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Majdoub M, Yanagisawa T, Quhal F, Laukhtina E, von Deimling M, Kawada T, Rajwa P, Bianchi A, Pallauf M, Mostafaei H, Chlosta M, Pradere B, Karakiewicz PI, Schmidinger M, Rub R, Shariat SF. Role of clinicopathological variables in predicting recurrence and survival outcomes after surgery for non-metastatic renal cell carcinoma: Systematic review and meta-analysis. Int J Cancer 2024; 154:1309-1323. [PMID: 38009868 DOI: 10.1002/ijc.34793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 11/29/2023]
Abstract
Renal cell carcinoma (RCC) represents 2% of all diagnosed malignancies worldwide, with disease recurrence affecting 20% to 40% of patients. Existing prognostic recurrence models based on clinicopathological features continue to be a subject of controversy. In this meta-analysis, we summarized research findings that explored the correlation between clinicopathological characteristics and post-surgery survival outcomes in non-metastatic RCC patients. Our analysis incorporates 99 publications spanning 140 568 patients. The study's main findings indicate that the following clinicopathological characteristics were associated with unfavorable survival outcomes: T stage, tumor grade, tumor size, lymph node involvement, tumor necrosis, sarcomatoid features, positive surgical margins (PSM), lymphovascular invasion (LVI), early recurrence, constitutional symptoms, poor performance status (PS), low hemoglobin level, high body-mass index (BMI), diabetes mellitus (DM) and hypertension. All of which emerged as predictors for poor recurrence-free survival (RFS) and cancer-specific survival. Clear cell (CC) subtype, urinary collecting system invasion (UCSI), capsular penetration, perinephric fat invasion, renal vein invasion (RVI) and increased C-reactive protein (CRP) were all associated with poor RFS. In contrast, age, sex, tumor laterality, nephrectomy type and approach had no impact on survival outcomes. As part of an additional analysis, we attempted to assess the association between these characteristics and late recurrences (relapses occurring more than 5 years after surgery). Nevertheless, we did not find any prediction capabilities for late disease recurrences among any of the features examined. Our findings highlight the prognostic significance of various clinicopathological characteristics potentially aiding in the identification of high-risk RCC patients and enhancing the development of more precise prediction models.
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Affiliation(s)
- Muhammad Majdoub
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Hillel Yaffe Medical Center, Affiliated to Technion-Israeli Institute of Technology, Hadera, Israel
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Markus von Deimling
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Alberto Bianchi
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maximilian Pallauf
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marcin Chlosta
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Jagiellonian University hospital, Krakow, Poland
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Manuela Schmidinger
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ronen Rub
- Department of Urology, Hillel Yaffe Medical Center, Affiliated to Technion-Israeli Institute of Technology, Hadera, Israel
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
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Oshiro H, Shimizu Y, Nakayasu R, Miyazaki Y, Utsunomiya N, Asai S, Kanamaru S. Bilateral adrenal metastases from renal cell carcinoma after robot-assisted partial nephrectomy. Int Cancer Conf J 2024; 13:49-53. [PMID: 38187184 PMCID: PMC10764699 DOI: 10.1007/s13691-023-00635-5] [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: 07/31/2023] [Accepted: 09/26/2023] [Indexed: 01/09/2024] Open
Abstract
Renal cell carcinoma often metastasizes to the adrenals; however, bilateral adrenal metastases are rare. We here report a patient with bilateral adrenal metastases from renal cell carcinoma after robot-assisted partial nephrectomy and review relevant published reports. A 64-year-old man underwent robot-assisted partial nephrectomy for a left renal tumor. During follow-up, he was diagnosed with bilateral adrenal metastases. He underwent left adrenalectomy followed by right partial adrenalectomy to preserve adrenal function. The renal tumor later metastasized to other parts of the body. He continues to receive systemic treatment and remains in partial remission. Patients with pT1aN0M0 renal cell carcinoma generally have a favorable prognosis. However, occasional such patients develop multiple metastases. To the best of our knowledge, this is the first reported case of bilateral adrenal metastases after partial nephrectomy. Clinicians should keep this rare scenario in mind.
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Affiliation(s)
- Hiroki Oshiro
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-Chome Nishi-ku, Kobe, Hyogo 651-2273 Japan
| | - Yousuke Shimizu
- Department of Urology, Osaka Red Cross Hospital, Osaka, Japan
| | - Ryota Nakayasu
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-Chome Nishi-ku, Kobe, Hyogo 651-2273 Japan
| | - Yu Miyazaki
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-Chome Nishi-ku, Kobe, Hyogo 651-2273 Japan
| | - Noriaki Utsunomiya
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-Chome Nishi-ku, Kobe, Hyogo 651-2273 Japan
| | - Satsuki Asai
- Department of Pathology, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo Japan
| | - Sojun Kanamaru
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-Chome Nishi-ku, Kobe, Hyogo 651-2273 Japan
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Castillo E, Martinez K. Late Recurrence of Renal Cell Carcinoma in Unusual Sites 23 Years After Nephrectomy. Cureus 2023; 15:e45707. [PMID: 37868443 PMCID: PMC10590181 DOI: 10.7759/cureus.45707] [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: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Renal cell carcinoma (RCC) is a common malignancy in the elderly population and it is notorious for its mechanism of late metastasis to unusual anatomical sites. Late recurrences are common following curative treatment, such as radical nephrectomy. Pancreatic metastases and hepatic metastatic lesions make the diagnosis and classification of a primary tumor challenging. This necessitates a high index of suspicion and an extensive interrogation. We present the case of a 68-year-old Hispanic female with progressive pain in the right upper quadrant, weight loss, and decreased appetite. She has a history of renal cell carcinoma treated with radical nephrectomy and radiotherapy. A pancreatic biopsy was performed based on the ultrasound and computed tomography findings at a private clinic. Subsequently, the patient was referred to the Instituto Oncologico Nacional (ION) due to immunohistochemical features suggestive of a well-differentiated neuroendocrine tumor. At ION, a more comprehensive medical history was obtained, and the immunohistochemistry panel was extended, confirming the diagnosis of late recurrence of RCC. One possible explanation for the very late relapse of our patient is the presence of malignant cells that were spared or seeded during the surgical intervention and remained dormant or latent, subsequently spreading via hematogenous dissemination or via the lymphatic system. We highlight the importance of medical history, pathological examination, and immunohistochemical analysis in establishing a differential diagnosis, given the nature of RCC, which can often present asymptomatically and has a propensity for late recurrence. Further research should focus on developing standardized surveillance protocols for such cases.
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Gaas MY, Kaprin AD, Vorobyev NV, Rapoport LM, Korolev DO, Kalpinsky AS. Markers of local kidney cancer recurrence: A surgeon's mistake or a pattern? Review. Urologia 2022:3915603221140964. [PMID: 36515572 DOI: 10.1177/03915603221140964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The influence of various morphological, anatomical, genetic and other factors on the local recurrence-free survival of patients who have undergone different renal cell cancer (RCC) treatment is still a rather complex, ambiguous and controversial issue for practicing oncourologists. This review evaluates the effect of several factors on both recurrence-free survival and local recurrence-free survival. The review includes articles, clinical cases, literature reviews, and meta-analyses highlighting the analysis of independent and interrelated predisposing factors for developing local recurrence of RCC from 1984 to 2020. The PubMed, Web of Science, and Scopus databases were searched in English, Spanish, and German. A review of the literature showed the role of the following indices in the local recurrence RCC: microvascular invasion (p = 0.001), tumor necrosis (p = 0.0001), high malignancy (Fuhrman III or IV) (HR = 38.3, 95% CI 3.1-467, p = 0.004) as histological factors, tumor size as an anatomical factor. Thus, the authors state that every centimeter of the tumor increases the risk of local recurrence (p < 0.05). A group from the Mayo Clinic showed the equivalence of different treatment methods in local RCC recurrence. Thus, in the group of patients with cT1a stage kidney cancer, the 5-year local recurrence-free survival rates were 97.7% (96.7-98.6), 95.9% (92.3-99.6), and 95.9% (92.3-99.6) for renal resection, RFA, and cryoablation, respectively. Surgical margin status is the most studied and controversial marker of local renal cell carcinoma recurrence. Researchers found a direct effect of PSM on the risk of local RCC recurrence (p < 0.01). The personalized approach with the search and evaluation of predisposing factors for the local recurrence, as well as further selection of the most optimal treatment, will allow oncourologists to improve both the effectiveness of primary treatment and the recurrence-free survival of patients.
