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Nkemjika S, Tokede O, Okosun IS, Jadotte Y, Pigott T. Biological sex disparity in survival outcomes following treatment for renal cell carcinoma: A systematic review and meta-analysis. Cancer Epidemiol 2023; 86:102409. [PMID: 37478631 DOI: 10.1016/j.canep.2023.102409] [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: 01/26/2023] [Accepted: 06/26/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Renal cell carcinoma (RCC), a type of kidney cancer has biological sex-based differences that play a role in cancer incidence. Specifically, the incidence of urinary system cancers in men is two times greater than in women, while the incidence of genital cancers is three times greater. There is conflicting epidemiologic and limited evidence in the literature to suggest apparent biological sex discrepancy. The primary objective of this review and meta-analysis is to synthesize evidence to understand biological sex disparity in the survival outcomes of RCC following any treatment intervention. METHODS A three-step search strategy was utilized in this review. We searched MEDLINE, EMBASE and PsycINFO databases for manuscript on biological sex differences in treatment outcomes. Study screening, critical appraisal, and data extraction were executed independently by pairs of reviewers among co-authors. Studies that had any form of treatment modality in the management of RCC were included. Study designs included observational studies in the form of prospective and retrospective studies that utilized cox proportional hazard assumption to conduct survival analysis. The data synthesis was carried out using the R metafor software package (Software version of 1.2.8) and Microsoft Office Excel 2019 package (Microsoft Corporation, USA). The random effects model was estimated using restricted maximum likelihood estimation (REML). Data synthesis included narrative review and meta-analysis. RESULTS We had 23 eligible studies for this review. On review of the full text, 35 studies were excluded due to irrelevances to measure estimates utilized. Finally, 12 studies were selected for the meta-analysis with a total of n = 21,2453 individuals. Females had a better survival outcome following a treatment intervention for RCC than their male counterpart [Mean effect size = -0.1737 (95 % CI: -0.2524, -0.0949)]. CONCLUSION Females were more likely to be cancer free than their male counterpart following treatment for RCC. This finding will inform appropriate decision making for stakeholders.
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Affiliation(s)
- Stanley Nkemjika
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, NY, USA.
| | | | - Ike S Okosun
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Yuri Jadotte
- Department of Family Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA; The Northeast Institute for Evidence Synthesis and Translation (NEST), JBI Center of Excellence, Rutgers School of Nursing, Newark, NJ, USA
| | - Therese Pigott
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
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Nayyar R, Khattar M, Dadhwal R, Singh P, Nayak B, Kumar R, Seth A. A Large Contemporary Experience of Renal Tumors in Young: Clinico-pathological Profile and Long-Term Survival Patterns. Indian J Surg Oncol 2023; 14:169-175. [PMID: 36891438 PMCID: PMC9986182 DOI: 10.1007/s13193-022-01643-2] [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: 04/11/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022] Open
Abstract
Renal tumors in young population are relatively rare. We reviewed our experience with renal masses in patients below 45 years of age. Our objective was to analyze clinico-pathological and survival characteristics of renal malignancy in young adults in contemporary era. The medical records of patients below 45 years of age who underwent surgery for renal mass at our tertiary care center between 2009 and 2019 were retrospectively analyzed. Pertinent clinical information was compiled, including age, gender, year and type of surgery, histopathology and survival data. A total of 194 patients who underwent nephrectomy for suspicious renal masses were included. Mean age was 35.5 (14-45) years and males were 125 (64.4%). A total of 29/198 (14.6%) specimens had benign disease. In addition, 155 (91.7%) out of 169 malignant tumors were renal cell carcinomas, clear cell variant being the most common type (51%). Compared to RCC, non-RCC tumors were more common in females (27.7 vs 78.6%, p < 0.0001), had an early age of diagnosis (27.2 vs 36.9 year, p < 0.00001) and poorer progression-free (58.3 vs 72.0%, p = 0.03) and overall survival (63.6 vs 84.2%, p = 0.02) at 6 years of follow-up. Renal masses in young adults are most commonly RCC but can also include other diverse types. RCC in young adults is usually organ confined and has good prognosis. As compared to RCC, non-RCC malignant tumors occur in young age, are more in females, and have worse prognosis. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-022-01643-2.
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Affiliation(s)
- Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Manish Khattar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Rohit Dadhwal
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029 India
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Schmeusser BN, Palacios AR, Midenberg E, Nabavizadeh R, Master VA, Joshi SS. Case report: Important considerations for a renal mass on a solitary kidney in an adult with history of childhood wilms tumor. Front Oncol 2022; 12:971341. [PMID: 35992837 PMCID: PMC9382288 DOI: 10.3389/fonc.2022.971341] [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: 06/16/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Adult survivors of childhood Wilms tumor are at an increased risk of secondary malignant neoplasms. The presence of a solitary kidney further complicates clinical management in this population. Herein, we present the case of a 37 year old female with a history of childhood Wilms tumor presenting with a secondary renal neoplasm. We highlight important clinical considerations for renal function preservation and present a finding of predisposition to kidney stone formation due to urinary stasis from distorted ureter architecture secondary to tumor mass effect.
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Adult Wilms tumor: An unusual case report with dedicated literature review. Clin Imaging 2022; 83:138-143. [DOI: 10.1016/j.clinimag.2021.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/12/2021] [Accepted: 12/30/2021] [Indexed: 11/21/2022]
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Alawad S, Alghamdi M, Alharbi M, Addar A, Al Khayal A, Alasker A. Characteristics of renal cell carcinoma in Saudi patients below the age of 50 years. Urol Ann 2022; 14:15-20. [PMID: 35197697 PMCID: PMC8815359 DOI: 10.4103/ua.ua_14_21] [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: 01/14/2021] [Accepted: 05/23/2021] [Indexed: 12/05/2022] Open
Abstract
Background: The incidence of renal cell carcinoma (RCC) in young adults has started to increase in recent years. Objectives: The objective of the study was to describe and compare the mode of presentation, incidence, risk factors, histopathological features, nephrectomy modalities used, and outcome in patients diagnosed with RCC below the age of 50. Materials and Methods: A total of 139 confirmed RCC patients diagnosed below the age of 50 years who underwent nephrectomy from January 1990 to April 2019 were included in this retrospective review. We compared the characteristics of two age groups (≤40 years and 41–50 years) and evaluated incidentally discovered versus symptomatic tumors in patients below 50 years. Results: Loin pain contributed to most symptomatic presentations in the older group (55%) (P = 0.014). Hypertension and diabetes were present in 24% of patients from 41 to 50 years of age versus 3.8% for hypertension and 5.7% for diabetes in the young group. (P = 0.001 and P = 0.004, respectively). Chromophobe was the second most common pathology (26.5%). Tumor size tended to be larger in the older group (P = 0.006). Fuhrman's grade was significantly lower in incidentally diagnosed patients (88.2%) (P = 0.006). The T stage was significantly lower in the incidental group (P = 0.005), but the mortality rate was higher in symptomatic patients (9.6%) (P = 0.013). Conclusion: RCC increases after the age of 40–50 years in the presence of other risk factors. Chromophobe represented almost a quarter percentage of the pathology, while partial nephrectomy yielded a better outcome.
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Nkemjika S, Tokede O, Jadotte Y, Olatunji E, Bosah J, Pigott T, Okosun IS. Biological sex disparity in survival outcomes following treatment for renal cell carcinoma: a systematic review protocol. JBI Evid Synth 2021; 19:3355-3362. [PMID: 34261092 DOI: 10.11124/jbies-20-00277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This systematic review will assess the biological sex disparity in survival outcomes following treatment for renal cell carcinoma and analyze the estimates of biological sex disparity outcomes following supposed or proposed curative treatment. INTRODUCTION Renal cell carcinoma is a type of kidney cancer. There is a lack of conformity in the literature on the biological sex disparity in survival outcomes after treatment. This review will help inform the decision-making of clinicians, health care administrators, policy makers, public health workers, and pharmaceutical/biotechnology researchers in predicting positive outcomes following treatment. INCLUSION CRITERIA The review will consider prospective and retrospective studies on any form of treatment for renal cell carcinoma. The Cox proportional hazard assumption will be used to conduct survival analysis. Hazard rates of participants' survivability across biological sex will also be reported. METHODS A three-step search strategy will be used. First, a limited search of MEDLINE, Embase, and PsycINFO was conducted and text words in the title, abstract, and index terms were analyzed. Second, a search using identified keywords and index terms will be tailored for all included databases. Third, the reference lists of all included reports and articles will be screened to search for additional studies. There will be no language or date restrictions. Papers not written in English but with a professional translated copy will be included. Study screening, critical appraisal, and data extraction will be conducted independently by pairs of reviewers. Data synthesis will include narrative review and meta-analysis, if appropriate. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020195721.
