Renal Vein Invasion Research Articles

7703 Adrenal Cortical Carcinoma With Vascular Involvement - Complex Case Requiring Life-Saving Surgery With Bovine Pericardium- IVC Reconstruction

Abstract Disclosure: V. mehta: None. M. Renzu: None. K.N. Pereira: None. S. Sampath: None. S. Sruthi: None. E.B. Ruby: None. Adrenocortical carcinomas (ACCs) are rare endocrine tumors that exhibit unusual biological characteristics. Roughly 66% of cases are functional and have excessive hormone release causing classic symptoms of hypercortisolism, including plethora, diabetes, muscle weakness/atrophy, virilization, and osteoporosis. Few present with vague signs due to mass effects, including but not limited to abdominal/flank pain, fullness, or early satiety; the rest are incidental findings. We present a case of a 55-year-old female with no medical history presented following weeks of progressive abdominal pain with abdominal wall erythema, leg swelling, and dyspnea along with hirsutism, leukocytosis, elevated BNP, hematuria concerning for abdominal wall cellulitis and new-onset CHF. Initial CT chest revealed incompletely visualized incidental adrenal mass. Further investigations with CT abdomen and lab work revealed a left adrenal mass suspicious for ACC, extending into the left renal vein and IVC, elevated urine metanephrines and normetanephrine, and elevated cortisol levels with low ACTH. The dexamethasone suppression test confirmed inadequate cortisol suppression. Patient underwent aggressive surgery with exploratory laparotomy revealing tumor thrombus in left renal vein extending into Inferior vena cava (IVC). A left adrenalectomy, nephrectomy, and IVC reconstruction using a Bovine Pericardial Patch (BPP), which is majorly used for arterial reconstruction, was performed. Pathology results indicated ACC, measuring 13.5 cm, with extension into renal vein and vascular invasion, staged as pT4pN0 cM0 without evidence of deficient mismatch repair protein expression. ACCs are rare and profoundly aggressive malignancies with an incidence rate of 0.7–2.0 per million per year with bimodal age distribution. Disease peaks before the age of five and in the fourth to fifth decade of life, with increased incidence in females. Diagnosis cannot be conclusively established by a single histological technique, imaging, hormonal work-up, or immunohistochemical labeling, but surgical excision is the gold standard. Complete surgical resection is the only possible approach for curing or improving survival chances in patients with adrenal mass/metastasis. A retrospective case study of 36 venous reconstructions using BPP showed few complications like thrombosis in 14% (versus 11% in autologous venous repair), 11% reoperated, 3-4% developed partial thrombus and hematoma. Our case exemplifies the successful management of challenging ACC with vascular involvement using BPP, which is mostly used for arterial repairs and is now expanding to venous repairs. Outcomes stress the ongoing need for research and collaborative efforts to refine and standardize the ideal approach to ACC patients with IVC thrombosis and the use of BPP in venous repair. Presentation: 6/1/2024

Prognostic significance of pT3a staging subclassifications in renal cell carcinoma: Not all pT3a are equal

ObjectiveTo 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. MethodsA 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). ResultsThe 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. ConclusionWe 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.

The Value of Radiological Imaging in Assessing Extrarenal Fat and Renal Vein Invasion in Renal Cell Carcinoma.

Renal cell carcinoma with extrarenal fat (perinephric or renal sinus fat) and renal vein invasion is the main evidence for the T3a stage according to the American Joint Committee on Cancer tumor-node-metastasis (TNM) staging system. Extrarenal fat invasion of renal cell carcinoma is defined as the presence of perinephric fat invasion or renal sinus fat invasion. Renal vein invasion is defined as the presence of main or segmental (branch) renal vein invasion. Accurate assessment of extrarenal fat and renal vein invasion is crucial for urologists to adopt the optimal therapeutic schedule, including radical nephrectomy or nephron-sparing treatments. Currently, imaging is still the most widely used means of examination for diagnosis and staging of renal cell carcinoma, especially multidetector computed tomography (MDCT). Therefore, we have, herein, summarized the latest progress and the future direction regarding imaging for assessing perinephric or renal sinus fat and renal vein invasion of renal cell carcinoma to assist clinical treatment selection and patient risk stratification.

