1
|
Khaleel S, Truong H, Jiang S, K-Lee P, Davelman B, Gordon D, Benfante N, Arora A, Ostrovnaya I, Tickoo S, Coleman J, Hakimi AA, Russo P. Adverse pathologic features impact survival outcomes for small renal masses following nephrectomy. Urol Oncol 2023; 41:391.e5-391.e11. [PMID: 37423816 PMCID: PMC11042782 DOI: 10.1016/j.urolonc.2023.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/30/2023] [Accepted: 06/18/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE While most small renal masses (SRM) < 4 cm have an excellent prognosis following resection, the impact of adverse T3a pathologic features on oncologic outcomes of SRMs remains unclear. We sought to compare clinical outcomes for surgically resected pT3a versus pT1a SRMs at our institution. MATERIALS AND METHODS We retrospectively reviewed records of patients who underwent radical or partial nephrectomy (RN, PN) for renal tumors <4 cm at our institution between 2010 and 2020. We compared features and outcomes of pT3a vs pT1a SRMs. Continuous and categorical variables were compared using Student's t and Pearson's chi-squared tests, respectively. Postoperative outcomes of interest including overall, cancer-specific, and recurrence-free survival (OS, CSS, and RFS) were analyzed using Kaplan-Meier method, Cox proportional hazard regression, and competing risk analysis. Analyses were performed using R statistical package (R Foundation, v4.0). RESULTS We identified 1,837 patients with malignant SRMs. Predictors of postoperative pT3a upstaging included higher renal score, larger tumor size, and presence of radiologic features concerning for T3a disease (odds ratio [OR] = 5.45, 95% confidence interval [CI] 3.92-7.59, P < 0.001). On univariable modeling, pT3a SRMs had higher positive margin rates (9.6% vs 4.1%, P < 0.001), worse OS (hazard ratio [HR] = 2.9, 95% CI 1.6-5.3, P = 0.002), RFS (HR 9.32, 95% CI 2-40.1, P = 0.003), and CSS (HR = 3.6, 95% CI 1.5-8.2, P = 0.003). On multivariable modeling, pT3a status remained associated with worse RFS (HR = 2.7, 95% CI 1.04-7, P = 0.04), but not OS (HR 1.6, 95% CI = 0.83-3.1, P = 0.2); multivariable modeling was deferred for CSS due to low event rates. CONCLUSIONS Adverse T3a pathologic features portend worse outcomes for SRMs, highlighting the crucial role of pre-operative planning and case selection. These patients have relatively poor prognosis, and should be monitored more closely and counseled for consideration of adjuvant therapy or clinical trials.
Collapse
Affiliation(s)
- Sari Khaleel
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hong Truong
- Department of Urology, Penn State University College of Medicine, Hershey, PA
| | - Song Jiang
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul K-Lee
- Department of Urology, SUNY Downstate Health Sciences University, New York, NY
| | - Benjamin Davelman
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Danielle Gordon
- Department of Urology, SUNY Downstate Health Sciences University, New York, NY
| | - Nicole Benfante
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Irina Ostrovnaya
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Satish Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan Coleman
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Ari Hakimi
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Russo
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY.
| |
Collapse
|
2
|
Elabbady A, Boudreau R, Mehrnoush V, Salem M, Fahmy A, Elabbady R, Kotb A. Rapid metachronous bladder metastasis of type 2 papillary renal cell carcinoma. Arch Clin Cases 2023; 10:93-96. [PMID: 37313126 PMCID: PMC10258733 DOI: 10.22551/2023.39.1002.10249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Renal cell carcinoma (RCC) frequently spreads to distant organs like the lung, lymph nodes, bone, and liver. However, there have been some reports of RCC bladder metastasis. We present a case of a 61-year-old man presented with total painless gross hematuria. The patient had a history of right radical nephrectomy for papillary (type 2) RCC, high-grade, pT3a with negative surgical margins. There was no evidence of metastases on 6-month surveillance CT. After one-year post-operation, at this current admission, the cystoscopy discovered a solid bladder mass away from the trigone in the right lateral bladder wall. The resected bladder mass was metastatic papillary RCC with PAX-8 positive but GATA-3 negative on immunostaining. A positron emission tomography scan confirmed multiple lung, liver, and osseous metastases. This case report can highlight the importance of having bladder metastasis in RCC mind, although rare, and may necessitate the surveillance measures like urine analysis at more frequent interval and CT Urography instead of regular CT to detect the RCC metastatic bladder cancer at early stage.