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Affiliation(s)
- Margarita Y Gaas
- Department Urology and Operative Nephrology with the Course of Oncourology of Medical Institute of Peoples' Friendship University of Russia, Moscow, Russian Federation
| | - Andrey D Kaprin
- Department Urology and Operative Nephrology with the Course of Oncourology of Medical Institute of Peoples' Friendship University of Russia, Moscow, Russian Federation
| | - Nikolay V Vorobyev
- Department of Oncology, Radiotherapy and Plastic Surgery of I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.,P.A. Hertsen Moscow Oncology Research Center, A Branch of FSBI NMRRC of the Ministry of Health of Russia, Moscow, Russian Federation
| | - Leonid M Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Dmitry O Korolev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Alexey S Kalpinsky
- Department of Tumors of the Reproductive and Urinary Organs, Moscow Research Oncological Institute, P. A. Herzen, Branch of the Federal State Budgetary Institution "National Research Center of Radiology," Moscow, Russian Federation
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Minghinelli FE, Recalde RJ, Prost DM, Cutuli HJ, Giovannini SJM, Zaninovich RS. Which biological pathways are responsible for the late appearance of brain metastases in renal cell carcinoma? Analysis of eight cases. Surg Neurol Int 2022; 13:466. [PMID: 36324953 PMCID: PMC9610221 DOI: 10.25259/sni_713_2022] [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: 08/08/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Renal cell carcinoma (RCC) represents 1% of all cancers and its brain metastases amount to 8.1% of all metastatic tumors. Late brain metastases are defined as tumors that appear 10 years after diagnosis of the primary lesion. The objective of this work is to discuss which biological pathways are responsible for the late appearance of these metastases analyzing eight cases. Case Description: We report here eight cases of late brain metastases of RCC treated between 2018 and 2021. Patients consulted for different clinical complaints. Brain magnetic resonance imaging and computed tomography scan were performed on all patients. They were treated by complete surgical resection plus radiosurgery or by radiosurgery alone. The histology of most metastases showed clear cell RCC. Conclusion: In the presence of a patient with an intracranial tumor and a history of RCC with more than 10 years of evolution, the presence of late metastasis should always be considered. There are many theories described in the literature that try to explain the late appearance of brain metastases from RCC (low mitotic index, impaired immune system, cross talk, self-seeding, and among others).
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Affiliation(s)
- Federico E. Minghinelli
- Department of Neurosurgery, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
| | - Rodolfo José Recalde
- Department of Neurosurgery, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
| | - Diego Martín Prost
- Department of Neurosurgery, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
| | - Hernán Javier Cutuli
- Ángel H. Roffo Institute of Oncology, University of Buenos Aires, School of Medicine, Buenos Aires, Argentina
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Sakurai Y, Matsuura H, Oshima Y, Hirai K, Tani E, Yoshimoto N, Minami K, Wakasa K, Hirashima T. A case of renal cell carcinoma with late recurrence in the bilateral hilar lymph nodes twenty years after surgery. Respir Med Case Rep 2022; 36:101617. [PMID: 35300291 PMCID: PMC8920930 DOI: 10.1016/j.rmcr.2022.101617] [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: 01/31/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022] Open
Abstract
Renal cell carcinoma (RCC) is a common malignancy with a high recurrence rate. However, brain and bilateral hilar lymph node (BHL) relapse is rare. A 65-year-old man with a chief complaint of hemosputum visited the primary care clinic. Computed tomography revealed BHL enlargement. Histopathological examination of biopsy specimens from the left lingular bronchus revealed RCC. This finding was similar to that of a left nephrectomy specimen of RCC observed 20 years ago. If patients have a medical history of RCC, physicians should consider the possibility of RCC recurrence, regardless of the number of years relapsed postoperatively.
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Lee CH, Chung J, Kwak C, Jeong CW, Seo SI, Kang M, Hong SH, Song C, Park JY, Hwang EC, Lee H, Ku JY, Seo WI, Choi SH, Ha HK. Targeted therapy response in early versus late recurrence of renal cell carcinoma after surgical treatment: A propensity score-matched study using the Korean Renal Cancer Study Group database. Int J Urol 2021; 28:417-423. [PMID: 33527588 DOI: 10.1111/iju.14485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/06/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To investigate the clinicopathological features and outcomes of targeted therapy in patients with recurrence of renal cell carcinoma in <5 years or ≥5 years after the surgical treatment for renal cell carcinoma. METHODS Patients with metastatic renal cell carcinoma treated with targeted therapy in a multicenter database were retrospectively characterized according to time from surgery to recurrence. Early recurrence was defined as recurrence within 5 years after surgery, and late recurrence was defined as occurring ≥5 years after surgery. The propensity scores for recurrence status were calculated, and patients with late recurrence were matched to patients with early recurrence at a 1:3 ratio. The oncological outcomes of targeted therapy in both groups were compared. RESULTS Among 716 patients, 512 (71.5%) experienced early recurrence and 204 (28.5%) experienced late recurrence. The patients with late recurrence presented with younger age at surgery, lower tumor stages and Fuhrman grade, and fewer sarcomatoid features and lymphovascular invasion (all P < 0.005). All differences in clinicopathological characteristics before targeted therapy disappeared after matching. Patients with late recurrence had significantly longer median overall survival (56 months vs 36 months; P < 0.0001) and median first-line progression-free survival (12 months vs 8 months; P = 0.031). The early recurrence status was a significantly worse predictor for overall survival and first-line progression-free survival (hazard ratio 1.30, P = 0.007; and hazard ratio 1.76, P < 0.001, respectively). CONCLUSIONS Late recurrence might have prognostic value in terms of oncological outcomes in metastatic renal cell carcinoma treated with targeted therapy.
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Affiliation(s)
- Chan Ho Lee
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jinsoo Chung
- Urologic Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Young Park
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Yoon Ku
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Won Ik Seo
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seock Hwan Choi
- Department of Urology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Choucair K, Parker NA, Al-Obaidi A, Alderson J, Truong P. Solitary, Late Metastatic Recurrence of Renal Cell Carcinoma to the Pancreas: A Case Report. Cureus 2020; 12:e8521. [PMID: 32537281 PMCID: PMC7286586 DOI: 10.7759/cureus.8521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Renal cell carcinoma (RCC) accounts for 3% of all adult malignancies and is known for metastatic initial presentation, unpredictable metastatic pathway, and late recurrence post-curative resection. We report a case of solitary late metastatic renal cell carcinoma to the pancreas more than 10 years after radical nephrectomy. A high index of suspicion must be maintained to detect RCC late recurrence and metastasis to rare and atypical locations. A lifelong follow-up is recommended.
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Affiliation(s)
- Khalil Choucair
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Nathaniel A Parker
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Ammar Al-Obaidi
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Joel Alderson
- Pathology, Ascension Via Christi St. Francis Hospital, Wichita, USA
| | - Phu Truong
- Hematology/Oncology, Cancer Center of Kansas, Wichita, USA
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唐 琦, 林 榕, 姚 林, 张 争, 郝 瀚, 张 崔, 蔡 林, 李 学, 何 志, 周 利. [Clinicopathologic features and prognostic analyses of locally recurrent renal cell carcinoma patients after initial surgery]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:628-631. [PMID: 31420612 PMCID: PMC7433486 DOI: 10.19723/j.issn.1671-167x.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the clinicopathologic features and potential prognostic predictors of locally recurrent renal cell carcinoma patients after initial surgery. METHODS Authors retrospectively analyzed data extracted from 81 patients who were treated for postoperative locally recurrence of renal cell carcinoma from January 2006 to June 2016 in the Department of Urology, Peking University First Hospital. Postoperative locally recurrence of renal cell carcinoma was defined as disease recurring in the remnant kidney, renal fossa, adjacent abdomen, ipsilateral adrenal and retroperitoneal lymph nodes. RESULTS In the study, 81 patients were finally included, of whom 43 were initially treated in our hospital and 38 were initially treat in other centers. Partial nephrectomy (PN) was performed for 38 cases (26 in our hospital and 12 in other hospitals) as initial treatment and radical nephrectomy (RN) was conducted for the remnant 43 cases (17 in our hospital and 26 in other hospitals). Overall median recurrence time was 26 months (range: 3-164 months), in which 26 months (range: 3-55 months) for PN cases and 30 months (range: 4-164 months) for RN cases (P=0.009). Sixty-nine patients had single site recurrence, including remnant kidney (n=29), renal fossa (n=20), abdomen (n=4), ipsilateral lymph nodes (n=5), ipsilateral adrenal (n=11), while 12 patients had multiple sites recurrence. Seventy-eight patients were managed by complete surgical resection, while three patients were managed by radiofrequency ablation. Postoperative pathological diagnoses included clear cell carcinoma (n=72), papillary renal cell carcinoma (n=8, 7 cases with type 1, 1 case with type 2) and Xp11 translocation/TFE3 gene fusion renal cell carcinoma (n=1). Complete pathologic information of the initial surgery could be extracted from 43 patients who were initially treated in our hospital. Seventeen patients with initial radical nephrectomy were staged as T1a (n=4), T1b (n=2), T2a (n=1), T3a (n=8), and T3b (n=2). Twenty-six patients with initial partial nephrectomy were staged as T1a (n=18), T1b (n=7), and T3a (n=1). For PN cohort, the patients with T1a stage disease had longer median recurrence time than those with beyond T1a stage disease, and the difference was significant (29 months vs. 18 months, P=0.041). At the end of the follow-up, 58 patients were alive, 4 died and 19 lost the follow-up. Overall, 3-year and 5-year disease free survival rates were 81.9%, and 53.6%, respectively. CONCLUSION The present research reported a large-scale single central experience of locally recurrent renal cell carcinoma. The recurrence time of the PN group is shorter than that of the RN group. For patients after PN surgery, median recurrence time is longer for patients with T1a stage tumor when compared with those with stage beyond T1a. Patients can obtain relative long-term survival after complete secondary surgery resection.
