significantly different from the computed tomography image group (all P<0.017). More cases underwent nephron-sparing surgery in the mixed reality groups than in the computed tomography image group (P<0.0017). Conclusions Low-dose computed tomography technology can be effectively applied to mixed reality optimization, reducing the effective dose and improving mixed reality quality. Optimized mixed reality can significantly increase the cases of successful nephron-sparing surgery and improve perioperative indexes.
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Affiliation(s)
- Guan Li
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhiqiang Cao
- Department of Urology, General Hospital of Northern Theater Command, Shenyang, China
| | - Jinbao Wang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xin Zhang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Longjiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jie Dong
- Department of Urology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Liu H, Kong QF, Li J, Wu YQ, Pan KH, Xu B, Wang YL, Chen M. A meta-analysis for comparison of partial nephrectomy vs. radical nephrectomy in patients with pT3a renal cell carcinoma. Transl Androl Urol 2021; 10:1170-1178. [PMID: 33850752 PMCID: PMC8039616 DOI: 10.21037/tau-20-1262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Kidney cancer is the most common malignant tumor of the kidney in adults. However, in terms of the treatment for pT3a renal cell carcinoma (RCC), whether partial nephrectomy (PN) can be selected is still controversial. This study was conducted to compare the efficacy of PN and radical nephrectomy (RN) in treatment for patients with pT3a RCC. Methods The relative English databases including PubMed and EMBASE were searched for studies comparing PN and RN for pT3a RCC between 2010 and 2020. Stata 13.0 software was used to compare the cancer-specific survival (CSS), overall survival (OS), cancer-specific mortality (CSM), relapse-free survival (RFS), complications and positive surgical margin. Results Nine articles were included with a total of 3,391 patients, of whom 2,113 received RN and 1,278 received PN. The results showed that there is no statistical difference in CSS, OS, CSM, RFS, complications and positive surgical margin between RN and PN. No heterogeneity was shown in study. Conclusions There were no differences in the CSS, OS, CSM, RFS, complications and positive surgical margin of the patients in RN and PN group. For pT3a RCC, RN did not provide a better survival benefit compared to PN. Considering PN can suppress the progression of tumor and reduce the risk of postoperative chronic renal insufficiency, we found PN is a good choice for pT3a RCC. However, further large-sample, studies are still needed in future.
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Affiliation(s)
- Hui Liu
- Department of Urology, Binhai People's Hospital, Yancheng, China
| | - Qing-Fang Kong
- Department of Nosocomial Infection, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Jian Li
- Department of Urology, Jinhu People's Hospital, Jinhu, China
| | - Yu-Qing Wu
- Zhongda Hospital of Southeast University, Southeast University, Lishui District People's Hospital, Nanjing, China
| | - Ke-Hao Pan
- Department of Urology, Binhai People's Hospital, Yancheng, China
| | - Bin Xu
- Department of Urology, Binhai People's Hospital, Yancheng, China
| | - Ya-Li Wang
- Department of Urology, Binhai People's Hospital, Yancheng, China
| | - Ming Chen
- Department of Urology, Binhai People's Hospital, Yancheng, China
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Quinlan M, Wei G, Davis N, Poyet C, Perera M, Bolton D, Lawrentschuk N. Renal Cell Carcinoma Follow-Up - Is it Time to Abandon Ultrasound? Curr Urol 2019; 13:19-24. [PMID: 31579200 DOI: 10.1159/000499299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/29/2018] [Indexed: 11/19/2022] Open
Abstract
Background We wished to compare the efficacy of ultrasound versus intravenous contrast-enhanced computed tomography (CT) for detecting recurrent renal cell carcinoma (RCC) by identifying patients presenting with such tumor burden and to evaluate the utility of these imaging modalities in these circumstances. Methods Patients who developed local and/or distant recurrences following surgical intervention for RCC were identified. The imaging regimen utilized during post-operative surveillance was analyzed to determine whether recurrent disease was identifiable on ultrasound or CT or both. Results Of the 22 patients with recurrent RCC, 16 had previously undergone radical nephrectomy and 6 had undergone partial nephrectomy. Median duration to RCC recurrence was 28.5 months (range 2-66 months). Fourteen patients (64%) underwent ultrasound during their follow-up surveillance protocol and 1 case of disease recurrence was detected by ultrasound before subsequent con-frmation with CT. All 22 patients underwent CT as a routine component of their follow-up surveillance protocol and all recurrences were detected by this modality. Six patients had recurrence in their ipsilateral kidney after partial nephrec-tomy - five had undergone ultrasound in their surveillance protocol and this modality failed to detect a recurrence in four of these patients. Conclusion Ultrasound is inferior to CT for detecting recurrent RCC. CT should be recognized as the standard diagnostic modality during post-operative surveillance, in contradiction to what is recommended in many guidelines.
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Affiliation(s)
- Mark Quinlan
- University of Melbourne, Department of Surgery, Urology Unit, Austin Hospital
| | - Gavin Wei
- University of Melbourne, Department of Surgery, Urology Unit, Austin Hospital
| | - Niall Davis
- University of Melbourne, Department of Surgery, Urology Unit, Austin Hospital
| | - Cedric Poyet
- University of Melbourne, Department of Surgery, Urology Unit, Austin Hospital
| | - Marlon Perera
- University of Melbourne, Department of Surgery, Urology Unit, Austin Hospital
| | - Damien Bolton
- University of Melbourne, Department of Surgery, Urology Unit, Austin Hospital
| | - Nathan Lawrentschuk
- University of Melbourne, Department of Surgery, Urology Unit, Austin Hospital.,EJ Whitten Prostate Cancer Research Center, Epworth Healthcare, Melbourne, VIC, Australia
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Xu C, Lin C, Xu Z, Feng S, Zheng Y. Tumor Enucleation vs. Partial Nephrectomy for T1 Renal Cell Carcinoma: A Systematic Review and Meta-Analysis. Front Oncol 2019; 9:473. [PMID: 31214511 PMCID: PMC6557988 DOI: 10.3389/fonc.2019.00473] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/17/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose: Tumor enucleation (TE) and partial nephrectomy (PN) have both become main treatment strategies for T1 renal cell carcinoma (RCC), despite the discrepancy between their safety margin. We performed a meta-analysis on all the relevant trials in order to compare the clinical efficacy and safety of TE with those of PN for RCC treatment. Methods: In this meta-analysis, randomized controlled trials or retrospective studies were included if they compared TE and PN therapy in patients with localized renal cancer. The main outcomes extracted were perioperative data and post-operative outcomes. Subgroups for analyses were undertaken according to tumor size and duration of follow up. Data were pooled using the generic variance method with a fixed or random effects model and expressed as mean differences or odds ratios with 95% CI. Results: A total of 13 studies containing 1,792 patients undergoing TE and 3,068 undergoing PN were identified. Our study showed that the patients received TE had significantly shorter operative time (MD = -28.46, 95% CI = -42.09, -14.83, P < 0.0001), less hospital day (MD = -0.68, 95% CI = -1.04, -0.31, P = 0.0003), less estimate blood loss (MD = -59.90, 95% CI = -93.23, -26.58, P = 0.0004) and smaller change in estimated glomerular filtration rate (fixed effect: MD = 4.66, 95% CI = 1.67, 7.66, P = 0.002), fewer complications (fixed effect: OR = 0.65, 95% CI = 0.50, 0.85, P = 0.001) compared with those received PN. However, there were no significant differences in terms of warm ischemic time, positive margin rates, recurrence rates and survival rates between the two groups. All the subgroup analyses presented consistent results with the overall analyses. Conclusions: Our findings suggested that TE is not only less-traumatizing and beneficial for recovery, but also better for renal function protection. Moreover, it did not show the evidence of an increase relapse rate or mortality rate when compared with PN.