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Affiliation(s)
- Stanley Nkemjika
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.,Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
| | - Oluwatosin Tokede
- Rural Health Corporation of Northeastern Pennsylvania, Freeland, PA, USA
| | - Yuri Jadotte
- Department of Family Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): A JBI Centre of Excellence, Rutgers School of Nursing, Newark, NJ, USA
| | - Eniola Olatunji
- Department of Health Policy, School of Public Health, Texas A&M, College Station, TX, USA
| | - John Bosah
- Montefiore Einstein Starfish Program, Montefiore Medical Center, Bronx, NY, USA
| | - Terri Pigott
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.,College of Education & Human Development, Georgia State University, Atlanta, GA, USA
| | - Ike S Okosun
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
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Renal cell carcinoma incidence rates and trends in young adults aged 20-39 years. Cancer Epidemiol 2020; 67:101762. [DOI: 10.1016/j.canep.2020.101762] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 11/20/2022]
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Zaharie A, Bolboacă SD, Moisoiu T, Burghelea D, Iacob G, Ghervan L, Elec FI. Renal Tumors in Young Adults: Is Preoperative Computer Tomography Imaging Suggestive for the Nature of the Tumors? Diagnostics (Basel) 2020; 10:diagnostics10060380. [PMID: 32517346 PMCID: PMC7345588 DOI: 10.3390/diagnostics10060380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 01/20/2023] Open
Abstract
Renal cell carcinoma (RCC) accounts for 2–3% of all adult malignant neoplasms and is even rarer in patients under 45 years old. Clear-cell carcinoma represents most of the pathological subtypes. Our study aimed to investigate the association between preoperative computer tomography imagistic evaluation and histopathological diagnosis of renal tumors in young adults. Patients younger than 45 years old with renal tumors who were referred for medical treatment at the Clinical Institute of Urology and Renal Transplantation Cluj-Napoca from 2012 to 2019 were considered eligible for the study. Medical charts were retrospectively reviewed, and patients with complete data regarding preoperative diagnostic, histopathological evaluation, and follow-up data, regardless of gender, were included in the study. Sixteen patients younger than 45 years fulfilled all the inclusion criteria and were evaluated. With two exceptions, the evaluated patients were in a T1 and T2 stage, with no vascular invasion or of the adjacent organs. Two-thirds of our patients had a clear-cell renal cell carcinoma. None of our patients fitted in the low complexity surgery category of the R.E.N.A.L. Nephrometry Score and 37.5% of them benefited from partial nephrectomy. Half of the suppositions made based on imaging were concordant with the histopathology report. Fifteen of the patients showed no recurrence during the respective follow-up interval. Computer tomography imaging reports showed on our sample a higher concordance with the histopathological report in the more common subtypes (namely Renal Clear Cell RCC), with typical appearances.
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Affiliation(s)
- Andreea Zaharie
- Department of Medical Imaging, “Leon Daniello” Pulmonology Hospital, Cluj-Napoca, Bogdan Petriceicu Hașdeu Street, no. 6, 400332 Cluj-Napoca, Romania
- Correspondence: (A.Z.); (S.D.B.); (F.I.E.); Tel.: +40-762-298-833 (A.Z.); +40-374-834-506 (S.D.B.); +40-722-822-740 (F.I.E.)
| | - Sorana D. Bolboacă
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Str., no. 6, 400349 Cluj-Napoca, Romania
- Correspondence: (A.Z.); (S.D.B.); (F.I.E.); Tel.: +40-762-298-833 (A.Z.); +40-374-834-506 (S.D.B.); +40-722-822-740 (F.I.E.)
| | - Tudor Moisoiu
- Department of Urology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania; (T.M.); (D.B.); (L.G.)
| | - Dan Burghelea
- Department of Urology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania; (T.M.); (D.B.); (L.G.)
| | - Gheorghita Iacob
- Department of Pathology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania;
| | - Liviu Ghervan
- Department of Urology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania; (T.M.); (D.B.); (L.G.)
- Department of Urology, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania
| | - Florin Ioan Elec
- Department of Urology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania; (T.M.); (D.B.); (L.G.)
- Department of Urology, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania
- Correspondence: (A.Z.); (S.D.B.); (F.I.E.); Tel.: +40-762-298-833 (A.Z.); +40-374-834-506 (S.D.B.); +40-722-822-740 (F.I.E.)
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Aslan R, Taken K, Eryılmaz R. Clinicopathological Features and Survival Data of Localized Renal Masses in Young Adults. Asian Pac J Cancer Prev 2018; 19:3233-3236. [PMID: 30486625 PMCID: PMC6318400 DOI: 10.31557/apjcp.2018.19.11.3233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose: Renal tumors are rarely seen in young adults. In this study, was aimed to report the data of 18-40 years old patients with Renal Cell Carcinoma (RCC) whom we operated. Material and Method: We retrospectively reviewed the data of patients between the ages of 18 and 40 years old patients who have renal masses. All patients were evaluated with chest X-ray, Computed tomography (CT) and/or MRI. Radical or partial nephrectomy was performed for clinical localized masses with malignancy suspicion. Clinicopathological features and survival data of all the patients were recorded. In the follow-up protocol routine blood tests, chest X-ray and abdominal CT were used. Results: A total of 42 patients, [22 (52.4%) male and 20 (47.6%) female], with a mean age of 34.48 (range 18 to 40) were included in the study. Of these, 32 (%76) had RCC and 10 (24%) had benign pathologies. Female patients had more benign pathology (35% vs 13.6%). The most commonly subtype of RCC (n = 22% 69) was clear cell RCC (cRCC), while the most common benign mass was oncocytoma (n = 4% 40). At the mean follow-up period of 42.34 months, overall survival rate was found to be 93.8%. Conclusion: Young adults with localized renal mass have benign pathology in a considerable rate. All of the malign masses in this population have low Furhman grade (1 or 2).
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Affiliation(s)
- Rahmi Aslan
- Department of Urology, Medical Faculty, Yuzunci Yıl University, Van, Turkey.
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Ratajczyk K, Czekaj A, Rogala J, Kowal P. Adult Wilms tumor with inferior vena cava thrombus and distal deep vein thrombosis - a case report and literature review. World J Surg Oncol 2018; 16:38. [PMID: 29471818 PMCID: PMC5824467 DOI: 10.1186/s12957-018-1343-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/15/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Adult Wilms tumor (WT, nephroblastoma) is a rare, but well-described renal neoplasm. Although inferior vena cava tumor thrombosis is present in up to 10% of Wilms tumors in childhood, only few cases of this clinical manifestation in adults have been reported. To the best of our knowledge, this is the first case of adult WT infiltrating into inferior vena cava (IVC) with concomitant distal deep vein thrombosis. CASE PRESENTATION A 28-year-old male patient with gross hematuria and right flank pain was diagnosed with right kidney tumor penetrating to IVC. Preoperatively, acute distal thrombosis in inferior vena cava and lower extremities veins occurred. Right radical nephrectomy with tumor thrombectomy via cavotomy was performed. In order to prevent pulmonary embolism, IVC was ligated below left renal vein level. Histopathological examination revealed a triphasic nephroblastoma without anaplastic features. Postoperatively, patient was diagnosed with metastatic liver disease, which was treated with two lines of chemotherapy followed by radiotherapy with achievement of complete response. CONCLUSIONS Adult WT occurs usually in young patients, under 40 years of age. Neoadjuvant chemotherapy proved to be effective in children, resulting with tumor shrinkage and venous tumor thrombus regression. Therefore, percutaneous biopsy should be always considered in young patients presenting with renal tumor invading venous system. IVC ligation is a safe treatment option in the event of complete inferior vena cava occlusion due to distal thrombosis concomitant to tumor thrombus, provided collateral venous pathways are well-developed.
