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Fleury R, Bertail T, Bensalah K, Bernhard JC, Audenet F, Waeckel T, Parier B, Champy C, Olivier J, Doumerc N, Tricard T, Branger N, Bruyere F, Neuville P, Surlemont L, Alexandre Long J, Fontenil A, Vallee M, Roupret M, Boissier R, Jacques Patard J, Durand M, Ouzaid I, Rouget B, Durand X, Joncour C, Belas O, Denise Gomez F, Bigot P, Khene ZE. The Impact of Histological Variants on Oncological Outcomes After Surgical Resection of a Nonmetastatic Renal Cell Carcinoma with Tumor Thrombus: A Multi-institutional Study. EUR UROL SUPPL 2024; 62:123-130. [PMID: 38496822 PMCID: PMC10940768 DOI: 10.1016/j.euros.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Background There is no definitive evidence of the prognosis impact of histological variants (HVs) in patients who undergo surgical resection of a nonmetastatic renal cell carcinoma (nm-RCC) with venous tumor thrombus (TT). Objective To investigate the impact of HVs on the prognosis of patients with nm-RCC with TT after radical surgery. Design setting and participants Patients who underwent radical nephrectomy with the removal of the venous TT for an nm-RCC were included in a retrospective study. Outcome measurements and statistical analysis Three groups were identified: clear cell (ccRCC), papillary (pRCC), and chromophobe (chRCC) RCC. The primary outcome measures (disease-free and overall survival [OS]) were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate Cox proportional hazard models were used to study the impact of HVs on survival. Results and limitations A total of 873 patients were included. The histological subtypes were distributed as follows: ccRCC in 780 cases, pRCC in 58 cases, and chRCC in 35 cases. At the time of data analysis, 612 patients were recurrence free and 228 had died. A survival analysis revealed significant differences in both OS and recurrence-free survival across histological subtypes, with the poorest outcomes observed in pRCC patients (p < 0.05). In a multivariable analysis, pRCC was independently associated with worse disease-free survival and OS (hazard ratio [HR]: 1.71; p = 0.01 and HR: 1.24; p = 0.04), while chRCC was associated with more favorable outcomes than ccRCC (HR: 0.05; p < 0.001 and HR: 0.02; p < 0.001). A limitation of the study is its retrospective nature. Conclusions In this multicentric series, HVs appeared to impact the medium-term oncological prognosis of kidney cancer with TT. Patient summary This study investigated the differences in oncological outcomes among histological variants (clear cell, papillary, and chromophobe) in a cohort of nonmetastatic renal cell carcinoma patients with venous tumor thrombus extension. We observed that these histological variants within this specific subgroup exhibit distinct outcomes, with papillary renal cell carcinoma being associated with the worst prognosis.
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Affiliation(s)
- Raphael Fleury
- Department of Urology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Théophile Bertail
- Department of Urology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Karim Bensalah
- Department of Urology, Centre Hospitalier Universitaire de Rennes, Rennes, France
- LTSI, Inserm U1099, Université de Rennes 1, Rennes, France
| | | | - Francois Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Thibaut Waeckel
- Department of Urology, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Bastien Parier
- Department of Urology, Hôpital Bicêtre, APHP, Paris, France
| | - Cécile Champy
- Department of Urology, Centre Hospitalier Henri Mondor, APHP, Créteil, France
| | - Jonathan Olivier
- Department of urology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Nicolas Doumerc
- Department of Urology, Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | - Thibault Tricard
- Department of Urology, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Nicolas Branger
- Department of Urology, Institut Paoli Calmettes de Marseille, Marseille, France
| | - Franck Bruyere
- Department of Urology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Paul Neuville
- Department of Urology, Hospices Civils de Lyon, Lyon, France
| | - Louis Surlemont
- Department of Urology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Jean Alexandre Long
- Department of Urology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Alexis Fontenil
- Department of Urology, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Maxime Vallee
- Department of Urology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Morgan Roupret
- Department of Urology, Hôpital de la Pitié Salpêtrière, APHP, Paris, France
| | - Romain Boissier
- Department of Urology, Hôpital de la Conception, APHM, Marseille, France
| | - Jean Jacques Patard
- Department of Urology, Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France
| | - Mathieu Durand
- Department of Urology, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Idir Ouzaid
- Department of Urology, Hôpital Bichat, APHP, Paris, France
| | - Benjamin Rouget
- Department of Urology, Centre Hospitalier de Libourne, Libourne, France
| | - Xavier Durand
- Department of Urology, Hôpital Privé Saint Joseph, Paris, France
| | - Charlotte Joncour
- Department of Urology, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Olivier Belas
- Department of Urology, Pôle Santé Sud au Mans, Le Mans, France
| | | | - Pierre Bigot
- Department of Urology, Centre Hospitalier Universitaire d’Angers, d’Angers, France
| | - Zine-Eddine Khene
- Department of Urology, Centre Hospitalier Universitaire de Rennes, Rennes, France
- LTSI, Inserm U1099, Université de Rennes 1, Rennes, France
| | - members of the French Committee of Urologic Oncology CCAFU
- Department of Urology, Centre Hospitalier Universitaire de Rennes, Rennes, France
- LTSI, Inserm U1099, Université de Rennes 1, Rennes, France
- Department of Urology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Department of Urology, Hôpital Européen Georges Pompidou, APHP, Paris, France
- Department of Urology, Centre Hospitalier Universitaire de Caen, Caen, France
- Department of Urology, Hôpital Bicêtre, APHP, Paris, France
- Department of Urology, Centre Hospitalier Henri Mondor, APHP, Créteil, France
- Department of urology, Centre Hospitalier Universitaire de Lille, Lille, France
- Department of Urology, Centre Hospitalier Universitaire Rangueil, Toulouse, France
- Department of Urology, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
- Department of Urology, Institut Paoli Calmettes de Marseille, Marseille, France
- Department of Urology, Centre Hospitalier Universitaire de Tours, Tours, France
- Department of Urology, Hospices Civils de Lyon, Lyon, France
- Department of Urology, Centre Hospitalier Universitaire de Rouen, Rouen, France
- Department of Urology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
- Department of Urology, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
- Department of Urology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Department of Urology, Hôpital de la Pitié Salpêtrière, APHP, Paris, France
- Department of Urology, Hôpital de la Conception, APHM, Marseille, France
- Department of Urology, Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France
- Department of Urology, Centre Hospitalier Universitaire de Nice, Nice, France
- Department of Urology, Hôpital Bichat, APHP, Paris, France
- Department of Urology, Centre Hospitalier de Libourne, Libourne, France
- Department of Urology, Hôpital Privé Saint Joseph, Paris, France
- Department of Urology, Centre Hospitalier Universitaire de Reims, Reims, France
- Department of Urology, Pôle Santé Sud au Mans, Le Mans, France
- Department of Urology, Hôpital Tenon, APHP, Paris, France
- Department of Urology, Centre Hospitalier Universitaire d’Angers, d’Angers, France
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2
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Taweemonkongsap T, Suk-Ouichai C, Jitpraphai S, Woranisarakul V, Hansomwong T, Chotikawanich E. Survival benefits after radical nephrectomy and IVC thrombectomy of renal cell carcinoma patients with inferior vena cava thrombus. Heliyon 2024; 10:e25835. [PMID: 38390094 PMCID: PMC10881333 DOI: 10.1016/j.heliyon.2024.e25835] [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: 08/21/2023] [Revised: 12/15/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Objective The role of tumor thrombus as a predictor of survival in patients with renal cell carcinoma (RCC) is controversial. This study aims to evaluate surgical and oncological outcomes after surgery in RCC with inferior vena cava (IVC) tumor thrombus patients. Materials and methods A total of 58 patients (2002-2019) underwent radical nephrectomy and IVC thrombectomy at our institute, were retrospectively reviewed. Kaplan-Meier analysis was utilized to compare survival benefits between cohorts and Cox-regression to evaluate potential predictors of patient survival. Results There were 5(8.6%), 21(36.2%), 23(39.7%) and 9 (15.5%) patients with tumor thrombus level I, II, III and IV respectively. The major complications (Clavien 3-5) were observed in 15 patients (25.8%) and 12 patients (80%) were patients with high thrombus level (III-IV). There was 9%mortality (5patients): 2 intraoperatively and 3 postoperatively. Median follow-up was 15 months (IQR:5-41). Two-year overall survival (OS) was 80% and 75% in all patients and pN0M0 cohort, respectively. There was significant difference in OS among each IVC thrombus level cohort (p < 0.02). Two-year OS of metastatic RCC patients was 67% and not significantly different when compared to non-metastatic cohort (p = 0.12). On multivariate analysis, only sarcomatoid dedifferentiation was associated with OS(p = 0.04). Disease-free survival was not significantly different among thrombus-level cohorts (p = 0.65). Conclusions Our study suggested that surgical treatment for RCC with IVC thrombus provided substantial OS outcomes. Although survival was significantly reduced with higher IVC thrombus level cohort, the level of thrombus itself was not an independent factor. Only sarcomatoid dedifferentiation was a predictor for reduced OS after radical nephrectomy and tumor thrombectomy. Meticulous patient selection and prompt counselling are substantial step for the operation.
