1
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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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2
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Prata F, Iannuzzi A, Tedesco F, Ragusa A, Civitella A, Pira M, Fantozzi M, Sica L, Scarpa RM, Papalia R. Surgical Outcomes of Hugo™ RAS Robot-Assisted Partial Nephrectomy for Cystic Renal Masses: Technique and Initial Experience. J Clin Med 2024; 13:3595. [PMID: 38930124 PMCID: PMC11204942 DOI: 10.3390/jcm13123595] [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: 05/25/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The Hugo™ Robot-Assisted Surgery (RAS) system is a new cutting-edge robotic platform designed for clinical applications. Nevertheless, its application for cystic renal tumors has not yet been thoroughly investigated. In this context, we present an initial series of Robot-Assisted Partial Nephrectomy (RAPN) procedures carried out using the Hugo™ RAS system for cystic renal masses. Methods: Between October 2022 and January 2024, twenty-seven RAPN procedures for renal tumors were performed at Fondazione Policlinico Universitario Campus Bio-Medico. Our prospective board-approved dataset was queried for "cystic features" (n = 12). Perioperative data were collected. The eGFR was calculated according to the CKD-EPI formula. Post-operative complications were reported according to the Clavien-Dindo classification. Computed tomography (CT) scans for follow-up were performed according to the EAU guidelines. Trifecta was defined as the coexistence of negative surgical margin status, no Clavien-Dindo grade ≥ 3 complications, and eGFR decline ≤ 30%. Results: All the patients successfully underwent RAPN without the need for conversion or additional port placement. The median docking and console time were 5.5 (IQR, 4-6) and 79.5 min (IQR, 58-91 min), respectively. No intraoperative complications occurred, as well as clashes between instruments or with the bedside assistant. Two minor postoperative complications were recorded (Clavien-Dindo II). At discharge, serum creatinine and eGFR were comparable to preoperative values. Only one patient (8.4%) displayed positive surgical margins. The rate of trifecta achievement was 91.7%. Conclusions: RAPN for cystic renal masses using the novel Hugo™ RAS system can be safely and effectively performed. This robotic system provided satisfactory peri-operative outcomes, preserving renal function and displaying low postoperative complications and a high trifecta rate achievement.
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Affiliation(s)
| | - Andrea Iannuzzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (F.P.); (F.T.); (A.R.); (A.C.); (M.P.); (M.F.); (L.S.); (R.M.S.); (R.P.)
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3
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Prata F, Ragusa A, Tedesco F, Pira M, Iannuzzi A, Fantozzi M, Civitella A, Scarpa RM, Papalia R. Trifecta Outcomes of Robot-Assisted Partial Nephrectomy Using the New Hugo™ RAS System Versus Laparoscopic Partial Nephrectomy. J Clin Med 2024; 13:2138. [PMID: 38610903 PMCID: PMC11012303 DOI: 10.3390/jcm13072138] [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: 03/17/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Laparoscopic partial nephrectomy (LPN) is still performed in many referred urological institutions, representing a valid alternative to robot-assisted partial nephrectomy (RAPN). We aimed to compare trifecta outcomes of LPN and RAPN with the Hugo™ RAS System. (2) Methods: Between October 2022 and September 2023, eighty-nine patients underwent minimally invasive partial nephrectomy (group A, RAPN = 27; group B, Laparoscopic PN = 62) for localized renal tumors at our Institution. Continuous variables were presented as median and IQR and compared by means of the Mann-Whitney U test, while categorical variables were presented as frequencies (%) and compared by means of the χ2 test. (3) Results: Group A showed a higher rate of male patients (81.5% vs. 59.7%, p = 0.04) and a higher trend towards larger clinical tumor size (34 vs. 29 mm, p = 0.14). All the other baseline variables were comparable between the two groups (all p > 0.05). Regarding post-operative data, group A displayed a lower operative time (92 vs. 149.5 min, p = 0.005) and a shorter hospital stay (3 vs. 5, p = 0.002). A higher rate of malignant pathology was evidenced in group A (77.8% vs. 58.1%, p = 0.07) as well as a lower trend towards positive surgical margins (3.7% vs. 4.8%, p = 0.82), even if not statistically significant. (4) Conclusions: The rate of trifecta achievement was 92.6% and 82.3% for group A and B (p = 0.10), respectively. In terms of trifecta outcomes, RAPN using the Hugo™ RAS System showed comparable results to LPN performed by the same experienced surgeon.
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Affiliation(s)
- Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (F.T.); (M.P.); (A.I.); (M.F.); (A.C.); (R.M.S.); (R.P.)
