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Palmateer G, Nicaise EH, Goodstein T, Schmeusser BN, Patil D, Imtiaz N, Shapiro DD, Abel EJ, Joshi S, Narayan V, Ogan K, Master VA. Paraneoplastic Resolution Holds Prognostic Utility in Patients with Metastatic Renal Cell Carcinoma. Cancers (Basel) 2024; 16:3678. [PMID: 39518116 PMCID: PMC11545392 DOI: 10.3390/cancers16213678] [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] [Received: 09/27/2024] [Revised: 10/28/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024] Open
Abstract
Background/Objectives: The presence of paraneoplastic syndromes (PNS) in patients with renal cell carcinoma (RCC) is associated with worse survival; however, little is known about whether resolution of PNS after intervention has any prognostic value. We sought to determine if resolution of PNS by one year after cytoreductive nephrectomy was significantly associated with improved overall survival (OS) and cancer-specific survival (CSS). Methods: We retrospectively reviewed a prospectively maintained nephrectomy database for patients with any histology metastatic RCC (mRCC) who underwent nephrectomy between 2000 and 2022. Patients with the necessary laboratory studies available within 90 days before and by one year after surgery were included for study. PNS resolution was defined as an abnormal value compared to established laboratory cutoffs by one year after surgery. Multiple PNS in one patient was allowed, and resolution of each PNS was measured separately. OS and CSS were assessed using Kaplan-Meier curves and Cox proportional hazards models. Results: A total of 253 patients met inclusion criteria. A total of 177 patients (70.0%) met criteria for at least one PNS resolution by one year. Five-year OS and CSS rates were 15.7% and 36.2% for no PNS resolved, 24.5% and 31.6% for 1 PNS resolved, and 43.0% and 58.2% for ≥2 PNS resolved, respectively (p < 0.001). On multivariable analysis, no PNS resolution was associated with worse OS (HR 2.75, p < 0.001) and CSS (HR 2.62, p < 0.001) compared to ≥2 PNS resolved. Conclusions: Resolution of preoperative PNS abnormalities by one year following surgery is associated with improved OS and CSS in patients with mRCC.
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Affiliation(s)
- Gregory Palmateer
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA; (G.P.); (E.H.N.); (T.G.); (D.P.); (N.I.); (S.J.); (V.N.); (K.O.)
| | - Edouard H. Nicaise
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA; (G.P.); (E.H.N.); (T.G.); (D.P.); (N.I.); (S.J.); (V.N.); (K.O.)
| | - Taylor Goodstein
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA; (G.P.); (E.H.N.); (T.G.); (D.P.); (N.I.); (S.J.); (V.N.); (K.O.)
| | - Benjamin N. Schmeusser
- Department of Urology, University of Indiana School of Medicine, Indianapolis, IN 46202, USA;
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA; (G.P.); (E.H.N.); (T.G.); (D.P.); (N.I.); (S.J.); (V.N.); (K.O.)
| | - Nahar Imtiaz
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA; (G.P.); (E.H.N.); (T.G.); (D.P.); (N.I.); (S.J.); (V.N.); (K.O.)
| | - Daniel D. Shapiro
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA; (D.D.S.); (E.J.A.)
| | - Edwin J. Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA; (D.D.S.); (E.J.A.)
| | - Shreyas Joshi
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA; (G.P.); (E.H.N.); (T.G.); (D.P.); (N.I.); (S.J.); (V.N.); (K.O.)
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Vikram Narayan
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA; (G.P.); (E.H.N.); (T.G.); (D.P.); (N.I.); (S.J.); (V.N.); (K.O.)
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA; (G.P.); (E.H.N.); (T.G.); (D.P.); (N.I.); (S.J.); (V.N.); (K.O.)
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA; (G.P.); (E.H.N.); (T.G.); (D.P.); (N.I.); (S.J.); (V.N.); (K.O.)
