Incidence Of RCC Research Articles

50 National trends in the surgical management of renal cell carcinoma in Germany

Abstract Background The incidence of RCC is increasing worldwide. For most patients with localized RCC, surgery remains the preferred treatment option. We aimed to investigate whether international trends towards minimally invasive procedures and nephron-sparing surgery are reflected in Germany. Methods Pseudonymized inpatient billing data from the AOK (Allgemeine Ortskrankenkassen), a non-profit oriented health insurance organization in Germany, was used for the conduct of the study. A total of 43,936 RCC cases were identified in which either a partial nephrectomy (PN, n = 20,030) or radical nephrectomy (RN, n = 21,906) was performed between 2012 and 2021. The proportions of different surgical procedures over time, as well as mortality (90 days), transfusion rate, reinterventions, and general postsurgical complications (30 days), were evaluated. Due to the use of pseudonymized data, no ethics vote was required. Results During the period of observation, there was a significant shift from RN to PN, with an increase in the proportion of PN among all procedures from 41.0% (1,918/4,684) in 2012 to 57.4% (2,274/3,960) in 2021 (p <0.001). Open surgery decreased for PN and RN but still accounted for the majority of all procedures (2021: 53.2% of PN and 65% of RN). Mortality was higher among patients with RN compared to PN (in hospital: 1.9% vs. 0.6%, 90 days: 4.7% vs. 1.2%). While general complication rates were similar (19.4% after PN versus 20.4% after RN), the reintervention rate was slightly higher after PN at 10.7% than after RN at 7.9%. Transfusion rates decreased significantly in several subgroups, favoring PN and minimally invasive approaches. Open surgical procedures were associated with higher unadjusted complication rates. Conclusions Despite shifts in favor of nephron-sparing surgery and minimally invasive surgery during the study period, open surgery remained the dominant surgical option for the treatment of renal cell carcinoma in Germany as of 2021. The adoption of laparoscopic and robotic-assisted techniques appears to reduce overall perioperative morbidity and consequently improve the quality of care in Germany. Further studies are required to examine patient level trends between type of surgical procedure, complication rates, and oncologic outcomes. Optimizing the assessment of the quality of care would enable further improvement of the quality itself.

Abstract 3140: Interleukin-34 regulates tumor immune microenvironment of renal cell carcinoma

Abstract Renal Cell Carcinoma (RCC) is a type of kidney cancer which derives from renal tubular epithelial cells and is responsible for approximately 90-95% of cases in adults. Incidence and prevalence of RCC are rising, and 5-year survival of metastatic disease is close to 10%. The therapy of RCC mainly targets the angiogenic and immunosuppressive tumor microenvironment (TME), but it is rarely curative and drug resistance is almost inevitable. Lack of validated biomarkers and scarce knowledge of the biological processes occurring during RCC progression are main reasons of therapy failure. Using an immunocompetent murine model of RCC, we identified Interleukin-34 (IL34) as potential biomarker of RCC progression, whose expression is associated with advanced tumor stage and reduced survival in RCC patients. In cancer, IL34 was demonstrated to regulate cancer cell proliferation and monocytes survival and differentiation into macrophages. Regarding to RCC, IL34 role in the TME still remains elusive and has never been described. To elucidate the function of IL34 in RCC biology, we undertook different approaches: Gene Ontology enrichment analysis of IL34 co-expressed genes, using the KIRC-TCGA database, which revealed that such genes are involved in different immune system related processes; orthotopic implantation of IL34 over-expressing murine renal cancer cells (i.e. RENCA cell line) in BALB/c mice, where we observed, both in primary tumors and lung metastases, an accumulation of tumor associated macrophages (TAM) expressing M2-type macrophage markers (e.g. Cd206 and Cd163). Subsequently, to deeply investigate how IL34 can finely tune the tumor immune microenvironment of RCC, we also employed an experiment of Single Nuclei Sequencing using murine samples over-expressing IL34 (or control empty vector). Briefly, RENCA cancer cells were implanted in BALB/c mice using two different injection modalities: orthotopic implantation in the kidney, to generate primary tumors; 2) tail vein injection, for lung metastases formation. After tumor or metastases formation, samples were snap-frozen in liquid nitrogen and processed for cDNA library preparation for next generation sequencing. Our project aims to elucidate how IL34 can be implicated in the regulation of TME in RCC and, in particular, of the phenotype of the accumulated TAM. As TAM are known to promote cancer progression by enhancing tumor angiogenesis and immunosuppression, the study of IL34 role in the TME can reveal novel paradigms in RCC biology, and may be fundamental to improve the current therapy (e.g. using drugs targeting IL34 activity). Citation Format: Andrea Emanuelli, Wilfried Souleyreau, Tiffanie Chouleur, Marie-Alix Derieppe, Andreas Bikfalvi. Interleukin-34 regulates tumor immune microenvironment of renal cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3140.

Improvement in colorectal cancer outcomes over time is limited to patients with left-sided disease.

