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Purdue MP, Dutta D, Machiela MJ, Gorman BR, Winter T, Okuhara D, Cleland S, Ferreiro-Iglesias A, Scheet P, Liu A, Wu C, Antwi SO, Larkin J, Zequi SC, Sun M, Hikino K, Hajiran A, Lawson KA, Cárcano F, Blanchet O, Shuch B, Nepple KG, Margue G, Sundi D, Diver WR, Folgueira MAAK, van Bokhoven A, Neffa F, Brown KM, Hofmann JN, Rhee J, Yeager M, Cole NR, Hicks BD, Manning MR, Hutchinson AA, Rothman N, Huang WY, Linehan WM, Lori A, Ferragu M, Zidane-Marinnes M, Serrano SV, Magnabosco WJ, Vilas A, Decia R, Carusso F, Graham LS, Anderson K, Bilen MA, Arciero C, Pellegrin I, Ricard S, Scelo G, Banks RE, Vasudev NS, Soomro N, Stewart GD, Adeyoju A, Bromage S, Hrouda D, Gibbons N, Patel P, Sullivan M, Protheroe A, Nugent FI, Fournier MJ, Zhang X, Martin LJ, Komisarenko M, Eisen T, Cunningham SA, Connolly DC, Uzzo RG, Zaridze D, Mukeria A, Holcatova I, Hornakova A, Foretova L, Janout V, Mates D, Jinga V, Rascu S, Mijuskovic M, Savic S, Milosavljevic S, Gaborieau V, Abedi-Ardekani B, McKay J, Johansson M, Phouthavongsy L, Hayman L, Li J, Lungu I, Bezerra SM, Souza AG, Sares CTG, Reis RB, Gallucci FP, Cordeiro MD, Pomerantz M, Lee GSM, Freedman ML, Jeong A, Greenberg SE, Sanchez A, Thompson RH, Sharma V, Thiel DD, Ball CT, Abreu D, Lam ET, Nahas WC, Master VA, Patel AV, Bernhard JC, Freedman ND, Bigot P, Reis RM, Colli LM, Finelli A, Manley BJ, Terao C, Choueiri TK, Carraro DM, Houlston R, Eckel-Passow JE, Abbosh PH, Ganna A, Brennan P, Gu J, Chanock SJ. Multi-ancestry genome-wide association study of kidney cancer identifies 63 susceptibility regions. Nat Genet 2024:10.1038/s41588-024-01725-7. [PMID: 38671320 DOI: 10.1038/s41588-024-01725-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/13/2024] [Indexed: 04/28/2024]
Abstract
Here, in a multi-ancestry genome-wide association study meta-analysis of kidney cancer (29,020 cases and 835,670 controls), we identified 63 susceptibility regions (50 novel) containing 108 independent risk loci. In analyses stratified by subtype, 52 regions (78 loci) were associated with clear cell renal cell carcinoma (RCC) and 6 regions (7 loci) with papillary RCC. Notably, we report a variant common in African ancestry individuals ( rs7629500 ) in the 3' untranslated region of VHL, nearly tripling clear cell RCC risk (odds ratio 2.72, 95% confidence interval 2.23-3.30). In cis-expression quantitative trait locus analyses, 48 variants from 34 regions point toward 83 candidate genes. Enrichment of hypoxia-inducible factor-binding sites underscores the importance of hypoxia-related mechanisms in kidney cancer. Our results advance understanding of the genetic architecture of kidney cancer, provide clues for functional investigation and enable generation of a validated polygenic risk score with an estimated area under the curve of 0.65 (0.74 including risk factors) among European ancestry individuals.
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Affiliation(s)
- Mark P Purdue
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | - Diptavo Dutta
- Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Mitchell J Machiela
- Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Timothy Winter
- Laboratory of Genetic Susceptibility, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | | | | | - Paul Scheet
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aoxing Liu
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Chao Wu
- Biosample Repository, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Samuel O Antwi
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - James Larkin
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Stênio C Zequi
- Department of Urology, A.C. Camargo Cancer Center, São Paulo, Brazil
- National Institute for Science and Technology in Oncogenomics and Therapeutic Innovation INCIT-INOTE, São Paulo, Brazil
- Latin American Renal Cancer Group, São Paulo, Brazil
- Department of Surgery, Division of Urology, São Paulo Federal University, São Paulo, Brazil
| | - Maxine Sun
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Keiko Hikino
- Laboratory for Pharmacogenomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Ali Hajiran
- Department of Urology, Division of Urologic Oncology, West Virginia University Cancer Institute, Morgantown, WV, USA
| | - Keith A Lawson
- Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Flavio Cárcano
- Department of Medical Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Brian Shuch
- Department of Urology, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Kenneth G Nepple
- Department of Urology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Gaëlle Margue
- Department of Urology, CHU Bordeaux, Bordeaux, France
| | - Debasish Sundi
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - W Ryan Diver
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | - Maria A A K Folgueira
- Departments of Radiology and Oncology, Comprehensive Center for Precision Oncology-C2PO, Centro de Investigação Translacional em Oncologia, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil
| | - Adrie van Bokhoven
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Kevin M Brown
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Jonathan N Hofmann
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Jongeun Rhee
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Meredith Yeager
- Cancer Genomics Research Laboratory, Frederick National Laboratory, Rockville, MD, USA
| | - Nathan R Cole
- Cancer Genomics Research Laboratory, Frederick National Laboratory, Rockville, MD, USA
| | - Belynda D Hicks
- Cancer Genomics Research Laboratory, Frederick National Laboratory, Rockville, MD, USA
| | - Michelle R Manning
- Cancer Genomics Research Laboratory, Frederick National Laboratory, Rockville, MD, USA
| | - Amy A Hutchinson
- Cancer Genomics Research Laboratory, Frederick National Laboratory, Rockville, MD, USA
| | - Nathaniel Rothman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Wen-Yi Huang
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Adriana Lori
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | | | | | - Sérgio V Serrano
- Department of Medical Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Ana Vilas
- Department of Pathology, Hospital Pasteur, Montevideo, Uruguay
| | - Ricardo Decia
- Department of Urology, Hospital Pasteur, Montevideo, Uruguay
| | | | - Laura S Graham
- Department of Medicine, Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kyra Anderson
- Oncology Clinical Research Support Team, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Cletus Arciero
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Solène Ricard
- Department of Urology, CHU Bordeaux, Bordeaux, France
| | - Ghislaine Scelo
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | - Rosamonde E Banks
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Naveen S Vasudev
- Department of Oncology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Naeem Soomro
- Department of Urology, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Grant D Stewart
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Adebanji Adeyoju
- Department of Urology, Stockport NHS Foundation Trust, Stockport, UK
| | - Stephen Bromage
- Department of Urology, Stockport NHS Foundation Trust, Stockport, UK
| | - David Hrouda
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Norma Gibbons
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Poulam Patel
- Division of Oncology, University of Nottingham, Nottingham, UK
| | - Mark Sullivan
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Protheroe