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Affiliation(s)
- 琦 唐
- />北京大学第一医院泌尿外科,北京大学泌尿外科研究所, 北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - 榕城 林
- />北京大学第一医院泌尿外科,北京大学泌尿外科研究所, 北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - 林 姚
- />北京大学第一医院泌尿外科,北京大学泌尿外科研究所, 北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - 争 张
- />北京大学第一医院泌尿外科,北京大学泌尿外科研究所, 北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - 瀚 郝
- />北京大学第一医院泌尿外科,北京大学泌尿外科研究所, 北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - 崔建 张
- />北京大学第一医院泌尿外科,北京大学泌尿外科研究所, 北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - 林 蔡
- />北京大学第一医院泌尿外科,北京大学泌尿外科研究所, 北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - 学松 李
- />北京大学第一医院泌尿外科,北京大学泌尿外科研究所, 北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - 志嵩 何
- />北京大学第一医院泌尿外科,北京大学泌尿外科研究所, 北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - 利群 周
- />北京大学第一医院泌尿外科,北京大学泌尿外科研究所, 北京 100034Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
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10
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Komanski CB, Rubino SM, Meyer JC, Greven CM. Choroidal Melanoma Mimicker: A Case of Metastatic Clear-Cell Renal Cell Carcinoma. Ocul Oncol Pathol 2018; 3:279-282. [PMID: 29344481 DOI: 10.1159/000462975] [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: 11/21/2016] [Revised: 02/03/2017] [Indexed: 11/19/2022] Open
Abstract
Choroidal melanoma is the most common primary intraocular malignancy, yet metastatic disease remains the most common malignancy of the eye. Differentiating these entities is essential as treatment, systemic associations, and prognosis vary dramatically between the two. Established diagnostic criteria are accurate for the diagnosis of uveal melanoma. Yet, metastatic disease may be misdiagnosed as a uveal melanoma in rare cases. We report a case of metastatic clear-cell renal cell carcinoma masquerading as uveal melanoma. A 73-year-old Caucasian man with a history of renal cell carcinoma presented with a 15 × 12 × 7 mm homogenous, pigmented, and acoustically hollow mass without hemorrhage or exudation. The patient was initially treated with plaque radiotherapy with good tumor regression. However, the patient developed pain and vision loss due to total exudative retinal detachment. Subsequent enucleation allowed histopathologic confirmation of clear-cell renal cell carcinoma. Nine years following enucleation, the patient remains in complete remission without evidence of other systemic metastases. Renal cell carcinoma should be considered when evaluating patients with probable uveal melanoma. Delayed-onset ocular metastasis from renal cell carcinoma exhibits an atypical clinical course with the possibility of durable remission following enucleation.
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Affiliation(s)
- Chris B Komanski
- Department of Ophthalmology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Shaina M Rubino
- Department of Ophthalmology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Jacob C Meyer
- Department of Ophthalmology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Craig M Greven
- Department of Ophthalmology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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11
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Zhang F, Zhao G, Wu P, An Q, Yang Y, Chen X, Wang J, Wei D. Asynchronous abdominal wall and sigmoid metastases in clear cell renal cell carcinoma: A case report and literature review. Asian J Urol 2018; 6:210-214. [PMID: 31061809 PMCID: PMC6488679 DOI: 10.1016/j.ajur.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/04/2017] [Accepted: 05/04/2017] [Indexed: 02/08/2023] Open
Abstract
Sigmoid metastasis of renal cell carcinoma (RCC) is very rare. Herein we report a case of pathologically proven asynchronous abdominal wall and sigmoid metastases after a right nephrectomy. An 84-year-old man underwent right radical nephrectomy for clear cell renal cell carcinoma (ccRCC) 13 years ago. Solitary contralateral abdominal wall metastasis was found for left abdominal mass 9 years after nephrectomy. The man experienced melena underwent resection of sigmoid colon tumor in February, 2016. The postoperative pathological examinations revealed that the tumors were metastases of ccRCC. Recurrence more than 5 years after nephrectomy has been accepted as late recurrence by the majority of urologists now. Late recurrence is one of the specific biological behaviors of RCC. Asynchronous late recurrence of abdominal wall and sigmoid metastases in ccRCC has not been reported before. When patients have sigmoid mass after nephrectomy for RCC, doctors may consider the possibility of late recurrence.
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Affiliation(s)
- Fangyuan Zhang
- Department of Urology, Beijing Hospital, The Fifth Clinical Medical School of Peking University, National Center of Gerontology, Beijing, China
| | - Gang Zhao
- Department of General Surgery, Beijing Hospital, The Fifth Clinical Medical School of Peking University, National Center of Gerontology, Beijing, China
| | - Pengjie Wu
- Department of Urology, Beijing Hospital, The Fifth Clinical Medical School of Peking University, National Center of Gerontology, Beijing, China
| | - Qi An
- Department of General Surgery, Beijing Hospital, The Fifth Clinical Medical School of Peking University, National Center of Gerontology, Beijing, China
| | - Yang Yang
- Department of General Surgery, Beijing Hospital, The Fifth Clinical Medical School of Peking University, National Center of Gerontology, Beijing, China
| | - Xin Chen
- Department of Urology, Beijing Hospital, The Fifth Clinical Medical School of Peking University, National Center of Gerontology, Beijing, China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, The Fifth Clinical Medical School of Peking University, National Center of Gerontology, Beijing, China
| | - Dong Wei
- Department of Urology, Beijing Hospital, The Fifth Clinical Medical School of Peking University, National Center of Gerontology, Beijing, China
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12
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Fukushima Y, Yoshikawa G, Takasago M, Shimizu S, Tsutsumi K. Extremely Delayed Multiple Brain Metastases from Renal Cell Carcinoma: Remission Achieved with Total Surgical Removal: Case Report and Literature Review. World Neurosurg 2016; 92:583.e13-583.e17. [DOI: 10.1016/j.wneu.2016.05.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/28/2022]
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13
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Tanimoto A, Takeuchi S, Yaegashi H, Kotani H, Kitai H, Nanjo S, Ebi H, Yamashita K, Mouri H, Ohtsubo K, Ikeda H, Yano S. Recurrence of renal cell carcinoma diagnosed using contralateral adrenal biopsy with endoscopic ultrasound-guided fine-needle aspiration. Mol Clin Oncol 2016; 4:537-540. [PMID: 27073657 DOI: 10.3892/mco.2016.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/21/2016] [Indexed: 11/05/2022] Open
Abstract
A 76-year-old female in whom a renal cell carcinoma (RCC) lesion was resected 19 years previously presented to our hospital with cognitive dysfunction. Magnetic resonance imaging and computed tomography revealed nodules in the brain, lung, adrenal gland and a pelvic osteolytic lesion. To identify the primary cancer site, the present study performed endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the left adrenal lesion. Consequently, the pathological findings of the tissue obtained by EUS-FNA were similar to those of the previous nephrectomy specimen, revealing that the adrenal lesion was the recurrence of RCC. The majority of the metastatic lesions in the patient were reduced in size by the multiple kinase inhibitor, pazopanib. Contralateral adrenal metastasis of RCC is rare and the use of EUS-FNA in the diagnosis of adrenal lesions remains to be elucidated. This is a rare case of adrenal lesion, diagnosed by EUS-FNA. Therefore, EUS-FNA is considered to be a useful diagnostic modality of adrenal metastases from unidentified primary tumor types.