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Affiliation(s)
- Congcong Xu
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Caixiu Lin
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhen Xu
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Sheng Feng
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yichun Zheng
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Gofrit ON, Rabinovich I, Yutkin V, Pode D, Duvdevani M, Landau EH, Hidas G, Goldberg SN. Abbreviated CT protocol for postoperative surveillance of renal cancer. Urol Oncol 2018; 36:498.e9-498.e13. [PMID: 30228095 DOI: 10.1016/j.urolonc.2018.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/24/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Postoperative surveillance protocols after nephrectomy for kidney cancer include periodic computed tomography (CT) scans of the chest and abdomen. A single study exposes the patient to 21 mSv (equivalent to 7-year exposure to natural background radiation). The objective of this study was to evaluate the hypothesis that an abbreviated CT protocol restricted to the chest and upper abdomen (i.e., to the level of the intervertebral disk L3-L4) is sufficient for routine postnephrectomy follow-up as it detects most tumor recurrence with lower radiation exposure. METHODS We identified 493 patients treated with radical or partial nephrectomy for localized kidney cancer and followed with periodic CT scans of the chest and abdomen for prolonged periods. The frequency and location of cancer recurrence were documented. The ratio of infield recurrence for the complete chest, and abdomen and for the abbreviated protocol was recorded. The decrease in radiation exposure was calculated. RESULTS At a median follow up of 96 months, 82 patients (16.6%) developed recurrence. The frequent sites of recurrence were the lungs (53), the bones (9), and local recurrence (22). Complete chest and abdominal CT identified 78 of the recurrences (95%) and the abbreviated protocol identifying all but one of these (94%). The abbreviated protocol exposed the patient to 48% (standard deviation 4.3%) less radiation compared to the full protocol. CONCLUSIONS Using an abbreviated CT protocol that includes the chest and upper abdomen for surveillance after surgery of localized kidney cancer decreases radiation exposure by half with only a minor decrease in the sensitivity of the examination.
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Affiliation(s)
- Ofer N Gofrit
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel.
| | - Igal Rabinovich
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - Dov Pode
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | | | - Ezekiel H Landau
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - S Nahum Goldberg
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
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Should We Separate the Pulmonary Surveillance Protocol for Postsurgical T1a and T1b Renal Cell Carcinoma? A Multicenter Database Analysis. Urology 2018; 122:127-132. [PMID: 30205104 DOI: 10.1016/j.urology.2018.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the incidence of pulmonary metastases (PM) and the utility of the surveillance chest radiography (CXR) in detecting PM after curative treatment to better define surveillance recommendations for T1a and T1b renal cell carcinoma. MATERIALS AND METHODS A retrospective review of a multi-institutional database was performed to include patients with renal masses treated with partial nephrectomy or radical nephrectomy. Patients were excluded for ≥T2 disease, benign pathology, and metastases. The primary outcome was the incidence of asymptomatic pulmonary lesion concerning for PM detected by CXR within 3 years. RESULTS Five hundred sixty-eight patients met criteria of which 384 had T1a and 184 had T1b at a mean follow-up of 45 and 43 months, respectively. Patients averaged 2.96 and 2.99 CXRs for T1a and T1b with 46.8% having surveillance beyond 3 years. Indeterminate lesions were found in 5.7% (22) of T1a and 5.4% (10) in T1b of which 0.01% (2) and 1.1% (2) were confirmed PM by chest computed tomography and biopsy. Three-year CXR surveillance period detected asymptomatic PM in zero and two patients for T1a and T1b, respectively. High risk pathological features were not present in patients with PM. There was no difference in the incidence PM for patients undergoing partial nephrectomy (3/290) or radical nephrectomy (1/278) (P = .62). CONCLUSION Our review suggests that post-treatment pulmonary surveillance should be reserved for T1b and may not be required for T1a given the low yield and false positives of CXR leading to unnecessary radiation and potential biopsies.
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Patel P, Nayak JG, Liu Z, Saarela O, Jewett M, Rendon R, Kapoor A, Black P, Tanguay S, Kawakami J, Moore R, Breau RH, Morash C, Pouliot F, Drachenberg DE. A Multicentered, Propensity Matched Analysis Comparing Laparoscopic and Open Surgery for pT3a Renal Cell Carcinoma. J Endourol 2018; 31:645-650. [PMID: 28381117 DOI: 10.1089/end.2016.0787] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION To compare outcomes following laparoscopic renal surgery (LRS) and open renal surgery (ORS) in the treatment of pathologic T3a (pT3a) renal cell carcinoma (RCC) using a propensity matched analysis. MATERIALS AND METHODS The Canadian Kidney Cancer Information System is a prospectively maintained database for patients diagnosed with RCC from 15 Canadian institutions. Patients treated for nonmetastatic pT3a RCC between 2008 and 2015 were included. Propensity score matching for age, gender, tumor size, grade, histology, and surgical approach was performed to compare laparoscopic radical and partial nephrectomy (LRN or LPN) with open radical or partial nephrectomy (ORN or OPN). The primary endpoint was recurrence-free survival (RFS). RESULTS Two hundred twenty-six (45%) patients underwent LRS (88% LRN and 12% LPN), and 275 (55%) underwent ORS (75% ORN and 25% OPN). After a median follow-up of 21.1 months, 155 (72 LRS and 83 ORS) patients experienced recurrence. The 3-year RFS was 63% and 50% for the LRS and ORS groups, respectively, p = 0.36. On subgroup analysis, there was no significant difference in RFS among patients who underwent radical nephrectomy (3-year RFS 61% in LRN compared with 46% in ORN group, p = 0.32) or partial nephrectomy (77% in LPN compared with 79% in OPN group, p = 0.82). CONCLUSIONS This study is the largest matched analysis comparing LRS and ORS for pT3a RCC. In matched patients, LRS showed no difference in oncologic outcomes compared with ORS and should be considered when technically feasible.
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Affiliation(s)
- Premal Patel
- 1 Section of Urology, University of Manitoba , Winnipeg, Canada
| | - Jasmir G Nayak
- 1 Section of Urology, University of Manitoba , Winnipeg, Canada
| | | | - Olli Saarela
- 3 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
| | - Michael Jewett
- 4 Division of Urology, University of Toronto , Toronto, Canada
| | - Ricardo Rendon
- 5 Department of Urology, Dalhousie University , Halifax, Canada
| | - Anil Kapoor
- 6 Division of Urology, McMaster University , Hamilton, Canada
| | - Peter Black
- 7 Department of Urologic Sciences, University of British Columbia , Vancouver, Canada
| | - Simon Tanguay
- 8 Division of Urology, McGill University , Montreal, Canada
| | - Jun Kawakami
- 9 Southern Alberta Institute of Urology, University of Calgary , Calgary, Canada
| | - Ronald Moore
- 10 Division of Urology, University of Alberta , Edmonton, Canada
| | - Rodney H Breau
- 11 Division of Urology, The Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Canada
| | - Chris Morash
- 11 Division of Urology, The Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Canada
| | - Frédéric Pouliot
- 12 Centre Hospitalier Universitaire de Québec , Quebec City, Canada
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Beisland C, Beisland HO. Natural and Clinical Course of Renal Cell Carcinoma — Better Prospect for the Patients. Scand J Surg 2016; 93:97-101. [PMID: 15285560 DOI: 10.1177/145749690409300203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The many improvements in diagnostic and therapeutic tools over the last half-century have changed the prospects for patients with renal cell carcinoma (RCC). Higher survival rates and less morbidity have been achieved. The disease is, however, still unpredictable and represents many unsolved problems. In this paper we focus on determinants of the natural and clinical course of RCC and the changes in regard to this over the last decades.