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Francesca I Nugent
- Department of Urology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | | | - Xiaoyu Zhang
- Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lisa J Martin
- Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Maria Komisarenko
- Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Timothy Eisen
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sonia A Cunningham
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Denise C Connolly
- Cancer Signaling and Microenvironment, Biosample Repository Facility, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Robert G Uzzo
- Department of Urology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - David Zaridze
- Department of Clinical Epidemiology, N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - Anush Mukeria
- Department of Clinical Epidemiology, N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - Ivana Holcatova
- Institute of Public Health and Preventive Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Oncology, Second Faculty of Medicine and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Anna Hornakova
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Foretova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Vladimir Janout
- Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | - Dana Mates
- Department of Occupational Health and Toxicology, National Center for Environmental Risk Monitoring, National Institute of Public Health, Bucharest, Romania
| | - Viorel Jinga
- Urology Department, Academy of Romanian Scientists, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Stefan Rascu
- Urology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mirjana Mijuskovic
- Clinic of Nephrology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Slavisa Savic
- Department of Urology, Clinical Hospital Center Dr Dragisa Misovic Dedinje, Belgrade, Serbia
| | - Sasa Milosavljevic
- International Organisation for Cancer Prevention and Research, Belgrade, Serbia
| | - Valérie Gaborieau
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | | | - James McKay
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Mattias Johansson
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Larry Phouthavongsy
- Ontario Tumour Bank, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Lindsay Hayman
- Diagnostic Development Program, Tissue Portal, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Jason Li
- Diagnostic Development Program, Tissue Portal, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Ilinca Lungu
- Ontario Tumour Bank, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Diagnostic Development Program, Tissue Portal, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | | | - Aline G Souza
- Departments of Medical Imaging, Hematology and Oncology, Division of Medical Oncology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Claudia T G Sares
- Departments of Surgery and Anatomy, Division of Urology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Rodolfo B Reis
- Departments of Surgery and Anatomy, Division of Urology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Fabio P Gallucci
- Surgery Department, Urology Division, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mauricio D Cordeiro
- Surgery Department, Urology Division, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Gwo-Shu M Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew L Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Boston, MA, USA
| | - Anhyo Jeong
- Department of Urology, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Samantha E Greenberg
- Department of Population Sciences, Genetic Counseling Shared Resource, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Alejandro Sanchez
- Department of Surgery, Division of Urology, Huntsman Cancer Institute and University of Utah, Salt Lake City, UT, USA
| | | | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| | - Colleen T Ball
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Diego Abreu
- Department of Urology, Hospital Pasteur, Montevideo, Uruguay
| | - Elaine T Lam
- Department of Medicine, Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William C Nahas
- Surgery Department, Urology Division, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Viraj A Master
- Department of Urology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | | | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Pierre Bigot
- Department of Urology, CHU Angers, Angers, France
| | - Rui M Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Leandro M Colli
- Departament of Medical Image, Hematology and Oncology, Division of Medical Oncology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Antonio Finelli
- Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Brandon J Manley
- Genitourinary Oncology Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Dirce M Carraro
- Clinical and Functional Genomics Group, CIPE (International Research Center), A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Richard Houlston
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, UK
| | | | - Philip H Abbosh
- Department of Nuclear Dynamics and Cancer, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Andrea Ganna
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Paul Brennan
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Jian Gu
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen J Chanock
- Laboratory of Genetic Susceptibility, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
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Margue G, Ferrer L, Etchepare G, Bigot P, Bensalah K, Mejean A, Roupret M, Doumerc N, Ingels A, Boissier R, Pignot G, Parier B, Paparel P, Waeckel T, Colin T, Bernhard JC. UroPredict: Machine learning model on real-world data for prediction of kidney cancer recurrence (UroCCR-120). NPJ Precis Oncol 2024; 8:45. [PMID: 38396089 PMCID: PMC10891119 DOI: 10.1038/s41698-024-00532-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Renal cell carcinoma (RCC) is most often diagnosed at a localized stage, where surgery is the standard of care. Existing prognostic scores provide moderate predictive performance, leading to challenges in establishing follow-up recommendations after surgery and in selecting patients who could benefit from adjuvant therapy. In this study, we developed a model for individual postoperative disease-free survival (DFS) prediction using machine learning (ML) on real-world prospective data. Using the French kidney cancer research network database, UroCCR, we analyzed a cohort of surgically treated RCC patients. Participating sites were randomly assigned to either the training or testing cohort, and several ML models were trained on the training dataset. The predictive performance of the best ML model was then evaluated on the test dataset and compared with the usual risk scores. In total, 3372 patients were included, with a median follow-up of 30 months. The best results in predicting DFS were achieved using Cox PH models that included 24 variables, resulting in an iAUC of 0.81 [IC95% 0.77-0.85]. The ML model surpassed the predictive performance of the most commonly used risk scores while handling incomplete data in predictors. Lastly, patients were stratified into four prognostic groups with good discrimination (iAUC = 0.79 [IC95% 0.74-0.83]). Our study suggests that applying ML to real-world prospective data from patients undergoing surgery for localized or locally advanced RCC can provide accurate individual DFS prediction, outperforming traditional prognostic scores.