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Affiliation(s)
- Azusa Tanimoto
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Shinji Takeuchi
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa 920-8641, Japan
| | - Hiroshi Kotani
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hidenori Kitai
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Shigeki Nanjo
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hiromichi Ebi
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Kaname Yamashita
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hisatsugu Mouri
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Koushiro Ohtsubo
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hiroko Ikeda
- Division of Pathology, Kanazawa University Hospital, Kanazawa, Ishikawa 920-8641, Japan
| | - Seiji Yano
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
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14
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Hamza A, Günther M, Behrendt W, Tietze S, Beige J. Reconstructive kidney surgery for organ-preserving therapy of renal tumors. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2015; 4:Doc10. [PMID: 26605133 PMCID: PMC4647129 DOI: 10.3205/iprs000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The objective of this study was to evaluate differences in various clinical endpoints in patients with reconstructive surgery by renal partial nephrectomy for tumors up to 4 cm compared to tumors larger than 4 cm. Material and methods: A total of 170 partial renal resection patients that presented malignant tumors were included in the retrospective study. Data was analyzed retrospectively based on internal clinic files, as well as a questionnaire to enhance the follow-up clinical outcomes data obtained. The most important outcomes determined included post-operative renal function, intra- and post-operative complications, local recurrence rate and total survival time. Results: The local recurrence rate was 6.1% for tumors up to 4 cm in size, compared to 14.9% for tumors that were larger than 4 cm. Compared to results for partial resection of T1a tumors, results for partial resection of tumors larger than 4 cm are worse in terms of post-operative renal function (p=0.007), as well as in terms of a total complications rate (p=0.048). It is important to note that there was not only a higher risk of post-operative bleeding that required transfusions (p=0.012), but also a higher risk of a hypertensive episode during the post-operative period reviewed (p=0.022). In addition, the total survival time for patients presenting tumors of up to 4 cm in size was significantly better (p=0.003). Conclusion: The results of our retrospective study of 170 patients that underwent partial renal resection after the diagnosis of malignant tumors, is that partial renal resection presents an oncologicaly safe surgical solution with low local recurrence rates. Additionally, partial resection in case of tumors that are larger than 4 cm showed worse post-operative renal function, a higher complications rate and a worse survival rate.
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Affiliation(s)
- Amir Hamza
- Department of Urology, Hospital St. Georg, Leipzig, Germany
| | - Manuel Günther
- Department of Urology, Hospital St. Georg, Leipzig, Germany
| | - Wolf Behrendt
- Department of Urology, Hospital St. Georg, Leipzig, Germany
| | - Stefan Tietze
- Department of Urology, Hospital St. Georg, Leipzig, Germany
| | - Joachim Beige
- Department of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany
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15
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Conti A, Santoni M, Sotte V, Burattini L, Scarpelli M, Cheng L, Lopez-Beltran A, Montironi R, Cascinu S, Muzzonigro G, Lund L. Small renal masses in the era of personalized medicine: Tumor heterogeneity, growth kinetics, and risk of metastasis. Urol Oncol 2015; 33:303-9. [DOI: 10.1016/j.urolonc.2015.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/07/2015] [Accepted: 04/06/2015] [Indexed: 12/26/2022]
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16
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Prognostic significance of host immune status in patients with late relapsing renal cell carcinoma treated with targeted therapy. Target Oncol 2015; 10:517-22. [PMID: 25559290 DOI: 10.1007/s11523-014-0356-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/18/2014] [Indexed: 02/07/2023]
Abstract
We aimed to assess the prognostic role of pretreatment neutrophilia, lymphocytopenia, and neutrophil to lymphocyte ratio (NLR) in patients treated with vascular endothelial growth factor-tyrosine kinase inhibitors (VEGFR-TKIs) for late relapsing (>5 years) metastatic renal cell carcinoma (mRCC). Data were collected from 13 Italian centers involved in the treatment of metastatic RCC. Late relapse was defined as >5 years after initial radical nephrectomy. One hundred fifty-one patients were included in this analysis. Among them, MSKCC risk score was favorable in 68 %, intermediate in 29 %, and poor in 3 %. Fifty-six patients (37 %) had NLR ≥3 at the start of VEGFR-TKI therapy (group A), while 95 had lower NLR (63 %, group B). The median overall survival (OS) was 28.8 months in group A and 68.7 months (95 % confidence interval (CI) 45.3-NA) in group B (p < 0.001). The median progression-free survival (PFS) was 15.8 months in group A and 25.1 months in group B (p = 0.03). At multivariate analysis, MSKCC risk group and NLR were independent prognostic factors for both OS and PFS. Pretreatment NLR is an independent prognostic factor for patients with late relapsing mRCC treated with first-line VEGFR-TKIs. A better characterization of baseline immunological impairment may optimize the management of this RCC subpopulation.
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17
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Santoni M, Conti A, Porta C, Procopio G, Sternberg CN, Basso U, De Giorgi U, Bracarda S, Rizzo M, Ortega C, Massari F, Iacovelli R, Derosa L, Masini C, Milella M, Di Lorenzo G, Atzori F, Pagano M, Buti S, De Vivo R, Mosca A, Rossi M, Paglino C, Verzoni E, Cerbone L, Muzzonigro G, Falconi M, Montironi R, Burattini L, Santini D, Cascinu S. Sunitinib, Pazopanib or Sorafenib for the Treatment of Patients with Late Relapsing Metastatic Renal Cell Carcinoma. J Urol 2015; 193:41-7. [DOI: 10.1016/j.juro.2014.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 01/17/2023]
Affiliation(s)
- Matteo Santoni
- Clinica di Oncologia Medica, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandro Conti
- Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Clinica di Urologia, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Camillo Porta
- Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Cora N. Sternberg
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - Umberto Basso
- Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori-I.R.S.T., Meldola (FC), Italy
| | - Sergio Bracarda
- Department of Oncology, Istituto Toscano Tumori, Ospedale San Donato USL-8, Arezzo, Italy
| | - Mimma Rizzo
- Department of Medical Oncology, Cardarelli Hospital, Napoli, Italy
| | - Cinzia Ortega
- Oncology Foundation of Piedmont, Institute for Cancer Research and Treatment, Laboratory Medicine, Candiolo, Italy
| | - Francesco Massari
- Medical Oncology, ‘G.B. Rossi’ Academic Hospital, University of Verona, Verona, Italy
| | - Roberto Iacovelli
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Lisa Derosa
- UO Oncologia Medica 2 Universitaria Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy
| | - Cristina Masini
- Oncology Division, Department of Oncology and Hematology, University of Modena e Reggio Emilia, Modena, Italy
| | - Michele Milella
- Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Di Lorenzo
- Genitourinary Cancer Section, Medical Oncology Division, Department of Endocrinology and Oncology, University Federico II, Napoli, Italy
| | - Francesco Atzori
- Medical Oncology Unit, Azienda Ospedaliero Universitaria of Cagliari, Cagliari, Italy
| | - Maria Pagano
- Department of Oncology, Oncology Unit, Azienda Ospedaliera AsMN, Istituto di Ricovero e cura a carattere scientifico, Reggio Emilia, Italy
| | - Sebastiano Buti
- Department of Oncology, University Hospital of Parma, Parma, Italy
| | - Rocco De Vivo
- Medical Oncology, S. Bortolo Hospital, Vicenza, Italy
| | - Alessandra Mosca
- Medical Oncology, Maggiore della Carità Hospital, University of Eastern Piedmont “A. Avogadro”, Novara, Italy
| | - Marta Rossi
- S.C. Oncologia Medica, Azienda Ospedaliera di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Chiara Paglino
- Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Elena Verzoni
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Linda Cerbone
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - Giovanni Muzzonigro
- Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Clinica di Urologia, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Massimo Falconi
- Division of Pancreatic and Digestive Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Università Politecnica delle Marche, School of Medicine, AOU Ospedali Riuniti, Ancona, Italy
| | - Luciano Burattini
- Clinica di Oncologia Medica, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Santini
- Oncologia Medica, University Campus Bio-Medico Roma, Rome, Italy
| | - Stefano Cascinu
- Clinica di Oncologia Medica, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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18
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Different clinicopathological features between patients who developed early and late recurrence following surgery for renal cell carcinoma. Int J Clin Oncol 2014; 20:802-7. [DOI: 10.1007/s10147-014-0775-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/20/2014] [Indexed: 12/20/2022]
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19
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Lee SH, Son HS, Cho S, Kim SJ, Yoo DS, Kang SH, Park SY, Park J, Chang SG, Jeon SH. Which Patients Should We Follow up beyond 5 Years after Definitive Therapy for Localized Renal Cell Carcinoma? Cancer Res Treat 2014; 47:489-94. [PMID: 25622589 PMCID: PMC4506106 DOI: 10.4143/crt.2014.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/07/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose Up to 10% of recurrences develop beyond 5 years after curative treatment of localized renal cell carcinoma (RCC). Clinicopathologic features were evaluated to determine which factors are associated with late recurrence. Materials and Methods A total of 753 patients were diagnosed with localized RCC from January 2000 to June 2008. We enrolled 225 patients who were treated surgically and had a minimal recurrence-free survival of 60 months. Patients who had recurrence beyond 5 years after nephrectomy were defined as the late recurrence group and the remaining patients as the recurrence-free group. Multivariate logistic regression analyses and the Cox proportional hazard model were used for determination of features associated with late recurrence. Results In multivariate analyses, age older than 60 (p=0.030), Fuhrman grade ≥ 3 (p=0.042), and pT stage ≥ pT2 (p=0.010) showed statistical association with late recurrence. The Cox proportional hazard model showed significant differences in recurrence-free survival when we classified the patients based on pT2 (p=0.007) and on patient age ≥ 60 years (p=0.039). Conclusion Patient age greater than 60 years, Fuhrman grade ≥ 3, and tumor stage ≥ pT2 are independent risk factors of recurrence more than 5 years after surgery in patients with RCC. Therefore, close lifelong follow-up is recommended for patients with these risk factors.
