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So WZ, Fong KY, Wang Z, Tiong HY. Outcomes of Localized Renal Cell Carcinoma Across Different Races. Clin Med Res 2023; 21:122-128. [PMID: 37985170 PMCID: PMC10659133 DOI: 10.3121/cmr.2023.1819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/10/2023] [Accepted: 05/17/2023] [Indexed: 11/22/2023]
Abstract
Introduction: Epidemiological outcomes of renal cell carcinoma (RCC) remain sparse. This study aims to compare preoperative characteristics, surgical outcomes, and oncological outcomes of RCC patients at a urology unit in Singapore.Methods: A retrospective cohort analysis of 137 RCC patients in the National University Hospital of Singapore who had undergone partial nephrectomy between 2009 and 2020 was conducted. χ2 tests (Chi-Square Test, Fisher's Exact Test) and one-way analysis of variance (ANOVA) were used for comparing categorical and continuous variables respectively. Kaplan-Meier estimates were used for survival analysis.Results: In total, 137 patients were identified (Chinese [n=82], Malay [n=19], Indian [n=15], Others [n=21]). Indian patients were diagnosed at an earlier age (52.13±10.52 years, P=0.018). A larger percentage of Malay patients (78.9%, P<0.001) were operated on before 2016, prior to the center's adoption of the robotic surgical technique. More Malay and Indian patients underwent laparoscopic surgery (36.8% and 46.7%, P=0.008), experiencing higher rates of intra-operative conversions compared to the Chinese and other ethnicities (5.3% and 13.3% vs. 0%, P=0.011). They also had longer post-operative stays compared to Chinese (7.42±6.46 days; 7.40±7.69 days vs. 4.88±2.87 days, P=0.036). Malays were much less likely to undergo robotic partial nephrectomy compared to Chinese patients (OR=0.295, 95% CI=0.102-0.856) and had the highest rate of metastatic recurrence (10.5%, P=0.023).
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Carbonara U, Amparore D, Gentile C, Bertolo R, Erdem S, Ingels A, Marchioni M, Muselaers CH, Kara O, Marandino L, Pavan N, Roussel E, Pecoraro A, Crocerossa F, Torre G, Campi R, Ditonno P. Current strategies to diagnose and manage of positive surgical margins and local recurrence after partial nephrectomy. Asian J Urol 2022; 9:227-242. [PMID: 36035342 PMCID: PMC9399527 DOI: 10.1016/j.ajur.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
Objective No standard strategy for diagnosis and management of positive surgical margin (PSM) and local recurrence after partial nephrectomy (PN) are reported in literature. This review aims to provide an overview of the current strategies and further perspectives on this patient setting. Methods A non-systematic review of the literature was completed. The research included the most updated articles (about the last 10 years). Results Techniques for diagnosing PSMs during PN include intraoperative frozen section, imprinting cytology, and other specific tools. No clear evidence is reported about these methods. Regarding PSM management, active surveillance with a combination of imaging and laboratory evaluation is the first option line followed by surgery. Regarding local recurrence management, surgery is the primary curative approach when possible but it may be technically difficult due to anatomy resultant from previous PN. In this scenario, thermal ablation (TA) may have the potential to circumvent these limitations representing a less invasive alternative. Salvage surgery represents a valid option; six studies analyzed the outcomes of nephrectomy on local recurrence after PN with three of these focused on robotic approach. Overall, complication rates of salvage surgery are higher compared to TA but ablation presents a higher recurrence rate up to 25% of cases that can often be managed with repeat ablation. Conclusion Controversy still exists surrounding the best strategy for management and diagnosis of patients with PSMs or local recurrence after PN. Active surveillance is likely to be the optimal first-line management option for most patients with PSMs. Ablation and salvage surgery both represent valid options in patients with local recurrence after PN. Conversely, salvage PN and radical nephrectomy have fewer recurrences but are associated with a higher complication rate compared to TA. In this scenario, robotic surgery plays an important role in improving salvage PN and radical nephrectomy outcomes.
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Affiliation(s)
- 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
- Corresponding author. Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, 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
| | - Cosimo Gentile
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, 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
| | - 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
| | - Michele Marchioni
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Constantijn H.J. Muselaers
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - 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
| | - Laura Marandino
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, 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
| | - Eduard Roussel
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - 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
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Torre
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Riccardo Campi
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
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Predicting Clear Cell Renal Cell Carcinoma Survival Using Kurtosis of Cytoplasm in the Hematoxylin Channel from Histology Slides. JOURNAL OF ONCOLOGY 2022; 2022:7693993. [PMID: 35069737 PMCID: PMC8776432 DOI: 10.1155/2022/7693993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022]
Abstract
Purpose Grade-dependent decrease of lipid storage in clear cell renal cell carcinoma (ccRCC) leads to morphology changes in HE sections. This study investigated the role of cytoplasmic features in frozen sections of ccRCC on prognosis using the digital pathology approach. Methods We established an automatic pipeline that performed tumor region selection, stain vector normalization, nuclei segmentation, and feature extraction based on the pathologic data from Shanghai General Hospital and The Cancer Genome Atlas database. Extracted features were subjected to survival analysis. Results Kurtosis of the cytoplasm in the hematoxylin channel was correlated with progression-free survival (HR 0.10, 95% CI: 0.04–0.24, p=6.52∗10−7) and overall survival (HR 0.11, 95% CI: 0.05–0.31, p=1.72∗10−5) in ccRCC, which outperformed other texture features in this analysis. Multivariate Cox regression analysis revealed that low kurtosis of cytoplasm in the hematoxylin channel was an independent predictor for a shorter progression-free survival time (p=0.044) and overall survival time (p = 0.01). Kaplan–Meier survival analysis of progression-free survival and overall survival also showed a significantly worse prognosis in patients with low kurtosis of the cytoplasm in the hematoxylin channel (both p < 0.0001). Lower kurtosis of cytoplasm in the hematoxylin channel was associated with higher pathologic grade, less cholesterol ester, and more mitochondrial DNA content. Conclusion Kurtosis of the cytoplasm in the hematoxylin channel predicts survival in clear cell renal cell carcinoma.
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