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Affiliation(s)
- Gaëlle Margue
- Bordeaux University Hospital, Urology department, Bordeaux, France.
- Kidney Cancer group of the French Association of Urology Cancer Committee, Paris, France.
| | - Loïc Ferrer
- SOPHiA GENETICS, Multimodal R&D team, Pessac, France
| | | | - Pierre Bigot
- Kidney Cancer group of the French Association of Urology Cancer Committee, Paris, France
- Angers University hospital, Urology department, Angers, France
| | - Karim Bensalah
- Rennes university hospital, Urology department, Rennes, France
| | | | - Morgan Roupret
- Kidney Cancer group of the French Association of Urology Cancer Committee, Paris, France
- La Pitié APHP, Urology department, Paris, France
| | - Nicolas Doumerc
- Kidney Cancer group of the French Association of Urology Cancer Committee, Paris, France
- Toulouse university hospital, Urology department, Toulouse, France
| | - Alexandre Ingels
- Kidney Cancer group of the French Association of Urology Cancer Committee, Paris, France
- Mondor-APHP, Urology department, Paris, France
| | - Romain Boissier
- Kidney Cancer group of the French Association of Urology Cancer Committee, Paris, France
- APHM, Urology department, Marseille, France
| | | | - Bastien Parier
- Kremlin-Bicêtre -APHP, Urology department, Paris, France
| | | | - Thibaut Waeckel
- Kidney Cancer group of the French Association of Urology Cancer Committee, Paris, France
- Caen University Hospital, Urology department, Caen, France
| | - Thierry Colin
- SOPHiA GENETICS, Multimodal R&D team, Pessac, France
| | - Jean-Christophe Bernhard
- Bordeaux University Hospital, Urology department, Bordeaux, France
- Kidney Cancer group of the French Association of Urology Cancer Committee, Paris, France
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Boulenger de Hauteclocque A, Ferrer L, Margue G, Etchepare G, Colin T, Bernhard JC. Reply to: machine learning in renal cell carcinoma research: promise and pitfalls of 'renal-izing' the potential of artificial intelligence. BJU Int 2023; 132:713-714. [PMID: 37460190 DOI: 10.1111/bju.16116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Affiliation(s)
| | | | - Gaëlle Margue
- Centre Hospitalier Universitaire de Bordeaux Groupe Hospitalier Pellegrin, Bordeaux, France
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Debard C, Margue G, Klein C, Rompré-Brodeur A, Marcq G, Bensadoun H, Robert G, Anidjar M, Bladou F. [Oncological and functional results of focal treatment of localized prostate cancer with HIFU]. Prog Urol 2023; 33:966-973. [PMID: 37770359 DOI: 10.1016/j.purol.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION In recent years, improved diagnosis of prostate cancer has allowed the development of focal therapy, in order to reduce the morbidity of treatments. Our study assesses the medium-term oncological and functional results of FocalOne® HIFU treatment in localized prostate cancer. METHODS This is a retrospective, multicentre study including patients with low- or intermediate-risk localized prostate cancer treated with Focal one HIFU between November 2014 and December 2019. The primary endpoint was the retreatment rate and subgroup analyses were performed to identify predictive factors of retreatment. RESULTS One hundred and thirty-seven patients were included with a median follow-up of 25.5 months. Seventy percent of patients had clinical stage T2, 64% had an ISUP score of 2 or 3 on initial biopsies and 38% were treated with hemi-ablation. Follow-up biopsies were performed in 76.6% of patients during follow-up with 21.8% having clinically significant cancers. The retreatment rate at 24 months was 37.2%, with positive biopsies being the primary criterion for retreatment. Patients with a PSA>8ng/mL had a significantly higher retreatment rate. Finally, morbidity remained acceptable with 5.8% of patients requiring reoperation for complications and 21% for de novo erectile dysfunction. CONCLUSION Our results are in agreement with those of the literature, seeming to indicate a lower morbidity of the focal treatment by HIFU compared to the radical treatments while offering an acceptable oncological control. Prospective randomized trials are ongoing. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- C Debard
- Service d'urologie, CHU de Pellegrin, Bordeaux, France.