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Affiliation(s)
- C Beisland
- Department of Surgery, Haukeland University Hospital, Bergen, Norway.
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9
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Follow-up imaging in the first two years after nephrectomy for T1 RCC: Over-use or necessary care? JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415815581096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: We sought to study patterns of imaging for follow-up after surgery for stage T1 renal cell carcinoma (RCC) at a single institution. We hypothesised that there would be significant variation in the use of surveillance imaging. Methods and materials: We evaluated the two-year follow-up of 317 consecutive patients undergoing radical or partial nephrectomy who were found to have pT1 RCC. Follow-up imaging data were collected. Surgical characteristics and tumour pathology data were analysed via a Poisson regression model to evaluate the incidence rate ratio for frequency of imaging based on each variable. Logistic regression was used to evaluate factors correlated with concordance with current imaging guidelines. Results: A total of 1016 imaging exams were performed after surgery on 268 patients. These studies identified four tumour recurrences: two local and two lung. The overall recurrence rate was 1.49%. Three recurrences were found within a two-year postoperative window, and one was recorded on the patient’s last clinic note after two years. Of 66 imaging exams with findings suspicious for recurrence, 62 were found to be false positives. All statistical analyses on a subgroup of 162 patients with full two-year follow-up failed to demonstrate any correlation between clinicopathologic variables and the frequency of abdominal imaging or concordance with current imaging guidelines. Conclusions: Frequent follow-up imaging studies were obtained despite a low recurrence rate. There was a high rate of false-positive findings on routine exams. No clinicopathologic criteria were identified that were correlated with increased imaging frequency.
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Canvasser NE, Stouder K, Lay AH, Gahan JC, Lotan Y, Margulis V, Raj GV, Sagalowsky AI, Cadeddu JA. The Usefulness of Chest X-Rays for T1a Renal Cell Carcinoma Surveillance. J Urol 2016; 196:321-6. [PMID: 26880407 DOI: 10.1016/j.juro.2016.02.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The overall incidence of pulmonary metastasis of T1 renal cell carcinoma is low. We evaluated the usefulness of chest x-rays based on the current AUA (American Urological Association) guidelines and NCCN Guidelines® for T1a renal cell carcinoma surveillance. MATERIALS AND METHODS Between 2006 and 2012, 258 patients with T1a renal cell carcinoma were treated with partial nephrectomy, radical nephrectomy or radio frequency ablation with surveillance followup at our institution. A retrospective chart review was performed to identify demographics, pathological findings and surveillance records. The primary outcome was the incidence of asymptomatic pulmonary recurrences diagnosed by chest x-ray in cases of T1a disease. Our secondary outcome was a comparison of diagnoses by treatment modality (partial nephrectomy, radical nephrectomy or radio frequency ablation). RESULTS Pulmonary metastases developed in 3 of 258 patients (1.2%) but only 1 (0.4%) was diagnosed by standard chest x-ray surveillance. Median followup in the entire cohort was 36 months (range 6 to 152) and 193 of 258 patients (75%) had greater than 24 months of followup. A mean of 3.3 surveillance chest x-rays were completed per patient. When assessed by treatment type, there was no significant difference in the recurrence rate for partial nephrectomy (0 of 191 cases), radical nephrectomy (0 of 22) or radio frequency ablation (1 of 45 or 2.2%) (p = 0.09). CONCLUSIONS Chest x-rays are a low yield diagnostic tool for detecting pulmonary metastasis in patients treated for T1a renal cel carcinoma. Treatment mode does not appear to influence the need for chest x-ray surveillance.
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Affiliation(s)
- Noah E Canvasser
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kylee Stouder
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aaron H Lay
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey C Gahan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ganesh V Raj
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Arthur I Sagalowsky
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
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11
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Follow-up After Treatment for Renal Cell Carcinoma: The Evidence Beyond the Guidelines. Eur Urol Focus 2016; 1:272-281. [DOI: 10.1016/j.euf.2015.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/15/2015] [Accepted: 04/04/2015] [Indexed: 01/20/2023]
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12
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Nayak JG, Patel P, Bjazevic J, Liu Z, Saarela O, Kapoor A, Rendon R, Kawakami J, Tanguay S, Breau RH, Black PC, Drachenberg DE. Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort. Can Urol Assoc J 2015; 9:397-402. [PMID: 26788228 DOI: 10.5489/cuaj.2848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We described the clinical and oncological outcomes of patients treated by laparoscopic surgery for non-metastatic pT3 renal cell carcinoma (RCC). METHODS We queried a multi-institutional database for patients diagnosed with non-metastatic pathological T3 RCC from 13 Canadian centres treated laparoscopically (radical or partial nephrectomy) between 2008 and 2014. Clinical and pathological outcomes were evaluated. Progression was defined as the development of recurrence or metastatic disease. Log-rank testing and Kaplan-Meier statistical methods assessed for differences and estimated progression-free survival (PFS). RESULTS In total, 176 patients were identified with a median age of 64 years. The median tumour size was 7.0 cm. Pre-clinical stage was cT1 to cT4 in 39%, 28%, 30% and 3%, respectively. The median blood loss was 150 mL (range: 0-6000) and the median operative time was 124 minutes (range: 60-360). Most lesions were clear cell RCC (80%). After a median follow-up of 17.6 months (range: 0.2-75.0), disease progression occurred in 26% (46/176) of patients, consisting of local recurrence in 7% (3/46), and metastatic disease in 93% (43/46). The 3-year PFS was 67%, with a median PFS of 49 months. Of those who progressed, the median time to progression was 10.3 months. CONCLUSIONS This study is the largest cohort of pT3 RCC patients treated laparoscopically in the literature and suggests that for properly selected patients, laparoscopic management of locally advanced renal masses yields acceptable short-term oncological outcomes.