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Affiliation(s)
- Tawatchai Taweemonkongsap
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalairat Suk-Ouichai
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Siros Jitpraphai
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varat Woranisarakul
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thitipat Hansomwong
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekkarin Chotikawanich
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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3
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Shapiro DD, Lozar T, Cheng L, Xie E, Laklouk I, Lee MH, Huang W, Jarrard DF, Allen GO, Hu R, Kinoshita T, Esbona K, Lambert PF, Capitini CM, Kendziorski C, Abel EJ. Non-Metastatic Clear Cell Renal Cell Carcinoma Immune Cell Infiltration Heterogeneity and Prognostic Ability in Patients Following Surgery. Cancers (Basel) 2024; 16:478. [PMID: 38339231 PMCID: PMC10854750 DOI: 10.3390/cancers16030478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024] Open
Abstract
Predicting which patients will progress to metastatic disease after surgery for non-metastatic clear cell renal cell carcinoma (ccRCC) is difficult; however, recent data suggest that tumor immune cell infiltration could be used as a biomarker. We evaluated the quantity and type of immune cells infiltrating ccRCC tumors for associations with metastatic progression following attempted curative surgery. We quantified immune cell densities in the tumor microenvironment and validated our findings in two independent patient cohorts with multi-region sampling to investigate the impact of heterogeneity on prognostic accuracy. For non-metastatic ccRCC, increased CD8+ T cell infiltration was associated with a reduced likelihood of progression to metastatic disease. Interestingly, patients who progressed to metastatic disease also had increased percentages of exhausted CD8+ T cells. Finally, we evaluated the spatial heterogeneity of the immune infiltration and demonstrated that patients without metastatic progression had CD8+ T cells in closer proximity to ccRCC cells. These data strengthen the evidence for CD8+ T cell infiltration as a prognostic biomarker in non-metastatic ccRCC and demonstrate that multi-region sampling may be necessary to fully characterize immune infiltration within heterogeneous tumors. Tumor CD8+ T cell infiltration should be investigated as a biomarker in adjuvant systemic therapy clinical trials for high-risk non-metastatic RCC.
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Affiliation(s)
- Daniel D. Shapiro
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI 53705, USA
| | - Taja Lozar
- McArdle Laboratory for Cancer Research, University of Wisconsin, Madison, WI 53706, USA
| | - Lingxin Cheng
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (L.C.)
| | - Elliot Xie
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (L.C.)
| | - Israa Laklouk
- Department of Pathology, University of California, Los Angeles, Los Angeles, CA 90024, USA;
| | - Moon Hee Lee
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Wei Huang
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA (R.H.); (K.E.)
| | - David F. Jarrard
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Glenn O. Allen
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Rong Hu
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA (R.H.); (K.E.)
| | - Toshi Kinoshita
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA (R.H.); (K.E.)
| | - Karla Esbona
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA (R.H.); (K.E.)
| | - Paul F. Lambert
- McArdle Laboratory for Cancer Research, University of Wisconsin, Madison, WI 53706, USA
| | - Christian M. Capitini
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA;
| | - Christina Kendziorski
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (L.C.)
| | - Edwin Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
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4
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Qu L, Chen H, Chen Q, Ge S, Jiang A, Yu N, Zhou Y, Kunc M, Zhou Y, Feng X, Zhai W, Wu Z, He M, Li Y, Chen R, Han B, Zeng X, Fu Y, Ji C, Fan X, Zhang G, Zhao C, Jing T, Feng C, Zhao H, Sun D, Wang L, Tai S, Zhang C, Chen S, Liu Y, Wang H, Gao J, Gu Y, Miao H, Zhao T, Yi X, Tang C, Fu D, He H, Rao Q, Zhou W, Xu N, Wang G, Liang C, Liu Z, Xia D, Zu X, Chen M, Guo H, Qin W, Wang Z, Xue W, Shi B, Wang S, Zheng J, Chen C, Zapała Ł, Ge J, Wang L. Development and validation of a prognostic model incorporating tumor thrombus grading for nonmetastatic clear cell renal cell carcinoma with tumor thrombus: A multicohort study. MedComm (Beijing) 2023; 4:e300. [PMID: 37484972 PMCID: PMC10357251 DOI: 10.1002/mco2.300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 07/25/2023] Open
Abstract
There is significant variability with respect to the prognosis of nonmetastatic clear cell renal cell carcinoma (ccRCC) patients with venous tumor thrombus (VTT). By applying multiregion whole-exome sequencing on normal-tumor-thrombus-metastasis quadruples from 33 ccRCC patients, we showed that metastases were mainly seeded by VTT (81.8%) rather than primary tumors (PTs). A total of 706 nonmetastatic ccRCC patients with VTT from three independent cohorts were included in this study. C-index analysis revealed that pathological grading of VTT outperformed other indicators in risk assessment (OS: 0.663 versus 0.501-0.610, 0.667 versus 0.544-0.651, and 0.719 versus 0.511-0.700 for Training, China-Validation, and Poland-Validation cohorts, respectively). We constructed a risk predicting model, TT-GPS score, based on four independent variables: VTT height, VTT grading, perinephric fat invasion, and sarcomatoid differentiation in PT. The TT-GPS score displayed better discriminatory ability (OS, c-index: 0.706-0.840, AUC: 0.788-0.874; DFS, c-index: 0.691-0.717, AUC: 0.771-0.789) than previously reported models in risk assessment. In conclusion, we identified for the first-time pathological grading of VTT as an unheeded prognostic factor. By incorporating VTT grading, the TT-GPS score is a promising prognostic tool in predicting the survival of nonmetastatic ccRCC patients with VTT.
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Kotlyar MJ, Krebs M, Solimando AG, Marquardt A, Burger M, Kübler H, Bargou R, Kneitz S, Otto W, Breyer J, Vergho DC, Kneitz B, Kalogirou C. Critical Evaluation of a microRNA-Based Risk Classifier Predicting Cancer-Specific Survival in Renal Cell Carcinoma with Tumor Thrombus of the Inferior Vena Cava. Cancers (Basel) 2023; 15:cancers15071981. [PMID: 37046643 PMCID: PMC10093292 DOI: 10.3390/cancers15071981] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
(1) Background: Clear cell renal cell carcinoma extending into the inferior vena cava (ccRCCIVC) represents a clinical high-risk setting. However, there is substantial heterogeneity within this patient subgroup regarding survival outcomes. Previously, members of our group developed a microRNA(miR)-based risk classifier—containing miR-21-5p, miR-126-3p and miR-221-3p expression—which significantly predicted the cancer-specific survival (CSS) of ccRCCIVC patients. (2) Methods: Examining a single-center cohort of tumor tissue from n = 56 patients with ccRCCIVC, we measured the expression levels of miR-21, miR-126, and miR-221 using qRT-PCR. The prognostic impact of clinicopathological parameters and miR expression were investigated via single-variable and multivariable Cox regression. Referring to the previously established risk classifier, we performed Kaplan–Meier analyses for single miR expression levels and the combined risk classifier. Cut-off values and weights within the risk classifier were taken from the previous study. (3) Results: miR-21 and miR-126 expression were significantly associated with lymphonodal status at the time of surgery, the development of metastasis during follow-up, and cancer-related death. In Kaplan–Meier analyses, miR-21 and miR-126 significantly impacted CSS in our cohort. Moreover, applying the miR-based risk classifier significantly stratified ccRCCIVC according to CSS. (4) Conclusions: In our retrospective analysis, we successfully validated the miR-based risk classifier within an independent ccRCCIVC cohort.