| | - G Margue
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - C Klein
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - A Rompré-Brodeur
- Department of Surgery (Division of Urology), Mc Gill University Health Center, Montreal, Canada
| | - G Marcq
- Service d'urologie, hôpital Claude-Huriez, CHU de Lille, Lille, France
| | - H Bensadoun
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - G Robert
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - M Anidjar
- Department of Surgery (Division of Urology), Mc Gill University Health Center, Montreal, Canada
| | - F Bladou
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
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5
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Klein C, Cazalas G, Margue G, Piana G, DE Kerviler E, Gangi A, Puech P, Nedelcu C, Grange R, Buy X, Michiels C, Jegonday MA, Rouviere O, Grenier N, Marcelin C, Bernhard JC. Percutaneous tumor ablation versus image guided robotic-assisted partial nephrectomy for cT1b renal cell carcinoma: a comparative matched-pair analysis (UroCCR 80). Minerva Urol Nephrol 2023; 75:559-568. [PMID: 37728492 DOI: 10.23736/s2724-6051.23.05274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Partial nephrectomy (PN) is the gold standard treatment for cT1b renal tumors. Percutaneous guided thermal ablation (TA) has proven oncologic efficacy with low morbidity for the treatment of small renal masses (<3 cm). Recently, 3D image-guided robot-assisted PN (3D-IGRAPN) has been described, and decreased perioperative morbidity compared to standard RAPN has been reported. Our objective was to compare two minimally invasive image-guided nephron-sparing procedures (TA vs. 3D-IGRAPN) for the treatment of cT1b renal cell carcinomas (4.1-7 cm). METHODS Patients treated with TA and 3D-IGRAPN for cT1b renal cell carcinoma, prospectively included in the UroCCR database (NCT03293563), were pair-matched for tumor size, pathology, and RENAL score. The primary endpoint was the local recurrence rate between the two groups. Secondary endpoints included metastatic evolution, perioperative complications, decrease in renal function, and length of hospitalization. RESULTS A total of 198 patients were included and matched into two groups of 72 patients. The local recurrence rate was significantly higher in the TA group than that in the 3D-IGRAPN group (4.2% vs. 15.2%, P=0.04). Metastatic evolution and perioperative outcomes such as major complications, eGFR decrease, and length of hospitalization did not differ significantly between the two groups. CONCLUSIONS 3D-IGRAPN resulted in a significantly lower local recurrence rate and comparable rates of complications and metastatic evolution compared with thermal ablation.
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Affiliation(s)
- Clément Klein
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France -
| | - Grégoire Cazalas
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Gaëlle Margue
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Gilles Piana
- Department of Radiology, Paoli-Calmettes Institute, Marseille, France
| | | | - Afshin Gangi
- Department of Interventional Radiology, Strasbourg University Hospital, Strasbourg, France
| | - Phillipe Puech
- Department of Radiology, Lille University Hospital, Lille, France
| | - Cosmina Nedelcu
- Department of Radiology, Angers University Hospital, Angers, France
| | - Remi Grange
- Department of Radiology, Saint-Etienne University Hospital, Saint Etienne, France
| | - Xavier Buy
- Department of Interventional Radiology, Bergonié Institute, Bordeaux, France
| | - Clément Michiels
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | | | | | - Nicolas Grenier
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Clément Marcelin
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
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Margue G, Ingels A, Bensalah K, Doumerc N, Vaessen C, Roupret M, Audenet F, Mejean A, Bruyere F, Olivier J, Baumert H, Michel C, Paparel P, Parier B, Sebe P, Long JA, Lang H, Lebret T, Patard JJ, Bernhard JC. Late complications and 5 years outcomes of robotic partial nephrectomy in France: prospective assessment in the French Kidney Cancer Research Network (UroCCR 10). World J Urol 2023; 41:2281-2288. [PMID: 37407720 DOI: 10.1007/s00345-023-04491-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/10/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE To describe the practice of robotic-assisted partial nephrectomy (RAPN) in France and prospectively assess the late complications and long-term outcomes. METHODS Prospective, multicenter (n = 16), observational study including all patients diagnosed with a renal tumor who underwent RAPN. Preoperative, intraoperative, postoperative, and follow-up data were collected and stored in the French research network for kidney cancer database (UroCCR). Patients were included over a period of 12 months, then followed for 5 years. RESULTS In total, 466 patients were included, representing 472 RAPN. The mean tumor size was 3.4 ± 1.7 cm, most of moderate complexity (median PADUA and RENAL scores of 8 [7-10] and 7 [5-9]). Indication for nephron-sparing surgery was relative in 7.1% of cases and imperative in 11.8%. Intraoperative complications occurred in 6.8% of patients and 4.2% of RAPN had to be converted to open surgery. Severe postoperative complications were experienced in 2.3% of patients and late complications in 48 patients (10.3%), mostly within the first 3 months and mainly comprising vascular, infectious, or parietal complications. At 5 years, 29 patients (6.2%) had chronic kidney disease upstaging, 21 (4.5%) were diagnosed with local recurrence, eight (1.7%) with contralateral recurrence, 25 (5.4%) with metastatic progression, and 10 (2.1%) died of the disease. CONCLUSION Our results reflect the contemporary practice of French expert centers and is, to our knowledge, the first to provide prospective data on late complications associated with RAPN. We have shown that RAPN provides good functional and oncologic outcomes while limiting short- and long-term morbidity. TRIAL REGISTRATION NCT03292549.
