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Ishiyama Y, Omae K, Kondo T, Yoshida K, Iizuka J, Takagi T. Predicting Recurrence After Radical Surgery for High-Risk Renal Cell Carcinoma: Development and Internal Validation of the "TOWARDS" Score. Ann Surg Oncol 2024; 31:3513-3522. [PMID: 38285306 DOI: 10.1245/s10434-024-14963-0] [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: 09/29/2023] [Accepted: 01/10/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Considering the reported greater benefits of immunotherapy and its unignorable adverse events in adjuvant therapy for high-risk renal cell carcinoma (hrRCC), accurate prediction may optimize drug use. METHODS The primary objective of this study was to generate a score-based prognostic model of recurrence-free survival in hrRCC. The study retrospectively evaluated 456 patients at two institutions who underwent radical surgery for nonmetastatic pT3-4 and/or N1-2 or pT2 and G4 disease. Clinical variables deemed universally available were selected through backward stepwise analysis and fitted by a multivariable Cox proportional hazards regression model. A point-based score was derived from regression coefficients. Discrimination, calibration, and decision curve analyses were conducted to evaluate predictive performance. Internal validation with bootstrapping was performed to correct for optimism. RESULTS The mean follow-up period was 55.3 months, and the median follow-up period was 28.0 months. During the follow-up period, the recurrence rate was 48.2% (n = 220) during a median of 75.7 months. Stepwise variable selection retained age, Eastern Cooperative Oncology Group (ECOG) performance status, presence or absence of symptoms, size of the primary tumor, pathologic T stage, pathologic N stage, tumor grade, and histology. Subsequently, the TOWARDS score (range 0-53) was developed from these variables. Internal validation showed an optimism-corrected C-index of 0.723 and a calibration slope of 0.834. The decision curve analysis showed the superiority of this score over the University of California, Los Angeles (UCLA) Integrated Staging System and GRade, Age, Nodes, and Tumor score. CONCLUSIONS The authors' novel TOWARDS scoring model had good accuracy for predicting disease recurrence in patients with hrRCC, and the clinical practicability was superior to that of the existing models.
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Affiliation(s)
- Yudai Ishiyama
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
- Department of Urology and Transplant Surgery, Toda Chuo General Hospital, Saitama, Japan.
| | - Kenji Omae
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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Pesonen M, Vähäkangas K. Involvement of per- and polyfluoroalkyl compounds in tumor development. Arch Toxicol 2024; 98:1241-1252. [PMID: 38478087 DOI: 10.1007/s00204-024-03685-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/22/2024] [Indexed: 03/27/2024]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are a large group of synthetic persistent chemicals, which are used in many industrial and commercial applications. Hundreds of different PFAS have been identified in the environment and they are commonly found also in human blood. Due to the chemical stability and extensive use, PFAS pose a risk for human health and wildlife. Mounting evidence indicates that PFAS-exposure adversely affects many organs including liver, kidney, and reproductive tissues and induces tumors in laboratory rodents. Epidemiological studies show association between PFAS-exposure and some tumors also in humans. Effects of PFAS-exposure are complex and obviously do not depend only on the concentration and the structure of PFAS, but also on age and sex of the exposed individuals. It has been difficult to show a causal link between PFAS-exposure and tumors. Moreover, molecular mechanisms of the PFAS effects in different tissues are poorly understood. PFAS are not directly mutagenic and they do not induce formation of DNA binding metabolites, and thus are assumed to act more through non-genotoxic mechanisms. In this review, we discuss the involvement of PFAS-compounds in tumor development in tissues where PFAS exposure has been associated with cancer in epidemiological and animal studies (liver, kidney, testicle and breast). We will focus on molecular pathways and mechanisms related to tumor formation following PFAS-exposure.
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Affiliation(s)
- Maija Pesonen
- Faculty of Health Sciences, School of Pharmacy/Toxicology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Kirsi Vähäkangas
- Faculty of Health Sciences, School of Pharmacy/Toxicology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
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Wang X, Shi A, Liu J, Kong W, Huang Y, Xue W, Yang F, Huang J. CDCA5-EEF1A1 interaction promotes progression of clear cell renal cell carcinoma by regulating mTOR signaling. Cancer Cell Int 2024; 24:147. [PMID: 38658931 PMCID: PMC11044369 DOI: 10.1186/s12935-024-03330-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 04/18/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Cell division cycle associated 5 (CDCA5) plays ontogenetic role in various human cancers. However, its specific function and regulatory mechanism in ccRCC remain uncertain. METHODS Immunohistochemistry and western blots were performed to investigate the expression of CDCA5 in ccRCC tissues. Genetic knockdown and upregulation of CDCA5 were performed to investigate its functional roles in ccRCC proliferation, migration, apoptosis and sunitinib resistance. Furthermore, Co-IP assay and LC-MS/MS were performed to investigate the underlying mechanisms. RESULTS We found that CDCA5 expression is frequently upregulated in ccRCC tumors and is associated with poor prognosis of ccRCC patients. Functionally, CDCA5 promotes proliferation, migration, and sunitinib resistance, while inhibiting apoptosis in ccRCC cells. In vivo mouse xenograft model confirms that silencing of CDCA5 drastically inhibits the growth of ccRCC. Mechanistically, we discovered that CDCA5 interacts with Eukaryotic Translation Elongation Factor 1 Alpha 1 (EEF1A1) to regulate mTOR signaling pathway, thereby promoting ccRCC progression. CONCLUSIONS Taken together, our results demonstrate the significant role of CDCA5 in ccRCC progression. The findings may provide insights for the development of new treatment strategies targeting CDCA5 for ccRCC patients.
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Affiliation(s)
- Xun Wang
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - An Shi
- Department of Critical Care Medicine, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Jie Liu
- Department of Pharmacy, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Wen Kong
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Yiran Huang
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Wei Xue
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Fan Yang
- Department of Pharmacy, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
| | - Jiwei Huang
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China.
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Biggeri A, Stoppa G, Facciolo L, Fin G, Mancini S, Manno V, Minelli G, Zamagni F, Zamboni M, Catelan D, Bucchi L. All-cause, cardiovascular disease and cancer mortality in the population of a large Italian area contaminated by perfluoroalkyl and polyfluoroalkyl substances (1980-2018). Environ Health 2024; 23:42. [PMID: 38627679 PMCID: PMC11022451 DOI: 10.1186/s12940-024-01074-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are associated with many adverse health conditions. Among the main effects is carcinogenicity in humans, which deserves to be further clarified. An evident association has been reported for kidney cancer and testicular cancer. In 2013, a large episode of surface, ground and drinking water contamination with PFAS was uncovered in three provinces of the Veneto Region (northern Italy) involving 30 municipalities and a population of about 150,000. We report on the temporal evolution of all-cause mortality and selected cause-specific mortality by calendar period and birth cohort in the local population between 1980 and 2018. METHODS The Italian National Institute of Health pre-processed and made available anonymous data from the Italian National Institute of Statistics death certificate archives for residents of the provinces of Vicenza, Padua and Verona (males, n = 29,629; females, n = 29,518) who died between 1980 and 2018. Calendar period analysis was done by calculating standardised mortality ratios using the total population of the three provinces in the same calendar period as reference. The birth cohort analysis was performed using 20-84 years cumulative standardised mortality ratios. Exposure was defined as being resident in one of the 30 municipalities of the Red area, where the aqueduct supplying drinking water was fed by the contaminated groundwater. RESULTS During the 34 years between 1985 (assumed as beginning date of water contamination) and 2018 (last year of availability of cause-specific mortality data), in the resident population of the Red area we observed 51,621 deaths vs. 47,731 expected (age- and sex-SMR: 108; 90% CI: 107-109). We found evidence of raised mortality from cardiovascular disease (in particular, heart diseases and ischemic heart disease) and malignant neoplastic diseases, including kidney cancer and testicular cancer. CONCLUSIONS For the first time, an association of PFAS exposure with mortality from cardiovascular disease was formally demonstrated. The evidence regarding kidney cancer and testicular cancer is consistent with previously reported data.
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Affiliation(s)
- Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua, Padua, Italy
| | - Giorgia Stoppa
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua, Padua, Italy.
| | | | - Giuliano Fin
- Comitato mamme NO-PFAS, Vicenza, Padua, Verona, Italy
| | - Silvia Mancini
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Valerio Manno
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Federica Zamagni
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | | | - Dolores Catelan
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua, Padua, Italy
| | - Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
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Checcucci E, Piana A, Volpi G, Quarà A, De Cillis S, Piramide F, Burgio M, Meziere J, Cisero E, Colombo M, Bignante G, Sica M, Granato S, Verri P, Gatti C, Alessio P, Di Dio M, Alba S, Fiori C, Amparore D, Porpiglia F. Visual extended reality tools in image-guided surgery in urology: a systematic review. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06699-6. [PMID: 38589511 DOI: 10.1007/s00259-024-06699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE The aim of this systematic review is to assess the clinical implications of employing various Extended Reality (XR) tools for image guidance in urological surgery. METHODS In June 2023, a systematic electronic literature search was conducted using the Medline database (via PubMed), Embase (via Ovid), Scopus, and Web of Science. The search strategy was designed based on the PICO (Patients, Intervention, Comparison, Outcome) criteria. Study protocol was registered on PROSPERO (registry number CRD42023449025). We incorporated retrospective and prospective comparative studies, along with single-arm studies, which provided information on the use of XR, Mixed Reality (MR), Augmented Reality (AR), and Virtual Reality (VR) in urological surgical procedures. Studies that were not written in English, non-original investigations, and those involving experimental research on animals or cadavers were excluded from our analysis. The quality assessment of comparative and cohort studies was conducted utilizing the Newcastle-Ottawa scale, whilst for randomized controlled trials (RCTs), the Jadad scale was adopted. The level of evidence for each study was determined based on the guidelines provided by the Oxford Centre for Evidence-Based Medicine. RESULTS The initial electronic search yielded 1,803 papers after removing duplicates. Among these, 58 publications underwent a comprehensive review, leading to the inclusion of 40 studies that met the specified criteria for analysis. 11, 20 and 9 studies tested XR on prostate cancer, kidney cancer and miscellaneous, including bladder cancer and lithiasis surgeries, respectively. Focusing on the different technologies 20, 15 and 5 explored the potential of VR, AR and MR. The majority of the included studies (i.e., 22) were prospective non-randomized, whilst 7 and 11 were RCT and retrospective studies respectively. The included studies that revealed how these new tools can be useful both in preoperative and intraoperative setting for a tailored surgical approach. CONCLUSIONS AR, VR and MR techniques have emerged as highly effective new tools for image-guided surgery, especially for urologic oncology. Nevertheless, the complete clinical advantages of these innovations are still in the process of evaluation.
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Affiliation(s)
- Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3,95, Candiolo, Turin, 10060, Italy.
| | - Alberto Piana
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | - Gabriele Volpi
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3,95, Candiolo, Turin, 10060, Italy
| | - Alberto Quarà
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Federico Piramide
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Mariano Burgio
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Juliette Meziere
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Edoardo Cisero
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Marco Colombo
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Gabriele Bignante
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Michele Sica
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Stefano Granato
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Paolo Verri
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Cecilia Gatti
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3,95, Candiolo, Turin, 10060, Italy
| | - Paolo Alessio
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3,95, Candiolo, Turin, 10060, Italy
| | - Michele Di Dio
- Dept. of Surgery, Division of Urology, SS Annunziata Hospital, Cosenza, Italy
| | - Stefano Alba
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | - Cristian Fiori
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Daniele Amparore
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
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Cayuela L, Font González R, Lendínez-Cano G, Medina-López R, Cayuela A. The influence of age, period, and cohort factors on the incidence of kidney cancer in Spain 1990-2019: Evidence from the global burden of disease study. Actas Urol Esp 2024:S2173-5786(24)00057-X. [PMID: 38599570 DOI: 10.1016/j.acuroe.2024.04.006] [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: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE This study aimed to assess the influence of age, period, and cohort (A-P-C) factors on kidney cancer (KC) incidence trends in Spain from 1990 to 2019. METHODS Employing data from the Global Burden of Disease Study 2019, we employed joinpoint analysis to determine long-term patterns and A-P-C modelling to quantify net drift, local drift, longitudinal age curves, and rate ratios (RRs) of period and cohort effects. RESULTS Over the period 1990-2019, an estimated 142,811 cases of KC were diagnosed in Spain. A consistent upward trend in KC incidence was observed for both men and women, with the male-to-female ratio remaining stable at 2.6. Joinpoint analysis identified three distinct periods for men: An initial period (1990-1995) characterised by a significant increase in rates, a subsequent period (1995-2016) characterised by a slowdown in the rate of increase, and a final period (2016-2019) in which rates have plateaued. In women, 2 time periods were observed: an initial period (1990-2007) in which rates increased significantly, followed by a period of stabilization (2007-2019). Men born in the early-mid 20th century had a rising KC risk, peaking in the 1960s. Women's risk rose steadily, peaking in the late 1990s. CONCLUSION A-P-C analysis reveals steady KC incidence increase in both genders over three decades. This highlights the need for targeted public health policies and effective prevention strategies.
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Affiliation(s)
- L Cayuela
- Servicio de Medicina Interna, Hospital Severo Ochoa, Leganés, Spain
| | - R Font González
- Servicio de Medicina Interna, Hospital Severo Ochoa, Leganés, Spain
| | - G Lendínez-Cano
- Unidad de Nefrología y Urología, Unidad de Uro-oncología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - R Medina-López
- Unidad de Nefrología y Urología, Unidad de Uro-oncología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Cayuela
- Unidad de Salud Pública, Prevención y Promoción de la Salud, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain.
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Furberg H, Bradshaw PT, Knezevic A, Olsson L, Petruzella S, Stein E, Paris M, Scott J, Akin O, Hakimi AA, Russo P, Sanchez A, Caan B, Mourtzakis M. Skeletal muscle and visceral adipose radiodensities are pre-surgical, non-invasive markers of aggressive kidney cancer. J Cachexia Sarcopenia Muscle 2024; 15:726-734. [PMID: 38263932 PMCID: PMC10995262 DOI: 10.1002/jcsm.13429] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Most studies on body composition in kidney cancer have been conducted among patients with metastatic disease. Given that aggressive tumours can adversely impact body composition and even non-metastatic tumours can be aggressive, we evaluated associations between pre-surgical body composition features and tumour pathological features in patients with non-metastatic clear cell renal cell cancer (ccRCC). METHODS The Resolve Cohort consists of 1239 patients with non-metastatic ccRCC who underwent nephrectomy at Memorial Sloan Kettering Cancer Center between 2000 and 2020. The cross-sectional areas and radiodensities of skeletal muscle, visceral adipose, and subcutaneous adipose tissues were determined from pre-surgical computed tomography (CT) scans at the third lumbar vertebrae using Automatica software. Pearson's correlation coefficients describe inter-relationships among BMI and body composition variables, while odds ratios (OR) and 95% confidence intervals (CI) estimate associations between continuous body composition features (per 1-standard deviation) and advanced stage (Stage III vs. Stages I-II) and high Fuhrman grade (Grades 3-4 vs. 1-2) from multivariable logistic regression models that considered the potential impact of biological sex, contrast enhanced CTs, and early age at onset of ccRCC. RESULTS The cohort was predominantly male (69%), white (89%), and had a median age of 58. The proportion of patients presenting with advanced stage and high-grade disease were 31% and 51%, respectively. In models that adjusted for demographics and all body composition variables simultaneously, decreasing skeletal muscle radiodensity (i.e., more fat infiltration) but increasing visceral adipose tissue radiodensity (i.e., more lipid depletion) were associated with advanced tumour features. Per 8.4 HU decrease in skeletal muscle radiodensity, the odds of presenting with advanced stage was 1.61 (95% CI: 1.34-1.93). Per 7.22 HU increase in visceral adipose tissue radiodensity, the odds of presenting with advanced stage was 1.45 (95% CI: 1.22-1.74). Skeletal muscle index (i.e., sarcopenia) was not associated with either tumour feature. Similar associations were observed for Fuhrman grade, a more direct marker of tumour aggressiveness. Associations did not differ by sex, contrast use, or age at onset of ccRCC. CONCLUSIONS Lipid infiltrated skeletal muscle, but lipid depleted visceral adipose tissue were independently associated with advanced tumour features in non-metastatic ccRCC. Findings highlight the importance of evaluating the full range of body composition features simultaneously in multivariable models. Interpreting pre-surgical CTs for body composition for patients may be a novel and non-invasive way to identify patients with aggressive renal tumours, which is clinically relevant as renal biopsies are not routinely performed.
