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Glicksman RM, Berlin A, Helou J, Loblaw A, Cheung P. FASTRACKing Our Understanding of Renal Function After Kidney Stereotactic Ablative Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 120:655-657. [PMID: 39326952 DOI: 10.1016/j.ijrobp.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/12/2024] [Indexed: 09/28/2024]
Affiliation(s)
- Rachel M Glicksman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Joelle Helou
- London Regional Cancer Program, Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Patrick Cheung
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Ye T, Shi X, Yu Y, Yu G, Xu B, Zhang Z, Wang S, Liu Z, Chen K, Wang S, Li H. Ultrasound-guided renal artery balloon catheter occluded hybrid partial nephrectomy (UBo-HPN) with branch renal artery occlusion: a single arm trial. World J Urol 2024; 42:570. [PMID: 39382799 DOI: 10.1007/s00345-024-05263-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 09/04/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND One key focus of partial nephrectomy is preserving renal function. Segmental renal artery occlusion with microdissection at the renal hilum confines ischemia, effectively reducing warm ischemic injury. Ultrasound-Guided Renal Artery Balloon Catheter Occluded Hybrid Partial Nephrectomy (UBo-HPN) can achieve branch occlusion without the need for dissecting the renal hilum. OBJECTIVE To investigate the feasibility and safety of UBo-HPN of branch renal artery occlusion in the treatment of localized renal tumors. SUBJECT AND METHODS A prospective single-arm analysis involving 20 patients with renal localized tumors underwent robot assisted UBo-HPN with branch renal artery occlusion from August 2021 to July 2023, with an average follow-up of 12 months. RESULTS All patient was successfully operated on without conversion to conventional arterial clamping or radical nephrectomy. One case (5%) of minor complication occurred in the whole cohort, which was bruising around the puncture site. The mean total operative time was 95.8 min, with a mean operative time of 21.25 min for vascular intervention. The mean warm ischemia time was 20.35 min, and the median estimated blood loss was 50 ml. The median eGFR preservation percentage at postoperative 48 h, 30 days, and the latest follow-up were 87.52%, 91.47%, and 92.2%, respectively. After a median follow-up of 10.2 (2.3-19.2) months, no patients had radiological tumor recurrence or died from tumor-related causes. CONCLUSIONS UBo-HPN with renal artery branch occlusion emerges as an efficient alternative to partial nephrectomy (PN), which achieved branch artery occlusion without dissecting the renal hilum. Long-term follow-up is expected for functional outcomes.
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Affiliation(s)
- Tianrun Ye
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Urology, The Central Hospital of Xiaogan, Xiaogan, China
| | - Xu Shi
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Yu
- Department of Ultrasound, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gan Yu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Xu
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Zongbiao Zhang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shen Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Liu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Chen
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Dong BN, Song J, Yang WL, Zhan H, Luan T, Wang JS. Comparison of Outcomes Between Partial and Radical Laparoscopic Nephrectomy for Localized Renal Tumors Larger Than Four Centimeters: A Systematic Review and Meta-Analysis. World J Oncol 2024; 15:625-639. [PMID: 38993256 PMCID: PMC11236382 DOI: 10.14740/wjon1866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/25/2024] [Indexed: 07/13/2024] Open
Abstract
Background Earlier studies have juxtaposed different laparoscopic methods for treating renal tumors; however, extensive evidence with a particular focus on large kidney tumors remains lacking. The objective of this meta-analysis was to assess the perioperative outcomes, kidney performance, and cancer-related results of laparoscopic partial nephrectomy (LPN) versus laparoscopic radical nephrectomy (LRN) for treating extensive, localized, non-metastatic kidney tumors (cT1b-cT2N0M0). Methods We systematically searched multiple databases from database inception until December 2023 for relevant studies. Selected data were analyzed with the Cochrane Collaboration's Review Manager 5.4 software using a random-effects model. Outcomes were expressed as odds ratios and weighted mean differences with 95% confidence intervals, considering a P value of < 0.05 as significant. Results Data from nine studies encompassing 1,303 patients (529 LPN, 774 LRN) revealed that LPN was associated with lengthier surgeries and increased blood loss compared to LRN. While LPN exhibited higher postoperative complication rates, the disparity did not reach statistical significance. LPN led to improved postoperative renal function, manifesting as a reduced estimated glomerular filtration rate (eGFR) decline and fewer incidents of new chronic kidney disease cases. Both groups demonstrated comparable tumor recurrence and overall mortality rates, but LPN exhibited significantly lower cancer-specific mortality rates. Conclusions LPN, despite longer operative times and greater intraoperative blood loss, was found to be superior to LRN in preserving postoperative renal function. Oncologically, LPN and LRN have comparable overall mortality rates, but LPN showed a significant advantage in terms of lower cancer-specific mortality rates.
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Affiliation(s)
- Bao Nan Dong
- Urology Surgery Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jie Song
- Urology Surgery Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Wen Li Yang
- Urology Surgery Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hui Zhan
- Urology Surgery Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ting Luan
- Urology Surgery Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jian Song Wang
- Urology Surgery Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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Rac G, Ellis JL, Lanzotti NJ, McCormick ME, Felice MD, Janakiraman S, Desai S, Halgrimson W, Patel HD, Gupta GN. The evolution of tumor enucleation partial nephrectomy: A comparison of perioperative outcomes for sutureless hemostatic bandage as an alternative to standard renorrhaphy. J Surg Oncol 2024. [PMID: 38992990 DOI: 10.1002/jso.27775] [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: 06/18/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND The standard approach to hemostasis during partial nephrectomy (PN) is to perform suture renorrhaphy (SR). Application of a hemostatic bandage (HB) is an alternative to minimize blood loss and devitalized renal parenchyma. We aim to evaluate perioperative outcomes of PN with tumor enucleation (TE) comparing SR to HB. METHODS We analyzed a retrospective cohort of 195 patients undergoing robot-assisted laparoscopic PN with TE performed at a tertiary referral center (2012-2022). Hemostasis was obtained with SR in 54 patients while 141 patients underwent application of HB consisting of Surgicel®, Gelfoam® soaked in thrombin, and Floseal®. RESULTS SR patients had tumors of greater complexity by RENAL nephrometry score compared to HB patients (p < 0.001). Operative time (141 vs. 183 min, p < 0.001), warm ischemia time (11.6 vs. 24.2 min, p < 0.001), estimated blood loss (37 vs. 214 mL, p < 0.001), and length of stay (1.2 vs. 1.8 days, p < 0.001) favored HB. There was no significant difference in Clavien-Dindo grade ≥3 complications (p = 0.22). Renal function was comparable with mean estimated glomerular filtration rate decrease of 0.66 and 0.54 mL/min/1.73 m2 at 3 months postoperatively for HB and SR, respectively (p = 0.93). CONCLUSIONS Application of an HB is a safe alternative to SR for hemostasis following PN with TE in appropriately selected patients.
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Affiliation(s)
- Goran Rac
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jeffrey L Ellis
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Nicholas J Lanzotti
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Mallory E McCormick
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Michael D Felice
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Sarang Janakiraman
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Shalin Desai
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Whitney Halgrimson
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois, USA
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
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5
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Wang Y, Butaney M, Wilder S, Ghani K, Rogers CG, Lane BR. The evolving management of small renal masses. Nat Rev Urol 2024; 21:406-421. [PMID: 38365895 DOI: 10.1038/s41585-023-00848-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/18/2024]
Abstract
Small renal masses (SRMs) are a heterogeneous group of tumours with varying metastatic potential. The increasing use and improving quality of abdominal imaging have led to increasingly early diagnosis of incidental SRMs that are asymptomatic and organ confined. Despite improvements in imaging and the growing use of renal mass biopsy, diagnosis of malignancy before treatment remains challenging. Management of SRMs has shifted away from radical nephrectomy, with active surveillance and nephron-sparing surgery taking over as the primary modalities of treatment. The optimal treatment strategy for SRMs continues to evolve as factors affecting short-term and long-term outcomes in this patient cohort are elucidated through studies from prospective data registries. Evidence from rapidly evolving research in biomarkers, imaging modalities, and machine learning shows promise in improving understanding of the biology and management of this patient cohort.
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Affiliation(s)
- Yuzhi Wang
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Khurshid Ghani
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Brian R Lane
- Division of Urology, Corewell Health West, Grand Rapids, MI, USA.
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
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Bodard S, Dariane C, Bibault JE, Boudhabhay I, Delavaud C, Timsit MO, Verkarre V, Méjean A, Hélénon O, Guinebert S, Correas JM. [Nephron sparing in the management of localized solid renal mass]. Bull Cancer 2024; 111:720-732. [PMID: 37169604 DOI: 10.1016/j.bulcan.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/30/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023]
Abstract
Managing a malignant renal tumor requires, first of all, a reflection on the necessity of its treatment. It must consider the renal function, altered at the time of diagnosis in 50% of cases. The treatment method chosen depends on many factors, in particular, the predicted residual renal function, the risk of chronic kidney disease, the need for temporary or long-term dialysis, and overall long-term survival. Other factors include the size, position, and number of tumors and a hereditary tumor background. When a renal-sparing management alternative is available, total nephrectomy should no longer be performed in patients with small malignant renal masses (cT1a). This may consist of surgery (partial nephrectomy or lumpectomy), percutaneous thermo-ablation (by radiofrequency, microwave, or cryotherapy). In patients with limited life expectancy, imaging-based surveillance may be proposed to suggest treatment in case of local progression. Good coordination between urologist, radiologist, nephrologist, and sometimes radiotherapist should allow optimal management of patients with a malignant renal tumor with or without underlying renal failure.
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Affiliation(s)
- Sylvain Bodard
- AP-HP, hôpital Necker-Enfants-Malades, service d'imagerie adulte, 75015 Paris, France; Université de Paris-Cité, 75006 Paris, France; Sorbonne université, laboratoire d'imagerie biomédicale, CNRS, Inserm, Paris, France; Groupe de recherche interdisciplinaire francophone en onco-néphrologie (GRIFON), Paris, France.
| | - Charles Dariane
- Université de Paris-Cité, 75006 Paris, France; AP-HP, hôpital européen Georges-Pompidou, service d'urologie, 75015 Paris, France
| | - Jean-Emmanuel Bibault
- Université de Paris-Cité, 75006 Paris, France; AP-HP, hôpital européen Georges-Pompidou, service de radiothérapie, 75015 Paris, France
| | - Idris Boudhabhay
- Université de Paris-Cité, 75006 Paris, France; AP-HP, hôpital Necker-Enfants-Malades, service de néphrologie et transplantation rénale adulte, 75015 Paris, France
| | - Christophe Delavaud
- AP-HP, hôpital Necker-Enfants-Malades, service d'imagerie adulte, 75015 Paris, France
| | - Marc-Olivier Timsit
- Université de Paris-Cité, 75006 Paris, France; AP-HP, hôpital européen Georges-Pompidou, service d'urologie, 75015 Paris, France
| | - Virginie Verkarre
- Université de Paris-Cité, 75006 Paris, France; AP-HP, hôpital européen Georges-Pompidou, service d'anatomie pathologie, 75015 Paris, France
| | - Arnaud Méjean
- Université de Paris-Cité, 75006 Paris, France; AP-HP, hôpital européen Georges-Pompidou, service d'urologie, 75015 Paris, France
| | - Olivier Hélénon
- AP-HP, hôpital Necker-Enfants-Malades, service d'imagerie adulte, 75015 Paris, France; Université de Paris-Cité, 75006 Paris, France
| | - Sylvain Guinebert
- AP-HP, hôpital Necker-Enfants-Malades, service d'imagerie adulte, 75015 Paris, France; Université de Paris-Cité, 75006 Paris, France
| | - Jean-Michel Correas
- AP-HP, hôpital Necker-Enfants-Malades, service d'imagerie adulte, 75015 Paris, France; Université de Paris-Cité, 75006 Paris, France; Sorbonne université, laboratoire d'imagerie biomédicale, CNRS, Inserm, Paris, France
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7
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Iguchi T, Matsui Y, Tomita K, Uka M, Umakoshi N, Kawabata T, Gobara H, Araki M, Hiraki T. Ablation of Kidney Tumors in Patients with Substantial Kidney Impairment: Current Status. Curr Oncol Rep 2024; 26:573-582. [PMID: 38625653 DOI: 10.1007/s11912-024-01533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE OF REVIEW To review the current status of kidney tumor ablation in patients with substantial kidney impairment. RECENT FINDINGS Few reports of kidney tumor ablation in such patients have recently been published. The reported prevalence of patients with stage 4 or 5 chronic kidney disease (CKD) among patients undergoing ablation is 2.0%-10%. In patients with stage 4 or 5 CKD, local tumor control rates were 88%-100%. The effect of ablation on CKD stage is unclear, and the observed deteriorations in kidney function are consistent with both the effect of cryoablation and the natural course of advanced CKD. According to guidelines, active surveillance may be selected. The goals of treatment are complete tumor removal and maintenance of kidney function, both of which can be met by ablation. Given the limited treatment options, ablation may play a pivotal role in the management of patients with advanced CKD.