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Affiliation(s)
- Gaëlle Margue
- Service d'urologie, Urology Department, Bordeaux University Hospital, CHU de Bordeaux, Place Amelie Raba Leon, 33000, Bordeaux, France.
| | - Alexandre Ingels
- Urology Department, Henri Mondor University Hospital, APHP, Paris, France
| | - Karim Bensalah
- Urology Department, Rennes University Hospital, Rennes, France
| | - Nicolas Doumerc
- Urology Department, Toulouse University Hospital, Toulouse, France
| | | | - Morgan Roupret
- Urology Department, Pitié-Saplétrière Hospital, APHP, Paris, France
| | - François Audenet
- Urology Department, European Georges Pompidou Hospital, Paris, France
| | - Arnaud Mejean
- Urology Department, European Georges Pompidou Hospital, Paris, France
| | - Franck Bruyere
- Urology Department, Tours University Hospital, Tours, France
| | | | - Hervé Baumert
- Urology Department, Saint Joseph Hospital, Paris, France
| | | | | | - Bastien Parier
- Urology Department, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Philippe Sebe
- Urology Department, Hospital Group Diaconesses Croix Saint-Simon, Paris, France
| | | | - Hervé Lang
- Urology Department, Strasbourg University Hospital, Strasbourg, France
| | - Thierry Lebret
- Urology Department, Foch Hospital, Paris Saclay University, Suresnes, France
| | | | - Jean-Christophe Bernhard
- Service d'urologie, Urology Department, Bordeaux University Hospital, CHU de Bordeaux, Place Amelie Raba Leon, 33000, Bordeaux, France
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Boulenger de Hauteclocque A, Michiels C, Sarrazin J, Faessel M, Sabatier J, Khaddad A, Margue G, Grenier N, Bos F, Estrade V, Bernhard JC. Three Dimensional Printing Technology Used to Create a High-Fidelity Ureteroscopy Simulator: Development and Validity Assessment (Rein-3D-Print-UroCCR-39). Urology 2023; 176:36-41. [PMID: 36907468 DOI: 10.1016/j.urology.2023.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/29/2023] [Accepted: 02/28/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE To create and assess the validity of a high-fidelity, three dimensional (3D) printed, flexible ureteroscopy simulator resulting from a real case. METHODS A patient's CT scan was segmented to obtain a 3D model in .stl format, including the urinary bladder, ureter and renal cavities. The file was printed and a kidney stone was introduced into the cavities. The simulated surgery consisted of monobloc stone extraction. Nineteen participants split into 3 groups according to their level (6 medical students, 7 residents and 6 urology fellows) performed the procedure twice at a 1-month interval. They were rated according to a global score and a task-specific score, based on an anonymized, timed video recording. RESULTS Participants demonstrated a significant improvement between the 2 assessments, both on the global score (29.4 vs 21.9 points out of 35; P < .001) and the task-specific score (17.7 vs 14.7 points out of 20; P < .001) as well as procedure time (498.5 vs 700 seconds; P = .001). Medical students showed the greatest progress for the global score (+15.5 points (mean), P = .001) and the task-specific score (+6.5 points (mean), P < .001). 69.2% of participants considered the model as visually quite realistic or highly realistic and all of them judged it quite or extremely interesting for intern training purposes. CONCLUSION Our 3D printed ureteroscopy simulator was able to enhance the progress of medical students who are new to endoscopy, whilst being valid and reasonably priced. It could become part of a training program in urology, in line with the latest recommendations for surgical education.
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Affiliation(s)
| | - Clément Michiels
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Joffrey Sarrazin
- Department of Additive Fabrication Engineering, Bordeaux University Technological Institute, Gradignan, France
| | - Matthieu Faessel
- Department of Additive Fabrication Engineering, Bordeaux University Technological Institute, Gradignan, France
| | - Jocelyn Sabatier
- Department of Additive Fabrication Engineering, Bordeaux University Technological Institute, Gradignan, France
| | | | - Gaëlle Margue
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Nicolas Grenier
- Department of Radiology, Bordeaux University Hospital, Bordeaux, France
| | - Frédéric Bos
- Department of Additive Fabrication Engineering, Bordeaux University Technological Institute, Gradignan, France
| | - Vincent Estrade
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
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Bernhard JC, Robert G, Ricard S, Rogier J, Degryse C, Michiels C, Margue G, Blanc P, Alezra E, Estrade V, Capon G, Bladou F, Ferriere JM. Nurse-led coordinated surgical care pathways for cost optimization of robotic-assisted partial nephrectomy: medico-economic analysis of the UroCCR-25 AMBU-REIN study. World J Urol 2023; 41:325-333. [PMID: 35727334 DOI: 10.1007/s00345-022-04066-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Robot-assisted partial nephrectomy (RAPN) reduces morbidity, enabling development of Enhanced Recovery After Surgery (ERAS) and day-case protocols. Additional financial costs limit its integration into clinical practice. We evaluated the medico-economic impact of RAPN using a nurse-led coordinated pathway of care (NLC-RAPN). METHODS All tumor RAPNs performed in 2017 were prospectively included in nurse-led protocols: NP-RAAC (ERAS) or Ambu-Rein (day case). Clinico-biological and pathological data were prospectively collected within the French Research Network for Kidney Cancer database (NCT03293563). Estimated costs were compared to "average" patients at the national level operated by open partial nephrectomy (OPN) or RAPN, using data from the 2017 French hospital discharge database and the national cost scale. RESULTS The NLC-RAPN cohort (n = 151) included 27 (18%) outpatients and the average hospital length of stay (LOS) was 2.4 days. In the national control cohorts for OPN (n = 2475) and RAPN (n = 3529), the average LOS were 8.0 and 5.2 days, respectively. The mean incomes per group were €7607 for NLC-RAPN, €9813 for OPN, and €8215 for RAPN. The mean daily cost of stay was €659 for NLC-RAPN, €838 for OPN, and €725 for RAPN. The overall cost for NLC-RAPN was €6594, €8733 for OPN, and €8763 for RAPN. The best operational margin was obtained for day-case NLC-RAPN (€1967). CONCLUSION Combining RAPN with nurse-led coordinated pathways of care led to a shorter hospital stay and reduced costs versus OPN. This may facilitate the economic sustainability of robotic assistance for hospitals where the extra cost is not covered by the healthcare system.