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Affiliation(s)
| | - Adrian Czekaj
- Department of Urology, Regional Specialist Hospital, Wroclaw, Poland
| | - Joanna Rogala
- Department of Pathology, Regional Specialist Hospital, Wroclaw, Poland
| | - Pawel Kowal
- Department of Urology, Regional Specialist Hospital, Wroclaw, Poland
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Perera M, Papa N, Ischia J, Christidis D, Bolton D, Lawrentschuk N. Trends in percutaneous renal biopsy: The evolving diagnostic pathway for the small renal mass. Urol Ann 2018; 10:237-239. [PMID: 30089978 PMCID: PMC6060599 DOI: 10.4103/0974-7796.236516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Marlon Perera
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Nathan Papa
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Joseph Ischia
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Urology, Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
| | - Daniel Christidis
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Damien Bolton
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Urology, Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Urology, Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Andreu Z, Otta Oshiro R, Redruello A, López-Martín S, Gutiérrez-Vázquez C, Morato E, Marina AI, Olivier Gómez C, Yáñez-Mó M. Extracellular vesicles as a source for non-invasive biomarkers in bladder cancer progression. Eur J Pharm Sci 2016; 98:70-79. [PMID: 27751843 DOI: 10.1016/j.ejps.2016.10.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/15/2016] [Accepted: 10/04/2016] [Indexed: 12/18/2022]
Abstract
Bladder cancer is the second most frequent malignancy of the urinary tract after prostate cancer. Current diagnostic techniques, such as cystoscopy and biopsies are highly invasive and accompanied of undesirable side effects. Moreover, there are no suitable biomarkers for relapse or progression prognosis. We analysed whether the specific composition of microRNAs (miRNAs) and proteins of extracellular vesicles (EVs) that urothelial tumour cells of bladder mucosa release into the urine, could reflect their pathologic condition. For this purpose, urinary EVs were isolated and their protein and miRNA composition evaluated in healthy donors and low or high-grade bladder cancer patients. Using a microarray platform containing probes for 851 human miRNAs we found 26 deregulated miRNAs in high-grade bladder cancer urine EVs, from which 23 were downregulated and 3 upregulated. Real-time PCR analysis pointed to miR-375 as a biomarker for high-grade bladder cancer while miR-146a could identify low-grade patients. Finally, several protein markers were also deregulated in EVs from tumour patients. Our data suggest that the presence of ApoB in the 100,000 pellet is a clear marker for malignancy.
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Affiliation(s)
- Zoraida Andreu
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Renan Otta Oshiro
- Servicio de Urología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Spain
| | - Alberto Redruello
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Soraya López-Martín
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Cristina Gutiérrez-Vázquez
- Servicio de Inmunología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Unidad de Proteómica, CBM-SO, Madrid, Spain; Departamento de Biología Molecular, UAM/CBM-SO, Madrid, Spain
| | | | | | - Carlos Olivier Gómez
- Servicio de Urología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Spain
| | - María Yáñez-Mó
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain; Departamento de Biología Molecular, UAM/CBM-SO, Madrid, Spain.
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Ju X, Li P, Shao P, Lv Q, Wang Z, Qin C, Li J. Retroperitoneal Laparoscopic Nephrectomy Combined with Bench Surgery and Autotransplantation for Renal Cell Carcinoma in the Solitary Kidney or Tumor Involving Bilateral Kidneys: Experience at a Single Center and Technical Considerations. Urol Int 2016; 97:473-479. [DOI: 10.1159/000448594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/19/2016] [Indexed: 11/19/2022]
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15
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Laguna MP. Re: Cystic Renal Cell Carcinoma Carries an Excellent Prognosis Regardless of Tumor Size. J Urol 2016; 196:1042-3. [PMID: 27628787 DOI: 10.1016/j.juro.2016.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2016] [Indexed: 11/26/2022]
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Chromophobe renal cell carcinoma in an 18-year-old female. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2016.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Liu S, Lee S, Rashid P, Bangash H, Hamid A, Lau J, Cohen R. Active surveillance is suitable for intermediate term follow-up of renal oncocytoma diagnosed by percutaneous core biopsy. BJU Int 2016; 118 Suppl 3:30-34. [PMID: 27457972 DOI: 10.1111/bju.13538] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Shuo Liu
- Royal Perth Hospital; Perth WA Australia
- Port Macquarie Base Hospital; Port Macquarie NSW Australia
| | - Stephen Lee
- Uropath Pty Ltd; West Leederville WA Australia
- Faculty of Medicine and Dentistry; School of Pathology and Laboratory Medicine; University of Western Australia; Crawley WA Australia
| | - Prem Rashid
- Port Macquarie Base Hospital; Port Macquarie NSW Australia
- Faculty of Medicine; Rural Clinical School; University of New South Wales; Sydney NSW Australia
| | - Haider Bangash
- Royal Perth Hospital; Perth WA Australia
- Fiona Stanley Hospital; Perth WA Australia
| | - Akhlil Hamid
- Royal Perth Hospital; Perth WA Australia
- Fiona Stanley Hospital; Perth WA Australia
| | - Jason Lau
- Uropath Pty Ltd; West Leederville WA Australia
| | - Ronald Cohen
- Uropath Pty Ltd; West Leederville WA Australia
- Faculty of Medicine and Dentistry; School of Pathology and Laboratory Medicine; University of Western Australia; Crawley WA Australia
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Yıkılmaz TN, Baş O, Arık Aİ, Hızlı F, Başar H. The relationship between histopathology and age factor in patients who were operated for renal masses. Turk J Urol 2015; 41:57-60. [PMID: 26328202 DOI: 10.5152/tud.2015.54521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/10/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Renal neoplasms have a predilection to occur in older patients and they are often malignant. They may have different structural characteristics according to age groups. In our study, we have investigated age-related demographic characteristics of the patients who were operated because of suspected malignant renal masses. MATERIALS AND METHODS Between 2010 and 2014, 129 patients were treated surgically for suspected malignant renal masses at our institution. These cases had undergone open radical, open partial, and laparoscopic radical nephrectomies. Patients were divided into two groups based on their ages and evaluated accordingly as Group 1 (≤50 years) and Group 2 (>50 years). Groups were compared based on their clinical and pathological features. RESULTS Group 1 and Group 2 consisted of 29 (22.4%) and 91 (77.6%) patients, respectively. The mean age of younger patients was 43.1 years (23-49 years), with a male to female ratio of 19/10, while the average tumor size was 57.6 mm (20-120 mm). Twenty-four patients (83%) had a malignant pathology and five patients (17%) had a benign pathology. Clear cell carcinoma was diagnosed in 67% of the patients in both groups. There was no significant difference with respect to age and tumor size of male and female patients in the younger age group, while younger female adults tended to have a more benign pathology than their male counterparts (40% and 5%, respectively, p<0.05). CONCLUSION There was no significant difference with respect to gender, tumor size, laterality, and surgical and pathologic features between younger and older patients. An organ- sparing approach should be strongly considered when treatment for renal tumors in young females is performed because of a potentially higher incidence of a benign pathology of renal masses.
