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Rossi SH, Harrison H, Usher-Smith JA, Stewart GD. Risk-stratified screening for the early detection of kidney cancer. Surgeon 2024; 22:e69-e78. [PMID: 37993323 DOI: 10.1016/j.surge.2023.10.010] [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: 09/27/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
Earlier detection and screening for kidney cancer has been identified as a key research priority, however the low prevalence of the disease in unselected populations limits the cost-effectiveness of screening. Risk-stratified screening for kidney cancer may improve early detection by targeting high-risk individuals whilst limiting harms in low-risk individuals, potentially increasing the cost-effectiveness of screening. A number of models have been identified which estimate kidney cancer risk based on both phenotypic and genetic data, and while several of the former have been shown to identify individuals at high-risk of developing kidney cancer with reasonable accuracy, current evidence does not support including a genetic component. Combined screening for lung cancer and kidney cancer has been proposed, as the two malignancies share some common risk factors. A modelling study estimated that using lung cancer risk models (currently used for risk-stratified lung cancer screening) could capture 25% of patients with kidney cancer, which is only slightly lower than using the best performing kidney cancer-specific risk models based on phenotypic data (27%-33%). Additionally, risk-stratified screening for kidney cancer has been shown to be acceptable to the public. The following review summarises existing evidence regarding risk-stratified screening for kidney cancer, highlighting the risks and benefits, as well as exploring the management of potential harms and further research needs.
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Affiliation(s)
- Sabrina H Rossi
- Department of Surgery, University of Cambridge, Cambridge, UK.
| | - Hannah Harrison
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Juliet A Usher-Smith
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
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Usher‐Smith JA, Harvey‐Kelly LLW, Rossi SH, Harrison H, Griffin SJ, Stewart GD. Acceptability and potential impact on uptake of using different risk stratification approaches to determine eligibility for screening: A population-based survey. Health Expect 2021; 24:341-351. [PMID: 33264472 PMCID: PMC8077132 DOI: 10.1111/hex.13175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/15/2020] [Accepted: 11/15/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Using risk stratification approaches to determine eligibility has the potential to improve efficiency of screening. OBJECTIVES To compare the public acceptability and potential impact on uptake of using different approaches to determine eligibility for screening. DESIGN An online population-based survey of 668 adults in the UK aged 45-79 including a series of scenarios in the context of a potential kidney cancer screening programme in which eligibility was determined by age, sex, age and sex combined, a simple risk score (age, sex, body mass index, smoking status), a complex risk score additionally incorporating family history and lifestyle, or a genetic risk score. OUTCOME MEASURES We used multi-level ordinal logistic regression to compare acceptability and potential uptake within individuals and multivariable ordinal logistic regression differences between individuals. RESULTS Using sex, age and sex, or the simple risk score were less acceptable than age (P < .0001). All approaches were less acceptable to women than men. Over 70% were comfortable waiting until they were older if the complex risk score or genetics indicated a low risk. If told they were high risk, 85% would be more likely to take up screening. Being told they were low risk had no overall influence on uptake. CONCLUSIONS Varying the starting age of screening based on estimated risk from models incorporating phenotypic or genetic risk factors would be acceptable to most individuals and may increase uptake. PATIENT OR PUBLIC CONTRIBUTION Two members of the public contributed to the development of the survey and have commented on this paper.