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Affiliation(s)
- Toshihiro Iguchi
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama, 700-8558, Japan.
- Department of Radiology, Okayama University Hospital, Okayama, Japan.
| | - Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Takahiro Kawabata
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Hospital, Okayama, Japan
- Division of Medical Informatics, Okayama University Hospital, Okayama, Japan
| | - Motoo Araki
- Department of Urology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Jensen CG, Dybdahl M, Valtersson J, Mussmann BR, Duus LA, Junker T, Pietersen PI, Lund L, Welch BT, Graumann O. Percutaneous Image-Guided Cryoablation of Endophytic Renal Cell Carcinoma. Cardiovasc Intervent Radiol 2024; 47:453-461. [PMID: 38483602 PMCID: PMC10997531 DOI: 10.1007/s00270-023-03633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/22/2023] [Indexed: 04/07/2024]
Abstract
PURPOSE Endophytic renal cancer treatment is a challenge. Due to difficulties in endophytic tumor visualization during surgical extirpation, image-guided percutaneous cryoablation (PCA) is an attractive alternative. The minimally invasive nature of PCA makes it favorable for comorbid patients as well as patients in which surgery is contraindicated. Oncological outcomes and complications after PCA of endophytic biopsy-proven renal cell carcinoma (RCC) were reviewed in this study. MATERIALS AND METHODS Patients were included after a multidisciplinary team conference from January 2015 to November 2021. Inclusion criteria were endophytic biopsy-proven T1 RCC treated with PCA with one year of follow-up. Complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system and the Clavien-Dindo classification (CDC) system. Major complications were defined as a grade ≥ 3 according to the CDC. RESULTS Fifty-six patients were included with a total of 56 endophytic tumors treated during 61 PCA sessions. The median RENAL nephrometry score was 9 (IQR 2), and the mean tumor size was 25.7 mm (SD ± 8.9 mm). Mean hospitalization time was 0.39 (SD ± 1.1) days. At a mean follow-up of 996 days (SD ± 559), 86% of tumors were recurrence free after one PCA. No patients progressed to metastatic disease. According to the CIRSE classification, 10.7% (n = 6) had grade 3 complications, and 5.4% (n = 3) had CDC major complications. CONCLUSION This study demonstrates that PCA of endophytic biopsy-proven T1 RCC is safe with few major complications and excellent local tumor control rates at almost three-year mean follow-up. LEVEL OF EVIDENCE 3: Retrospective cohort study.
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Affiliation(s)
- Christian Greve Jensen
- Faculty of Health Sciences, Medicine, University of Southern Denmark (SDU), Odense, Denmark
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
| | - Marco Dybdahl
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
| | - John Valtersson
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
| | - Bo Redder Mussmann
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Louise Aarup Duus
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
| | - Theresa Junker
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Urology, OUH, Odense, Denmark
| | - Pia Iben Pietersen
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
| | - Lars Lund
- Department of Urology, OUH, Odense, Denmark
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ole Graumann
- Faculty of Health Sciences, Medicine, University of Southern Denmark (SDU), Odense, Denmark.
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark.
- Department of Radiology, Aarhus University, Arhus, Denmark.
- Aarhus University, Arhus, Denmark.
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9
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Siva S, Bressel M, Sidhom M, Sridharan S, Vanneste BGL, Davey R, Montgomery R, Ruben J, Foroudi F, Higgs B, Lin C, Raman A, Hardcastle N, Hofman MS, De Abreu Lourenco R, Shaw M, Mancuso P, Moon D, Wong LM, Lawrentschuk N, Wood S, Brook NR, Kron T, Martin J, Pryor D. Stereotactic ablative body radiotherapy for primary kidney cancer (TROG 15.03 FASTRACK II): a non-randomised phase 2 trial. Lancet Oncol 2024; 25:308-316. [PMID: 38423047 DOI: 10.1016/s1470-2045(24)00020-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Stereotactic ablative body radiotherapy (SABR) is a novel non-invasive alternative for patients with primary renal cell cancer who do not undergo surgical resection. The FASTRACK II clinical trial investigated the efficacy of SABR for primary renal cell cancer in a phase 2 trial. METHODS This international, non-randomised, phase 2 study was conducted in seven centres in Australia and one centre in the Netherlands. Eligible patients aged 18 years or older had biopsy-confirmed diagnosis of primary renal cell cancer, with only a single lesion; were medically inoperable, were at high risk of complications from surgery, or declined surgery; and had an Eastern Cooperative Oncology Group performance status of 0-2. A multidisciplinary decision that active treatment was warranted was required. Key exclusion criteria were a pre-treatment estimated glomerular filtration rate of less than 30 mL/min per 1·73 m2, previous systemic therapies for renal cell cancer, previous high-dose radiotherapy to an overlapping region, tumours larger than 10 cm, and direct contact of the renal cell cancer with the bowel. Patients received either a single fraction SABR of 26 Gy for tumours 4 cm or less in maximum diameter, or 42 Gy in three fractions for tumours more than 4 cm to 10 cm in maximum diameter. The primary endpoint was local control, defined as no progression of the primary renal cell cancer, as evaluated by the investigator per Response Evaluation Criteria in Solid Tumours (version 1.1). Assuming a 1-year local control of 90%, the null hypothesis of 80% or less was considered not to be worthy of proceeding to a future randomised controlled trial. All patients who commenced trial treatment were included in the primary outcome analysis. This trial is registered with ClinicalTrials.gov, NCT02613819, and has completed accrual. FINDINGS Between July 28, 2016, and Feb 27, 2020, 70 patients were enrolled and initiated treatment. Median age was 77 years (IQR 70-82). Before enrolment, 49 (70%) of 70 patients had documented serial growth on initial surveillance imaging. 49 (70%) of 70 patients were male and 21 (30%) were female. Median tumour size was 4·6 cm (IQR 3·7-5·5). All patients enrolled had T1-T2a and N0-N1 disease. 23 patients received single-fraction SABR of 26 Gy and 47 received 42 Gy in three fractions. Median follow-up was 43 months (IQR 38-60). Local control at 12 months from treatment commencement was 100% (p<0·0001). Seven (10%) patients had grade 3 treatment-related adverse events, with no grade 4 adverse events observed. Grade 3 treatment-related adverse events were nausea and vomiting (three [4%] patients), abdominal, flank, or tumour pain (four [6%]), colonic obstruction (two [3%]), and diarrhoea (one [1%]). No treatment-related or cancer-related deaths occurred. INTERPRETATION To our knowledge, this is the first multicentre prospective clinical trial of non-surgical definitive therapy in patients with primary renal cell cancer. In a cohort with predominantly T1b or larger disease, SABR was an effective treatment strategy with no observed local failures or cancer-related deaths. We observed an acceptable side-effect profile and renal function after SABR. These outcomes support the design of a future randomised trial of SABR versus surgery for primary renal cell cancer. FUNDING Cancer Australia Priority-driven Collaborative Cancer Research Scheme.
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Affiliation(s)
- Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia.
| | - Mathias Bressel
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia
| | - Mark Sidhom
- Department of Radiation Oncology, Liverpool Hospital, Liverpool, NSW, Australia; South West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Swetha Sridharan
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia
| | - Ben G L Vanneste
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, Netherlands; Department of Human Structure and Repair, Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Ryan Davey
- TransTasman Radiation Oncology Group, Waratah, NSW, Australia
| | | | - Jeremy Ruben
- Department of Radiation Oncology, Alfred Health Radiation Oncology, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, VIC, Australia
| | - Braden Higgs
- Department of Radiation Oncology, Royal Adelaide Hospital, South Australia, Australia; Department of Radiation Oncology, University of South Australia, Adelaide, SA, Australia
| | - Charles Lin
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Avi Raman
- Department of Urology, John Hunter Hospital, Newcastle, NSW, Australia; The University of Newcastle, NSW, Australia
| | - Nicholas Hardcastle
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia
| | - Michael S Hofman
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Mark Shaw
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Pascal Mancuso
- Department of Urology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Daniel Moon
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Royal Melbourne Clinical School, University of Melbourne, VIC, Australia
| | - Lih-Ming Wong
- Department of Surgery, University of Melbourne, VIC, Australia; Department of Urology, St Vincent's Health, Melbourne, VIC, Australia
| | - Nathan Lawrentschuk
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Surgery, University of Melbourne, VIC, Australia
| | - Simon Wood
- University of Queensland, Brisbane, QLD, Australia; Department of Urology and Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Nicholas R Brook
- Department of Urology, Royal Adelaide Hospital, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Tomas Kron
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia
| | - Jarad Martin
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia; The University of Newcastle, NSW, Australia
| | - David Pryor
- Department of Urology and Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia
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10
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Ullah A, Yasinzai AQK, Daino N, Tareen B, Jogezai ZH, Sadia H, Jamil N, Baloch G, Karim A, Badini K, Wali A, Waheed A, Khan M, Asif B, Kakar K, Heneidi S, Sidhwa F, Karki NR. Papillary Renal Cell Carcinoma: Demographics, Survival Analysis, Racial Disparities, and Genomic Landscape. J Kidney Cancer VHL 2023; 10:33-42. [PMID: 38162463 PMCID: PMC10755762 DOI: 10.15586/jkcvhl.v10i4.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024] Open
Abstract
Papillary renal cell carcinoma (PRCC) is the second most common histological subtype of renal cell cancer. This research aims to present a large database study highlighting the demographic, clinical, and pathological factors, racial disparities, prognosis, and survival of PRCC. The clinical and demographic data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database, and molecular data was cured from the Catalogue Of Somatic Mutations in Cancer (COSMIC) database. PRCC had a median age of diagnosis at 64 years, with a higher incidence in men (77%), and Whites (68%). 70.3% of cases were Grades I-IV (13, 53, 31, and 3%, respectively). In patients with known data, 85% were localized to the kidney, and 84% of cases were 7 cm in size. No metastasis occurred in 97% of the known data. The most common treatment offered was surgical resection (9%). The 5-year overall survival was 79%, with patients undergoing surgery having a 90.6% 5-year survival. Multivariable analysis revealed age > 60 years, Black race, poor histologic differentiation, distant metastases, and tumor size > 10 cm as independent risk factors for mortality. The most common mutations identified from the COSMIC database were MET, KMT2D, KMT2C, ARID1A, and SPEN. PRCC affects male individuals in the sixth decade of life. Increased age, Black race, distant metastases, and tumors > 10 cm are associated with a worse prognosis. Surgical resection offers a favorable survival outcome. Next-generation sequencing (NGS) could identify potentially targetable alterations and future personalized therapeutic approaches.
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Affiliation(s)
- Asad Ullah
- Department of Pathology and Laboratory Medicine, Texas Tech University Health Sciences Center, Lubbock , TX, USA
| | | | - Naema Daino
- Medical College of Georgia, Augusta, GA, USA
| | - Bisma Tareen
- Department of Medicine, Bolan Medical College, Quetta, Pakistan
| | | | | | - Nimra Jamil
- Department of Medicine, Bolan Medical College, Quetta, Pakistan
| | - Girahnaz Baloch
- Department of Medicine, Bolan Medical College, Quetta, Pakistan
| | - Adil Karim
- Department of Internal Medicine, Integris Baptist Health, Oklahoma City, OK, USA
| | | | - Agha Wali
- Department of Medicine, Bolan Medical College, Quetta, Pakistan
| | - Abdul Waheed
- Department of Surgery, San Joaquin General Hospital, French Camp, CA, USA
| | - Marjan Khan
- Department of Internal Medicine, Marshfield Clinic, Marshfield, WI, USA
| | - Bina Asif
- Bannu Medical College, Bannu, Pakistan
| | | | - Saleh Heneidi
- Department of Pathology, Kaiser Permanente South Bay, Los Angeles, CA, USA
| | - Feroze Sidhwa
- Department of Surgery, San Joaquin General Hospital, French Camp, CA, USA
| | - Nabin R Karki
- Department of Hematology and Medical Oncology, University of South Alabama, Mobile, AL, USA
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11
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Duus LA, Junker T, Rasmussen BSB, Vilstrup MH, Lund L, Pedersen M, Graumann O. Renal functional outcomes after robot-assisted partial nephrectomy and percutaneous cryoablation of clinical T1 renal cell carcinoma - A prospective study. J Clin Imaging Sci 2023; 13:37. [PMID: 38205274 PMCID: PMC10778061 DOI: 10.25259/jcis_66_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/25/2023] [Indexed: 01/12/2024] Open
Abstract
Objectives The objective of this study was to investigate renal function after robot-assisted partial nephrectomy (RAPN) and percutaneous cryoablation (PCA) in clinical stage T1 (cT1) renal cell carcinoma (RCC) and evaluate the relationship between baseline renal function and renal functional outcome. Material and Methods Patients with cT1 RCC treated with RAPN or PCA were prospectively enrolled between June 2019 and January 2021. Renal function was evaluated using estimated glomerular filtration rate, Tc-99m diethylenetriamine-pentaacetate plasma clearance, Tc-99m mercaptoacetyltriglycine renography, and renal volume at baseline and 6 months after treatment. Results Fifty-six patients were included (18 RAPN, 38 PCA). PCA patients had a significantly higher age (68.5 years; P = 0.019) and Charlson comorbidity index (3.0; P = 0.007). Tumor characteristics did not differ significantly between RAPN and PCA. Total renal volume decreased significantly after PCA (-18.2 cm3; P = 0.001). Baseline chronic disease stage IIIb-IV leads to a greater reduction in renal volume (-31.8 cm3; P = 0.003) but not other renal function measures. Renal function declined significantly after either treatment without significant differences between RAPN and PCA. Conclusion This study found a small, similar decrease in renal function 6 months after RAPN or PCA, despite significant differences in baseline patient characteristics. Reduced renal function at baseline did not lead to a worse renal functional outcome.