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Affiliation(s)
- Helena Furberg
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Patrick T. Bradshaw
- Division of Epidemiology, School of Public HealthUniversity of California BerkeleyBerkeleyCAUSA
| | - Andrea Knezevic
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Linnea Olsson
- Department of EpidemiologyUniversity of North CarolinaChapel HillNCUSA
| | - Stacey Petruzella
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Emily Stein
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Mike Paris
- Department of KinesiologyUniversity of WaterlooWaterlooCanada
| | - Jessica Scott
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Oguz Akin
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - A. Ari Hakimi
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Paul Russo
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | | | - Bette Caan
- Department of EpidemiologyKaiser PermanenteOaklandCAUSA
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Collatuzzo G, Hamdani M, Boffetta P. Risk of bladder, kidney and prostate cancer from occupational exposure to welding fumes: a systematic review and meta-analysis. Int Arch Occup Environ Health 2024; 97:221-230. [PMID: 38231405 DOI: 10.1007/s00420-023-02040-0] [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: 09/23/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Our aimed to conduct a meta-analysis of cohort studies on risk of genitourinary (GU) cancers in workers exposed to welding fumes (WF). METHODS We performed a systematic review of studies published on Pubmed, Scopus and Embase following PRISMA criteria. Two researchers selected cohort studies on WF exposure. From 2582 articles, 7 non-overlapping studies were included. Quality of studies was scored according to CASP. We run a random effects meta-analysis to calculate the relative risk (RR) and 95% confidence intervals (CI) of GU cancer, overall and stratified by cancer, country, and quality score. RESULTS We included seven studies reporting results on GU cancers, including prostate, bladder and kidney cancer (PC, BC, and KC). The RR was 1.19 (95% CI = 1.07-1.32, 16 risk estimates) for GU cancer; 1.13 (95% CI = 0.90-1.42, 4 risk estimates) for PC; 1.26 (95% CI = 0.98-1.60, 7 risk estimates) for BC and 1.28 (95% CI = 1.12-1.47, 5 risk estimates) for KC. Heterogeneity was present in all meta-analyses (p < 0.001). The increased risk was more pronounced in North American than in European studies (respectively, OR = 1.35, 95% CI = 1.18-1.55; OR = 1.13, 95% CI = 1.01-1.27 p heterogeneity = 0.03). There was no heterogeneity according to quality score (p = 0.4). Data were insufficient to investigate associations by industry or welding type. Publication bias for each cancer was excluded. CONCLUSION This meta-analysis suggests increased risk of KC and BC, but not of PC, in workers exposed to WF. Confounding by other occupational and non-occupational risk factors could not be excluded. Data were not adequate to address the risk of specific exposure circumstances.
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Affiliation(s)
- Giulia Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, BO, Italy
| | - Maha Hamdani
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, BO, Italy.
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA.
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
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Borcinova M, Bartolini R, Foley LK, Novak V, Taborska P, Stakheev D, Rataj M, Smrz D, Fialova M, Hacek J, Komarc M, Vesely S, Babjuk M, Striz I, Bartunkova J, Buchler T, Ozaniak Strizova Z. Distinct leukocyte populations and cytokine secretion profiles define tumoral and peritumoral areas in renal cell carcinoma. Transl Oncol 2024; 42:101891. [PMID: 38310685 PMCID: PMC10862072 DOI: 10.1016/j.tranon.2024.101891] [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: 07/11/2023] [Revised: 11/17/2023] [Accepted: 01/23/2024] [Indexed: 02/06/2024] Open
Abstract
Renal cell carcinoma (RCC) is a common malignancy frequently diagnosed at the metastatic stage. We performed a comprehensive analysis of the tumor immune microenvironment (TIME) in RCC patients, including the peritumoral tissue microenvironment, to characterize the phenotypic patterns and functional characteristics of infiltrating immune cells. T cells from various compartments (peripheral blood, tumor, peritumoral area, and adjacent healthy renal tissue) were assessed using flow cytometry and Luminex analyses, both before and after T cell-specific stimulation, to evaluate activation status and migratory potential. Our findings demonstrated that tumor-infiltrating lymphocytes (TILs) exhibited heightened cytokine production compared to peritumoral T cells (pTILs), acting as the primary source of cytotoxic markers (IFN-γ, granzyme B, and FasL). CD8+ T cells primarily employed Fas Ligand for cytotoxicity, while CD4+ T cells relied on CD107a. In addition, a statistically significant negative correlation between patient mortality and the presence of CD4+CD107+ pTILs was demonstrated. The engagement with the PD-1/PD-L1 pathway was also more evident in CD4+ and CD8+ pTILs as opposed to TILs. PD-L1 expression in the non-leukocyte fraction of the tumor tissue was relatively lower than in their leukocytic counterparts and upon stimulation, peripheral blood T cells displayed much stronger responses to stimulation than TILs and pTILs. Our results suggest that tumor and peritumoral T cells exhibit limited responsiveness to additional activation signals, while peripheral T cells retain their capacity to respond to stimulatory signals.
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Affiliation(s)
- Martina Borcinova
- Gynecologic Oncology Centre, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Robin Bartolini
- Lausanne Center for Immuno-oncology Toxicities (LCIT), Service of Immunology and Allergy, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Lily Koumbas Foley
- Chemokine Research Group, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TT, UK
| | - Vojtech Novak
- Department of Urology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Pavla Taborska
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Dmitry Stakheev
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Michal Rataj
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Daniel Smrz
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Martina Fialova
- Department of Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jaromir Hacek
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Stepan Vesely
- Department of Urology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marek Babjuk
- Department of Urology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Ilja Striz
- Department of Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jirina Bartunkova
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Tomas Buchler
- Department of Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Zuzana Ozaniak Strizova
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
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10
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Rezaee ME, Pallauf M, Fletcher SA, Pavlovich CP, Baraban E, Ged Y, Singla N. Prognostic significance of pT3a staging subclassifications in renal cell carcinoma: Not all pT3a are equal. Urol Oncol 2024; 42:119.e23-119.e29. [PMID: 38355353 DOI: 10.1016/j.urolonc.2024.01.031] [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: 08/24/2023] [Revised: 11/21/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To examine the prognostic significance of perinephric fat, renal sinus fat, and renal vein invasion in patients with pT3a renal cell carcinoma (RCC) by histologic type. METHODS A population-based retrospective cohort study of patients with pT3aN0M0 RCC was performed using Surveillance, Epidemiology, and End Results (SEER) data for the years 2010 through 2019. Cox proportional hazards models were used to examine the relationship between pT3a subclassification groups and cancer-specific survival (CSS) by histological subtype (clear cell, papillary, chromophobe, and other). RESULTS The cohort consisted of 10,170 patients with pT3a RCC, including 8,446 (83.0%) with clear cell RCC and 1,724 (17.0%) with nonclear cell RCC (nccRCC). Median follow up was 36 months. Differences in CSS by pT3a subclassification groups were observed in all histological subtypes but were most pronounced in nccRCC, specifically papillary RCC. Compared to perinephric fat (PF) invasion only, renal vein (RV) invasion (HR = 4.9, 95%CI: 2.5-9.3, P < 0.01), renal sinus fat invasion (HR = 3.0, 95%CI: 1.4-6.2), RV and PF invasion (HR = 7.5, 95%CI: 3.5-16.0), and combination of all three characteristics (HR = 4.4, 95%CI: 1.2-15.5) were associated with worse CSS in patients with papillary RCC. CONCLUSION We examined the prognostic role of pT3a staging subclassifications in RCC by histologic subtype and observed survival differences, particularly in papillary RCC. Our findings highlight the need to refine pT3a staging criteria to help guide individualized, multimodal treatment strategies for locally advanced RCC.
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Affiliation(s)
- Michael E Rezaee
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Maximilian Pallauf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Urology, University of Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Sean A Fletcher
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christian P Pavlovich
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ezra Baraban
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yasser Ged
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD.
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Neves JB, Warren H, Santiapillai J, Rode N, Cullen D, Pavlou M, Walkden M, Patki P, Barod R, Mumtaz F, Aitchison M, Bandula S, Pizzo E, Ranieri V, Williams N, Wildgoose W, Gurusamy K, Emberton M, Bex A, Tran MGB. Nephron Sparing Treatment (NEST) for Small Renal Masses: A Feasibility Cohort-embedded Randomised Controlled Trial Comparing Percutaneous Cryoablation and Robot-assisted Partial Nephrectomy. Eur Urol 2024; 85:333-336. [PMID: 37684178 DOI: 10.1016/j.eururo.2023.07.012] [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: 03/29/2023] [Revised: 06/22/2023] [Accepted: 07/19/2023] [Indexed: 09/10/2023]
Abstract
There is a paucity of high-level evidence on small renal mass (SRM) management, as previous classical randomised controlled trials (RCTs) failed to meet accrual targets. Our objective was to assess the feasibility of recruitment to a cohort-embedded RCT comparing cryoablation (CRA) to robotic partial nephrectomy (RPN). A total of 200 participants were recruited to the cohort, of whom 50 were enrolled in the RCT. In the CRA intervention arm, 84% consented (95% confidence interval [CI] 64-95%) and 76% (95% CI 55-91%) received CRA; 100% (95% CI 86-100%) of the control arm underwent RPN. The retention rate was 90% (95% CI 79-96%) at 6 mo. In the RPN group 2/25 (8%) were converted intra-operative to radical nephrectomy. Postoperative complications (Clavien-Dindo grade 1-2) occurred in 12% of the CRA group and 29% of the RPN group. The median length of hospital stay was shorter for CRA (1 vs 2 d; p = 0.019). At 6 mo, the mean change in renal function was -5.0 ml/min/1.73 m2 after CRA and -5.8 ml/min/1.73 m2 after RPN. This study demonstrates the feasibility of a cohort-embedded RCT comparing CRA and RPN. These data can be used to inform multicentre trials on SRM management. PATIENT SUMMARY: We assessed whether patients with a small kidney tumour would consent to a trial comparing two different treatments: cryoablation (passing small needles through the skin to freeze the kidney tumour) and surgery to remove part of the kidney. We found that most patients agreed and a full trial would therefore be feasible.
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Affiliation(s)
- Joana B Neves
- Division of Surgery and Interventional Sciences, University College London, London, UK; Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Hannah Warren
- Division of Surgery and Interventional Sciences, University College London, London, UK; Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Joseph Santiapillai
- Division of Surgery and Interventional Sciences, University College London, London, UK; Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Nicola Rode
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - David Cullen
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, UK
| | - Miles Walkden
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK; Department of Interventional Radiology, University College London Hospital, London, UK
| | - Prasad Patki
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Ravi Barod
- Division of Surgery and Interventional Sciences, University College London, London, UK; Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Faiz Mumtaz
- Division of Surgery and Interventional Sciences, University College London, London, UK; Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Michael Aitchison
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Steven Bandula
- Department of Interventional Radiology, University College London Hospital, London, UK
| | - Elena Pizzo
- Department of Allied Health Research, University College London, London, UK
| | - Veronica Ranieri
- Clinical Psychology, Tavistock and Portman Foundation Trust, London, UK
| | - Norman Williams
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | | | - Kurinchi Gurusamy
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - Axel Bex
- Division of Surgery and Interventional Sciences, University College London, London, UK; Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Maxine G B Tran
- Division of Surgery and Interventional Sciences, University College London, London, UK; Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK.
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13
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Baudo A, Incesu RB, Morra S, Scheipner L, Jannello LMI, de Angelis M, Siech C, Tian Z, Acquati P, Tilki D, Longo N, Ahyai S, de Cobelli O, Briganti A, Chun FKH, Saad F, Shariat SF, Carmignani L, Karakiewicz PI. Other-Cause Mortality, According to Partial vs. Radical Nephrectomy: Age and Stage Analyses. Clin Genitourin Cancer 2024; 22:181-188. [PMID: 38042729 DOI: 10.1016/j.clgc.2023.10.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION We tested the association between other-cause mortality and partial vs. radical nephrectomy in patients with T1a, T1b, and T2 renal cell carcinoma, across all patient ages. MATERIAL AND METHODS Within the Surveillance, Epidemiology, and End Results database (2010-2020), patients with localized renal cell carcinoma stages (T1a-T1b-T2, N0, M0), who underwent partial or radical nephrectomy were identified. Only patients with tumor size 2 to 10 cm were included. Cumulative incidence plots and multivariable competing risks regression models were used. RESULTS Of 68,195 patients, 28,845 (42%) underwent partial nephrectomy vs. 39,350 (58%) radical nephrectomy. In T1a patients, 5-year other-cause mortality rates were 6% for partial nephrectomy vs. 11% for radical nephrectomy (Δ=5%). In T1a patients, partial nephrectomy independently predicted lower other-cause mortality, across all ages (HR: 0.73, P < .001). In age category subgroup analyses addressing T1a patients, in all age categories, partial nephrectomy invariably predicted lower other-cause mortality than radical nephrectomy: ≤59 years (HR: 0.67, P < .001); 60 to 69 years (HR: 0.70, P < .001); and ≥70 years (HR: 0.79, P < .001). Finally, in T1b patients, as well as in T2 patients, no other-cause mortality advantage was recorded for partial vs. radical nephrectomy: T1b (8 vs. 10%, Δ=2%); T2 (8 vs. 9%, Δ=1%). CONCLUSIONS Relative to radical nephrectomy, partial nephrectomy is associated with lower other-cause mortality in stage T1a renal cell carcinoma patients across all age categories, including the oldest patients. Conversely, no clinically meaningful other-cause mortality benefit was associated with partial nephrectomy in stages T1b or T2, regardless of age, including youngest patients.
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Affiliation(s)
- Andrea Baudo
- Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IRCCS Policlinico San Donato, Milan, Italy.
| | - Reha-Baris Incesu
- Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Morra
- Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Lukas Scheipner
- Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Medical University of Graz, Graz, Austria
| | - Letizia Maria Ippolita Jannello
- Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IEO European Institute of Oncology, Milan, Italy
| | - Mario de Angelis
- Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carolin Siech
- Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Zhe Tian
- Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada
| | - Pietro Acquati
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Sascha Ahyai
- Department of Urology, Medical University of Graz, Graz, Austria
| | | | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Fred Saad
- Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Luca Carmignani
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy; Department of Urology, IRCCS Ospedale Galeazzi, Sant'Ambrogio, Milan, Italy
| | - Pierre I Karakiewicz
- Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada
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14
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Amparore D, Checcucci E, Piramide F, Busacca G, Volpi G, De Cillis S, Sica M, Verri P, Piana A, Di Dio M, Fiori C, Porpiglia F. Robotic Vena Cava Thrombectomy with Three-dimensional Augmented Reality Guidance. EUR UROL SUPPL 2024; 62:43-46. [PMID: 38434189 PMCID: PMC10909593 DOI: 10.1016/j.euros.2024.02.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
Robotic surgery has recently been used for treatment of renal cell carcinoma (RCC) and neoplastic thrombus located in the renal vein or inferior vena cava (IVC). Accurate identification of the thrombus location is crucial, and three-dimensional augmented reality (3D AR) may be valuable in achieving this. We enrolled patients with nonmetastatic RCC and level 0-I venous thrombus (Mayo Clinic classification) for robot-assisted radical nephrectomy and thrombectomy with 3D AR guidance. Five patients were prospectively enrolled; three had a level 0 thrombus and two had a level I thrombus. The mean operative time was 123 ± 15 min, mean IVC clamping time was 9.4 ± 6.8 min, and mean estimated blood loss was 750 ± 150 ml. The AR system allowed precise estimation of the thrombus location in all cases. No intraoperative complications or postoperative Clavien-Dindo grade >2 complications occurred. Use of 3D AR guidance allowed correct estimation of the limits of the thrombus and guided the surgeon in selecting an appropriate surgical strategy.