Collapse
Affiliation(s)
| | - Ryan Boudreau
- Northern Ontario School of Medicine University, Ontario, Canada
| | - Vahid Mehrnoush
- Northern Ontario School of Medicine University, Ontario, Canada
| | - Mona Salem
- Alexandria University, Alexandria, Egypt
| | | | | | - Ahmed Kotb
- Northern Ontario School of Medicine University, Ontario, Canada
| |
Collapse
|
3
|
Xiong S, Jiang M, Jiang Y, Hu B, Chen R, Yao Z, Deng W, Wan X, Liu X, Chen L, Fu B. Partial Nephrectomy Versus Radical Nephrectomy for Endophytic Renal Tumors: Comparison of Operative, Functional, and Oncological Outcomes by Propensity Score Matching Analysis. Front Oncol 2022; 12:916018. [PMID: 35957884 PMCID: PMC9360524 DOI: 10.3389/fonc.2022.916018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/22/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose The study aimed to compare operative, functional, and oncological outcomes between partial nephrectomy (PN) and radical nephrectomy (RN) for entophytic renal tumors (ERTs) by propensity score matching (PSM) analysis. Methods A total of 228 patients with ERTs who underwent PN or RN between August 2014 and December 2021 were assessed. A PSM in a 1:1 ratio was conducted to balance the differences between groups. Perioperative characteristics, renal functional, and oncological outcomes were compared between groups. Univariate and multivariate logistic and Cox proportional hazard regression analyses were used to determine the predictors of functional and survival outcomes. Results After PSM, 136 cases were matched to the PN group (n = 68) and the RN group (n = 68). Patients who underwent RN had shorter OT, less EBL, and lower high-grade complications (all p <0.05) relative to those who underwent PN. However, better perseveration of renal function was observed in the PN group, which was reflected in 48-h postoperative AKI (44.1% vs. 70.6%, p = 0.002), 1-year postoperative 90% eGFR preservation (45.6% vs. 22.1%, p = 0.004), and new-onset CKD Stage ≥III at last follow-up (2.9% vs. 29.4%, p <0.001). RN was the independent factor of short-term (OR, 2.812; 95% CI, 1.369–5.778; p = 0.005) and long-term renal function decline (OR, 10.242; 95% CI, 2.175–48.240; p = 0.003). Furthermore, PN resulted in a better OS and similar PFS and CSS as compared to RN (p = 0.042, 0.15, and 0.21, respectively). RN (OR, 7.361; 95% CI, 1.143–47.423; p = 0.036) and pT3 stage (OR, 4.241; 95% CI, 1.079–16.664; p = 0.039) were independent predictors of overall mortality. Conclusion Among patients with ERTs, although the PN group showed a higher incidence of high-grade complications than RN, when technically feasible and with experienced surgeons, PN is recommended for better preservation of renal function, longer OS, and similar oncological outcomes.
Collapse
Affiliation(s)
- Situ Xiong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Ming Jiang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Yi Jiang
- Jiangxi Institute of Urology, Nanchang, China
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bing Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Ru Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Zhijun Yao
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Xianwen Wan
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Bin Fu, ; Xiaoqiang Liu, ; Luyao Chen, ; Xianwen Wan,
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Bin Fu, ; Xiaoqiang Liu, ; Luyao Chen, ; Xianwen Wan,
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Bin Fu, ; Xiaoqiang Liu, ; Luyao Chen, ; Xianwen Wan,
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
- *Correspondence: Bin Fu, ; Xiaoqiang Liu, ; Luyao Chen, ; Xianwen Wan,
| |
Collapse
|
4
|
Oake JD, Patel P, Lavallée LT, Lattouf JB, Saarela O, Klotz L, Moore RB, Kapoor A, Finelli A, Rendon RA, Kawakami J, So AI, Drachenberg DE. Outcomes and prognosticators of stage 4 renal cell carcinoma with pathological T4 primary lesion using a large, Canadian, multi-institutional database. Can Urol Assoc J 2019; 14:24-30. [PMID: 31348746 DOI: 10.5489/cuaj.5941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The primary objective of this study was to evaluate outcomes and prognosticators in patients who underwent radical nephrectomy (RN) or cytoreductive nephrectomy (CN), depending on the clinical stage of disease preoperatively, with a pathological T4 (pT4) renal cell carcinoma (RCC) outcome. There is little data on the outcome of this specific subset of patients. METHODS From 2009-2016, we identified patients in the Canadian Kidney Cancer information system (CKCis) who underwent RN or CN and were found to have pT4 RCC. Clinical, operative, and pathological variables were analyzed with univariable and multivariable Cox proportional hazard models to identify factors associated with overall survival (OS). Survival curves were created using Kaplan-Meier methods and compared using the log-rank test. RESULTS A total of 82 patients were included in the study cohort. Median patient age was 62 years (interquartile range [IQR] 55, 70). Fifty (61%) patients had clear-cell histology and 14 (17%) had sarcomatoid characteristics. Median followup was 12 months (IQR 3, 24). At last followup, eight (10%) patients are alive with no evidence of disease, 27 (33%) are alive with disease, four (5%) were lost to followup, 36 (44%) died of disease, and seven (8%) died of other causes. Tumor histological subtype (clear-cell vs. non-clear-cell) (p=0.0032), larger tumor size (cm) (p=0.012), and Fuhrman grade (G4 vs. G2-G3) (p=0.045) were significantly associated with mortality in a multivariable Cox regression model. CONCLUSIONS For patients with pT4 RCC after RN or CN, survival is poor. Sarcomatoid features, non-clear-cell histology, and presence of systemic symptoms were associated with worse OS.
