Concomitant Malignant Disease Research Articles

MP64-07 DEVELOPMENT OF AN INDIVIDUAL POSTOPERATIVE PREDICTION MODEL FOR KIDNEY CANCER RECURRENCE USING MACHINE LEARNING (UroCCR STUDY 120)

You have accessJournal of UrologyCME1 Apr 2023MP64-07 DEVELOPMENT OF AN INDIVIDUAL POSTOPERATIVE PREDICTION MODEL FOR KIDNEY CANCER RECURRENCE USING MACHINE LEARNING (UroCCR STUDY 120) Gaëlle Margue, Loïc Ferrer, Guillaume Etchepare, Karim Bensalah, Arnaud Mejean, Morgan Roupret, Nicolas Doumerc, Alexandre Ingels, Romain Boissier, Géraldine Pignot, Bastien Parier, Philippe Paparel, Thibaut Waeckel, Pierre Bigot, and Jean-Christophe Bernhard Gaëlle MargueGaëlle Margue More articles by this author , Loïc FerrerLoïc Ferrer More articles by this author , Guillaume EtchepareGuillaume Etchepare More articles by this author , Karim BensalahKarim Bensalah More articles by this author , Arnaud MejeanArnaud Mejean More articles by this author , Morgan RoupretMorgan Roupret More articles by this author , Nicolas DoumercNicolas Doumerc More articles by this author , Alexandre IngelsAlexandre Ingels More articles by this author , Romain BoissierRomain Boissier More articles by this author , Géraldine PignotGéraldine Pignot More articles by this author , Bastien ParierBastien Parier More articles by this author , Philippe PaparelPhilippe Paparel More articles by this author , Thibaut WaeckelThibaut Waeckel More articles by this author , Pierre BigotPierre Bigot More articles by this author , and Jean-Christophe BernhardJean-Christophe Bernhard More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney cancer is of increasing incidence worldwide. It is most often diagnosed at a localized stage where surgical management is the gold standard. Current prognostic scores offer moderate predictive performance which leads to difficulties in establishing follow-up recommendations for patients after surgery and selecting patients who could benefit from adjuvant therapy. Our objective is to develop a model for individual prediction of the recurrence risk after surgery using machine learning (ML). METHODS: From the french research network on kidney cancer database UroCCR (NCT 03293563), a cohort of patients undergoing surgery between May 2000 and January 2020 for a localized or locally advanced renal cell carcinoma (pT1-T4, N0, M0) was analyzed. Patients with a genetic cancer, a concomitant malignant disease or a chronic inflammatory disease were excluded. For each patient, clinical, biological, histological, and radiological data were collected.Participating sites were randomly assigned to the training or testing cohort with a 67/33 ratio of patients. Missing data were multiply imputed using the MICE algorithm and gradient boosted trees. Several ML algorithms were trained on the training data set and parameters of each algorithm were optimized using repeated cross-validation procedure. C-index at 5 years was used as optimization metric. The predictive performance of the algorithm was then evaluated on the test dataset using C-index and AUC. RESULTS: In total, 3255 patients were split in training and test cohorts of 2172 and 1083 patients, respectively. The enclosed patients had tumors with a mean size of 4cm and 71% of ccRCC; 3.6% had locoregional recurrence, 7% had metastatic progression and 2.4% died. The median follow-up was 25 months. The best results in DFS prediction were obtained using a Cox PH model including 18 variables with a C-index of 0,75 and an AUC of 0,71 at 5 years. Comparatively, the C-index of the UISS and SSIGN scores were of 0.61 and 0.72. Shapley values graphs were generated to display the predicted DFS and the relative contribution of each feature leading to the personalized prediction. CONCLUSIONS: ML applied to data from patients undergoing surgery for localized kidney cancer appears to provide good individual DFS predictions comparing to usual scores. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e883 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gaëlle Margue More articles by this author Loïc Ferrer More articles by this author Guillaume Etchepare More articles by this author Karim Bensalah More articles by this author Arnaud Mejean More articles by this author Morgan Roupret More articles by this author Nicolas Doumerc More articles by this author Alexandre Ingels More articles by this author Romain Boissier More articles by this author Géraldine Pignot More articles by this author Bastien Parier More articles by this author Philippe Paparel More articles by this author Thibaut Waeckel More articles by this author Pierre Bigot More articles by this author Jean-Christophe Bernhard More articles by this author Expand All Advertisement PDF downloadLoading ...