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Affiliation(s)
- Daniele Amparore
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Federico Piramide
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Giovanni Busacca
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Gabriele Volpi
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Michele Sica
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Paolo Verri
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Michele Di Dio
- Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy
| | - Cristian Fiori
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
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15
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Checcucci E, Amparore D, Volpi G, De Cillis S, Piramide F, Verri P, Piana A, Sica M, Gatti C, Alessio P, Quarà A, Burgio M, Colombo M, Busacca G, Mottrie A, Cherullo E, Breda A, Antonelli A, Bollens R, Minervini A, Porter J, Schiavina R, Autorino R, Tewari A, Di Dio M, Fiori C, Porpiglia F. Metaverse Surgical Planning with Three-dimensional Virtual Models for Minimally Invasive Partial Nephrectomy. Eur Urol 2024; 85:320-325. [PMID: 37673751 DOI: 10.1016/j.eururo.2023.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/28/2023] [Revised: 06/30/2023] [Accepted: 07/19/2023] [Indexed: 09/08/2023]
Abstract
The recent integration of new virtual visualization modalities with artificial intelligence and high-speed internet connection has opened the door to the advent of the metaverse in medicine. In this totally virtual environment, three-dimensional virtual models (3DVMs) of the patient's anatomy can be visualized and discussed via digital avatars. Here we present for the first time a metaverse preoperative clinical case discussion before minimally invasive partial nephrectomy. The surgeons' digital avatars met in a virtual room and participated in a virtual consultation on the surgical strategy and clamping approach before the procedure. Robotic or laparoscopic procedures are then carried out according to the simulated surgical strategy. We demonstrate how this immersive virtual reality experience overcomes the barriers of distance and how the quality of surgical planning is enriched by a great sense of "being there", even if virtually. Further investigation will improve the quality of interaction with the models and among the avatars.
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Affiliation(s)
- Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy.
| | - Daniele Amparore
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Gabriele Volpi
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Federico Piramide
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy; Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Paolo Verri
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy; Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alberto Piana
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy; Romolo Hospital, Rocca di Neto, Italy
| | - Michele Sica
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Cecilia Gatti
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy; Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Paolo Alessio
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Alberto Quarà
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Mariano Burgio
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Marco Colombo
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Giovanni Busacca
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Alex Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Edward Cherullo
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alessandro Antonelli
- Urology Unit AUOI Verona, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Renaud Bollens
- Urology Department, Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - James Porter
- Department of Urology, Swedish Medical Group, Seattle, WA, USA
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Ashutosh Tewari
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Michele Di Dio
- Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy
| | - Cristian Fiori
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
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16
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Warren H, Rautio A, Marandino L, Pyrgidis N, Tzelves L, Roussel E, Muselaers S, Erdem S, Palumbo C, Amparore D, Wu Z, Ciccarese C, Diana P, Borregales L, Pavan N, Pecoraro A, Caliò A, Klatte T, Carbonara U, Marchioni M, Bertolo R, Campi R, Tran MG. Diagnostic Biopsy for Small Renal Tumours: A Survey of Current European Practice. EUR UROL SUPPL 2024; 62:54-60. [PMID: 38585205 PMCID: PMC10998268 DOI: 10.1016/j.euros.2024.02.002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 04/09/2024] Open
Abstract
Background and objective Renal tumour biopsy (RTB) can help in risk stratification of renal tumours with implications for management, but its utilisation varies. Our objective was to report current practice patterns, experiences, and perceptions of RTB and research gaps regarding RTB for small renal masses (SRMs). Methods Two web-based surveys, one for health care providers (HCPs) and one for patients, were distributed via the European Association of Urology Young Academic Urologist Renal Cancer Working Group and the European Society of Residents in Urology in January 2023. Key findings and limitations The HCP survey received 210 responses (response rate 51%) and the patient survey 54 responses (response rate 59%). A minority of HCPs offer RTB to >50% of patients (14%), while 48% offer it in <10% of cases. Most HCPs reported that RTB influences (61.5%) or sometimes influences (37.1%) management decisions. Patients were more likely to favour active treatment if RTB showed high-grade cancer and less likely to favour active treatment for benign histology. HCPs identified situations in which they would not favour RTB, such as cystic tumours and challenging anatomic locations. RTB availability (67%) and concerns about delays to treatment (43%) were barriers to offering RTB. Priority research gaps include a trial demonstrating that RTB leads to better clinical outcomes, and better evidence that benign/indolent tumours do not require active treatment. Conclusions and clinical implications Utilisation of RTB for SRMs in Europe is low, even though both HCPs and patients reported that RTB results can affect disease management. Improving timely access to RTB and generating evidence on outcomes associated with RTB use are priorities for the kidney cancer community. Patient summary A biopsy of a kidney mass can help patients and doctors make decisions on treatment, but our survey found that many patients in Europe are not offered this option. Better access to biopsy services is needed, as well as more research on what happens to patients after biopsy.
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Affiliation(s)
- Hannah Warren
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Aleksandra Rautio
- North Estonia Medical Centre, Clinic of General and Oncourology, Tallinn, Estonia
| | | | - Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | | | - Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Stijn Muselaers
- Department of Urology, Radboudumc, Nijmegen, The Netherlands
| | - Selcuk Erdem
- Department of Urology, Istanbul University, Istanbul, Turkey
| | - Carlotta Palumbo
- Department of Urology, University of Eastern Piedmont, Vercelli, Italy
| | | | - Zhenjie Wu
- Department of Urology, Changhai Hospital Naval Medical University, Shanghai, China
| | - Chiara Ciccarese
- Department of Medical Oncology, Fondaziona Policlionico Universatario A. Gemelli IRCCS, Rome, Italy
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Leonardo Borregales
- Columbia University Division of Urology, Mount Sinai Medical Centre, Miami, FL, USA
| | - Nicola Pavan
- University of Palmero and University of Trieste, Palmero, Italy
| | - Angela Pecoraro
- San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Anna Caliò
- Department of Pathology, University of Verona, Verona, Italy
| | - Tobias Klatte
- Department of Urology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Umberto Carbonara
- Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. D’Annunzio University of Chieti, Chieti, Italy
| | | | - Riccardo Campi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Maxine G.B. Tran
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
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17
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Beckermann KE, Patnaik A, Winer I, Tan W, Bashir B, Kyriakopoulos CE, Sweis RF, Chamberlain M, Rini BI. A phase 1b open-label study to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics of py314 in combination with pembrolizumab in patients with advanced renal cell carcinoma. Invest New Drugs 2024; 42:179-184. [PMID: 38372949 DOI: 10.1007/s10637-024-01419-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024]
Abstract
Checkpoint inhibition (CPI) is a standard therapeutic approach in metastatic renal cell carcinoma (RCC). However, not all patients respond to CPI, and the immune suppressive characteristics of the RCC tumor microenvironment may contribute to treatment failure. Triggering Receptor Expressed on Myeloid Cells-2 (TREM2) is a transmembrane protein expressed on a subset of myeloid cells with M2-like anti-inflammatory properties that has previously been associated with disease recurrence after nephrectomy and poor outcomes when expressed at high levels. PY314 is a humanized monoclonal antibody targeting TREM2 that depletes tumor-associated macrophages. In this study, the combination of PY314 and pembrolizumab was investigated in patients with CPI-refractory RCC. Eligible patients had clear cell RCC with disease progression on prior CPI either in combination or sequentially with VEGF-TKI. Patients were treated with PY314 10 mg/kg in combination with pembrolizumab 200 mg IV every 21 days. The primary objective was to assess safety and tolerability and secondary objectives included pharmacokinetics and anti-tumor activity by RECIST v1.1. Seventeen patients were enrolled with a median age of 67 years, 82% male, 100% had prior CPI, and 76% had received three or more prior lines of therapy. The combination of PY314 and pembrolizumab demonstrated an acceptable safety profile with 47.1% any grade treatment-related adverse events (AE) (including only 5.9% grade ≥ 3), the most common being fatigue, pyrexia, nausea, and infusion-related reactions. One patient achieved a partial response (6%), and four patients had stable disease (24%) as their best response. The median PFS was 1.4 months (95% CI 1.2- 3.8). The combination of PY314 and pembrolizumab was safe, but the limited anti-tumor effect observed suggests that TREM2 targeting in conjunction with PD-1 blockade may not overcome resistance to prior CPI. Further investigation is warranted to determine if improved efficacy can be achieved in IO-naïve settings. Trial Registration: NCT04691375.
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Affiliation(s)
- Kathryn E Beckermann
- Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB 777, Nashville, TN, 37232, USA
| | - Amita Patnaik
- START South Texas Accelerated Research Therapeutics, San Antonio, TX, 78229, USA
| | - Ira Winer
- Department of Oncology, Wayne State University and Karmanos Cancer Institute, Detroit, MI, 48201, USA
| | | | - Babar Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | | | - Randy F Sweis
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Marc Chamberlain
- Starlight/Lantern Pharma, 7700 Windrose Ave. Office 3-187, Piano, TX, USA
| | - Brian I Rini
- Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB 777, Nashville, TN, 37232, USA.
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Chlorogiannis DD, Kratiras Z, Efthymiou E, Moulavasilis N, Kelekis N, Chrisofos M, Stravodimos K, Filippiadis DK. Percutaneous Microwave Ablation Versus Robot-Assisted Partial Nephrectomy for Stage I Renal Cell Carcinoma: A Propensity-Matched Cohort Study Focusing Upon Long-Term Follow-Up of Oncologic Outcomes. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03695-z. [PMID: 38561521 DOI: 10.1007/s00270-024-03695-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To retrospectively compare long-term oncologic outcomes of percutaneous computed tomography-guided microwave ablation (MWA) and robot-assisted partial nephrectomy (RAPN) for the treatment of stage 1 (T1a and T1b) renal cell carcinoma (RCC) patients. MATERIALS AND METHODS Institutional database research identified all T1 RCC patients who underwent either MWA or RAPN. Models were adjusted with propensity score matching. Kaplan-Meier log-rank test analyses and Cox proportional hazard regression models were used to compare the oncologic outcomes. Patient and tumor characteristics, technical success as well as oncologic outcomes were evaluated and compared between the 2 groups. RESULTS After propensity score matching, a total of 71 patients underwent percutaneous MWA (mean age 70 ± 10 years) and 71 underwent RAPN (mean age 60 ± 9 years). At 8-year follow-up, the estimated survival rates for MWA cohort were 98% (95% confidence interval [CI] 95-100%) for overall survival, 97% (95% CI 93-100%) for recurrence-free survival, and 97% (95% CI 93-100%) for metastasis-free survival. The matched cohort that underwent RAPN exhibited survival rates of 100% (95% CI 100-100%) for overall survival, 98% (95% CI 94-100%) for recurrence-free survival, and 98% (95% CI 94-100%) for metastasis-free survival. After performing log-rank testing, these rates were not significantly different (p values of 0.44, 0.67, and 0.67, respectively). CONCLUSION The results of the present study suggest that both MWA and RAPN are equally effective in terms of oncologic outcome for the treatment of T1 RCC.
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Affiliation(s)
| | - Zisis Kratiras
- 3rd Department of Urology, University General Hospital "ATTIKON," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evgenia Efthymiou
- 2nd Department of Radiology, University General Hospital "ATTIKON," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Napoleon Moulavasilis
- 1st Department of Urology, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, University General Hospital "ATTIKON," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Chrisofos
- 3rd Department of Urology, University General Hospital "ATTIKON," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstandinos Stravodimos
- 1st Department of Urology, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris K Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON," Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Siech C, Baudo A, de Angelis M, Jannello LMI, Di Bello F, Goyal JA, Tian Z, Saad F, Shariat SF, Longo N, Carmignani L, de Cobelli O, Briganti A, Kosiba M, Mandel P, Kluth LA, Chun FKH, Karakiewicz PI. Perioperative Complications and In-Hospital Mortality in Partial and Radical Nephrectomy Patients with Heart-Valve Replacement. Ann Surg Oncol 2024:10.1245/s10434-024-15228-6. [PMID: 38526833 DOI: 10.1245/s10434-024-15228-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND In-hospital mortality and complication rates after partial and radical nephrectomy in patients with history of heart-valve replacement are unknown. PATIENTS AND METHODS Relying on the National Inpatient Sample (2000-2019), kidney cancer patients undergoing partial or radical nephrectomy were stratified according to presence or absence of heart-valve replacement. Multivariable logistic and Poisson regression models addressed adverse hospital outcomes. RESULTS Overall, 39,673 patients underwent partial nephrectomy versus 94,890 radical nephrectomy. Of those, 248 (0.6%) and 676 (0.7%) had a history of heart-valve replacement. Heart-valve replacement patients were older (median partial nephrectomy 69 versus 60 years; radical nephrectomy 71 versus 63 years), and more frequently exhibited Charlson comorbidity index ≥ 3 (partial nephrectomy 22 versus 12%; radical nephrectomy 32 versus 23%). In partial nephrectomy patients, history of heart-valve replacement increased the risk of cardiac complications [odds ratio (OR) 4.33; p < 0.001), blood transfusions (OR 2.00; p < 0.001), intraoperative complications (OR 1.53; p = 0.03), and longer hospital stay [rate ratio (RR) 1.25; p < 0.001], but not in-hospital mortality (p = 0.5). In radical nephrectomy patients, history of heart-valve replacement increased risk of postoperative bleeding (OR 4.13; p < 0.001), cardiac complications (OR 2.72; p < 0.001), intraoperative complications (OR 1.53; p < 0.001), blood transfusions (OR 1.27; p = 0.02), and longer hospital stay (RR 1.12; p < 0.001), but not in-hospital mortality (p = 0.5). CONCLUSIONS History of heart-valve replacement independently predicted four of twelve adverse outcomes in partial nephrectomy and five of twelve adverse outcomes in radical nephrectomy patients including intraoperative and cardiac complications, blood transfusions, and longer hospital stay. Conversely, no statistically significant differences were observed in in-hospital mortality.
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Affiliation(s)
- Carolin Siech
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, Québec, Canada.
- Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany.
| | - Andrea Baudo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, Québec, Canada
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - Mario de Angelis
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, Québec, Canada
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Letizia Maria Ippolita Jannello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, Québec, Canada
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Francesco Di Bello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, Québec, Canada
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Jordan A Goyal
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, Québec, Canada
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, Québec, Canada
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, Québec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Luca Carmignani
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
- Department of Urology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
- Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Alberto Briganti
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marina Kosiba
- Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany
| | - Philipp Mandel
- Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany
| | - Luis A Kluth
- Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany
| | - Felix K H Chun
- Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, Québec, Canada
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20
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Huang Q, Yang J, Liu GX, Zi H, Tang SD, Jia HC, Li W, Xu XF, Zeng XT. Changes in disease burden and global inequalities in bladder, kidney and prostate cancers from 1990 to 2019: a comparative analysis based on the global burden of disease study 2019. BMC Public Health 2024; 24:891. [PMID: 38528465 DOI: 10.1186/s12889-024-18353-9] [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: 01/02/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Bladder, kidney and prostate cancers make significant contributors to cancer burdens. Exploring their cross-country inequalities may inform equitable strategies to meet the 17 sustainable development goals before 2030. METHODS We analyzed age-standardized disability-adjusted life-years (ASDALY) rates for the three cancers based on Global Burden of Diseases Study 2019. We quantified the inequalities using slope index of inequality (SII, absolute measure) and concentration index (relative measure) associated with national sociodemographic index. RESULTS Varied ASDALY rates were observed in the three cancers across 204 regions. The SII decreased from 35.15 (95% confidence interval, CI: 29.34 to 39.17) in 1990 to 15.81 (95% CI: 7.99 to 21.79) in 2019 for bladder cancers, from 78.94 (95% CI: 75.97 to 81.31) in 1990 to 59.79 (95% CI: 55.32 to 63.83) in 2019 for kidney cancer, and from 192.27 (95% CI: 137.00 to 241.05) in 1990 to - 103.99 (95% CI: - 183.82 to 51.75) in 2019 for prostate cancer. Moreover, the concentration index changed from 12.44 (95% CI, 11.86 to 12.74) in 1990 to 15.72 (95% CI, 15.14 to 16.01) in 2019 for bladder cancer, from 33.88 (95% CI: 33.35 to 34.17) in 1990 to 31.13 (95% CI: 30.36 to 31.43) in 2019 for kidney cancer, and from 14.61 (95% CI: 13.89 to 14.84) in 1990 to 5.89 (95% CI: 5.16 to 6.26) in 2019 for prostate cancer. Notably, the males presented higher inequality than females in both bladder and kidney cancer from 1990 to 2019. CONCLUSIONS Different patterns of inequality were observed in the three cancers, necessitating tailored national cancer control strategies to mitigate disparities. Priority interventions for bladder and kidney cancer should target higher socioeconomic regions, whereas interventions for prostate cancer should prioritize the lowest socioeconomic regions. Additionally, addressing higher inequality in males requires more intensive interventions among males from higher socioeconomic regions.