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Affiliation(s)
- Jean-Christophe Bernhard
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France.
- UroCCR, French Research Network On Kidney Cancer, Bordeaux, France.
| | - Grégoire Robert
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Solène Ricard
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
- UroCCR, French Research Network On Kidney Cancer, Bordeaux, France
| | - Julien Rogier
- Department of Anesthesiology, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Cécile Degryse
- Department of Anesthesiology, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Clément Michiels
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Gaëlle Margue
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Peggy Blanc
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Eric Alezra
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Vincent Estrade
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Grégoire Capon
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Franck Bladou
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Jean-Marie Ferriere
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
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Margue G, Ferrer L, Etchepare G, Bensalah K, Mejean A, Roupret M, Doumerc N, Ingels A, Boissier R, Pignot G, Parier B, Paparel P, Waeckel T, Bigot P, Colin T, Bernhard JC. Development of an individual postoperative prediction model for kidney cancer recurrence using machine learning (UroCCR study 120). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00519-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Allenet C, Klein C, Rouget B, Margue G, Capon G, Alezra E, Blanc P, Estrade V, Bladou F, Robert G, Bernhard JC. Can Pre-Operative Neutrophil-to-Lymphocyte Ratio (NLR) Help Predict Non-Metastatic Renal Carcinoma Recurrence after Nephrectomy? (UroCCR-61 Study). Cancers (Basel) 2022; 14:cancers14225692. [PMID: 36428784 PMCID: PMC9688470 DOI: 10.3390/cancers14225692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Recent studies suggested that the neutrophil-to-lymphocyte ratio (NLR) could play a key role in tumor initiation, progression and response to treatments. The main objective was to assess the prognostic value of the pre-operative NLR on recurrence-free survival (RFS) in patients with non-hereditary localized renal cell carcinoma. From the UroCCR database (NCT03293563), factors influencing the disease recurrence of consecutive patients who underwent nephrectomy for cT1-T4 N0M0 were analyzed using multi-variate cox regression and log-rank methods. We included 786 patients, among which 135 (17.2%) experienced a recurrence at a median time of 23.7 [8.5-48.6] months. RFS for patients with a pre-operative NLR of <2.7 was 94% and 88% at 3 and 5 years, respectively, versus 76% and 63% for patients with a NLR of ≥2.7 (p < 0.001, log-rank test). To predict the risk of post-operative recurrence, the NLR was combined with the UCLA integrated staging system (UISS), and we defined four groups of the UroCCR-61 predictive model. The RFS rates at 3 and 5 years were 100% and 97% in the very-low-risk group, 93% and 86% in the low-risk group, 78% and 68% in the intermediate-risk group and 63% and 46% in the high-risk group (p < 0.0001). The pre-operative NLR seems to be an inexpensive and easily accessible prognostic bio-marker for non-metastatic RCCs.
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Affiliation(s)
- Clément Allenet
- Department of Urology, Bordeaux Pellegrin University Hospital,33000 Bordeaux, France
- Department of Health Sciences, University of Bordeaux, 33000 Bordeaux, France
| | - Clément Klein
- Department of Urology, Bordeaux Pellegrin University Hospital,33000 Bordeaux, France
- Department of Health Sciences, University of Bordeaux, 33000 Bordeaux, France
| | - Benjamin Rouget
- Department of Urology, Robert Boulin Hospital, 33500 Libourne, France
| | - Gaëlle Margue
- Department of Urology, Bordeaux Pellegrin University Hospital,33000 Bordeaux, France
- Department of Health Sciences, University of Bordeaux, 33000 Bordeaux, France
| | - Grégoire Capon
- Department of Urology, Bordeaux Pellegrin University Hospital,33000 Bordeaux, France
- Department of Health Sciences, University of Bordeaux, 33000 Bordeaux, France
| | - Eric Alezra
- Department of Urology, Bordeaux Pellegrin University Hospital,33000 Bordeaux, France
- Department of Health Sciences, University of Bordeaux, 33000 Bordeaux, France
| | - Peggy Blanc
- Department of Urology, Bordeaux Pellegrin University Hospital,33000 Bordeaux, France
- Department of Health Sciences, University of Bordeaux, 33000 Bordeaux, France
| | - Vincent Estrade
- Department of Urology, Bordeaux Pellegrin University Hospital,33000 Bordeaux, France
- Department of Health Sciences, University of Bordeaux, 33000 Bordeaux, France
| | - Franck Bladou
- Department of Urology, Bordeaux Pellegrin University Hospital,33000 Bordeaux, France
- Department of Health Sciences, University of Bordeaux, 33000 Bordeaux, France
| | - Grégoire Robert
- Department of Urology, Bordeaux Pellegrin University Hospital,33000 Bordeaux, France
- Department of Health Sciences, University of Bordeaux, 33000 Bordeaux, France
| | - Jean-Christophe Bernhard
- Department of Urology, Bordeaux Pellegrin University Hospital,33000 Bordeaux, France
- Department of Health Sciences, University of Bordeaux, 33000 Bordeaux, France
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Margue G, Allenet C, Michiels C, Estrade V, Alezra E, Capon G, Bladou F, Robert G, Bernhard JC. Technical tips of 3D Image Guided Robotic Assisted Partial Nephrectomy (3D-IGRAPN) for the management of a hilar tumor. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Margue G, Callede E, Ricard S, Picard F, Dubernet C, Robert G, Bladou F, Bernhard JC. [Digital transformation of perioperative nurse-coordinated protocols in renal surgery for enhanced recovery and outpatient surgery using UroConnect® application]. Prog Urol 2022; 32:888-892. [PMID: 36055902 DOI: 10.1016/j.purol.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
Abstract
Robot Assisted Partial Nephrectomy (RAPN) is a standard of care for localized renal tumors. It allows a good carcinological control while limiting complications. Despite numerous benefits, the economic sustainability of robotic assistance remains a challenge in the French health care system. The introduction in our institution of two perioperative nurse-coordinated protocols for patients undergoing RAPN (Enhanced Recovery After Surgery: NP-RAAC in 2015 and Outpatient: Ambu-Rein in 2016) is associated with a shortening of the average length of hospital stay, thus reducing the cost of robotic assisted procedures. With the aim of improving efficiency of nursing support within these protocols, we have introduced digitalized nursing coordination by developing a urological perioperative application: UroConnect®. This device is offered to patients by the coordinating nurses during a preoperative visit. It provides information on the pathology and its surgical management. Self-completed questionnaires sent at key moments collect data from the first month after surgery and detect patients presenting difficulties or complications, allowing the nurses to respond with appropriate care. The application allows a secure discharge, a personalised follow-up and an increase in the patient's autonomy and compliance with care.