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4
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Caliò A, Amparore D, Roussel E, Bertolo R, Erdem S, Marchioni M, Pavan N, Campi R. The World Health Organization 2022 Classification of renal tumors: key updates for urologists. Minerva Urol Nephrol 2023; 75:766-769. [PMID: 38126288 DOI: 10.23736/s2724-6051.23.05434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Anna Caliò
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy -
| | - Daniele Amparore
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Eduard Roussel
- Department of Urology, University Hospitals of Leuven, Leuven, Belgium
| | | | - Selçuk Erdem
- Division of Urologic Oncology, Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
- Department of Urology, SS Annunziata Hospital, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
| | - Nicola Pavan
- Unit of Urology, Department of Surgical, Oncological and Oral Sciences, P. Giaccone University Hospital, Palermo, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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5
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Alam R, Yerrapragada A, Wlajnitz T, Watts E, Pallauf M, Enikeev D, Chang P, Wagner AA, McKiernan JM, Pierorazio PM, Allaf ME, Singla N. Evaluation of Growth Rates for Small Renal Masses in Elderly Patients Undergoing Active Surveillance. EUR UROL SUPPL 2023; 50:78-84. [PMID: 37101773 PMCID: PMC10123410 DOI: 10.1016/j.euros.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
Background As the adoption of active surveillance (AS) for small renal masses (SRMs) grows, the number of elderly patients enrolled for a prolonged period of time will increase. However, our understanding of comparative growth rates (GRs) in aging patients with SRMs remains poor. Objective To examine whether particular age cutoffs are associated with an increased GR for patients undergoing AS for SRMs. Design setting and participants We identified all patients with SRMs enrolled in the multi-institutional, prospective Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry since 2009 who elected for AS. Outcome measurements and statistical analysis Two definitions of GR were examined: GR from the initial image (GRi) and GR from the prior image (GRp). Image measurements were dichotomized based on patient age at the time of imaging. Multiple age cutoffs were examined: 65, 70, 75, and 80 yr. Mixed-effect linear regression examined the associations between age and GR, with controlling to account for multiple measurements from the same individual. Results and limitations We examined 2542 measurements from 571 patients. The median age at enrollment was 70.9 yr (interquartile range [IQR] 63.2-77.4) with a median tumor diameter of 1.8 cm (IQR 1.4-2.5). As a continuous variable, age was not associated with GRi (-0.0001 cm/yr, 95% confidence interval [CI] -0.007 to 0.007, p = 0.97) or GRp (0.008 cm/yr, 95% CI -0.004 to 0.020, p = 0.17) after adjustment. The only age thresholds associated with an increased GR were 65 yr for GRi and 70 yr for GRp. Limitations include the one-dimensional nature of the measurements used. Conclusions Increased age for patients on AS for SRMs is not associated with increased GRs. Patient summary We examined whether patients undergoing active surveillance (AS) exhibited accelerated growth of their small renal masses (SRMs) after a certain age. No demonstrable change was seen, suggesting that AS is a safe and durable management option for aging patients with SRMs.
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Affiliation(s)
- Ridwan Alam
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anirudh Yerrapragada
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tina Wlajnitz
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emelia Watts
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Maximilian Pallauf
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Peter Chang
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andrew A. Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - James M. McKiernan
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Phillip M. Pierorazio
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mohamad E. Allaf
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nirmish Singla
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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6
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Bertolo R, Amparore D, Diana P, Erdem S, Marandino L, Carbonara U, Borregales LD, Muselaers S, Pavan N, Pecoraro A, Roussel E, Pecoraro A, Marchioni M, Campi R. Cryoablation of small renal masses in patients with solitary kidneys: worth crossing the road for? Minerva Urol Nephrol 2022; 74:794-798. [PMID: 36629808 DOI: 10.23736/s2724-6051.22.05184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Riccardo Bertolo
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy -
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Pietro Diana
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - Selcuk Erdem
- Division of Urologic Oncology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Laura Marandino
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Carbonara
- Unit of Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Leonardo D Borregales
- Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, NY, USA
| | - Stijn Muselaers
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicola Pavan
- Unit of Urology, Department of Surgical, Oncological and Oral Sciences, P. Giaccone University Hospital, Palermo, Italy
| | - Angela Pecoraro
- Division of Urology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Eduard Roussel
- Department of Urology, University Hospitals of Leuven, Leuven, Belgium
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, G. D'Annunzio Chieti-Pescara University, Chieti, Italy.,Department of Urology, SS Annunziata Hospital, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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7