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Affiliation(s)
- Juliet A. Usher‐Smith
- The Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | | | - Sabrina H. Rossi
- Department of OncologyUniversity of Cambridge, Addenbrooke’s Hospital, Cambridge Biomedical CampusCambridgeUK
| | - Hannah Harrison
- The Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Simon J. Griffin
- The Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Grant D. Stewart
- Department of SurgeryUniversity of Cambridge, Addenbrooke’s Hospital, Cambridge Biomedical CampusCambridgeUK
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Yamauchi FI, Paiva OA, Mussi TC, Francisco Neto MJ, Baroni RH. A comparative study of ultrasound and cross-sectional imaging for detection of small renal masses: anatomic factors and radiologist's experience. EINSTEIN-SAO PAULO 2020; 18:eAO5576. [PMID: 33206813 PMCID: PMC7647384 DOI: 10.31744/einstein_journal/2020ao5576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/24/2020] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate anatomic factors and radiologist's experience in the detection of solid renal masses on ultrasonography. Methods: We searched for solid renal masses diagnosed on cross-sectional imaging from 2007 to 2017 that also had previous ultrasonography from the past 6 months. The following features were evaluated: nodule size, laterality, location and growth pattern, patient body mass index and radiologist's experience in ultrasound. In surgically resected cases, pathologic reports were evaluated. Unpaired t test and χ2 test were used to evaluate differences among subgroups, using R-statistics. Statistical significance was set at p<0.05. Results: The initial search of renal nodules on cross-sectional imaging resulted in 428 lesions and 266 lesions were excluded. Final cohort included 162 lesions and, of those, 108 (67%) were correctly detected on ultrasonography (Group 1) and 54 (33%) were missed (Group 2). Comparison of Groups 1 and 2 were as follows, respectively: body mass index (27.7 versus 27.1; p=0.496), size (2.58cm versus 1.74cm; p=0.003), laterality (54% versus 59% right sided; p=0.832), location (27% versus 22% upper pole; p=0.869), growth pattern (25% versus 28% endophytic; p=0.131) and radiologist's experience (p=0.300). From surgically resected cases, histology available for Group 1 was clear cell (n=11), papillary (n=15), chromophobe (n=2) renal cell carcinoma, oncocytoma (n=1), and, for Group 2, clear cell (n=7), papillary (n=5) renal cell carcinoma, oncocytoma (n=2), angiomyolipoma, chromophobe renal cell carcinoma, and interstitial pyelonephritis (n=1, each). Conclusion: Size was the only significant parameter related to renal nodule detection on ultrasound.
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Vasudev NS, Wilson M, Stewart GD, Adeyoju A, Cartledge J, Kimuli M, Datta S, Hanbury D, Hrouda D, Oades G, Patel P, Soomro N, Sullivan M, Webster J, Selby PJ, Banks RE. Challenges of early renal cancer detection: symptom patterns and incidental diagnosis rate in a multicentre prospective UK cohort of patients presenting with suspected renal cancer. BMJ Open 2020; 10:e035938. [PMID: 32398335 PMCID: PMC7223292 DOI: 10.1136/bmjopen-2019-035938] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To describe the frequency and nature of symptoms in patients presenting with suspected renal cell carcinoma (RCC) and examine their reliability in achieving early diagnosis. DESIGN Multicentre prospective observational cohort study. SETTING AND PARTICIPANTS Eleven UK centres recruiting patients presenting with suspected newly diagnosed RCC. Symptoms reported by patients were recorded and reviewed. Comprehensive clinico-pathological and outcome data were also collected. OUTCOMES Type and frequency of reported symptoms, incidental diagnosis rate, metastasis-free survival and cancer-specific survival. RESULTS Of 706 patients recruited between 2011 and 2014, 608 patients with a confirmed RCC formed the primary study population. The majority (60%) of patients were diagnosed incidentally. 87% of patients with stage Ia and 36% with stage III or IV disease presented incidentally. Visible haematuria was reported in 23% of patients and was commonly associated with advanced disease (49% had stage III or IV disease). Symptomatic presentation was associated with poorer outcomes, likely reflecting the presence of higher stage disease. Symptom patterns among the 54 patients subsequently found to have a benign renal mass were similar to those with a confirmed RCC. CONCLUSIONS Raising public awareness of RCC-related symptoms as a strategy to improve early detection rates is limited by the fact that related symptoms are relatively uncommon and often associated with advanced disease. Greater attention must be paid to the feasibility of screening strategies and the identification of circulating diagnostic biomarkers.