Role of clinicopathological variables in predicting recurrence and survival outcomes after surgery for non-metastatic renal cell carcinoma: Systematic review and meta-analysis.

Renal cell carcinoma (RCC) represents 2% of all diagnosed malignancies worldwide, with disease recurrence affecting 20% to 40% of patients. Existing prognostic recurrence models based on clinicopathological features continue to be a subject of controversy. In this meta-analysis, we summarized research findings that explored the correlation between clinicopathological characteristics and post-surgery survival outcomes in non-metastatic RCC patients. Our analysis incorporates 99 publications spanning 140 568 patients. The study's main findings indicate that the following clinicopathological characteristics were associated with unfavorable survival outcomes: T stage, tumor grade, tumor size, lymph node involvement, tumor necrosis, sarcomatoid features, positive surgical margins (PSM), lymphovascular invasion (LVI), early recurrence, constitutional symptoms, poor performance status (PS), low hemoglobin level, high body-mass index (BMI), diabetes mellitus (DM) and hypertension. All of which emerged as predictors for poor recurrence-free survival (RFS) and cancer-specific survival. Clear cell (CC) subtype, urinary collecting system invasion (UCSI), capsular penetration, perinephric fat invasion, renal vein invasion (RVI) and increased C-reactive protein (CRP) were all associated with poor RFS. In contrast, age, sex, tumor laterality, nephrectomy type and approach had no impact on survival outcomes. As part of an additional analysis, we attempted to assess the association between these characteristics and late recurrences (relapses occurring more than 5 years after surgery). Nevertheless, we did not find any prediction capabilities for late disease recurrences among any of the features examined. Our findings highlight the prognostic significance of various clinicopathological characteristics potentially aiding in the identification of high-risk RCC patients and enhancing the development of more precise prediction models.

Predictive factors and oncological outcomes of pathological T3a upstaging in patients with clinical T1 renal cell carcinoma undergoing partial nephrectomy.

To investigate predictive factors and oncological outcomes of pathological T3a upstaging in renal cell carcinoma patients who were initially diagnosed as clinical T1 and treated with partial nephrectomy. The clinical records and survival data of 1617 patients, who had undergone partial nephrectomy for clinical T1 renal cell carcinoma at Tokyo Women's Medical University, Tokyo, Japan between January 2011 and December 2020, were analyzed retrospectively. Of 1617 clinical T1 renal cell carcinoma patients who underwent partial nephrectomy, 28 (1.73%) had pathological T3a upstaging. In the multivariable analysis for pathological T3a upstaging using logistic regression models, male sex and clinical T1b were significant factors associated with pathological T3a upstaging (male sex: odds ratio=5.07, 95% confidence interval: 1.18-21.8, clinical T1b: odds ratio=8.36, 95% confidence interval: 3.56-19.6). The Kaplan-Meier method of the recurrence-free survival showed shorter recurrence-free survival in patients with pathological T3a upstaging than in those with pathological T1 (P<0.0001). In the multivariable analysis using Cox proportional hazards regression models, pathological T3a upstaging was no longer significantly associated with recurrence-free survival after adjustment for other pathological factors (hazard ratio=1.59, 95% confidence interval: 0.58-4.36). In a sensitivity analysis that analyzed its components individually instead of whole pathological T3a, neither perinephric fat invasion, sinus fat invasion, nor renal vein invasion was associated with recurrence-free survival. Male sex and clinical T1b were significant predictors for pathological T3a upstaging after partial nephrectomy in clinical T1 renal cell carcinoma patients. Although patients with pathological T3a upstaging had worse recurrence-free survival compared with those without upstaging, multivariable analyses revealed that pathological T3a upstaging was not an independent predictor for poor recurrence-free survival.