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Affiliation(s)
- Mischa J. Kotlyar
- Department of Urology and Pediatric Urology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Markus Krebs
- Department of Urology and Pediatric Urology, University Hospital Würzburg, 97080 Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Antonio Giovanni Solimando
- Guido Baccelli Unit of Internal Medicine, Department of Precision and Regenerative Medicine and Ionian Area-(DiMePRe-J), School of Medicine, Aldo Moro University of Bari, 70124 Bari, Italy
- IRCCS Istituto Tumori “Giovanni Paolo II” of Bari, 70124 Bari, Italy
| | - André Marquardt
- Department of Pathology, Klinikum Stuttgart, 70174 Stuttgart, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef, University of Regensburg Medical Center, 93053 Regensburg, Germany
| | - Hubert Kübler
- Department of Urology and Pediatric Urology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Ralf Bargou
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Susanne Kneitz
- Physiological Chemistry I, Theodor-Boveri-Institute, Biocenter, University of Würzburg, 97074 Würzburg, Germany
| | - Wolfgang Otto
- Department of Urology, Caritas St. Josef, University of Regensburg Medical Center, 93053 Regensburg, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef, University of Regensburg Medical Center, 93053 Regensburg, Germany
| | - Daniel C. Vergho
- Department of Urology, Caritas St. Josef, University of Regensburg Medical Center, 93053 Regensburg, Germany
| | - Burkhard Kneitz
- Department of Urology and Pediatric Urology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Charis Kalogirou
- Department of Urology and Pediatric Urology, University Hospital Würzburg, 97080 Würzburg, Germany
- Correspondence: ; Tel.: +49-931-201-32001
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6
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Baboudjian M, Gondran-Tellier B, Khene Z, Bigot P, Mejean A, Lang H, Lebacle C, Doumerc N, Bruyere F, Nouhaud FX, Ouzaid I, Bensalah K, Bernhard JC, Boissier R. Predictive factors of recurrence after surgery in patients with non-metastatic renal cell carcinoma with venous tumor thrombus (UroCCR-56 Study). World J Urol 2023; 41:295-302. [PMID: 33765164 DOI: 10.1007/s00345-021-03640-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/15/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the oncological outcomes of renal cell carcinoma (RCC) associated with tumor thrombus and identify predictive factors of recurrence. METHODS Multi-institutional study that included patients with cT3-4N0-1M0 RCC with tumoral thrombus identified in the prospective UroCCR database (CNIL DR 2013-206; NCT03293563). pT3a without involvement of the renal vein were excluded. All patients underwent radical nephrectomy and a thrombectomy of the renal vein ± inferior vena cava ± right atrium. The primary endpoint was recurrence-free survival (RFS). Thirty-two patients who had adjuvant therapies (tyrosine kinase inhibitors or mTOR inhibitor) were compared to control group (surveillance) in a propensity score-matched 1:1 sub-analysis RESULTS: A total of 432 patients were included: 70.4% pT3a, 20.1% pT3b, 4.2% pT3c and 5.3% pT4. Tumor characteristics were: 90.7% clear cell RCC, 13.9% pN1, and 87.1% high Fuhrman grade. 173 patients (40%) had disease recurrence, and median RFS was 37.3 months (95% CI, 26.4-46.7). In a multivariate analysis (Cox model), predictive factors of recurrence were: pT4 (HR 2.66; 95% CI, 1.42-4.99; p = 0.002), pN1 (HR 2.53; 95% CI, 1.46-4.39; p < 0.001), tumor necrosis (HR 2.92; 95% CI, 1.85-4.62; p < 0.001), tumor size > 10 cm (HR 1.56; 95% CI, 1.08-2.24; p = 0.018). Adjuvant therapy was a protective factor of cancer recurrence (HR 0.33; 95% CI, 0.17-0.66; p = 0.002). Propensity score-matched sub-analysis of adjuvant vs control (surveillance) confirmed adjuvant treatment as a protective factor of cancer recurrence (Log rank p = 0.015). CONCLUSIONS In this contemporary multi-institutional cohort of RCC + tumor thrombus, we reported higher recurrence rate shortly after surgical excision and demonstrated an oncological benefit of adjuvant treatment.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology and Kidney Transplantation, Aix-Marseille University, La Conception Academic Hospital, APHM147 boulevard baille, 13005, Marseille, France
| | - Bastien Gondran-Tellier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, La Conception Academic Hospital, APHM147 boulevard baille, 13005, Marseille, France
| | | | - Pierre Bigot
- Department of Urology, University of Angers, Angers, France
| | - Arnaud Mejean
- Department of Urology, HEGP Hospital, APHP, Paris, France
| | - Hervé Lang
- Department of Urology, University of Strasbourg, Strasbourg, France
| | - Cedric Lebacle
- Department of Urology, Bicetre University Hospital, APHP, University Paris-Saclay, Le Kremlin-Bicetre, France
| | - Nicolas Doumerc
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Franck Bruyere
- Department of Urology, University of Tours, Tours, France
| | | | - Idir Ouzaid
- Department of Urology, Bichat University Hospital, APHP, Paris, France
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | | | - Romain Boissier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, La Conception Academic Hospital, APHM147 boulevard baille, 13005, Marseille, France.
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7
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Jarocki M, Karska J, Kowalski S, Kiełb P, Nowak Ł, Krajewski W, Saczko J, Kulbacka J, Szydełko T, Małkiewicz B. Interleukin 17 and Its Involvement in Renal Cell Carcinoma. J Clin Med 2022; 11:jcm11174973. [PMID: 36078902 PMCID: PMC9457171 DOI: 10.3390/jcm11174973] [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: 06/19/2022] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022] Open
Abstract
Nowadays, molecular and immunological research is essential for the better understanding of tumor cells pathophysiology. The increasing number of neoplasms has been taken under ‘the molecular magnifying glass’ and, therefore, it is possible to discover complex relationships between the cytophysiology and immune system action. An example could be renal cell carcinoma (RCC) which has deep interactions with immune mediators such as Interleukin 17 (IL-17)—an inflammatory cytokine reacting to tissue damage and external pathogens. RCC is one of the most fatal urological cancers because of its often late diagnosis and poor susceptibility to therapies. IL-17 and its relationship with tumors is extremely complex and constitutes a recent topic for numerous studies. What is worth highlighting is IL-17’s dual character in cancer development—it could be pro- as well as anti-tumorigenic. The aim of this review is to summarize the newest data considering multiple connections between IL-17 and RCC.
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Affiliation(s)
- Michał Jarocki
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Julia Karska
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Szymon Kowalski
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Paweł Kiełb
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Łukasz Nowak
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Wojciech Krajewski
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Jolanta Saczko
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Julita Kulbacka
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Tomasz Szydełko
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Bartosz Małkiewicz
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Correspondence: ; Tel.: +48-506-158-136
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Li Y, Liu Z, Zhao X, Hong P, Zhao X, Zhu G, Tang S, Ge L, Zhang S, Liu C, Wang S, Zhang H, Ma L. Nomogram for predicting survival of renal cell carcinoma with tumor thrombus based on perioperative clinicopathological factors from a Chinese high-volume center. Int J Urol 2022; 29:984-993. [PMID: 35474347 DOI: 10.1111/iju.14913] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate perioperative clinicopathological predictors and establish a predictive nomogram for survival in patients with renal cell carcinoma and venous tumor thrombus undergoing nephrectomy and thrombectomy. METHODS Patients with renal cell carcinoma and venous tumor thrombus undergoing nephrectomy and thrombectomy were included in the study between January 2014 and June 2020. Cox regression analysis was used for univariate and multivariate survival analyses. A predictive nomogram for survival was established and internally validated using bootstrap resampling method. RESULTS A total of 228 patients were enrolled in this study. The median age was 60 years (interquartile range 53-66 years), consisting of 174 (76.3%) males and 54 (23.7%) females. The median follow-up time was 17.5 months (range 1-74 months), 26.8% (61 of 228) patients died of all causes. In multivariable analysis, hemoglobin less than the lower limit of normal (hazard ratio 1.73; 95% confidence interval 1.01-2.96; P = 0.045), sarcomatoid feature (hazard ratio 3.67; 95% confidence interval 1.97-6.82; P < 0.001), perirenal fat invasion (hazard ratio 1.80; 95% confidence interval 1.05-3.09; P = 0.033), histological subtype (hazard ratio 2.74; 95% confidence interval 1.39-5.41; P = 0.004), and metastasis at surgery (hazard ratio 1.71; 95% confidence interval 1.01-2.90; P = 0.047) were independently associated with overall survival. The result of internal validation presented that the predictive performance of the nomogram for survival measured by C-index was 0.77. CONCLUSIONS We developed a predictive nomogram with well-internal validation for survival in patients with renal cell carcinoma and venous tumor thrombus, which can greatly promote risk stratification and treatment planning.
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Affiliation(s)
- Yuxuan Li
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xiaoyu Zhao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guodong Zhu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shiying Tang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Liyuan Ge
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shumin Wang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Lv Z, Feng HY, Wang T, Ma X, Zhang X. Preoperative systemic inflammation response index indicates poor prognosis in patients treated with resection of renal cell carcinoma with inferior vena cava tumor thrombus. Urol Oncol 2022; 40:167.e9-167.e19. [PMID: 35042663 DOI: 10.1016/j.urolonc.2021.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/02/2021] [Accepted: 11/29/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate the prognostic value of systemic Inflammation Response Index (SIRI) in patients with renal cell carcinoma and inferior vena cava tumor thrombus (RCC-IVCTT) treated with radical nephrectomy and IVCTT thrombectomy. METHODS We retrospectively reviewed the clinical data of 144 consecutive patients with RCC-IVCTT who received radical nephrectomy and IVCTT thrombectomy at our center from January 2008 to August 2018. Receiver operating characteristic curve analysis was performed to calculate the optimal cutoff value of preoperative SIRI. Kaplan-Meier analysis was used to compare progression-free survival (PFS) and overall survival (OS). Univariable and multivariable Cox proportional hazard models were constructed to identify the independent prognostic factor for OS and PFS. The Harrell concordance index (C-index) was used to assess whether preoperative SIRI could improve the predictive accuracy of the existent prognostic models including Tumor, Node, Metastasis (TNM) stage model, University of California at Los Angeles Integrated Staging System (UISS) model and Stage, Size, Grade and Necrosis (SSIGN) model. RESULTS Elevated preoperative SIRI was significantly correlated with clinicopathologic features that are associated with tumor progression. Patients were divided into a high or low SIRI group by the optimal cutoff value of SIRI. Patients in the high SIRI group had longer postoperative hospital stays and lost more blood during surgery. Kaplan Meier curve showed that high SIRI was correlated with decreased OS (P = 0.036) and PFS (P = 0.039) for patients with RCC-IVCTT after surgery. Increased preoperative SIRI was an independently risk factor for decreased OS (P = 0.038) and PFS (P = 0.021). To evaluate PFS, integrating SIRI to each model led to an increased predictive accuracy of 13.2% for TNM staging model (P = 0.007), 14.4% for UISS model (P = 0.000), 12.9% for SSIGN model (P = 0.003). To evaluate OS, integrating SIRI to each model led to an increased predictive accuracy of 13.2% for TNM staging model (P = 0.006), 12.8% for UISS model (P = 0.004), 12.4% for SSIGN model (P = 0.008). CONCLUSIONS Preoperative SIRI serves as an independent predictor of prognosis for patients with RCC-IVCTT after surgery. Adding preoperative SIRI to the established prognostic models enhance their predictive accuracy.