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Affiliation(s)
- Jasmir G Nayak
- Section of Urology, University of Manitoba, Winnipeg, MB;; Department of Urology, University of Washington, Seattle, WA
| | - Premal Patel
- Department of Urology, University of Washington, Seattle, WA
| | | | | | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, NS
| | - Jun Kawakami
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC
| | - Rodney H Breau
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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Stewart SB, Thompson RH, Psutka SP, Cheville JC, Lohse CM, Boorjian SA, Leibovich BC. Evaluation of the National Comprehensive Cancer Network and American Urological Association renal cell carcinoma surveillance guidelines. J Clin Oncol 2014; 32:4059-65. [PMID: 25403213 DOI: 10.1200/jco.2014.56.5416] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The National Comprehensive Cancer Network (NCCN) and American Urological Association (AUA) provide guidelines for surveillance after surgery for renal cell carcinoma (RCC). Herein, we assess the ability of the guidelines to capture RCC recurrences and determine the duration of surveillance required to capture 90%, 95%, and 100% of recurrences. PATIENTS AND METHODS We evaluated 3,651 patients who underwent surgery for M0 RCC between 1970 and 2008. Patients were stratified as AUA low risk (pT1Nx-0) after partial (LR-partial) or radical nephrectomy (LR-radical) or as moderate/high risk (M/HR; pT2-4Nx-0/pTanyN1). Guidelines were assessed by calculating the percentage of recurrences detected when following the 2013 and 2014 NCCN and AUA recommendations, and associated Medicare costs were compared. RESULTS At a median follow-up of 9.0 years (interquartile range, 5.7 to 14.4 years), a total of 1,088 patients (29.8%) experienced a recurrence. Of these, 390 recurrences (35.9%) were detected using 2013 NCCN recommendations, 742 recurrences (68.2%) were detected using 2014 NCCN recommendations, and 728 recurrences (66.9%) were detected using AUA recommendations. All protocols missed the greatest amount of recurrences in the abdomen and among pT1Nx-0 patients. To capture 95% of recurrences, surveillance was required for 15 years for LR-partial, 21 years for LR-radical, and 14 years for M/HR patients. Medicare surveillance costs for one LR-partial patient were $1,228.79 using 2013 NCCN, $2,131.52 using 2014 NCCN, and $1,738.31 using AUA guidelines. However, if 95% of LR-partial recurrences were captured, costs would total $9,856.82. CONCLUSION If strictly followed, the 2014 NCCN and AUA guidelines will miss approximately one third of RCC recurrences. Improved surveillance algorithms, which balance patient benefits and health care costs, are needed.
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Breda A, Konijeti R, Lam JS. Patterns of recurrence and surveillance strategies for renal cell carcinoma following surgical resection. Expert Rev Anticancer Ther 2014; 7:847-62. [PMID: 17555395 DOI: 10.1586/14737140.7.6.847] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Renal cell carcinoma (RCC) remains one of the most lethal urologic malignancies, with up to 40% of patients eventually dying of cancer progression. Despite advances in the diagnosis, staging and treatment of patients with RCC, approximately a third of patients who undergo surgery for clinically localized RCC will suffer a recurrence. Timely identification of recurrences following surgical extirpation is imperative in the treatment of these patients. RCC is known to metastasize through hematogenous routes of spread to distant organ sites and via lymphatic channels to regional lymph nodes. The path of tumor escape is associated with diverse clinical outcomes and a unique tumor biology. A consensus on surveillance regimens for patients following surgical resection of localized disease is lacking. The most extensively used system for providing prognostic information regarding survival and recurrence of disease has historically been the tumor-node-metastasis (TNM) classification system. As a result, most contemporary surveillance protocols have tailored follow-up regimens according to stage-based stratifications. Numerous studies have recently demonstrated that certain clinical and histopathological factors can improve the prediction of tumor recurrence. The incorporation of these prognostic factors into stage-based stratification models should be better than stage alone in attempting to provide a rational approach to identifying treatable recurrences while minimizing unnecessary exams and tests, as well as patient anxiety. Advances in the understanding of the pathogenesis, behavior and molecular biology of RCC have paved the way for developments that may enhance early diagnosis and prognostication, and improve survival for patients. Lastly, molecular markers should, in the future, revolutionize surveillance protocols for RCC by tailoring follow-up to specific molecular classifications.
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Affiliation(s)
- Alberto Breda
- David Geffen School of Medicine, University of California--Los Angeles, Department of Urology, Los Angeles, CA 90095-1738, USA.
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15
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Lin YK, Gettle L, Raman JD. Significant variability in 10-year cumulative radiation exposure incurred on different surveillance regimens after surgery for pT1 renal cancers: yet another reason to standardize protocols? BJU Int 2013; 111:891-6. [DOI: 10.1111/j.1464-410x.2012.11531.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yu-Kuan Lin
- Division of Urology (Surgery); Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Lori Gettle
- Department of Radiology; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Jay D. Raman
- Division of Urology (Surgery); Penn State Milton S. Hershey Medical Center; Hershey PA USA
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16
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Badalato GM, Kates M, Wisnivesky JP, Choudhury AR, McKiernan JM. Survival after partial and radical nephrectomy for the treatment of stage T1bN0M0 renal cell carcinoma (RCC) in the USA: a propensity scoring approach. BJU Int 2011; 109:1457-62. [PMID: 21933334 DOI: 10.1111/j.1464-410x.2011.10597.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
UNLABELLED Study Type - Therapy (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Partial nephrectomy has become the standard of care for T1a renal tumours, and the application of nephron-sparing techniques has increasingly been expanded to patients with localized T1b cancers. However, the relative efficacy of partial versus radical nephrectomy for these medium-sized tumours has yet to be definitively established. This study employs a propensity scoring approach within a large US population-based cohort to determine that no survival differences exist among patients with T1b renal tumours undergoing partial versus radical nephrectomy. OBJECTIVES To compare survival after partial nephrectomy (PN) vs radical nephrectomy (RN) among patients with stage TIb renal cell carcinoma (RCC) using a propensity scoring approach. Propensity score analysis is a statistical methodology that controls for non-random assignment of patients in observational studies. PATIENTS AND METHODS Using the Surveillance, Epidemiology, and End Results registry, 11,256 cases of RCCs of 4-7 cm that underwent PN or RN between 1998 and 2007 were identified. Propensity score analysis was used to adjust for potential differences in baseline characteristics between patients in the two treatment groups. Overall survival (OS) and cancer-specific survival (CSS) of patients undergoing PN vs RN was compared in stratified and adjusted analysis, controlling for propensity scores. RESULTS In all, 1047 (9.3%) patients underwent PN. For the entire cohort, no difference in survival was found in patients treated with PN as compared with RN, as shown by the adjusted hazard ratio (HR) for OS (1.10; 95% confidence interval [CI]: 0.91-1.36) and renal-CSS (HR 0.91; 95% CI: 0.65-1.27). When the cohort was stratified by tumour size and age, no difference in survival was identified between the groups. CONCLUSIONS Even when stratified by tumour size and age, a survival difference between PN and RN in a propensity-adjusted cohort of patients with T1b RCC could not be confirmed. If validated in prospective studies, PN may become the preferred treatment for T1b renal tumours in centres experienced with nephron-sparing surgery.
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Affiliation(s)
- Gina M Badalato
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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17
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Yuen JSP. Molecular targeted therapy in advanced renal cell carcinoma: A review of its recent past and a glimpse into the near future. Indian J Urol 2011; 25:427-36. [PMID: 19955664 PMCID: PMC2808643 DOI: 10.4103/0970-1591.57899] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Renal cell carcinoma (RCC) is the most lethal of all urologic malignancies. Recent translational research in RCC has led to the discovery of a new class of therapeutics that specifically target important signaling molecules critical in the pathogenesis of the disease. It is now clear that these new molecular targeted agents have revolutionized the management of patients with metastatic RCC. However, the exact molecular mechanism accounting for their clinical effect is largely unknown and a significant proportion of patients with metastatic RCC do not respond to these therapeutics. This review presents the relevant background leading to the development of molecular targeted therapy for patients with advanced RCC and summarizes current management issues in particular relating to the emerging problem of treatment resistance and the need for clinical and laboratory biomarkers to predict treatment outcomes in these patients. In addition, this paper will also address surgical issues in the era of molecular targeted therapy including the role of cytoreductive surgery and surgical safety issues post-molecular therapy. Lastly, this review will also address the need to explore new molecular treatment targets in RCC and briefly present our work on one of the promising molecular targets - the type 1 insulin-like growth factor receptor (IGF1R), which may in the near future lead to the development of anti-IGF1R therapy for patients with advanced RCC.