Percutaneous endoscopic discectomy might be effective in selected cases of pyogenic spondylitis.

Percutaneous endoscopic discectomy (PED) has been reported to be an effective procedure and minimally invasive surgical therapy for various spinal pathologies. To evaluate the clinical outcome of patients with pyogenic spondylitis who were treated with PED. Twenty-four patients with pyogenic spondylitis who underwent PED were evaluated for medical history, level of the affected intervertebral space, mode of onset, plain radiographs, epidural or psoas abscesses on MRI, results of blood and intraoperative sample cultures, preoperative C-reactive protein (CRP) level, time until postoperative CRP normalization (CRP < 0.3), and any additional surgery. Patients who underwent additional surgery and showed uncontrollable inflammation were considered to have "failed" PED for pyogenic spondylitis. To elucidate the factors that were significantly associated with a failure of PED for pyogenic spondylitis, statistical analyses were conducted by univariate analysis. Control of inflammation was achieved in 19 of 24 patients (76%) after PED for pyogenic spondylitis. The remaining five patients failed to achieve infection control by PED. One such patient was not able to control the infection after PED, and another patient developed an epidural abscess 2 weeks after PED. Remaining three "failed" patients had exacerbations of their infections during the postoperative course and required additional surgery. Univariate analyses demonstrated that diabetes mellitus (DM; p = 0.05), hemodialysis due to DM-induced renal failure (p = 0.02), concomitant malignant disease (p = 0.09), and acute onset (p = 0.05) were possibly correlated with PED failure. Stepwise logistic regression analysis revealed that hemodialysis due to DM-induced renal failure was an independent factor associated with PED failure (p = 0.03). PED might be considered as one of the alternative therapeutic options before invasive radical surgeries for pyogenic spondylitis after failure of standard conservative therapy. Even by less invasive PED, pyogenic spondylitis patients with DM-hemodialysis showed poor outcome.

Management of abdominal aortic aneurysm and concomitant malignant disease.

Concomitant malignant disease and abdominal aortic aneurysms (AAA) represent a challenging issue in terms of treatment priority, timing and perspectives. This systematic review provides an overview of the available literature about AAA and concomitant malignant disease. We conducted a literature search of all the English-language medical literature in Medline (through PubMed), Embase, Clinical Trial databases and the Cochrane Library up to December 31st, 2018. The literature about AAA and concomitant malignant disease is mostly based on retrospective small case series. Two recently published meta-analyses focusing on the management of AAA and concomitant abdominal neoplasms came to the same conclusion "treat what is most threatening or symptomatic first." The threshold to treat asymptomatic AAA should not be altered in patients with AAA and concomitant cancer including cases under chemotherapy. An asymptomatic AAA of at least 55 mm anatomically suitable for EVAR, should only be treated first in patients with at least a life expectancy of two years followed by staged cancer surgery two weeks later. Decisions about management of AAA and concomitant malignant disease should be based on clinical judgment applied individually in a multidisciplinary setting ("treat first what kills first"). The indication for treatment is not different than in patients with AAA without cancer. A staged approach is preferable and ideally the AAA should be excluded by endovascular means if anatomically suitable. An international registry should be initiated to gather more evidence about the management and outcomes of patients with AAA and concomitant carcinoma.