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Muselaers S, Amparore D, Bertolo R, Diana P, Erdem S, Marandino L, Carbonara U, Borregales LD, Pavan N, Pecoraro A, Roussel E, Pecoraro A, Campi R, Marchioni M. Optimizing postoperative follow-up in RCC patients: why does it always have to be black and white? Minerva Urol Nephrol 2022; 74:822-824. [PMID: 36629817 DOI: 10.23736/s2724-6051.22.05211-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Stijn Muselaers
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands -
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Pietro Diana
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - Selçuk Erdem
- Division of Urologic Oncology, Department of Urology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Laura Marandino
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Carbonara
- Unit of Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Leonardo D Borregales
- Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, NY, USA
| | - Nicola Pavan
- Unit of Urology, Department of Surgical, Oncological and Oral Sciences, P. Giaccone University Hospital, Palermo, Italy
| | - Angela Pecoraro
- Division of Urology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Eduard Roussel
- Department of Urology, University Hospitals of Leuven, Leuven, Belgium
| | - Alessio Pecoraro
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, G. D'Annunzio Chieti-Pescara University, Chieti, Italy.,Department of Urology, SS Annunziata Hospital, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
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8
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Stewart GD, Klatte T, Cosmai L, Bex A, Lamb BW, Moch H, Sala E, Siva S, Porta C, Gallieni M. The multispeciality approach to the management of localised kidney cancer. Lancet 2022; 400:523-534. [PMID: 35868329 DOI: 10.1016/s0140-6736(22)01059-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 12/12/2022]
Abstract
Historically, kidney cancer was approached in a siloed single-speciality way, with urological surgeons managing the localised stages of the disease and medical oncologists caring for patients if metastases developed. However, improvements in the management of localised kidney cancer have occurred rapidly over the past two decades with greater understanding of the disease biology, diagnostic options, and innovations in curative treatments. These developments are favourable for patients but provide a substantially more complex landscape for patients and clinicians to navigate, with associated challenging decisions about who to treat, how, and when. As such, the skill sets needed to manage the various aspects of the disease and guide patients appropriately outstrips the capabilities of one particular specialist, and the evolution of a multispeciality approach to the management of kidney cancer is now essential. In this Review, we summarise the current best multispeciality practice for the management of localised kidney cancer and the areas in need of further research and development.
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Affiliation(s)
- Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; CRUK Cambridge Centre, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Laura Cosmai
- Division of Nephrology and Dialysis, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Axel Bex
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Benjamin W Lamb
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; School of Allied Health, Anglia Ruskin University, Cambridge, UK
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Evis Sala
- CRUK Cambridge Centre, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Camillo Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy; Division of Medical Oncology, AOU Consorziale Policlinico di Bari, Bari, Italy
| | - Maurizio Gallieni
- Division of Nephrology and Dialysis, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy; Department of Clinical and Biomedical Sciences, Università di Milano, Milan, Italy
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9
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Benefit and Harm of Active Surveillance for Biopsy-proven Renal Oncocytoma: A Systematic Review and Pooled Analysis. EUR UROL SUPPL 2022; 41:8-15. [PMID: 35633831 PMCID: PMC9130085 DOI: 10.1016/j.euros.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 01/09/2023] Open
Abstract
Context Active surveillance (AS) of biopsy-proven renal oncocytomas may reduce overtreatment. However, on biopsy, the risk of misdiagnosis owing principally to entities with peculiar hybrids and overlap morphology, and phenotypes argues for early intervention. Objective To assess the benefit and harm of AS in biopsy-proven renal oncocytoma. Evidence acquisition A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We systematically searched PubMed, Scopus, and Web of Science databases from September 26 up to October 2021, for studies that analyzed the outcomes of AS in patients with biopsy-proven renal oncocytoma. Evidence synthesis A total of ten studies with 633 patients met our inclusion criteria and were included for analysis. After a median follow-up of 34.5 mo (95% confidence interval [CI] 30.6–38.4), the overall definitive treatment rate from AS to definitive treatment was 17.3% (n = 75/433, six studies). The pooled pathological agreement between the initial renal mass biopsy and the surgical pathology report was 91.1%. The main indications for surgery during follow-up were rapid tumor growth and patient request. The pooled median growth rate was 1.55 mm/yr (95% CI 0.9–2.2). No metastasis or death related to renal oncocytoma was reported. Conclusions Annual tumor growth of biopsy-proven renal oncocytoma is low. AS is oncologically safe, with favorable compliance of patients. Crossover to definitive treatment revealed a strong concordance between biopsy and final pathology. Further studies on the long-term outcomes of AS are needed. Patient summary In this study, we examined the benefit and harm of active surveillance (AS) in biopsy-proven oncocytoma. Based on the available data, AS appears oncologically safe and may represent a promising alternative to immediate treatment. Patients should be included in AS decision discussions.