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Affiliation(s)
- John S P Yuen
- Department of Urology, Singapore General Hospital, Outram Rd, Singapore 169 608, Singapore
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18
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Abel EJ, Culp SH, Meissner M, Matin SF, Tamboli P, Wood CG. Identifying the risk of disease progression after surgery for localized renal cell carcinoma. BJU Int 2010; 106:1277-83. [PMID: 20394619 DOI: 10.1111/j.1464-410x.2010.09337.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify factors in a large cohort of patients with pathologically localized renal cell carcinoma (RCC) that predicted disease progression after surgery, as RCC most commonly presents as a localized tumour which is treated with surgical excision. PATIENTS AND METHODS Using an institutional database, we identified all patients who underwent radical or partial nephrectomy and had pathologically confirmed pT1 or pT2 RCC. Multivariable stepwise logistic regression analysis was used to calculate an odds ratio corresponding to the odds of progression to metastatic disease during surveillance, based on several clinical and pathological variables. We defined those variables that remained significant on multivariable analysis as risk factors and, based on the number of risk factors, we assessed risk of disease progression. RESULTS In all, 925 patients were eligible for analysis with a median follow-up of 48.2 months. There was progression to metastatic disease in 53 (5.7%) patients; pT1 in 20/774 (2.6%), pT2 in 33/151 (21.9%). Risk factors included pT2 disease, male gender, symptoms at presentation (local or constitutional), presence of sarcomatoid de-differentiation, and macroscopic necrosis on final pathology. In 177 patients with no risk factors, none progressed; 20 of 618 (3.2%) with one or two risk factors had progression at a median of 37.1 months; 33 of 130 (25.4%) with three or more risk factors progressed at a median of 25.2 months. CONCLUSIONS We identified five risk factors that can help to predict those patients with pT1 or pT2 RCC at highest risk for disease progression after surgery. The potential for disease progression is exceedingly low in patients with no risk factors and surveillance can be minimized in this group.
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Affiliation(s)
- E Jason Abel
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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19
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Siddiqui SA, Frank I, Cheville JC, Lohse CM, Leibovich BC, Blute ML. Postoperative surveillance for renal cell carcinoma: a multifactorial histological subtype specific protocol. BJU Int 2009; 104:778-85. [PMID: 19338559 DOI: 10.1111/j.1464-410x.2009.08499.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Kanao K, Mizuno R, Kikuchi E, Miyajima A, Nakagawa K, Ohigashi T, Nakashima J, Oya M. Preoperative Prognostic Nomogram (Probability Table) for Renal Cell Carcinoma Based on TNM Classification. J Urol 2009; 181:480-5; discussion 485. [DOI: 10.1016/j.juro.2008.10.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Indexed: 11/15/2022]
Affiliation(s)
- Kent Kanao
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Akira Miyajima
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ken Nakagawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Ohigashi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Jun Nakashima
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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21
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22
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Renal Cell Cancer. Oncology 2007. [DOI: 10.1007/0-387-31056-8_46] [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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23
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Skolarikos A, Alivizatos G, Laguna P, de la Rosette J. A Review on Follow-Up Strategies for Renal Cell Carcinoma after Nephrectomy. Eur Urol 2007; 51:1490-500; discussion 1501. [PMID: 17229521 DOI: 10.1016/j.eururo.2006.12.031] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2006] [Accepted: 12/24/2006] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To provide a comprehensive review of the evidence supporting the necessity for follow-up after nephrectomy for renal cell carcinoma. METHODS We searched the Medline, MeSH, EMBASE, and Cochrane databases using the terms "renal cell cancer," "kidney neoplasm," "follow-up," "surveillance," "prognosis," and "staging" to look for human/English language/Randomized Controlled Trials/Clinical trials/Review articles/Meta-analysis/Practiced Guidelines, and Editorials. RESULTS No consensus currently exists on surveillance guidelines after radical or partial nephrectomy for renal cell carcinoma. The rationale for follow-up strategies is to detect local recurrence or metastatic disease and to allow appropriate treatment. Most of the surveillance protocols recommend various follow-up strategies for all tumour stages. The emphasis on follow-up should be during the first 3-5 yr after nephrectomy. There is no consensus about which investigations should be performed and at what intervals. Most surgeons rely on symptom enquiry, physical examination, chest x-ray, and computed tomography scanning. A protocol based on the stage of the initial tumour is adapted by the majority of the investigators. Patients should be followed similarly after radical or partial nephrectomy on the basis of stage-oriented protocols. The combination of various prognostic factors requires further validation over stage-based protocols. There is a paucity of guidelines in the literature regarding follow-up for patients with hereditary forms of renal cell carcinoma. CONCLUSIONS Current guidelines for follow-up are based on observational and case studies. While this fact precludes a high level of evidence-based guidelines, we have to conclude that this is the best available evidence to date.
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Affiliation(s)
- Andreas Skolarikos
- Athens Medical School, 2nd Department of Urology, Sismanoglio Hopsital, Athens, Greece.
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24
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Gofrit ON, Shapiro A, Pizov G, Landau EH, Katz R, Zorn KC, Pode D. Does Stage T3a Renal Cell Carcinoma Embrace a Homogeneous Group of Patients? J Urol 2007; 177:1682-6. [PMID: 17437782 DOI: 10.1016/j.juro.2007.01.064] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE Renal cell carcinoma invading the perinephric fat is classified as a stage T3a tumor in the 2002 TNM version. Based on long-term followup we examined the prognostic significance of this definition. MATERIALS AND METHODS We evaluated the outcome in 237 consecutive patients with localized renal cell carcinoma operated on between January 1985 and December 1997. Median followup was 8 years. Disease-free survival was analyzed using univariate and multivariate analyses. Based on this we proposed and tested a new TNM system against the 2002 TNM version. RESULTS Tumor recurrence was diagnosed in 48 patients (20.2%) at a median of 21.5 months. Diameter based analysis of stage T3a revealed that this was an inhomogeneous group that included patients with small tumors and an excellent prognosis along with patients with large tumors and a poor prognosis. Based on this information we initiated a modified TNM staging system that ignores perinephric fat invasion. In the proposed staging system stage T1a includes tumors 4 cm or less and stage T1b includes tumors more than 4 but 7 cm or less. Stage T2 is divided into T2a-tumors greater than 7 but 10 cm or less and T2b-tumors greater than 10 cm. Stage T3a is reserved for renal vein tumor invasion. The proposed TNM performed better than the 2002 version using the Nagelkerke R(2) test (0.439 vs 0.359), and the Hosmer and Lemeshow test (0.335 vs 0.191). CONCLUSIONS The current definition of stage T3a renal cell carcinoma embraces an inhomogeneous group of patients with marked differences in prognosis. We believe that tumor invasion into the perinephric fat does not necessarily predict aggressive biological behavior.
