1
|
Taneja S, Bonert M, Hoogenes J, Matsumoto K, Shayegan B, Matsumoto ED, Lambe S, Piercey K, Kapoor A. Predictors of disease recurrence in high-risk non-metastatic renal cell carcinoma patients post-surgical resection A single-center, retrospective study. Can Urol Assoc J 2024; 18:E53-E58. [PMID: 37931279 PMCID: PMC10954279 DOI: 10.5489/cuaj.8449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Approximately 20-40% of kidney cancer patients treated for localized disease experience post-surgical recurrence. Several prognostic models exist to help clinicians determine the risk of distant recurrence, but these models vary in criteria and endpoints. We aimed to examine the recurrence rate and clinicopathologic factors as predictors of recurrence in high-risk renal cell carcinoma (RCC) patients. METHODS We conducted a single-center, retrospective chart review of pT3 RCC patients who underwent a nephrectomy between January 2000 and December 2015. Patients registered in clinical trials for adjuvant therapy and those with fewer than three years of followup were excluded. Kaplan-Meier survival analysis and univariate and multivariate Cox regression were performed to identify the rate and predictors of disease recurrence. RESULTS Eighty-eight pT3 RCC patients were included, and 39 patients had recurrence with a median of 23.5 months (range 1.6-127.5). Nine patients had disease recurrence beyond 58 months. Kaplan-Meier log-rank tests identified patients with negative surgical margins and low Fuhrman nuclear grades had greater recurrence-free survival. Univariate Cox regression revealed positive surgical margins, high Fuhrman nuclear grade, and large tumor sizes were significant predictors. In the multivariate Cox regression model, high Fuhrman nuclear grade and positive surgical margins were significant predictors of recurrence. CONCLUSIONS Disease recurrence occurred in 44% of pT3-staged patients. High Fuhrman nuclear grade and positive surgical margins were associated with time to recurrence. Physicians should use prognostic models to facilitate conversations about disease recurrence and continue to monitor high-risk patients beyond the recommended five-year followup period. We recommend monitoring pT3 resected patients for up to 10 years post-surgery.
Collapse
Affiliation(s)
- Shipra Taneja
- Division of Urology, Department of Surgery, McMaster University, Hamilton ON, Canada
| | - Michael Bonert
- Department of Pathology, McMaster University, Hamilton, ON, Canada
| | - Jen Hoogenes
- Division of Urology, Department of Surgery, McMaster University, Hamilton ON, Canada
| | - Katelyn Matsumoto
- Division of Urology, Department of Surgery, McMaster University, Hamilton ON, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, Hamilton ON, Canada
| | - Edward D Matsumoto
- Division of Urology, Department of Surgery, McMaster University, Hamilton ON, Canada
| | - Shahid Lambe
- Division of Urology, Department of Surgery, McMaster University, Hamilton ON, Canada
| | - Kevin Piercey
- Division of Urology, Department of Surgery, McMaster University, Hamilton ON, Canada
| | - Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton ON, Canada
| |
Collapse
|
2
|
Dibajnia P, Cardenas LM, Lalani AKA. The emerging landscape of neo/adjuvant immunotherapy in renal cell carcinoma. Hum Vaccin Immunother 2023; 19:2178217. [PMID: 36775257 PMCID: PMC10026863 DOI: 10.1080/21645515.2023.2178217] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Adjuvant and neoadjuvant therapies that reduce the risk of renal cell carcinoma (RCC) recurrence remain an area of unmet need. Advances have been made in metastatic RCC recently by leveraging PD-1/PD-L1 immune checkpoint inhibitors (ICIs). These agents are currently being investigated in the adjuvant and neoadjuvant settings to determine if intervention early in the disease trajectory offers a clinically meaningful benefit. While a disease-free survival benefit has been demonstrated with pembrolizumab, results from other ICI studies have not been positive to date. More mature data from these studies are needed to determine whether there is a survival benefit to ICIs in the curative-intent setting. The success of ICIs has also ushered a new wave of studies combining ICIs with other agents such as targeted therapies and vaccines, which are in early stages of investigation. We review the current state of adjuvant/neoadjuvant therapy in RCC and highlight opportunities for ongoing study.