A patient with a history of breast cancer and multiple bone lesions: a case report

BackgroundLong-term severe hyperparathyroidism leads to thinning of cortical bone and cystic bone defects referred to as osteitis fibrosa cystica. Cysts filled with hemosiderin deposits may appear colored as “brown tumors.” Osteitis fibrosa cystica and brown tumors are occasionally visualized as multiple, potentially corticalis-disrupting bone lesions mimicking metastases by bone scintigraphy or 18F-fluorodeoxyglucose positron emission tomography.Case presentationWe report a case of a 72-year-old white woman who presented with malaise, weight loss, and hypercalcemia. She had a history of breast cancer 7 years before. The practitioner, suspecting bone metastases, initiated bone scintigraphy, which showed multiple bone lesions, and referred her to our hospital for further investigations. Laboratory investigations confirmed hypercalcemia but revealed a constellation of primary hyperparathyroidism and not hypercalcemia of malignancy; in the latter condition, a suppressed rather than an increased value of parathyroid hormone would have been expected. A parathyroid adenoma was found and surgically removed. The patient’s postoperative course showed a hungry bone syndrome, and brown tumors were suspected. With the background of a previous breast cancer and lytic, partly corticalis-disrupting bone lesions, there was a great concern not to miss a concomitant malignant disease. Biopsies were not diagnostic for either malignancy or brown tumor. Six months after the patient’s neck surgery, imaging showed healing of the bone lesions, and bone metastases could be excluded.ConclusionsThis case shows essential differential diagnosis in a patient with hypercalcemia and multiple bone lesions. Whenever multiple, fluorodeoxyglucose-avid bone lesions are found, malignancy and metabolic bone disease should both be included in the differential diagnosis. Fluorodeoxyglucose-avid and corticalis-disrupting lytic lesions also occur in benign bone disease. There may be very few similar cases with heterogeneous and widespread bone lesions reported in the literature, but we think our patient’s case is particularly remarkable for its detailed imaging and the well-documented course.

1268 SIGNIFICANCE OF RANDOM BLADDER BIOPSIES IN PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF NON-MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Detection and Screening1 Apr 20121268 SIGNIFICANCE OF RANDOM BLADDER BIOPSIES IN PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF NON-MUSCLE INVASIVE BLADDER CANCER Masafumi Kumano, Hideaki Miyake, and Masato Fujisawa Masafumi KumanoMasafumi Kumano Kobe, Japan More articles by this author , Hideaki MiyakeHideaki Miyake Kobe, Japan More articles by this author , and Masato FujisawaMasato Fujisawa Kobe, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1600AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Random bladder biopsies, taken from normal areas of urothelium, are widely performed to detect concomitant carcinoma in situ (CIS) in patients undergoing transurethral resection (TUR) of non-muscle invasive bladder cancer. However, there are few reports investigating the outcomes of random bladder biopsies based on the data from large series; thus, the significance of random biopsies remains controversial. The objective of this study was to retrospectively review the clinical outcomes of random bladder biopsies in patients with non-muscle invasive bladder cancer to identify predictive factors significantly associated with the findings of random biopsies. METHODS This study included a total of 451 consecutive patients with histopathologically confirmed non-muscle invasive bladder cancer who underwent TUR and random bladder biopsies. The random biopsies were taken from the seven different sites of normal-appearing urothelium, including right wall, left wall, trigone, dome, posterior wall, anterior wall and prostatic urethra. RESULTS Random biopsies were positive in 72 patients (16.0%), of whom 66 (91.7%) and 6 (8.3%) were diagnosed as Tis and Ta, respectively. The incidence of positive random biopsies was significantly associated with past history of upper urinary tract cancer, urinary cytology before TUR, number of tumors, pathological stage, tumor grade and presence of concomitant CIS. Univariate analysis identified past history of upper urinary tract cancer, urinary cytology before TUR and number of tumors as significant predictors of positive random biopsies, among which only urinary cytology before TUR appeared to be independently associated with positive random bladder biopsies on multivariate analysis. Furthermore, consideration of the preoperative finding of urinary cytology could diagnose concomitant malignant disease by random biopsies with 59.4% sensitivity, 88.8% specificity, 50.0% positive predictive value and 92.0% negative predictive value. CONCLUSIONS These findings suggest that the outcome of urinary cytology before TUR could be a useful predictor of positive biopsies in patients with non-muscle invasive bladder cancer. Accordingly, it would be important to further discuss the indication of random bladder biopsies in patients who were preoperatively diagnosed as negative in urinary cytology in order to avoid unnecessary biopsies. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e513 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masafumi Kumano Kobe, Japan More articles by this author Hideaki Miyake Kobe, Japan More articles by this author Masato Fujisawa Kobe, Japan More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Relation of the HAS-BLED Bleeding Risk Score to Major Bleeding, Cardiovascular Events, and Mortality in Anticoagulated Patients With Atrial Fibrillation