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Affiliation(s)
- Louise Aarup Duus
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Theresa Junker
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | | - Mie Holm Vilstrup
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - Michael Pedersen
- Department of Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Graumann
- UNIFY, Research- and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
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12
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Del Cura Rodríguez JL, Zabala-Landa R, Korta-Gomez I. Percutaneous ablation of renal tumors: Long-term outcomes. RADIOLOGIA 2023; 65:492-501. [PMID: 38049248 DOI: 10.1016/j.rxeng.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/10/2021] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To evaluate the long-term outcomes of renal tumor ablation, analyzing efficacy, long-term survival, and factors associated with complications and therapeutic success. MATERIAL AND METHODS We retrospectively reviewed 305 ablations (generally done with expandable electrodes) of 273 renal tumors between May 2005 and April 2019. We analyzed survival, primary and secondary efficacy, and complications according to various patient factors and tumor characteristics. RESULTS Mean blood creatinine was 1.14 mg/dL before treatment and 1.30 mg/dL after treatment (p < 0.0001). Complications were observed in 13.25% of the ablations, including major complications in in 4.97%. Complications were associated with age (p = 0.013) and tumor diameter (p < 0.0001). Primary efficacy was 96.28%. Incomplete ablation was more common in lesions measuring > 4 cm in diameter (p = 0.002). Secondary efficacy was 95.28%. The only factor associated with the risk of recurrence was the size of the tumor (p = 0.02). Overall survival was 95.26% at 1 year, 77.01% at 5 years, and 51.78% at 10 years, with no differences between patients with malignant and benign lesions. Mortality was higher in patients with creatinine >1 (p = 0.05) or ASA > 2 (p = 0.0001). CONCLUSIONS Percutaneous ablation is extremely efficacious for renal tumors; it improves the prognosis of renal carcinoma to the point where it does not differ from that of benign lesions. Complications are rare. Like survival, complications are associated with age and overall health status.
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Affiliation(s)
- J L Del Cura Rodríguez
- Servicio de Radiodiagnóstico, Hospital Universitario Donostia, Donostia-San Sebastián, Spain.
| | - R Zabala-Landa
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - I Korta-Gomez
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
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13
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Knudsen JS, Duus LA, Junker T, Mussmann B, Graumann O. Percutaneous Renal Tumor Cryoablation Effect on Renal Function. J Endourol 2023; 37:1149-1155. [PMID: 37578120 DOI: 10.1089/end.2021.0959] [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: 08/15/2023] Open
Abstract
Background: Percutaneous cryoablation (PCA) of renal tumors is a well-established alternative to partial nephrectomy, but the effects on renal function after the procedure are not well-documented. The purpose of this study was to evaluate renal function after computed tomography-guided PCA. Materials and Methods: A retrospective cohort study including 259 patients treated with PCA at Odense University Hospital, Denmark from January 1, 2015 to December 31, 2019. Both patients with malignant (96%) and benign tumors (4%) were included. Mean age of patients was 66.5 years (standard deviation [SD] = 10.9, range: 27-91) and 174 (67%) patients were men. Baseline estimated glomerular filtration rate (eGFR) was recorded at baseline and 12 months after cryoablation. Results: Mean tumor size was 27.5 mm (SD = 10.0) distributed in seven different histopathological types, mainly clear cell renal-cell carcinoma (RCC) (64%) and papillary RCC (22%). Mean eGFR at baseline was 73.7 mL/min/1.73 m2 (SD = 23.2) with a follow-up mean eGFR of 69.7 (SD = 23.7) (p < 0.0001). At baseline before intervention 190 patients (73%) had eGFR matching chronic kidney disease (CKD) groups 1 and 2 (normal to mild CKD), 64 patients (24%) matching CKD group 3 (average CKD), and 1% in groups 4 and 5. At 12-month follow-up, 171 patients (66%) had eGFR matching CKD groups 1 and 2, 77 patients (30%) matching CKD group 3 and 11 patients (4%) matching CKD groups 4 and 5. In patients with skewed renography who had PCA in the kidney with better excretion, eGFR at baseline was 64.7 and 61.2 at follow-up (p = 0.703). Conclusions: This study showed minimal decline in renal function 12 months after PCA, even for patients with reduced renal function. PCA is therefore considered a safe and relevant intervention.
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Affiliation(s)
- Jens Steensen Knudsen
- Department of Medicine, Faculty of Health Sciences, University of Southern Denmark (SDU), Odense, Denmark
- Research and Innovation Unit of Radiology, SDU, Odense, Denmark
| | - Louise Aarup Duus
- Research and Innovation Unit of Radiology, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
| | - Theresa Junker
- Research and Innovation Unit of Radiology, SDU, Odense, Denmark
| | - Bo Mussmann
- Research and Innovation Unit of Radiology, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
- Department of Health Sciences, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ole Graumann
- Research and Innovation Unit of Radiology, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
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14
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Omae K, Kondo T, Fukuma S, Ikenoue T, Toki D, Tachibana H, Horiuchi T, Ishiyama R, Yoshino M, Ishiyama Y, Fukuhara S, Tanabe K, Takagi T. Effects of remote ischemic preconditioning on renal protection in patients undergoing robot-assisted laparoscopic partial nephrectomy. J Robot Surg 2023; 17:2081-2087. [PMID: 37213027 DOI: 10.1007/s11701-023-01616-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
We aimed to evaluate the renoprotective effects of remote ischemic preconditioning (RIPC) in patients undergoing robot-assisted laparoscopic partial nephrectomy (RAPN). Data from 59 patients with solitary renal tumors who underwent RAPN with RIPC comprising three cycles of 5-min inflation to 200 mmHg of a blood pressure cuff applied to one lower limb followed by 5-min reperfusion by cuff deflation, from 2018 to 2020 were analyzed. Patients who underwent RAPN for solitary renal tumors without RIPC between 2018 and 2020 were selected as controls. The postoperative estimated glomerular filtration rate (eGFR) at the nadir during hospitalization and the percentage change from baseline were compared using propensity score matching analysis. We performed a sensitivity analysis with imputations for missing postoperative renal function data weighted by the inverse probability of the data being observed. Of the 59 patients with RIPC and 482 patients without RIPC, 53 each were matched based on propensity scores. No significant differences in the postoperative eGFR in mL/min/1.73 m2 at nadir (mean difference 3.8; 95% confidence interval [CI] - 2.8 to 10.4) and its percentage change from baseline (mean difference 4.7; 95% CI - 1.6 to 11.1) were observed between the two groups. Sensitivity analysis also indicated no significant differences. No complications were associated with the RIPC. In conclusion, we found no significant evidence of the protective effect of RIPC against renal dysfunction after RAPN. Further research is required to determine whether specific patient subgroups benefit from RIPC.Trial registration number: UMIN000030305 (December 8, 2017).
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Affiliation(s)
- Kenji Omae
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tatsuyoshi Ikenoue
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Data Science and AI Innovation Research Promotion Center, Shiga University, Hikone, Japan
| | - Daisuke Toki
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
- Department of Urology, Saiseikai Kazo Hospital, Kazo, Japan
| | - Toshihide Horiuchi
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Ryo Ishiyama
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Maki Yoshino
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yudai Ishiyama
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
- Department of Urology, Toda Chuo General Hospital, Toda, Japan
| | - Shunichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan
- Department of Health Policy Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kazunari Tanabe
- Robotic Surgery/Organ Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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15
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Umakoshi N, Iguchi T, Matsui Y, Tomita K, Uka M, Kawabata T, Munetomo K, Nagata S, Gobara H, Araki M, Hiraki T. Renal cryoablation combined with prior transcatheter arterial embolization in non-dialysis patients with stage 4 or 5 chronic kidney disease: a retrospective study. Jpn J Radiol 2023; 41:1007-1014. [PMID: 37002430 PMCID: PMC10468427 DOI: 10.1007/s11604-023-01416-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE To retrospectively evaluate cryoablation combined with prior transcatheter arterial embolization (TAE) for renal cell carcinoma (RCC) in non-dialysis patients with stage 4 or 5 chronic kidney disease (CKD). MATERIALS AND METHODS Patients with stage 4 or 5 CKD undergoing TAE and cryoablation for RCC between May 2012 and October 2021 were included. TAE was selectively performed using iodized oil with absolute ethanol or gelatin sponge 1-14 days before cryoablation. Local efficacy, safety, and changes in renal function were evaluated. RESULTS Nine patients (seven men and two women; median age, 64 years; range 52-88 years) with nine RCCs (mean diameter, 3.0 ± 1.0 cm; range 1.7-4.7 cm) were included. The mean pre-treatment estimated glomerular filtration rate (eGFR) was 24.2 ± 5.6 ml/min/1.73 m2 (range 10.4-29.2 ml/min/1.73 m2). The mean amount of contrast medium used in TAE was 58 ± 29 ml (range 40-128 ml). Except in one patient (grade 3 pyelonephritis), no grade ≥ 3 complications occurred. During the follow-up period (median, 18 months; range 7-54 months), no local tumor progression occurred. In two patients with pre-treatment eGFR of < 20 ml/min/1.73 m2, hemodialysis was initiated at 3 and 19 months after cryoablation. At their last follow-up, the remaining seven patients showed a decrease of 6.2 ± 5.3 ml/min/1.73 m2 (range 0.7-17.2 ml/min/1.73 m2) in their eGFR. CONCLUSION Cryoablation combined with TAE for RCC in non-dialysis patients with stage 4 or 5 CKD was effective and safe, with an acceptable impact on renal function.
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Affiliation(s)
- Noriyuki Umakoshi
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-Cho, Kitaku, Okayama 700-8558 Japan
| | - Toshihiro Iguchi
- Deptartment of Radiological Technology, Okayama University Graduate School of Health Science, Okayama, Japan
| | - Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama, 700-8558 Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-Cho, Kitaku, Okayama 700-8558 Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-Cho, Kitaku, Okayama 700-8558 Japan
| | - Takahiro Kawabata
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-Cho, Kitaku, Okayama 700-8558 Japan
| | - Kazuaki Munetomo
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-Cho, Kitaku, Okayama 700-8558 Japan
| | - Shoma Nagata
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-Cho, Kitaku, Okayama 700-8558 Japan
| | - Hideo Gobara
- Division of Medical Informatics, Okayama University Hospital, 2-5-1 Shikata-Cho Kita-Ku, Okayama, 700-8558 Japan
| | - Motoo Araki
- Department of Urology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama, 700-8558 Japan
| | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama, 700-8558 Japan
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16
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Ali SN, Tano Z, Landman J. The Changing Role of Renal Mass Biopsy. Urol Clin North Am 2023; 50:217-225. [PMID: 36948668 DOI: 10.1016/j.ucl.2023.01.002] [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: 02/22/2023]
Abstract
The incidence and prevalence of small renal masses (SRMs) continues to rise and with increased detection comes increases in surgical management, although the probability of an SRM being benign is upward of 30%. An extirpative treatment first diagnose-later strategy persists and clinical tools for risk stratification such as renal mass biopsy remain severely underutilized. The overtreatment of SRMs has multiple detrimental effects including surgical complications, psychosocial stress, financial loss, and reduced renal function leading to downstream effects such as the need for dialysis and cardiovascular disease.
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Affiliation(s)
| | - Zachary Tano
- Department of Urology, University of California, Irvine, CA, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, CA, USA.