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Affiliation(s)
- G Margue
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France.
| | - E Callede
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France; Réseau français de recherche sur le cancer du rein UroCCR, Bordeaux, France
| | - S Ricard
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France; Réseau français de recherche sur le cancer du rein UroCCR, Bordeaux, France
| | - F Picard
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - C Dubernet
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - G Robert
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - F Bladou
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - J C Bernhard
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France; Réseau français de recherche sur le cancer du rein UroCCR, Bordeaux, France
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13
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Margue G, Michiels C, Allenet C, Dupitout L, Ricard S, Jambon E, Blanc P, Alezra E, Estrade V, Capon G, Bladou F, Robert G, Grenier N, Bernhard JC. Feasibility of salvage robotic partial nephrectomy after ablative treatment failure (UroCCR-62 study). Minerva Urol Nephrol 2022; 74:209-215. [PMID: 35345389 DOI: 10.23736/s2724-6051.22.04693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ablative therapies (AT) are increasingly being offered to patients with kidney tumors. In cases of failure or local relapse, salvage surgery may be required. Such procedures often require an open approach, are difficult and have received little attention in the literature. We aim to evaluate the feasibility of salvage robot-assisted partial nephrectomy (sRAPN) after AT. METHODS We conducted a monocentric retrospective study of all patients who benefited from sRAPN. Clinical data were collected prospectively after written consent in the French UroCCR database. RESULTS Between 2013 and 2020, 724 RAPN were performed in our center; of these, 11 patients underwent salvage RAPN and four (36.4%) had an imperative indication for a solitary kidney. The median patient age was 54 (49-72) years, median preoperative glomerular filtration rate (GFR) was 65.5 (42.9-88.4) mL/min/1.73 m2, and median tumor diameter was 34 (16-38) mm. Extensive perinephric fibrosis was present in 90.9% of cases. Postoperative complications occurred in 36.4% of patients, including major complications in 18.2%. The median GFR at three months (56.8 [45.9-63.9] mL/min/1.73 m2) and at last follow-up (52.1 [45.85-68.3] mL/min/1.73 m2) were not significantly different to the preoperative GFR (P=0.51 and P=0.65, respectively). During follow-up (median 12 months), three patients (all with Von Hippel Lindau disease) developed a recurrence, but none were on the sRAPN site. CONCLUSIONS Our series of sRAPN following AT failure confirms that such surgery is feasible with good functional and oncological results. However, these surgeries remain difficult, are associated with significant complication rate and should be performed in expert centers.
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Affiliation(s)
- Gaëlle Margue
- Department of Urology, Bordeaux University Hospital, Bordeaux, France -
| | - Clément Michiels
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Clément Allenet
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Laure Dupitout
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Solène Ricard
- French Research Network on Kidney Cancer (UroCCR), Bordeaux, France
| | - Eva Jambon
- Department of Radiology, Bordeaux University Hospital, Bordeaux, France
| | - Peggy Blanc
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Eric Alezra
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Vincent Estrade
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Grégoire Capon
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Franck Bladou
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Grégoire Robert
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Nicolas Grenier
- Department of Radiology, Bordeaux University Hospital, Bordeaux, France
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Ali Benali N, Pradère B, Lannes F, Thi Dang V, Mauger de Varennes A, Gaillard C, Berchiche W, Margue G, Bardet F, Manuguerra A, Pinar U, Duquesne I, Plassais C, Wandoren W, Hulin M, Khene ZE, Vallée M, Michiels C, Chabenes M, Gaillard V, Felber M, Kaulanjan K, Dominique I, Sbizerra M, Seizilles de Mazancourt E, Freton L, Gondran-Tellier B, Matillon X. TORSAFUF - Surgical exploration for torsion of spermatic cord suspicion and risk factors for unnecessary surgery: Results of a French nationwide retrospective study on 2940 patients. Prog Urol 2021; 32:92-100. [PMID: 34920923 DOI: 10.1016/j.purol.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/10/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUNDS Spermatic cord torsion is a frequent urological emergency that mostly concerns teenagers and young adults. This study aimed to determine the clinical and surgical characteristics of young adults who had scrotal exploration for suspected spermatic cord torsion and to identify clinical risk factors associated with needless scrotal exploration. METHODS We retrospectively collected national data from patients aged 12years and older who underwent a surgical exploration for suspicion of torsion of the spermatic cord between 2005 and 2019 in 17 hospitals. We analyzed demographics, surgical and postoperative characteristics in our population. We compared the cohort according to the intraoperative diagnosis of torsion or not. RESULTS In total, 2940 had surgical exploration: 1802 (61.3%) patients had torsion of the spermatic cord and 1138 (38.7%) had another diagnosis. In multivariate analysis, age (OR: 1.04; 95% CI: 1.01-1.06; P=0.005), medical history of cryptorchism (OR: 4.14; 95% CI: 1.05-16.31; P=0.042) and VAS pain score (OR: 0.91; 95% CI: 0.83-0.98; P=0.018) were risk factors significantly associated with unnecessary surgical exploration. The rate of complications in the 90days after surgery was 11% in the "torsion" group, and 9.7% in the "non-torsion" group (P=0.28). CONCLUSION Scrotal exploration without intraoperative diagnosis of torsion was performed in 40% of our cohort. VAS pain score and cryptorchism history can help for the diagnosis but scrotal exploration remains the way to diagnose spermatic cord torsion and should be performed on the slightest suspicion, even after 24hours of symptoms, as the chances for testicular salvage remains around 50%.