Incidence and mortality of colorectal cancer (CRC) declined over the last decades. However, survival depends on the primary tumor location. It is unknown if all progress in outcomes vary depending on left-sided (LCRC) versus right-sided (RCC) colorectal cancer. We compare incidence and mortality rates over time according to the primary tumor location. Data from the Austrian National Cancer Registry spanning from 1983 to 2018 were used to calculate annual incidence and mortality rates and survival stratified by primary tumor localization and stage. Joinpoint regression with linear regression models were used on different subgroups to identify significant changes of incidence- and mortality slopes. A total of 168,260 (incidence dataset) and 87,355 cases (mortality dataset) were identified. Survival of disseminated RCC was worse compared to LCRC (HR 1.14; CI 1.106-1.169). Total and LCRC incidence and mortality rates declined steadily over time, whereas the rates of RCC did not. Incidence of disseminated RCC declined significantly less (slope - 0.07; CI - 0.086; - 0.055) than in LCRC (slope - 0.159; CI - 0.183; - 0.136); mortality rate of RCC was unchanged over time. Incidence and mortality of localized RCC remained unchanged over time, whereas both rates declined independently of stage in LCRC. Colorectal cancer outcomes during the last 35years have preferentially improved in LCRC but not in RCC, indicating that the progress made is limited to LCRC. It is necessary to define RCC as a distinct form of CRC and to focus on specific strategies for its early detection and treatment.

Oncological Outcomes of Primary Renal Malignancies other than Clear Cell Renal Carcinoma: A Retrospective Study from a Tertiary Centre in Southern India

Introduction: A lot of research is available about clear cell Renal Carcinomas (ccRCC). But there are lesser known facts about other subtypes of renal malignancies. With advances in immunohistochemical and cytogenetic techniques, new variants of renal tumours are being increasingly reported. The treatment and prognosis of such rare malignancies is still an enigma. Aim: To analyse the incidence, clinicopathological features, surgical treatment, and survival of non clear cell RCC at the tertiary care centre. Materials and Methods: The present study was a retrospective study in which histopathological reports of 77 nephrectomy specimens who underwent surgical treatment for suspected renal tumours from 2013-2018 were reviewed. Of which 19 (24%) patients had documented uncommon histologic variants of RCC. The clinical, demographic, and histologic characteristics of these patients were analysed, and survival was evaluated. The characteristic light microscopy and immunohistochemical features of these lesions were documented. Results: Mean age was 45 years (21-67 years). Out of 19 patients, 14 (73.6%) were males, and 5 (26.4%) were females. Mean tumour size was 8.8 cm (range 6-36) in the largest dimension. About 17 (22%) patients underwent radical nephrectomy, and 2 (2.5%) were treated with partial nephrectomy. Patients with collecting duct, synovial sarcoma, and primitive Neuroectodermal tumour (PNET) had associated inferior vena caval thrombus and underwent venous thrombectomy. Adjuvant treatment in the form of chemotherapy was instituted in collecting duct, adult Wilms and pure sarcomas. There was no mortality in the papillary carcinoma, and the worst prognosis was encountered in collecting duct carcinoma. Conclusion: Papillary variant had a good outcome as compared to other non clear cell carcinomas. RCC with sarcomatoid variant has a poor prognosis. Variants like renal sarcomas are rare but can be managed by nephron sparing surgeries with adjuvant therapies.

Acute Kidney Injury Instigates Malignant Renal Cell Carcinoma via CXCR2 in Mice with Inactivated Trp53 and Pten in Proximal Tubular Kidney Epithelial Cells.

Renal cell carcinoma (RCC) is one of the most common urologic malignancies with the highest mortality rates worldwide. However, relevant mouse models that recapitulated the genetic alterations found in RCC have been lacking. In this study, we crossed Trp53 and Pten conditional knockout mice with Ggt1-Cre mice to generate a Ggt1-Cre; Trp53LoxP/LoxP ; PtenLoxP/LoxP ; YFPLoxP/LoxP (GPPY) mouse model, which resulted in the formation of dysplastic lesions involving kidney tubular epithelial cells (TEC), with only approximately 25% of mice developing RCC at an advanced age. Combining CRISPR/Cas9-mediated Vhl knockout in these mice increased the frequency of dysplasia, but failed to increase the incidence of RCC. Assessments of whether ischemic injury of TECs in the GPPY kidney without Vhl knockout influences the emergence of RCC revealed that advanced RCC predominantly emerged in the contralateral, noninjured kidney with 100% penetrance at a younger age, but rarely in the injured kidney due to severely damaged ischemic TEC. Injured TEC released CXCL1 into the microenvironment that traveled systemically to activate fibroblasts and recruit neutrophils to enable emergence of RCC in the contralateral kidney. Fibroblasts responded to CXCL1 via CXCR2 and recruited tumor-associated neutrophils, which in turn mediated tumor-promoting inflammation and angiogenesis. Treatment with anti-CXCR2 antibodies abolished the emergence of malignant RCC. Collectively, these results demonstrate a defining functional role of systemic inflammation and microenvironment in the emergence of malignant cancer from preestablished dysplastic precursor lesions. SIGNIFICANCE: These results identify a role for CXCL1/CXCR2 and the tumor microenvironment in the development of RCC. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/81/10/2690/F1.large.jpg.See related commentary by Kusmartsev, p. 2584.