Stroke risk in atrial fibrillation (AF) using oral vitamin K antagonists is closely related to bleeding risk. The HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR [international normalized ratio], elderly, drugs/alcohol concomitantly) bleeding score has demonstrated usefulness in assessing major bleeding risk in patients with AF. However, risk factors for warfarin-associated bleeding also predict stroke risk in patients with AF. We tested the usefulness of the HAS-BLED score for predicting both major bleeding and cardiovascular events in a cohort of anticoagulated patients with AF. We recruited 965 consecutive anticoagulated outpatients with permanent or paroxysmal AF who were stabilized for at least 6 months on oral anticoagulation (international normalized ratio, 2.0-3.0). Medical history and HAS-BLED score were assessed. Cox regression models were used to determine the association between clinical risk factors and bleeding episodes, adverse cardiovascular events, and mortality. The median HAS-BLED score was 2 (range, 0-6; 29% with a score ≥3 [ie, high risk]). Median follow-up was 861 days (range, 718-1016 days). Independent predictors for major bleeding were age ≥75 years (hazard ratio [HR], 1.74; 95% CI, 1.05-2.87; P=0.030), male sex (HR, 1.70; 95% CI, 1.03-2.80; P=0.036), renal impairment (HR, 2.12; 95% CI, 1.20-3.73; P=0.010), previous bleeding episode (HR, 6.00; 95% CI, 3.73-9.67; P<0.001), current alcohol consumption (HR, 2.28; 95% CI, 1.03-5.06; P=0.043), and concomitant malignant disease (HR, 2.17; 95% CI, 1.13-4.18; P=0.020). Independent predictors for adverse cardiovascular events were age >75 years (HR, 2.20; 95% CI, 1.40-3.46; P=0.001), heart failure (HR, 1.78; 95% CI, 1.20-2.86; P=0.001), and previous stroke (HR, 1.85; 95% CI, 1.20-2.86; P<0.001). The HAS-BLED score was highly predictive for major bleeding events (HR, 2.04; 95% CI, 1.68-2.49; P<0.001) and adverse cardiovascular events (HR, 1.51; 95% CI, 1.27-1.81; P<0.001). The incidence of both bleeding and adverse cardiovascular events was higher as HAS-BLED score increased, and crude bleeding rates only exceeded thrombotic events at a HAS-BLED score >3. The HAS-BLED score also predicted all-cause mortality (HR, 1.68; 95% CI, 1.40-2.01; P<0.001). The HAS-BLED score not only is useful in the assessment of bleeding risk, but also shows some predictive value for cardiovascular events and mortality in anticoagulated patients with AF, consistent with the relationship between thrombosis and bleeding. Nonetheless, the HAS-BLED score has been designed for predicting bleeding risk rather than thrombotic events per se, and specific risk scores for cardiovascular events and mortality should be applied for these events.

Prospective analysis of risk factors and distribution of venous thromboembolism in the population-based Malmö Thrombophilia Study (MATS)