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17
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Allinovi M, Sessa F, Villa G, Cocci A, Innocenti S, Zanazzi M, Tofani L, Paparella L, Curi D, Cirami CL, Campi R, Mari A, Ognibene A, Lorubbio M, Fanelli A, Romagnoli S, Romagnani P, Minervini A. Novel Biomarkers for Early Detection of Acute Kidney Injury and Prediction of Long-Term Kidney Function Decline after Partial Nephrectomy. Biomedicines 2023; 11:biomedicines11041046. [PMID: 37189664 DOI: 10.3390/biomedicines11041046] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Identifying acute kidney injury (AKI) within few hours of onset is certainly helpful. However, early prediction of a long-term eGFR decline may be an even more important goal. Our aim was to identify and compare serum [creatinine, kineticGFR, cystatin C, neutrophil gelatinase–associated lipocalin (NGAL)] and urinary (NephroCheck, NGAL, proteinuria, albuminuria, acantocytes at urinary sediment) predictors of AKI that might efficiently predict long-term GFR decline after robotic Nephron-Spearing Surgery (rNSS). Methods: Monocentric prospective observational study. Patients scheduled for rNSS for suspected localized Renal Cell Carcinoma from May 2017 to October 2017 were enrolled. Samples were collected preoperatively and postoperatively (timepoints: 4 h, 10 h, 24 h, 48 h), while kidney function was re-assessed up to 24 months. Results: 38 patients were included; 16 (42%) developed clinical AKI. The eGFR decline at 24 months was more pronounced after postoperative AKI (−20.75 vs. −7.20, p < 0.0001). KineticGFR at 4 h (p = 0.008) and NephroCheck at 10 h (p = 0.001) were, at multivariable linear regression analysis, efficient predictors of post-operative AKI and long-term eGFR decline if compared to creatinine (R2 0.33 vs. 0.04). Conclusions: NephroCheck and kineticGFR have emerged as promising noninvasive, accurate, and early biomarkers of postoperative AKI and long-term GFR decline after rNSS. Combining NephroCheck and kineticGFR in clinical practice would allow to identify high risk of postoperative AKI and long-term GFR decline as early as 10 h after surgery.
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18
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Okhawere KE, Grauer R, Zuluaga L, Meilika KN, Ucpinar B, Beksac AT, Razdan S, Saini I, Abramowitz C, Abaza R, Eun DD, Bhandari A, Hemal AK, Porter J, Stifelman MD, Menon M, Badani KK. Operative and oncological outcomes of salvage robotic radical and partial nephrectomy: a multicenter experience. J Robot Surg 2023:10.1007/s11701-023-01538-6. [PMID: 36928751 DOI: 10.1007/s11701-023-01538-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/08/2023] [Indexed: 03/18/2023]
Abstract
We aim to describe the perioperative and oncological outcomes for salvage robotic partial nephrectomy (sRPN) and salvage robotic radical nephrectomy (sRRN). Using a prospectively maintained multi-institutional database, we compared baseline clinical characteristics and perioperative and postoperative outcomes, including pathological stage, tumor histology, operative time, ischemia time, estimated blood loss (EBL), length of stay (LOS), postoperative complication rate, recurrence rate, and mortality. We identified a total of 58 patients who had undergone robotic salvage surgery for a recurrent renal mass, of which 22 (38%) had sRRN and 36 (62%) had sRPN. Ischemia time for sRPN was 14 min. The median EBL was 100 mL in both groups (p = 0.581). One intraoperative complication occurred during sRRN, while three occurred during sRPN cases (p = 1.000). The median LOS was 2 days for sRRN and 1 day for sRPN (p = 0.039). Postoperatively, one major complication occurred after sRRN and two after sRPN (p = 1.000). The recurrence reported after sRRN was 5% and 3% after sRPN. Among the patients who underwent sRRN, the two most prevalent stages were pT1a (27%) and pT3a (27%). Similarly, the two most prevalent stages in sRPN patients were pT1a (69%) and pT3a (6%). sRRN and sRPN have similar operative and perioperative outcomes. sRPN is a safe and feasible procedure when performed by experienced surgeons. Future studies on large cohorts are essential to better characterize the importance and benefit of salvage partial nephrectomies.
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Affiliation(s)
- Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Laura Zuluaga
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Kirolos N Meilika
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Burak Ucpinar
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Indu Saini
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Chiya Abramowitz
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Ronney Abaza
- Department of Urology, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine Temple University, Philadelphia, PA, USA
| | - Akshay Bhandari
- Division of Urology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James Porter
- Department of Urology, Swedish Urology, Seattle, WA, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA.
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Acute kidney injury as an independent predicting factor for stage 3 or higher chronic kidney disease after nephrectomy. Urol Oncol 2023; 41:149.e1-149.e9. [PMID: 36463084 DOI: 10.1016/j.urolonc.2022.10.011] [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: 11/25/2021] [Revised: 08/25/2022] [Accepted: 10/11/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The association between postoperative acute kidney injury (AKI) and long-term renal function after nephrectomy has not been fully explored, with accurate prognostic models in which AKI is an independent predicting variable still being absent. METHODS We conducted a retrospective study of 528 patients who underwent unilateral radical nephrectomy or partial nephrectomy owing to renal cell carcinoma between January 2013 and December 2016. Postoperative AKI was defined as an absolute increase in serum creatinine level by 0.3 mg/dl or ≥5 0% increase from the preoperative value within 48 hours after surgery. The endpoint was the time to the incident stage 3 or higher chronic kidney disease (defined as eGFR<60 ml/min/1.73m²), or any claim for initiation of dialysis. Cox proportional hazards regression analysis was conducted to construct the final model. Internal validation was performed using 10-fold cross-validation. The model was evaluated in discrimination by Harrell's C-index and area under curve (AUC) values, and calibration by calibration plots. RESULTS Five hundred twenty-eight patients were finally enrolled in the study cohort, and the median follow-up period was 38 months. Among 528 admitted patients, 232 (43.9%) developed AKI, and stage 3 or higher CKD occurred in 47 (8.9%) patients during the follow-up time, with 33 in 47 patients (70.2%) having postoperative AKI. AKI was significantly correlated with poor prognosis of renal function (HR = 3.079, P < 0.001). After the adjustment of conventional predictors, AKI was still independently related to kidney function deterioration, and the correlation was influenced by the severity of AKI. Five variables were selected to establish the prognostic model, including age, surgery type, preoperative estimated glomerular filtration rate, preoperative blood urea nitrogen, and postoperative AKI. The model had good discrimination, with the Harrell's C-index of 0.92 (95% CI 0.89-0.95), and AUC values varying from 87.7 to 95.7 at different time points. CONCLUSIONS AKI during the perioperative period is an independent predicting factor of stage 3 or higher CKD after nephrectomy.
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Pandolfo SD, Beksac AT, Derweesh I, Celia A, Schiavina R, Bianchi L, Costa G, Carbonara U, Loizzo D, Lucarelli G, Cerrato C, Imbimbo C, Mirone V, Elbich J, Basile G, Hampton LJ, Kim FJ, Capitanio U, Kaouk J, Autorino R. Percutaneous Ablation vs Robot-Assisted Partial Nephrectomy for Completely Endophytic Renal Masses: A Multicenter Trifecta Analysis with a Minimum 3-Year Follow-Up. J Endourol 2023; 37:279-285. [PMID: 36367175 DOI: 10.1089/end.2022.0478] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To compare outcomes of robot-assisted partial nephrectomy (RAPN) and percutaneous tumor ablation (PTA) for completely endophytic renal masses. Methods: Data of patients who underwent RAPN or PTA for treatment of completely endophytic (three points for "E" domain of R.E.N.A.L. score) were collected from seven high-volume U.S. and European centers. PTA included cryoablation, radiofrequency, or microwave ablation. Baseline characteristics, clinical, surgical, and postoperative outcomes were compared. Recurrence-free survival (RFS) was calculated with Kaplan-Meier analysis. Trifecta was used as arbitrary combined outcome parameter as proxy for treatment "quality." Multivariable logistic regression model assessed predictors of trifecta failure. Results: One hundred fifty-two patients (RAPN, n = 60; PTA, n = 92) were included in the analysis. RAPN group was younger (p < 0.001), had lower American Society of Anesthesiologists score (p = 0.002), and higher baseline estimated glomerular filtration rate (p < 0.001). There was no difference in clinical tumor size, clinical T stage, and tumor complexity scores. PTA had significantly lower rate of overall (p < 0.001) and minor (p < 0.001) complications. ΔeGFR at 1 year was statistically higher for RAPN (-15.5 mL/min vs -3.1 mL/min; p = 0.005), no difference in ΔeGFR at last follow-up (p = 0.22) was observed. No difference in recurrences (RAPN, n = 2; PTA, n = 6) and RFS was found (p = 0.154). Trifecta achievement was higher for RAPN but not statistically different (65.3% vs 58.8%; p = 0.477). R.E.N.A.L. Nephrometry Score resulted predictive of trifecta failure (odds ratio = 1.47; confidence interval = 1.13-1.90; p = 0.004). Conclusions: PTA confirms to be an effective treatment for completely endophytic renal masses, offering low complications and good mid-term functional and oncologic outcomes. These outcomes compare favorably with those of RAPN, which seem to be the preferred option for younger and less comorbid patients.
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Affiliation(s)
- Savio Domenico Pandolfo
- Division of Urology, Massey Cancer Center, VCU Health, Richmond, Virginia, USA.,Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II," Napoli, Italy
| | - Alp T Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ithaar Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Costa
- Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy
| | - Umberto Carbonara
- Division of Urology, Massey Cancer Center, VCU Health, Richmond, Virginia, USA
| | - Davide Loizzo
- Division of Urology, Massey Cancer Center, VCU Health, Richmond, Virginia, USA.,Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Clara Cerrato
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II," Napoli, Italy
| | - Vicenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II," Napoli, Italy
| | - Jeffrey Elbich
- Department of Radiology, Vascular Interventional Radiology, VCU Health, Richmond, Virginia, USA
| | - Giuseppe Basile
- Department of Urology, San Raffaele Scientific Institute, Milan, Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lance J Hampton
- Division of Urology, Massey Cancer Center, VCU Health, Richmond, Virginia, USA
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center, Denver, Colorado, USA
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Riccardo Autorino
- Division of Urology, Massey Cancer Center, VCU Health, Richmond, Virginia, USA
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Ginsburg KB, Strother M, Schober JP, Bigalli AAC, Ruth K, Chen DY, Greenberg RE, Smaldone MC, Viterbo R, Uzzo RG, Correa AF, Kutikov A. No difference in renal function outcomes for patients with oncocytoma managed with active surveillance vs. partial nephrectomy. Urol Oncol 2023; 41:149.e11-149.e16. [PMID: 36586809 PMCID: PMC9992304 DOI: 10.1016/j.urolonc.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/24/2022] [Accepted: 09/22/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To investigate the difference in renal function outcomes for patients with oncocytomas undergoing active surveillance (AS) vs. partial nephrectomy (PN). METHODS We reviewed our institutional database for patients with biopsy/surgically confirmed oncocytoma from 2000-2020. The primary outcome was to assess for differences in renal function outcomes in patients undergoing AS vs. PN. We fit two generalized estimating equation (GEE) with an interaction term between follow up time and management strategy to predict 1) mean eGFR for patients managed with AS and PN and 2) the probability of progression to CKD stage III or greater. RESULTS We identified 114 eligible patients, of which 32 were managed with AS. Median follow-up was 21 months vs. 44 months for PN vs. AS patients. AS patients tended to be older (median: 72 years vs. 65 years, P<0.001) and have lower baseline renal function (median: eGFR: 71 mL/min/1.73m2 vs. 82 mL/min/1.73m2, P<0.001) compared with PN patients. Renal mass size from baseline imaging was similar between patients undergoing PN vs. AS (2.8 cm vs. 2.9 cm, P=0.634). For patients undergoing PN vs. AS, there was not a significant difference in predicted longitudinal eGFR (-0.079, 95% CI -0.18-0.023, P=0.129) or predicted probability of progression to CKD stage III or greater (OR: 0.61, 95% CI: 0.16-2.33, P=0.47). CONCLUSIONS In our institutional dataset, patients undergoing AS or PN with an oncocytoma had similar long-term renal function outcomes. Given similar renal function outcomes in patients undergoing AS and PN, surgery should remain reserved for select patients with oncocytomas.
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Affiliation(s)
- Kevin B Ginsburg
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA.
| | - Marshall Strother
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA; Department of Urology, Oregon Health and Science University, Portland, OR.
| | - Jared P Schober
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA.
| | | | - Karen Ruth
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, PA.
| | - David Yt Chen
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA.
| | - Richard E Greenberg
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA.
| | - Marc C Smaldone
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA.
| | - Rosalia Viterbo
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA.
| | - Robert G Uzzo
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA.
| | - Andres F Correa
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA.
| | - Alexander Kutikov
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA.
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Hao C, Liu J, Ladbury C, Dorff T, Sampath S, Pal S, Dandapani S. Stereotactic body radiation therapy to the kidney for metastatic renal cell carcinoma: A narrative review of an emerging concept. Cancer Treat Res Commun 2023; 35:100692. [PMID: 36842365 DOI: 10.1016/j.ctarc.2023.100692] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
This narrative review provides a historical overview of cytoreductive nephrectomy for metastatic renal cell carcinoma (mRCC) and examines the safety and therapeutic potential of cytoreductive stereotactic body radiation therapy (SBRT) for mRCC in the modern immunotherapy era. In the last five years, the introduction of immune checkpoint inhibitors for the treatment of mRCC has improved outcomes for patients. This has brought forth new exploration of the role of CN in combination with immunotherapy. Early retrospective evidence suggests that there may be a benefit of deferred CN after immunotherapy (IOT) for de novo mRCC patients. However, there has also been concern regarding the feasibility of surgery after IOT due to inflammation. SBRT may be an appropriate alternative in these circumstances. Since 1999, cytoreductive SBRT has been used for inoperable primary RCC. Several prospective and retrospective studies treating the kidney tumor for localized RCC have shown that this technique is safe and produces favorable and durable local control. SBRT has also exhibited similar effectiveness to CN, while providing additional benefits including noninvasiveness and the ability to treat tumors that can't be treated with nephrectomy or ablation due to size or location. Furthermore, SBRT confers immunostimulatory effects, which are hypothesized to work synergistically with immunotherapy. Clinicians should consider SBRT a safe and reliable alternative to CN for RCC patients. Ongoing studies are exploring the utility of SBRT for treatment of the primary tumor in mRCC patients receiving standard of care immunotherapy.