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Affiliation(s)
- Naveen S Vasudev
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Michelle Wilson
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Grant D Stewart
- University of Cambridge, Cambridge, Cambridgeshire, UK
- Department of Urology, NHS Lothian, Edinburgh, Edinburgh, UK
| | - Adebanji Adeyoju
- Department of Urology, Stockport NHS Foundation Trust, Stockport, Stockport, UK
| | - Jon Cartledge
- Department of Urology, Saint James's University Hospital, Leeds, Leeds, UK
| | - Michael Kimuli
- Department of Urology, Saint James's University Hospital, Leeds, Leeds, UK
| | - Shibendra Datta
- Department of Urology, University Hospital of Wales Healthcare NHS Trust, Cardiff, Cardiff, UK
| | - Damian Hanbury
- Department of Urology, Lister Hospital, Stevenage, Hertfordshire, UK
| | - David Hrouda
- Department of Urology, Charing Cross Hospital, London, London, UK
| | - Grenville Oades
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, Glasgow, UK
| | - Poulam Patel
- Division of Cancer and Stem Cells, University of Nottingham, Nottingham, UK
| | - Naeem Soomro
- Department of Urology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, UK
| | - Mark Sullivan
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Jeff Webster
- Department of Urology, Northwick Park Hospital, Harrow, London, UK
| | - Peter J Selby
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Rosamonde E Banks
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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Strizova Z, Bartunkova J, Smrz D. The challenges of adoptive cell transfer in the treatment of human renal cell carcinoma. Cancer Immunol Immunother 2019; 68:1831-1838. [PMID: 31222485 PMCID: PMC11028041 DOI: 10.1007/s00262-019-02359-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022]
Abstract
Renal cell carcinoma (RCC) is one of the most lethal urologic malignancies. Its incidence continues to rise worldwide with a rate of 2% per year. Approximately, one-third of the RCC patients are diagnosed at advanced stages due to the asymptomatic nature of its early stages. This represents a great hurdle, since RCC is largely chemoresistant/radioresistant, and targeted therapy of mRCC still has limited efficacy. The 5-year survival rate of metastatic RCC (mRCC) is only around 10%. Adoptive cell transfer (ACT), a particular form of cell-based anticancer immunotherapy, is a promising approach in the treatment of mRCC. The vaccination principle, however, faces unique challenges that preclude the efficacy of ACT. In this article, we review the main challenges of ACT in the treatment of mRCC and describe multiple methods that can be used to overcome these challenges. In this respect, the ultimate purpose of this review is to provide a descriptive tool by which to improve the development of novel protocols for ACT of mRCC.
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Affiliation(s)
- Zuzana Strizova
- Institute of Immunology, 2nd Faculty of Medicine and Motol University Hospital, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Jirina Bartunkova
- Institute of Immunology, 2nd Faculty of Medicine and Motol University Hospital, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Daniel Smrz
- Institute of Immunology, 2nd Faculty of Medicine and Motol University Hospital, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic.
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Rossi SH, Blick C, Nathan P, Nicol D, Stewart GD, Wilson ECF. Expert Elicitation to Inform a Cost-Effectiveness Analysis of Screening for Renal Cancer. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:981-987. [PMID: 31511187 DOI: 10.1016/j.jval.2019.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 03/06/2019] [Accepted: 03/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Population screening for renal cell carcinoma (RCC) using ultrasound has the potential to improve survival outcomes; however, a cost-effectiveness analysis (CEA) has yet to be performed. Owing to the lack of existing evidence, we performed structured expert elicitation to derive unknown quantities to inform the CEA. OBJECTIVE To elicit the cancer stage distribution (proportion of individuals with each stage of cancer) for different RCC screening scenarios and the annual transition probabilities for undiagnosed disease becoming diagnosed in the National Health Service. METHODS The study design and reporting adhered to the Reporting Guidelines for the Use of Expert Judgement in Model-Based Economic Evaluations. The elicitation was conducted face-to-face or via telephone between each individual expert and the facilitator, aided by online material. For multinomial data, Connor-Mosimann and modified Connor-Mosimann distributions were fitted for each expert and for all experts combined using mathematical linear pooling. RESULTS A total of 24 clinical experts were invited, and 71% participated (7 urologists, 6 oncologists, 4 radiologists). The modified Connor-Mosimann distribution provided the best fit for most elicited quantities. Greater uncertainty was noted for the elicited transition probabilities compared with the elicited stage distributions. CONCLUSION We performed the first expert elicitation of RCC screening parameters, crucial information that will inform the CEA of screening. In addition, the elicited quantities may enable future health economic evaluations assessing the value of diagnostic tools and pathways in RCC.