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10
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Piana A, Andras I, Diana P, Verri P, Gallioli A, Campi R, Prudhomme T, Hevia V, Boissier R, Breda A, Territo A. Small renal masses in kidney transplantation: overview of clinical impact and management in donors and recipients. Asian J Urol 2022; 9:208-214. [PMID: 36035353 PMCID: PMC9399547 DOI: 10.1016/j.ajur.2022.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/24/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022] Open
Abstract
Kidney transplantation is the best replacement treatment for the end-stage renal disease. Currently, the imbalance between the number of patients on a transplant list and the number of organs available constitutes the crucial limitation of this approach. To expand the pool of organs amenable for transplantation, kidneys coming from older patients have been employed; however, the combination of these organs in conjunction with the chronic use of immunosuppressive therapy increases the risk of incidence of graft small renal tumors. This narrative review aims to provide the state of the art on the clinical impact and management of incidentally diagnosed small renal tumors in either donors or recipients. According to the most updated evidence, the use of grafts with a small renal mass, after bench table tumor excision, may be considered a safe option for high-risk patients in hemodialysis. On the other hand, an early small renal mass finding on periodic ultrasound-evaluation in the graft should allow to perform a conservative treatment in order to preserve renal function. Finally, in case of a renal tumor in native kidney, a radical nephrectomy is usually recommended.
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11
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Campi R, Muselaers S, Bertolo R, Erdem S, Marchioni M, Ingels A, Kara Ö, Carbonara U, Pecoraro A, Pavan N, Marandino L, Roussel E, Amparore D. Selecting the best candidates for non-surgical management of localized renal masses: the Occam's razor. Minerva Urol Nephrol 2022; 74:368-371. [PMID: 35607785 DOI: 10.23736/s2724-6051.22.04964-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy -
| | - Stijn Muselaers
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Selçuk Erdem
- Division of Urologic Oncology, Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, G. D'Annunzio University, Chieti, Italy.,Department of Urology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Alexandre Ingels
- Department of Urology, Henri Mondor University Hospital, APHP, Créteil, France.,Biomaps, UMR1281, INSERM, CNRS, CEA, University of Paris Saclay, Villejuif, France
| | - Önder Kara
- School of Medicine, Department of Urology, Kocaeli University, Kocaeli, Turkey
| | - Umberto Carbonara
- Unit of Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Angela Pecoraro
- Division of Urology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Nicola Pavan
- Department of Medical, Surgical and Health Science, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Laura Marandino
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eduard Roussel
- Department of Urology, Leuven University Hospital, Leuven, Belgium
| | - Daniele Amparore
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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12
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Fiori C, Porpiglia F. Renal cancer: From current evidences to future perspectives. Asian J Urol 2022; 9:199-200. [PMID: 36035348 PMCID: PMC9399550 DOI: 10.1016/j.ajur.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022] Open
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Campi R, Berni A, Amparore D, Bertolo R, Capitanio U, Carbonara U, Erdem S, Ingels A, Kara O, Klatte T, Kriegmair M, Marchioni M, Minervini A, Mir MC, Papalia R, Pavan N, Pecoraro A, Gomez Rivas J, Rivasi G, Roussel E, Ungar A, Serni S, Esperto F. Impact of frailty on perioperative and oncologic outcomes in patients undergoing surgery or ablation for renal cancer: a systematic review. Minerva Urol Nephrol 2021; 74:146-160. [PMID: 34714036 DOI: 10.23736/s2724-6051.21.04583-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Frailty has been recognized as a major risk factor for adverse perioperative and oncological outcomes in patients with genitourinary malignancies. Yet, the evidence supporting such an association in patients with renal cell carcinoma (RCC) is still sparse. Herein we provide an updated comprehensive overview of the impact of frailty on perioperative and oncologic outcomes in patients undergoing surgery or ablation for RCC. EVIDENCE ACQUISITION A systematic review of the English-language literature was conducted using the MEDLINE (Via PubMed), Web of Science and the Cochrane Library databases according to the principles highlighted by the EAU Guidelines Office and the PRISMA statement recommendations. The review protocol was registered on PROSPERO (CRD42021242516). The overall quality of evidence was assessed according to GRADE recommendations. EVIDENCE SYNTHESIS Overall, 18 studies were included in the qualitative analysis. Most of these were retrospective single-centre series including patients undergoing surgery for non-metastatic RCC. The overall quality of evidence was low. A variety of measures were used for frailty assessment, including the Canadian Study of Health and Aging Frailty Index, the five-item frailty index, the Modified Rockwood's Clinical Frailty Scale Score, the Hopkins Frailty score, the Groningen Frailty Index, and the Geriatric nutritional risk index. Sarcopenia was defined based on the Lumbar skeletal muscle mass at cross-sectional imaging, the skeletal muscle index, the total psoas area, or the psoas muscle index. Overall, available studies point to frailty and sarcopenia as potential independent risk factors for worse perioperative and oncological outcomes after surgery or ablation for different RCC stages. Increased patient's frailty was indeed associated with higher risk of perioperative complications, healthcare resources utilization, readmission rates and longer hospitalization periods, as well as potentially lower cancer specific or overall survival. CONCLUSIONS Frailty has been consistently associated with worse outcomes after surgery for RCC, reinforcing the value of preoperative frailty assessment in carefully selected patients. Given the low quality of the available evidence (especially in the setting of tumour ablation), prospective studies are needed to standardize frailty assessments and to identify patients who are expected to benefit most from preoperative geriatric evaluation, aiming to optimize decision-making and postoperative outcomes in patients with RCC.