Collapse
Affiliation(s)
- Pooya Dibajnia
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON , Canada
| | - Luisa M Cardenas
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON , Canada
| | - Aly-Khan A Lalani
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON , Canada
| |
Collapse
|
3
|
Pedraza-Sánchez JP, Chaves-Marcos R, Mazuecos-Quirós J, Bisonó-Castillo ÁL, Osmán-García I, Gutiérrez-Marín CM, Medina López RA, Juárez Soto Á. Percutaneous radiofrequency ablation is an effective treatment option for small renal masses, comparable to partial nephrectomy. Eur Radiol 2023; 33:7371-7379. [PMID: 37280356 DOI: 10.1007/s00330-023-09779-7] [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: 06/30/2022] [Revised: 03/20/2023] [Accepted: 04/14/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The standard therapy for small renal masses (SRMs) remains partial nephrectomy (PN), which is associated with relatively high morbidity and complication rate. Therefore, percutaneous radiofrequency ablation (PRFA) emerges as an alternative therapy. This study aimed to compare the efficacy, safety, and oncological outcomes of PRFA versus PN. METHODS A multicenter non-inferiority study with retrospective analysis of 291 patients with SRMs (N0M0), who underwent PN or PRFA (2:1), recruited prospectively from two hospitals in the Andalusian Public Health System, Spain, between 2014 and 2021. Comparisons of treatment features were evaluated using the t test, Wilcoxon-Mann-Whitney U test, chi-square test, Fisher test, and Cochran-Armitage trend test. Kaplan-Meier curves depicted overall survival (OS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS) rates in the overall study population. RESULTS A total of 291 consecutive patients were identified; 111 and 180 patients underwent PRFA and PN, respectively. Median follow-up time was 38 and 48 months, and mean hospitalization days were 1.04 and 3.57 days, respectively. The variables underpinned with high surgical risk were significantly increased in PRFA compared to those in PN (mean age was 64.56 and 57.47 years, the solitary kidney presence was 12.6% and 5.6%, ASA score ≥ 3 was 36% and 14.5%, respectively). The rest of oncological outcomes were comparable amongst PRFA and PN. Patients undergoing PRFA did not improve OS, LRFS, and MFS compared to those undergoing PN. Limitations comprise retrospective design and limited statistical power. CONCLUSION PRFA for SMRs in high-risk patients is non-inferior in terms of oncological outcomes and safety compared to PN. CLINICAL RELEVANCE STATEMENT Our study has a direct clinical application as it proves that radiofrequency ablation is an effective and uncomplicated therapeutic option for patients with small renal masses. KEY POINTS •There are non-inferiority results in overall survival, local recurrence-free survival, and metastasis-free survival between PRFA and PN. •Our two-center study showed that PRFA is non-inferior to PN in oncological outcomes. •Contrast-enhanced power ultrasound-guided PRFA provides an effective therapy for T1 renal tumors.
Collapse
Affiliation(s)
- José Pablo Pedraza-Sánchez
- Urology Clinical Unit, University Hospital of Jerez de La Frontera, Ctra. Trebujena, S/N, 11407, Jerez de La Frontera, Cádiz, Spain.