Background Despite venous thromboembolism (VTE) being a major cause of morbidity and mortality, there is still limited information on its prevalence and incidence in the general population. Objective To evaluate risk factors, distribution and epidemiology of VTE in the Malmö area with 280 000 inhabitants. Methods Patients diagnosed with VTE at Malmö University Hospital in 1998–2006 were invited to a prospective population-based study. Blood sampling and a questionnaire study could be performed in 70% of patients. Remaining 30% were excluded due to language problems, dementia, other severe disease, or unwillingness to participate. Results During 1998–2006 1140 VTE patients (559 men [49%, age 62 ± 16 years] and 581 women [51%, age 61 ± 20 years]) were included. Deep venous thrombosis (DVT) occurred in 882 (77%), pulmonary embolism (PE) in 330 (29%), and both DVT and PE in 72 (6%). The most common acquired risk factors among VTE patients were hormone therapy (24% of female DVT patients and 19% of female PE patients), immobilisation (17% of DVT patients and 18% of PE patients), previous surgery (13% of DVT patients and 19% of PE patients), and concomitant malignant disease (12% of DVT patients and 11% of PE patients). A positive family history for VTE was obtained from 25% of DVT patients and 22% of PE patients. Yearly incidences of VTE, DVT and PE in Malmö were 66, 51, and 19/100.000, respectively. Conclusion Hormone therapy, immobilisation, previous surgery and concomitant malignancy were the most common acquired risk factors among VTE patients in this population-based study. The VTE-incidence was lower than in earlier epidemiological studies.

Stem cell transplantation in multiple sclerosis: multiple choices and multiple challenges.

Multiple sclerosis (MS) is generally considered as an autoimmune disease of the central nervous system. This concept has led to the idea that profound immunosuppression followed by transplantation of stem cell grafts would stop, or at least slow down, disease activity. Supported by the positive effects of hematopoietic stem cell transplantation (HSCT) on experimental autoimmune encephalomyelitis and by anecdotal reports on the beneficial effect of HSCT on MS patients with concomitant malignant disease, HSCT programs for MS have been initiated worldwide. At this stage, it is impossible to draw general conclusions from the preliminary data reported and therefore overenthusiastic expectations should be tempered. The follow-up periods are too short the groups are too small, the selected patients and protocols too heterogeneous, and publication bias on positive results cannot be excluded. However, there is ample evidence that HSCT is a technically feasible approach in MS, not more dangerous than in the hemato-oncological diseases. For every step in the HSCT procedure, there are many different options. The time has come for a systematic analysis of the safety and efficacy associated with the different methodologies.

Role of off-pump coronary artery bypass grafting in patients with malignant neoplastic disease.

Although the long-term benefits of conventional coronary artery bypass grafting (CABG) are obvious, postoperative morbidity and mortality and the length of recovery associated with cardiopulmonary bypass are the main concerns of cardiac surgeons and cardiologists. The aim of this study was to demonstrate the effectiveness and advantage of the off-pump CABG for patients with concomitant malignant disorders requiring myocardial revascularization. From March 1997 to February 1999, 51 patients underwent off-pump CABG. Of these, there were 9 patients who had concomitant malignant disease requiring noncardiac surgery: gastric cancer (4), urinary bladder cancer (2), cholangioma (1), lung cancer (1) and colon cancer (1). Off-pump CABG was performed through a sternotomy, left thoracotomy or subxiphoid incision. Five patients received single grafting and 4 received double. The mean operative time for the off-pump CABG was 167 min. The total amount of bleeding during the off-pump CABG was 450-890 ml. Simultaneous noncardiac operations were carried out in 5 patients. The other 4 patients underwent subsequent operations for the malignancy uneventfully. In contrast, of the 4 patients with concomitant malignant disorders who underwent standard CABG during the period before the use of off-pump CABG, 2 died without undergoing the subsequent noncardiac operation. Off-pump CABG is quite efficient and is of great advantage in patients with malignancy who require myocardial revascularization in addition to noncardiac surgery for the cancer.

Treatment of patients with venous thromboembolism and malignant disease: Should vena cava filter placement be routine?

