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Mourão TC, Abreu D, Carvalhal GF, Gueglio G, da Costa WH, Calsavara VF, Meza-Montoya L, Bengió RG, Scorticati C, Castillejos-Molina R, Rodríguez-Covarrubias F, Autran-Gómez AM, Campos-Salcedo JG, Nolazco A, Ameri C, Zampolli H, Langenhin R, Muguruza D, Machado MT, Mingote P, Clavijo J, Nogueira L, Clark O, Rovegno AR, Secin FP, Decia R, Guimarães GC, Glina S, Rodríguez-Faba O, Palou J, Zequi SC. Small renal masses in Latin-American population: characteristics and prognostic factors for survival, recurrence and metastasis - a multi-institutional study from LARCG database. BMC Urol 2020; 20:85. [PMID: 32615971 PMCID: PMC7331283 DOI: 10.1186/s12894-020-00649-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/19/2020] [Indexed: 12/24/2022] Open
Abstract
Background To evaluate demographic, clinical and pathological characteristics of small renal masses (SRM) (≤ 4 cm) in a Latin-American population provided by LARCG (Latin-American Renal Cancer Group) and analyze predictors of survival, recurrence and metastasis. Methods A multi-institutional retrospective cohort study of 1523 patients submitted to surgical treatment for non-metastatic SRM from 1979 to 2016. Comparisons between radical (RN) or partial nephrectomy (PN) and young or elderly patients were performed. Kaplan-Meier curves and log-rank tests estimated 10-year overall survival. Predictors of local recurrence or metastasis were analyzed by a multivariable logistic regression model. Results PN and RN were performed in 897 (66%) and 461 (34%) patients. A proportional increase of PN cases from 48.5% (1979–2009) to 75% (after 2009) was evidenced. Stratifying by age, elderly patients (≥ 65 years) had better 10-year OS rates when submitted to PN (83.5%), than RN (54.5%), p = 0.044. This disparity was not evidenced in younger patients. On multivariable model, bilaterality, extracapsular extension and ASA (American Society of Anesthesiologists) classification ≥3 were predictors of local recurrence. We did not identify significant predictors for distant metastasis in our series. Conclusions PN is performed in Latin-America in a similar proportion to developed areas and it has been increasing in the last years. Even in elderly individuals, if good functional status, sufficiently fit to surgery, and favorable tumor characteristics, they should be encouraged to perform PN. Intending to an earlier diagnosis of recurrence or distant metastasis, SRM cases with unfavorable characteristics should have a more rigorous follow-up routine.
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Affiliation(s)
- Thiago Camelo Mourão
- A.C. Camargo Cancer Center, Rua Antônio Prudente 211, Liberdade, São Paulo, 01509-010, Brazil.
| | | | | | | | - Walter H da Costa
- A.C. Camargo Cancer Center, Rua Antônio Prudente 211, Liberdade, São Paulo, 01509-010, Brazil
| | - Vinicius Fernando Calsavara
- Epidemiology and Statistics Department, International Research Center, A.C.Camargo Cancer Center, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Raúl Langenhin
- Corporación Médica de Paysandú (COMEPA), Paysandu, Uruguay
| | - Diego Muguruza
- Corporación Médica de Paysandú (COMEPA), Paysandu, Uruguay
| | - Marcos Tobias Machado
- Instituto Arnaldo Vieira de Carvalho, São Paulo, Brazil.,ABC Medical School, São Paulo, Brazil
| | | | | | - Lucas Nogueira
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Agustín R Rovegno
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | | | | | - Gustavo C Guimarães
- Surgical Oncology Coordinator at Beneficencia Portuguesa Hospital, São Paulo, Brazil
| | - Sidney Glina
- ABC Medical School, São Paulo, Brazil.,Ipiranga Hospital, São Paulo, Brazil
| | | | | | - Stenio C Zequi
- A.C. Camargo Cancer Center, Rua Antônio Prudente 211, Liberdade, São Paulo, 01509-010, Brazil.,National Institute for Science and Technology in Oncogenomics and Therapeutic Innovation, AC Camargo Cancer Center, São Paulo, Brazil
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Garza-Gangemi AM, Castillejos-Molina RA, Gueglio G, Tobia Gonzalez IP, Jurado AM, Meza-Montoya L, Scorticati CH, Henriques-da-Costa W, Yandian J, Ubillos L, Glina S, Tobias-Machado M, Rodríguez-Faba O, Ameri C, Nolazco A, Martinez P, Franco-Carvalhal G, Bengio RG, Cristian Arribillaga L, Langenhin R, Muguruza D, Campos-Salcedo JG, Bravo-Castro EI, Mingote PA, Ginestar N, Autran-Gomez AM, Langenhin R, Puente R, Decia R, Cardoso-Guimarães G, Langenhin R, Palou-Redorta J, Abreu-Clavijo D, de-Cassio-Zequi S, Rodriguez-Covarrubias FT. Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group. Rev Invest Clin 2020; 72. [PMID: 33057321 DOI: 10.24875/ric.20000018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. OBJECTIVE The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. METHODS This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (less than 75 vs. ≥75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. RESULTS There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p less than 0.01) and higher ASA score (ASA > 2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p less than 0.01), EBL ≥ 500 cc (OR 3.34, p less than 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. CONCLUSIONS Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities.
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Affiliation(s)
- Adrián M Garza-Gangemi
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gustavo Franco-Carvalhal
- School of Medicine,Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | | | - Raúl Langenhin
- Corporación Médica de Paysandú (COMEPA),Paysandu,Uruguay
| | - Diego Muguruza
- Corporación Médica de Paysandú (COMEPA),Paysandu,Uruguay
| | | | | | | | | | | | - Raúl Langenhin
- Corporación Médica de Paysandú (COMEPA),Paysandu,Uruguay
| | | | | | | | - Raúl Langenhin
- Corporación Médica de Paysandú (COMEPA),Paysandu,Uruguay
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