Validity of a multiphase CT-based radiomics model in predicting the Leibovich risk groups for localized clear cell renal cell carcinoma: an exploratory study

ObjectiveTo develop and validate a multiphase CT-based radiomics model for preoperative risk stratification of patients with localized clear cell renal cell carcinoma (ccRCC).MethodsA total of 425 patients with localized ccRCC were enrolled and divided into training, validation, and external testing cohorts. Radiomics features were extracted from three-phase CT images (unenhanced, arterial, and venous), and radiomics signatures were constructed by the least absolute shrinkage and selection operator (LASSO) regression algorithm. The radiomics score (Rad-score) for each patient was calculated. The radiomics model was established and visualized as a nomogram by incorporating significant clinical factors and Rad-score. The predictive performance of the radiomics model was evaluated by the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA).ResultsThe AUC of the triphasic radiomics signature reached 0.862 (95% CI: 0.809–0.914), 0.853 (95% CI: 0.785–0.921), and 0.837 (95% CI: 0.714–0.959) in three cohorts, respectively, which were higher than arterial, venous, and unenhanced radiomics signatures. Multivariate logistic regression analysis showed that Rad-score (OR: 4.066, 95% CI: 3.495–8.790) and renal vein invasion (OR: 12.914, 95% CI: 1.118–149.112) were independent predictors and used to develop the radiomics model. The radiomics model showed good calibration and discrimination and yielded an AUC of 0.872 (95% CI: 0.821–0.923), 0.865 (95% CI: 0.800–0.930), and 0.848 (95% CI: 0.728–0.967) in three cohorts, respectively. DCA showed the clinical usefulness of the radiomics model in predicting the Leibovich risk groups.ConclusionsThe radiomics model can be used as a non-invasive and useful tool to predict the Leibovich risk groups for localized ccRCC patients.Critical relevance statementThe triphasic CT-based radiomics model achieved favorable performance in preoperatively predicting the Leibovich risk groups in patients with localized ccRCC. Therefore, it can be used as a non-invasive and effective tool for preoperative risk stratification of patients with localized ccRCC.Key points• The triphasic CT-based radiomics signature achieves better performance than the single-phase radiomics signature.• Radiomics holds prospects in preoperatively predicting the Leibovich risk groups for ccRCC.• This study provides a non-invasive method to stratify patients with localized ccRCC.Graphical

Interpretability of radiomics models is improved when using feature group selection strategies for predicting molecular and clinical targets in clear-cell renal cell carcinoma: insights from the TRACERx Renal study

BackgroundThe aim of this work is to evaluate the performance of radiomics predictions for a range of molecular, genomic and clinical targets in patients with clear cell renal cell carcinoma (ccRCC) and demonstrate the impact of novel feature selection strategies and sub-segmentations on model interpretability.MethodsContrast-enhanced CT scans from the first 101 patients recruited to the TRACERx Renal Cancer study (NCT03226886) were used to derive radiomics classification models to predict 20 molecular, histopathology and clinical target variables. Manual 3D segmentation was used in conjunction with automatic sub-segmentation to generate radiomics features from the core, rim, high and low enhancing sub-regions, and the whole tumour. Comparisons were made between two classification model pipelines: a Conventional pipeline reflecting common radiomics practice, and a Proposed pipeline including two novel feature selection steps designed to improve model interpretability. For both pipelines nested cross-validation was used to estimate prediction performance and tune model hyper-parameters, and permutation testing was used to evaluate the statistical significance of the estimated performance measures. Further model robustness assessments were conducted by evaluating model variability across the cross-validation folds.ResultsClassification performance was significant (p < 0.05, H0:AUROC = 0.5) for 11 of 20 targets using either pipeline and for these targets the AUROCs were within ± 0.05 for the two pipelines, except for one target where the Proposed pipeline performance increased by > 0.1. Five of these targets (necrosis on histology, presence of renal vein invasion, overall histological stage, linear evolutionary subtype and loss of 9p21.3 somatic alteration marker) had AUROC > 0.8. Models derived using the Proposed pipeline contained fewer feature groups than the Conventional pipeline, leading to more straightforward model interpretations without loss of performance. Sub-segmentations lead to improved performance and/or improved interpretability when predicting the presence of sarcomatoid differentiation and tumour stage.ConclusionsUse of the Proposed pipeline, which includes the novel feature selection methods, leads to more interpretable models without compromising prediction performance.Trial registrationNCT03226886 (TRACERx Renal)