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Affiliation(s)
- Claire Hao
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Jason Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Colton Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Tanya Dorff
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Sagus Sampath
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Sumanta Pal
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Savita Dandapani
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA.
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Histopathologic features and parameters predicting recurrence potential of small renal masses. Curr Urol 2023. [DOI: 10.1097/cu9.0000000000000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Glicksman RM, Cheung P, Korol R, Niglas M, Nusrat H, Erler D, Vesprini D, Swaminath A, Davidson M, Zhang L, Chu W. Stereotactic Body Radiotherapy for Renal Cell Carcinoma: Oncological and Renal Function Outcomes. Clin Oncol (R Coll Radiol) 2023; 35:20-28. [PMID: 35948465 DOI: 10.1016/j.clon.2022.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/24/2022] [Accepted: 06/17/2022] [Indexed: 01/04/2023]
Abstract
AIMS To evaluate oncological and renal function outcomes of stereotactic body radiotherapy (SBRT) for medically inoperable patients with localised renal cell carcinoma. MATERIALS AND METHODS Consecutive patients treated with curative intent SBRT (30-45 Gy in five fractions or 42 Gy in three fractions) were included. Data on local control (Response Evaluation Criteria in Solid Tumors [RECIST] v1.1), distant metastasis, impact on estimated glomerular filtration rate (eGFR) and proportional ipsilateral and contralateral renal functions (measured through renal scans) were collected. Univariate and multivariable analyses were conducted to determine association of variables with oncological and renal function outcomes. RESULTS Seventy-four patients were analysed. The median follow-up was 27.8 months (interquartile range 17.6-41.7). Fifty-seven per cent had tumours ≥ T1b. One-, 2- and 4-year cumulative incidence of local failure was 5.85, 7.77 and 7.77%, respectively. The cumulative incidence of distant metastasis at 2 years was 4.24%. On multivariable analysis, a lower planning target volume (PTV) mean dose (P = 0.019) and a larger PTV (P = 0.005) were significantly associated with the risk of developing local failure. A lower PTV maximum dose (P = 0.039) was significantly associated with the risk of developing distant metastasis. The median change in global eGFR (ml/min) from pre-SBRT levels was -7.0 (interquartile range -14.5 to -1.0) at 1 year and -11.5 (interquartile range -19.5 to -4.0) at 2 years. The proportion of ipsilateral (differential) renal function decreased over time from 47% of overall renal function pre-SBRT to 36% at 2 years, whereas the proportion of contralateral renal function correspondingly improved. On multivariable analysis, a higher volume of uninvolved renal cortex (P < 0.0001) was significantly associated with a smaller decrease in eGFR over time. CONCLUSION In this large institutional cohort, oncological outcomes of renal cell carcinoma treated with SBRT were favourable and a longitudinal decline in renal function in the ipsilateral kidney and compensatory increase in the contralateral kidney were observed. Clinical and dosimetric factors were significantly associated with oncological and renal function outcomes.
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Affiliation(s)
- R M Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
| | - P Cheung
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - R Korol
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - M Niglas
- R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Ontario, Canada
| | - H Nusrat
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - D Erler
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - D Vesprini
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - A Swaminath
- Juravinski Cancer Centre, Hamilton, Ontario, Canada; Department of Radiation Oncology, McMaster University, Hamilton, Ontario, Canada
| | - M Davidson
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - L Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - W Chu
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Lapierre A, Badet L, Rouviere O, Crehange G, Berthiller J, Paparel P, Chapet O. Safety and Efficacy of Stereotactic Ablative Radiation Therapy for Renal Cell Cancer: 24-Month Results of the RSR1 Phase 1 Dose Escalation Study. Pract Radiat Oncol 2023; 13:e73-e79. [PMID: 35842186 DOI: 10.1016/j.prro.2022.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) has become a new therapeutic option for primary renal cell carcinoma. However, treatment doses lack consistency in the literature. The primary objective of this study was to determine the maximum tolerated dose for renal cancer SBRT. METHODS AND MATERIALS This phase 1 multicentric dose-escalation study assessed 4 dose levels: 8 Gy × 4, 8 Gy × 5, 10 Gy × 4, and 12 Gy × 4. The primary objective of this study was to determine the maximal tolerated dose, defined by the occurrence of dose-limiting toxicity was defined as any acute side effect of grade ≥4 based on the Common Terminology Criteria for Averse Events, version 4.0. RESULTS From October 2010 to September 2017, 13 patients were enrolled. The median follow-up was 23 months. There was no dose-limiting toxicity in our study, and the highest dose was reached successfully. No acute or late toxic effects above grade 2 were seen. There was no significant alteration of renal function after treatment. At 24 months, 2 patients had partial response and the others had stable disease. CONCLUSIONS After 24 months of follow-up, no dose-limiting toxicity was seen at any of the prescribed dose levels in our study. The findings suggest that our last dose level of 48 Gy in 4 12-Gy fractions can be considered safe and can be used in further studies.
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Affiliation(s)
- Ariane Lapierre
- Département de Radiothérapie Oncologie, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France; Université de Lyon, Lyon, France
| | - Lionel Badet
- Service d'Urologie, Chirurgie de la Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Rouviere
- Service d'Imagerie Urinaire et Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Gilles Crehange
- Département de Radiothérapie Oncologique, Institut Curie, Paris, France
| | - Julien Berthiller
- Service de Recherche et d'Epidemiologie Clinique, Pole de Santé Publique, Hospices Civils de Lyon
| | | | - Olivier Chapet
- Département de Radiothérapie Oncologie, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France; Université de Lyon, Lyon, France.
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Siva S, Ali M, Correa RJM, Muacevic A, Ponsky L, Ellis RJ, Lo SS, Onishi H, Swaminath A, McLaughlin M, Morgan SC, Cury FL, Teh BS, Mahadevan A, Kaplan ID, Chu W, Grubb W, Hannan R, Staehler M, Warner A, Louie AV. 5-year outcomes after stereotactic ablative body radiotherapy for primary renal cell carcinoma: an individual patient data meta-analysis from IROCK (the International Radiosurgery Consortium of the Kidney). Lancet Oncol 2022; 23:1508-1516. [PMID: 36400098 DOI: 10.1016/s1470-2045(22)00656-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stereotactic ablative body radiotherapy (SABR) is a non-invasive treatment option for primary renal cell carcinoma, for which long-term data are awaited. The primary aim of this study was to report on long-term efficacy and safety of SABR for localised renal cell carcinoma. METHODS This study was an individual patient data meta-analysis, for which patients undergoing SABR for primary renal cell carcinoma across 12 institutions in five countries (Australia, Canada, Germany, Japan, and the USA) were eligible. Eligible patients had at least 2 years of follow-up, were aged 18 years or older, had any performance status, and had no previous local therapy. Patients with metastatic renal cell carcinoma or upper-tract urothelial carcinoma were excluded. SABR was delivered as a single or multiple fractions of greater than 5 Gy. The primary endpoint was investigator-assessed local failure per the Response Evaluation Criteria in Solid Tumours version 1.1, and was evaluated using cumulative incidence functions. FINDINGS 190 patients received SABR between March 23, 2007, and Sept 20, 2018. Single-fraction SABR was delivered in 81 (43%) patients and multifraction SABR was delivered in 109 (57%) patients. Median follow-up was 5·0 years (IQR 3·4-6·8). 139 (73%) patients were men, and 51 (27%) were women. Median age was 73·6 years (IQR 66·2-82·0). Median tumour diameter was 4·0 cm (IQR 2·8-4·9). 96 (75%) of 128 patients with available operability details were deemed inoperable by the referring urologist. 56 (29%) of 190 patients had a solitary kidney. Median baseline estimated glomerular filtration rate (eGFR) was 60·0 mL/min per 1·73 m2 (IQR 42·0-76·0) and decreased by 14·2 mL/min per 1·73 m2 (IQR 5·4-22·5) by 5 years post-SABR. Seven (4%) patients required dialysis post-SABR. The cumulative incidence of local failure at 5 years was 5·5% (95% CI 2·8-9·5) overall, with single-fraction SABR yielding fewer local failures than multifraction (Gray's p=0·020). There were no grade 3 toxic effects or treatment-related deaths. One (1%) patient developed an acute grade 4 duodenal ulcer and late grade 4 gastritis. INTERPRETATION SABR is effective and safe in the long term for patients with primary renal cell carcinoma. Single-fraction SABR might yield less local failure than multifraction, but further evidence from randomised trials is needed to elucidate optimal treatment schedules. These mature data lend further support for renal SABR as a treatment option for patients unwilling or unfit to undergo surgery. FUNDING None.
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Affiliation(s)
- Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.
| | - Muhammad Ali
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Rohann J M Correa
- Department of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Alexander Muacevic
- European Radiosurgery Center Munich, University of Munich Hospitals, Munich, Germany
| | - Lee Ponsky
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Anand Swaminath
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Mark McLaughlin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott C Morgan
- Department of Radiology, Radiation Oncology and Medical Physics, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Fabio L Cury
- Division of Radiation Oncology, Department of Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Houston, TX, USA
| | - Anand Mahadevan
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Irving D Kaplan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - William Chu
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - William Grubb
- Department of Radiation Oncology, Augusta University, Augusta, GA, USA
| | - Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael Staehler
- Department of Urology, University of Munich Hospitals, Munich, Germany
| | - Andrew Warner
- Department of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Alexander V Louie
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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French AFU Cancer Committee Guidelines - Update 2022-2024: management of kidney cancer. Prog Urol 2022; 32:1195-1274. [DOI: 10.1016/j.purol.2022.07.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
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Hao X, Lai W, Xia X, Xu J, Wu Y, Lv C, Lv K, Huang S, Luo Z, Meng Q, Yuan Q, Dong J. Transplant or dialysis: What’s the better choice for RCC-induced ESRD patients? A 20-year analysis of OPTN/UNOS data. Front Oncol 2022; 12:955771. [PMID: 36249010 PMCID: PMC9558276 DOI: 10.3389/fonc.2022.955771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The incidence of end-stage renal disease (ESRD) caused by renal cell carcinoma (RCC) is increasing with the high prevalence of RCC as well as those with treatment-related renal function impairment. Worries about tumor recurrence after transplant-related immunosuppression hinder the recommendation of kidney transplantation for RCC-induced ESRD patients. However, no direct analysis has been performed to identify whether kidney transplantation can offer better survival than maintaining dialysis. Materials and methods This retrospective population-based cohort study was based on Organ Procurement and Transplantation Network data released in March 2021. Characteristics and outcomes were compared, including the patient and graft survival of candidates and recipients with RCC-induced ESRD etiology as well as other primary diseases. Results Patients with RCC-induced ESRD were older; more likely to be male, White, and obese; and more likely to have a history of diabetes and dialysis. They also had higher creatinine levels, more delayed graft function, more primary non-function, and higher Kidney Donor Profile Index score donors, compared with the glomerulonephritis (GN) group. While waiting, RCC candidates suffered the worst outcomes of all groups, a 44% (adjusted hazard ratio [aHR], 1.44 [1.27–1.62]) higher risk of removal than GN patients. After transplantation, RCC recipients demonstrated comparable patient survival and better graft survival (p=0.21 and p=0.13, respectively). Compared with still-waiting RCC patients, the RCC recipients who received kidney transplants had significantly better outcomes (13.6 [9.3–17.8] vs. 61 [52–68.4] %), decreasing the death or deteriorating risk by 84% (aHR, 0.16 [0.13–0.20]). Conclusions Patients with RCC-induced ESRD can dramatically benefit from kidney transplantation. Hence, these patients should not be limited to transplantation by strict strategies or a delayed waiting time out of their malignancy history.