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
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Jalowiec KA, Vrotniakaite-Bajerciene K, Jalowiec J, Frey N, Capraru A, Wojtovicova T, Joncourt R, Angelillo-Scherrer A, Tichelli A, Porret NA, Rovó A. JAK2 Unmutated Polycythaemia-Real-World Data of 10 Years from a Tertiary Reference Hospital. J Clin Med 2022; 11:jcm11123393. [PMID: 35743463 PMCID: PMC9225037 DOI: 10.3390/jcm11123393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: Polycythaemia is defined by an increase in haemoglobin (Hb) concentration, haematocrit (Hct) or red blood cell (RBC) count above the reference range adjusted to age, sex and living altitude. JAK2 unmutated polycythaemia is frequent but under-investigated in original publications. In this retrospective cohort study, we investigated the clinical and laboratory data, underlying causes, management and outcomes of JAK2 unmutated polycythaemia patients. (2) Methods: The hospital database was searched to identify JAK2 unmutated patients fulfilling WHO 2016 Hb/Hct criteria for PV (Hb >16.5 g/dL in men and >16 g/dL in women, or Hct > 49% in men and >48% in women, or RBC mass > 25% above mean normal predicted value) between 2008 and 2019. Clinical and laboratory data were collected and analysed. (3) Results: From 727,731 screened patients, 294 (0.04%) were included, the median follow-up time was 47 months. Epo and P50 showed no clear pattern in differentiating causes of polycythaemia. In 30%, the cause remained idiopathic, despite extensive work-up. Sleep apnoea was the primary cause, also in patients under 30. Around 20% had received treatment at any time, half of whom had ongoing treatment at the end of follow-up. During follow-up, 17.2% developed a thromboembolic event, of which 8.5% were venous and 8.8% arterial. The mortality was around 3%. (4) Conclusions: Testing for Epo and P50 did not significantly facilitate identification of underlying causes. The frequency of sleep apnoea stresses the need to investigate this condition. Idiopathic forms are common. A diagnostic flowchart based on our data is proposed here. NGS testing should be considered in young patients with persisting polycythaemia, irrespective of Epo and P50 levels.
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Affiliation(s)
- Katarzyna Aleksandra Jalowiec
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
- Correspondence:
| | - Kristina Vrotniakaite-Bajerciene
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
| | | | - Noel Frey
- IDSC Insel Data Science Center, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland;
| | - Annina Capraru
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
| | - Tatiana Wojtovicova
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
| | - Raphael Joncourt
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
| | - Anne Angelillo-Scherrer
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
| | - Andre Tichelli
- Haematology, University Hospital of Basel, 4031 Basel, Switzerland;
| | - Naomi Azur Porret
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
| | - Alicia Rovó
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
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Anžej Doma S, Drnovšek E, Kristan A, Fink M, Sever M, Podgornik H, Belčič Mikič T, Debeljak N, Preložnik Zupan I. Diagnosis and management of non-clonal erythrocytosis remains challenging: a single centre clinical experience. Ann Hematol 2021; 100:1965-1973. [PMID: 34013406 PMCID: PMC8285333 DOI: 10.1007/s00277-021-04546-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/01/2021] [Indexed: 12/31/2022]
Abstract
Erythrocytosis has a diverse background. While polycythaemia vera has well defined criteria, the diagnostic approach and management of other types of erythrocytosis are more challenging. The aim of study was to retrospectively analyse the aetiology and management of non-clonal erythrocytosis patients referred to a haematology outpatient clinic in an 8-year period using a 3-step algorithm. The first step was inclusion of patients with Hb > 185 g/L and/or Hct > 0.52 in men and Hb > 165 g/L and/or Hct > 0.48 in women on two visits ≥ two months apart, thus confirming true erythrocytosis. Secondly, polycythaemia vera was excluded and secondary causes of erythrocytosis (SE) identified. Thirdly, idiopathic erythrocytosis patients (IE) were referred to next-generation sequencing for possible genetic background evaluation. Of the 116 patients, 75 (65%) are men and 41 (35%) women, with non-clonal erythrocytosis 34/116 (29%) had SE, 15/116 (13%) IE and 67/116 (58%) stayed incompletely characterized (ICE). Patients with SE were significantly older and had significantly higher Hb and Hct compared to patients with IE. Most frequently, SE was attributed to obstructive sleep apnoea and smoking. Phlebotomies were performed in 56, 53 and 40% of patients in the SE, IE, and ICE group, respectively. Approx. 70% of patients in each group received aspirin. Thrombotic events were registered in 12, 20 and 15% of SE, IE and ICE patients, respectively. Congenital erythrocytosis type 4 (ECYT4) was diagnosed in one patient. The study demonstrates real-life management of non-clonal erythrocytosis which could be optimized using a 3-step diagnostic algorithm.
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Affiliation(s)
- Saša Anžej Doma
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Eva Drnovšek
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Aleša Kristan
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Martina Fink
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Matjaž Sever
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Helena Podgornik
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Aškerčeva 7, 1000, Ljubljana, Slovenia
| | - Tanja Belčič Mikič
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Nataša Debeljak
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Irena Preložnik Zupan
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia. .,Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia.
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