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Affiliation(s)
- Sang Hyub Lee
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hee Seo Son
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seok Cho
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Sang Jin Kim
- Department of Urology, Myongji Hospital, Goyang, Korea
| | - Dae Seon Yoo
- Department of Urology, Eulji University School of Medicine, Daejeon, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Sung Yul Park
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Jinsung Park
- Department of Urology, Eulji University School of Medicine, Daejeon, Korea
| | - Sung-Goo Chang
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung Hyun Jeon
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
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20
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Tietze S, Herms M, Behrendt W, Krause J, Hamza A. [Controversies of partial nephrectomy for renal cell carcinoma : survey in the German-speaking countries]. Urologe A 2014; 53:1181-5. [PMID: 24824467 DOI: 10.1007/s00120-014-3469-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The goal of this study was to evaluate how partial nephrectomy is technically performed in Germany, Austria, and Switzerland. METHODS A one-page anonymous questionnaire was designed to evaluate the indication, the technical procedure, and the follow-up of R1 situation after partial nephrectomy. Furthermore, the size of the hospitals and their catchment areas were recorded. The questionnaire was sent to 341 clinics and a statistical analysis was performed. RESULTS The response rate was 69 %. Up to 99 % of the clinics also perform partial resection in T1b tumors. Of those responding, 58 % perform this surgery laparoscopically, and 83 % of the surgeries are performed in warm ischemia. For the follow-up, 29 % suggest imaging within the first 6 weeks. According to this survey, maximum care clinics perform laparoscopic nephrectomy more frequently (p = 0.003). CONCLUSION The survey of 236 hospitals performing partial nephrectomy shows great variability in the indication, technique, and aftercare of organ-preserving renal tumor surgery. It also shows that a large proportion of tumors >4 cm undergo organ-preserving surgery, many of them minimally invasive. The diverse handling with positive instantaneous section and R1 results suggest the need for further studies concerning long-term follow-up after minimally invasive surgery with R1 situation and renal tumors > T1a.
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Affiliation(s)
- S Tietze
- Klinik für Urologie und Andrologie, Klinikum St. Georg gGmbH, Delitzscher Straße 141, 04129, Leipzig, Deutschland,
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21
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Galsky MD. Metastatic renal cancer: better never than late. Eur Urol 2013; 65:1093-4. [PMID: 23954087 DOI: 10.1016/j.eururo.2013.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/01/2013] [Indexed: 01/24/2023]
Affiliation(s)
- Matthew D Galsky
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA.
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22
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Brookman-May SD, May M, Shariat SF, Novara G, Zigeuner R, Cindolo L, De Cobelli O, De Nunzio C, Pahernik S, Wirth MP, Longo N, Simonato A, Serni S, Siracusano S, Volpe A, Morgia G, Bertini R, Dalpiaz O, Stief C, Ficarra V. Time to recurrence is a significant predictor of cancer-specific survival after recurrence in patients with recurrent renal cell carcinoma--results from a comprehensive multi-centre database (CORONA/SATURN-Project). BJU Int 2013; 112:909-16. [PMID: 23890378 DOI: 10.1111/bju.12246] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the prognostic impact of time to recurrence (TTR) on cancer-specific survival (CSS) after recurrence in patients with renal cell carcinoma (RCC) undergoing radical nephrectomy or nephron-sparing surgery. To analyse differences in clinical and histopathological criteria between patients with early and late recurrence. PATIENTS AND METHODS Of 13,107 patients with RCC from an international multicentre database, 1712 patients developed recurrence in the follow-up (FU), at a median (interquartile range) of 50.1 (25-106) months. In all, 1402 patients had recurrence at ≤5 years (Group A) and 310 patients beyond this time (Group B). Differences in clinical and histopathological variables between patients with early and late recurrence were analysed. The influence of TTR and further variables on CSS after recurrence was assessed by Cox regression analysis. RESULTS Male gender, advanced age, tumour diameter and stage, Fuhrman grade 3-4, lymphovascular invasion (LVI), and pN + stage were significantly more frequent in patients with early recurrence, who had a significantly reduced 3-year CSS of 30% compared with patients in Group B (41%; P = 0.001). Age, gender, tumour histology, pT stage, and continuous TTR (hazard ratio 0.99, P = 0.006; monthly interval) independently predicted CSS. By inclusion of dichotomised TTR in the multivariable model, a significant influence of this variable on CSS was present until 48 months after surgery, but not beyond this time. CONCLUSIONS Advanced age, male gender, larger tumour diameters, LVI, Fuhrman grade 3-4, pN + stage, and advanced tumour stages are associated with early recurrence. Up to 4 years from surgery, a shorter TTR independently predicts a reduced CSS after recurrence.
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Affiliation(s)
- Sabine D Brookman-May
- Department of Urology, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany
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23
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Brookman-May S, May M, Shariat SF, Xylinas E, Stief C, Zigeuner R, Chromecki T, Burger M, Wieland WF, Cindolo L, Schips L, De Cobelli O, Rocco B, De Nunzio C, Feciche B, Truss M, Gilfrich C, Pahernik S, Hohenfellner M, Zastrow S, Wirth MP, Novara G, Carini M, Minervini A, Simeone C, Antonelli A, Mirone V, Longo N, Simonato A, Carmignani G, Ficarra V. Features associated with recurrence beyond 5 years after nephrectomy and nephron-sparing surgery for renal cell carcinoma: development and internal validation of a risk model (PRELANE score) to predict late recurrence based on a large multicenter database (CORONA/SATURN Project). Eur Urol 2012; 64:472-7. [PMID: 22748912 DOI: 10.1016/j.eururo.2012.06.030] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Approximately 10-20% of recurrences in patients treated with nephrectomy for renal cell carcinoma (RCC) develop beyond 5 yr after surgery (late recurrence). OBJECTIVE To determine features associated with late recurrence. DESIGN, SETTING, AND PARTICIPANTS A total of 5009 patients from a multicenter database comprising 13 107 RCC patients treated surgically had a minimum recurrence-free survival of 60 mo (median follow-up [FU]: 105 mo [range: 78-135]); at last FU, 4699 were disease free (median FU: 103 mo [range: 78-134]), and 310 patients (6.2%) experienced disease recurrence (median FU: 120 mo [range: 93-149]). INTERVENTIONS Patients underwent radical nephrectomy or nephron-sparing surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable regression analyses identified features associated with late recurrence. Cox regression analyses evaluated the association of features with cancer-specific mortality (CSM). RESULTS AND LIMITATIONS Lymphovascular invasion (LVI) (odds ratio [OR]: 3.07; p<0.001), Fuhrman grade 3-4 (OR: 1.60; p=0.001), and pT stage >pT1 (OR: 2.28; p<0.001) were significantly associated with late recurrence. Based on accordant regression coefficients, these parameters were weighted with point values (LVI: 2 points; Fuhrman grade 3-4: 1 point, pT stage >1: 2 points), and a risk score was developed for the prediction of late recurrences. The calculated values (0 points: late recurrence risk 3.1%; 1-3 points: 8.4%; 4-5 points: 22.1%) resulted in a good-, intermediate- and poor-prognosis group (area under the curve value for the model: 70%; 95% confidence interval, 67-73). Multivariable Cox regression analysis showed LVI (HR: 2.75; p<0.001), pT stage (HR: 1.24; p<0.001), Fuhrman grade (HR: 2.40; p<0.001), age (HR: 1.01; p<0.001), and gender (HR: 0.71; p=0.027) to influence CSM significantly. Limitations are based on the multicenter and retrospective study design. CONCLUSIONS LVI, Fuhrman grade 3/4, and a tumor stage >pT1 are independent predictors of late recurrence after at least 5 yr from surgery in patients with RCC. We developed a risk score that allows for prognostic stratification and individualized aftercare of patients with regard to counseling, follow-up scheduling, and clinical trial design.