Synchronous tumors in an elderly patient – A rare case report

A 70 year old male was admitted with abdominal pain, weight loss, vomiting, difficulty in eating both solid and liquid food & malena for 20 days. On clinical examination patient’s conjunctiva is pale and his blood investigation shows Hemoglobin of 6 g/dl and Normocytic normochromic anemia in peripheral smear. Upper GI endoscopy shows ulceroproliferative growth in the antrum extending into pylorus with complete Gastric outlet obstruction Endoscopic gastric biopsy shows mucinous adenocarcinoma with invasion into muscularis propria. Abdominal CT scan shows a hyper vascular tumor in the Left kidney measuring 9x6x5 cms. Further subtotal gastrectomy and Radical left nephrectomy were performed. Final pathology report was Gastric adenocarcinoma (T2a) with renal cell carcinoma (T3a). Post operative period was uneventful. Elderly people with early gastric cancers have a relative higher probability of developing a synchronous tumour than younger people. The incidence of synchronous gastric cancer and RCC is quite low, and concomitant surgery is rare. It is appreciated that simultaneously both Subtotal gastrectomy and Radical nephrectomy can be performed without any major surgical complications. Our case report also alerts the treating physician to search for any synchronous cancers in the patient suffering from gastric cancer. Keywords: Synchronous cancers, Gastric cancers, Renal cancers,

Rightward shift in colorectal cancer: experience in 1101 patients.

In the past decades the right colon cancer showed a higher incidence rate than left colon cancer. This trend is known as "proximal shift" or "rightwards shift." We evaluated rightward shift phenomenon in our region. We collected data from 1101 colorectal cancer patients who underwent curative surgery at Parma University Hospital from 01 January 2004 through 01 January 2018. We divided patients into seven subgroups according to the time of surgery to evaluate epidemiological changes through the years of colon cancer. We found a non-linear rightward shift trend of CRC. The incidence of RCC was the 40% between 2004-2005 and 51% in the biennium 2016-2017 (60% in 2012-2013 and 57% in 2014-2015). The patients with RCC were significantly older than patients with LCC. RCCs have poor differentiated tumors. Metastatic disease showed a similar distribution both in left and right CRCs. Peritoneum was the most common metastasis location from right-sided colon cancer. Data suggest the existence of two different tumor entities in CRC between right-sided colon cancer and left-sided colon cancer. The proximal shift may be a reflection of improved screening programs, diagnostic accuracy and population aging. Ethnicity, gender, diet, environment, and socioeconomic status contribute to CRC incidence and prevalence in different regions.

Simultaneous totally robotic rectal resection and partial nephrectomy: case report and review of literature

IntroductionThe incidence of synchronous RCC and colorectal cancer is heterogeneous ranging from 0.03 to 4.85%. Instead, only one case of huge colon carcinoma and renal angiomyolipoma was reported. The treatment of synchronous kidney and colorectal neoplasm is, preferably, synchronous resection. Currently, laparoscopic approach has shown to be feasible and safe, and it has become the gold standard of synchronous resection due to advantages of minimally invasive surgery. We presented a case synchronous renal neoplasm and colorectal cancer undergone simultaneous totally robotic renal enucleation and rectal resection with primary intracorporeal anastomosis. As our knowledge, this is the first case in literature of simultaneous robotic surgery for renal and colorectal tumor.Case presentationA 53-year-old woman was affected by recto-sigmoid junction cancer and a solid 5 cm left renal mass. We performed a simultaneous robotic low anterior rectal resection and renal enucleation. Total operative time was 260 min with robotic time of 220 min; estimated blood loss was 150 ml; time to flatus was 72 h, and oral diet was administered 4 days after surgery. The patient was discharged on the eighth post-operative day without peri- and post-operative complication. The definitive histological examination showed a neuroendocrine tumor pT2N1 G2, with negative circumferential and distal resection margins. Renal tumor was angiomyolipoma. At 23 months follow-up, the patient is recurrence free.Discussion and conclusionAs our knowledge, we described the first case in literature of simultaneous robotic anterior rectal resection and partial nephrectomy for treatment of colorectal tumor and renal mass. Robotic rectal resection with intracorporeal anastomosis surgery seems to be feasible and safe even when it is associated with simultaneous partial nephrectomy. Many features of robotic technology could be useful in combined surgery. This strategy is recommended only when patients’ medical conditions allow for longer anesthesia exposure. The advantages are to avoid a delay treatment of second tumor, to reduce the time to start the post-operative adjuvant chemotherapy, to avoid a second anesthetic procedure, and to reduce the patient discomfort. However, further studies are needed to evaluate robotic approach as standard surgical strategy for simultaneous treatment of colorectal and renal neoplasm.