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Affiliation(s)
- Xiaowei Hao
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wenhui Lai
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Postgraduate, Hebei North University, Zhangjiakou, China
| | - Xinze Xia
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Urology, Shanxi Medical University, Taiyuan, China
| | - Junnan Xu
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yangyang Wu
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chao Lv
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Kaikai Lv
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shuai Huang
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Postgraduate, Hebei North University, Zhangjiakou, China
| | - Zhenjun Luo
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Qingyang Meng
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qing Yuan
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Qing Yuan, ; Jun Dong,
| | - Jun Dong
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Qing Yuan, ; Jun Dong,
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Zhang S, Qin Z, Bi H, Tao L, Zhang F, Zhang H, Wang W, Wu J, Huang Y, Ma L. A "3S+f" Nephrometry Score System to Predict the Clinical Outcomes of Laparoscopic Nephron-Sparing Surgery. Front Oncol 2022; 12:922082. [PMID: 35912177 PMCID: PMC9330399 DOI: 10.3389/fonc.2022.922082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background When we treat renal cell carcinoma by laparoscopic nephron-sparing surgery (NSS), it is essential to use an evaluation system to predict clinical outcomes. Hitherto, there are more than a dozen nephrometry score systems. In this study, through assessing the correlations between nephrometry score systems and clinical outcomes, we aim to provide a novel nephrometry score system-the "3S+f" score system-to simplify the evaluation of technical complexity of partial nephrectomy. Methods We retrospectively collected the data of 131 patients who underwent NSS, which was performed by a single surgeon (SZ) from January 2013 to July 2018 at Peking University Third Hospital. The "3S+f" score system contains four parameters: "size, side, site, and fat", all of which can be obtained from preoperative imaging data. We evaluated the correlations between the "3S+f" score and clinical outcomes, and compared R.E.N.A.L. score and PADUA score. Results All the three nephrometry score systems were related to some clinical outcomes in univariate analyses. In multivariate regression models, the "3S+f" score, the R.E.N.A.L. score, and the PADUA score were significantly associated with operative time (p = 0.016, p = 0.035, and p = 0.001, respectively) and warm ischemia time (all p = 0.008, p < 0.001, and p < 0.001, respectively). "3S+f" was also significantly related to extubation time > 5 days (p = 0.018). In predicting operative time > 120 min and extubation time >5 days from ROC curves, the AUCs of the "3S+f" score (0.717 and 0.652, respectively) were larger than both the R.E.N.A.L (0.598 and 0.554, respectively) and PADUA (0.600 and 0.542, respectively) score systems. Conclusion A novel nephrometry score system-the "3S+f" score system-shows equivalent correlation and the ability in predicting clinical outcomes when compared to the R.E.N.A.L. score system and the PADUA score system, which can describe renal tumors.
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Affiliation(s)
- Shudong Zhang
- Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
| | - Zijian Qin
- Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
| | - Hai Bi
- Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
| | - Liyuan Tao
- Department of Epidemiology, Peking University Third Hospital, Peking University, Beijing, China
| | - Fan Zhang
- Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
| | - Wei Wang
- Department of Urology, Peking Tongren Hospital, Beijing, China
| | - Jitao Wu
- Department of Urology, Yantai Yuhuangding Hospital, Yantai, China
| | - Yi Huang
- Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
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Patel HD, Koehne EL, Gali K, Lanzotti NJ, Rac G, Desai S, Pahouja G, Quek ML, Gupta GN. Robotic-assisted tumor enucleation versus standard margin partial nephrectomy: Perioperative, renal functional, and oncologic outcomes for low and intermediate complexity renal masses. Urol Oncol 2022; 40:347.e9-347.e16. [PMID: 35551863 DOI: 10.1016/j.urolonc.2022.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/23/2022] [Accepted: 04/06/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Standard margin partial nephrectomy (SPN) with sharp incision across normal renal parenchyma carries perioperative morbidity and renal functional implications. Tumor enucleation (TE) is an alternative approach using a natural plane of dissection around the tumor pseudocapsule to maximize parenchymal preservation. We compared perioperative, functional, and oncologic outcomes for robotic-assisted TE to SPN. MATERIALS AND METHODS Patients ≥18 years of age undergoing robotic-assisted TE or SPN were included (2008-2020). Baseline demographics and tumor characteristics were compared. Perioperative, renal functional, and oncologic outcomes were assessed for comparative effectiveness. RESULTS A total of 467 patients were included with 176 (37.7%) TE and 291 (62.3%) SPN. Baseline characteristics and final histology were comparable; 18% of patients had baseline stage 3 chronic kidney disease. TE had lower median blood loss, operative time, length of stay, and fewer complications compared to SPN. Positive margin rates were higher for TE vs. SPN (8.5% vs. 3.4%, P = 0.04) with similar recurrence rates (2.3% vs. 3.4%, P = 0.48) and no difference in cancer-specific or overall survival with median 4.0 years follow-up. Baseline estimated glomerular filtration rate was comparable (76.1 vs. 78.2, P = 0.63) while renal function in the first year was better preserved with TE (74.6 vs. 68.1, P < 0.001) showing an 8-point estimated glomerular filtration rate (P = 0.001) advantage after adjustment. The rate of stage ≥3 chronic kidney disease by 12 months was lower for TE compared to SPN (21.5% vs. 34.1%, P = 0.006). CONCLUSIONS TE is an alternative approach to SPN associated with favorable perioperative and renal functional outcomes. While positive margin rates are higher, longer-term recurrence rates are no different suggesting pseudocapsule disruption during TE has limited impact on oncologic outcomes.
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Affiliation(s)
- Hiten D Patel
- Department of Urology, Loyola University Medical Center, Maywood, IL.
| | | | - Keshava Gali
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | | | - Goran Rac
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Shalin Desai
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Gaurav Pahouja
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Marcus L Quek
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, IL; Department of Radiology, Loyola University Medical Center, Maywood, IL; Department of Surgery, Loyola University Medical Center, Maywood, IL
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Trevisani F, Floris M, Vago R, Minnei R, Cinque A. Long Non-Coding RNAs as Novel Biomarkers in the Clinical Management of Papillary Renal Cell Carcinoma Patients: A Promise or a Pledge? Cells 2022; 11:1658. [PMID: 35626699 PMCID: PMC9139553 DOI: 10.3390/cells11101658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 12/22/2022] Open
Abstract
Papillary renal cell carcinoma (pRCC) represents the second most common subtype of renal cell carcinoma, following clear cell carcinoma and accounting for 10-15% of cases. For around 20 years, pRCCs have been classified according to their mere histopathologic appearance, unsupported by genetic and molecular evidence, with an unmet need for clinically relevant classification. Moreover, patients with non-clear cell renal cell carcinomas have been seldom included in large clinical trials; therefore, the therapeutic landscape is less defined than in the clear cell subtype. However, in the last decades, the evolving comprehension of pRCC molecular features has led to a growing use of target therapy and to better oncological outcomes. Nonetheless, a reliable molecular biomarker able to detect the aggressiveness of pRCC is not yet available in clinical practice. As a result, the pRCC correct prognosis remains cumbersome, and new biomarkers able to stratify patients upon risk of recurrence are strongly needed. Non-coding RNAs (ncRNAs) are functional elements which play critical roles in gene expression, at the epigenetic, transcriptional, and post-transcriptional levels. In the last decade, ncRNAs have gained importance as possible biomarkers for several types of diseases, especially in the cancer universe. In this review, we analyzed the role of long non-coding RNAs (lncRNAs) in the prognosis of pRCC, with a particular focus on their networking. In fact, in the competing endogenous RNA hypothesis, lncRNAs can bind miRNAs, resulting in the modulation of the mRNA levels targeted by the sponged miRNA, leading to additional regulation of the target gene expression and increasing complexity in the biological processes.
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Affiliation(s)
- Francesco Trevisani
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milano, Italy;
- Unit of Urology, San Raffaele Scientific Institute, 20132 Milano, Italy
- Biorek s.r.l., San Raffaele Scientific Institute, 20132 Milano, Italy;
| | - Matteo Floris
- Nephrology, Dialysis, and Transplantation Division, G. Brotzu Hospital, University of Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Riccardo Vago
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milano, Italy;
| | - Roberto Minnei
- Nephrology, Dialysis, and Transplantation Division, G. Brotzu Hospital, University of Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Alessandra Cinque
- Biorek s.r.l., San Raffaele Scientific Institute, 20132 Milano, Italy;
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del Cura Rodríguez J, Zabala-Landa R, Korta-Gomez I. Ablación percutánea de tumores renales: resultados a largo plazo. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Optimizing Perioperative Treatment for Kidney Cancer. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Park IC, Yoon SK, Kim DW. Risk Factors for Renal Function Impairment Following Radiofrequency Ablation of Renal Tumors. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:317-330. [PMID: 36237917 PMCID: PMC9514441 DOI: 10.3348/jksr.2021.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/03/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022]
Abstract
Purpose Materials and Methods Results Conclusion
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Affiliation(s)
- Il Cheol Park
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Seong Kuk Yoon
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Dong Won Kim
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
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Schieda N, Krishna S, Pedrosa I, Kaffenberger SD, Davenport MS, Silverman SG. Active Surveillance of Renal Masses: The Role of Radiology. Radiology 2021; 302:11-24. [PMID: 34812670 DOI: 10.1148/radiol.2021204227] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Active surveillance of renal masses, which includes serial imaging with the possibility of delayed treatment, has emerged as a viable alternative to immediate therapeutic intervention in selected patients. Active surveillance is supported by evidence that many benign masses are resected unnecessarily, and treatment of small cancers has not substantially reduced cancer-specific mortality. These data are a call to radiologists to improve the diagnosis of benign renal masses and differentiate cancers that are biologically aggressive (prompting treatment) from those that are indolent (allowing treatment deferral). Current evidence suggests that active surveillance results in comparable cancer-specific survival with a low risk of developing metastasis. Radiology is central in this. Imaging is used at the outset to estimate the probability of malignancy and degree of aggressiveness in malignant masses and to follow up masses for growth and morphologic change. Percutaneous biopsy is used to provide a more definitive histologic diagnosis and to guide treatment decisions, including whether active surveillance is appropriate. Emerging applications that may improve imaging assessment of renal masses include standardized assessment of cystic and solid masses and radiomic analysis. This article reviews the current and future role of radiology in the care of patients with renal masses undergoing active surveillance.
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Affiliation(s)
- Nicola Schieda
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Satheesh Krishna
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Ivan Pedrosa
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Samuel D Kaffenberger
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Matthew S Davenport
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Stuart G Silverman
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
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Haroon M, Sathiadoss P, Hibbert RM, Jeyaraj SK, Lim C, Schieda N. Imaging considerations for thermal and radiotherapy ablation of primary and metastatic renal cell carcinoma. Abdom Radiol (NY) 2021; 46:5386-5407. [PMID: 34245341 DOI: 10.1007/s00261-021-03178-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
Ablative (percutaneous and stereotactic) thermal and radiotherapy procedures for management of both primary and metastatic renal cell carcinoma are increasing in popularity in clinical practice. Data suggest comparable efficacy with lower cost and morbidity compared to nephrectomy. Ablative therapies may be used alone or in conjunction with surgery or chemotherapy for treatment of primary tumor and metastatic disease. Imaging plays a crucial role in pre-treatment selection and planning of ablation, intra-procedural guidance, evaluation for complications, short- and long-term post-procedural surveillance of disease, and treatment response. Treatment response and disease recurrence may differ considerably after ablation, particularly for stereotactic radiotherapy, when compared to conventional surgical and chemotherapies. This article reviews the current and emerging role of imaging for ablative therapy of renal cell carcinoma.
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McElroy KM, Reisenauer CJ, Welch BT, Takahashi EA, Frimpong RG, Atwell TD, Fleming CJ, Thompson SM. Long-term renal function outcomes after renal cryoablation complicated by major hemorrhage requiring selective transarterial embolization. Abdom Radiol (NY) 2021; 46:4898-4907. [PMID: 34169336 DOI: 10.1007/s00261-021-03182-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine long-term renal function outcomes after renal cryoablation complicated by major hemorrhage requiring transarterial embolization compared to patients who underwent uncomplicated renal cryoablation without major hemorrhage. METHODS Utilizing a matched cohort study design, retrospective review identified 23 patients who underwent percutaneous image-guided renal cryoablation complicated by major hemorrhage requiring ipsilateral transarterial embolization (TAE group) and a control group of 23 patients who underwent uncomplicated renal cryoablation matched 1:1 by age, gender and RENAL Nephrometry score at a single institution from 1/1/2005 to 12/31/2019. Primary outcome parameters included change in creatinine (mg/dl) and estimated glomerular filtration rate (ml/min/1.73 m2; eGFR) from baseline and were compared between TAE and control group using a paired t-test. RESULTS There was a significantly higher proportion of patients on pre-ablation anticoagulation in the TAE v. control group (30% v. 4%; p = 0.047), but all patients were off anticoagulation and with normal coagulation parameters at the time of cryoablation. Otherwise there were no significant differences in clinical, renal tumor, Charlson co-morbidity index, baseline renal function or cryoablation parameters between the TAE and control group. In the post-ablation period, there was trend toward greater increase in creatinine from baseline to worst post-ablation creatinine in the TAE v. the control group (+ 0.5 ± 0.7 mg/dl v. 0.2 ± 0.1 mg/dl; p = 0.056). However, at a mean follow-up of 42.7 ± 35.7 months, there was no significant difference between the TAE and control group in creatinine (p = 0.68), eGFR (p = 0.60) or change from baseline in creatinine (p = 0.28), eGFR (p = 0.80) or CKD stage (p = 0.74). No patient required initiation of hemodialysis. CONCLUSION Selective transarterial embolization for post-renal cryoablation hemorrhage does not significantly affect long-term renal function compared to cryoablation alone. Pre-ablation anticoagulation despite normal coagulation at time of ablation may be a risk factor for post-ablation hemorrhage, and warrants further evaluation when considering pre-ablation embolization.