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Affiliation(s)
- Sabine Brookman-May
- Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Department of Urology, Munich, Germany.
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Park YH, Baik KD, Lee YJ, Ku JH, Kim HH, Kwak C. Late recurrence of renal cell carcinoma >5 years after surgery: clinicopathological characteristics and prognosis. BJU Int 2012; 110:E553-8. [PMID: 22578274 DOI: 10.1111/j.1464-410x.2012.11246.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED What's known on the subject? and What does the study add? Late recurrence more than five years after the initial treatment is one of the biological behaviours specific for RCC. In our study, late recurrence was observed in 8.8% of the patients. Also, patients with late recurrence had more favorable clinicopathological features and better prognosis with long cancer-specific survival after recurrence. Age and preoperative hs-CRP levels may be independent predictive factors for late recurrence of RCC. OBJECTIVE • To evaluate the clinicopathological features and prognosis of late recurrence of renal cell carcinoma (RCC). PATIENTS AND METHODS • A total of 747 patients who had undergone curative surgery for RCC with follow-up of >5 years or recurrence within 5 years were included in the study. • The patients were stratified into four groups based on cancer-free intervals: no recurrence (no recurrence >5 years after surgery, n= 425), synchronous metastasis (n= 138), early recurrence (recurrence within 5 years, n= 143), and late recurrence (recurrence after 5 years, n= 41). • Multivariate analysis was performed to identify the clinicopathological factors affecting late recurrence and its clinical outcome. RESULTS • The subgroups were significantly different in clinicopathological variables, including age, preoperative haemoglobin, platelet count, high-sensitivity C-reactive protein (hs-CRP) levels, pT stage and nuclear grade. • In multiple logistic regression analysis, age (odds ratio [OR] 1.085, 95% confidence interval [CI] 1.012-1.163, P= 0.022), and preoperative hs-CRP levels (OR 6.211, 95% CI 1.590-24.270, P= 0.009) were independent predictive factors for late recurrence. • In patients with synchronous metastasis, early recurrence and late recurrence, 5-year cancer-specific survival rates after recurrence were 27.0%, 41.1% and 73.7%, respectively (P < 0.001). • Multivariate Cox analysis indicated that cancer-free interval, as well as body mass index, initial symptoms, Fuhrman's nuclear grade, sarcomatoid differentiation, lymphovascular invasion and metastasectomy, were independent predictive factors for cancer-related death. CONCLUSIONS • Late recurrence of RCC is not a rare event. • Patients with late recurrence had more favourable clinicopathological features and better prognosis with long cancer-specific survival after recurrence. • Age and preoperative hs-CRP levels may be independent predictive factors for late recurrence of RCC.
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Affiliation(s)
- Yong Hyun Park
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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25
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Miyao N, Naito S, Ozono S, Shinohara N, Masumori N, Igarashi T, Nakao M, Tsushima T, Senga Y, Horie S, Kanayama HO, Tokuda N, Kobayashi M. Late recurrence of renal cell carcinoma: retrospective and collaborative study of the Japanese Society of Renal Cancer. Urology 2010; 77:379-84. [PMID: 20970828 DOI: 10.1016/j.urology.2010.07.462] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 06/27/2010] [Accepted: 07/10/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate in collaboration the clinical features of late recurrence of renal cell carcinoma (RCC). Late recurrence is one of the specific biologic behaviors of RCC; however, the clinical and pathologic features of the late recurrence of RCC are not fully understood. METHODS A total of 470 patients who had undergone curative treatment of RCC and had not developed recurrence within 10 years of follow-up were documented from 13 institutions of the board members of the Japanese Society of Renal Cancer. Multivariate analysis with Cox proportional hazards model was used to determine the pathologic and clinical factors affecting the late recurrence and survival of patients with RCC ≥10 years after surgery. Survival analysis was performed using the Kaplan-Meier method. RESULTS During the 10-28-year (median 13.2) observation period, 30 patients (6.4%) developed a late recurrence. The disease-free survival rate at 15 and 20 years was 89.5% and 78.4%, respectively. Multivariate analysis showed that lymph node metastasis was the only factor to predict for late recurrence (P = .0334). Age at nephrectomy was the only prognostic factor for overall survival on multivariate analysis (P < .0001). Of the 470 patients, 30 had developed late recurrence in 44 sites, including the lung (36.4%), kidney (25%), and bone (13.6%), followed by the brain, pancreas, adrenal gland, lymph nodes, and liver. Late recurrences in the lung or kidney were observed at any time ≥10 years after nephrectomy. CONCLUSIONS Late recurrence of RCC after initial treatment is not a rare event, and lifelong follow-up is necessary.
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Affiliation(s)
- Noriomi Miyao
- Department of Urology, Muroran City General Hospital, Muroran, Japan.
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26
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Jadav AM, Thrumurthy SG, DeSousa BA. Solitary colonic metastasis from renal cell carcinoma presenting as a surgical emergency nine years post-nephrectomy. World J Surg Oncol 2010; 8:54. [PMID: 20587023 PMCID: PMC2902475 DOI: 10.1186/1477-7819-8-54] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 06/29/2010] [Indexed: 11/20/2022] Open
Abstract
Late colonic metastasis following curative surgery for renal cell carcinoma has rarely been described. We present the first reported case of solitary colonic renal cell carcinoma metastasis presenting as an intra-abdominal bleed, nine years post-nephrectomy.
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Affiliation(s)
- Alka M Jadav
- Department of Lower Gastrointestinal Surgery, Royal Preston Hospital, Preston, PR2 9HT, UK
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27
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Nóbrega de Jesus CM, Silva Casafus FA, Agostinho AD. Surgical treatment of renal cell carcinoma recurrence at the renal fossa following radical nephrectomy. SAO PAULO MED J 2008; 126:194-6. [PMID: 18711661 PMCID: PMC11026015 DOI: 10.1590/s1516-31802008000300011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 12/06/2006] [Accepted: 05/05/2008] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Isolated renal cell carcinoma recurrence at the renal fossa is a rare event. This condition occurs in 1 to 2% of radical nephrectomy cases. It is usually seen in postoperative follow-up imaging examinations such as abdominal computed tomography or abdominal ultrasound. There is controversy among urologists and oncologists regarding the best way to treat this rare situation, because of the few cases in the literature. CASE REPORT We report on a case of isolated recurrence at the renal fossa due to renal cell carcinoma (RCC), four and a half years after radical nephrectomy, without evidence of metastases in other organs. The diagnosis was made from abdominal tomography performed during outpatient follow-up, in which a retroperitoneal mass was observed in the renal fossa. Excision was carried out by means of a subcostal transversal incision, without complications. One and a half years after the procedure, there was evidence of metastasis in the left lung and, six months later, another recurrence at the ninth anterior right rib, while the patient remained asymptomatic. Aggressive surgical treatment is a good method for controlling this rare situation of single retroperitoneal RCC recurrence. Abdominal tomography must continue to be performed over long periods of follow-up, to monitor for RCC following radical nephrectomy, in order to diagnose any late retroperitoneal recurrences. These must be treated as single RCC metastases.