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Affiliation(s)
- N Ali Benali
- Department of Urology, Poitiers University Hospital, Poitiers, France.
| | - B Pradère
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - F Lannes
- Department of Urology, Nord University Hospital, Marseille, France
| | - V Thi Dang
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | | | - C Gaillard
- Department of Urology, Tours University Hospital, Tours, France
| | - W Berchiche
- Department of Urology, Nord University Hospital, Marseille, France
| | - G Margue
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - F Bardet
- Department of Urology, Dijon University Hospital, Dijon, France
| | - A Manuguerra
- Department of Urology, Nancy University Hospital, Nancy, France
| | - U Pinar
- Department of Urology, Hôpitaux Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - I Duquesne
- Department of Urology, Hôpitaux Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - C Plassais
- Department of Urology, Hôpitaux Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - W Wandoren
- Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe
| | - M Hulin
- Department of Urology, Reims University Hospital, Reims, France
| | - Z-E Khene
- Department of Urology, Rennes University Hospital, Rennes, France
| | - M Vallée
- Department of Urology, Poitiers University Hospital, Poitiers, France; Poitiers University, INSERM U1070, "Pharmacologie des Anti-Infectieux", UFR Médecine-Pharmacie, Pôle Biologie Santé, Poitiers, France
| | | | - C Michiels
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - M Chabenes
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - V Gaillard
- Department of Urology, Strasbourg University Hospital, Strasbourg, France
| | - M Felber
- Department of Urology, Nancy University Hospital, Nancy, France
| | - K Kaulanjan
- Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe
| | - I Dominique
- Department of Urology, Lyon Sud University Hospital, Lyon, France
| | - M Sbizerra
- Department of Urology, Lyon Sud University Hospital, Lyon, France
| | | | - L Freton
- Department of Urology, Rennes University Hospital, Rennes, France
| | | | - X Matillon
- Department of Urology, Lyon Sud University Hospital, Lyon, France
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Margue G, Debard C, Michiels C, Dupitout L, Alezra E, Estrade V, Blanc P, Capon G, Robert G, Bladou F, Bernhard J. Tumorectomies rénales multiples, robot-assistées sans clampage et guidées par modélisation 3D. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Margue G, Michiels C, Allenet C, Dupitout L, Ricard S, Blanc P, Alerzra E, Estrade V, Capon G, Bladou F, Robert G, Grenier N, Bernhard J. Faisabilité des néphrectomies partielles robot-assistées de rattrapage après échec de traitement ablatif (Étude UROCCR–62). Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Margue G, Percot M, Dupitout L, Michiels C, Blanc P, Alezra E, Estrade V, Capon G, Bladou F, Robert G, Grenier N, Bernhard JC. MP49-05 FEASIBILITY OF SALVAGE ROBOTIC PARTIAL NEPHRECTOMY AFTER ABLATIVE TREATMENT FAILURE (UROCCR- 62 STUDY). J Urol 2021. [DOI: 10.1097/ju.0000000000002075.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Berchiche W, Sbizzera M, Lannes F, Pinar U, Duquesne I, Felber M, Plassais C, Dang V, Ali Benali N, Gaillard C, Mauger De Varennes A, Margue G, Bardet F, Hulin M, Manuguerra A, Wandoren W, Chabennes M, Gaillard V, Matillon X, Khene Z, Pradere B. Impact of testicular torsion on fertility and erectile dysfunction: A multicenter national retrospective studyTORSAFUF. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00899-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Margue G, Percot M, Dupitout L, Michiels C, Blanc P, Alezra E, Estrade V, Capon G, Bladou F, Robert G, Grenier N, Bernhard J. Feasibility of salvage robotic partial nephrectomy after ablative treatment failure (UroCCR-62 study). Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00944-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Seizilles de Mazancourt E, Pradere B, Duquesne I, Pinar U, Felber M, Plassais C, Dang V, Ali Benali N, Berchiche W, Gaillard C, Mauger de Varennes A, Margue G, Bardet F, Hulin M, Manuguerra A, Wandoren W, Chabenes M, Sbizzera M, Khene Z, Matillon X. Heure limite de prise en charge opératoire pour torsion du cordon spermatique : résultats d’une série rétrospective multicentrique de 2986 patients sur 15 ans. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mauger de Varennes A, Khene Z, Pradere B, Lannes F, Freton L, Dang V, Berchiche W, Ortier E, Michiels C, Margue G, Gaillard C, Ali Benali N, Bardet F, Hulin M, Gaillard V, Manuguerra A, Pinar U, Duquesne I, Felber M, Plassais C. Marqueurs biologiques préopératoires prédictifs de la viabilité testiculaire suite à une torsion du cordon spermatique. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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