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Affiliation(s)
- Ofer N Gofrit
- Department of Urology and Pathology, Hadassah University Hospital, Jerusalem, Israel.
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25
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Abstract
This article discusses the computed tomography (CT) and magnetic resonance (MR) scanning techniques used for the detection and staging of renal cell carcinoma and their pitfalls. Comparison between the Robson and recent modifications to the TNM classifications is also addressed. The accuracy of CT and MR in the staging of renal cell carcinoma and the role of positron emission tomography (PET) scanning is outlined and finally the surveillance of patients who have had curative treatment of renal cell carcinoma is briefly addressed.
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Affiliation(s)
- Isaac R Francis
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109-0030, USA.
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26
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Klatte T, Ittenson A, Röhl FW, Ecke M, Allhoff EP, Böhm M. Perioperative immunomodulation with interleukin-2 in patients with renal cell carcinoma: results of a controlled phase II trial. Br J Cancer 2006; 95:1167-73. [PMID: 17031403 PMCID: PMC2360567 DOI: 10.1038/sj.bjc.6603391] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We conducted a non-randomised controlled phase II trial to investigate the role of preoperative administration of interleukin-2 (IL-2) in patients with renal cell carcinoma undergoing tumour nephrectomy. A total of 120 consecutive patients were allocated alternately to the two study groups: perioperative immunomodulation with IL-2 (IL-2 group; n=60) and perioperative immunomonitoring without immunomodulation (control group; n=60). Patients from the IL-2 group received four doses of 10 × 106 IU m−2 twice daily subcutaneously a week before operation followed by a daily maintenance dose of 3 × 106 IU m−2 subcutaneously until a day before the operation. Parameters of cellular and humoral immunity (leucocytes, T-cell markers CD3, CD4, and CD8, B-cell marker CD19, monocyte marker CD14, natural killer (NK) cell markers CD16, CD56, and CD57, activation markers CD6, CD25, CD28, and CD69, progenitor cell marker CD34, as well as IL-2, IL-6, IL-10, soluble IL-2 receptor, IL-1 receptor antagonist, transforming growth factor-β1, and vascular endothelial growth factor) were measured in peripheral venous blood at various intervals. Interleukin-2-related toxicity was WHO grade 1 (24%), 2 (67%), and 3 (9%). In the postoperative period, T-cell markers, activation markers, and NK cell markers decreased, and IL-6 and IL-10 increased. However, all these alterations were significantly less accentuated in patients who had been pretreated with IL-2. Median follow-up was 40 months. Tumour-specific survival in the IL-2 group and the control group was 98 vs 81% after 1 year and 86 vs 73% after 5 years (P=0.04). A similar effect was found for progression-free survival. We conclude that IL-2 can be safely administered in the perioperative period and modulates immunological parameters. However, to validate the survival data, a larger randomised phase III trial is needed.
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Affiliation(s)
- T Klatte
- Department of Urology, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - A Ittenson
- Institute of Immunology, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - F-W Röhl
- Institute of Biometrics and Medical Informatics, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - M Ecke
- Department of Urology, Städtisches Klinikum, Birkenallee 34, 39130 Magdeburg, Germany
| | - E P Allhoff
- Department of Urology, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - M Böhm
- Department of Urology, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany
- E-mail:
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27
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Rouvière O, Bouvier R, Négrier S, Badet L, Lyonnet D. Nonmetastatic renal-cell carcinoma: is it really possible to define rational guidelines for post-treatment follow-up? ACTA ACUST UNITED AC 2006; 3:200-13. [PMID: 16596144 DOI: 10.1038/ncponc0479] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Accepted: 02/16/2006] [Indexed: 11/09/2022]
Abstract
Defining rational follow-up guidelines in patients treated for cancer is important, from both a medical and an economical perspective. Renal-cell carcinoma is reputed to be unpredictable in its course and only a few, and often contradictory, follow-up guidelines exist for patients treated for nonmetastatic renal-cell carcinoma. Recent advances in tumor biology have contributed to a better understanding of this cancer and have indicated that personalized follow-up regimens, based on tumor and host molecular characteristics, might be possible in the near future.
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Affiliation(s)
- Olivier Rouvière
- Department of Urinary, Vascular and Interventional Radiology, Edouard Herriot Hospital, Lyon, France.
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28
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Bradford TJ, Montie JE, Hafez KS. The Role of Imaging in the Surveillance of Urologic Malignancies. Urol Clin North Am 2006; 33:377-96. [PMID: 16829272 DOI: 10.1016/j.ucl.2006.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urologic malignancies are common, accounting for approximately 25% of all new cancer cases in the United States. Patients with urologic malignancies require long-term surveillance to detect progression or recurrence as early as possible. The urologist is faced with the task of balancing patient safety and cost-effectiveness, while finding the most practical follow-up regimen. For each urologic malignancy, this article reviews the commonly used radiologic techniques for surveillance and offers recommended follow-up schedules.
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Affiliation(s)
- Timothy J Bradford
- Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA
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29
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Affiliation(s)
- Chaan S Ng
- Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
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30
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Han WK, Lee YS, Kim HJ, Rha KH, Hong SJ, Yang SC. Comparison of the Prognosis between pT3a Only Patients with Perirenal Fat Invasion and T1/T2 Patients, Respectively: Is It Necessary to Revise Stage T3a? Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.8.829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Seong Lee
- Department of Urology, Hallym University College of Medicine, Seoul, Korea
| | - Hyung Joon Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Jun Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Choul Yang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Roberts WW, Bhayani SB, Allaf ME, Chan TY, Kavoussi LR, Jarrett TW. PATHOLOGICAL STAGE DOES NOT ALTER THE PROGNOSIS FOR RENAL LESIONS DETERMINED TO BE STAGE T1 BY COMPUTERIZED TOMOGRAPHY. J Urol 2005; 173:713-5. [PMID: 15711249 DOI: 10.1097/01.ju.0000153638.15018.58] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pathological stage has been the most widely used prognosticator for evaluating surgically managed cases of renal cell carcinoma. Minimally invasive surgical approaches are being increasingly used to treat small masses for which traditionally pathological information is lacking (morcellation) or absent (radio frequency ablation or cryoablation). Preoperative cross-sectional imaging by computerized tomography (CT) or magnetic resonance imaging has been used to stage renal tumors clinically but it can lead to variances with traditional pathological staging systems, particularly with respect to microscopic invasion beyond the renal capsule. In this study we assessed whether radiographically staged clinical T1 lesions that were pathological T1 behave differently than those that were clinical stage T1 and up staged to pT3a. MATERIALS AND METHODS The records of 296 patients who underwent surgical treatment for renal cell carcinoma at The Johns Hopkins Hospital between 1990 and 1999 were retrospectively reviewed. All patients had undergone preoperative CT or magnetic resonance imaging, which was used to assign a clinical stage and size (largest diameter) to each tumor in accordance with the 1997 TNM staging system. Following surgical resection pathological stage, size and tumor grade were determined. Only the 186 patients with clinical T1 tumors were included in this analysis. RESULTS Of the 186 patients who were clinically found to have T1 lesions 125 (67%) had pathological T1 and 57 (31%) had pathological T3a lesions. All surgical margins and lymph nodes were negative at surgical resection. Mean tumor size +/- SD was 3.9 +/- 1.5 cm for pT1 lesions and 3.8 +/- 1.5 cm for pT3a lesions. When comparing these pathological groups using Kaplan-Meier analysis, 5-year recurrence-free survival was not statistically different in patients with pT1 and pT3a lesions (90.6 and 97.5%, respectively). CONCLUSIONS Patients in whom the initial classification of T1 renal cell carcinoma by CT was up graded to T3a on pathological analysis (invasion of fat within Gerota's fascia) showed the same recurrence-free survival rate as patients with pathologically confirmed T1 lesions. Thus, smaller tumors (less than 7 cm) that are up graded to T3a based on capsule invasion behave much like T1 tumors and exact pathological T staging does not appear to impact overall survival.