Collapse
Affiliation(s)
- Justin D Oake
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Premal Patel
- Department of Urology, University of Miami, Miami, FL, United States
| | | | | | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Laurence Klotz
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Ronald B Moore
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Jun Kawakami
- Division of Urology, University of Calgary, Calgary, AB, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | | |
Collapse
|
5
|
Kassouf W, Monteiro LL, Drachenberg DE, Fairey AS, Finelli A, Kapoor A, Lattouf JB, Leveridge MJ, Power NE, Pouliot F, Rendon RA, Sabbagh R, So AI, Tanguay S, Breau RH. Canadian Urological Association guideline for followup of patients after treatment of non-metastatic renal cell carcinoma. Can Urol Assoc J 2018; 12:231-238. [PMID: 30139427 DOI: 10.5489/cuaj.5462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Wassim Kassouf
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Adrian S Fairey
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Robert Sabbagh
- Division of Urology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Simon Tanguay
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
6
|
Patel P, Nayak JG, Liu Z, Saarela O, Jewett M, Rendon R, Kapoor A, Black P, Tanguay S, Kawakami J, Moore R, Breau RH, Morash C, Pouliot F, Drachenberg DE. A Multicentered, Propensity Matched Analysis Comparing Laparoscopic and Open Surgery for pT3a Renal Cell Carcinoma. J Endourol 2018; 31:645-650. [PMID: 28381117 DOI: 10.1089/end.2016.0787] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION To compare outcomes following laparoscopic renal surgery (LRS) and open renal surgery (ORS) in the treatment of pathologic T3a (pT3a) renal cell carcinoma (RCC) using a propensity matched analysis. MATERIALS AND METHODS The Canadian Kidney Cancer Information System is a prospectively maintained database for patients diagnosed with RCC from 15 Canadian institutions. Patients treated for nonmetastatic pT3a RCC between 2008 and 2015 were included. Propensity score matching for age, gender, tumor size, grade, histology, and surgical approach was performed to compare laparoscopic radical and partial nephrectomy (LRN or LPN) with open radical or partial nephrectomy (ORN or OPN). The primary endpoint was recurrence-free survival (RFS). RESULTS Two hundred twenty-six (45%) patients underwent LRS (88% LRN and 12% LPN), and 275 (55%) underwent ORS (75% ORN and 25% OPN). After a median follow-up of 21.1 months, 155 (72 LRS and 83 ORS) patients experienced recurrence. The 3-year RFS was 63% and 50% for the LRS and ORS groups, respectively, p = 0.36. On subgroup analysis, there was no significant difference in RFS among patients who underwent radical nephrectomy (3-year RFS 61% in LRN compared with 46% in ORN group, p = 0.32) or partial nephrectomy (77% in LPN compared with 79% in OPN group, p = 0.82). CONCLUSIONS This study is the largest matched analysis comparing LRS and ORS for pT3a RCC. In matched patients, LRS showed no difference in oncologic outcomes compared with ORS and should be considered when technically feasible.
Collapse
Affiliation(s)
- Premal Patel
- 1 Section of Urology, University of Manitoba , Winnipeg, Canada
| | - Jasmir G Nayak
- 1 Section of Urology, University of Manitoba , Winnipeg, Canada
| | | | - Olli Saarela
- 3 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
| | - Michael Jewett
- 4 Division of Urology, University of Toronto , Toronto, Canada
| | - Ricardo Rendon
- 5 Department of Urology, Dalhousie University , Halifax, Canada
| | - Anil Kapoor
- 6 Division of Urology, McMaster University , Hamilton, Canada
| | - Peter Black
- 7 Department of Urologic Sciences, University of British Columbia , Vancouver, Canada
| | - Simon Tanguay
- 8 Division of Urology, McGill University , Montreal, Canada
| | - Jun Kawakami
- 9 Southern Alberta Institute of Urology, University of Calgary , Calgary, Canada
| | - Ronald Moore
- 10 Division of Urology, University of Alberta , Edmonton, Canada
| | - Rodney H Breau
- 11 Division of Urology, The Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Canada
| | - Chris Morash
- 11 Division of Urology, The Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Canada
| | - Frédéric Pouliot
- 12 Centre Hospitalier Universitaire de Québec , Quebec City, Canada
| | | |
Collapse
|
7
|
Pathological Upstaging of Clinical T1 to Pathological T3a Renal Cell Carcinoma: A Multi-institutional Analysis of Short-term Outcomes. Urology 2016; 94:154-60. [DOI: 10.1016/j.urology.2016.03.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/09/2016] [Accepted: 03/21/2016] [Indexed: 01/08/2023]
|