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Affiliation(s)
- Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy - .,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy - .,European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group -
| | - Alessandro Berni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Daniele Amparore
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Riccardo Bertolo
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | - Umberto Capitanio
- Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Carbonara
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Selcuk Erdem
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Division of Urologic Oncology, Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Alexandre Ingels
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Urology, University Hospital Henri Mondor, APHP, Créteil, France.,Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France
| | - Onder Kara
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Maximilian Kriegmair
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Urology, University Medical Centre Mannheim, Mannheim, Germany
| | - Michele Marchioni
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University G D'Annunzio Chieti-Pescara, Chieti, Italy.,Department of Urology, SS Annunziata Hospital, G D'Annunzio University of Chieti, Chieti, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Maria C Mir
- Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Nicola Pavan
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Angela Pecoraro
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain.,European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
| | - Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Eduard Roussel
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Esperto
- Department of Urology, Campus Bio-Medico University, Rome, Italy.,European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
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14
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Marchioni M, Amparore D, Ingels A, Carbonara U, Pecoraro A, Roussel E, Campi R. Renal tumors ablation. Minerva Urol Nephrol 2021; 73:549-551. [PMID: 34494416 DOI: 10.23736/s2724-6051.21.04605-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Michele Marchioni
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy.,Department of Urology, SS Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Daniele Amparore
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Alexandre Ingels
- Department of Urology, APHP, Henri Mondor University Hospital, Créteil, France.,Biomaps, UMR1281, INSERM, CNRS, CEA, Paris Saclay University, Villejuif, France
| | - Umberto Carbonara
- Unit of Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Angela Pecoraro
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Eduard Roussel
- Department of Urology, University Hospitals of Leuven, Leuven, Belgium
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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15
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Klatte T, Berni A, Serni S, Campi R. Intermediate- and long-term oncological outcomes of active surveillance for localized renal masses: a systematic review and quantitative analysis. BJU Int 2021; 128:131-143. [PMID: 34060192 DOI: 10.1111/bju.15435] [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] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate intermediate- and long-term oncological outcomes of active surveillance (AS) for localized renal masses (LRMs). METHODS This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered on PROSPERO (CRD42021230416). Studies on AS for LRMs with at least 3 years' follow-up were eligible. Two review authors independently screened the literature, extracted data, and assessed risk of bias. The primary outcomes were metastasis rate, renal cell carcinoma (RCC)-specific mortality (RCC-SM) and all-cause mortality (ACM). Pooled estimates were obtained from random-effects models. Subgroup analyses were performed for small renal masses (SRMs; ≤4 cm) and non-SRMs (>4 cm). RESULTS We analysed 18 unique cohorts comprising 2066 patients. The pooled initial maximum tumour size was 2.8 cm (95% confidence interval [CI] 2.7-3.0) and the percutaneous biopsy rate was 28%. The pooled mean annual growth rate was 2.8 mm (95% CI 2.1-3.4). Within a pooled mean follow-up of 53 months, 2.1% (95% CI 1.0-3.6) of patients developed metastatic disease, 1.0% (95% CI 0.3-2.1) died from RCC and 22.6% (95% CI 15.8-30.2) died from any cause. For patients with SRMs (nine studies, n = 987), the pooled metastasis rate was 1.8% (95% CI 0.5-3.7), RCC-SM was 0.6% (95% CI 0-2.1), and ACM was 28.5% (95% CI 17.4-41.4). Across five studies reporting on outcomes of 239 patients with non-SRMs, the pooled metastasis rate was 5.1% (95% CI 0-17.3), RCC-SM was 2.1% (95% CI 0-8.9) and ACM was 29.1% (95% CI 13.6-47.3). This review is limited by non-standardized inclusion criteria, definitions and follow-up, data heterogeneity, limited patient numbers in sub-analyses and absence of high-quality studies. CONCLUSIONS Active surveillance is a safe intermediate- and long-term management option for well-selected patients with LRMs, especially those with SRMs. Limited data are available for non-SRMs, but current evidence would support further evaluation of this approach in selected patients. It is not possible to draw definitive conclusions until more high-quality data become available.