MP41-08 PROGNOSTIC SIGNIFICANCE OF PT3A STAGING SUBCLASSIFICATIONS IN NON-CLEAR CELL RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP41-08 PROGNOSTIC SIGNIFICANCE OF PT3A STAGING SUBCLASSIFICATIONS IN NON-CLEAR CELL RENAL CELL CARCINOMA Michael Rezaee, Maximilian Pallauf, Roy Elias, Sean Fletcher, Christian Pavlovich, Ezra Baraban, Yasser Ged, and Nirmish Singla Michael RezaeeMichael Rezaee More articles by this author , Maximilian PallaufMaximilian Pallauf More articles by this author , Roy EliasRoy Elias More articles by this author , Sean FletcherSean Fletcher More articles by this author , Christian PavlovichChristian Pavlovich More articles by this author , Ezra BarabanEzra Baraban More articles by this author , Yasser GedYasser Ged More articles by this author , and Nirmish SinglaNirmish Singla More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003279.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies in clear cell renal cell carcinoma (RCC) have suggested that the pT3a staging subclassification based on perinephric fat, renal sinus fat, and renal vein invasion may represent an overly heterogenous group of patients with varying survival trajectories. A similar evaluation has not yet been performed in patients with non-clear cell pathology. Therefore, we examined the prognostic significance of perinephric fat, renal sinus fat, and renal vein invasion in pT3a non-clear cell RCC (nccRCC) patients. METHODS: A population-based retrospective cohort study of patients with pT3aN0M0 nccRCC was performed using Surveillance, Epidemiology, and End Results (SEER) data for the years 2010 through 2019. Patients were grouped by pT3a subclassification: perinephric fat, renal sinus fat, and segmental or renal vein invasion. Cox proportional hazards models were used to examine the relationship between pT3a subclassification groups and cancer-specific survival, overall and by histological subtype (papillary, chromophobe, and other nccRCC tumors). RESULTS: The final analysis sample consisted of 1,640 pT3aN0M0 nccRCC patients with a median follow up of 4 years. Compared to perinephric fat invasion, segmental or renal vein invasion was associated with significantly worse cancer-specific survival (hazard ratio [HR] 3.0, 95% CI: 2.1 – 4.3, Figure 1) overall. Of these patients, 51.1%, 38.4%, and 10.5% had papillary, chromophobe, and other nccRRC tumors, respectively. Among patients with papillary (HR 4.8, 95% CI: 2.8 – 8.3) and chromophobe (HR 2.9, 95% CI: 1.1 – 7.9) pT3a tumors, segmental or renal vein invasion was associated with significantly worse cancer-specific survival compared to perinephric fat invasion. No difference was observed in cancer-specific survival by pT3a subgroups for other nccRCC tumors. Patients with two pT3a characteristics had significantly worse cancer-specific survival compared to those with only one (HR 2.1, 95% CI: 1.5 to 3.1). CONCLUSIONS: Cancer-specific survival is significantly worse in pT3a nccRCC patients with segmental or renal involvement, particularly in those with papillary and chromophobe tumors. Current RCC staging guidelines may underestimate the prognostic value of segmental or renal vein involvement relative to other pT3a criteria. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e557 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rezaee More articles by this author Maximilian Pallauf More articles by this author Roy Elias More articles by this author Sean Fletcher More articles by this author Christian Pavlovich More articles by this author Ezra Baraban More articles by this author Yasser Ged More articles by this author Nirmish Singla More articles by this author Expand All Advertisement PDF downloadLoading ...

Retrograde venous invasion in renal cell carcinoma: a gross diagnosis 

Renal cell carcinoma, notably clear cell renal cell carcinoma in particular, show remarkable predisposition for intravenous growth. Retrograde venous invasion results in intravascular emboli in renal sinus and intrarenal veins, and nodules in renal parenchyma (after extravascular spread). In our experience, we observed this phenomenon in five cases out of 204 renal cell tumors: four in clear cell renal cell carcinomas (4/166 or 2.4%) and 12.5% of those clear cell carcinomas with major renal vein invasion (4/34 or 12.5%). Since it is a recently described phenomenon, easily identifiable a bisected specimen, we believe it would be valuable to show our experience in recognizing and reporting the frequency of this finding in our practice.