ALK-rearranged renal cell carcinomas in Polish population

Anaplastic lymphoma kinase (ALK) is a receptor tyrosine kinase, the activation of which is considered an important event in the pathogenesis of several neoplasms and a predictive factor for the targeted therapy with ALK inhibitors. Thus far, ALK rearrangements have been identified in 22 renal cell carcinomas in both pediatric and adult patients. We evaluated the incidence of ALK rearrangement-associated RCC in adult Central European population. An immunohistochemical evaluation of 1019 kidney tumors was performed with use of three different clones of anti-ALK antibodies. None of the tested samples showed positive staining, which suggests that the incidence of ALK rearrangement-associated renal cell carcinomas is significantly lower in the Polish population, and indicates a potential association between ethnicity and occurrence of these rare neoplasms.

Abstract 5798: Elucidating novel role of bezafibrate, a PPARα agonist as potential anticancer agent in the treatment of renal cell carcinoma

Abstract Renal Cell Carcinoma (RCC) accounts for 2 - 3% of all the malignant diseases worldwide, leading to a mortality of around 1.7 lakh every year. Incidence of RCC in eight major markets has been predicted to increase by 63% over the period from 2013 to 2023. The current treatment modules are dominated by anti-angiogenic agents and tyrosine kinase inhibitors (TKIs). In the coming years, Programmed Cell Death - 1 inhibitors are set to replace TKIs as the preferred standard of care (SOC) drug. However, owing to the long waiting periods associated with these agents to reach the market, there is a significant unmet medical need for development of new drugs. Discovery and development of new drugs is an expensive process associated with long incubation periods. Hence repurposing of an already existing drug is an attractive and cost effective substitute. We have identified Bezafibrate, a FDA approved drug for the treatment of hyperlipidaemia, as a potential anti-cancer agent against RCC. It acts as a PPARα agonist, thereby promoting the uptake and catabolism of fatty acids. Several studies have shown its role in inhibition of cyclin-dependent kinases, thereby arresting the cells in G0/G1 phase of cell cycle. It has been reported to be successfully used in combination with other respective SOC drugs in the treatment of leukaemia and colorectal cancer. However, the efficacy of bezafibrate as a single agent or in combination with SOC for the treatment of renal cancer has not yet been reported. In this study, we have evaluated Bezafibrate against a panel of 10 RCC cell lines including patient derived cells (PDX). It displayed an in vitro dose dependent cytotoxicity with a mean IC50 of 1222 μM and 985 μM in a 2D and 3D setup respectively. Importantly, the combination of sunitinib, a SOC and bezafibrate showed an overall additive effect in suppressing colony formation by 1183L (PDX) and SN12C cell lines seeded on soft agar coated plates. Further, in vivo efficacy studies were performed in sub cutaneously implanted A498 cells in athymic nude mice xenograft model treated with drug alone and in combination. Sunitinib and bezafibrate alone exhibited a mean tumor growth inhibition of 50.78% and 31.59% respectively on day 20 as compared to the control group. Interestingly, the combination was able to inhibit the growth of tumor by 66.76% on the same day (n = 7). Moreover, the cell cycle analysis, differential gene and protein expression studies involving markers for cell cycle regulation, proliferation and apoptosis show promising results. Thus, our results indicate bezafibrate as a promising candidate against RCC. Furthermore, the novel combination involving Bezafibrate and Sunitinib synergistically ameliorates the proliferation and migration potential of the cancer cells. Hence, this combination may be significantly helpful in reducing the dosage of Sunitinib without compromising on its therapeutic potential. Citation Format: Srikanth Iyer, Jeevan Ghosalkar, Geena Malhotra, Kalpana Joshi. Elucidating novel role of bezafibrate, a PPARα agonist as potential anticancer agent in the treatment of renal cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5798.

Imaging features of papillary renal cell carcinoma with cystic change-dominant appearance in the era of the 2016 WHO classification.

Papillary renal cell carcinoma (P-RCC) typically exhibits a homogeneous, solid hypovascular mass; P-RCC with a cystic appearance is atypical. Tubulocystic RCC (TC-RCC), a newly proposed entity for renal tumors in the 2016 WHO classification, and cystic papillary RCC, may yield similar imaging findings. Therefore, we investigated the incidence of papillary RCC with cystic changes and compared its CT and pathologic features to differentiate between two entities. We retrospectively evaluated 26 consecutive patients diagnosed with P-RCC. Two radiologists consensually identified dominant masses indicative of cystic changes on CT scans and recorded their Bosniak classification. In addition, two pathologists inspected the whole area of tumors macroscopically, labeled them as solid- or cystic change-dominant tumors, determined the pathogenesis of the cystic components (necrosis or hemorrhage), and recorded their inherent cystic characteristics (with/without TC-RCC components). We defined masses with cystic changes involving more than 50% of the entire tumor as cystic change-dominant tumors. Of the 26 tumors, 7 (27%) were diagnosed cystic change-dominant based on imaging and pathologic findings, of these, 2 were classified as Bosniak type III and 5 as Bosniak type IV. The pathologists confirmed that two type IV tumors demonstrated extensive necrosis and one type IV tumor revealed extensive hemorrhage. Four P-RCCs (type III and IV, 2 each) were of a mixed type harboring both solid and cystic components. Only one tumor exhibited a multilocular cystic appearance. All 7 cystic change-dominant P-RCCs were pathologically diagnosed as a pure P-RCC without TC-RCC components. While P-RCCs may contain cystic features, the multilocular type of cystic P-RCC is rare.