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Dorset University Hospitals NHS Foundation Trust, Bournemouth, UK.,Department of Surgery, University of Cambridge, Cambridge, UK
| | - Alessandro Berni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands
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16
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Marchioni M, Rivas JG, Autran A, Socarras M, Albisinni S, Ferro M, Schips L, Scarpa RM, Papalia R, Esperto F. Biomarkers for Renal Cell Carcinoma Recurrence: State of the Art. Curr Urol Rep 2021; 22:31. [PMID: 33886004 PMCID: PMC8062344 DOI: 10.1007/s11934-021-01050-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW We aim to summarize the current state of art about the possible use of biomarkers for predicting renal cell carcinoma (RCC) recurrence after curative treatment. In addition, we aim to provide a snapshot about the clinical implication of biomarkers use for follow-up planification. RECENT FINDINGS A wide variety of biomarkers have been proposed. RCC biomarkers have been individuated in tumoral tissue, blood, and urine. A variety of molecules, including proteins, DNA, and RNA, warrant a good accuracy for RCC recurrence and progression prediction. Their use in prediction models might warrant a better patients' risk stratification. Future prognostic models will probably include a combination of classical features (tumor grade, stage, etc.) and novel biomarkers. Such models might allow a more accurate treatment and follow-up planification.
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Affiliation(s)
- Michele Marchioni
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, "G. d'Annunzio University", Chieti, Italy.
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio" Chieti-Pescara, Via dei Vestini, Campus universitario, 66100, Chieti, Italy.
| | | | - Anamaria Autran
- Department of Urology, Fundacion Jimemez Diaz, Madrid, Spain
| | - Moises Socarras
- Instituto de Cirugia Urologica Avanzada (ICUA), Madrid, Spain
| | - Simone Albisinni
- Urology Department, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Luigi Schips
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, "G. d'Annunzio University", Chieti, Italy
| | | | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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17
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de Silva S, Lockhart KR, Aslan P, Nash P, Hutton A, Malouf D, Lee D, Cozzi P, MacLean F, Thompson J. The diagnostic utility of diffusion weighted MRI imaging and ADC ratio to distinguish benign from malignant renal masses: sorting the kittens from the tigers. BMC Urol 2021; 21:67. [PMID: 33888122 PMCID: PMC8063409 DOI: 10.1186/s12894-021-00832-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background MRI is playing an increasing role in risk stratification and non-invasive diagnosis of the undifferentiated small renal mass. This study was designed to assess the reliability of MRI in diagnostic evaluation of renal masses, specifically characterising lesions with diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) values. Methods This is a retrospective analysis of patients undergoing MRI as part of their clinical workup for a renal mass suspicious for renal cell carcinoma (RCC) on CT or ultrasound followed by biopsy and/or surgical excision. All cases were conducted on 3 Tesla MRI, with conventional breath-held sequences, DWI and dynamic contrast enhanced phases. Tumour regions of interest were evaluated on ADC maps and compared with T2 weighted and post-contrast images. Results Of the 66 renal tumours included, 33 (50.0%) were Clear Cell RCC, 11 (16.7%) were Oncocytoma, nine (13.6%) were Angiomyolipoma (AML), nine (13.6%) were Papillary RCC and four (6.1%) were Chromophobe RCC. Oncocytoma had the largest ADC values, significantly larger than AMLs and all RCC subtypes (p < 0.001). The average ADC value was also significantly larger in Clear Cell RCCs compared to AMLs, and other RCC subtypes (p < 0.001). Conclusions MRI with DWI/ADC imaging may aid the differentiation of oncocytomas from RCCs and stratify RCC subtypes, Further studies are required to validate these findings. Trial registration: Not applicable/retrospective study.