Purpose: It has been proposed that inferior vena cava filter placement should be the initial treatment of deep venous thrombosis (DVT) or pulmonary embolus (PE) in patients with coexisting malignant disease. We have chosen instead to selectively place filters only in patients with either a contraindication to anticoagulation therapy or a subsequent complication from anticoagulation therapy. The treatment efficacy and mortality rates in patients with concomitant malignant disease and venous thromboembolism using this approach was determined. Methods: We retrospectively reviewed all patients at our institution with malignant disease in whom venous thromboembolism developed between August 1991 through August 1996 and identified 166 patients with PE (n = 8), DVT (n = 147), and DVT/PE (n = 11). Of these patients, 138 (83.1%) were initially treated with anticoagulation therapy, and 28 (16.9%) had primary filter placement because of contraindications to anticoagulation therapy (10 for intracranial tumors, 11 for recent or upcoming operations, 6 for recent hemorrhage, and 1 for a malignant bloody pericardial effusion). Results: Thirty-two (23%) of the 138 patients who initially underwent anticoagulation therapy subsequently required a filter for the following reasons: bleeding (n = 15, 10.9%); recurrent thromboembolism (n = 6, 4.3%); heparin-induced thrombocytopenia (n = 1, 0.7%); and perceived high risk for bleeding with continued anticoagulation therapy (n = 11, 8%). Both bleeding and recurrent thromboembolism developed in 1 patient. Sixty patients (36%) received filters. No major technical complications occurred from filter placement. Major recurrent thromboembolic complications developed in 10 patients: DVT (n = 6, 10%), PE (n = 2, 3.3%), inferior vena cava thrombosis and phlegmasia cerulea dolens (n = 1, 1.7%), superior vena cava thrombosis (n = 1, 1.7%). Venous gangrene developed in 1 patient with DVT. The 1-year actuarial survival rates for patients treated with filter and anticoagulation therapy were 35% and 38%, respectively ( P = NS). Conclusion: In summary, our experience suggests that 64% of patients with malignant disease and venous thromboembolism are effectively treated with anticoagulation alone; 17% require primary filter placement for standard indications, and an additional 19% require subsequent filter placement because of complications (primarily bleeding) or failure of anticoagulation therapy. Although technical complications of filter placement are low, serious life-threatening or limb-threatening thromboembolic complications developed in 17% of patients. Survival was poor in all patients, regardless of treatment. These data support a conservative approach of routine anticoagulation therapy with selective filter placement. (J Vasc Surg 1998;28:800-7.)

Hepatic Lesions in Adult Coeliac Disease

In the period 1970 to 1987, 171 patients with small-intestinal mucosal atrophy have been hospitalized in our department. Of these, 132 patients fulfilled the diagnostic criteria of coeliac disease on the basis of histologic findings and clinical improvement on a gluten-free diet. Aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), and alkaline phosphatase (ALP) were chosen as markers of hepatic involvement. Elevation above the normal range in one or more of these tests was seen in 62 patients (47.0%, group I). In 70 patients (53.0%, group II) of similar age the levels of these variables were normal. In group I, 14 (10.6%) patients had an elevation of ALP only, leaving 48 (36.4%) patients with pathologic values for one or both transaminases. In group I, 32 patients had their ASAT, ALAT, and ALP reexamined after at least 6 months of gluten-free diet. Among the patients with increased values of one or both transaminases 18 patients were tested before and at least 6 months after start of gluten-free diet. The variables were significantly reduced in all patients. Liver biopsies were performed in 37 patients, and findings were normal in 5. In 25 patients the changes were classified as non-specific. Chronic active hepatitis was demonstrated in five patients. In one of these patients primary sclerosing cholangitis and ulcerative colitis were also diagnosed. Concomitant malignant disease was found in 22 patients, of whom 16 had malignant lymphoma. Malignant disease was seen more often in group I than group II (p less than 0.01). In conclusion, liver lesions were found in a great proportion of the patients with coeliac disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal transplantation in patients with carcinoma.

Four patients in terminal renal failure who had various malignant tumours were treated by haemodialysis and cadaveric renal transplantation. One patient with a testicular seminoma and one with leiomyosarcomatous changes in polycystic kidneys were successfully grafted after removal of the tumours and both were healthy at three and two-and-a-half years afterwards without evidence of recurrence of tumour.One patient with an invasive carcinoma of the renal pelvis was successfully transplanted and remained well for eight months but rapidly deteriorated and died of extensive metastases. Another patient with a malignant melanoma died more than one year after unsuccessful grafting.The presence of concomitant malignant disease in patients with chronic renal failure need not necessarily exclude them from the chance of long-term treatment, including renal transplantation. Each patient should be considered individually from the point of view of the nature of the malignancy, its duration, and treatment.