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Affiliation(s)
- Taha Numan Yıkılmaz
- Clinic of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Center, Ankara, Turkey
| | - Okan Baş
- Clinic of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Center, Ankara, Turkey
| | - Ali İhsan Arık
- Clinic of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Center, Ankara, Turkey
| | - Fatih Hızlı
- Clinic of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Center, Ankara, Turkey
| | - Halil Başar
- Clinic of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Center, Ankara, Turkey
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Winters BR, Gore JL, Holt SK, Harper JD, Lin DW, Wright JL. Cystic renal cell carcinoma carries an excellent prognosis regardless of tumor size. Urol Oncol 2015; 33:505.e9-13. [PMID: 26319351 DOI: 10.1016/j.urolonc.2015.07.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/22/2015] [Accepted: 07/26/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cystic renal cell carcinoma (cystic RCC) is thought to carry an improved prognosis relative to clear cell RCC (CCRCC); however, this is based on small case series. We used a population-based tumor registry to compare clinicopathologic features and cancer-specific mortality (CSM) of cystic RCC with those of CCRCC. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results database was queried for all patients diagnosed and treated for cystic RCC and CCRCC between 2001 and 2010. Clinical and pathologic factors were compared using t tests and chi-square tests as appropriate. Kaplan-Meier survival analysis compared CSM differences between cystic RCC and CCRCC. RESULTS A total of 678 patients with cystic RCC and 46,677 with CCRCC were identified. The mean follow-up duration was 52 and 40 months, respectively. When compared with CCRCC patients, those with cystic RCC were younger (mean age 58 vs. 61 y, P < 0.001), more commonly black (22% vs. 9%, P < 0.001), and female (45% vs. 41%, P = 0.02). Cystic RCCs were more commonly T1a tumors (66% vs. 55%, P < 0.001), well differentiated (33% vs. 16%, P < 0.001), and smaller (mean size = 3.8 vs. 4.5 cm, P < 0.001). Cystic RCC was associated with a reduction in CSM when compared with CCRCC (P = 0.002). In a subset analysis, this reduction in CSM was seen only for those with T1b/T2 tumors (P = 0.01) but not for those with T1a RCCs lesions (P = 0.31). CONCLUSIONS We report the largest series of cystic RCC and corroborate the findings of improved CSM when compared with CCRCC for larger tumors; however, no difference was noted in smaller tumors, suggesting that tumor biology becomes more relevant to prognosis with increasing size. These data may suggest a role for active surveillance in appropriately selected patients with small, cystic renal masses.
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Affiliation(s)
- Brian R Winters
- Department of Urology, University of Washington School of Medicine, Seattle, WA.
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Daniel W Lin
- Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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Ha SB, Kwak C. Current status of renal biopsy for small renal masses. Korean J Urol 2014; 55:568-73. [PMID: 25237457 PMCID: PMC4165918 DOI: 10.4111/kju.2014.55.9.568] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/26/2014] [Indexed: 02/05/2023] Open
Abstract
Small renal masses (SRMs) are defined as radiologically enhancing renal masses of less than 4 cm in maximal diameter. The incidence of renal cell carcinoma (RCC) has increased in recent years, which is mainly due to the rise in incidental detection of localized SRMs. However, the cancer-specific mortality rate is not increasing. This discrepancy may be dependent on the indolent nature of SRMs. About 20% of SRMs are benign, and smaller masses are likely to have pathologic characteristics of low Fuhrman grade and clear cell type. In addition, SRMs are increasingly detected in elderly patients who are likely to have comorbidities and are a high-risk group for active treatment like surgery. As the information about the nature of SRMs is improved and management options for SRMs are expanded, the current role of renal mass biopsy for SRMs is also expanding. Traditionally, renal mass biopsy has not been accepted as a standard diagnostic tool in the clinical scenario because of several issues about safety and accuracy. However, current series on SRM biopsy have reported high diagnostic accuracy with rare complications. Studies of modern SRM biopsy have reported diagnostic accuracy greater than 90% with very high specificity. Also, current series have shown very rare morbid cases caused by renal mass biopsy. Currently, renal biopsy of SRMs can be recommended in most cases except when patients have imaging or clinical characteristics indicative of pathology and in cases in which conservative management is not considered.
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Affiliation(s)
- Seung Beom Ha
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Wang YJ, Han TT, Xue JX, Chang DS, Li HQ, Li P, Wang JD, Wang YJ, Xia TY. Stereotactic gamma-ray body radiation therapy for asynchronous bilateral renal cell carcinoma. Radiol Med 2014; 119:878-83. [DOI: 10.1007/s11547-014-0402-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/05/2014] [Indexed: 10/25/2022]
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Do Young Patients with Renal Cell Carcinoma Feature a Distinct Outcome after Surgery? A Comparative Analysis of Patient Age Based on the Multinational CORONA Database. J Urol 2014; 191:310-5. [DOI: 10.1016/j.juro.2013.08.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2013] [Indexed: 11/24/2022]
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23
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Evaluation of anatomic and morphologic nomogram to predict malignant and high-grade disease in a cohort of patients with small renal masses. Urol Oncol 2014; 32:37.e17-23. [DOI: 10.1016/j.urolonc.2013.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 02/22/2013] [Accepted: 03/11/2013] [Indexed: 01/20/2023]
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Laguna MP. Re: an investigation of risk factors for renal cell carcinoma by histologic subtype in two case-control studies. J Urol 2013; 191:55. [PMID: 24331471 DOI: 10.1016/j.juro.2013.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kim MH, Lee J, Cho G, Cho KS, Kim J, Kim JK. MDCT-based scoring system for differentiating angiomyolipoma with minimal fat from renal cell carcinoma. Acta Radiol 2013; 54:1201-9. [PMID: 23864062 DOI: 10.1177/0284185113491087] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Subtype-related various computed tomography (CT) features of renal cell carcinoma (RCC) are a confusing factor in differentiating angiomyolipoma with minimal fat (AMLmf) from RCC. To overcome RCC heterogeneity, a scoring system, which integrates multiple discrimitive parameters can be helpful for differentiating AMLmf from RCC. PURPOSE To develop a MDCT-based scoring system for differentiating AMLmf from RCC. MATERIAL AND METHODS In 407 patients with pathologically confirmed 48 AMLmfs and 359 RCCs (247 clear cell RCCs, 67 papillary RCCs, and 45 chromophobe RCCs), MDCT features (ratio of long-to-short diameter, enhancement characteristics, tumor attenuation on unenhanced scan, tumor margin, calcification), age, and sex were compared between AMLmf and RCCs. Based on logistic regression, a scoring system for diagnosing AMLmf over RCC was built, and its diagnostic accuracy was evaluated. RESULTS Scores suggesting AMLmf, i.e. the logit function as used in logistic regression analysis, were calculated as follows: Score = e(6.16.A-0.003.B+1.20.C+0.97.D+2.13.E-0.05.F)/1+e(6.16.A-0.003.B+1.20.C+0.97.D+2.13.E-0.05.F), where A = ratio of long-to-short diameter, B = enhancement amount in early excretory phase, C = homogeneous enhancement, D = tumor attenuation on unenhanced scan, E = sex, and F = age. Area under receiver-operating characteristics curve of scoring system was 0.919. With a score of 0.204 or higher, the scoring system yielded greatest accuracy (90%, 368/407) for diagnosing AMLmf over RCC, which was greater than that of any single MDCT or clinical parameter (53-85%) (P < 0.05). With a score of 0.317 or higher, sensitivity and specificity were 68% (32/48) and 95% (340/359). CONCLUSION MDCT-based scoring system can improve diagnostic performance of MDCT in differentiating AMLmf from RCC and help patients with AMLmf to avoid unnecessary surgery with high specificity.