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Affiliation(s)
- Sabrina H Rossi
- Academic Urology Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
| | - Christopher Blick
- Harold Hopkins Department of Urology, Royal Berkshire Hospital, Reading, UK
| | - Paul Nathan
- Department of Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - David Nicol
- Department of Urology, Royal Marsden Hospital, London, UK; Institute of Cancer Research, London, UK
| | - Grant D Stewart
- Academic Urology Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Edward C F Wilson
- Cambridge Centre for Health Services Research, University of Cambridge, Institute of Public Health, Cambridge, UK
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Yap LC, Leonard F, Cullen I, Daly P. Renal cell carcinoma in Ireland: rising mortality and survival. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818813784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this study was to evaluate the rising trend in the incidence and mortality of renal cell carcinoma in Ireland. Methods: Data from the National Cancer Registry of Ireland on primary adenocarcinomas of the kidney from 2003 to 2013 were evaluated. Statistical analysis was performed on the data using IBM SPSS statistics V24 software package and Microsoft Excel Software. Results: There were 3801 cases of adenocarcinoma of the kidney with 29% of tumours (n=1103) being found incidentally. The age-adjusted incidence rate of renal cell carcinoma in 2003 was 4.66 per 100,000 women and 8.78 per 100,000 men. These figures have risen to 5.78 and 13.14 in 2013, respectively. There was an annual percentage change of +2.2% for women and +4.1% for men from the years 2003 to 2013. For both sexes the age-standardised all-cause mortality rate for renal adenocarcinoma increased from 1.07 per 100,000 in 2003 to 4.32 ± 0.06 per 100,000 in 2013, an annual percentage change of +15%. Age-adjusted mortality rates in the female population in Ireland increased from 0.78 to 2.66, an annual percentage change of +13.1% and from 1.41 to 6.04 in men, an annual percentage change of +15.8%. Conclusion: There is a paradox emerging in Ireland, with both rising survival rates for renal cell carcinoma and rising mortality rates. While the increased incidence of renal cell carcinoma in Ireland can be attributed somewhat to the increased use of various imaging modalities, it may also be attributed to the significant rise in modifiable risk factors as seen in other developed countries, namely hypertension, obesity, and smoking. Level of evidence: 2c
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Affiliation(s)
- Lee Chien Yap
- Department of Urology, University Hospital Waterford, Ireland
| | - Frank Leonard
- Department of Mathematics, Waterford Institute of Technology, Ireland
| | - Ivor Cullen
- Department of Urology, University Hospital Waterford, Ireland
| | - Padraig Daly
- Department of Urology, University Hospital Waterford, Ireland
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Brennan O, Oh S, Necas M. The value of surveying the kidneys during pelvic ultrasound examinations. Australas J Ultrasound Med 2019; 22:118-128. [PMID: 34760548 PMCID: PMC8411717 DOI: 10.1002/ajum.12122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pelvic ultrasounds are commonly performed for various clinical indications in female patients presenting to the hospital. A survey of the kidneys is routinely included as part of the examination, but there is limited justification for their inclusion in the assessment of every female presenting for a pelvic ultrasound. METHOD We examined the utility of surveying the kidney ultrasound during pelvic ultrasonography by reviewing the records of 1009 pelvic ultrasound examinations in 1000 women. RESULTS In total, 46 incidental findings were identified, but 91% of these were clinically inconsequential. Only four patients had incidental findings of high clinical priority requiring specialist treatment. Of these, two patients were symptomatic and had urinary tract obstruction due to stones. The other two patients harboured asymptomatic renal cell carcinomas. The overall incidence of renal incidental findings of high clinical priority in asymptomatic patients was two in 1009 examinations (1999 kidneys). CONCLUSION Indiscriminate uncritical screening of the kidneys in women presenting for pelvic ultrasound is not evidence-based and represents a low-yield examination with extremely low rate of incidental findings of clinical significance.