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Affiliation(s)
- Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Yang
- Department of Urology, The First People's Hospital of Tianmen in Hubei Province, The Affiliated Hospital of Hubei University of Science and Technology, Tianmen, China
| | - Guo-Xiong Liu
- Department of Urology, Xianyang Central Hospital, Xianyang, China
| | - Hao Zi
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shi-Di Tang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hai-Chang Jia
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Li
- Department of Oncology, The First People's Hospital of Tianmen in Hubei Province, The Affiliated Hospital of Hubei University of Science and Technology, Tianmen, China.
| | - Xiao-Feng Xu
- Department of Urology, Xianyang Central Hospital, Xianyang, China.
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.
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21
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Das P, Booth A, Donaldson R, Berfeld N, Nordstrom B, Carroll R, Dhokia P, Clark A, Vaz L. Patient Characteristics, Treatment Patterns, and Outcomes for Patients With Renal Cell Carcinoma in England: A Retrospective Cohort Study. Clin Genitourin Cancer 2024:102081. [PMID: 38641444 DOI: 10.1016/j.clgc.2024.102081] [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: 01/25/2024] [Revised: 03/11/2024] [Accepted: 03/15/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND AND OBJECTIVE Considering the rapidly evolving treatment landscape of renal cell carcinoma (RCC), recent descriptions of the RCC population in the UK are lacking, as are real-world data on treatment and patient outcomes. To analyse the demographic and clinical characteristics, treatment patterns, and overall survival of patients with RCC using national data sets in England. PATIENTS AND METHODS This was a retrospective cohort study of patients diagnosed with RCC (all stages) between 2014-2018 using demographic, clinical, cancer registration, and treatment data. Patients were followed until death or study end (December 31, 2020). Treatments administered in each line were described to understand treatment sequencing. Kaplan-Meier methods were used for time-to-event analyses. Factors associated with discontinuation and survival were identified using Cox proportional hazard models. RESULTS AND LIMITATIONS Among 32,577 included patients, the median age at diagnosis was 66 years, 63.4% were male, and 6,786 (20.8%) had metastatic RCC at diagnosis. Tyrosine kinase inhibitor (TKI) monotherapy was the most common treatment class across lines. Over three quarters of patients (78.5% [95% CI: 78.0-78.9]) were alive one year after diagnosis (93.2% in the non-metastatic at diagnosis subgroup and 37.1% among patients with metastases at diagnosis). At three years post initial diagnosis, 18.0% patients were alive in the metastatic at diagnosis subgroup. Rapid evolution of the treatment landscape limits the results regarding lines of therapy. CONCLUSION This large-scale study provides insight on characteristics of patients with RCC, and it highlights the need for better treatment options to improve survival.
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Affiliation(s)
- Prantik Das
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK; School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | | | | | | | | | | | - Luis Vaz
- Bristol Myers Squibb, Uxbridge, UK
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22
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Gentry V, Talluri S, Hessler R, Waldorf B. A rare case of collecting duct renal cell carcinoma. Urol Case Rep 2024; 53:102685. [PMID: 38404685 PMCID: PMC10884329 DOI: 10.1016/j.eucr.2024.102685] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024] Open
Abstract
Collecting duct carcinoma is an exceptionally rare and aggressive form of renal cell carcinoma (RCC), representing between 0.4 and 1.8% of RCC cases. The most commonly affected demographic are young African-American males. Here, we present a rare case of collecting duct RCC in a 22 year-old Caucasian female with final pathological staging of pT1aN1 who underwent robot-assisted right radical nephrectomy, with peri-hilar and para-aortic lymph node dissection. Given her node-positivity, adjunctive treatment is discussed.
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Affiliation(s)
- Vance Gentry
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Sriharsha Talluri
- University of Tennessee College of Medicine – Chattanooga, 979 East Third Street, Suite C-925, Chattanooga, TN, 37403, USA
| | - Richard Hessler
- Erlanger Health System, Department of Pathology, 975 East Third Street, Chattanooga, TN, 37403, USA
| | - Benjamin Waldorf
- University of Tennessee College of Medicine – Chattanooga, 979 East Third Street, Suite C-925, Chattanooga, TN, 37403, USA
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23
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García-Donas J, de Velasco G, Madurga R, Chamorro J, Rosero D, Etxaniz O, Pérez-Gracia JL, Pinto Á, Cacho D, Barba M, Borrega P, Lázaro M, Rodriguez L, Villalobos L, García L, Cuellar A, Solís-Hernández MP, González A, Pernaut C, Rodríguez-Moreno JF. Case-control study assessing the impact of COVID19 in advanced kidney cancer patients treated with antiangiogenics or immunotherapy: the COVID-REN study. Clin Transl Oncol 2024; 26:732-738. [PMID: 37556096 DOI: 10.1007/s12094-023-03295-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/06/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Cancer is a risk factor for developing severe COVID19. Additionally, SARS-CoV2 has a special tropism for renal cells and complications like thrombosis or cytokine storm could be enhanced by standard treatments in kidney cancer (i.e., antiangiogenics or immunotherapy). Thus, understanding the impact of COVID19 in patients with this tumor is key for their correct management. METHODS We designed a retrospective case-control study comparing the outcome of three groups of advanced kidney cancer patients on systemic treatment: cohort A (developed COVID19 while on antiangiogenics), cohort B (developed COVID19 while on immunotherapy) and cohort C (non-infected). Matching factors were age, gender, and treatment. RESULTS 95 patients were recruited in 16 centers in Spain from September 2020 to May 2021. Finally, 85 were deemed as eligible (23 cohort A, 21 cohort B, 41 cohort C). Patients with COVID required more dose interruptions (25 vs. six) and hospitalizations (10 vs. none) than those without COVID (both p = 0.001). No difference between cohorts A and B was observed regarding hospitalization or length of stay. No ICU admission was registered and one patient in cohort B died due to COVID19. Regarding cancer evolution, three patients in cohort A presented progressive disease after COVID19 compared to two in cohort B. One case in cohort B, initially deemed as stable disease, achieved a partial response after COVID19. CONCLUSIONS Kidney cancer patients who developed COVID19 while on systemic therapy required more treatment interruptions and hospitalizations than those non-infected. However, no significant impact on cancer outcome was observed. Also, no difference was seen between cases on antiangiogenics or immunotherapy.
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Affiliation(s)
| | | | - Rodrigo Madurga
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Diana Rosero
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Diego Cacho
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María Barba
- HM Hospitales-Centro Integral Oncológico Clara Campal, Madrid, Spain
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24
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Duong NX, Nguyen T, Le MK, Sawada N, Kira S, Kondo T, Inukai T, Mitsui T. NAA10 gene expression is associated with mesenchymal transition, dedifferentiation, and progression of clear cell renal cell carcinoma. Pathol Res Pract 2024; 255:155191. [PMID: 38340582 DOI: 10.1016/j.prp.2024.155191] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION We aimed to investigate the expression and prognostic role of NAA10 in clear cell renal cell carcinoma (ccRCC). MATERIAL AND METHODS We performed a gene expression and survival analysis based on the human cancer genome atlas database of ccRCC patients (TCGA-KIRC). RESULTS The patients in the TCGA-KIRC (n = 537) were divided into two subgroups: NAA10-low and NAA10-high expression groups. NAA10-high ccRCC exhibited higher T stages (p = 0.002), a higher frequency of distant metastasis (p = 0.018), more advanced AJCC stages (p < 0.001), a lower overall survival time (p = 0.036), and a lower survival rate (p < 0.001). NAA10-high ccRCC was associated with increased activity of non-specific oncogenic pathways, including oxidative phosphorylation (p < 0.001) and cell cycle progression [G2 to M phase transition (p = 0.045) and E2F targets (p < 0.001)]. Additionally, the NAA10-high tumors showed reduced apoptosis via TRIAL pathways (p < 0.001) and increased levels of activity that promoted epithelial-mesenchymal transition (p = 0.026) or undifferentiation (p = 0.01). In ccRCC, NAA10 expression was found to be a negative prognostic factor in both non-metastatic (p < 0.001) and metastatic tumors (p = 0.032). CONCLUSIONS In ccRCC, NAA10 expression was shown to be a negative prognostic factor related to tumor progression rather than tumor initiation, and high NAA10 expression promoted epithelial-mesenchymal transition and undifferentiation.
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Affiliation(s)
- Nguyen Xuong Duong
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo-city 409-3898, Japan; Department of Urology, Cho Ray Hospital, Ho Chi Minh city, Vietnam.
| | - Thao Nguyen
- Department of Pediatrics, University of Yamanashi Graduate School of Medical Sciences, Chuo-city 409-3898, Japan.
| | - Minh-Khang Le
- Department of Human Pathology, University of Yamanashi Graduate School of Medical Sciences, Chuo-city 409-3898, Japan.
| | - Norifumi Sawada
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo-city 409-3898, Japan.
| | - Satoru Kira
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo-city 409-3898, Japan.
| | - Tetsuo Kondo
- Department of Human Pathology, University of Yamanashi Graduate School of Medical Sciences, Chuo-city 409-3898, Japan.
| | - Takeshi Inukai
- Department of Pediatrics, University of Yamanashi Graduate School of Medical Sciences, Chuo-city 409-3898, Japan.
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo-city 409-3898, Japan.
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25
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Connors C, Levy M, Chin CP, Wang D, Omidele O, Larenas F, Palese M. Differences in cancer presentation, treatment, and mortality between rural and urban patients diagnosed with kidney cancer in the United States. Urol Oncol 2024; 42:72.e9-72.e17. [PMID: 38195330 DOI: 10.1016/j.urolonc.2023.12.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/14/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Rural-urban discrepancies in care and outcomes for kidney cancer (KCa) in the United States remains poorly understood. Our study aims to improve our understanding of the influence of rurality on KCa outcomes in the United States by analyzing differences in presentation, treatment, and mortality between urban areas (UAs) and rural areas (RAs) in the Surveillance, Epidemiology, and End Results (SEERs) database. METHODS SEERs data was queried from 2000 to 2019 for KCa patients. Patient counties were classified as UAs, rural adjacent areas (RAAs), or rural nonadjacent areas (RNAs) using Rural Urban Continuum Codes. Demographic, tumor characteristics, and treatment variables were compared. Propensity score matching was performed to create matched UA-RAA and UA-RNA cohorts. Multivariate regression evaluated rural-urban status as a predictor of treatment selection. Multivariate cox regression assessed the predictive value of rural-urban status for overall survival (OS) and cancer-specific survival (CSS). Kaplan-Meier analysis was used to generate survival curves for OS and CSS. RESULTS 179,509 KCa patients were identified (UA = 87.0%, RAA = 7.7%, RNA = 5.3%). Patients in RAs were more likely to present with tumors of higher grade and stage than UAs. Following multivariate analysis, rural residency predicted undergoing nephrectomy (RAA: OR = 1.177, RNA: OR = 1.210) but was a negative predictor of receiving partial nephrectomy (RAA: OR = 0.744, RNA: OR = 0.717), all P < 0.001. Multivariate cox regression demonstrated that RAA or RNA residency was predictive of overall and cause-specific mortality. After matching, median OS was 151, 124, and 118 months for UA, RAA, and RNA cohorts respectively; mean CSS was 152, 147, and 144 months for UA, RAA, and RNA cohorts, respectively, all P < 0.001. Stage-specific analysis of CSS demonstrated significantly poorer CSS among RNA patients for localized, regionalized, and distant KCa after matching. Only RAA patients with localized KCa experienced significantly lower CSS than UA patients. CONCLUSIONS Patients in RAs are more likely to present with advanced KCa at diagnosis compared to those in UAs and may also experience different treatment options including a lesser likelihood of undergoing partial nephrectomy. Rural patients with KCa also demonstrated significantly worse OS and CSS compared to their urban counterparts. Further patient-level studies are required to better understand the discrepancy in CSS between urban and rural patients diagnosed with KCa.
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Affiliation(s)
- Christopher Connors
- Department of Urology; Icahn School of Medicine at Mount Sinai; New York, NY.
| | - Micah Levy
- Department of Urology; Icahn School of Medicine at Mount Sinai; New York, NY
| | - Chih Peng Chin
- Department of Urology; Icahn School of Medicine at Mount Sinai; New York, NY
| | - Daniel Wang
- Department of Urology; Icahn School of Medicine at Mount Sinai; New York, NY
| | - Olamide Omidele
- Department of Urology; Icahn School of Medicine at Mount Sinai; New York, NY
| | - Francisca Larenas
- Department of Urology; Icahn School of Medicine at Mount Sinai; New York, NY
| | - Michael Palese
- Department of Urology; Icahn School of Medicine at Mount Sinai; New York, NY
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26
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Lanzotti NJ, Felice M, Janakiraman S, Lewer O, James C, Ellis JL, Rac G, Patel HD, Gupta GN. Robotic transperitoneal versus retroperitoneal approach for anterior renal mass nephron-sparing surgery. J Robot Surg 2024; 18:75. [PMID: 38353825 PMCID: PMC11001301 DOI: 10.1007/s11701-023-01798-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/16/2023] [Indexed: 02/16/2024]
Abstract
Robotic nephron-sparing surgery is traditionally performed via a transperitoneal (TP) approach. However, the retroperitoneal (RP) approach has gained popularity, particularly for posterolateral renal masses. The RP approach is associated with shorter operative time, less blood loss, and shorter length of stay, while preserving oncologic outcomes in selected masses. Here, we aim to assess the feasibility of the RP approach in excising anterior renal masses. Patients ≥ 18 years of age who underwent robotic nephron-sparing surgery for anterior renal masses were retrospectively identified (2008-2022). Baseline demographics, tumor characteristics, and perioperative data were collected and characterized based on TP vs RP approaches. Wilcoxon rank sum test and Pearson's Chi-squared test were used to compare continuous and categorical variables, respectively. Two hundred and sixteen patients were included-178 (82.4%) underwent TP approach and 38 (17.6%) underwent RP approach. Baseline demographics, preoperative tumor size, and renal nephrometry scores were similar. The RP approach was associated with shorter operative (150 vs 203 min, p < 0.001) and warm ischemia time (12 vs 21 min, p < 0.001), and less blood loss (20 vs 100 cc, p = 0.002) (Table 1). The RP approach was associated with shorter length of stay (1 vs 2 days, p < 0.001) and less total complications (5.3% vs 19.1%, p = 0.038). Major complication (Clavien-Dindo Grade > 3) rates were similar. There was no difference in positive surgical margin rates or pathologic characteristics. Robotic RP approach for nephron-sparing surgery is feasible for eligible anterior tumors and is associated with favorable perioperative outcomes with preserved negative surgical margin rates. Table 1 Patient baseline demographics Overall Transperitoneal Retroperitoneal p value Median/N IQR/% Median/N IQR/% Median/N IQR/% N 216 178 82.4% 38 17.6% Age (years) 60.5 (52.1-67.7) 60.4 (52.8-67.7) 61.6 (49.1-69.2) 0.393 Sex Male 126 58.3% 100 56.2% 26 68.4% Female 90 41.7% 78 43.8% 12 31.6% 0.165 Race White 162 75.0% 137 77.0% 25 65.8% Asian 4 1.9% 2 1.1% 2 5.3% Black 21 9.7% 18 10.1% 3 7.9% Hispanic 26 12.0% 18 10.1% 8 21.1% Other 2 0.9% 2 1.1% 0 0.0% 0.197 Body mass index (kg/m2) < 25 32 14.8% 25 14.0% 7 18.4% 25-30 68 31.5% 55 30.9% 13 34.2% 30-35 60 27.8% 50 28.1% 10 26.3% 35 + 56 25.9% 48 27.0% 8 21.1% 0.808 Prior abdominal surgery Yes 118 54.6% 104 58.4% 14 36.8% No 98 45.4% 74 41.6% 24 63.2% 0.015 Prior kidney surgery Yes 10 4.6% 9 5.1% 1 2.6% No 206 95.4% 169 94.9% 37 97.4% 0.518 Chronic kidney disease stage ≥ 3 Yes 45 20.8% 38 21.3% 7 18.4% No 171 79.2% 140 78.7% 31 81.6% 0.687 Charlson comorbidity index 0 138 63.9% 116 65.2% 22 57.9% 1 46 21.3% 38 21.4% 8 21.1% 2 19 8.8% 13 7.3% 6 15.8% ≥ 3 13 6.0% 11 6.2% 2 5.3% 0.412 Tumor size (cm) 2.7 (2-3.6) 2.8 (2-3.5) 2.55 (2-3.7) 0.796 Tumor laterality Left 100 46.3% 78 43.8% 22 57.9% Right 116 53.7% 100 56.2% 16 42.1% 0.114 Clinical T stage cT1a 186 86.1% 152 85.4% 34 89.5% cT1b 30 13.9% 26 14.6% 4 10.5% 0.509 RENAL Nephrometry score Low (4 to 6) 94 43.5% 76 42.7% 18 47.4% Intermediate (7 to 9) 112 51.9% 94 52.8% 18 47.4% High (≥ 10) 19 4.6% 8 4.5% 2 5.3% 0.829 TE tumor enucleation, SPN standard margin partial nephrectomy, IQR interquartile range.