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Affiliation(s)
- Mi-hyun Kim
- Department of Radiology, Research Institute of Radiology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - JungBok Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gyunggoo Cho
- Division of Magnetic Resonance, Korea Basic Science Institute, Chungbuk, Republic of Korea
| | - Kyoung-Sik Cho
- Department of Radiology, Research Institute of Radiology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jungmi Kim
- Sogang Center for Writing, Sogang University, Seoul, Republic of Korea
| | - Jeong Kon Kim
- Department of Radiology, Research Institute of Radiology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Division of Magnetic Resonance, Korea Basic Science Institute, Chungbuk, Republic of Korea
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Shin TY, Kim J, Koo KC, Lim SK, Kim DW, Kang MW, Rha KH, Choi YD, Ham WS. Assessing the anatomical characteristics of renal masses has a limited effect on the prediction of pathological outcomes in solid, enhancing, small renal masses: results using the PADUA classification system. BJU Int 2013; 113:754-61. [DOI: 10.1111/bju.12446] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Tae Young Shin
- Department of Urology; Hallym University College of Medicine; Chuncheon Korea
| | - Jongchan Kim
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Kyo Chul Koo
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Sey Kiat Lim
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Dong Wook Kim
- Department of Urology; Hallym University College of Medicine; Chuncheon Korea
| | - Min Woong Kang
- Biostatistics Collaboration Unit; Yonsei University College of Medicine; Seoul Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Won Sik Ham
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
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Costa WHD, Rocha RM, Cunha IWD, Guimaraes GC, Zequi SDC. Immunohistochemical expression of CD44s in renal cell carcinoma lacks independent prognostic significance. Int Braz J Urol 2013; 38:456-65. [PMID: 22951174 DOI: 10.1590/s1677-55382012000400004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2012] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To analyze the immunohistochemical expression of the standard isoform of CD44 (CD44s) adhesion molecule in clear cell renal cell carcinoma (CCRCC) and its impact on clinical outcomes. MATERIALS AND METHODS Ninety-nine consecutive patients treated surgically for RCC between 1992 and 2009 were selected. A single pathologist reviewed all cases to effect a uniform reclassification and determine the most representative tumor areas for construction of a tissue microarray. The same pathologist, who was blinded to the outcome of the cases, semi-quantitatively scored the staining intensity of CD44s in all specimens. The counting was done using the H-Score algorithm. RESULTS Of the 99 immunostained RCC specimens, 57(57.7 %) showed low expression, and 42(42.4 %) showed high expression levels of CD44s. The expression of CD44s was directly associated with tumor size (p = 0.03), clinical stage (p = 0.02) and Fuhrman grade (p = 0.02). Disease specifi c survival (DSS) rates for patients whose specimens expressed low and high levels of CD44s was 88.1 % and 67.5 %, respectively (p = 0.009). Progression free survival (PFS) rates in patients with low and high expression of CD44s were 78.8 % and 61.7 %, respectively (p = 0.05). Classical features such as the presence of metastasis and clinical stage remained isolated predictors of survival. CONCLUSIONS Immunohistochemical expression of CD44s was associated with important clinical variables such as stage and Fuhrman grade. However, it was not an independent predictor of survival. Therefore, we believe it has a limited role as a prognostic marker in patients with CCRCC.
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Bell MD, Lavallée LT, Dahm P, Witiuk K, Breau RH. Diagnostic tests in urology: percutaneous biopsy of renal masses. BJU Int 2013; 111:362-4. [PMID: 23356750 DOI: 10.1111/j.1464-410x.2012.11440.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Purdue MP, Moore LE, Merino MJ, Boffetta P, Colt JS, Schwartz KL, Bencko V, Davis FG, Graubard BI, Janout V, Ruterbusch JJ, Beebe-Dimmer J, Cote ML, Shuch B, Mates D, Hofmann JN, Foretova L, Rothman N, Szeszenia-Dabrowska N, Matveev V, Wacholder S, Zaridze D, Linehan WM, Brennan P, Chow WH. An investigation of risk factors for renal cell carcinoma by histologic subtype in two case-control studies. Int J Cancer 2013; 132:2640-7. [PMID: 23150424 DOI: 10.1002/ijc.27934] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 10/05/2012] [Indexed: 12/23/2022]
Abstract
To investigate whether renal cell carcinoma (RCC) histologic subtypes possess different etiologies, we conducted analyses of established RCC risk factors by subtype (clear cell, papillary and chromophobe) in two case-control studies conducted in the United States (1,217 cases, 1,235 controls) and Europe (1,097 cases, 1,476 controls). Histology was ascertained for 706 U.S. cases (58% of total) and 917 European cases (84%) through a central slide review conducted by a single pathologist. For the remaining cases, histology was abstracted from the original diagnostic pathology report. Case-only analyses were performed to compute odds ratios (ORs) and 95% confidence intervals (CI) summarizing subtype differences by age, sex and race. Case-control analyses were performed to compute subtype-specific ORs for other risk factors using polytomous regression. In case-only analyses, papillary cases (N = 237) were older (OR = 1.2, 95% CI = 1.1-1.4 per 10-year increase), less likely to be female (OR = 0.5, 95% CI = 0.4-0.8) and more likely to be black (OR = 2.6, 95% CI = 1.8-3.9) as compared to clear cell cases (N = 1,524). In case-control analyses, BMI was associated with clear cell (OR = 1.2, 95% CI = 1.1-1.3 per 5 kg/m(2) increase) and chromophobe RCC (N = 80; OR = 1.2, 95% CI = 1.1-1.4), but not papillary RCC (OR = 1.1, 95% CI = 1.0-1.2; test versus clear cell, p = 0.006). No subtype differences were observed for associations with smoking, hypertension or family history of kidney cancer. Our findings support the existence of distinct age, sex and racial distributions for RCC subtypes, and suggest that the obesity-RCC association differs by histology.
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Affiliation(s)
- Mark P Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
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Abstract
PURPOSE OF REVIEW Small renal masses (SRMs) are frequently encountered due to the ubiquitous use of abdominal cross-sectional imaging. Enhanced risk prediction in the management of SRMs would allow for a more informed decision of which, if any, patients would benefit from the available intervention modalities. RECENT FINDINGS Data suggest that a substantial proportion of SRMs are benign and that a significant proportion demonstrate indolent clinical behavior, leading to increased implementation of active surveillance strategies. Extirpative treatment of SRMs may be associated with worse outcomes, particularly in the elderly and infirm. Patient characteristics, including advanced age and comorbidity, and tumor anatomy are being increasingly recognized as having significant prognostic importance in terms of which type of treatment to offer. Further, a recent renewed interest in renal mass biopsy for risk stratification in SRMs has occurred as tumor size, radiographic characteristics, and growth kinetics are limited in their predictive capacity. SUMMARY Within the last decade, the reference standard treatment of SRMs evolved from radical nephrectomy to nephron-sparing approaches. This evolution continues, as we learn more about the complex interplay between patient and tumor characteristics and, as outcomes data mature, to ablative therapies and active surveillance.
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Mustafa G, Ilhan G, Necip P, Kerem T, Kadir C. Nature of lesions undergoing radical nephrectomy for renal cancer. Asian Pac J Cancer Prev 2012; 13:4431-3. [PMID: 23167356 DOI: 10.7314/apjcp.2012.13.8.4431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM The aim of the present study was to evaluate retrospectively histopathologically-diagnosed lesions that were detected in the kidney after radical nephrectomy for a preoperative diagnosis of kidney cancer. METHODS The medical records of 83 patients (51 male, 32 female) were included. Preoperative staging was accomplished by various methods including physical examination, blood hemography and biochemistry, abdominal ultrasonography (US), chest x-ray, abdominal computed tomography (CT) and abdominal magnetic resonance imaging (MRI). RESULTS Totals of 70 patients underwent radical nephrectomy and 13 nephron sparing surgery. Of the 83 patients, 70 had malignant lesions (renal cell carcinoma, squamous cell carcinoma or other malignancies) 13 had a variety of benign lesions, the most frequently detected being oncoytoma (6), angiomyolipoma (3), xanthogranulamatous pyelonephritis (2), cortical cyst (1) and chronic pyelonephritic change (1). CONCLUSION It was concluded that in spite of great technological developments regarding radiological imaging modalities such as US, CT and MRI, benign lesions might still be detected pathologically in patients who undergo radical nephrectomy with the preoperative diagnosis of renal cancer. But, all renal masses should be regarded as malignant and should be managed surgically otherwise proven benign.
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Affiliation(s)
- Gunes Mustafa
- Yuzuncu Yil University, Medical Faculty, Department of Urology, Van, Turkey.