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28
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Master VA, Gottschalk AR, Kane C, Carroll PR. MANAGEMENT OF ISOLATED RENAL FOSSA RECURRENCE FOLLOWING RADICAL NEPHRECTOMY. J Urol 2005; 174:473-7; discussion 477. [PMID: 16006867 DOI: 10.1097/01.ju.0000165574.62188.d0] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Local recurrence of renal cell carcinoma in the renal fossa without distant metastatic disease is an infrequent occurrence. Management of this lesion can be challenging, with relatively few series in the literature. We describe our use of surgical extirpation with adjuvant intraoperative radiation. MATERIALS AND METHODS The University of California, San Francisco Urologic Oncology database and the University of California, San Francisco Radiation Oncology database were queried for all patients with locally recurrent renal fossa recurrence. Only patients with recurrence of renal cell carcinoma in the renal fossa were included. Survival, complications and the use of adjuvant therapy in the form of intraoperative radiation therapy were noted. RESULTS A total of 14 patients were treated for this lesion between 1990 and 2003. Mean time to recurrence was 40 months (range 5 to 180). Only 1 patient was symptomatic preoperatively, while in 13 disease had been detected on routine computerized tomography followup. Mean size of the recurrent tumor was 6.35 cm (range 2 to 17). 9 patients died of progressive, metastatic disease after a mean of 17 months (range 1 to 56) and 5 are alive with a mean survival of 66 months (range 14 to 86). The time to recurrence after nephrectomy approached statistical significance (p =0.06) when comparing the patients who were alive vs those who died of disease. Additionally, there was no statistical difference in size of mass recurrence between these 2 groups. There was no difference in survival due to adjuvant intraoperative radiation therapy. Local fossa re-recurrence developed in 2 patients. Survival was 40% at 2 years and 30% at 5 years from surgery. Complications, including minor complications, occurred in 42% of patients and there was no perioperative mortality. CONCLUSIONS Selected patients with isolated local recurrence in the renal fossa may have favorable and durable outcomes following surgical resection and possibly adjuvant intraoperative radiation therapy for isolated renal fossa recurrence following radical nephrectomy. Development of novel and effective systemic therapy is needed in high risk patients with renal cancer.
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Affiliation(s)
- Viraj A Master
- Department of Urology, Department of Radiation Oncology, University of California, San Francisco, CA 94143, USA
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29
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Chang WT, Chai CY, Lee KT. Unusual upper gastrointestinal bleeding due to late metastasis from renal cell carcinoma: a case report. Kaohsiung J Med Sci 2004; 20:137-41. [PMID: 15124899 DOI: 10.1016/s1607-551x(09)70098-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A case of recurrent massive upper gastrointestinal bleeding originating from metastatic renal cell carcinoma is reported. A 63-year-old woman underwent right nephrectomy 9 years previously and experienced no recurrence during follow-up. A gradually enlarging ulcerative tumor over the bulb of the duodenum and four subsequent episodes of massive bleeding from this tumor occurred between June 2001 and March 2002. The patient underwent surgery in April 2002 for intractable bleeding from the tumor. Renal cell carcinoma metastasis to the duodenum was confirmed from the surgical specimen. Upper gastrointestinal bleeding due to malignancy is very rare and the duodenum is the least frequently involved site. Furthermore, a solitary late renal cell carcinoma metastasis 9 years after a nephrectomy is extremely uncommon. This case suggests that life-long follow-up of renal cell carcinoma patients is necessary, owing to unpredictable behavior and the possibility of long disease-free intervals. In nephrectomized patients suffering from gastrointestinal bleeding, complete evaluation, especially endoscopic examination, is indicated. The possibility of late recurrent renal cell carcinoma metastasis to the gastrointestinal tract should be kept in mind, although it is rare. If the patient is fit for surgery, metastatectomy is the first choice of treatment.
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Affiliation(s)
- Wen-Tsan Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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30
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Outcome Of Surgical Treatment Of Isolated Local Recurrence After Radical Nephrectomy For Renal Cell Carcinoma. J Urol 2002. [DOI: 10.1097/00005392-200204000-00013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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31
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Schrödter S, Hakenberg OW, Manseck A, Leike S, Wirth MP. Outcome Of Surgical Treatment Of Isolated Local Recurrence After Radical Nephrectomy For Renal Cell Carcinoma. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65167-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Steffen Schrödter
- From the Department of Urology, University Hospital Carl-Gustav Carus, Dresden, Germany
| | - Oliver W. Hakenberg
- From the Department of Urology, University Hospital Carl-Gustav Carus, Dresden, Germany
| | - Andreas Manseck
- From the Department of Urology, University Hospital Carl-Gustav Carus, Dresden, Germany
| | - Steffen Leike
- From the Department of Urology, University Hospital Carl-Gustav Carus, Dresden, Germany
| | - Manfred P. Wirth
- From the Department of Urology, University Hospital Carl-Gustav Carus, Dresden, Germany
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32
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Uchida K, Miyao N, Masumori N, Takahashi A, Oda T, Yanase M, Kitamura H, Itoh N, Sato M, Tsukamoto T. Recurrence of renal cell carcinoma more than 5 years after nephrectomy. Int J Urol 2002; 9:19-23. [PMID: 11972645 DOI: 10.1046/j.1442-2042.2002.00418.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We evaluated clinical features and predictive factors for the recurrence of renal cell carcinoma (RCC) developing more than 5 years after nephrectomy. METHODS We retrospectively reviewed 239 patients with RCC who underwent surgery for the primary lesion. To identify factors that affected recurrence more than 5 years after nephrectomy (delayed recurrence) and its clinical outcomes, we performed a multivariate analysis using Cox's proportional hazards model and a survival study. RESULTS Recurrence developing within 5 years after nephrectomy (early recurrence) was found in 57 patients and delayed recurrence in 11 patients. The multivariate analysis revealed no clinical and pathologic features influencing delayed recurrence in 114 patients who survived more than 5 years after nephrectomy without having early recurrence. The patients with delayed recurrence showed better clinical outcomes than those with early recurrence when the rate was determined from the time of recurrence. CONCLUSIONS Although delayed recurrence is not a rare event for patients with RCC, no clinical and pathologic factors at the time of the initial treatment can predict the recurrence. Patients who are free of recurrence for more than 5 years after surgery for a primary lesion should be carefully followed up for delayed recurrence.
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Affiliation(s)
- Kohsuke Uchida
- Department of Urology (Clinical Pathology Division), Sapporo Medical University School of Medicine, Japan
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33
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Nabeyama R, Tanaka K, Matsuda S, Iwamoto Y. Multiple intramuscular metastases 15 years after radical nephrectomy in a patient with stage IV renal cell carcinoma. J Orthop Sci 2001; 6:189-92. [PMID: 11484108 DOI: 10.1007/s007760100070] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2000] [Accepted: 10/12/2000] [Indexed: 02/09/2023]
Abstract
We report an 81-year-old man with late recurrent multiple metastases in skeletal muscles 15 years after radical nephrectomy was carried out for stage IV renal cell carcinoma (RCC). The tumors were located in the left triceps muscle and the brachioradial muscle. We performed surgical resections of both tumors, and histological analysis revealed that they were both metastatic RCC of the clear-cell type. In this case report, we discuss the characteristics and differential diagnosis of this tumor on magnetic resonance imaging, and we also refer to the rarity of muscle metastasis and the unpredictable tendency of this tumor to remain dormant for long periods.
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Affiliation(s)
- R Nabeyama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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34
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Utsunomiya K, Yamamoto H, Koiwai H, Kirii Y, Kashiwagi H, Konishi F, Kurihara K, Kawai T, Sugano K. Solitary colonic metastasis from renal cell carcinoma 9 years after nephrectomy: report of a case. Int J Colorectal Dis 2001; 16:193-4. [PMID: 11459294 DOI: 10.1007/s003840000281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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35
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Onodera Y, Matsuda N, Ohta M, Goto R, Fujii N, Yamada Y, Ikeuchi T, Kai Y. Prognostic significance of tumor grade for renal cell carcinoma. Int J Urol 2000; 7:4-9. [PMID: 10701884 DOI: 10.1046/j.1442-2042.2000.00132.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The natural history and prognosis of renal cell carcinoma cannot be predicted. Based on the Japanese classification system, the value of nuclear grade were assessed as a possible prognostic factor for renal cell carcinomas. METHODS In this retrospective study of 116 patients with renal cell carcinoma, radical nephrectomy was performed. Survival rates were calculated using the Kaplan-Meier method and multivariate analysis was performed using Cox's proportional hazard model. RESULTS Distribution by stage and grade in the population of renal cell carcinomas was as follows: pT1 in 13 cases (11.3%), pT2 in 65 cases (56.5%), pT3 in 36 cases (31.3%) and pT4 in one case (0.9%) and grade 1, 28 (24.1%), grade 2, 69 (59.5%) and grade 3, 16 (13.8%). Three cases could not be determined because of pre-operative embolization of the renal cell carcinomas. Nuclear grade was correlated with stage (P=0.0002), the presence of perirenal fat involvement (P=0.003) and metastases (P=0.007). A significant difference in survival was found between grades 1 and 3 (P=0.0001) and grades 2 and 3 (P=0.0001), respectively. Survival was significantly correlated with sex (P=0.0125), tumor size (P=0.0001), the presence of lymph node metastasis (P=0.0001), renal vein involvement (P=0.0001), perirenal fat involvement (P=0.002) or distant metastasis (P=0.0001). The multivariate analysis showed that the occurrence of tumor grade (P=0.0006) or distant metastasis were independent prognostic values. CONCLUSION The observations lead us to conclude that the nuclear grade according to the Japanese classification system appears to be of reliable prognostic value for renal cell carcinomas.