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Affiliation(s)
- Zheng Lv
- Department of Urology, The Tianjin Third Central Hospital Affiliated of Nankai University; Department of Urology, The third Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hua-Yi Feng
- Medical School of Chinese PLA, Beijing, China; Department of Urology, The third Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Tao Wang
- Medical School of Chinese PLA, Beijing, China; Department of Urology, The third Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xin Ma
- Department of Urology, The third Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China.
| | - Xu Zhang
- Department of Urology, The third Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China.
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Oncologic Outcomes of Renal Cell Carcinoma Patients Undergoing Radical Nephrectomy and Venous Thrombectomy: Prospective Follow-Up from a Single Center. JOURNAL OF ONCOLOGY 2022; 2022:9191659. [PMID: 35342403 PMCID: PMC8947865 DOI: 10.1155/2022/9191659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/18/2022] [Indexed: 12/31/2022]
Abstract
Purpose To evaluate the long-term oncologic outcomes of renal cell carcinoma (RCC) patients with venous thrombus after radical nephrectomy and venous thrombectomy (RN-VT) and to determine the prognostic factors. Methods and Materials We reported our follow-up data of RCC patients with venous thrombus from January 2014 to September 2020. We used the Kaplan-Meier method to assess the overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). The Cox proportional hazards regression model and competing risk model were used. Results After a median follow-up of 31 mon, eight-five patients (31.5%) died, and cancer-specific deaths occurred in 60 patients (22.2%). The 1 yr and 3 yr CSS were 89.3% and 72.7%, respectively. The median OS was 56.0 mon (95% CI 47.6-64.3 mon), and the 1 yr, 3 yr, and 5 yr OS were 87.0%, 62.1%, and 44.8%, respectively. For M1 patients, the median OS was 27.0 mon (95% CI 22.0-42.0 mon), and the 1 yr, 3 yr, and 5 yr OS were 78.0%, 41.5%, and 23.3%, respectively. For M0 patients, the median RFS was 38.0 mon (95% CI 32.5-43.5 mon), and the 1 yr and 3 yr RFS were 81.2% and 52.3%, respectively. Multivariate analyses showed that papillary RCC (HR 2.95, 95% CI 1.80-4.82, P < 0.001) or other RCC (HR 3.88, 95% CI 2.03-7.41, P < 0.001), perinephric fat invasion (HR 1.53, 95% CI 1.03-2.26, P = 0.04), sarcomatoid differentiation (HR 2.85, 95% CI 1.64-4.95, P < 0.001), Fuhrman grade 3 (HR 2.10, 95% CI 1.28-3.44, P = 0.003) or 4 (HR 3.55, 95% CI 2.09-6.03, P < 0.001), and distant metastasis (HR 1.76, 95% CI 1.18-2.63, P = 0.006) were associated with a worse CSS. Adjuvant therapy (HR 0.63, 95% CI 0.43-0.92, P = 0.02) was associated with a better CSS. Conclusions RCC patients can have an acceptable long-term survival after RN-VT. Prognostic factors influencing CSS included nonclear cell RCC histology, higher Fuhrman grade, sarcomatoid differentiation, perinephric fat invasion, distant metastasis, and adjuvant therapy.
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Zhang Y, Tian X, Bi H, Yan Y, Liu Z, Liu C, Zhang S, Ma L. A Nomogram Predicting the Progression-Free Survival of Nonmetastatic Renal Cell Carcinoma Patients With Venous Thrombus After Surgery. Front Oncol 2022; 12:765092. [PMID: 35402218 PMCID: PMC8988056 DOI: 10.3389/fonc.2022.765092] [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: 08/26/2021] [Accepted: 02/24/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives To demonstrate the progression-free survival (PFS) of nonmetastatic renal cell carcinoma (RCC) patients with venous thrombus after radical nephrectomy and venous thrombectomy (RN-VT) and to develop and validate a nomogram to predict the PFS of patients after RN-VT. Materials and Methods We reported our prospective follow-up data of RCC patients with venous thrombus from January 2014 to September 2020 (n = 199). We used the Kaplan–Meier method to assess the PFS. The Cox proportional hazards regression model was used to determine the predictors. Nomograms predicting the PFS was established, and external validation was performed. Calibration curves and decision curves were generated to assess the predictive efficacy and clinical benefit. Results After a median follow-up of 32 months, 79 patients (39.7%) had disease progression and the median PFS was 41.0 months (95% CI 34.8–53.2 months). The 1-year, 3-year, and 5-year PFS rates were 78.4%, 45.4%, and 30.0%, respectively. Multivariate analysis showed that Fuhrman grade [grade 4: hazard ratio (HR) 1.92, 95% CI 1.10–3.34, P = 0.02], pathological type (papillary RCC: HR 3.02, 95% CI 1.79–5.10, P < 0.001), perinephric fat invasion (HR 1.54, 95% CI 1.12–2.10, P = 0.007), sarcomatoid differentiation (HR 2.97, 95% CI 1.24–7.13, P = 0.02) were associated with a worse PFS, and adjuvant therapy (HR 0.32, 95% CI 0.18–0.59, P < 0.001) could lead to a better PFS. A nomogram based on the predictors was externally validated to have good discrimination and calibration, and it could improve PFS prediction to obtain a clinical benefit. Conclusions We constructed and validated a nomogram to predict the 1-year, 3-year, and 5-year PFS of M0 RCC patients with venous thrombus after surgery. The model can help identify patients who can benefit the most from surgery and develop the criteria for clinical trial enrollment.
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Affiliation(s)
| | | | | | | | | | | | | | - LuLin Ma
- *Correspondence: LuLin Ma, ; ShuDong Zhang,
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12
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Predictors of Survival in Patients Undergoing Surgery for Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus. Clin Genitourin Cancer 2022; 20:e330-e338. [PMID: 35279419 PMCID: PMC9486579 DOI: 10.1016/j.clgc.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/27/2022] [Accepted: 02/05/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Surgical resection of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus is a complex procedure with significant morbidity. Patient selection is critical to determining whether the benefits of the procedure outweigh the risks. In this study, we identified and stratified the risk factors that were associated with overall survival (OS) and recurrence-free survival (RFS) in patients undergoing surgical resection of RCC with IVC thrombus. METHODS We identified all patients with RCC with IVC tumor thrombus (stages cT3b and cT3c) who had undergone radical nephrectomy with tumor thrombectomy between December 1, 1993 and June 30, 2009. Kaplan-Meier method was used to estimate OS and RFS. Cox proportional hazards models were used to determine the association between risk factors and OS. Patients were stratified into 3 groups based on the number of risk factors present at diagnosis. RESULTS Two hundred twenty-four patients were included in the study. A total of 45.3% of patients had metastasis at presentation, 84.5% had cT3b, and 90.2% had clear cell RCC. cT3c, cN1, and cM1 were significantly associated with the risk of death. Group 1 patients (0 risk factors) had a median OS duration of 77.6 months (95% CI 50.5-90.4), group 2 (1 risk factor) 26.0 months (95% CI 19.5-35.2), and group 3 (≥2 risk factors) 8.9 months (95% CI 5.2-12.9; P < .001). CONCLUSIONS Stratification of patients with RCC and IVC thrombus by risk factors allowed us to predict survival duration. In patients with ≥2 risk factors, new treatment strategies with preoperative systemic therapy may improve survival.