MP100-09 DOES ROUTINE BIOPSY IMPROVE DETECTION OF RESIDUAL RCC POST MICROWAVE ABLATION?

You have accessJournal of UrologyKidney Cancer: Ablative Therapy1 Apr 2017MP100-09 DOES ROUTINE BIOPSY IMPROVE DETECTION OF RESIDUAL RCC POST MICROWAVE ABLATION? Brett Johnson, Amy Lim, Shane Wells, Sara Best, Michael Hartung, Meghan Lubner, Timothy Ziemlewicz, J. Louis Hinshaw, Fred Lee, Wei Huang, Richard Yang, Stephen Y Nakada, and E. Jason Abel Brett JohnsonBrett Johnson More articles by this author , Amy LimAmy Lim More articles by this author , Shane WellsShane Wells More articles by this author , Sara BestSara Best More articles by this author , Michael HartungMichael Hartung More articles by this author , Meghan LubnerMeghan Lubner More articles by this author , Timothy ZiemlewiczTimothy Ziemlewicz More articles by this author , J. Louis HinshawJ. Louis Hinshaw More articles by this author , Fred LeeFred Lee More articles by this author , Wei HuangWei Huang More articles by this author , Richard YangRichard Yang More articles by this author , Stephen Y NakadaStephen Y Nakada More articles by this author , and E. Jason AbelE. Jason Abel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3116AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The histologic presence of residual RCC following thermal ablation without radiographic evidence of tumor is of uncertain clinical significance. The purpose of this study is to evaluate the incidence of viable RCC in patients with no radiographic recurrence following percutaneous microwave (MW) ablation. METHODS Routine post-ablation biopsy was obtained approximately 9 months following ablation. Four cores were routinely sampled from the ablation bed (2 for H&E staining, 2 for NAD diaphorase testing). A pilot study included ex-vivo ablation of RCC immediately following nephrectomy to evaluate histologic effect of ablation. RESULTS Pilot study included 10 patients who had nephrectomy for RCC. A sample containing tumor and normal renal parenchyma was evaluated histologically following ex-vivo supra-therapeutic MW ablation. Preservation of tumor histology was demonstrated in specimens evaluated after H&E processing. Fifty-six biopsy proven RCC tumors in 52 patients (37M/15F, median age: 67.5 IQR: 64 - 71.3) following percutaneous MW ablation from April 2012 through May 2016 were evaluated. Median tumor diameter and nephrometry score were 2.8 cm (IQR: 2.0 - 3.2) and 6.5 (IQR: 5.0 - 8.0). Median Charlson Co-Morbidity Index was 2.0 (IQR: 0.75 - 3.0). Clear cell histology represented 40/56 (71.4%). Median follow up was 15.3 months (IQR: 8.4 - 27.0). Median time between ablation and biopsy was 9.3 months (IQR: 9.0 - 10.3). Following ablation, ablation zone biopsy has no RCC present in 51/56 (91.1%) tumors while 5/56 (8.9%) had the appearance of histologically residual tumor. Positive versus negative post-ablation biopsies did not significantly differ in nephrometry score, age, tumor size, or histology (p > 0.05). In patients with residual tumor, 2 were treated with repeat ablation and 3 elected surveillance. No patients have subsequently developed radiologically identifiable kidney recurrence and one patient with negative renal ablation bed biopsy was treated surgically for recurrence outside kidney and is currently NED. CONCLUSIONS Histologically identifiable tumor was identified in 9% of routine biopsies in the absence of radiologic recurrence following microwave ablation. The clinical significance of preserved tissue histology is unclear as no patients have radiological recurrence in ablated renal tumors to date. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1333 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Brett Johnson More articles by this author Amy Lim More articles by this author Shane Wells More articles by this author Sara Best More articles by this author Michael Hartung More articles by this author Meghan Lubner More articles by this author Timothy Ziemlewicz More articles by this author J. Louis Hinshaw More articles by this author Fred Lee More articles by this author Wei Huang More articles by this author Richard Yang More articles by this author Stephen Y Nakada More articles by this author E. Jason Abel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD48-09 CANCER-SPECIFIC SURVIVAL IS NOT AFFECTED BY HISTOLOGY OF T1 TUMORS UNDERGOING PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VI1 Apr 2016PD48-09 CANCER-SPECIFIC SURVIVAL IS NOT AFFECTED BY HISTOLOGY OF T1 TUMORS UNDERGOING PARTIAL NEPHRECTOMY Michael Daugherty, Michael Daneshvar, and Oleg Shapiro Michael DaughertyMichael Daugherty More articles by this author , Michael DaneshvarMichael Daneshvar More articles by this author , and Oleg ShapiroOleg Shapiro More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2731AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES As the incidence of RCC is rising with increased utilization of cross-sectional imaging, renal tumors are often diagnosed at smaller size and earlier stage of presentation. Partial nephrectomy (PN) is the standard therapy for small renal masses and has had even