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Affiliation(s)
- Nicholas J Lanzotti
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA.
| | - Michael Felice
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Sarang Janakiraman
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Owen Lewer
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Christopher James
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Jeffrey L Ellis
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Goran Rac
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
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Meneghetti I, Sighinolfi MC, Dibitetto F, Collins JW, Mosillo L, Catalano C, Rocco B, De Dominicis M, De Maria M. Partial nephrectomy series using Versius robotic surgical system: technique and outcomes of an initial experience. J Robot Surg 2024; 18:73. [PMID: 38349425 DOI: 10.1007/s11701-024-01843-8] [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: 11/20/2023] [Accepted: 01/21/2024] [Indexed: 02/15/2024]
Abstract
Partial nephrectomy (PN) represents a procedure where the use of a robot has further enabled successful completion of this complex surgery. The results of this procedure using Versius Robotic Surgical System (VRSS) still need to be evaluated. Our working group described the technique and reported the initial results of a series of PN using VRSS. We presented our setting, surgical technique and outcomes for PN, using VRSS. Between 2022 and 2023, 15 patients underwent PN performed by two surgeons in two different centers. Fifteen patients underwent PN. The median lesion size identified on preoperative imaging was 4 (IQR 2.3-5) cm. Median PADUA score was 8 (IQR 7-9). Two procedures were converted to radical nephrectomy for enhanced oncological disease control. Of the 13 nephrectomies that were completed as partial, 7 were performed clampless and 6 with warm ischemia clamping. Median clamping time was 10 (IQR 9-11) minutes. No procedure was converted to open. Median blood loss was 200 (IQR 100-250) mL. Median total operative time was 105 (IQR 100-110) minutes. Median console time was 75 (IQR 66-80) minutes. Median set-up time was 13 (IQR 12-14) minutes. No intraoperative complications were reported. The median hospitalization time was 4 (IQR 3.5-4) days. None of the patients were transfused and none of the patients required readmission. In a pathology report, one patient had a positive surgical margin. Our initial experience suggests that performing PN using VRSS is feasible with good short-term outcomes.
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Affiliation(s)
| | | | - Francesco Dibitetto
- Department of Urology, Uroclinic Casa di Cura Nuova Villa Claudia, Rome, Italy
| | - Justin W Collins
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK
- Division of Uro-oncology, University College London Hospital, London, UK
- CMR Surgical, Cambridge, UK
| | - Luca Mosillo
- Department of Urology, Apuane Hospital, Massa, Italy
| | | | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Mauro De Dominicis
- Department of Urology, Uroclinic Casa di Cura Nuova Villa Claudia, Rome, Italy
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Jiang L, Tong Y, Wang J, Jiang J, Gong Y, Zhu D, Zheng L, Zhao D. A dynamic visualization clinical tool constructed and validated based on the SEER database for screening the optimal surgical candidates for bone metastasis in primary kidney cancer. Sci Rep 2024; 14:3561. [PMID: 38347099 PMCID: PMC10861469 DOI: 10.1038/s41598-024-54085-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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/08/2024] [Indexed: 02/15/2024] Open
Abstract
The implementation of primary tumor resection (PTR) in the treatment of kidney cancer patients (KC) with bone metastases (BM) has been controversial. This study aims to construct the first tool that can accurately predict the likelihood of PTR benefit in KC patients with BM (KCBM) and select the optimal surgical candidates. This study acquired data on all patients diagnosed with KCBM during 2010-2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was utilized to achieve balanced matching of PTR and non-PTR groups to eliminate selection bias and confounding factors. The median overall survival (OS) of the non-PTR group was used as the threshold to categorize the PTR group into PTR-beneficial and PTR-Nonbeneficial subgroups. Kaplan-Meier (K-M) survival analysis was used for comparison of survival differences and median OS between groups. Risk factors associated with PTR-beneficial were identified using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC), area under the curve (AUC), calibration curves, and decision curve analysis (DCA) were used to validate the predictive performance and clinical utility of the nomogram. Ultimately, 1963 KCBM patients meeting screening criteria were recruited. Of these, 962 patients received PTR and the remaining 1061 patients did not receive PTR. After 1:1 PSM, there were 308 patients in both PTR and non-PTR groups. The K-M survival analysis results showed noteworthy survival disparities between PTR and non-PTR groups, both before and after PSM (p < 0.001). In the logistic regression results of the PTR group, histological type, T/N stage and lung metastasis were shown to be independent risk factors associated with PTR-beneficial. The web-based nomogram allows clinicians to enter risk variables directly and quickly obtain PTR beneficial probabilities. The validation results showed the excellent predictive performance and clinical utility of the nomograms for accurate screening of optimal surgical candidates for KCBM. This study constructed an easy-to-use nomogram based on conventional clinicopathologic variables to accurately select the optimal surgical candidates for KCBM patients.
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Affiliation(s)
- Liming Jiang
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin, People's Republic of China
| | - Yuexin Tong
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin, People's Republic of China
| | - Jun Wang
- Department of Orthopedics, Rizhao People's Hospital, Rizhao, 276800, Shandong, People's Republic of China
| | - Jiajia Jiang
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin, People's Republic of China
| | - Yan Gong
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin, People's Republic of China
| | - Dejin Zhu
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin, People's Republic of China
| | - Linyang Zheng
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin, People's Republic of China
| | - Dongxu Zhao
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin, People's Republic of China.
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29
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Rac G, Ellis JL, Janakiraman S, Plumb A, Elliott N, Lanzotti NJ, Lee JH, Gali K, Quek ML, Patel HD, Gupta GN. Risk of pseudoaneurysm and bleeding complications after partial nephrectomy: comparison of tumor enucleation to standard margin technique. J Robot Surg 2024; 18:65. [PMID: 38329585 DOI: 10.1007/s11701-023-01808-3] [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: 10/02/2023] [Accepted: 12/23/2023] [Indexed: 02/09/2024]
Abstract
Partial nephrectomy (PN) is the gold standard for the resection of amenable small renal masses. Some surgeons have adopted tumor enucleation (TE) over the standard margin PN (SPN) technique based on preservation of healthy renal parenchyma by following the tumor pseudocapsule. However, TE may also confer additional advantages due to avoidance of sharp incision including reduction in perioperative and bleeding complications. Therefore, we evaluated the rate of pseudoaneurysms and other complications following TE vs. SPN. A retrospective cohort study of patients undergoing PN (TE and SPN) between 2008 and 2020 was conducted. Baseline characteristics were compared between the TE and SPN cohorts with univariable and multivariable logistic regression models. A total of 534 patients were included, 195 (36.5%) receiving TE and 339 (63.5%) SPN. There were no differences in baseline patient demographics. There was no difference in RENAL nephrometry scores between the two groups (p = 0.47). TE had lower rates of postoperative complications (11.3 vs. 21.5%, p = 0.002). TE had less bleeding complications (2.1 vs. 8.0%, p = 0.002) with no pseudoaneurysm events following TE compared to 12 following SPN (0.0 vs. 3.5%, p = 0.008). Need for interventional radiology largely reflected pseudoaneurysm differences (0 (0.0%) TE vs. 13 (3.8%) SPN, p = 0.006. Readmission occurred less often after TE vs. SPN (4.1 vs. 8.3%, p = 0.07). Patients receiving TE experienced no clinically significant pseudoaneurysm formation and were less likely to have any bleeding complication or major complication postoperatively. TE may be preferred when minimizing morbidity aligns with patient selection and preferences.
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Affiliation(s)
- Goran Rac
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Jeffrey L Ellis
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Sarang Janakiraman
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Arden Plumb
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA.
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Radiology, Loyola University Medical Center, Maywood, IL, USA.
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
| | - Nicholas Elliott
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | | | - Jae Han Lee
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Keshava Gali
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Marcus L Quek
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
- Department of Radiology, Loyola University Medical Center, Maywood, IL, USA
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
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30
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S V, Balasubramanian S, Perumal E, Santhakumar K. Identification of key genes and signalling pathways in clear cell renal cell carcinoma: An integrated bioinformatics approach. Cancer Biomark 2024:CBM230271. [PMID: 38427469 DOI: 10.3233/cbm-230271] [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] [Indexed: 03/03/2024]
Abstract
BACKGROUND Clear cell Renal Cell Carcinoma (ccRCC) is one of the most prevalent types of kidney cancer. Unravelling the genes responsible for driving cellular changes and the transformation of cells in ccRCC pathogenesis is a complex process. OBJECTIVE In this study, twelve microarray ccRCC datasets were chosen from the gene expression omnibus (GEO) database and subjected to integrated analysis. METHODS Through GEO2R analysis, 179 common differentially expressed genes (DEGs) were identified among the datasets. The common DEGs were subjected to functional enrichment analysis using ToppFun followed by construction of protein-protein interaction network (PPIN) using Cytoscape. Clusters within the DEGs PPIN were identified using the Molecular Complex Detection (MCODE) Cytoscape plugin. To identify the hub genes, the centrality parameters degree, betweenness, and closeness scores were calculated for each DEGs in the PPIN. Additionally, Gene Expression Profiling Interactive Analysis (GEPIA) was utilized to validate the relative expression levels of hub genes in the normal and ccRCC tissues. RESULTS The common DEGs were highly enriched in Hypoxia-inducible factor (HIF) signalling and metabolic reprogramming pathways. VEGFA, CAV1, LOX, CCND1, PLG, EGF, SLC2A1, and ENO2 were identified as hub genes. CONCLUSION Among 8 hub genes, only the expression levels of VEGFA, LOX, CCND1, and EGF showed a unique expression pattern exclusively in ccRCC on compared to other type of cancers.
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Affiliation(s)
- Vinoth S
- Zebrafish Genetics Laboratory, Department of Genetic Engineering, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Tamil Nadu, India
| | - Satheeswaran Balasubramanian
- Molecular Toxicology Laboratory, Department of Biotechnology, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - Ekambaram Perumal
- Molecular Toxicology Laboratory, Department of Biotechnology, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - Kirankumar Santhakumar
- Zebrafish Genetics Laboratory, Department of Genetic Engineering, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Tamil Nadu, India
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Reese SW, Eismann L, White C, Villada JA, Khaleel S, Ostrovnaya I, Vazquez-Rivera K, Carlo MI, Feldman D, Lee CH, Motzer R, Voss MH, Kotecha RR, Matulewicz RS, Goh A, Coleman J, Russo P, Hakimi AA. Surgical outcomes of cytoreductive nephrectomy in patients receiving systemic immunotherapy for advanced renal cell carcinoma. Urol Oncol 2024; 42:32.e9-32.e16. [PMID: 38135627 PMCID: PMC10922785 DOI: 10.1016/j.urolonc.2023.12.003] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 11/15/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE The use of systemic immune checkpoint blockade before surgery is increasing in patients with metastatic renal cell carcinoma, however, the safety and feasibility of performing consolidative cytoreductive nephrectomy after the administration of systemic therapy are not well described. PATIENTS AND METHODS A retrospective review of patients undergoing nephrectomy was performed using our prospectively maintained institutional database. Patients who received preoperative systemic immunotherapy were identified, and the risk of postoperative complications were compared to those who underwent surgery without upfront systemic treatment. Perioperative characteristics and surgical complications within 90 days following surgery were recorded. RESULTS Overall, we identified 220 patients who underwent cytoreductive nephrectomy from April 2015 to December 2022, of which 46 patients (21%) received systemic therapy before undergoing surgery. Unadjusted rates of surgical complications included 20% (n = 35) in patients who did not receive upfront systemic therapy and 20% (n = 9) in those who received upfront systemic immunotherapy. In our propensity score analysis, there was no statistically significant association between receipt of upfront immunotherapy and 90-day surgical complications [odds ratio (OR): 1.82, 95% confidence interval (CI): 0.59-5.14; P = 0.3]. This model, however, demonstrated an association between receipt of upfront immunotherapy and an increased odds of requiring a blood transfusion [OR: 4.53, 95% CI: 1.83-11.7; P = 0.001]. CONCLUSION In our cohort, there was no significant difference in surgical complications among patients who received systemic therapy before surgery compared to those who did not receive upfront systemic therapy. Cytoreductive nephrectomy is safe and with low rates of complications following the use of systemic therapy.
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Affiliation(s)
- Stephen W Reese
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lennert Eismann
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Urology, Ludwig-Maximilians University, Geschwister-Scholl-Platz 1, München, Germany
| | - Charlie White
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Juan Arroyave Villada
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sari Khaleel
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Irina Ostrovnaya
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katiana Vazquez-Rivera
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria I Carlo
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Darren Feldman
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Chung-Han Lee
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Motzer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martin H Voss
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ritesh R Kotecha
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard S Matulewicz
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alvin Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Zhang X, Bolck HA, Rupp NJ, Moch H. Genomic alterations and diagnosis of renal cancer. Virchows Arch 2024; 484:323-337. [PMID: 37999735 PMCID: PMC10948545 DOI: 10.1007/s00428-023-03700-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/24/2023] [Accepted: 11/04/2023] [Indexed: 11/25/2023]
Abstract
The application of molecular profiling has made substantial impact on the classification of urogenital tumors. Therefore, the 2022 World Health Organization incorporated the concept of molecularly defined renal tumor entities into its classification, including succinate dehydrogenase-deficient renal cell carcinoma (RCC), FH-deficient RCC, TFE3-rearranged RCC, TFEB-altered RCC, ALK-rearranged RCC, ELOC-mutated RCC, and renal medullary RCC, which are characterized by SMARCB1-deficiency. This review aims to provide an overview of the most important molecular alterations in renal cancer, with a specific focus on the diagnostic value of characteristic genomic aberrations, their chromosomal localization, and associations with renal tumor subtypes. It may not yet be the time to completely shift to a molecular RCC classification, but undoubtedly, the application of molecular profiling will enhance the accuracy of renal cancer diagnosis, and ultimately guide personalized treatment strategies for patients.
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Affiliation(s)
- Xingming Zhang
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstr. 12, 8091, Zurich, Switzerland
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hella A Bolck
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstr. 12, 8091, Zurich, Switzerland
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstr. 12, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstr. 12, 8091, Zurich, Switzerland.