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Affiliation(s)
- William W Roberts
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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Chae EJ, Kim JK, Kim SH, Bae SJ, Cho KS. Renal cell carcinoma: analysis of postoperative recurrence patterns. Radiology 2004; 234:189-96. [PMID: 15537838 DOI: 10.1148/radiol.2341031733] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively analyze the recurrence patterns of renal cell carcinoma (RCC) and the factors affecting tumor recurrence. MATERIALS AND METHODS The institutional review board approved this study; patient informed consent was not required. There were 162 men (mean age, 54 years +/- 13 [standard deviation]) and 32 women (mean age, 56 years +/- 11) who had undergone complete surgical resection of RCC. Mean follow-up period was 45 months (range, 7-92 months). In consensus, two radiologists determined the presence or absence of tumor recurrence and recorded the time and sites of tumor recurrence. The relationships between tumor recurrence and tumor factors, including greatest diameter (> or =5 cm or <5 cm), T stage, N stage, stage group, histologic subtype, and nuclear grade, were evaluated by using Kaplan-Meier statistics. RESULTS Tumor recurred in 41 (21%) patients. The mean time of tumor recurrence was 17 months (range, 3-50 months). Tumor recurred within 2 years after surgery in 34 (83%) patients. Tumor recurrence sites included lung (n = 29), bone (n = 13), the nephrectomy site (n = 7), brain (n = 6), liver (n = 5), mediastinal lymph nodes (n = 5), the contralateral kidney (n = 4), and the neck muscles (n = 2). The recurrence rate was greater for tumors 5 cm or larger than for those smaller than 5 cm, greater for T3a or T3b tumors than for T1 tumors, greater for stage III tumors than for stage I tumors, and greater for tumors with a nuclear grade of 3 or 4 than for those with a nuclear grade of 1 or 2 (P < .05 for all). CONCLUSION RCC usually recurs within 2 years after surgery, with the lung being the most vulnerable site; greatest tumor diameter, T stage, stage group, and nuclear grade are important factors for recurrence.
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Affiliation(s)
- Eun Jin Chae
- Department of Radiology, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea
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Ficarra V, Novara G, Galfano A, Artibani W. Neoplasm Staging and Organ-Confined Renal Cell Carcinoma: A Systematic Review. Eur Urol 2004; 46:559-64. [PMID: 15474263 DOI: 10.1016/j.eururo.2004.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Several TNM staging system editions were published over the years for renal cell carcinoma (RCC). Using a search strategy similar to the one used by the TNM process Subcommittee for "literature watch", we searched MEDLINE with the intent to critically analyze literature concerning the different TNM editions and the data regarding the optimal breakpoints to substratify localized RCC. MATERIAL AND METHODS The electronic search was conducted as follows: "Neoplasm staging" [MeSH] AND "Carcinoma, Renal Cell" [MeSH]. At the end of a process of abstract analysis performed separately by three of the authors, 34 papers were included in the systematic review. RESULTS All the 34 selected papers were retrospective studies. According to the 1987 version of TNM classification, no paper showed statistically significant cancer-specific survival probability differences between stage I and stage II RCC. According to the 1997 TNM version, the results were controversial. While a few papers found significantly different cancer-specific survival rates between stage I and stage II RCC, several others failed to do so. With the aim to stratify patients with localized RCC, most of the papers proposed an ideal breakpoint ranging from 4.5 to 5.5 cm. CONCLUSION This literature review highlighted that a correct definition of the staging of organ-confined RCC was far from being achieved and provided an appropriate synopsis of the available data for further update of the TNM staging system.
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Affiliation(s)
- Vincenzo Ficarra
- Cattedra e Divisione Clinicizzata di Urologia, Università di Verona, Ospedale Policlinico, Piazzale Ludovico Scuro, 37134 Verona, Italy.
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Steiner T, Knels R, Schubert J. Prognostic Significance of Tumour Size in Patients after Tumour Nephrectomy for Localised Renal Cell Carcinoma. Eur Urol 2004; 46:327-30. [PMID: 15306102 DOI: 10.1016/j.eururo.2004.06.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Staging of the primary tumour is accepted as the most important prognostic factor in organ confined renal cell carcinoma. METHODS The outcome of 286 patients with non-metastatic RCC treated by radical nephrectomy at our institution between 1968 and 1992 was evaluated retrospectively. The median follow-up was 114 +/- 62.6 months. In T1/T2 tumours, the validity of tumour size cut-off points for predicting survival outcome was tested. RESULTS According to the 1997 TNM classification, 168 patients (59%) showed pathological stage T1 (72 stage T1a, 96 stage T1b), 30 (10%) showed stage T2, 84 patients (29%) demonstrated T3 tumours (53 stage T3a, 31 stage T3b), and 4 patients (2%) presented with T4 tumours. The median survival estimated by Kaplan-Meier analysis for T1a, T1b, T2, T3a, T3b and T4 tumours was over 300 months, 187.0 +/- 32.76; 177.0 +/- 1.21; 121.0 +/- 2.57; 124.0 +/- 11.82 and 52.0 +/- 18.38 months, respectively. Regarding survival in T1/T2 tumours Cox regression analysis yielded the highest significance level for a tumour size cut-off point at 4 cm (p = 0.003; 95%CI 1.511-6.991), but no prognostic value for a cut-off point at 7 cm (T1 vs. T2) (p = 0.375; 95%CI 0.655-3.071). CONCLUSIONS Tumour size is an important prognostic factor in patients with organ confined RCC. The recently specified new cut-off point of 4 cm for T1a/T1b tumours is feasible for separating groups with different survival after tumour nephrectomy and should be considered as the new boundary between T1 and T2 stages. Hence, a more accurate prediction of prognostic differences between these groups should be possible.
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Affiliation(s)
- Thomas Steiner
- Department of Urology, Friedrich-Schiller-University, D-07740 Jena, Germany.