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Cost NG, Cost CR, Geller JI, Defoor WR. Adolescent urologic oncology: current issues and future directions. Urol Oncol 2012; 32:59-69. [PMID: 23141778 DOI: 10.1016/j.urolonc.2012.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 07/09/2012] [Accepted: 08/02/2012] [Indexed: 01/04/2023]
Abstract
Recent Surveillance Epidemiology and End Results (SEER) data indicate that the annual cancer incidence in adolescents is higher than in children, and is on the rise. However, the amount of attention, research funding, and therapeutic progress made in the adolescent oncology population pales in comparison with that of pediatric oncology. Issues of adolescent oncology have only recently been acknowledged by leaders in the field, and current efforts now focus on raising awareness of this unique patient group. In urology, there have been many gains made in pediatric urologic oncology, most notably in Wilms tumor and genitourinary rhabdomyosarcoma (genitourinary [GU] rhabdomyosarcoma [RMS]); however, there has been little to no progress in the adolescent population. In general, adolescent cancer represents the interface between pediatric and adult oncology. Similarly, adolescent urologic oncology must be approached as a distinct entity because of the unique disease processes, treatment-related comorbidities, and psychosocial issues. This article will serve to review the most pertinent adolescent urologic oncologic diagnoses (testicular germ call malignancy, the second peak of the bimodal age distribution of GU-RMS, and adolescent renal malignancies). Also, we focus on such issues as the therapeutic impact on fertility, radiation exposure during therapy, and surveillance, risk of secondary malignancy, the long-term impact of chemotherapy, and the psychosocial burden of cancer in this population. Lastly, we highlight future directions and the foreseeable obstacles towards achieving the same research and therapeutic success enjoyed in pediatric urologic oncology.
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Affiliation(s)
- Nicholas G Cost
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Carrye R Cost
- Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - James I Geller
- Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - W Robert Defoor
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Zhang S, Zhao X, Ji C, Liu G, Li X, Zhang G, Gan W, Guo H. Radiofrequency ablation of synchronous bilateral renal cell carcinoma. Int J Urol 2011; 19:241-7. [DOI: 10.1111/j.1442-2042.2011.02918.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Histopathology of surgically treated renal tumours in young adults: a developing country perspective. J Cancer Res Clin Oncol 2011; 138:189-94. [PMID: 22083212 DOI: 10.1007/s00432-011-1082-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 11/01/2011] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is no data on the histopathological characteristics of renal tumours in young adults in Pakistan. MATERIALS AND METHODS We retrospectively analysed 133 young adults (age: 16 to ≤40 years) who underwent nephrectomy for suspected renal cancer from 1994 till July 2010. The demographical and pathological parameters were determined from original surgical biopsy reports and case files, and analysed. RESULTS The mean age of patients was 33.3 ± 6.2 years. Overall, 121 (88.9%) renal tumours were malignant, and 15 (11%) benign. Among malignant tumours, renal cell carcinoma (RCC) was predominant (100/121; 82.6%). The subtypes of RCC included: clear cell RCC, 84 (84%); papillary RCC, 11 (11%), chromophobe RCC, 3 (3%) and sarcomatoid RCC, 2 (2%). Other malignant tumours included: transitional cell carcinoma (9/121; 7.4%), primitive neuroectodermal tumour (5/121; 4.1%), synovial sarcoma (2/121; 1.6%), Non-Hodgkin's lymphoma (2/121; 1.6%), leiomyosarcoma (1/121; 0.8%), malignant fibrous histiocytoma (1/121; 0.8%) and squamous cell carcinoma (1/121; 0.8%). Among benign tumours, there were 11 cases of angiomyolipoma (11/15; 73.3%), three cases of oncocytoma (3/15; 20%) and one case of schwannoma (1/15; 6.6%). Almost two-third (62.7%) patients had stage I/II tumours, 22 (18.1%) stage III and 23 (19%) stage IV disease at the time of surgery. CONCLUSION A wide variety of renal tumours is documented in young adults with large size of the tumours and late presentation in our population.
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Lee LS, Yuen JSP, Sim HG. Renal Cell Carcinoma in Young Patients is Associated with Poorer Prognosis. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n9p401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: Renal cell carcinoma (RCC) in young patients is uncommon but thought to represent a distinctive clinical entity from older patients with different clinico-pathologic features and outcomes. We evaluated the association of age at the time of diagnosis with pathological staging, histological parameters, disease recurrence and overall survival (OS) following radical or partial nephrectomy for non-metastatic RCC in native kidneys. Materials and Methods: A retrospective review of 316 patients with RCC after nephrectomy at a single institution between January 2001 and June 2008 was performed. Eligible patients included all histologically proven primary non-metastatic RCC treated by radical or partial nephrectomy. They were categorised into group A (≤40 years at diagnosis) and B (>40 years). Differences in clinical parameters were analysed using the Mann Whitney U test. The prognostic potential of age at diagnosis was evaluated using Cox proportional hazards regression. Survival was estimated using the Kaplan Meier method. Results: There were 33 patients in group A and 283 patients in group B. There were more non-clear cell tumours in the younger group (30% vs 14%, P <0.05). No statistical differences were found in the stage and grade of both groups. At a median follow-up time of 41 months, the younger group had a higher metastatic rate (18% vs 10.5%, P <0.05), lower 5-year cancer-specific survival (82% vs 98%, P <0.05) and lower 5-year OS (82 % vs 95%, P<0.05). Conclusion: Younger patients were more likely to have non-clear cell RCC with higher disease recurrence and lower OS. They should not be assumed to have similar features and outcomes as screen-detected early RCC in older patients.
Key words: Age, Cancer recurrence, Overall survival, Renal cell carcinoma, Nephrectomy
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Phé V, Yates DR, Renard-Penna R, Cussenot O, Rouprêt M. Is there a contemporary role for percutaneous needle biopsy in the era of small renal masses? BJU Int 2011; 109:867-72. [PMID: 21895938 DOI: 10.1111/j.1464-410x.2011.10544.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate based on the best available data whether there is a contemporary role for percutaneous needle biopsy in the era of small renal masses. PATIENTS AND METHODS SRMs are acknowledged to be tumours less than 4cm and account for 48%-66% of new kidney cancers. Renal mass biopsy (RMB), traditionally limited to specific clinical scenarios and with inherent diagnostic accuracy problems has increased in popularity in recent years and is a potential valuable tool in the assessment of SRMs. Our discussion focuses on these issues. We performed a thorough Medline literature review using a combination of the following keywords; small renal mass, renal biopsy, percutaneous renal biopsy, renal mass biopsy and renal cell carcinoma. We identified the seminal articles with data/information pertaining to renal mass biopsy in small renal masses. RESULTS The facts that 1) a significant number of SRMs are diagnosed in an elderly patient cohort, 2) 20% of SRMs are benign on formal histology, 3) there are various management strategies now available and 4) modern RMB has a diagnostic accuracy >90% with few complications, are all reasons why there has been renewed interest in RMB. CONCLUSION There is a contemporary role for RMB in the era of SRM as the incorporation of molecular profiling of tissue from RMB would augment our ability to risk stratify SRMs on an individual patient basis and adopt management accordingly. However, clinical judgement is paramount as there remains an unpredictable non-negligible risk of disease progression and metastasis whilst on surveillance.
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Affiliation(s)
- Véronique Phé
- Academic Department of Urology and of Radiology of La Pitié-Salpétrière Tenon, University Paris VI, Paris, France
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Abstract
The term renal cell carcinoma (RCC) is used to describe a heterogeneous group of tumors that vary histologically, genetically and molecularly. Extensive research has been conducted to identify characteristics that predict outcomes among patients with RCC. In addition to histological subtype these include tumor size, patient age, mode of presentation and various hematological indices, among others. Several groups have incorporated these clinical and pathological features into nomograms which help the clinician better define individual patient prognosis and direct the optimum therapeutic approach. In the present article we review these prognostic variables and nomograms for RCC.
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Affiliation(s)
- Robert C Flanigan
- Department of Urology, Loyola University Stritch School of Medicine, Maywood, Illinois 60153, USA.