| | - Reyes Chaves-Marcos
- Department of Urology and Nephrology, Virgen del Rocío University Hospital, Biomedical Institute of Seville (Ibis), CSIC/University of Seville, Seville, Spain
| | - Javier Mazuecos-Quirós
- Urology Clinical Unit, University Hospital of Jerez de La Frontera, Ctra. Trebujena, S/N, 11407, Jerez de La Frontera, Cádiz, Spain
| | - Álvaro Luis Bisonó-Castillo
- Urology Clinical Unit, University Hospital of Jerez de La Frontera, Ctra. Trebujena, S/N, 11407, Jerez de La Frontera, Cádiz, Spain
| | - Ignacio Osmán-García
- Department of Urology and Nephrology, Virgen del Rocío University Hospital, Biomedical Institute of Seville (Ibis), CSIC/University of Seville, Seville, Spain
| | - Carlos Miguel Gutiérrez-Marín
- Department of Radiology, Virgen del Rocío University Hospital, Biomedical Institute of Seville (Ibis), CSIC/University of Seville, Seville, Spain
| | - Rafael Antonio Medina López
- Department of Urology and Nephrology, Virgen del Rocío University Hospital, Biomedical Institute of Seville (Ibis), CSIC/University of Seville, Seville, Spain
| | - Álvaro Juárez Soto
- Urology Clinical Unit, University Hospital of Jerez de La Frontera, Ctra. Trebujena, S/N, 11407, Jerez de La Frontera, Cádiz, Spain
| |
Collapse
|
4
|
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
|
5
|
Parmar A, Ghosh S, Sahgal A, Lalani AKA, Hansen AR, Reaume MN, Wood L, Basappa NS, Heng DYC, Graham J, Kollmannsberger C, Soulières D, Breau RH, Tanguay S, Kapoor A, Pouliot F, Bjarnason GA. Evaluating the impact of early identification of asymptomatic brain metastases in metastatic renal cell carcinoma. Cancer Rep (Hoboken) 2023; 6:e1763. [PMID: 36517084 PMCID: PMC10026314 DOI: 10.1002/cnr2.1763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 09/14/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Brain metastases (BM) in metastatic renal cell carcinoma (mRCC) have been reported to be present in up to 25% of patients diagnosed with mRCC. There is limited published literature evaluating the role of routine intra-cranial imaging for the screening of asymptomatic BM in mRCC. AIMS To evaluate the potential utility of routine intra-cranial imaging, a retrospective cohort study was conducted to characterize the outcomes of mRCC patients who presented with asymptomatic BM, as compared to symptomatic BM. METHODS AND RESULTS The Canadian Kidney Cancer Information System (CKCis) database was used to identify mRCC patients diagnosed with BM. This cohort was divided into two groups based on the presence or absence of BM symptoms. Details regarding patient demographics, disease characteristics, systemic treatments, BM characteristics and survival outcomes were extracted. Statistical analysis was through chi-square tests, analysis of variance, and Kaplan-Meier method to characterize survival outcomes. A p-value of <0.05 was considered statistically significant for all analyses. A total of 267 mRCC patients with BM were identified of which 106 (40%) presented with asymptomatic disease. The majority of patients presented with multiple (i.e., >1) BM (75%) with no significant differences noted in number of BM or BM-directed therapy received in symptomatic, as compared to asymptomatic BM patients. Median [95% confidence interval (CI)] overall survival (OS) from mRCC diagnosis was 42 months (95% CI: 32-62) for patients with asymptomatic BM, and 39 months (95% CI: 29-48) with symptomatic BM (p = 0.10). OS from time of BM diagnosis was 28 months (95% CI: 18-42) for the asymptomatic BM group, as compared to 13 months (95% CI: 10-21) in the symptomatic BM group (p = 0.04). CONCLUSIONS Given a substantial proportion of patients may present with asymptomatic BM, limiting intra-cranial imaging to patients with symptomatic BM, may be associated with a missed opportunity for timely diagnosis and treatment. The utility of routine intra-cranial imaging in patients with renal cell carcinoma, warrants further prospective evaluation.
Collapse
Affiliation(s)
- Ambica Parmar
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sunita Ghosh
- Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Arjun Sahgal
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Aly-Khan A Lalani
- Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Aaron R Hansen
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - M Neil Reaume
- Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Lori Wood
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Naveen S Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Denis Soulières
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | | | - Anil Kapoor
- Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Frédéric Pouliot
- Cancer Research Center, Centre Hospitalier Universitaire de Québec - Université Laval, Québec City, QC, Canada
| | - Georg A Bjarnason
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
6
|
MicroRNA as a Biomarker for Diagnostic, Prognostic, and Therapeutic Purpose in Urinary Tract Cancer. Processes (Basel) 2021. [DOI: 10.3390/pr9122136] [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] Open
Abstract
The incidence of urologic cancers, including kidney, upper tract urothelial, and bladder malignancies, is increasing globally, with a high percentage of cases showing metastasis upon diagnosis and low five-year survival rates. MicroRNA (miRNA), a small non-coding RNA, was found to regulate the expression of oncogenes and tumor suppressor genes in several tumors, including cancers of the urinary system. In the current review, we comprehensively discuss the recently reported up-or down-regulated miRNAs as well as their possible targets and regulated pathways involved in the development, progression, and metastasis of urinary tract cancers. These miRNAs represent potential therapeutic targets and diagnostic/prognostic biomarkers that may help in efficient and early diagnosis in addition to better treatment outcomes.