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Tumor Thrombus Into the Inferior Vena Cava After Resection of Renal Cell Carcinoma: Recurrence or Tumor Thrombus Left Behind? Urology 2020; 148:e17-e22. [PMID: 33181121 DOI: 10.1016/j.urology.2020.10.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe a series of 3 cases of renal cell carcinoma that developed a metachronic recurrence in the form of inferior vena cava tumor thrombus after a first attempt of curative intent by means of radical nephrectomy. METHODS A complete work-up consisting of total body computed tomography and transesophagic echocardiography was performed in all cases. After extensive counseling a decision for surgical excision was made. We used a transplant-based approach to eliminate every vestige of visible neoplastic tissue including the tumor thrombus in all cases. Three different approaches, including tangential and circumferencial excision of the inferior vena cava with or without caval replacement by prosthetic vascular graft were used for caval management after thrombectomy. RESULTS Estimated blood loss ranged between 500 and 2000 cc. Transfusion requirements varied from 1-9 red blood cell packed units. Complete thrombectomy along with excision of all visible neoplastic lesions was achieved in all cases. One of the patients experimented a cardiac arrest on postoperative day 7 without fatal consequences that increased de length of stay (range 7-30 days). No other major complications were registered. None of the patients died in the first 30 days after the procedure. CONCLUSION The transplant-based surgical approach to thrombectomy in these cases provides for excellent exposure and vascular control, thus minimizing the complication rate and resulting a safe treatment option for the patient.
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Liu J, Huang Y, Cheng Q, Wang J, Zuo J, Liang Y, Yuan G. miR-1-3p suppresses the epithelial-mesenchymal transition property in renal cell cancer by downregulating Fibronectin 1. Cancer Manag Res 2019; 11:5573-5587. [PMID: 31417307 PMCID: PMC6594013 DOI: 10.2147/cmar.s200707] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/14/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Renal cell cancer (RCC) is one of the primary causes of malignancy deaths all over the world. The most important cause of RCC-related mortality is metastasis. Epithelial-mesenchymal transition (EMT) plays an important role in metastasis of malignant tumors including RCC. miR-1-3p is confirmed to be decreased in many types of cancer. Nevertheless, the function of miR-1-3p in RCC metastasis and EMT process was still unclear. Materials and methods In this study, information from clinical investigation, in vitro study, and in vivo study discovered miR-1-3p expression character and its status in RCC. The character of miR-1-3p in invasive and metastatic properties in vitro and in vivo was also inspected in RCC cells and xenograft tumor model, and expression levels of EMT markers were evaluated in RCC cells and tissues. Results miR-1-3p was proved to be decreased in RCC cell lines and tissues compared with normal renal cells and tissues. miR-1-3p expression level in RCC tissues was closely related with capsulation, lymph node metastasis, and vascular invasion. miR-1-3p was found to be able to block the EMT process in A498 and CAKI-1 RCC cells and tumors. Luciferase reporter assay and expression level rescue assays were employed to reveal that miR-1-3p inhibited the invasion and migration property of RCC cells by directly targeting Fibronectin 1. Upregulation of Fibronectin 1 partially reversed the suppressive effect of miR-1-3p on EMT process. Conclusion In brief, this study has verified that miR-1-3p blocked the EMT process of RCC cells by reducing Fibronectin 1 expression. miR-1-3p/Fibronectin 1 axis may be considered as a new target for drug development of RCC.
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Affiliation(s)
- Jianghui Liu
- Department of Emergency and Internal Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
| | - Yingxiong Huang
- Department of Emergency and Internal Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
| | - Quanyong Cheng
- Department of Emergency and Internal Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
| | - Jifei Wang
- Department of Emergency and Internal Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
| | - Jidong Zuo
- Department of Emergency and Internal Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
| | - Ying Liang
- Department of Nephrology, The Eighth People's Hospital of Guangzhou, Guangdong 510060, People's Republic of China
| | - Gang Yuan
- Department of Emergency and Internal Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
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Barbas Bernardos G, Herranz Amo F, Caño Velasco J, Cancho Gil M, Mayor de Castro J, Aragón Chamizo J, Polanco Pujol L, Hernández Fernández C. Influence of venous tumour extension on local and remote recurrence of stage pT3a pN0 cM0 kidney tumours. Actas Urol Esp 2019; 43:77-83. [PMID: 30268687 DOI: 10.1016/j.acuro.2018.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND OBJECTIVE One of the inherent features of kidney tumours is the capacity to spread inside the venous system as tumour thrombi. The aim of this study was to assess in patients with stage pT3apN0cM0 kidney cancer whether venous tumour involvement influenced tumour recurrence. MATERIALS AND METHODS A retrospective analysis of patients with stage pT3apN0cM0 kidney cancer treated with radical nephrectomy between 1990-2015. Univariate and multivariate Cox regression analysis to identify predictive variables and independent predictive variables relating to recurrence. RESULTS The results of 153 patients were studied. The median follow-up was 82 (IQR 36-117) months. Recurrence-free survival at 5 years was 58.9% with a median of 97 (95% CI 49.9-144.1) months. Seventy-seven (50.3%) patients recurred. Seventy cases 70 (90.9%) had distant metastases, 17 (14.2%) of these patients had local recurrence in the bed of nephrectomy. Tumour necrosis (p=.0001), and microvascular invasion (p=.001) were identified as independent predictors of tumour recurrence in the multivariable analysis. CONCLUSIONS In our series, after multivariable analysis, venous tumour extension was not related to recurrence. Tumour necrosis and microvascular infiltration did behave as independent predictive factors of tumour recurrence.
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Cao C, Bi X, Liang J, Li L, Zhang H, Xiao Z, Xiao Z, Tian J, Wang D, Guan K, Li C, Ma J, Zheng S, Shou J. Long-term survival and prognostic factors for locally advanced renal cell carcinoma with renal vein tumor thrombus. BMC Cancer 2019; 19:144. [PMID: 30760245 PMCID: PMC6373083 DOI: 10.1186/s12885-019-5359-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 02/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous related studies have mainly focused on renal cell carcinoma (RCC) with venous tumor thrombus, specifically inferior vena cava tumor thrombus with renal vein tumor thrombus (RVTT). However, only a few studies have focused on postoperative long-term survival of RCC patients exclusively with RVTT. Our aim was to investigate the independent prognostic factors for locally advanced RCC with RVTT in China. METHODS Patients with locally advanced RCC with RVTT were enrolled for the study from January 2000 to December 2015. All patients underwent radical nephrectomy. Survival analysis was estimated using Kaplan-Meier. Univariable and multivariable survival analyses were performed using COX. Patients were divided into high-risk, middle-risk, and low-risk groups based on independent prognostic factors and then analyzed for survival. RESULTS One hundred twenty-eight consecutive patients (103 men & 25 women) were enrolled with a median age of 61 years. Thrombi were all graded 0 using the Mayo system, of which 23 were friable. None of the thrombi detached during surgery. 121 patients were successfully followed up, with a median follow-up period of 47 months. Median overall survival was 127 months (95%CI: 101-153). The 5-year and 10-year cancer-specific survival (CSS) rate was 67.9 and 57.0%. 59 patients had recurrence with median time of 40 months. Friable thrombus, paraneoplastic syndrome (PNS), modified Fuhrman grade 3/4 and perirenal fat invasion were independent prognostic factors (p < 0.05). The 5-year CSS for the Low-risk group (no factors) was 100%, Middle-risk group (1-2 factors) was 68.6%, while the High-risk group (3-4 factors) was 0%. CONCLUSIONS After radical surgery, RCC patients with RVTT had a relatively fair prognosis except for patients with friable thrombus, PNS, higher modified Fuhrman grade and perirenal fat invasion.
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Affiliation(s)
- Chuanzhen Cao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China.,Department of Urology, Civil Aviation General Hospital & Civil Aviation Clinical Medical College of Peking University, Beijing, 100123, China
| | - Xingang Bi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China
| | - Jing Liang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China
| | - Lin Li
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China
| | - Huijuan Zhang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China
| | - Zhendong Xiao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China
| | - Zejun Xiao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China
| | - Jun Tian
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China
| | - Dong Wang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China
| | - Kaopeng Guan
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China
| | - Changling Li
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China
| | - Jianhui Ma
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China
| | - Shan Zheng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China.
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Panjiayuan Nanli 17#, Chaoyang District, 100021, People's Republic of China.