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Ku JH, Moon KC, Kwak C, Kim HH. Disease-specific survival in patients with renal cell carcinoma: an audit of a large series from Korea. Jpn J Clin Oncol 2010; 41:110-4. [PMID: 20802005 DOI: 10.1093/jjco/hyq161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To evaluate the question of whether or not young age is an independent prognostic factor for disease-specific survival in Korean patients with renal cell carcinoma. METHODS A total of 785 patients with an age range of 22-84 years (median, 56) were included in the study. Patients were categorized according to age; 40 years or less (n = 93), 41-60 years (n = 416) and older than 60 years (n = 276). RESULTS Patients 40 years or less at diagnosis differed significantly from older patients for the following parameters: smaller tumour diameter (P = 0.001), less advanced stage (P = 0.002), lower Fuhrman nuclear grade (P = 0.017) and fewer clear cell carcinomas (P < 0.001). Five-year disease-specific survival rate in patients 40 years or younger was also higher than that of older patients (92.7% versus 86.0% versus 69.2%; P < 0.001). When subgroup analysis was performed, only in patients with tumour diameter 4.1-7.0 cm (P = 0.018), pT1-pT2,N0,M0 (P = 0.001) or clear cell type carcinoma (P < 0.001), disease-specific survival probability for patients 40 years or younger was higher than that of older patients. When the Cox proportional hazards model was applied, age at diagnosis was not an independent prognostic predictor of disease-specific survival. CONCLUSIONS Tumours found in young adults show more favourable histological features than those found in older adults. However, according to results from multivariate analysis, young patients do not have higher disease-specific survival rate after adjusting for clinical and pathological variables.
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Affiliation(s)
- Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, 28, Yongon Dong, Jongno Ku, Seoul 110-744, South Korea
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Baek M, Jung JY, Kim JJ, Park KH, Ryu DS. Characteristics and clinical outcomes of renal cell carcinoma in children: A single center experience. Int J Urol 2010; 17:737-40. [DOI: 10.1111/j.1442-2042.2010.02588.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dulabon LM, Lowrance WT, Russo P, Huang WC. Trends in renal tumor surgery delivery within the United States. Cancer 2010; 116:2316-21. [PMID: 20225227 DOI: 10.1002/cncr.24965] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Most small renal tumors are amenable to partial nephrectomy (PN). Studies have documented the association of radical nephrectomy (RN) with an increased risk of comorbid conditions, such as chronic kidney disease. Despite evidence of equivalent oncologic outcomes, PN remains under used within the United States. In this study, the authors identified the most recent trends in kidney surgery for small renal tumors and determined which factors were associated with the use of PN versus RN within the United States. METHODS A population-based patient cohort was analyzed using the Surveillance, Epidemiology and End Results cancer registry (SEER 1999-2006). The authors identified 18,330 patients ages 40 to 90 years who underwent surgery for kidney tumors <or=4 cm in the United States between 1999 and 2006. RESULTS In total, 11,870 patients (65%) underwent RN, and 6460 patients (35%) underwent PN. The ratio of PN to RN increased yearly (P < .001), representing 45% of kidney surgeries in 2006 for small tumors. There were significant differences in the cohort of patients who underwent PN versus RN, including age, sex, tumor location, marital status, year of treatment, and tumor size. When adjusting for these variables, being a man, age <or=70 years, urban residence, smaller tumor size, and more recent treatment year were predictors of PN. CONCLUSIONS Although the total numbers of PN procedures increased in the United States between 1999 and 2006, there remains a significant under use of PN, particularly among women, the elderly, and those living in rural locations. Further investigation will be required to determine the reasons for these disparities, and strategies to optimize access to PN need to be developed.
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Affiliation(s)
- Lori M Dulabon
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
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41
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Zisman A, Patard JJ, Raz O, Klatte T, Haifler M, Mendlovic S, Sandbank J, Belldegrun AS, Lindner A, Leibovici D, Pantuck AJ. Sex, age, and surgeon decision on nephron-sparing surgery are independent predictors of renal masses with benign histologic findings--a multicenter survey. Urology 2010; 76:541-6. [PMID: 20494411 DOI: 10.1016/j.urology.2010.01.089] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 01/31/2010] [Accepted: 01/31/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To define the preoperative independent predictors indicating that renal mass has benign histologic features. METHODS A total of 1664 patients with Stage T1-T2N0M0 with a unilateral renal mass underwent nephrectomy. The endpoint at multivariate analysis was benign versus malignant histologic features. RESULTS The surgical approach (odds ratio [OR] 2.9, P = .0001), sex (OR 1.97, P = .0001), and age (OR 1.01, P = .007) were independent predictors for the malignant-benign distinction. Malignant tumors were more likely to occur in men (878 of 1009, 87%) versus women (515 of 651, 79%; P <.001). A weak relationship was found between an increasing tumor size and malignancy risk in men only. High-grade renal cell carcinoma was more prevalent in men (31% versus 21%, P = .001). The histologic tumor types were distributed differently between the 2 sexes: 8% papillary renal cell carcinoma in women versus 16% in men, 86% and 78% clear cell renal cell carcinoma, 33% and 57% oncocytoma, and 40% versus 12% angiomyolipoma, respectively. The physician's preoperative judgment regarding tumor amenability for nephron-sparing surgery resulted in patient selection: 10% benign tumors for radical nephrectomy versus 25% for partial nephrectomy (P = .001) and 31% versus 20% high-grade tumors, respectively (P = .0001). CONCLUSIONS Renal tumors were consistently benign in 20% of women, regardless of size. In contrast, in men, the malignancy risk increased slightly with tumor size. The surgeons' preoperative decision regarding nephron-sparing surgery caused a selection bias in favor of benign lesions, regardless of sex. Our findings support the possibility of basing treatment decisions on the preoperative biopsy findings. Such changes could alter current practice and limit treatment of histologically proven benign lesions to surveillance or ablation only.
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Affiliation(s)
- Amnon Zisman
- Department of Urology, Harofeh Medical Center, Zerifin, Israel.
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Ignee A, Straub B, Schuessler G, Dietrich CF. Contrast enhanced ultrasound of renal masses. World J Radiol 2010; 2:15-31. [PMID: 21160736 PMCID: PMC2998906 DOI: 10.4329/wjr.v2.i1.15] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 01/20/2010] [Accepted: 01/22/2010] [Indexed: 02/06/2023] Open
Abstract
Contrast enhanced ultrasound (CEUS) has gained clinical importance over the last years for the characterization of hepatic masses. Its role in extrahepatic indications has been investigated repeatedly but has been less comprehensively studied. Currently more than 50% of renal masses are incidentally diagnosed, mostly by B-mode ultrasound. The method of choice for characterization of renal lesions is contrast enhanced computed tomography (CECT). In the case of cystic lesions CECT refers to the Bosniak classification for cystic lesions to assess the risk of malignant behavior. The majority of masses are renal cell carcinoma, but the exact proportion is controversial. Disadvantages of CECT are a significant risk for patients with impaired renal function, allergic reactions and hyperthyroidism due to iodinated contrast agents. Several studies concerning CEUS for the characterization of both solid and cystic renal lesions have been published, but prospective multicenter studies are missing, the presented data being mainly descriptive. The aim of the this manuscript is to review the current literature for CEUS in renal masses, to summarize the available data and focus on possible concepts for studies in the future.