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Affiliation(s)
- Y Onodera
- Department of Urology, Showa University Fujigaoka Hospital, Showa University School of Medicine, Yokohama, Japan
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36
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Takashi M, Hibi H, Ohmura M, Sato K, Sakata T, Ando M. Renal fossa recurrence of a renal cell carcinoma 13 years after nephrectomy: a case report. Int J Urol 1997; 4:508-11. [PMID: 9354955 DOI: 10.1111/j.1442-2042.1997.tb00294.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Between 1980 and 1995, we performed a nephrectomy with curative intent on 183 patients with renal cell carcinoma at Nagoya University Hospital. Among these patients, 5 (2.7%) developed renal fossa recurrence (median follow-up, 65 months). We report a case of such a recurrence found 13 years after a nephrectomy for renal cell carcinoma (stage pT3a, pN0, M0). A 62-year-old female presented with a nodule on her back. Computed tomography and magnetic resonance imaging revealed a mass in the right back and retroperitoneum, and a biopsy revealed the tumor to be a renal cell carcinoma. Complete resection was performed, followed by administration of alpha-interferon. The patient is doing well 16 months after the operation. The case illustrates that very long-term follow-up after a nephrectomy is mandatory for patients with perinephric invasion of a renal cell carcinoma due to the risk of renal fossa recurrence.
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Affiliation(s)
- M Takashi
- Department of Urology, Nagoya University School of Medicine, Japan
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37
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Tapper H, Klein H, Rubenstein W, Intriere L, Choi Y, Kazam E. Recurrent renal cell carcinoma after 45 years. Clin Imaging 1997; 21:273-5. [PMID: 9215475 DOI: 10.1016/s0899-7071(96)00042-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Late recurrence of renal cell carcinoma (RCC), arbitrarily defined as > 10 years post nephrectomy, is rare. The longest known clinical disease-free interval of 36 years was reported by Walter and Gellespie in 1960. We report a case of recurrent RCC presenting 45 years after nephrectomy.
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Affiliation(s)
- H Tapper
- Department of Diagnostic Radiology, Cornell University Medical Center, New York Hospital, New York 10021, USA
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38
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Abstract
We evaluated the role of lymphadenectomy (LND) in the prevention of local recurrence following radical nephrectomy for renal cell carcinoma (RCC) by two retrospective studies. In one, the relative importance of various tumor characteristics to the subsequent development of local recurrence was investigated in 37 patients who underwent radical nephrectomy and later progressed. In 29 evaluable patients, only nodal metastasis was predictive of local recurrence, which developed in 6 of 7 node-positive patients. In our second study the records of 69 consecutive patients with RCC who underwent radical nephrectomy with or without simultaneous LND (N = 42 and 27, respectively) were reviewed. Local control after LND was excellent in node-positive disease; in no node-positive patient with unilateral RCC has a local recurrence developed (N = 5). LND did not extend hospitalization or add to the morbidity of radical nephrectomy.
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Affiliation(s)
- E Phillips
- Department of Surgery, University of Wisconsin School of Medicine, Madison
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39
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Freedman AI, Tomaszewski JE, Van Arsdalen KN. Solitary late recurrence of renal cell carcinoma presenting as duodenal ulcer. Urology 1992; 39:461-3. [PMID: 1580040 DOI: 10.1016/0090-4295(92)90248-u] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The natural history of renal cell carcinoma is often unpredictable and even bizarre. We report a case of solitary late recurrence of renal cell carcinoma presenting as a duodenal ulcer and review the relevant literature.
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Affiliation(s)
- A I Freedman
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia
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40
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Abstract
Concanavalin A (Con A)-induced suppressor cell activity against the proliferative response of autologous lymphocytes to phytohemagglutinin was examined in peripheral blood lymphocytes derived from 12 normal control subjects and 25 patients with renal cell carcinoma (RCC). The Con A-induced suppressor cell activity in patients with RCC (23.4 +/- 21.4%) was significantly higher than that in control subjects (9.7 +/- 10.7%, P less than 0.05). No significant difference between the degree of suppressor cell activity and stage of disease, grade of malignancy, or cell type was found, although the suppressor activity in patients with tumor microscopically infiltrated by lymphocytes was significantly higher than in patients without lymphocyte-infiltration into the tumor (P less than 0.05). Furthermore, compared with control subjects, Con A-induced suppressor activity in patients with high stage and in those with lymphocyte infiltration into the tumor was significantly higher (P less than 0.05 and P less than 0.01, respectively). In conclusion, because patients with RCC have high suppressor cell activity, abrogation of this activity may be necessary to treat the RCC.
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Affiliation(s)
- E Nakano
- Department of Urology, Osaka University Medical School, Japan
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41
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Thomason PA, Peterson LS, Staniunas RJ. Solitary colonic metastasis from renal-cell carcinoma 17 years after nephrectomy. Report of a case. Dis Colon Rectum 1991; 34:709-12. [PMID: 1855429 DOI: 10.1007/bf02050356] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Late recurrence of renal-cell carcinoma can present many years after nephrectomy. To the best of our knowledge, we are reporting the first known case of solitary metastatic renal-cell carcinoma to the colon occurring 17 years after nephrectomy.
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Affiliation(s)
- P A Thomason
- Department of Diagnostic Radiology, Lahey Clinic Medical Center, Burlington, Massachusetts
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42
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Takatera H, Maeda O, Oka T, Namiki M, Nakano E, Matsuda M, Arita N, Jamshidi J, Ushio Y, Sonoda T. Solitary late recurrence of renal cell carcinoma. J Urol 1986; 136:799-800. [PMID: 3761434 DOI: 10.1016/s0022-5347(17)45083-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Solitary late recurrence is an unpredictable behavior pattern of renal cell carcinoma. We describe a patient with recurrence at the cranial bone 10 years after surgical management and another with recurrence at the sacral bone 13 years after treatment with radiotherapy and alpha-interferon. Both patients have been followed satisfactorily for 9 months. Unpredictable behavior of renal cell carcinoma makes lifelong followup of patients necessary. If a solitary recurrence is detected operative management definitely should be considered depending on the site of recurrence.
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Nakano E, Tada Y, Ichikawa Y, Fujioka H, Ishibasi M, Matsuda M, Takaha M, Sonoda T. Cytotoxic activity of peripheral blood lymphocytes grown with interleukin 2 against autologous cultured tumor cells in patients with renal cell carcinoma: preliminary report. J Urol 1985; 134:24-8. [PMID: 3925165 DOI: 10.1016/s0022-5347(17)46964-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To examine the use of interleukin 2 as a therapeutic agent for human renal cell carcinoma the peripheral blood lymphocytes derived from patients with renal cell carcinoma were grown in interleukin 2 and tested in a 4-hour 51chromium release cytotoxicity assay against autologous cultured tumor cells. Peripheral blood lymphocytes, which were cultured separately in medium alone, mitomycin C-treated tumor cells, 20 per cent interleukin 2 and tumor cells plus interleukin 2, were used as effector cells. In all patients neither peripheral blood lymphocytes in medium alone nor in mitomycin C-treated tumor cells could lyse their own tumor cells. However, in 5 of 7 patients peripheral blood lymphocytes grown in interleukin 2 regardless of the presence of mitomycin C-treated tumor cells were capable of causing 5.7, 9.4, 12.7, 36.1 and 52.5 per cent lysis at effector/target cell ratios of 25, 50, 50, 50 and 25, respectively. However, more significant cytotoxicity was not obtained by peripheral blood lymphocytes cultured with tumor cells and interleukin 2. These results suggest that interleukin 2 might become a useful agent for patients with renal cell carcinoma.
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