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Wang BS, Ma RZ, Liu YQ, Liu Z, Tao LY, Lu M, Wang GL, Zhang SD, Lu J, Ma LL. Body mass index as an independent risk factor for inferior vena cava resection during thrombectomy for venous tumor thrombus of renal cell carcinoma. World J Surg Oncol 2019; 17:17. [PMID: 30646899 PMCID: PMC6334420 DOI: 10.1186/s12957-019-1560-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
Objective To define preoperative clinical and radiographic risk factors for the need of inferior vena cava (IVC) resection in patients with renal cell carcinoma (RCC) and IVC tumor thrombus. Methods We reviewed data of 121 patients with renal cell carcinoma and venous tumor thrombus receiving radical nephrectomy and thrombectomy at our institution between 2015 and 2017, and 86 patients with Mayo I–IV level tumor thrombus were included in the final analysis. Clinical features, operation details, and pathology data were collected. Preoperative images were reviewed separately by two radiologists. Univariable and multivariable logistic regression analyses were applied to evaluate clinical and radiographic risk factors of IVC resection. Results Of the 86 patients, 44 (51.2%) received IVC resection during thrombectomy. In univariate analysis, we found that body mass index (BMI) (odds ratio [OR] = 1.22, P = 0.003), primary tumor diameter (OR = 0.84, P = 0.022), tumor thrombus width (OR = 1.08, P = 0.037), tumor thrombus level (OR = 1.57, P = 0.030), and IVC occlusion (OR = 2.67, P = 0.038) were associated with the need for resection of the IVC. After adjusting for the other factors, BMI (OR = 1.18, P = 0.019) was the only significant risk factor for IVC resection. Multivariable analysis in Mayo II–IV subgroups confirmed BMI as an independent risk factor (OR = 1.26, P = 0.024). A correlation between BMI and the width (Pearson’s correlation coefficient [PCC] = 0.27, P = 0.014) and length (PCC = 0.23, P = 0.037) of the tumor thrombus was noticed. Conclusion We identified BMI as an independent risk factor for IVC resection during thrombectomy of RCC with tumor thrombus in a Chinese population. More careful preoperative preparation for the IVC resection and/or reconstruction is warranted in patients with higher BMI.
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Affiliation(s)
- Bin-Shuai Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Run-Zhuo Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Yu-Qing Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Li-Yuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Guo-Liang Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shu-Dong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing, China.
| | - Lu-Lin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China.
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18
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Ku JY, Kim S, Hong SB, Lee JG, Lee CH, Choi SH, Ha HK. Prognostic indicators of pulmonary metastasis in patients with renal cell carcinoma who have undergone radical nephrectomy. Oncol Lett 2019; 17:3009-3016. [PMID: 30854079 DOI: 10.3892/ol.2019.9912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 11/26/2018] [Indexed: 12/21/2022] Open
Abstract
The aim of the present study was to validate prognostic indicators of pulmonary metastasis in patients with renal cell carcinoma (RCC) that have undergone nephrectomy treatment. The data from 356 patients who underwent nephrectomy were investigated and subsequently divided into 2 groups, according to the pulmonary metastasis status. The risk factors for pulmonary metastasis were examined in all patients. In the subgroup analysis, the risk factors were additionally verified in patients with pulmonary nodules using univariate and multivariate logistic regression analyses. The status of pulmonary nodules and pulmonary metastasis were confirmed through preoperative chest radiography by two radiologists. Pulmonary metastasis was observed in 33 (9.3%) patients with a median follow-up time of 54.4 months (interquartile range, 38.8-71.8). Patients with pulmonary nodules indicated significantly increased rates of pulmonary metastasis, compared with patients without pulmonary nodules (24.2 vs. 6.1%; P<0.001). In multivariate analysis, the presence of pulmonary nodules [hazard ratio (HR)=3.15; P=0.0262], albumin (HR=0.42; P=0.0490) and pTstage (HR=3.63; P=0.0475) were indicated to be independent prognostic markers for pulmonary metastasis. In subgroup analysis, pTstage was the only independent prognostic indicator for pulmonary metastasis in these patients (HR=9.81; P=0.0033). In patients with RCC, the presence of pulmonary nodules was associated with pulmonary metastasis. Furthermore, pTstage is a negative prognostic indicator in patients with pulmonary nodules. Therefore, a chest radiologic short-term follow-up is required for these patients.
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Affiliation(s)
- Ja Yoon Ku
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea
| | - Suk Kim
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea
| | - Seung Baek Hong
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea
| | - Jong Geun Lee
- Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju 63241, Republic of Korea
| | - Chan Ho Lee
- Department of Urology, Busan Paik Hospital, College of Medicine, Inje University, Busan 47392, Republic of Korea
| | - Seock Hwan Choi
- Department of Urology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea
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19
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Oh JJ, Lee JK, Do Song B, Lee H, Lee S, Byun SS, Lee SE, Hong SK. Accurate Risk Assessment of Patients with Pathologic T3aN0M0 Renal Cell Carcinoma. Sci Rep 2018; 8:13914. [PMID: 30224666 PMCID: PMC6141461 DOI: 10.1038/s41598-018-32362-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 09/06/2018] [Indexed: 12/27/2022] Open
Abstract
To develop a more precise risk-stratification system by investigating the prognostic impact of tumor growth within fatty tissues surrounding the kidney and/or renal vein. We conducted a retrospective review of the medical records of 211 patients with a pathologic diagnosis of T3aN0M0RCC among 4,483 renal cell carcinoma (RCC) patients from February 1988 to December 2015 according to the number of T3a pathologies—extrarenal fat invasion (EFI) and/or renal venous invasion (RVI). During a mean follow-up duration of 38.8 months, the patients with both pathologies (EFI + RVI) had lower recurrence free survival (RFS) rate than those with only a single pathology (p = 0.001). Using multivariable Cox regression analysis, the presence of both factors was shown to be an independent predictor of RFS (HR = 1.964, p = 0.032); cancer specific survival rate was not different among patients with EFI and/or RVI. Patients with pathologic T3aN0M0 RCC presenting with both EFI and RVI were at an increased risk of recurrence following nephrectomy. Therefore, pathologic T3a RCC could be sub-divided into those with favorable and unfavorable disease according to presence of EFI and/or RVI pathologies.
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Affiliation(s)
- Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Keun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Byung Do Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea. .,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.
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20
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Życzkowski M, Prokopowicz G, Taborowski P, Nowakowski K, Rajwa P, Stelmach P, Paradysz A. Basic Parameters of Blood Count, Serum Sodium, and Creatinine as Prognostic Factors for Renal Cell Carcinoma at Five-Year Follow-Up. Med Sci Monit 2018; 24:3895-3902. [PMID: 29885161 PMCID: PMC6024718 DOI: 10.12659/msm.906867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Several nomograms were developed for predicting the potential recurrence and cancer death risk in renal cell carcinoma patients. The combination of TNM classification and appropriately selected clinical classifiers allows for the creation of simple and effective risk calculators. Material/Methods There were 230 patients with renal cell cancer enrolled in this study. Basic parameters of blood count, serum creatinine and sodium concentrations, and histopathological features of the tumors were analyzed. A determination of whether any of the tested parameters could be used to assess the prognosis of kidney cancer was performed. Results When the platelet cell count (PLT) increased by 10 thousand/μL, the risk of metastasis was higher by 5%, and cancer recurrence and death by 10%. A low-risk recurrence group was identified: T1b, PLT <230, Na of 140.6 mmol/L. A high-risk recurrence group was identified: T3a, PLT >280, Na of 143.4 mmol/L. A low-risk cancer specific mortality group was identified: T2a, absence of metastases, preoperative creatinine level of 85.6 μmol/L, and the value of PLT 227.0×103. A high-risk cancer specific mortality group was identified: T3a, the presence of metastases in the lungs (M), serum creatinine before treatment level of 97.9 μmol/L, and the value of PLT 299.5×103. Conclusions Preoperative PLT, serum sodium, and tumor staging were independent risk factors for local recurrence. Blood PLT, serum sodium, creatinine, and tumor staging were useful indicators for estimating 5-year cancer specific survival.
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Affiliation(s)
- Marcin Życzkowski
- Department of Urology, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Prokopowicz
- Department of Urology, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Piotr Taborowski
- Department of Urology, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Nowakowski
- Department of Urology, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Paweł Rajwa
- Department of Urology, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Paweł Stelmach
- Department of Urology, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Andrzej Paradysz
- Department of Urology, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
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21
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Oka S, Inoshita N, Miura Y, Oki R, Miyama Y, Nagamoto S, Ogawa K, Sakaguchi K, Kondoh C, Kurosawa K, Urakami S, Takano T, Okaneya T. The loss of BAP1 protein expression predicts poor prognosis in patients with nonmetastatic clear cell renal cell carcinoma with inferior vena cava tumor thrombosis. Urol Oncol 2018; 36:365.e9-365.e14. [PMID: 29853346 DOI: 10.1016/j.urolonc.2018.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/18/2018] [Accepted: 04/24/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Renal cell carcinoma (RCC) is characterized by a propensity for extension into the renal vein and inferior vena cava (IVC) and is associated with poor prognosis. BAP1 mutation, which occurs in about 15% of patients with clear cell RCC (ccRCC), also predicts poor prognosis. The aim of this study was to elucidate the association between BAP1 protein expression and clinicopathological outcomes in patients with nonmetastatic ccRCC with an IVC tumor thrombus (IVCTT). MATERIAL AND METHODS Thirty-five patients with nonmetastatic ccRCC with an IVCTT who underwent radical nephrectomy and tumor thrombectomy at our institution from 1999 to 2010 were retrospectively evaluated. Immunohistochemical (IHC) analyses were performed for the expression of BAP1 protein, and the associations between the expression of BAP1 and clinical outcomes were assessed. Survival analyses were performed using the Kaplan-Meier method and log-rank test. Multivariate analyses of the associations between disease-free survival (DFS) and clinical variables including BAP1 protein expression, tumor size, Karnofsky performance status (KPS) score, and the extension level of the tumor thrombus were performed using a Cox proportional hazard model. RESULTS The median follow-up time was 58.8 months (range: 2-130 months). The median age was 68 years (range: 37-80 years). The median size of the primary tumor was 9.6cm (range: 3.0-15.0cm). The IVCTT extended above and below the diaphragm in 10 (28.6%) and 25 (71.4%) patients, respectively. The KPS score was>80 in 23 patients (65.7%). BAP1 protein expression on IHC was positive in 24 cases (68.8%) and negative in 11 cases (31.2%). The median overall survival in cases with BAP1-negative and -positive tumor on IHC staining were 44.7 and 81.5 months, respectively (P = 0.052). BAP1-negative tumor on IHC staining was associated with a significantly shorter DFS than BAP1-positive tumor (median DFS = 10.0 vs. 26.0 months, respectively; P = 0.011). Multivariate analysis showed that only BAP1-negative tumor on IHC staining was significantly associated with shorter DFS (P = 0.004). CONCLUSIONS Patients whose tumors had loss of BAP1 protein expression were significantly associated with poor prognosis in patients with ccRCC with an IVCTT who underwent radical nephrectomy and tumor thrombectomy.