become more regularly performed for T1b tumors. Renal surgery is often performed without a tissue diagnosis prior to extirpation. We hypothesize that RCC histology will not affect survival outcomes in those patient undergoing PN. METHODS SEER-18 registries database was queried for all cases of clear cell (CC), papillary (Pap) and chromophobe (Chr) RCC that underwent PN for T1 tumors between the years 2004 and 2012. Patients with unknown grade, race, and age were excluded from analysis. T-test and chi-square analysis was used to compare continuous and categorical variables, respectively. Overall survival (OS) and cancer-specific survival (CSS) was compared between histologies and T stage using logRank analysis. RESULTS There were 10,647, 3,032, and 886 CC, Pap, and Chr tumors that met our inclusion criteria. There were significant differences seen in all patient demographics and tumor characteristics between groups (Table 1). There was a larger percentage of males (77.5%) in the papillary cohort. There was no difference in CSS for T1a or T1b tumors according to tumor histology (p=0.07 and 0.46, respectively). There was an improved OS for Chr T1a tumors (p=0.015) CONCLUSIONS For small renal masses, histology does not appear to have an effect on CSS. Although T1a Chr tumors have an improved OS, it is of unclear etiology. It appears that histologic subtypes affect different patient populations but will need to be elucidated in further study. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1178 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Michael Daugherty More articles by this author Michael Daneshvar More articles by this author Oleg Shapiro More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP41-20 RACE EFFECTS ON PATHOLOGICAL AND FUNCTIONAL OUTCOMES AFTER ROBOTIC PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I1 Apr 2016MP41-20 RACE EFFECTS ON PATHOLOGICAL AND FUNCTIONAL OUTCOMES AFTER ROBOTIC PARTIAL NEPHRECTOMY Onder Kara, Hiury Andrade, Homayoun Zargar, Oktay Akca, Matthew Maurice, Peter Caputo, Daniel Ramirez, Ercan Malkoc, Charles Modlin, and Jihad Kaouk Onder KaraOnder Kara More articles by this author , Hiury AndradeHiury Andrade More articles by this author , Homayoun ZargarHomayoun Zargar More articles by this author , Oktay AkcaOktay Akca More articles by this author , Matthew MauriceMatthew Maurice More articles by this author , Peter CaputoPeter Caputo More articles by this author , Daniel RamirezDaniel Ramirez More articles by this author , Ercan MalkocErcan Malkoc More articles by this author , Charles ModlinCharles Modlin More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.187AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of RCC has risen more rapidly in the African-American (AA) population compared to non-AA patients in the United States. Our aim was to explore the potential effects of race on pathological outcomes of renal tumor and on kidney function preservation in the patients undergoing robotic partial nephrectomy (RPN) at our center. METHODS Retrospective review of our institutional review board approved database for patients undergoing RPN from 2006-2014 was performed. AA and non-AA groups were compared with regards to demographics, tumor characteristics, functional data and, oncological outcomes. For functional outcomes, groups were matched (1:1) in terms of age, preoperative estimated glomerular filtration rate (eGFR) and R.E.N.A.L score. RESULTS From the total of 1005 patients, 84 were AA. Age and the tumor size were comparable between the two groups (2.7 vs. 3 cm; p=0.29). Proportion of patients with papillary RCC was higher among AAs compared to non-AAs (43.3% vs. 19.4%; p<0.001) (Table 1). After matching AA patients with non-AA counterparts (1:1 matching), eGFR preservation at latest follow up after surgery was comparable between groups (84.3% vs. 85%; p=0.25) (Table 2). AA race (OR 3.62, p<0.001), male gender (OR 2.05, p<0.001) and low preoperative eGFR (OR 0.97, p<0.001) were predictors of papillary RCC on multivariate analyses (Table 3). CONCLUSIONS The incidence of papillary RCC is higher in AA patients undergoing RPN. There was no difference in kidney function recovery after RPN in both AA and non-AA groups. AA race itself is not a significant factor in determining renal malignancy. Further studies are needed to clarify the impact of higher prevalence of papillary tumors in AA group in terms of long-term oncological and functional outcomes. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e568 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Onder Kara More articles by this author Hiury Andrade More articles by this author Homayoun Zargar More articles by this author Oktay Akca More articles by this author Matthew Maurice More articles by this author Peter Caputo More articles by this author Daniel Ramirez More articles by this author Ercan Malkoc More articles by this author Charles Modlin More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Race effects on pathological and functional outcomes after robotic partial nephrectomy in a single academic tertiary care center.