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Survey of Endourology. J Endourol 2009. [DOI: 10.1089/end.2009.1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jeong IG, Yoo CH, Song K, Park J, Cho YM, Song C, Hong JH, Ahn H, Kim CS. Age at Diagnosis is an Independent Predictor of Small Renal Cell Carcinoma Recurrence-Free Survival. J Urol 2009; 182:445-50. [PMID: 19524959 DOI: 10.1016/j.juro.2009.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2008] [Indexed: 11/28/2022]
Affiliation(s)
- In Gab Jeong
- Departments of Urology and Pathology (YMC), Asan Medical Center, Seoul, Republic of Korea
| | - Chang Hee Yoo
- Departments of Urology and Pathology (YMC), Asan Medical Center, Seoul, Republic of Korea
| | - Kanghyon Song
- Departments of Urology and Pathology (YMC), Asan Medical Center, Seoul, Republic of Korea
| | - Jinsung Park
- Departments of Urology and Pathology (YMC), Asan Medical Center, Seoul, Republic of Korea
| | - Yong Mee Cho
- Departments of Urology and Pathology (YMC), Asan Medical Center, Seoul, Republic of Korea
| | - Cheryn Song
- Departments of Urology and Pathology (YMC), Asan Medical Center, Seoul, Republic of Korea
| | - Jun Hyuk Hong
- Departments of Urology and Pathology (YMC), Asan Medical Center, Seoul, Republic of Korea
| | - Hanjong Ahn
- Departments of Urology and Pathology (YMC), Asan Medical Center, Seoul, Republic of Korea
| | - Choung-Soo Kim
- Departments of Urology and Pathology (YMC), Asan Medical Center, Seoul, Republic of Korea
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Murphy AM, Buck AM, Benson MC, McKiernan JM. Increasing detection rate of benign renal tumors: evaluation of factors predicting for benign tumor histologic features during past two decades. Urology 2009; 73:1293-7. [PMID: 19371933 DOI: 10.1016/j.urology.2008.12.072] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 11/23/2008] [Accepted: 12/01/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine whether the detection of benign renal tumors is increasing and to identity the predictors of benign histologic features. The detection of renal cortical tumors has increased with the increased use of abdominal imaging. Current imaging and biopsy techniques cannot predict the renal tumor histologic features with complete accuracy, and many patients undergo surgery for benign lesions. METHODS The Columbia Urologic Oncology Database was reviewed, and 1244 patients who had undergone partial or radical nephrectomy from 1988 to 2007 were identified. A cohort of 775 patients with a tumor diameter of <or.0 cm, nonmetastatic disease, and nonfamilial disease was selected. Univariate and multivariate logarithmic regression analyses were used to determine the parameters to predict for benign histologic features. RESULTS The proportion of renal surgery for benign tumors of <or.0 cm in diameter has increased annually. When patients were stratified by the year of surgery, the proportion of benign tumors was 5.0% before 1998, 15.2% from 1998 to 2003, and 21.2% from 2004 to 2007. The mean diameter of benign and malignant tumors was 3.0 and 3.5 cm, respectively, and the mean tumor diameter significantly decreased during the study period (P = .006). Using multivariate analysis, the year of surgery, tumor diameter, and female sex were independent predictors of benign histologic features (P < .05). Age, incidental diagnosis, body mass index, and race were not significant predictors (P > .05). CONCLUSIONS Even when controlling for tumor diameter and sex, the incidence of benign tumors detected at renal surgery at our institution has increased significantly in the past 2 decades.
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Affiliation(s)
- Alana M Murphy
- Department of Urology, Columbia University, Medical Center, New York, New York 10032, USA.
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Nese N, Paner GP, Mallin K, Ritchey J, Stewart A, Amin MB. Renal cell carcinoma: assessment of key pathologic prognostic parameters and patient characteristics in 47 909 cases using the National Cancer Data Base. Ann Diagn Pathol 2009; 13:1-8. [DOI: 10.1016/j.anndiagpath.2008.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Scoll BJ, Wong YN, Egleston BL, Kunkle DA, Saad IR, Uzzo RG. Age, tumor size and relative survival of patients with localized renal cell carcinoma: a surveillance, epidemiology and end results analysis. J Urol 2008; 181:506-11. [PMID: 19084868 DOI: 10.1016/j.juro.2008.10.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Recent data demonstrate that age may be a significant independent prognostic variable following treatment for renal cell carcinoma. We analyzed data from the SEER (Surveillance, Epidemiology and End Results) database to evaluate the relative survival of patients treated surgically for localized renal cell carcinoma as related to tumor size and patient age. MATERIALS AND METHODS Patients in the SEER database with localized renal cell carcinoma were stratified into cohorts by age and tumor size. Three and 5-year relative survival, the ratio of observed survival in the cancer population to the expected survival of an age, sex and race matched cancer-free population, was calculated with SEER-Stat. Brown's method was used for hypothesis testing. RESULTS A total of 8,578 patients with surgically treated, localized renal cell carcinoma were identified. While 3 and 5-year survival for patients with small (less than 4 cm) renal cell carcinoma was no different from that of matched cancer-free controls, patients treated for large (greater than 7 cm) localized renal cell carcinoma experienced decreased 5-year relative survival across all age groups. Therefore, age was not a significant predictor of relative survival for patients with small (less than 4 cm) or large (greater than 7 cm) tumors. However, a statistically significant trend toward lower relative survival with increasing age was demonstrated in patients with medium size tumors (4 to 7 cm). Hypothesis testing confirmed these findings. CONCLUSIONS These data suggest that relative survival is high in patients with tumors less than 4 cm and lower in patients with tumors larger than 7 cm regardless of age. However, increasing age may be related to worse outcomes in patients with tumors 4 to 7 cm. The cause of this observation warrants further investigation.
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Affiliation(s)
- Benjamin J Scoll
- Department of Urologic Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania 19111, USA
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Clinicopathological features and survival rates of patients with renal cell carcinoma under 50 years of age. Open Med (Wars) 2008. [DOI: 10.2478/s11536-008-0038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractWe analyzed the clinicopathological features and survival rates of the patients with renal cell carcinoma younger than 50 years old. Between 2004 and 2007, 28 patients between 19–49 years underwent surgery for renal cell carcinoma. Presenting symptoms, type of the surgery performed, postoperative outcomes and duration of follow-up were recorded. Mean age was 41.5±7.6 years and 75% of patients were male. The tumor was symptomatic in 19(67.9%) and incidental in 9(32.1%) patients. Radical nephrectomy and nephron-sparing surgery were performed in 18(64.3%) and 10(35.7%) patients, respectively. The most common histologic type was clear cell(67.9%). The mean tumor diameters were 3.5±0.95 and 7.4±5.2 cm in the incidental and symptomatic groups, respectively(p=0.035). Incidentally discovered tumors and tumors treated by NSS did not include Fuhrman grade 4. There were no differences regarding pathological stage and Fuhrman grades when patients were grouped according to their symptomatology(p=0.242 and p=0.265, respectively). Overall mortality was 17.9%(n=5) whereas 4 patients(14.3%) died because of cancer. The mean survival was 30.6 months and cancer specific survival rate was 85.2%. Most of the tumors in this age group were symptomatic and most common histologic subtype was clear cell carcinoma. Incidentally discovered tumors had statistically significant lower tumor size.
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Thompson RH, Ordonez MA, Iasonos A, Secin FP, Guillonneau B, Russo P, Touijer K. Renal cell carcinoma in young and old patients--is there a difference? J Urol 2008; 180:1262-6; discussion 1266. [PMID: 18707708 DOI: 10.1016/j.juro.2008.06.037] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Indexed: 01/30/2023]
Abstract
PURPOSE Renal cell carcinoma is rare in patients younger than 40 years and conflicting data regarding presentation and outcome are present in the literature. We reviewed our experience with young patients with renal cell carcinoma and compared them to their older counterparts. MATERIALS AND METHODS We identified 1,720 patients 18 to 79 years old who were treated with partial or radical nephrectomy for renal cell carcinoma between 1989 and 2005. Patients were grouped according to age and outcome analysis was performed. RESULTS Of the 1,720 patients with renal cell carcinoma 89 (5%), 672 (39%) and 959 (56%) were younger than 40, 40 to 59 and 60 to 79 years old, respectively. There were no significant differences in sex, tumor size, TNM stage or multifocality by age group. However, patients younger than 40 years were significantly more likely to present with symptomatic tumors (p = 0.028). Additionally, there were significant differences in histology by age (p <0.001), that is chromophobe histology decreased while papillary histology increased with age. Despite similar tumor sizes in each age group the percent of patients treated with partial nephrectomy decreased with age. Of patients younger than 40 years 49% were treated with partial nephrectomy compared with 35% and 30% of those 40 to 59 and 60 to 79 years old, respectively (p <0.001). At a median followup of 2.6 years (range 0 to 14.5) we did not observe a significant difference in cancer specific survival according to age (p = 0.17). CONCLUSIONS Younger patients with renal cell carcinoma are more likely to have symptomatic tumors with chromophobe histology, although the prognosis appears similar across age groups. Older patients are more likely to be treated with radical nephrectomy, which requires careful scrutiny for current clinical practice.
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Affiliation(s)
- R Houston Thompson
- Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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