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Affiliation(s)
- Suguru Oka
- Department of Urology, Toranomon Hospital, Tokyo, Japan
| | - Naoko Inoshita
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Yuji Miura
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan.
| | - Ryosuke Oki
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Yu Miyama
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Kohei Ogawa
- Department of Urology, Toranomon Hospital, Tokyo, Japan
| | | | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | | | | | - Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
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22
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Nini A, Capitanio U, Larcher A, Dell’Oglio P, Dehò F, Suardi N, Muttin F, Carenzi C, Freschi M, Lucianò R, La Croce G, Briganti A, Colombo R, Salonia A, Castiglioni A, Rigatti P, Montorsi F, Bertini R. Perioperative and Oncologic Outcomes of Nephrectomy and Caval Thrombectomy Using Extracorporeal Circulation and Deep Hypothermic Circulatory Arrest for Renal Cell Carcinoma Invading the Supradiaphragmatic Inferior Vena Cava and/or Right Atrium. Eur Urol 2018; 73:793-799. [DOI: 10.1016/j.eururo.2017.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
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23
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Gu L, Li H, Chen L, Li X, Wang B, Huang Q, Zhang F, Fan Y, Gao Y, Peng C, Ma X, Zhang X. Postoperative Adjuvant Sorafenib or Sunitinib for Nonmetastatic Renal Cell Carcinoma with Venous Tumor Thrombus: a Prospective Cohort Study. Transl Oncol 2017; 10:949-955. [PMID: 29035731 PMCID: PMC5645483 DOI: 10.1016/j.tranon.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 01/22/2023] Open
Abstract
PURPOSE: To evaluate the efficacy and safety of antiangiogenic agents (sorafenib and sunitinib) as postoperative adjuvant therapy in patients with nonmetastatic renal cell carcinoma (RCC) and venous tumor thrombus (VTT). MATERIAL AND METHODS: From March 2006 to January 2016, 147 patients who met the inclusion criteria were enrolled; 27 patients received sorafenib, and 17 patients received sunitinib. After radical nephrectomy and thrombectomy, the duration of maintenance targeted medication treatment was approximately 1 year. The primary objective was to compare disease-free survival (DFS) between each experimental group and control. Secondary end points included overall survival (OS) and toxic effects. RESULTS: The three groups were well balanced in terms of age, body mass index, gender, performance status, medical history, American Society of Anesthesiologists score, surgical approach, and tumor side and size. However, more patients receiving adjuvant therapy had inferior vena cava tumor thrombus. DFS and OS did not differ significantly between groups (P = .459 and .871, respectively). After adjusting for potential confounding factors, results of multivariate analysis proved that postoperative adjuvant therapy was not an independent factor for predicting DFS and OS (P > .05 for both). The subgroup analyses for inferior vena cava tumor thrombus found similar results. The common adverse events were hand-foot syndrome, diarrhea, fatigue, and neutropenia. The adverse effects were mild in both groups, and the incidence was not significantly different between sorafenib and sunitinib. CONCLUSIONS: Adjuvant treatment postoperatively with sorafenib or sunitinib showed no survival benefit relative to control for patients with nonmetastatic RCC and VTT in a prospective cohort study.
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Affiliation(s)
- Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xintao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Baojun Wang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Qingbo Huang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Fan Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yang Fan
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yu Gao
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Cheng Peng
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xin Ma
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
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24
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Abel EJ, Masterson TA, Karam JA, Master VA, Margulis V, Hutchinson R, Lorentz CA, Bloom E, Bauman TM, Wood CG, Blute ML. Predictive Nomogram for Recurrence following Surgery for Nonmetastatic Renal Cell Cancer with Tumor Thrombus. J Urol 2017; 198:810-816. [DOI: 10.1016/j.juro.2017.04.066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Affiliation(s)
- E. Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Timothy A. Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jose A. Karam
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ryan Hutchinson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - C. Adam Lorentz
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Evan Bloom
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tyler M. Bauman
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christopher G. Wood
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Michael L. Blute
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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25
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Blick C, Ritchie AWS, Eisen T, Stewart GD. Improving outcomes in high-risk, nonmetastatic renal cancer: new data and ongoing trials. Nat Rev Urol 2017; 14:753-759. [PMID: 28762388 DOI: 10.1038/nrurol.2017.123] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
High-risk, localized renal cancer is associated with recurrence rates of up to 75% at 10 years. The outcomes of patients at this disease stage depend on optimal patient stratification, surgical management and systemic therapy selection. Current evidence does not support the use of adjuvant therapy in patients with high-risk, localized disease. During the past 12 months, the results of large, randomized-controlled trials of adjuvant tyrosine kinase inhibitor (TKI) treatment, such as ASSURE and S-TRAC, have been published, but their findings are conflicting. Whether TKIs will become standard of care in the adjuvant setting depends on the long-term data from ongoing trials. In addition, several new trials that evaluate the utility of novel immune checkpoint inhibitors in this patient group are currently recruiting. The management of renal cancer is likely to evolve at a rapid pace over the next few years and matching patients with the appropriate therapeutic regimen is likely to be a focus of future research.
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Affiliation(s)
- Chris Blick
- Harold Hopkins Department of Urology, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
| | - Alastair W S Ritchie
- Department of Urology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester GL1 3NN, UK
| | - Timothy Eisen
- Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Grant D Stewart
- Academic Urology Group, University of Cambridge, Box 43, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
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26
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Cytoreductive Nephrectomy for Renal Cell Carcinoma with Venous Tumor Thrombus. J Urol 2017; 198:281-288. [DOI: 10.1016/j.juro.2017.03.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 11/20/2022]
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27
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Zhang X, Wang C, Li H, Niu X, Liu X, Pei D, Guo X, Xu X, Li Y. miR-338-3p inhibits the invasion of renal cell carcinoma by downregulation of ALK5. Oncotarget 2017; 8:64106-64113. [PMID: 28969055 PMCID: PMC5609987 DOI: 10.18632/oncotarget.19329] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/13/2017] [Indexed: 12/20/2022] Open
Abstract
Background The current study aims to elucidate the role of miRNA-338-3p (miR-338-3p) in the invasion of renal cell carcinoma (RCC). Methods Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed to detect the expression of miR-338-3p in human RCC cell lines with high metastatic potential (Caki-1) and low metastatic potential (786-O), respectively. The Caki-1 and 786-O cells were transfected with miR-338-3p mimic or inhibitor. Wound healing assay, Transwell assay and western blotting were performed to analyze the invasive ability and expression of activin receptor-like kinase 5 (ALK5) in the RCC cell lines. During the 36-month follow-up, we detected the expressions of miR-338-3p and ALK5 in 22 RCC cases with metastasis and 60 cases achieving a remission. Results miR-339-3p was significantly downregulated in the Caki-1 cells as compared with the 786-O cells. The transfection with miR-338-3p inhibitor caused an increased invasive ability of both two cell lines. However, the transfection with miR-338-3p mimic caused a reduction of the invasiveness. In RCC cells, the expression of ALK5 was negatively correlated to miR-338-3p. Upregulation of ALK5 partially counteracted the miR-338-3p-induced invasiveness of RCC cells. We subsequently found the negative correlations between miR-338-3p and metastasis/ALK5 expression could be also observed in human RCC tissues. Conclusion Taken together, these results indicate that miR-338-3p acts as a novel tumor suppressor to inhibit the invasion of RCC by regulating ALK5 expression.