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Affiliation(s)
- Suresh de Silva
- Faculty of Medicine, University of NSW, Kensington, NSW, Australia. .,Department of Radiology, I-MED Radiology Network, Sydney, Australia.
| | | | - Peter Aslan
- Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - Peter Nash
- Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - Anthony Hutton
- Faculty of Medicine, University of NSW, Kensington, NSW, Australia.,Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - David Malouf
- Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - Dominic Lee
- Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - Paul Cozzi
- Hurstville Private Hospital, Hurstville, NSW, Australia
| | - Fiona MacLean
- Department of Anatomical Pathology, Sonic Healthcare, Ryde, NSW, Australia
| | - James Thompson
- Faculty of Medicine, University of NSW, Kensington, NSW, Australia.,Department of Urology, St George Hospital, Kogarah, NSW, Australia
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18
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Umari P, Rizzo M, Billia M, Stacul F, Bertolotto M, Cova MA, Bondonno G, Perri D, Liguori G, Volpe A, Trombetta C. Oncological outcomes of active surveillance and percutaneous cryoablation of small renal masses are similar at intermediate term follow-up. Minerva Urol Nephrol 2021; 74:321-328. [PMID: 33781019 DOI: 10.23736/s2724-6051.21.04217-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Active surveillance (AS) and minimally invasive ablative therapies such as percutaneous cryoablation (PCA) are emerging as alternative treatment modalities in the management of small renal masses (SRMs). METHODS Fifty-nine patients underwent PCA since 2011 and 75 underwent AS since 2010 at two different institutions. Only patients with follow-up ≥ 6 months were included. All patients were followed with a standardized protocol. Treatment failure was defined by dimensional progression for AS and renal recurrence for PCA, in addition to stage and/or metastatic progression for both groups. RESULTS Treatment failure was observed in 14 cases (18,7%) during AS (mainly due to dimensional progression) and 12 patients (16%) underwent delayed intervention with a mean follow-up of 36,83 months. Seven patients (11,9%) in the PCA group experienced treatment failure with a mean follow-up of 33,39 months and 3 of them underwent re-ablation successfully. Cancer-specific-survival at 2 and 5 years was 100% and 95,8% in AS-group vs. 98,2% and 98,2% in PCA-group (p=0,831). One patient in both groups died from metastatic disease. Overall-survival at 2 and 5 years was 91,7% and 82,4% in the AS-group vs. 96,5% and 96,5% in the PCA-group (p=0,113). Failure-free survival at 2 and 5 years was 90,9% and 70,1% in the AS-group vs. 93,1% and 70,9% in the PCA-group (p=0,645). CONCLUSIONS AS and PCA provide similar survival outcomes and are safe and valid treatment options for elderly and comorbid patients with SRMs.
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Affiliation(s)
- Paolo Umari
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy -
| | - Michele Rizzo
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Michele Billia
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Fulvio Stacul
- Radiology Department, Maggiore Hospital, Trieste, Italy
| | - Michele Bertolotto
- Radiology Department, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Maria Assunta Cova
- Radiology Department, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Gianmarco Bondonno
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Davide Perri
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Giovanni Liguori
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Alessandro Volpe
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Carlo Trombetta
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
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Zhang K, Xu C, Liu S, Jiang Y, Zhao X, Ma S, Li Y, Yang F, Wang Y, Meng P, Shi C, Han D, Wen W, Qin W. The Diagnostic and Immunotherapeutic Value of CD248 in Renal Cell Carcinoma. Front Oncol 2021; 11:644612. [PMID: 33791227 PMCID: PMC8006336 DOI: 10.3389/fonc.2021.644612] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Renal cell carcinoma (RCC) is the most common malignancy in the urinary system. Despite substantial improvements in available treatment options, the survival outcome of advanced RCC is unsatisfactory. Identifying novel biomarkers to assist in early diagnosis and to screen patients who are sensitive to immunotherapy would be beneficial. CD248 is a promising candidate that deserves to be investigated. Methods: The Cancer Genome Atlas (TCGA) data set and clinical specimens were adopted to analyze the expression of CD248 between normal and tumor tissues. Univariate and multivariate Cox regression analyses were employed to identify independent prognostic factors and construct a CD248-based prognostic signature. The correlation among the present signature, tumor-infiltrating immune cells (TIICs), the tumor mutation burden (TMB), and immunomodulatory molecules was evaluated. The weighted gene co-expression network analysis (WGCNA), the enrichment analysis, and the miRNA correlation analysis were performed to explore the underlying mechanism of CD248 in the progression of RCC. Results: The overexpression of CD248 in RCC was related to a poor prognosis, and a CD248-based prognostic signature could precisely stratify patients with RCC with different survival outcomes regardless of the training or testing cohort. The present signature could reflect the immunosuppressive landscape of RCC (i.e., increased infiltration of regulatory T cells and upregulated immune checkpoints), accompanied by deteriorated clinicopathologic indexes. The TMB and immunostimulatory molecules expression also increased with the risk score generated from the present signature. CD248 co-expressed gene sets were identified through the WGCNA algorithm, and several immunosuppressive Gene Ontology (GO) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were significantly enriched. The result of CD248-correlated miRNA further emphasized the importance of CD248 in RCC. Conclusion: CD248 is a valuable biomarker to improve the diagnostic and therapeutic efficiency of RCC. The immunosuppressive effect of CD248 co-expressed genes may provide insight for the present study, and miRNA would help to reveal the mechanism of the expressive regulation of CD248.