Adrenocortical carcinoma with venous tumor invasion: is there a role for mini-invasive surgery?

This study aims to investigate early oncologic outcomes in patients with adrenocortical carcinoma (ACC) with venous invasion (VI) treated using both open and mini-invasive approaches. We conducted a retrospective analysis of 4 international referral center databases, including all the patients undergoing adrenalectomy for ACC with VI from January 2007 to March 2020. According to CT scan or MRI, the tumor thrombus was classified into four levels: (1) adrenal vein invasion; (2) renal vein invasion; (3) infra-hepatic Inferior vena cava (IVC); and (4) retro-hepatic IVC. In addition, we divided our patients into patients who had undergone open surgery and mini-invasive surgery. We identified 20 patients with a median follow-up of 12 months. The median tumor size was 110mm. ENSAT stage was II in 4 patients, III in 13 patients, and IV in 3 patients. Tumor thrombus extended in the adrenal vein (n=5), renal vein (n=1), infra-hepatic IVC (n=9), or into the retro-hepatic IVC (n=5). Ten patients were treated with a mini-invasive approach. The patient treated with an open approach reported a more aggressive disease. The two groups did not differ in surgical margins, surgical time, blood losses, complications, and length of stay. The prognosis resulted worse in the patient undergoing open. Kaplan-Meier analysis indicated a difference in OS for the patients stratified by ENSAT stage (Log-rank p=0.011); we also reported a difference in DFS for patients stratified for thrombus extension (p=0.004) and ENSAT stage (p<0.001). The DFS of patients with VI from ACC is influenced by the staging and the extension of the venous invasion; the staging influences the OS. The mini-invasive approach seems feasible in selected patients; however, further studies investigating the oncological outcomes are needed. A mini-invasive approach for adrenal tumors with venous invasion is an explorable option in very selected patients.

Semantic Computed Tomography Features for Predicting BRCA1-associated Protein 1 and/or Tumor Protein p53 Gene Mutation Status in Clear Cell Renal Cell Carcinoma

The purpose of this study was to explore the semantic computed tomography (CT) features associated with BRCA1-associated protein 1 (BAP1) and/or tumor protein p53 (TP53) mutation in clear cell renal cell carcinoma (ccRCC). Clinical characteristics and gene mutation information of 336 ccRCC patients were retrieved from The Cancer Genome Atlas-Kidney Renal Clear Cell Carcinoma database (TCGA-KIRC). Kaplan-Meier analysis was performed to examine prognosis by gene mutation. The CT imaging data and gene mutation information of 156 ccRCC patients treated between January 2019 and January 2021 (the training cohort) were retrospectively analyzed. The CT imaging information and gene mutation data of 123 patients with ccRCC were downloaded from The Cancer Imaging Archive and The Cancer Genome Atlas database (the external validation cohort). Univariate Chi-square test and multivariate binary logistic regression analysis were performed to determine predictors of gene mutation; a nomogram was developed using these predictors. Receiver operating characteristic curve analysis and the Hosmer-Lemeshow test were performed to evaluate the performance of the nomogram. Kaplan-Meier analysis showed that BAP1 and/or TP53 mutation was significantly correlated with worse survival outcome. Multivariate binary logistic regression analysis indicated ill-defined margin (P=.001), spiculated margin (P=.018), renal vein invasion (P=.002), and renal pelvis invasion (P=.001) were independent predictors of BAP1 and/or TP53 mutation. A nomogram containing these 4 semantic CT features was constructed; the area under the receiver operating characteristic curves was 0.872 (95% CI, 0.809-0.920). The Hosmer-Lemeshow test showed acceptable goodness-of-fit for the nomogram (X2=1.194, P=.742). The nomogram was validated in the validation cohort; it showed good accuracy (area under the receiving operating characteristic curve=0.819, 95% CI, 0.740-0.883) and was well calibrated (X2=3.934, P=.559). Semantic CT features are a potential and promising method for predicting BAP1 and/or TP53 mutation status in ccRCC patients.