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Affiliation(s)
| | - Sheila Oh
- Department of UltrasoundWaikato HospitalHamiltonNew Zealand
| | - Martin Necas
- Department of UltrasoundWaikato HospitalHamiltonNew Zealand
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Rossi SH, Klatte T, Usher-Smith J, Stewart GD. Epidemiology and screening for renal cancer. World J Urol 2018; 36:1341-1353. [PMID: 29610964 PMCID: PMC6105141 DOI: 10.1007/s00345-018-2286-7] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 03/28/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The widespread use of abdominal imaging has affected the epidemiology of renal cell carcinoma (RCC). Despite this, over 25% of individuals with RCC have evidence of metastases at presentation. Screening for RCC has the potential to downstage the disease. METHODS We performed a literature review on the epidemiology of RCC and evidence base regarding screening. Furthermore, contemporary RCC epidemiology data was obtained for the United Kingdom and trends in age-standardised rates of incidence and mortality were analysed by annual percentage change statistics and joinpoint regression. RESULTS The incidence of RCC in the UK increased by 3.1% annually from 1993 through 2014. Urinary dipstick is an inadequate screening tool due to low sensitivity and specificity. It is unlikely that CT would be recommended for population screening due to cost, radiation dose and increased potential for other incidental findings. Screening ultrasound has a sensitivity and specificity of 82-83% and 98-99%, respectively; however, accuracy is dependent on tumour size. No clinically validated urinary nor serum biomarkers have been identified. Major barriers to population screening include the relatively low prevalence of the disease, the potential for false positives and over-diagnosis of slow-growing RCCs. Individual patient risk-stratification based on a combination of risk factors may improve screening efficiency and minimise harms by identifying a group at high risk of RCC. CONCLUSION The incidence of RCC is increasing. The optimal screening modality and target population remain to be elucidated. An analysis of the benefits and harms of screening for patients and society is warranted.
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Affiliation(s)
- Sabrina H. Rossi
- Academic Urology Group, University of Cambridge, Addenbrooke’s Hospital, Cambridge Biomedical Campus, Hills Road, Box 43, Cambridge, CB2 0QQ UK
| | - Tobias Klatte
- Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ UK
| | - Juliet Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR UK
| | - Grant D. Stewart
- Academic Urology Group, University of Cambridge, Addenbrooke’s Hospital, Cambridge Biomedical Campus, Hills Road, Box 43, Cambridge, CB2 0QQ UK
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Abstract
Urological malignancies are a major source of morbidity and mortality in men over 40. Screening for those malignancies has a potential benefit of reducing both. However, even after more than two decades of screening for prostate cancer, the implications of most resulting information are still a matter of debate. Controversy extends over several aspects of prostate cancer screening programs, including age of onset, defining populations at risk, most appropriate intervals, as well as the optimal methods to be used for screening. The medical community is still divided regarding the effectiveness of prostate cancer-related death prevention and its benefits-to-harms ratio, reflecting an inconsistency regarding screening recommendations. Similarly, benefits of screening for urothelial and kidney tumors are yet lacking high-level evidence, although recent evidence supports screening of populations at risk. Clearly, the current era of evolving molecular and genetic biomarkers harbors the potential to change screening practice. In this paper, we review current guidelines as well as giving an update on new developments which might influence screening strategies in common urological malignancies.
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Affiliation(s)
- Azik Hoffman
- Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, ON, Canada
| | - Elizabeth E Half
- Department of Gastroenterology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa Israel
- Gastroenterology Institute, Rambam Health Care Campus, Haifa, Israel
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