To explore the potential effects of race on pathological outcomes of renal tumor and on kidney function preservation in the patients undergoing robotic partial nephrectomy (RPN) at our center. Retrospective review of our institutional review board approved database for African-American (AA) patients undergoing RPN from 2006 to 2014 was performed. AA and non-AA groups were compared with regards to demographics, tumor characteristics, functional data and, oncological outcomes. For functional outcomes, groups were matched (1:1) in terms of age, preoperative estimated glomerular filtration rate (eGFR) and R.E.N.A.L score. From the total of 1005 patients, 84 were AA. Age and the tumor size were comparable between the two groups (2.7 vs. 3cm; p=0.29). Proportion of patients with papillary RCC was higher among AAs compared to non-AAs (43.3 vs. 19.4%; p<0.001). After matching AA patients with non-AA counterparts (1:1 matching), eGFR preservation at latest follow up after surgery was comparable between groups (84.3 vs. 85%; p=0.25). AA race (OR 3.62, p<0.001), male gender (OR 2.05, p<0.001) and low preoperative eGFR (OR 0.97, p<0.001) were predictors of papillary RCC on multivariate analyses. The incidence of papillary RCC is higher in AA patients undergoing RPN. There was no difference in kidney function recovery after robotic partial nephrectomy in both AA and non-AA groups. AA race itself is not a significant factor in determining renal malignancy. Further studies are needed to clarify the impact of higher prevalence of papillary tumors in AA group in terms of long-term oncological and functional outcomes.

MP50-09 ROLE OF REPEAT BIOPSY IN THE FOLLOW-UP OF RENAL LESIONS WITH A PRIOR NON-DIAGNOSTIC BIOPSY OF THE SAME MASS

total and fatal pathology-confirmed RCC by BMI immediately prior to diagnosis. Models were adjusted for diabetes, hypertension, smoking, alcohol intake, NSAID use, physical activity, and parity in women. Results from the two cohorts were pooled using random effects metaanalysis. RESULTS: We confirmed 351 cases of RCC, including 105 fatal cases, in NHS, and 225 cases in HPFS, with 49 fatal cases. Compared to women with normal BMI (18.5-24.9 kg/m2) immediately prior to diagnosis, obese women (BMI 30) had a non-significantly increased risk of RCC (HR 1.29, 95% CI: 0.97-1.72, p-trend1⁄40.04), adjusting for possible confounders. The HR for fatal RCC was similar (HR 1.30, 95% CI: 0.77-2.20, p-trend1⁄40.50). Obese men had a nonsignificantly increased risk of RCC (HR 1.44, 95% CI: 0.95-2.19, ptrend1⁄40.08), with a significantly increased risk of fatal RCC (HR 2.48, 95% CI: 1.08-5.72, p-trend1⁄40.16). There was no evidence of significant differences in the associations by sex. The pooled HRs for total RCC incidence were 1.21 (95% CI: 0.99-1.47) for overweight and 1.34 (95% CI: 1.05-1.69) for obese compared to normal weight, p-trend1⁄40.007. For fatal RCC, the pooled HRs were 1.11 (95% CI: 0.75-1.63) for overweight and 1.65 (0.95% CI: 0.90-3.04) for obese, p-trend1⁄40.18. CONCLUSIONS: Our results support that obesity is a risk factor for RCC incidence. Associations for fatal RCC were similar in magnitude to those for total RCC, though not statistically significant, suggesting that obesity is also adversely associated with risk of fatal RCC.

MP50-08 DIAGNOSTIC SUCCESS AND PREDICTION OF TUMOR SUBTYPE OF RENAL MASS BIOPSY IMPROVES WITH EXPERIENCE: LONGITUDINAL RESULTS IN A SINGLE SERIES COHORT OF 1233 TUMORS

total and fatal pathology-confirmed RCC by BMI immediately prior to diagnosis. Models were adjusted for diabetes, hypertension, smoking, alcohol intake, NSAID use, physical activity, and parity in women. Results from the two cohorts were pooled using random effects metaanalysis. RESULTS: We confirmed 351 cases of RCC, including 105 fatal cases, in NHS, and 225 cases in HPFS, with 49 fatal cases. Compared to women with normal BMI (18.5-24.9 kg/m2) immediately prior to diagnosis, obese women (BMI 30) had a non-significantly increased risk of RCC (HR 1.29, 95% CI: 0.97-1.72, p-trend1⁄40.04), adjusting for possible confounders. The HR for fatal RCC was similar (HR 1.30, 95% CI: 0.77-2.20, p-trend1⁄40.50). Obese men had a nonsignificantly increased risk of RCC (HR 1.44, 95% CI: 0.95-2.19, ptrend1⁄40.08), with a significantly increased risk of fatal RCC (HR 2.48, 95% CI: 1.08-5.72, p-trend1⁄40.16). There was no evidence of significant differences in the associations by sex. The pooled HRs for total RCC incidence were 1.21 (95% CI: 0.99-1.47) for overweight and 1.34 (95% CI: 1.05-1.69) for obese compared to normal weight, p-trend1⁄40.007. For fatal RCC, the pooled HRs were 1.11 (95% CI: 0.75-1.63) for overweight and 1.65 (0.95% CI: 0.90-3.04) for obese, p-trend1⁄40.18. CONCLUSIONS: Our results support that obesity is a risk factor for RCC incidence. Associations for fatal RCC were similar in magnitude to those for total RCC, though not statistically significant, suggesting that obesity is also adversely associated with risk of fatal RCC.