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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Yim K, Hsu SH, Nolazco JI, Cagney D, Mak RH, D'Andrea V, Singer L, Williams C, Huynh E, Han Z, Martin N, Nguyen P, Kibel AS, Choueiri TK, Chang SL, Leeman JE. Stereotactic Magnetic Resonance-guided Adaptive Radiation Therapy for Localized Kidney Cancer: Early Outcomes from a Prospective Phase 1 Trial and Supplemental Cohort. Eur Urol Oncol 2024; 7:147-150. [PMID: 37487813 DOI: 10.1016/j.euo.2023.07.002] [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: 03/20/2023] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/26/2023]
Abstract
Stereotactic magnetic resonance (MR)-guided adaptive radiotherapy (SMART) for renal cell carcinoma may result in more precise treatment delivery through the capabilities for improved image quality, daily adaptive planning, and accounting for respiratory motion during treatment with real-time MR tracking. In this study, we aimed to characterize the safety and feasibility of SMART for localized kidney cancer. Twenty patients with localized kidney cancer (ten treated in a prospective phase 1 trial and ten in the supplemental cohort) were treated to 40 Gy in five fractions on a 0.35 T MR-guided linear accelerator with daily adaptive planning and a cine MR-guided inspiratory breath hold technique. The median follow-up time was 17 mo (interquartile range: 13-20 months). A single patient developed local failure at 30 mo. No grade ≥3 adverse events were reported. The mean decrease in estimated glomerular filtration rate was -1.8 ml/min/1.73 m2 (95% confidence interval or CI [-6.6 to 3.1 ml/min/1.73 m2]), and the mean decrease in tumor diameter was -0.20 cm (95% CI [-0.6 to 0.2 cm]) at the last follow-up. Anterior location and overlap of the 25 or 28 Gy isodose line with gastrointestinal organs at risk were predictive of the benefit from online adaptive planning. Kidney SMART is feasible and, at the early time point evaluated in this study, was well tolerated with minimal decline in renal function. More studies are warranted to further evaluate the safety and efficacy of this technique. PATIENT SUMMARY: For patients with localized renal cell carcinoma who are not surgical candidates, stereotactic magnetic resonance--guided adaptive radiotherapy is a feasible and safe noninvasive treatment option that results in minimal impact on kidney function.
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Affiliation(s)
- Kendrick Yim
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Shu-Hui Hsu
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
| | | | - Daniel Cagney
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
| | - Raymond H Mak
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
| | - Vincent D'Andrea
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Lisa Singer
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher Williams
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
| | - Elizabeth Huynh
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
| | - Zhaohui Han
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
| | - Neil Martin
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
| | - Paul Nguyen
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jonathan E Leeman
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA.
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Kowalewski KF, Neuberger M, Sidoti Abate MA, Kirchner M, Haney CM, Siegel F, Westhoff N, Michel MS, Honeck P, Nuhn P, Kriegmair MC. Randomized Controlled Feasibility Trial of Robot-assisted Versus Conventional Open Partial Nephrectomy: The ROBOCOP II Study. Eur Urol Oncol 2024; 7:91-97. [PMID: 37316398 DOI: 10.1016/j.euo.2023.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/13/2022] [Revised: 05/02/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is no evidence from randomized controlled trials (RCTs) comparing robot-assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN). OBJECTIVE To assess the feasibility of trial recruitment and to compare surgical outcomes between RAPN and OPN. DESIGN, SETTING, AND PARTICIPANTS ROBOCOP II was designed as single-center, open-label, feasibility RCT. Patients with suspected localized renal cell carcinoma referred for PN were randomized at a 1:1 ratio to either RAPN or OPN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the feasibility of recruitment, assessed as the accrual rate. Secondary outcomes included perioperative and postoperative data. Data were analyzed descriptively in a modified intention-to-treat population consisting of randomized patients who underwent surgery. RESULTS AND LIMITATIONS A total of 50 patients underwent RAPN or OPN (accrual rate 65%). In comparison to OPN, RAPN had lower blood loss (OPN 361 ml, standard deviation [SD] 238; RAPN 149 ml, SD 122; difference 212 ml, 95% confidence interval [CI] 105-320; p < 0.001), less need for opioids (OPN 46%; RAPN 16%; difference 30%, 95% CI 5-54; p = 0.024), and fewer complications according to the mean Comprehensive Complication Index (OPN 14, SD 16; RAPN 5, SD 15; difference 9, 95% CI 0-18; p = 0.008). OPN has a shorter operative time (OPN 112 min, SD 29; RAPN 130 min, SD 32; difference -18 min, 95% CI -35 to -1; p = 0.046) and warm ischemia time (OPN 8.7 min, SD 7.1; RAPN 15.4 min, SD 7.0; difference 6.7 min, 95% CI -10.7 to -2.7; p = 0.001). There were no differences between RAPN and OPN regarding postoperative kidney function. CONCLUSIONS This first RCT comparing OPN and RAPN met the primary outcome of the feasibility of recruitment; however, the window for future RCTs is closing. Each approach has advantages over the other, and both remain safe and effective options. PATIENT SUMMARY For patients with a kidney tumor, open surgery and robot-assisted keyhole surgery are both feasible and safe approaches for partial removal of the affected kidney. Each approach has known advantages. Long-term follow-up will explore differences in quality of life and cancer control outcomes.
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Affiliation(s)
- Karl-Friedrich Kowalewski
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Manuel Neuberger
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marie Angela Sidoti Abate
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marietta Kirchner
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | | | - Fabian Siegel
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Niklas Westhoff
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maurice-Stephan Michel
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Patrick Honeck
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian Christian Kriegmair
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
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Zhang W, Yang C, Zou L, Zang Y, Hu J, Hu Y, Xu C, Liu R, Wang H, Xiong Z. Combining MTI-31 with RAD001 inhibits tumor growth and invasion of kidney cancer by activating autophagy. J Appl Genet 2024; 65:103-112. [PMID: 37932653 DOI: 10.1007/s13353-023-00796-2] [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: 09/04/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
At most of the times, patients who are diagnosed with kidney cancer should be provided with systemic treatment as drug resistance is a challenging issue in the treatment of this disease. The progression of the cancer can be inhibited with the help of mTOR inhibitors namely RAD001 (everolimus) and MTI-31. In literature, it has been revealed that these mTOR inhibitors have the potential to stimulate autophagy. This degradation pathway boosts the survival rate of the cancerous cells that are subjected to anti-cancer therapy. In this study, CCK8, colony formation assays, and ethynyl deoxyuridine (EdU) analysis were conducted to detect cell proliferation. Furthermore, Transwell assays were also conducted for cell migration analysis. In addition to these, the researchers also performed the flow cytometry process to identify the cells that are undergoing apoptosis. In vivo, experiments were conducted to measure the growth of tumors and metastasis. In this study, the treatment provided through a combination of MTI-31 and RAD001 significantly inhibited the kidney cancer cells' proliferation and tumor growth. Furthermore, there was a notable reduction in the migration and invasion of kidney cancer cells upon the neighboring cells. The outcomes from the mechanistic studies infer that the combination of MTI-31 and RAD001 increases the LC3 levels, which in turn translates into the activation of autophagy. To conclude, the combination of MTI-31 and RAD001 improves the anti-cancerous impact produced by RAD001 in vivo through the promotion of autophagy.
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Affiliation(s)
- Wenye Zhang
- Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, China
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Institute of Urology, Fudan University, Shanghai, 200040, China
| | - Chen Yang
- Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, China
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Institute of Urology, Fudan University, Shanghai, 200040, China
| | - Lujia Zou
- Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, China
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Institute of Urology, Fudan University, Shanghai, 200040, China
| | - Yiwen Zang
- Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, China
| | - Jimeng Hu
- Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, China
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Institute of Urology, Fudan University, Shanghai, 200040, China
| | - Yun Hu
- Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, China
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Institute of Urology, Fudan University, Shanghai, 200040, China
| | - Chenyang Xu
- Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, China
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Institute of Urology, Fudan University, Shanghai, 200040, China
| | - Rongzong Liu
- Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, China
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Institute of Urology, Fudan University, Shanghai, 200040, China
| | - Hao Wang
- Teaching Center of Experimental Medicine, Shanghai Medical College, Fudan University, 138 Yixueyuan Rd, Shanghai, 200032, China.
| | - Zuquan Xiong
- Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, China.
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, China.
- Institute of Urology, Fudan University, Shanghai, 200040, China.
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Rossi SH, Harrison H, Usher-Smith JA, Stewart GD. Risk-stratified screening for the early detection of kidney cancer. Surgeon 2024; 22:e69-e78. [PMID: 37993323 DOI: 10.1016/j.surge.2023.10.010] [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: 09/27/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
Earlier detection and screening for kidney cancer has been identified as a key research priority, however the low prevalence of the disease in unselected populations limits the cost-effectiveness of screening. Risk-stratified screening for kidney cancer may improve early detection by targeting high-risk individuals whilst limiting harms in low-risk individuals, potentially increasing the cost-effectiveness of screening. A number of models have been identified which estimate kidney cancer risk based on both phenotypic and genetic data, and while several of the former have been shown to identify individuals at high-risk of developing kidney cancer with reasonable accuracy, current evidence does not support including a genetic component. Combined screening for lung cancer and kidney cancer has been proposed, as the two malignancies share some common risk factors. A modelling study estimated that using lung cancer risk models (currently used for risk-stratified lung cancer screening) could capture 25% of patients with kidney cancer, which is only slightly lower than using the best performing kidney cancer-specific risk models based on phenotypic data (27%-33%). Additionally, risk-stratified screening for kidney cancer has been shown to be acceptable to the public. The following review summarises existing evidence regarding risk-stratified screening for kidney cancer, highlighting the risks and benefits, as well as exploring the management of potential harms and further research needs.
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Affiliation(s)
- Sabrina H Rossi
- Department of Surgery, University of Cambridge, Cambridge, UK.
| | - Hannah Harrison
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Juliet A Usher-Smith
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
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Gul ZG, Sharbaugh DR, Ellimoottil C, Rak KJ, Yabes JG, Davies BJ, Jacobs BL. Telemedicine in urologic oncology care: Will telemedicine exacerbate disparities? Urol Oncol 2024; 42:28.e1-28.e7. [PMID: 38220521 DOI: 10.1016/j.urolonc.2023.10.002] [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: 06/25/2023] [Revised: 09/15/2023] [Accepted: 10/16/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Disparities in prostate, bladder, and kidney cancer outcomes are associated with access to care. Telemedicine can improve access but may be underutilized by certain patient populations. Our objective was to determine if the patient populations who suffer worse oncologic outcomes are the same as those who are less likely to use telemedicine. METHODS Using an institutional database, we identified all prostate, bladder and kidney cancer encounters from March 14, 2020 to October 31, 2021 (n = 15,623; n = 4, 14; n = 3,830). Telemedicine was used in 13%, 8%, and 12% of these encounters, respectively. We performed random effects modeling analysis to examine patient and provider characteristics associated with telemedicine use. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were reported as measures of association. RESULTS Among prostate, bladder, and kidney cancer patients, Black patients had lower odds of a telemedicine encounter (OR 0.51, 95% CI 0.37-0.69; OR 0.22, 95% CI 0.07-0.70; OR 0.46, 95% CI 0.24-0.86), and patients residing in small and isolated small rural towns areas had higher odds of a telemedicine encounter (OR 1.44, 95% CI 1.09-1.91; OR 2.12, 95% CI 1.14-3.94; OR 1.89, 95% CI 1.12-3.19). Compared to providers in practice ≤5 years, providers in practice for 6 to 15 years had significantly higher odds of a telemedicine encounter for prostate and bladder cancer patients (OR 4.10, 95% CI 1.4511.58; OR 3.42, 95% CI 1.09-10.77). CONCLUSION The lower rates of telemedicine use among Black patients could exacerbate pre-existing disparities in prostate, bladder, and kidney cancer outcomes.
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Affiliation(s)
- Zeynep G Gul
- Department of Surgery, Division of Urology, University of Washington in St. Louis, St. Louis, MO.
| | - Danielle R Sharbaugh
- Department of Urology, Division of Health Services Research, University of Pittsburgh, Pittsburgh, PA
| | - Chad Ellimoottil
- Department of Urology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Kimberly J Rak
- Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jonathan G Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Benjamin J Davies
- Department of Urology, Division of Health Services Research, University of Pittsburgh, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology, Division of Health Services Research, University of Pittsburgh, Pittsburgh, PA
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Semko SL, Voylenko OA, Pikul MV, Stakhovskyi OE, Kononenko OA, Vitruk IV, Stakhovsky EO, Hrechko B. Comparison of aggressiveness in central versus peripheral T1a clear-cell renal cell carcinoma. Urol Oncol 2024; 42:31.e9-31.e15. [PMID: 38151425 DOI: 10.1016/j.urolonc.2023.11.014] [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: 05/15/2023] [Revised: 09/21/2023] [Accepted: 11/19/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE This study aimed to estimate the difference between peripheral and central small renal lesions in terms of their oncologic potential. METHODS Cross-sectional retrospective analysis of patients with small renal masses (T1a) who underwent surgical treatment between January 2008 and July 2019 at the affiliated hospital. Only patients with ccRCC pathology were included. Cases were divided into 2 groups depending on tumor location (central or peripheral) based on the R.E.N.A.L and local nephrometry scoring. Presence of nodal involvement, distant metastases, ISUP grade and endophytic growth were defined as aggressiveness predictors. Statistical analyses was performed using a standard statistical software (IBM SPPS Statistics Ver. 22), with P < 0.05 considered statistically significant. Associations between tumor location and Fuhrman grade, exo-/endophytic growth, TNM classification, and type of operation were tested using the Pearson χ² test and 1-way ANOVA test. RESULTS Patients with centrally located tumors had a higher incidence of clinical and pathological lymph node involvement (P = 0.02, χ2 = 5.1). Patients in both groups had an equal number of distant metastases at the time of diagnosis (P = 0.3, χ2 = 0.8). The operation time was significantly longer in patients with central lesions, which obviously showed higher tumor complexity in this group (P < 0.005). Pathological evaluation revealed differences between ISUP grades in both groups (P < 0.005, χ2 = 29.9). Central masses were characterized by higher aggressiveness, indicating a worse prognosis. Furthermore, the cases in the first group were more often endophytic (P = 0.03, χ2 = 0.9). Nevertheless, this did not affect the surgical strategy in most cases with a tendency toward partial nephrectomy. Eventually, organ-sparing treatment was preferable in both groups (P = 0.13, χ2 = 2.29). CONCLUSION Centrally located kidney cancer has showed in present study a higher incidence of high ISUP grade, regional nodal involvement and endophytic growth type. Endophytic growth type was associated with worse ISUP grading. Distribution of ISUP grade was not age depended, thus showing no difference by this criterion, when comparing different age groups. Higher ISUP grade was strongly associated with presence of distant metastases in T1a kidney tumors. Further analysis is needed to investigate aggressiveness of centrally located T1a RCC, as it may influence current conservative management options.
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Affiliation(s)
- Sofiya L Semko
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine.
| | - Oleg A Voylenko
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
| | - Maksym V Pikul
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
| | - Oleksandr E Stakhovskyi
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
| | - Oleksii A Kononenko
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
| | - Iurii V Vitruk
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
| | - Eduard O Stakhovsky
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
| | - Bohdan Hrechko
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
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Egen L, Demmel GS, Grilli M, Studier-Fischer A, Nickel F, Haney CM, Mühlbauer J, Hartung FO, Menold HS, Piazza P, Rivas JG, Checcucci E, Puliatti S, Belenchon IR, Taratkin M, Rodler S, Cacciamani G, Michel MS, Kowalewski KF. Biophotonics-Intraoperative Guidance During Partial Nephrectomy: A Systematic Review and Meta-analysis. Eur Urol Focus 2024:S2405-4569(24)00008-7. [PMID: 38278713 DOI: 10.1016/j.euf.2024.01.005] [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: 11/02/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
CONTEXT Partial nephrectomy (PN) with intraoperative guidance by biophotonics has the potential to improve surgical outcomes due to higher precision. However, its value remains unclear since high-level evidence is lacking. OBJECTIVE To provide a comprehensive analysis of biophotonic techniques used for intraoperative real-time assistance during PN. EVIDENCE ACQUISITION We performed a comprehensive database search based on the PICO criteria, including studies published before October 2022. Two independent reviewers screened the titles and abstracts followed by full-text screening of eligible studies. For a quantitative analysis, a meta-analysis was conducted. EVIDENCE SYNTHESIS In total, 35 studies were identified for the qualitative analysis, including 27 studies on near-infrared fluorescence (NIRF) imaging using indocyanine green, four studies on hyperspectral imaging, two studies on folate-targeted molecular imaging, and one study each on optical coherence tomography and 5-aminolevulinic acid. The meta-analysis investigated seven studies on selective arterial clamping using NIRF. There was a significantly shorter warm ischemia time in the NIRF-PN group (mean difference [MD]: -2.9; 95% confidence interval [CI]: -5.6, -0.1; p = 0.04). No differences were noted regarding transfusions (odds ratio [OR]: 0.5; 95% CI: 0.2, 1.7; p = 0.27), positive surgical margins (OR: 0.7; 95% CI: 0.2, 2.0; p = 0.46), or major complications (OR: 0.4; 95% CI: 0.1, 1.2; p = 0.08). In the NIRF-PN group, functional results were favorable at short-term follow-up (MD of glomerular filtration rate decline: 7.6; 95% CI: 4.6, 10.5; p < 0.01), but leveled off at long-term follow-up (MD: 7.0; 95% CI: -2.8, 16.9; p = 0.16). Remarkably, these findings were not confirmed by the included randomized controlled trial. CONCLUSIONS Biophotonics comprises a heterogeneous group of imaging modalities that serve intraoperative decision-making and guidance. Implementation into clinical practice and cost effectiveness are the limitations that should be addressed by future research. PATIENT SUMMARY We reviewed the application of biophotonics during partial removal of the kidney in patients with kidney cancer. Our results suggest that these techniques support the surgeon in successfully performing the challenging steps of the procedure.