Collapse
|
7
|
Shiff B, Breau RH, Mallick R, Pouliot F, So A, Tanguay S, Kapoor A, Lattouf JB, Lavallée L, Fairey A, Finelli A, Bhindi B, Kawakami J, Rendon R, Bansal RK. Prognostic significance of extent of venous tumor thrombus in patients with non-metastatic renal cell carcinoma: Results from a Canadian multi-institutional collaborative. Urol Oncol 2021; 39:836.e19-836.e27. [PMID: 34556430 DOI: 10.1016/j.urolonc.2021.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The prognostic significance of level of venous tumor thrombus (VTT) extension in patients with non-metastatic renal cell carcinoma (RCC) has been controversial. The aim of this study was to examine the prognostic significance of VTT extent in patients who underwent surgery for non-metastatic RCC. MATERIALS AND METHODS The Canadian Kidney Cancer information system database was used to identify patients who underwent surgery for non-metastatic RCC and VTT from January 2011 to December 2019. Association between VTT level and recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) was examined. Univariable and multivariable analyses were performed to estimate predictors of survival. RESULTS Out of 6,340 patients during the study period, 228 patients (3.6%) had VTT. VTT was level 0 in 84 (37%), level I to II in 112 (49%), and level III to IV in 33 (14%) patients as per the Mayo Clinic classification. Median age was 65.4 years (interquartile range [IQR] 57.6-72.2) and 169 (74.1%) were male. After a median follow-up of 21.2 months, VTT level did not significantly impact the RFS, CSS, or OS. For VTT level 0, I to II, and III to IV, there was no significant difference in estimated 5-year RFS (31%, 23%, and 30.5%; P > 0.05), CSS (70%, 69%, and 55%; P > 0.05) and OS (64%, 66%, and 50%; P > 0.05). Adjusting for known prognostic factors, thrombus level was not associated with risk of recurrence or death. CONCLUSION In a large, multi-institutional cohort of patients undergoing surgery for non-metastatic RCC with tumor thrombus, thrombus extent was not independently associated with recurrence or death.
Collapse
Affiliation(s)
- Benjamin Shiff
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Frédéric Pouliot
- Division of Urology, Université Laval, Quebec City, Quebec, Canada
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, British Columbia, Canada, Vancouver
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, Quebec, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | | | - Luke Lavallée
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | - Adrian Fairey
- Division of Urology, University of Alberta, Edmonton, Alberta, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Bimal Bhindi
- Section of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Jun Kawakami
- Section of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rahul K Bansal
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada.
| |
Collapse
|
8
|
Bilateral Single-Stage Nephrectomy for Synchronous Bilateral Renal Cell Carcinoma. J Kidney Cancer VHL 2021; 8:7-11. [PMID: 33564613 PMCID: PMC7842839 DOI: 10.15586/jkcvhl.v8i1.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 01/14/2021] [Indexed: 11/18/2022] Open
Abstract
Bilateral synchronous renal cell carcinoma (RCC) is uncommonly encountered. Debate exists among urologists in managing these cases in a single surgery versus staged surgeries. We aim to report our experience in managing encountered cases using single-stage surgeries. Retrospective collection of cases with pathologically confirmed RCC that had single-stage bilateral renal surgery over the past 2 years. Three cases were identified. Patients were managed using bilateral transverse lateral lumbotomy. All patients did not have intraoperative or postoperative complications. Kidney function stayed stable after surgery. Single-stage bilateral renal surgery is a safe procedure. Bilateral transverse lateral lumbotomy allows for a fast and safe surgery with minimal complications. There is a possible histological dis-concordance in bilateral synchronous RCC.