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Hotakainen K, Ljungberg B, Haglund C, Nordling S, Paju A, Stenman UH. Expression of the free beta-subunit of human chorionic gonadotropin in renal cell carcinoma: prognostic study on tissue and serum. Int J Cancer 2003; 104:631-5. [PMID: 12594819 DOI: 10.1002/ijc.11000] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Expression of the free beta-subunit of human chorionic gonadotropin (hCGbeta) in malignant tumors is frequently associated with aggressive disease. We have shown previously that the pretreatment serum concentration of hCGbeta is an independent prognostic variable in patients with renal cell carcinoma (RCC). We now compare the serum levels with the expression of hCGbeta antigen and mRNA in tumor tissue and studied whether these are associated with the clinical outcome. Serum samples were collected before surgery from patients with RCC (n = 256) and from 84 apparently healthy controls. HCGbeta in serum was measured by a time-resolved immunofluorometric assay. Tissue expression was detected by immunohistochemical staining of a tissue microarray (TMA) comprising 229 samples, and in selected cases by reverse transcription polymerase chain reaction (RT-PCR) of hCGbeta mRNA (n = 20) from tumor tissue. The prognostic value of hCGbeta in serum and tissue and the association with usual clinicopathological variables was analyzed by the Kaplan-Meier method, the log-rank test, Cox multiple hazard regression, Mann-Whitney U-test or Kruskal-Wallis test. The serum concentrations of hCGbeta were increased in 27% of the RCC patients and patients with increased hCGbeta levels had significantly shorter survival time than those with levels below the median (cut-off 1.2 pmol l(-1), p = 0.0044). HCGbeta antigen was detected in 15% (35 of 229) of the tumors by immunohistochemistry, and hCGbeta mRNA in 8 of 20 samples (40%) by RT-PCR. Tissue positivity for hCGbeta antigen was not associated significantly with mRNA expression, serum concentrations of hCGbeta or survival. In multivariate analysis tumor stage, grade, size and serum hCGbeta were independent prognostic variables. The serum concentration of hCGbeta is an independent prognostic variable in RCC. Tissue expression of hCGbeta detected by immunohistochemistry occurs in 15% of RCCs but it is not significantly associated with prognosis. Expression at the mRNA level seems to be associated with other predictors of adverse outcome.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Renal Cell/blood
- Carcinoma, Renal Cell/chemistry
- Carcinoma, Renal Cell/diagnosis
- Carcinoma, Renal Cell/pathology
- Chorionic Gonadotropin, beta Subunit, Human/analysis
- Chorionic Gonadotropin, beta Subunit, Human/blood
- Chorionic Gonadotropin, beta Subunit, Human/genetics
- Disease Susceptibility
- Female
- Humans
- Male
- Middle Aged
- Prognosis
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Survival Rate
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Affiliation(s)
- Kristina Hotakainen
- Department of Clinical Chemistry, Helsinki University Central Hospital and Helsinki University, Helsinki, Finland.
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Abstract
The incidence of renal cell carcinoma (RCC) continues to rise steadily; unfortunately, our ability to cure patients with metastatic RCC remains limited. When developing and evaluating new treatment protocols, it is important to consider the role of prognostic factors, often defined as pretreatment features, that are predictive of outcome. The complexity and variability of patients' individual clinical outcome and the recently recognized limitation of conventional staging systems have lead to the formulation of integrated prognostic staging systems. In this review, we discuss the evolution of various clinically relevant integrated staging systems for RCC.
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Affiliation(s)
- Dan Leibovici
- Urology Department, Oncology Department, Assaf-Harofeh Medical Center, Zerifin 70300, Israel
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Domínguez Domínguez M, Quintero Rodríguez R, Ibáñez Suárez R, Arroyo Maestre JM, Camacho González JE. [Bilateral synchronous renal cell carcinoma. Report of a case]. Actas Urol Esp 2002; 26:796-800. [PMID: 12645376 DOI: 10.1016/s0210-4806(02)72858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The radical nephrectomy is considered to be the optional treatment for renal carcinoma. In the last years, the good results with partial resection shows conservadora surgery the most suitable treatment for well-localized bilateral renal tumours. In this cases dialysis is avoided, and the subsequent risk of immunological deficit and the higher possibility of metastasic illness are minimized. Nowadays, however, there seems to be some controversy over conservative surgery, concerning applications and technique of surgery to practice (partial resection vs. enucleation). We have a case of bilateral synchronic renal cell carcinoma where radical surgery on the left kidney was put into practice, as it presented a great tumour with multiples points corticals confirmed by PAAF and conservative surgery on the right kidney with enucleation of localized mass in the lower renal. The patient held normal renal function with a good quality of life for five years, finding out then, in one of the radiological tests, carcinoma relapse in the only kidney, that forced to radical surgery and to his inclusion in dialysis programme.
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Peschaud F, Cheynel N, Hagry O, Tremeaux JC, Rat P, Favre JP. [Surgical treatment of pancreatic metastases from renal carcinoma]. ANNALES DE CHIRURGIE 2002; 127:527-31. [PMID: 12404847 DOI: 10.1016/s0003-3944(02)00839-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Pancreatic metastases from renal carcinoma are poorly known. The aim of this study was to report clinical and radiological manifestations, the treatment performed, and the observed survival in 7 patients with this rare entity. RESULTS All patients were operated on. One patient had nonresectable tumor. Six patients underwent curative resection. There was one postoperative death. Follow-up after pancreatectomy ranged from 6 months to 3 years. Two patients developed extra-pancreatic metastases one year and 3 years after pancreatectomy respectively. CONCLUSIONS Pancreatic metastases from renal carcinoma are rare and often occur several years after nephrectomy. However their resection is often possible and allows a good long-term survival. PATIENTS AND METHODS From 1988 to 2000, 7 patients (5 men and 2 women, mean age = 66 years) with pancreatic metastases from a renal cell carcinoma were observed in the same center. One patient had synchronous metastasis; in the 6 others, metastases were diagnosed 4 to 16 years after nephrectomy, and were revealed by pain (n = 2), gastrointestinal bleeding (n = 1), faintness (n = 1) or routine follow-up (n = 2). The diagnosis of metastases was made by contrast-enhanced abdominal CT-scan.
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Affiliation(s)
- F Peschaud
- Service de chirurgie digestive, thoracique et cancérologique, Hôpital du Bocage, 2, Boulevard Maréchal-de-Lattre-de-Tassigny, BP 1542, 21034 Dijon, France
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Okada D, Koizumi K, Kawamoto M, Haraguchi S, Hirata T, Hirai K, Mikami I, Fukushima M, Tanaka S. A case of chronic expanding hematoma presenting as a huge mass in the pleural cavity. J NIPPON MED SCH 2002; 69:282-5. [PMID: 12068320 DOI: 10.1272/jnms.69.282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report a case of a huge chronic expanding hematoma completely removed by surgery. A 71-year-old man was found to have a 3-cm-diameter round nodule in the posterior mediastinum seven years previously. He was not administered any treatment because he did not have any other serious symptoms. There was nothing in his history that could be related to his present condition, such as thoracic surgical treatment or tuberculosis. The massive tumor in the left pleural cavity grew, compressing the left lung and heart gradually in the past seven years. Cytological examination of a needle biopsy specimen showed only erythrocytes with a few infiltrating inflammatory cells. Moreover, his preoperative histopathological analysis did not reveal any significant findings. Therefore, he underwent complete resection of the hematoma including the fibrous capsule and left lower lobectomy. Severance of abundant new vascularizations caused massive bleeding. The postoperative course was uneventful. There was no recurrence in the two years. In cases of gradual growth of a mass without indications of malignancy, we should consider the existence of a chronic expanding hematoma even in patients without a history of thoracic operation or tuberculosis.
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Affiliation(s)
- Daisuke Okada
- Second Department of Surgery, Nippon Medical School, Japan
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