De Novo Renal Cell Carcinoma in a Kidney Allograft Treated with Percutaneous Radiofrequency Ablation: A Case Report

th leading cancer type detected in males in the United States [1]. RCC accounts for 2-3% of all cancers in the general population compared to 5-7% of cancers diagnosed in kidney transplant recipients [2] However, the actual incidence of RCC in kidney transplant patients is low (0.5-1.6%), and the development of de novo tumor in the allograft is uncommon (0.1-0.3%) [3-7] Allograft tumors can either develop as a consequence of transmission of occult malignancy from the donor kidney or de novo; the former usually occurs early while the latter late following transplantation. We report herein a case of probable de novo RCC diagnosed in a renal allograft 58 months following kidney transplantation that was managed successfully with radiofrequency ablation.

Predicted plasma 25‐hydroxyvitamin D and risk of renal cell cancer

BackgroundAlthough the kidney is a primary organ for vitamin D metabolism, the association between vitamin D and renal cell cancer (RCC) remains unclear.MethodsWe prospectively evaluated the association between predicted plasma 25‐hydroxyvitamin D [25(OH)D] and RCC risk among 72,051 women and 46,380 men from 1986 to 2008. Predicted plasma 25(OH)D scores were computed using validated regression models that included major determinants of vitamin D status (race, UV‐B flux, physical activity, body mass index, vitamin D intake, alcohol consumption, and post‐menopausal hormone use in women). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. All statistical tests were two‐sided.ResultsDuring 22 years of follow‐up, we documented 201 cases of incident RCC in women and 207 cases in men. The multivariable HRs between extreme quintiles of predicted 25(OH)D score were 0.51 (95% CI 0.32–0.80) in women, 0.59 (95% CI 0.37–0.94) in men, and 0.55 (95% CI 0.39–0.76; Ptrend &lt; .0001) in the pooled cohorts. An increment of 10 ng/ml in predicted 25(OH)D score was associated with a 43% lower incidence of RCC (pooled HR 0.57; 95% CI 0.43–0.77). We found no significant association between vitamin D intake and RCC incidence.ConclusionHigher predicted plasma 25(OH)D levels were associated with a significantly lower risk of RCC in men and women.

Association of renal cell carcinoma and hematologic malignancy.

449 Background: An increased incidence of both RCC and HM occurring in the same patients has been reported. Also, a relationship between adenocarcinoma and HM has been previously suggested. Moreover, detailed family history in our patients with RCC suggested an increased incidence of HM in their family members. The purpose of this study is to characterize the HM in relatives of patients with RCC. Methods: Data from 700 patients with RCC seen by us from 2004 to the present were retrospectively evaluated through chart review. The patient, family history and pathology characteristics were collected to determine the frequency of HM in first and second-degree relatives of patients with RCC. Pedigrees were then constructed and subtypes of HM were characterized. Results: A family history of HM was observed in 74 relatives involving 59 families. Of these, 50/74 cases of HM were in first-degree relatives and 19/74 were in second-degree relatives. The most common HMs were lymphoma and leukemia: 24 non-Hodgkin’s lymphoma, 8 Hodgkin’s lymphoma, 8 lymphoma not further specified (NOS), 11 chronic lymphocytic leukemia, 1 chronic myeloid leukemia, 1 acute myeloid leukemia, 5 acute leukemia NOS and 4 leukemia NOS. Other HM observed were multiple myeloma in 2 patients, Waldenström’s macroglobulinemia, myelodysplastic syndrome, and myelofibrosis. Additionally, 2 relatives had blood cancers that were NOS. Of the 59 patients with RCC, 40 had clear cell histology, 4 papillary, 3 chromophobe, 1 sarcomatoid, 1 transitional and in 10, RCC histology was not recorded. Conclusions: HM is observed in patients with RCC with increased frequency compared with the SEER database. We now observed an increased frequency of HM in relatives of patients with RCC. The majority of HMs observed were B-cell malignancies, as we previously reported for HMs that occur in patients with breast cancer or RCC. The etiology of this association remains unclear, but suggests a common etiopathogenesis for RCC and B-cell tumors. Genetic mutations, hereditary immunological defects, and environmental factors may be involved. A larger study with statistical evaluation for confirmation is required. We plan to collect serum and tissue samples from patients and relatives for future molecular studies.