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Affiliation(s)
- Xiaoqian Zhang
- Department of Clinical Laboratory, Henan Province Hospital of TCM, The Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450002, Henan Province, China
| | - Chunxia Wang
- Department of Clinical Laboratory, Henan Province Hospital of TCM, The Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450002, Henan Province, China
| | - Hui Li
- Department of Clinical Laboratory, Henan Province Hospital of TCM, The Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450002, Henan Province, China
| | - Xiaobin Niu
- Department of Clinical Laboratory, Henan Province Hospital of TCM, The Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450002, Henan Province, China
| | - Xinwei Liu
- Department of Clinical Laboratory, Henan Province Hospital of TCM, The Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450002, Henan Province, China
| | - Dongxu Pei
- Department of Clinical Laboratory, Henan Province Hospital of TCM, The Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450002, Henan Province, China
| | - Xiaolan Guo
- Department of Clinical Laboratory, Henan Province Hospital of TCM, The Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450002, Henan Province, China
| | - Xiaona Xu
- Department of Clinical Laboratory, Henan Province Hospital of TCM, The Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450002, Henan Province, China
| | - Yongwei Li
- Department of Clinical Laboratory, Henan Province Hospital of TCM, The Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450002, Henan Province, China
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28
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Park M, Shim M, Kim M, Song C, Kim CS, Ahn H. Prognostic heterogeneity in T3aN0M0 renal cell carcinoma according to the site of invasion. Urol Oncol 2017; 35:458.e17-458.e22. [PMID: 28476528 DOI: 10.1016/j.urolonc.2016.05.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/22/2016] [Accepted: 05/16/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE We investigated the influence of the site of invasion on recurrence and survival in patients with pT3aN0M0 renal cell carcinoma (RCC). MATERIALS AND METHODS We reviewed the data of 266 patients with pT3aN0M0 RCC who underwent nephrectomy and divided them into the following 5 groups according to the site of invasion: perinephric invasion (PNI), sinus fat invasion (SFI), PNI and SFI without renal vein invasion (RVI) (i.e., PNI+SFI), RVI, and RVI with PNI and/or SFI (RVI+PNI±SFI). Subgroup analysis was performed to verify the differences in prognosis according to the extent of renal vein invasion using Cox regression models. RESULTS A total of 111 patients (41.7%) experienced recurrence and 59 patients (22.2%) died of disease during follow-up (median = 58.1mo; interquartile range: 37.2-86.5). Patients with RVI showed significantly poorer outcomes than those with fat invasion in terms of 5-year recurrence-free survival (34.3% vs. 62.2%, P<0.001) and cancer-specific survival (62.8% vs. 84.1%; P<0.001). In multivariate analysis, RVI was an independent prognostic factor for recurrence and survival. In 94 patients with RVI, the 5-year recurrence-free survival rates were 50.0%, 33.9%, and 8.9% for the thrombus-only, the vascular wall invasion with negative surgical margin, and the vascular wall invasion with positive surgical margin groups, respectively (P<0.001), and the cancer-specific survival rates were 82.3%, 56.6%, and 20.0%, respectively (P<0.001). Wall invasion was the only independent prognostic factor for cancer-specific survival in these patients. CONCLUSIONS Patients with pT3aN0M0 RCC with RVI have a significantly poorer prognosis than those with fat invasion. The prognosis differs according to the extent of RVI. Wall invasion should be considered a negative prognostic indicator in patients with T3a RCC.
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Affiliation(s)
- Myungchan Park
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Myungsun Shim
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, GyeongGi-Do, South Korea
| | - Myong Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Yoo S, Song SH, Go H, You D, Song C, Hong JH, Kim CS, Ahn H, Jeong IG. Fate of newly developed pulmonary embolism after surgery for renal cell carcinoma with vena cava thrombus. Int Urol Nephrol 2017; 49:1157-1163. [DOI: 10.1007/s11255-017-1583-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/01/2017] [Indexed: 12/29/2022]
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Gu L, Wang Z, Chen L, Ma X, Li H, Nie W, Peng C, Li X, Gao Y, Zhang X. A proposal of post-operative nomogram for overall survival in patients with renal cell carcinoma and venous tumor thrombus. J Surg Oncol 2017; 115:905-912. [PMID: 28230236 DOI: 10.1002/jso.24575] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/03/2017] [Accepted: 01/26/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Liangyou Gu
- Department of Urology, State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital, PLA Medical School; Beijing China
| | - Zihuan Wang
- Institute of Occupational Health; Beijing Center for Disease Control and Prevention; Beijing China
| | - Luyao Chen
- Department of Urology, State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital, PLA Medical School; Beijing China
| | - Xin Ma
- Department of Urology, State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital, PLA Medical School; Beijing China
| | - Hongzhao Li
- Department of Urology, State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital, PLA Medical School; Beijing China
| | - Wenyuan Nie
- Department of Urology, State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital, PLA Medical School; Beijing China
| | - Cheng Peng
- Department of Urology, State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital, PLA Medical School; Beijing China
| | - Xintao Li
- Department of Urology, State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital, PLA Medical School; Beijing China
| | - Yu Gao
- Department of Urology, State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital, PLA Medical School; Beijing China
| | - Xu Zhang
- Department of Urology, State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital, PLA Medical School; Beijing China
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Choi DK, Jeon HG, Jeong CW, Kwak C, Song C, Chung J, Hong SK, Hong SH, Seo SI. Surgical treatment of renal cell carcinoma: Can morphological features of inferior vena cava tumor thrombus on computed tomography or magnetic resonance imaging be a prognostic factor? Int J Urol 2017; 24:102-109. [DOI: 10.1111/iju.13272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 11/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Don Kyoung Choi
- Department of Urology; Hallym University Kangnam Sacred Heart Hospital; Hallym University School of Medicine; Seoul Korea
| | - Hwang Gyun Jeon
- Department of Urology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Chang Wook Jeong
- Department of Urology; Seoul National University Hospital; Seoul National University of Medicine; Seoul Korea
| | - Cheol Kwak
- Department of Urology; Seoul National University Hospital; Seoul National University of Medicine; Seoul Korea
| | - Cheryn Song
- Department of Urology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Jinsoo Chung
- Department of Urology; National Cancer Center; Goyang Korea
| | - Sung Kyu Hong
- Department of Urology; Seoul National University Bundang Hospital; Seongnam Korea
| | - Sung-Hoo Hong
- Department of Urology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Seong Il Seo
- Department of Urology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
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Preoperative Gamma-Glutamyltransferase Is Associated with Cancer-Specific Survival and Recurrence-Free Survival of Nonmetastatic Renal Cell Carcinoma with Venous Tumor Thrombus. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3142926. [PMID: 28168196 PMCID: PMC5266806 DOI: 10.1155/2017/3142926] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/23/2016] [Accepted: 12/20/2016] [Indexed: 12/23/2022]
Abstract
Introduction. To evaluate the prognostic significance of preoperative gamma-glutamyltransferase (GGT) on the subgroup of nonmetastatic renal cell carcinoma (RCC) with venous tumor thrombus. Materials and Methods. We retrospectively reviewed the institutional database and collected the medical data of 156 patients with nonmetastatic RCC with venous tumor thrombus between March 2004 and December 2014. Kaplan-Meier and Cox regression analyses were applied to determine the prognostic factors for cancer-specific survival (CSS) and recurrence-free survival (RFS). Results. The median value and optimal cutoff point of preoperative GGT were 23.0 and 37.5 IU/L, respectively. In the entire cohort, 67 (42.9%) patients experienced disease recurrence, and 46 (29.5%) patients died. Kaplan-Meier analysis revealed that the CSS and RFS rates were lower in patients with preoperative GGT ≥ 37.5 IU/L than in those with preoperative GGT < 37.5 IU/L. Multivariate Cox proportional hazard analysis demonstrated that high preoperative GGT was significantly associated with shorter CSS (hazard ratio [HR]: 2.115; 95% CI: 1.164–3.843; p = 0.014) and RFS (HR: 1.955; 95% CI: 1.166–3.276; p = 0.011), after adjusting other covariates. Conclusions. Preoperative GGT can serve as an independent prognostic biomarker of nonmetastatic RCC patients with venous tumor thrombus. Further prospective study is warranted to confirm our results.
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Parker WP, Boorjian SA, Zaid HB, Cheville JC, Leibovich BC, Thompson RH. Surgical Management and Oncologic Outcomes of Recurrent Venous Tumor Thrombus after Prior Nephrectomy for Renal Cell Carcinoma. Eur Urol Focus 2016; 2:625-630. [DOI: 10.1016/j.euf.2016.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/08/2016] [Accepted: 05/06/2016] [Indexed: 11/27/2022]
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Kleinclauss F, Thuret R, Murez T, Timsit M. Transplantation rénale et cancers urologiques. Prog Urol 2016; 26:1094-1113. [DOI: 10.1016/j.purol.2016.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 12/18/2022]
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Tornberg SV, Nisen H, Visapää H, Kilpeläinen TP, Järvinen R, Mirtti T, Kantonen I, Simpanen J, Bono P, Taari K, Järvinen P. Outcome of surgery for patients with renal cell carcinoma and tumour thrombus in the era of modern targeted therapy. Scand J Urol 2016; 50:380-6. [DOI: 10.1080/21681805.2016.1217558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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