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Affiliation(s)
- Luisa Egen
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany.
| | - Greta S Demmel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Maurizio Grilli
- Library of the Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Alexander Studier-Fischer
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Caelan M Haney
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - Julia Mühlbauer
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Friedrich O Hartung
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Hanna S Menold
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Pietro Piazza
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Juan Gomez Rivas
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
| | - Enrico Checcucci
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Surgery, FPO-IRCCS Candiolo Cancer Institute, Turin, Italy
| | - Stefano Puliatti
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Urology, University of Modena, and Reggio Emilia, Modena, Italy
| | - Ines Rivero Belenchon
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Urology and Nephrology Department, Virgen del Rocío University Hospital, Seville, Spain
| | - Mark Taratkin
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands
| | - Severin Rodler
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Urology, University Hospital LMU Munich, Munich, Germany
| | - Giovanni Cacciamani
- Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Maurice S Michel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Mannheim, Germany; Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands
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Mizuno R, Yasumizu Y, Tanaka N, Takeda T, Morita S, Matsumoto K, Kosaka T, Asanuma H, Oya M. Anemia in patients ≥ 75 years with metastatic clear cell renal cell carcinoma: an important poor prognostic factor in the international metastatic renal cell carcinoma database consortium model. BMC Urol 2024; 24:13. [PMID: 38212721 PMCID: PMC10782570 DOI: 10.1186/s12894-024-01403-0] [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: 05/24/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Due to an increase in life expectancy, the incidence of metastatic renal cell carcinoma (mRCC) in patients aged ≥75 years has been increasing. In this study we investigated the characteristics before treatment and the outcomes of systemic therapies for patients aged ≥75 years with mRCC and compared the results with those for patients aged < 75 years in order to determine whether differences in age influenced survival. METHODS A total of 206 consecutive Japanese patients with mRCC, including 47 patients aged ≥75 years, who received systemic therapy were included. Clinical data from medical records were retrieved and analyzed retrospectively. Survival analyses were determined using a Kaplan-Meier method, and analyzed with a log-rank test. RESULTS Elderly patients categorized as favorable risk group based on the International Metastatic RCC Database Consortium (IMDC) stratification system were significantly lower. Among IMDC risk factors, the rate of anemia was significantly higher in elderly patients. No statistically significant benefit in progression free survival for first and second line treatment was observed, whereas improvements in overall survival as well as cancer specific survival were seen in patients aged < 75 years. CONCLUSIONS For mRCC patients aged ≥75 years, a higher proportion of base line anemia, which resulted in higher rates of IMDC intermediate/poor risk, would be responsible for shorter OS/CSS. Furthermore, mRCC patients aged ≥75 years tend to receive BSC instead of second line active treatment. Overcoming under-treatment in elderly patients might help to prolong survival in mRCC.
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Affiliation(s)
- Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, 1608582, Japan.
| | - Yota Yasumizu
- Department of Urology, Keio University School of Medicine, Tokyo, 1608582, Japan
| | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, Tokyo, 1608582, Japan
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, Tokyo, 1608582, Japan
| | - Shinya Morita
- Department of Urology, Keio University School of Medicine, Tokyo, 1608582, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, Tokyo, 1608582, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, 1608582, Japan
| | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, Tokyo, 1608582, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, 1608582, Japan
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Wang K, Chen H, Chen X, Fang Z, Xiao E, Liao Q. The Role MicroRNA-135a in Suppressing Tumor Growth in Kidney Cancer Through the Regulation of Phosphoprotein Phosphatase2A and the Activation of the AKT and ERK1/2 Signaling Pathways. J Cancer 2024; 15:999-1008. [PMID: 38230208 PMCID: PMC10788712 DOI: 10.7150/jca.90756] [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: 10/04/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
Background: Kidney cancer is a frequently occurring malignant tumor in the urinary system, with rising morbidity and mortality rates in recent times. Developing new biomarkers and therapeutic targets is essential to improve the prognosis of patients affected by kidney cancer. In recent years, miRNAs' role in tumorigenesis and development has received growing attention. miRNAs constitute a group of small non-coding RNA molecules that regulate gene expression, affecting various biological processes, including cell proliferation, differentiation, and apoptosis. Of the many miRNAs, miR-135a plays a pivotal role in several cancers. Nevertheless, the precise mechanisms and functions concerning miR-135a in renal cancer remain incompletely understood. Therefore, this study aims to analyze the effects of miR-135a on renal cancer replication and migration and its possible mechanisms, and to provide new strategies for the diagnosis and treatment of renal cancer. Methods: Renal cell lines (ACHN, A498) with stable hyperexpression of miR-135a and reduced expression of miR-135a were constructed by lentivirus packaging. The changes of replication, clone formation and migration ability of overexpressed miR-135a and overexpressed miR-135a in ACHN and A498 renal cell lines were detected. The possible mechanism of miR-135a affecting the replication of kidney cancer was analyzed by target gene prediction, double luciferase test, Western blotting and subcutaneous tumorigenicity assay in nude mice. Results: Hyperexpression of miR-135a can inhibit kidney cancer replication, whereas miR-135a knockdown potentially enhances replication. However, neither hyperexpression nor knockdown of miR-135a affects the migration ability of kidney cancer cells. The protein expression of PP2A-B56-γ, PP2A-Cα and PP2A-Cβ in renal cell line decreased after hyperexpression of miR-135a, while the protein expression of PP2A-B56-γ, PP2A-Cα and PP2A-Cβ increased after knockdown of miR-135a. In addition, the protein expression of p-Akt and p-ERK1/2 proteins in kidney cancer cells after hyperexpression of miR-135a were down-regulated, while the protein expression of p-Akt and p-ERK1/2 were up-regulated in kidney cancer cells after knockdown of miR-135a. In subcutaneous tumor formation experiments in nude mice, tumor size within nude mice in the miR-135a group was significantly smaller than in the control group. Conclusion: MiR-135a could suppress the replication of kidney cancer by modulating PP2A and AKT, ERK1/2 signaling pathways.
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Affiliation(s)
- Kangning Wang
- Department of Urology Surgery, Xiangya Hospital Central South University, Changsha Hunan Province, 410008, China
- Department of Urology laboratory, Guangdong Medical University, Zhanjiang, Guangdong Province, 524001, China
| | - Hege Chen
- Department of Urology laboratory, Guangdong Medical University, Zhanjiang, Guangdong Province, 524001, China
| | - Xiang Chen
- Department of Urology Surgery, Xiangya Hospital Central South University, Changsha Hunan Province, 410008, China
| | - Zesong Fang
- Department of Urology laboratory, Guangdong Medical University, Zhanjiang, Guangdong Province, 524001, China
| | - Enhua Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Qiuling Liao
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
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Panhelleux M, Balssa L, David A, Thiery-Vuillemin A, Kleinclauss F, Frontczak A. Evaluation of local control after percutaneous microwave ablation versus partial nephrectomy: A propensity score matched study. Fr J Urol 2024; 34:102534. [PMID: 37798161 DOI: 10.1016/j.purol.2023.09.021] [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] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION The incidence of small renal tumors (≤4cm) is on the rise. The gold standard treatment is partial nephrectomy (PN) but focal therapy can be a good alternative. We evaluated oncological control after treatment of T1a renal tumors by microwave ablation (MWA) compared to PN. METHODS This is a retrospective, single-center study of all patients treated for TNM stage T1a renal tumors by either PN or MWA between 2010 and 2020. A propensity score was calculated and patients were matched 2:1 to compare recurrence-free survival, metastasis-free survival and overall survival between groups. We also compared postoperative complications using the Clavien-Dindo classification. RESULTS After matching and propensity score, the two groups (41 MWA and 82 PN) were comparable. The median follow-up was 23 months (interquartiles, 9-48 months). Recurrence-free survival was higher in the PN group compared to MWA, with a recurrence rate of 17.1% in the MWA group vs 4.9% in the PN group (P=0.003). MWA treatment was a risk factor for tumor recurrence (P=0.002), but there was no significant difference in terms of metastasis-free survival (P=0.549) or overall survival (P=0.539). MWA was associated with fewer postoperative complications (P=0.0005). CONCLUSION This study shows that MWA was associated with higher risk of recurrence but similar metastasis-free survival and overall survival compared to PN. Recurrence was treated with new MWA or active surveillance. MWA may be an interesting alternative to PN for small renal tumors. LEVEL OF EVIDENCE Grade C.
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Affiliation(s)
- M Panhelleux
- Urology Department, University Hospital Center, Besançon, France; University of Franche-Comte, Besançon, France.
| | - L Balssa
- Urology Department, University Hospital Center, Besançon, France
| | - A David
- Radiology Department, University Hospital Center, Besançon, France
| | - A Thiery-Vuillemin
- University of Franche-Comte, Besançon, France; Imagery and Therapeutics, EA 4662, Nanomedecine Lab, Besançon, France; Oncology Department, University Hospital Center, Besançon, France
| | - F Kleinclauss
- Urology Department, University Hospital Center, Besançon, France; University of Franche-Comte, Besançon, France; Imagery and Therapeutics, EA 4662, Nanomedecine Lab, Besançon, France
| | - A Frontczak
- Urology Department, University Hospital Center, Besançon, France; University of Franche-Comte, Besançon, France; Imagery and Therapeutics, EA 4662, Nanomedecine Lab, Besançon, France
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Jonasch E, Bauer TM, Papadopoulos KP, Plimack ER, Merchan JR, McDermott DF, Dror Michaelson M, Appleman LJ, Roy A, Perini RF, Liu Y, Choueiri TK. Phase I LITESPARK-001 study of belzutifan for advanced solid tumors: Extended 41-month follow-up in the clear cell renal cell carcinoma cohort. Eur J Cancer 2024; 196:113434. [PMID: 38008031 DOI: 10.1016/j.ejca.2023.113434] [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: 08/15/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Accumulation of the HIF-2α transcription factor is an oncogenic event implicated in the tumorigenesis of clear cell renal cell carcinoma (ccRCC). In the phase I LITESPARK-001 study, the first-in-class HIF-2α inhibitor belzutifan demonstrated antitumor activity and an acceptable safety profile for pretreated patients with advanced ccRCC. Updated data with additional follow-up of > 40 months are presented. METHODS LITESPARK-001 is an ongoing open-label study with a 3 + 3 dose-escalation design followed by an expansion phase. Patients with ccRCC enrolled at 7 sites received belzutifan 120 mg orally once daily until disease progression, unacceptable toxicity, or patient withdrawal. The data cutoff date was July 15, 2021. The primary end point was identifying the maximum tolerated dose and/or the recommended phase II dose. Secondary end points included objective response rate (ORR) and duration of response (DOR) per RECIST v1.1 by investigator assessment and safety. RESULTS Median follow-up was 41.2 months (range, 38.2-47.7). Patients received a median of 3 (range, 1-9) prior systemic therapies. Of 55 patients, 14 (25 %) achieved an objective response. Median DOR was not reached (range, 3.1 + to 38.0 + months). Adverse events (AEs) attributed to study treatment by investigator assessment were reported in 53 patients (96 %). 22 patients (40 %) had grade 3 treatment-related AEs; the most common were anemia (n = 13; 24 %) and hypoxia (n = 7; 13 %). No grade 4 or 5 treatment-related AEs occurred. CONCLUSION After a median follow-up of 41.2 months, belzutifan monotherapy demonstrated durable antitumor activity in patients with advanced ccRCC and acceptable safety. CLINICALTRIALS gov. NCT02974738.
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Affiliation(s)
- Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Ngo XT, El-Achkar A, Dobbs RW, Tiong HY, Chau QT, Tran TT, Van Dinh LQ, Zein M, Le NT, Truong HTT, Tran TS, Thai MS, Nguyen TT. Laparoscopic retroperitoneal heminephrectomy for renal cell carcinoma in horseshoe kidney: a case report and review of the literature. J Med Case Rep 2023; 17:512. [PMID: 38087334 PMCID: PMC10717455 DOI: 10.1186/s13256-023-04274-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION In this case report, we demonstrate our technique of a retroperitoneal laparoscopic heminephrectomy for a T1b right hilar tumor in a horseshoe kidney. CASE PRESENTATION A 77-year-old Vietnamese woman presented to the hospital because of right flank pain. On presentation, her serum creatinine was 0.86 mg/dL and glomerular filtration rate was 65.2 mL/minute/1.73 m2. According to her renal scintigraphy, glomerular filtration rates of the right and left moieties were 24.2 and 35.5 mL/minute, respectively. Computed tomography imaging demonstrated a 5.5 × 5.0 cm solid hilar mass with a cT1bN0M0 tumor stage was in the right moiety. After discussion, the patient elected a minimally invasive surgery to treat her malignancy. The patient was placed in a flank position. We used Gaur's balloon technique to create the retroperitoneal working space, and four trocar ports were planned for operation. Three arteries were dissected, including two arteries feeding the right moiety, one artery feeding the isthmus, and one vein, which was clipped and divided by Hem-o-lok. The isthmusectomy was performed with an Endostapler. Consequently, the ureter was clipped and divided. Finally, the whole right segment of the horseshoe kidney was mobilized and taken out via the flank incision. RESULTS The total operative time was 250 min with an estimated blood loss of 200 mL. The patient's serum creatinine after surgery was 1.08 mg/dL, and glomerular filtration rate was 49.47 mL/minute/1.73 m2. The patient was discharged on postoperative day #4 without complication. Final pathologic examination of the tumor specimen revealed a Fuhrman grade II clear cell renal cell carcinoma, capsular invasion, with negative surgical margins. After a three-month follow-up, the serum creatinine was 0.95 mg/dL, and glomerular filtration rate was 57.7 mL/minute/1.73 m2. Local recurrence or metastasis was not detected by follow-up computed tomography imaging. CONCLUSIONS Retroperitoneal laparoscopic heminephrectomy is a safe and feasible technique for patients with renal cell carcinoma in a horseshoe kidney and may be particularly useful in low income settings without access to robotic technology.
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Affiliation(s)
- Xuan Thai Ngo
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | | | - Ryan W Dobbs
- Cook County Health and Hospitals System, Chicago, IL, USA
| | - Ho Yee Tiong
- National University Hospital, Singapore, Singapore
| | | | | | | | - Marwan Zein
- American University of Beirut, Beirut, Lebanon
| | | | | | | | - Minh Sam Thai
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tuan Thanh Nguyen
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
- Cho Ray Hospital, Ho Chi Minh City, Vietnam.
- University of California Irvine, Irvine, USA.
- Department of Urology, UC Irvine Health, 3800 W Chapman Ave, Suite 7200, Orange, CA, 92868, USA.