Collapse
|
9
|
Guo Y, Kapoor A, Cheon P, So AI, Lattouf JB, Jamal M. Canadian Urological Association best practice report: Diagnosis and management of sporadic angiomyolipomas. Can Urol Assoc J 2020; 14:E527-E536. [PMID: 33213697 DOI: 10.5489/cuaj.6942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Yanbo Guo
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Paul Cheon
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Baptiste Lattouf
- Departments of Surgery and Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Munir Jamal
- Division of Urology, Department of Surgery, Trillium Health Partners, Mississauga, ON, Canada
| |
Collapse
|
10
|
Lam CJ, Wong NC, Voss M, Mironov O, Connolly M, Matsumoto ED, Kapoor A. Surveillance post-radiofrequency ablation for small renal masses: Recurrence and followup. Can Urol Assoc J 2020; 14:398-403. [PMID: 32574144 DOI: 10.5489/cuaj.6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Small renal masses (SRMs), enhancing tumors <4 cm in diameter, are suspicious for renal cell carcinoma (RCC). The incidence of SRMs have risen with the increased quality and frequency of imaging. Partial nephrectomy is widely accepted as a nephron-sparing approach for the management of clinically localized RCC, with a greater than 90% disease-specific survival for stage T1a. Radiofrequency ablation (RFA) has been emerging as an alternative management strategy, with evidence suggesting RFA as a safe alternative for SRMs. We aimed to evaluate the time to recurrence and recurrence rates of SRMs treated with RFA at our institution. METHODS A retrospective review between October 2011 and May 2019 identified 141 patients with a single SRM treated with RFA at Hamilton Health Sciences and St. Joseph's Healthcare Hamilton. Patients with familial syndromes and distant metastases were excluded. Repeat RFAs of the ipsilateral kidney for incomplete ablation were not considered a new procedure. The primary variable measured was time from initial ablation to recurrence. A Cox proportional hazard regression model was used to identify possible prognostic variables for tumor recurrence defined a priori, including age, gender, mass size, RENAL nephrometry, and PADUA scores. RESULTS The overall average age of our patients was 69.0±11.1 years, with 71.6% being male. Average tumor size was 2.6±0.8 cm. There were 22/154 total recurrences (15.6%) post-RFA. Median followup time was 67 (18-161) months. Those with new recurrences had median time to recurrence of 15 months and no recurrence beyond 53 months. Thirteen of 141 patients had residual disease (9.2%) and were identified within the first eight months post-RFA. The only prognostic variable identified as a predictor of residual disease was tumor size (hazard ratio 2.265; p<0.001). CONCLUSIONS This study shows the risk of a new recurrence following RFA for SRMs is 6.4%. Most recurrences (9.2%) were a result of residual tumor at the ablation site identified within the first eight months post-RFA. No recurrences were identified beyond 53 months, with a total median followup time of 67 months. Tumor size alone, without need for complex scoring systems, may serve as a predictor of incomplete ablation following RFA and could be used to assist in shared decision-making on management strategies.
Collapse
Affiliation(s)
- Cameron J Lam
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nathan C Wong
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Maurice Voss
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Oleg Mironov
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Michael Connolly
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Edward D Matsumoto
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
11
|
Spooner J, Birk M, Salina D, Hoag N. Images - A nose metastasis heralding renal cell carcinoma recurrence 25 years post-nephrectomy. Can Urol Assoc J 2019; 14:E111-E112. [PMID: 31599715 DOI: 10.5489/cuaj.5905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jesse Spooner
- University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Manjot Birk
- University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Davide Salina
- University of British Columbia, Department of Pathology, Victoria, BC, Canada
| | - Nathan Hoag
- University of British Columbia, Department of Urologic Sciences, Victoria, BC, Canada
| |
Collapse
|
12
|
Ismail A, Elmansy H, Shahrour W, Prowse O, Kotb A. Very late locally recurrent chromophobe renal cell carcinoma: 15 years following radical nephrectomy for low-stage disease. J Surg Case Rep 2019; 2019:rjz257. [PMID: 31528331 PMCID: PMC6736281 DOI: 10.1093/jscr/rjz257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022] Open
Abstract
The majority of patients with renal cell carcinoma develop recurrence within 5 years following radical nephrectomy. Very late sole local recurrence beyond 10 years is rare, and all reported cases had clear cell histology. Surgical resection of local recurrence remains the best option for disease management. This case opens the way for further studying the rare histological variants of renal cancer and to encourage prolonged follow-up and offering surgery as the best option for managing these cases.
Collapse
Affiliation(s)
- Asmaa Ismail
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Owen Prowse
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| |
Collapse
|