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Affiliation(s)
- Kevin M McElroy
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | | | - Brian T Welch
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Edwin A Takahashi
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Richard G Frimpong
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Thomas D Atwell
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Chad J Fleming
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Scott M Thompson
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
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Zhang W, Che B, Xu S, Mu Y, He J, Tang K. Comparison of Sutureless Versus Suture Partial Nephrectomy for Clinical T1 Renal Cell Carcinoma: A Meta-Analysis of Retrospective Studies. Front Oncol 2021; 11:713645. [PMID: 34540681 PMCID: PMC8445026 DOI: 10.3389/fonc.2021.713645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/13/2021] [Indexed: 12/29/2022] Open
Abstract
Background Partial nephrectomy (PN) is the recommended treatment for T1 renal cell carcinoma (RCC). Compared with suture PN, sutureless PN reduces the difficulty and time of operation, but the safety and feasibility have been controversial. This meta-analysis was conducted to compare the function and perioperative outcomes of suture and sutureless PN for T1 RCC. Methods Systematic literature review was performed up to April 2021 using multiple databases to identify eligible comparative studies. According to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria, identification and selection of the studies were conducted. Meta-analysis was performed for studies comparing suture to sutureless PN for both T1a and T1b RCC. In addition, subgroup analysis was performed on operation time, warm ischemia time, estimated blood loss, and postoperative complications. Sensitivity analysis was used in analysis with high heterogeneity (operation time and estimated blood loss). Results Eight retrospective studies were included with a total of 1,156 patients; of the 1,156 patients, 499 received sutureless PN and 707 received suture PN. The results showed that sutureless PN had shorter operative time (I2 = 0%, P < 0.001), warm ischemia time (I2 = 97.5%, P < 0.001), and lower clamping rate (I2 = 85.8%, P = 0.003), but estimated blood loss (I2 = 76.6%, P = 0.064) had no difference. In the comparison of perioperative outcomes, there was no significant difference in postoperative complications (I2 = 0%, P = 0.999), positive surgical margins (I2 = 0%, P = 0.356), postoperative estimated glomerular filtration rat (eGFR) (I2 = 0%, P = 0.656), and tumor recurrence (I2 = 0%, P = 0.531). Conclusions In T1a RCC with low RENAL score, sutureless PN is a feasible choice, whereas it should not be overestimated in T1b RCC.
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Affiliation(s)
- Wenjun Zhang
- Department of Urology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Bangwei Che
- Department of Urology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shenghan Xu
- Department of Urology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yi Mu
- Department of Urology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jun He
- Department of Urology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Kaifa Tang
- Department of Urology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Institute of Medical Science of Guizhou Medical University, Guiyang, China
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Lee M, Wang Q, Wanchoo R, Eswarappa M, Deshpande P, Sise ME. Chronic Kidney Disease in Cancer Survivors. Adv Chronic Kidney Dis 2021; 28:469-476.e1. [PMID: 35190113 DOI: 10.1053/j.ackd.2021.10.007] [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: 06/21/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 11/11/2022]
Abstract
As breakthroughs in cancer care are leading to improved long-term outcomes in a subset of advanced cancers, there is a growing population of long-term cancer survivors that are at risk of long-term complications. In this review, we summarize what is known about chronic kidney disease in cancer survivors, focusing on the following high-risk groups: survivors of childhood cancers, stem cell transplant recipients, patients with renal cell carcinoma, patients exposed to cisplatin and other nephrotoxic chemotherapies, and patients receiving immunotherapy for cancer. As new anticancer therapies are developed, more research is needed to understand the long-term risks of kidney function decline and to devise methods to prevent chronic kidney disease.
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40
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Acosta Ruiz V, Båtelsson S, Onkamo E, Wernroth L, Nilsson T, Lönnemark M, Dahlman P, Magnusson A. Split renal function after treatment of small renal masses: comparison between radiofrequency ablation and laparoscopic partial nephrectomy. Acta Radiol 2021; 62:1248-1256. [PMID: 32910686 PMCID: PMC8392853 DOI: 10.1177/0284185120956281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) and laparoscopic partial nephrectomy (LPN) are used to treat small renal masses (SRM; ≤4 cm), although there are conflicting results in the changes in creatinine and estimated glomerular filtration rate (eGFR) after treatment. On contrast-enhanced computed tomography (CE-CT) images, the quantity and quality of renal function can be evaluated by calculating the split renal function (SRF). PURPOSE To compare renal function after RFA or LPN treatment of SRMs through evaluation of the SRF in the affected kidney. MATERIAL AND METHODS Single T1a renal tumors successfully treated with RFA (n = 60) or LPN (n = 31) were retrospectively compared. The SRF was calculated on pre-treatment CE-CT images and the first follow-up exam after completed treatment. Serum creatinine and eGFR values were collected simultaneously. To compare renal function outcomes, Student's t-test and multivariable linear regression models (adjusted to RFA/LPN treatment, pre-treatment SRF/eGFR, BMI, age, tumor characteristics, and Charlson Comorbidity Index) were used. RESULTS SRF was reduced in both groups, although reduction was greater in the LPN group (LPN -5.7%) than in the RFA group (RFA -3.5%; P = 0.013). After adjusted analysis, the LPN group still had greater SRF reduction (difference 3.2%, 95% confidence interval 1.3-1.5; P = 0.001). There was no difference between groups in the change of creatinine/eGFR after treatment. CONCLUSION Both RFA and LPN are nephron-sparing when treating SRMs. However, in this series, reduction of SRF in the affected kidney was smaller after RFA, having a more favorable preservation of renal function than LPN.
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Affiliation(s)
- Vanessa Acosta Ruiz
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Sarah Båtelsson
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Elina Onkamo
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Lisa Wernroth
- Department of Medical Sciences - Molecular Epidemiology, Uppsala University, Uppsala Sweden
| | - Thomas Nilsson
- Department of Medical Sciences - Nephrology, Uppsala University, Uppsala Sweden
| | - Maria Lönnemark
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Pär Dahlman
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Anders Magnusson
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
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41
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Peired AJ, Antonelli G, Angelotti ML, Allinovi M, Guzzi F, Sisti A, Semeraro R, Conte C, Mazzinghi B, Nardi S, Melica ME, De Chiara L, Lazzeri E, Lasagni L, Lottini T, Landini S, Giglio S, Mari A, Di Maida F, Antonelli A, Porpiglia F, Schiavina R, Ficarra V, Facchiano D, Gacci M, Serni S, Carini M, Netto GJ, Roperto RM, Magi A, Christiansen CF, Rotondi M, Liapis H, Anders HJ, Minervini A, Raspollini MR, Romagnani P. Acute kidney injury promotes development of papillary renal cell adenoma and carcinoma from renal progenitor cells. Sci Transl Med 2021; 12:12/536/eaaw6003. [PMID: 32213630 DOI: 10.1126/scitranslmed.aaw6003] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 10/15/2019] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
Acute tissue injury causes DNA damage and repair processes involving increased cell mitosis and polyploidization, leading to cell function alterations that may potentially drive cancer development. Here, we show that acute kidney injury (AKI) increased the risk for papillary renal cell carcinoma (pRCC) development and tumor relapse in humans as confirmed by data collected from several single-center and multicentric studies. Lineage tracing of tubular epithelial cells (TECs) after AKI induction and long-term follow-up in mice showed time-dependent onset of clonal papillary tumors in an adenoma-carcinoma sequence. Among AKI-related pathways, NOTCH1 overexpression in human pRCC associated with worse outcome and was specific for type 2 pRCC. Mice overexpressing NOTCH1 in TECs developed papillary adenomas and type 2 pRCCs, and AKI accelerated this process. Lineage tracing in mice identified single renal progenitors as the cell of origin of papillary tumors. Single-cell RNA sequencing showed that human renal progenitor transcriptome showed similarities to PT1, the putative cell of origin of human pRCC. Furthermore, NOTCH1 overexpression in cultured human renal progenitor cells induced tumor-like 3D growth. Thus, AKI can drive tumorigenesis from local tissue progenitor cells. In particular, we find that AKI promotes the development of pRCC from single progenitors through a classical adenoma-carcinoma sequence.
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Affiliation(s)
- Anna Julie Peired
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence 50139, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy
| | - Giulia Antonelli
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence 50139, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy
| | - Maria Lucia Angelotti
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence 50139, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy
| | - Marco Allinovi
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence 50139, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy.,Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Florence 50139, Italy
| | - Francesco Guzzi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy
| | - Alessandro Sisti
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence 50139, Italy
| | - Roberto Semeraro
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy
| | - Carolina Conte
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence 50139, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy
| | - Benedetta Mazzinghi
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence 50139, Italy
| | - Sara Nardi
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence 50139, Italy
| | - Maria Elena Melica
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence 50139, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy
| | - Letizia De Chiara
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence 50139, Italy
| | - Elena Lazzeri
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence 50139, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy
| | - Laura Lasagni
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence 50139, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy
| | - Tiziano Lottini
- Department of Experimental and Clinical Medicine, Section of Internal Medicine, University of Florence, Florence 50139, Italy
| | - Samuela Landini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy
| | - Sabrina Giglio
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence 50139, Italy
| | - Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence 50139, Italy
| | - Alessandro Antonelli
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia 25123, Italy
| | - Francesco Porpiglia
- Department of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin 10043, Italy
| | - Riccardo Schiavina
- Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna 40138, Italy
| | | | - Davide Facchiano
- Department of Urology, Careggi Hospital, University of Florence, Florence 50139, Italy
| | - Mauro Gacci
- Department of Urology, Careggi Hospital, University of Florence, Florence 50139, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence 50139, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence 50139, Italy
| | - George J Netto
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Rosa Maria Roperto
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence 50139, Italy
| | - Alberto Magi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy
| | | | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S., Scientific Institute of Pavia, Pavia 28100, Italy
| | | | - Hans-Joachim Anders
- Division of Nephrology, Medizinische Klinik and Poliklinik IV, Klinikum der LMU München, Munich 80336, Germany
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence 50139, Italy
| | | | - Paola Romagnani
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence 50139, Italy. .,Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence 50139, Italy.,Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence 50139, Italy
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A 25 year perspective on the evolution and advances in an understanding of the biology, evaluation and treatment of kidney cancer. Urol Oncol 2021; 39:548-560. [PMID: 34092483 DOI: 10.1016/j.urolonc.2021.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 01/20/2023]
Abstract
The diagnosis, evaluation and management of patients with renal cell carcinoma has transformed in the 21st century. Utilizing biological discoveries and technological advances, the field has moved from blunt surgical and largely ineffective medical treatments, to nuanced and fine-tuned approaches based on biology, extent of disease and patient preferences. In this review we will summarize the last 25 years of progress in kidney cancer.
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43
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Microwave ablation of cT1a renal cell carcinoma: oncologic and functional outcomes at a single center. Clin Imaging 2021; 76:199-204. [PMID: 33964597 DOI: 10.1016/j.clinimag.2021.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Percutaneous ablation is an established alternative to surgical intervention for small renal masses. Radiofrequency and cryoablation have been studied extensively in the literature. To date, series assessing the efficacy and safety of microwave ablation (MWA) are limited. We present a cohort of 110 renal tumors treated with MWA. METHODS A review of the medical record between January 2015 and July 2019 was performed, retrospectively identifying 101 patients (110 tumors). All ablations were performed by a single board-certified urologist/interventional radiologist. Demographic information, intraoperative, postoperative, and follow-up surveillance data were recorded. RESULTS Median (IQR) age was 69.7 years (60.8-77.0); 27 (24%) were female. Median (IQR) BMI was 27.0 (25.1-30.2) and Charleston Comorbidity Index was 5.0 (4.0-6.0). 82 tumors were biopsy-confirmed renal cell carcinoma/oncocytic neoplasms. Median (IQR) tumor size was 2.0 cm (1.5-2.6). Median (IQR) RENAL nephrometry score was 6.0 (5.0-8.0). Technical success was achieved in all patients and all but one patient were discharged on the same day. Median (IQR) eGFR at baseline and 1 year were 71.9 mL/min/1.73 m2 (56.5-82) and 63.0 mL/min/1.73 m2 (54.0-78.2); the difference was -5.3 (p = 0.12). Two Clavien-Dindo type-I complications, one type-II complication, and one type-III complication were experienced in this cohort. Median radiographic follow-up was 376.5 days with 2 tumors (2.4% of RCC/oncocytic neoplasms) having recurred to date. CONCLUSIONS MWA is a safe and efficacious treatment option for small renal masses with minimal adverse events and low rates of recurrence in this cohort of 101 patients. Continued follow-up is needed to assess long-term outcomes.