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Affiliation(s)
- Keying Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chao Xu
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shaojie Liu
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yao Jiang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaolong Zhao
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shanjin Ma
- Department of Urology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yu Li
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fa Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yan Wang
- Department of Emergency, 987th Hospital of the Chinese People's Liberation Army, Baoji, China
| | - Ping Meng
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Changhong Shi
- Laboratory Animal Center, Fourth Military Medical University, Xi'an, China
| | - Donghui Han
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Weihong Wen
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
| | - Weijun Qin
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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20
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Campi R, Stewart GD, Staehler M, Dabestani S, Kuczyk MA, Shuch BM, Finelli A, Bex A, Ljungberg B, Capitanio U. Novel Liquid Biomarkers and Innovative Imaging for Kidney Cancer Diagnosis: What Can Be Implemented in Our Practice Today? A Systematic Review of the Literature. Eur Urol Oncol 2021; 4:22-41. [DOI: 10.1016/j.euo.2020.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/26/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022]
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21
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Contrast-enhanced ultrasound (CEUS) imaging for active surveillance of small renal masses. World J Urol 2021; 39:2853-2860. [PMID: 33495864 DOI: 10.1007/s00345-021-03589-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/05/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of contrast-enhanced ultrasound (CEUS) imaging for monitoring small (< 4 cm) renal masses (SRM) in patients undergoing active surveillance (AS). METHODS We retrospectively selected all consecutive patients with SRMs who underwent AS for at least 6 months at our Institution between January 2014 and December 2018. CEUS imaging was performed by two experienced genitourinary radiologists at established time points. The accuracy of CEUS for monitoring SRM size was compared with that of CT scan. For solid SRMs, four enhancement patterns (EP) were recorded. Radiological progression was defined as SRM growth rate ≥ 5 mm/year. RESULTS Overall, 158/1049 (15.1%) patients with SRMs underwent AS. At a median follow-up of 25 months (IQR 13-39), no patient died due to renal cell carcinoma (RCC). No patients experienced CEUS-related adverse events. There was a large variability in the pattern of growth of SRMs (overall median growth rate: 0.40 mm/year), with 9.5% of SRMs showing radiological progression. The median SRM size was comparable between CEUS and CT scan examinations at all time points. The vast majority (92.7%) of SRMs did not show a change in their EP over time; and there was no association between the SRM's EP and radiological progression or SRM size. Overall, 43 (27.2%) patients underwent delayed intervention (DI); median SRM size, and median growth rate were significantly higher in these patients as compared to those continuing AS. CONCLUSION In experienced hands, CEUS is a safe and effective strategy for active monitoring of SRMs in well-selected patients undergoing AS.
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22
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Available active surveillance follow-up protocols for small renal mass: a systematic review. World J Urol 2021; 39:2875-2882. [PMID: 33452911 DOI: 10.1007/s00345-020-03581-6] [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: 10/03/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate follow-up strategies for active surveillance of renal masses and to assess contemporary data. METHODS We performed a comprehensive search of electronic databases (Embase, Medline, and Cochrane). A systematic review of the follow-up protocols was carried out. A total of 20 studies were included. RESULT Our analysis highlights that most of the series used different protocols of follow-up without consistent differences in the outcomes. Most common protocol consisted in imaging and clinical evaluation at 3, 6, and 12 months and yearly thereafter. Median length of follow-up was 42 months (range 1-137). Mean age was 74 years (range 67-83). Of 2243 patients 223 (10%) died during the follow-up and 19 patients died of kidney cancer (0.8%). The growth rate was the most used parameter to evaluate disease progression eventually triggering delayed intervention. Maximal axial diameter was the most common method to evaluate growth rate. CT scan is the most used, probably because it is usually more precise than kidney ultrasound and more accessible than MRI. Performing chest X-ray at every check does not seem to alter the clinical outcome during AS. CONCLUSION The minimal cancer-specific mortality does not seem to correlate with the follow-up scheme. Outside of growth rate and initial size, imaging features to predict outcome of RCC during AS are limited. Active surveillance of SRM is a well-established treatment option. However, standardized follow-up protocols are lacking. Prospective, randomized, trials to evaluate the best follow-up strategies are pending.
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