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Harasemiw O, Nayak JG, Grubic N, Ferguson TW, Sood MM, Tangri N. A Predictive Model for Kidney Failure After Nephrectomy for Localized Kidney Cancer: The Kidney Cancer Risk Equation. Am J Kidney Dis 2023; 82:656-665. [PMID: 37394174 DOI: 10.1053/j.ajkd.2023.06.002] [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: 12/19/2022] [Accepted: 06/12/2023] [Indexed: 07/04/2023]
Abstract
RATIONALE & OBJECTIVE Nephrectomy is the mainstay of treatment for individuals with localized kidney cancer. However, surgery can potentially result in the loss of kidney function or in kidney failure requiring dialysis/kidney transplantation. There are currently no clinical tools available to preoperatively identify which patients are at risk of kidney failure over the long term. Our study developed and validated a prediction equation for kidney failure after nephrectomy for localized kidney cancer. STUDY DESIGN Population-level cohort study. SETTING & PARTICIPANTS Adults (n=1,026) from Manitoba, Canada, with non-metastatic kidney cancer diagnosed between January 1, 2004, and December 31, 2016, who were treated with either a partial or radical nephrectomy and had at least 1 estimated glomerular filtration rate (eGFR) measurement before and after nephrectomy. A validation cohort included individuals in Ontario (n=12,043) with a diagnosis of localized kidney cancer between October 1, 2008, and September 30, 2018, who received a partial or radical nephrectomy and had at least 1 eGFR measurement before and after surgery. NEW PREDICTORS & ESTABLISHED PREDICTORS Age, sex, eGFR, urinary albumin-creatinine ratio, history of diabetes mellitus, and nephrectomy type (partial/radical). OUTCOME The primary outcome was a composite of dialysis, transplantation, or an eGFR<15mL/min/1.73m2 during the follow-up period. ANALYTICAL APPROACH Cox proportional hazards regression models evaluated for accuracy using area under the receiver operating characteristic curve (AUC), Brier scores, calibration plots, and continuous net reclassification improvement. We also implemented decision curve analysis. Models developed in the Manitoba cohort were validated in the Ontario cohort. RESULTS In the development cohort, 10.3% reached kidney failure after nephrectomy. The final model resulted in a 5-year area under the curve of 0.85 (95% CI, 0.78-0.92) in the development cohort and 0.86 (95% CI, 0.84-0.88) in the validation cohort. LIMITATIONS Further external validation needed in diverse cohorts. CONCLUSIONS Our externally validated model can be easily applied in clinical practice to inform preoperative discussions about kidney failure risk in patients facing surgical options for localized kidney cancer. PLAIN-LANGUAGE SUMMARY Patients with localized kidney cancer often experience a lot of worry about whether their kidney function will remain stable or will decline if they choose to undergo surgery for treatment. To help patients make an informed treatment decision, we developed a simple equation that incorporates 6 easily accessible pieces of patient information to predict the risk of reaching kidney failure 5 years after kidney cancer surgery. We expect that this tool has the potential to inform patient-centered discussions tailored around individualized risk, helping ensure that patients receive the most appropriate risk-based care.
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Affiliation(s)
- Oksana Harasemiw
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Manitoba; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Jasmir G Nayak
- Men's Health Clinic Manitoba, University of Manitoba, Winnipeg, Manitoba; Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, Manitoba
| | - Nicholas Grubic
- ICES, Toronto, Ontario; Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Thomas W Ferguson
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Manitoba; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Manish M Sood
- ICES, Toronto, Ontario; Division of Nephrology, Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Manitoba; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba.
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Priyam J, Saxena U. Therapeutic applications of carbon nanomaterials in renal cancer. Biotechnol Lett 2023; 45:1395-1416. [PMID: 37864745 DOI: 10.1007/s10529-023-03429-0] [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: 06/07/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 10/23/2023]
Abstract
Carbon nanomaterials (CNMs), including carbon nanotubes (CNTs), graphene, and nanodiamonds (NDs), have shown great promise in detecting and treating numerous cancers, including kidney cancer. CNMs can increase the sensitivity of diagnostic techniques for better kidney cancer identification and surveillance. They enable targeted medicine delivery specifically to tumour locations, with little effect on healthy tissue. Because of their unique chemical and physical characteristics, they can avoid the body's defence mechanisms, making it easier to accumulate where tumours exist. Consequently, CNMs provide more effective drug delivery to kidney cancer cells. It also helps in improving the efficacy of treatment. This review explores the potential of several CNMs in improving therapeutic strategies for kidney cancer. We briefly covered the physicochemical properties and therapeutic applications of CNMs. Additionally, we discussed how structural modifications in CNMs enhance their precision in treating renal cancer. A thorough overview of CNM-based gene, peptide, and drug delivery strategies for the treatment of renal cancer is presented in this review. It covers information on other CNM-based therapeutic approaches, such as hyperthermia, photodynamic therapy, and photoacoustic therapy. Also, the interactions of CNMs with the tumour microenvironment (TME) are explored, including modulation of the immune response, regulation of tumour hypoxia, interactions between CNMs and TME cells, effects of TME pH on CNMs, and more. Finally, potential side effects of CNMs, such as toxicity, bio corona formation, enzymatic degradation, and biocompatibility, are also discussed.
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Affiliation(s)
- Jyotsna Priyam
- Department of Biotechnology, National Institute of Technology Warangal, Warangal, Telangana, 506004, India
| | - Urmila Saxena
- Department of Biotechnology, National Institute of Technology Warangal, Warangal, Telangana, 506004, India.
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Shrivastava N, Sharma G, Ahluwalia P, Gautam G, Erdem S, Amparore D, Marchioni M, Pavan N, Marandino L, Roussel E, Campi R, Bertolo R. Off-clamp Versus On-clamp Robot-assisted Partial Nephrectomy: A Systematic Review and Quantitative Synthesis by the European Association of Urology Young Academic Urologists Renal Cancer Study Group. EUR UROL SUPPL 2023; 58:10-18. [PMID: 38028236 PMCID: PMC10630115 DOI: 10.1016/j.euros.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Context The superiority of off-clamp robot-assisted partial nephrectomy (RAPN) over the on-clamp technique has recently been questioned by randomized controlled trials comparing the two techniques. Objective To systematically review the recent literature and perform a quantitative synthesis of data on the comparison of off-clamp versus off-clamp hilar control during RAPN. Evidence acquisition A systematic search was performed in the PubMed, Embase, Web of Science, and Scopus databases for studies comparing off-clamp versus on-clamp RAPN in terms of perioperative and functional outcomes. The study protocol was registered in the PROSPERO database (CRD42023413160). Only prospective randomized controlled trials and retrospective matched observational studies were included. The primary outcome of the study was the percentage decrease in the estimated glomerular filtration rate (eGFR). Evidence synthesis A total of 11 studies were included involving a total of 2483 patients (944 patients in the off-clamp and 1539 patients in the on-clamp group). There was no difference between the two groups in the percentage decline in eGFR (mean difference [MD] 0.04%, 95% confidence interval [CI] -3.7% to 3.86%; p = 0.98). There were so significant differences between the groups for length of hospital stay (p = 0.56), complications (p = 0.08), conversion to open or radical surgery (p = 0.18), estimated blood loss (p = 0.06), or need for blood transfusion (p = 0.07). The operative time was shorter in the off-clamp group (MD-21.89 min, 95% CI -42.5 to -1.27; p = 0.04) but after sensitivity analysis the difference was no longer statistically significant (p = 0.15). The positive surgical margin rate was significantly lower in the off-clamp group (odds ratio 0.6, 95% CI 0.39-0.91; p = 0.02). Conclusions Our review revealed no clinically relevant differences in perioperative and functional outcomes between off-clamp and on-clamp RAPN. Patient summary In this review, we compared the two methods of controlling the kidney blood vessels during robot-assisted surgery to remove part of the kidney. We noted that there was no difference between the two groups for outcomes such as complications and the decrease in kidney function after surgery.
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Affiliation(s)
- Nikita Shrivastava
- Department of Urology, DKS Superspeciality Hospital and Postgraduate Institute, Raipur, India
| | - Gopal Sharma
- Urologic Oncology and Robotic Surgery, Medanta The Medicity, Gurugram, India
| | - Puneet Ahluwalia
- Urologic Oncology and Robotic Surgery, Medanta The Medicity, Gurugram, India
| | - Gagan Gautam
- Urologic Oncology and Robotic Surgery, Medanta The Medicity, Gurugram, India
| | - Selcuk Erdem
- Urologic Oncology Division, Urology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Michele Marchioni
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. D’Annunzio Chieti-Pescara University, Chieti, Italy
- Department of Urology, SS Annunziata Hospital, G. D’Annunzio Chieti-Pescara University, Chieti, Italy
| | - Nicola Pavan
- Unit of Urology, Department of Surgical, Oncological and Oral Sciences, P. Giaccone University Hospital, Palermo, Italy
| | - Laura Marandino
- Clinical Research Fellow in Renal & Melanoma, Royal Marsden Hospital, London, UK
| | - Eduard Roussel
- Department of Urology, University Hospitals of Leuven, Leuven, Belgium
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - European Association of Urology Young Academic Urologists Renal Cancer Study Group‡
- Department of Urology, DKS Superspeciality Hospital and Postgraduate Institute, Raipur, India
- Urologic Oncology and Robotic Surgery, Medanta The Medicity, Gurugram, India
- Urologic Oncology Division, Urology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. D’Annunzio Chieti-Pescara University, Chieti, Italy
- Department of Urology, SS Annunziata Hospital, G. D’Annunzio Chieti-Pescara University, Chieti, Italy
- Unit of Urology, Department of Surgical, Oncological and Oral Sciences, P. Giaccone University Hospital, Palermo, Italy
- Clinical Research Fellow in Renal & Melanoma, Royal Marsden Hospital, London, UK
- Department of Urology, University Hospitals of Leuven, Leuven, Belgium
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Urology Unit, San Carlo di Nancy Hospital, Rome, Italy
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Chen YW, Wang L, Panian J, Dhanji S, Derweesh I, Rose B, Bagrodia A, McKay RR. Treatment Landscape of Renal Cell Carcinoma. Curr Treat Options Oncol 2023; 24:1889-1916. [PMID: 38153686 PMCID: PMC10781877 DOI: 10.1007/s11864-023-01161-5] [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] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
OPINION STATEMENT The treatment landscape of renal cell carcinoma (RCC) has evolved significantly over the past three decades. Active surveillance and tumor ablation are alternatives to extirpative therapy in appropriately selected patients. Stereotactic body radiation therapy (SBRT) is an emerging noninvasive alternative to treat primary RCC tumors. The advent of immune checkpoint inhibitors (ICIs) has greatly improved the overall survival of advanced RCC, and now the ICI-based doublet (dual ICI-ICI doublet; or ICI in combination with a vascular endothelial growth factor tyrosine kinase inhibitor, ICI-TKI doublet) has become the standard frontline therapy. Based on unprecedented outcomes in the metastatic with ICIs, they are also being explored in the neoadjuvant and adjuvant setting for patients with high-risk disease. Adjuvant pembrolizumab has proven efficacy to reduce the risk of RCC recurrence after nephrectomy. Historically considered a radioresistant tumor, SBRT occupies an expanding role to treat RCC with oligometastasis or oligoprogression in combination with systemic therapy. Furthermore, SBRT is being investigated in combination with ICI-doublet in the advanced disease setting. Lastly, given the treatment paradigm is shifting to adopt ICIs at earlier disease course, the prospective studies guiding treatment sequencing in the post-ICI setting is maturing. The effort is ongoing in search of predictive biomarkers to guide optimal treatment option in RCC.
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Affiliation(s)
- Yu-Wei Chen
- Division of Hematology Oncology, University of California San Diego, San Diego, CA, USA
| | - Luke Wang
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Justine Panian
- School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Sohail Dhanji
- Department of Urology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ithaar Derweesh
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Brent Rose
- Department of Radiation Oncology, University of California San Diego, San Diego, CA, USA
| | - Aditya Bagrodia
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Rana R McKay
- Division of Hematology Oncology, University of California San Diego, San Diego, CA, USA.
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Krebs M, Kotlyar MJ, Fahl J, Janaki Raman S, Röhrig F, Marquardt A, Kübler H, Kneitz B, Schulze A, Kalogirou C. Metformin Regulates the miR-205/VEGFA Axis in Renal Cell Carcinoma Cells: Exploring a Clinical Synergism with Tyrosine Kinase Inhibitors. Urol Int 2023; 108:49-59. [PMID: 38035560 PMCID: PMC10836959 DOI: 10.1159/000535025] [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: 05/28/2023] [Accepted: 10/14/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Metformin (MF) intake could be associated with a favorable outcome in sunitinib (SUT)- and axitinib (AX)-treated clear cell renal cell carcinoma (ccRCC) patients. Functionally, MF induces miR-205, a microRNA serving as a tumor suppressor in several cancers. METHODS Real-time quantitative PCR, viability assays, and Western blotting analyzed MF and SUT/AX effects in RCC4 and 786-O cells. A tetracycline-inducible overexpression model was used to study the role of miR-205 and its known target gene, VEGFA. We analyzed miR-205 and VEGFA within a public and an in-house ccRCC cohort. Human umbilical vein endothelial cell (HUVEC) sprouting assays examined miR-205 effects on angiogenesis initiation. To determine the influence of the von Hippel-Lindau tumor suppressor (VHL), we examined VHLwt reexpressing RCC4 and 786-O cells. RESULTS Viability assays confirmed a sensitizing effect of MF toward SUT/AX in RCC4 and 786-O cells. Overexpression of miR-205 diminished VEGFA expression - as did treatment with MF. Tumor tissue displayed a downregulation of miR-205 and an upregulation of VEGFA. Accordingly, miR-205 caused less and shorter vessel sprouts in HUVEC assays. Finally, VHLwt-expressing RCC4 and 786-O cells displayed higher miR-205 and lower VEGFA levels. CONCLUSION Our results support the protective role of MF in ccRCC and offer functional insights into the clinical synergism with tyrosine kinase inhibitors.
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Affiliation(s)
- Markus Krebs
- Department of Urology and Pediatric Urology, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | - Mischa J Kotlyar
- Department of Urology and Pediatric Urology, University Hospital Würzburg, Würzburg, Germany,
- Department of Interdisciplinary Critical Care Medicine and Intermediate Care, Helios Clinic Erfurt, Erfurt, Germany,
| | - Julian Fahl
- Department of Urology and Pediatric Urology, University Hospital Würzburg, Würzburg, Germany
| | - Sudha Janaki Raman
- Chair of Biochemistry and Molecular Biology, Biocenter, University of Würzburg, Würzburg, Germany
| | - Florian Röhrig
- Chair of Biochemistry and Molecular Biology, Biocenter, University of Würzburg, Würzburg, Germany
| | - André Marquardt
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
- Institute of Pathology, Klinikum Stuttgart, Stuttgart, Germany
| | - Hubert Kübler
- Department of Urology and Pediatric Urology, University Hospital Würzburg, Würzburg, Germany
| | - Burkhard Kneitz
- Department of Urology and Pediatric Urology, University Hospital Würzburg, Würzburg, Germany
| | - Almut Schulze
- Chair of Biochemistry and Molecular Biology, Biocenter, University of Würzburg, Würzburg, Germany
- Division of Tumor Metabolism and Microenvironment, German Cancer Research Center, Heidelberg, Germany
| | - Charis Kalogirou
- Department of Urology and Pediatric Urology, University Hospital Würzburg, Würzburg, Germany
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50
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Myers AA, Briganti A, Leibovich B, Lerner SP, Moschini M, Rouprêt M, Shariat SF, Spiess PE, Stenzl A, Taneja SS, Touijer KA, Kamat AM. Contemporary Role of Lymph Node Dissection in Genitourinary Cancers: Where Are We in 2023? Eur Urol Oncol 2023:S2588-9311(23)00245-6. [PMID: 37980250 DOI: 10.1016/j.euo.2023.10.028] [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: 09/15/2023] [Revised: 10/16/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023]
Abstract
CONTEXT Lymphadenectomy during surgery for genitourinary malignancies has varying benefits. OBJECTIVE To review contemporary evidence on lymph node dissection in genitourinary cancers. EVIDENCE ACQUISITION We performed a collaborative review to summarize current evidence supporting lymph node dissection in urothelial, prostate, kidney, penile, and testis cancers. We present the evidence on patient selection and recommended dissection templates, and highlight knowledge gaps and ongoing areas of investigation. EVIDENCE SYNTHESIS Lymph node dissection remains the reference standard for lymph node staging. Pathologic nodal stage informs prognosis and guides adjuvant treatment. Appropriate template and patient selection are paramount to optimize outcomes and capitalize on the selective therapeutic benefits. CONCLUSIONS Accurate staging with lymphadenectomy is contingent on appropriate template selection. The cumulative benefit will depend on judicious patient selection. PATIENT SUMMARY We performed a collaborative review by a diverse group of experts in urology. We reviewed current evidence on lymph node dissection.
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Affiliation(s)
- Amanda A Myers
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Seth P Lerner
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Marco Moschini
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Morgan Rouprêt
- Urology, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Philippe E Spiess
- Department of GU Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, FL, USA
| | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Samir S Taneja
- Department of Urology, NYU Langone Health, New York, NY, USA
| | - Karim A Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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