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44
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Abstract
Renal cell carcinoma is associated with chronic kidney disease as well as with common risk factors including hypertension and diabetes mellitus. Localized renal cell carcinoma is treated surgically and in these cases has a favorable prognosis. In particular, in those individuals with small renal masses (≤4 cm), preservation of kidney function should be prioritized. Postoperative chronic kidney disease or end-stage renal disease prevention should include baseline kidney function and risk factor assessment, nontumor renal biopsy, as well as counseling on treatment options to discuss maximizing kidney function preservation. Postnephrectomy prognosis can be determined with repeat laboratory and clinical assessment. Ultimately, early involvement of the nephrologist in a multidisciplinary team including the urology team will enable the reduction of postsurgical kidney disease related morbidity and potentially mortality.
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Affiliation(s)
- Susie L Hu
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.
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45
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Chandrasekar T, Boorjian SA, Capitanio U, Gershman B, Mir MC, Kutikov A. Collaborative Review: Factors Influencing Treatment Decisions for Patients with a Localized Solid Renal Mass. Eur Urol 2021; 80:575-588. [PMID: 33558091 DOI: 10.1016/j.eururo.2021.01.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT With the addition of active surveillance and thermal ablation (TA) to the urologist's established repertoire of partial (PN) and radical nephrectomy (RN) as first-line management options for localized renal cell carcinoma (RCC), appropriate treatment decision-making has become increasingly nuanced. OBJECTIVE To critically review the treatment options for localized, nonrecurrent RCC; to highlight the patient, renal function, tumor, and provider factors that influence treatment decisions; and to provide a framework to conceptualize that decision-making process. EVIDENCE ACQUISITION A collaborative critical review of the medical literature was conducted. EVIDENCE SYNTHESIS We identify three key decision points when managing localized RCC: (1) decision for surveillance versus treatment, (2) decision regarding treatment modality (TA, PN, or RN), and (3) decision on surgical approach (open vs minimally invasive). In evaluating factors that influence these treatment decisions, we elaborate on patient, renal function, tumor, and provider factors that either directly or indirectly impact each decision point. As current nomograms, based on preselected patient datasets, perform poorly in prospective settings, these tools should be used with caution. Patient decision aids are an underutilized tool in decision-making. CONCLUSIONS Localized RCC requires highly nuanced treatment decision-making, balancing patient- and tumor-specific clinical variables against indirect structural influences to provide optimal patient care. PATIENT SUMMARY With expanding treatment options for localized kidney cancer, treatment decision is highly nuanced and requires shared decision-making. Patient decision aids may be helpful in the treatment discussion.
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Affiliation(s)
- Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Maria Carmen Mir
- Department of Urology, Fundación Instituto Valenciano Oncologia, Valencia, Spain
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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46
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Bianchi L, Mineo Bianchi F, Chessa F, Barbaresi U, Casablanca C, Piazza P, Mottaran A, Droghetti M, Roveroni C, Balestrazzi E, Gentile G, Gaudiano C, Bertaccini A, Marcelli E, Porreca A, DE Concilio B, Serra C, Celia A, Brunocilla E, Schiavina R. Percutaneous tumor ablation versus partial nephrectomy for small renal mass: the impact of histologic variant and tumor size. Minerva Urol Nephrol 2020; 73:581-590. [PMID: 33256358 DOI: 10.23736/s2724-6051.20.03983-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim, of this study was to investigate recurrence rates in patients with T1 renal cell carcinoma (RCC) undergone partial nephrectomy (PN), radiofrequency ablation (RFA) or cryoablation (Cryo). METHODS We retrospectively evaluated data from 665 (81.4%), 68 (8.3%) and 83 (10.3%) patients who underwent PN, RFA and Cryo, respectively. Kaplan-Meier curves depict recurrence-free survival (RFS) rates in the overall population and after stratifying according to tumor's histology (namely, clear cell RCC and non-clear RCC) and size (namely <2 cm and 2-4 cm). Multivariable Cox regression model was used to identify predictors of recurrence. Cumulative-incidence plots evaluated disease recurrence and other causes of mortality (OCM). RESULTS Patients referred to PN experienced higher RFS rate compared to those treated with RFA and Cryo at 60-month in the overall population (96.4% vs. 79.4% vs. 87.8%), in patients with clear cell RCC (93.3% vs. 75% vs. 80.4%) and in those with tumor of 2-4 cm (97.3% vs. 78% and 84.4%; all P≤0.01). In patients with non-clear cell RCC and with tumor <2cm, PN showed higher RFS rate at 60-month as compared to RFA (97.9% vs. 84.4% and 95.1% vs. 78.1%, respectively: all P≤0.02). At multi-variate analysis, ablative techniques (RFA [HR=4.03] and Cryo [HR=3.86]) were independent predictors of recurrence (all P<0.03). At competing risks analysis, recurrence rate and OCM were 7.3% and 1.3% vs. 25% and 7.2% vs. 19.9% and 19.9% for PN, RFA and Cryo, respectively. CONCLUSIONS PN and Cryo showed similar RFS rates in patients with non-clear cell RCC and with renal mass <2cm.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy - .,University of Bologna, Bologna, Italy -
| | - Federico Mineo Bianchi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Umberto Barbaresi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Carlo Casablanca
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Pietro Piazza
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Angelo Mottaran
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Carlo Roveroni
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Eleonora Balestrazzi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Giorgio Gentile
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | | | - Angelo Porreca
- Department of Radiology, IRCCS University Hospital of Bologna, Bologna, Italy
| | | | - Carla Serra
- Unit of Interventional Ultrasound, Department of Organ Failure and Transplantations, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Eugenio Brunocilla
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
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47
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Cosmai L, Porta C, Foramitti M, Perrone V, Mollica L, Gallieni M, Capasso G. Preventive strategies for acute kidney injury in cancer patients. Clin Kidney J 2020; 14:70-83. [PMID: 33564407 PMCID: PMC7857811 DOI: 10.1093/ckj/sfaa127] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Indexed: 12/13/2022] Open
Abstract
Acute kidney injury (AKI) is a common complication of cancer that occurs in up to 50% of neoplastic patients during the natural history of their disease; furthermore, it has a huge impact on key outcomes such as overall prognosis, length of hospitalization and costs. AKI in cancer patients has different causes, either patient-, tumour- or treatment-related. Patient-related risk factors for AKI are the same as in the general population, whereas tumour-related risk factors are represented by compression, obstruction, direct kidney infiltration from the tumour as well by precipitation, aggregation, crystallization or misfolding of paraprotein (as in the case of multiple myeloma). Finally, treatment-related risk factors are the most common observed in clinical practice and may present also with the feature of tumour lysis syndrome or thrombotic microangiopathies. In the absence of validated biomarkers, a multidisciplinary clinical approach that incorporates adequate assessment, use of appropriate preventive measures and early intervention is essential to reduce the incidence of this life-threatening condition in cancer patients.
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Affiliation(s)
- Laura Cosmai
- Onco-Nephrology Outpatient Clinic, Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Camillo Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari 'A. Moro', Bari, Italy.,Division of Medical Oncology, AOU Consorziale Policlinico di Bari, Bari
| | | | - Valentina Perrone
- Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Ludovica Mollica
- Division of Medical Oncology, AOU Consorziale Policlinico di Bari, Bari.,Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Maurizio Gallieni
- Department of Clinical and Biomedical Sciences 'Luigi Sacco', University of Milano, Milan, Italy.,Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy.,Biogem Research Institute, Ariano Irpino, Italy
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48
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Patel DN, Ghali F, Meagher MF, Javier-Desloges J, Patel SH, Soliman S, Hakimi K, Yuan J, Murphy J, Derweesh IH. Utilization of renal mass biopsy in patients with localized renal cell carcinoma: A population-based study utilizing the National Cancer Database. Urol Oncol 2020; 39:79.e1-79.e8. [PMID: 33160847 DOI: 10.1016/j.urolonc.2020.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/02/2020] [Accepted: 10/19/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate trends and factors predicting use of renal mass biopsy (RMB) for localized Renal Cell Carcinoma in the United States (US) in the context of current guidelines recommendations. METHODS We queried the National Cancer Database for cT1-cT3N0M0 Renal Cell Carcinoma diagnosed between 2004 and 2015. Temporal trends of RMB were characterized based on tumor size, treatment (partial nephrectomy [PN], radical nephrectomy [RN], ablation, and no treatment), age and Charlson Comorbidity Index with slopes compared using analysis of variance. Multivariable analysis was used to determine factors associated with use of RMB. RESULTS Of 338,252 patients analyzed, 11.9% (40,276) underwent RMB. Use of RMB increased throughout the study period from 1,586 (7.6%) in 2004 to 5,629 (16.2%) in 2015 (P < 0.001). Use of RMB increased greatest for ablation (27 to 63%, P < 0.001) and tumors 2-4 cm (9 to 20%, P < 0.001). Multivariable analysis showed year of diagnosis (OR = 1.06; P < 0.001), higher education (OR = 1.09; P < 0.001) and insured status (OR = 1.23; P < 0.001) were associated with increased RMB. Compared to tumors ≤2 cm, tumors 2.1-4 cm (OR = 1.36; P=<0.001), 4.1-7 cm (OR = 1.18; P <0.001) and >7 cm (OR = 1.05; P = 0.03) were associated with higher rates of RMB. Compared to RN, PN was not associated with increased RMB (OR = 1.00; P = 0.92), while ablation (OR = 10.90; P < 0.001) and no surgical treatment (OR = 4.83; P < 0.001) were. CONCLUSION RMB utilization increased overall, with largest increase associated with ablation. Nonetheless, only two-thirds of patients underwent RMB with ablation, suggesting persistent underutilization. Rates of RMB for tumors ≤2 cm and in those undergoing no treatment increased less, suggesting less utilization for surveillance. However, rates for tumors >2-4 cm increased more, suggesting selective utilization of RMB to guide decision-making and risk stratification in small renal masses.
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Affiliation(s)
- Devin N Patel
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Fady Ghali
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | | | | | - Sunil H Patel
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Shady Soliman
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Kevin Hakimi
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Julia Yuan
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - James Murphy
- Department of Radiation Oncology, UC San Diego School of Medicine, La Jolla, CA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA.
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Robotic-assisted Partial Nephrectomy for "Very Small" (<2 cm) Renal Mass: Results of a Multicenter Contemporary Cohort. Eur Urol Focus 2020; 7:1115-1120. [PMID: 33153954 DOI: 10.1016/j.euf.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patient with "very small" (<2 cm) renal mass can be offered active surveillance, thermal ablation, or partial nephrectomy. The management strategy will consider patient preferences and prioritize potential harms associated with each of these options. To date, outcomes of robot-assisted partial nephrectomy (RAPN) in patients with "very small" renal masses have not been reported. OBJECTIVE To assess the outcomes of RAPN among patients with "very small" renal masses. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective analysis of a multi-institutional database including RAPN cases performed at eight high-volume US and European centers between 2009 and 2019. Patients were stratified into two groups according to clinical tumor size: <2 cm ("very small" renal mass, study group) and 2-4 cm (control group). INTERVENTION RAPN for renal masses. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Baseline characteristics and intraoperative, pathological, and postoperative data were compared between the study and the control group. A "trifecta" was used as surrogate of "surgical quality." RESULTS AND LIMITATIONS Overall, a total of 1019 patients were included in the analysis. Of these, 352 had a renal mass of <2 cm (34.5%) and 667 (65.5%) had a renal mass of 2-4 cm. At baseline, the study group presented a lower rate of chronic kidney disease ≥stage III (p < 0.001), a lower RENAL score (p = 0.001), and lower rates of hilar (p = 0.04) and endophytic (p = 0.02) masses. Warm ischemia time was shorter for the study group (median 14 vs 18 min, p < 0.001), which also showed a lower rate of overall postoperative complications (9.6% vs 14.7%, p < 0.001) and no major complications. In terms of oncological outcomes, three and ten patients developed a local recurrence in the study and the control group, respectively (p = 0.1). In the study group, higher estimated glomerular filtration rates were found at discharge (p = 0.001) and at the last follow-up (p = 0.007), which showed a "trifecta" achievement of 90.6%. The retrospective design may limit the generalizability of the findings. CONCLUSIONS Whenever an active treatment is indicated or warranted, RAPN represents a minimally invasive management option for "very small" renal masses, as it carries minimal risk of complications and has minimal impact on renal function. While both active surveillance and kidney ablation remain valid management options in these cases, RAPN can be offered and discussed with patients as it provides excellent outcomes with low morbidity. PATIENT SUMMARY In this report, we observed that robot-assisted partial nephrectomy represents a true minimally invasive active treatment for "very small" renal masses (<2 cm), as it carries minimal risk of complications and has minimal impact on renal function.
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Bensalah K, Bigot P, Albiges L, Bernhard J, Bodin T, Boissier R, Correas J, Gimel P, Hetet J, Long J, Nouhaud F, Ouzaïd I, Rioux-Leclercq N, Méjean A. Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : prise en charge du cancer du rein. Prog Urol 2020; 30:S2-S51. [DOI: 10.1016/s1166-7087(20)30749-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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