Rhabdoid Melanoma Solitary Metastasis to Kidney with Renal Vein Invasion Mimicking Renal Cell Carcinoma

Abstract Introduction/Objective 83 percent of malignant melanoma cases present as localized skin lesions. However, a small percentage of patients present with concurrent metastatic disease or experience late metastasis. Metastatic melanoma has highly variable presentation and morphology, frequently mimicking other tumors. The most common metastatic sites in order of frequency are skin and subcutaneous tissue, lungs, liver, bones, and brain. While rare, metastasis to the kidney can occur and typically takes the form of multiple micrometastases. Methods/Case Report Here we present an unusual case of a late, purely rhabdoid large solitary renal metastatic melanoma with renal vein invasion, mimicking rhabdoid renal cell carcinoma. The patient is an 84 year old male with a remote history (30 years) of cutaneous malignant melanoma who was referred with a CT scan demonstrating 7.9 x 5.7 x 5.7 mass in the lower pole of the left kidney with a tumor thrombus in the renal vein hhighly suspicious radiographically for renal cell carcinoma. The patient underwent a radical nephrectomy. Macroscopically there was a solitary 7.7 x 6.3 x 5.5 cm tan-grey mass in the lower pole with gross invasion into the renal sinus fat and renal vein resembling the macroscopic appearance of a renal cell carcinoma. Microscopic examination demonstrated pleomorphic tumor cells with pure rhabdoid morphology, extensive necrosis and Lymphovascular invasion. No pigment was identified. No classic clear cell areas were identified. Immunohistochemical stains were positive for S100, SOX10 Melan-A, HMB45 and vimentin and negative for AE1/3, CK7, CAIX, PAX8, P63, CD117 and AMACR. Multiple resected lymph nodes were negative for metastasis Results (if a Case Study enter NA) NA. Conclusion This case is a rare and unusual presentation of melanoma, and it’s important to keep this diagnosis in consideration in the setting of unusual morphology of renal tumors.

MicroRNA Associated with the Invasive Phenotype in Clear Cell Renal Cell Carcinoma: Let-7c-5p Inhibits Proliferation, Migration, and Invasion by Targeting Insulin-like Growth Factor 1 Receptor.

Differential microRNA (miRNA) expression can portend clear cell renal cell carcinoma (ccRCC) progression. In a previous study, we identified a subset of dysregulated miRNA in small renal masses, pT1 ccRCC (≤5 cm) that are associated with an aggressive phenotype. The present study investigated miRNA expression in clinical stage I (cT1) tumors (≤5 cm), comparing pathologic stage I (pT1) tumors to those upstaged to pathologic stage 3 (pT3) after surgery following identification of renal vein invasion or invasion into adjacent fat tissue within Gerota’s fascia. Twenty cT1 tumors were examined in an miRNA screening, 10 pT1 and 10 pT3 tumors. The ccRCC cell lines 786-O and Caki-1 were used to assess the impact of let-7c-5p and its protein target insulin-like growth factor 1 receptor (IGF1R). Cells were transfected with pre-let-7c-5p and assessed through cell proliferation, migration, and invasion assays. IGF1R expression was evaluated through Simple Western, and interaction between let-7c-5p and IGF1R was confirmed via luciferase reporter assay. Screening identified 20 miRNA, including let-7c-5p, that were dysregulated between pT1 and pT3 upstaged tumors. This miRNA was also downregulated in our previous study of pT1 tumors that progressed to metastatic disease. Transfection of ccRCC cells with pre-let-7c-5p significantly inhibited proliferation, migration, invasion, and IGF1R expression. These findings suggest that miRNA dysregulation is involved in ccRCC progression, specifically through invasion, and that let-7c-5p downregulation contributes to the aggressiveness of small ccRCC tumors, in part, through its regulation of IGF1R.

Böbrek Tümörlü Hastalarda Histopatolojik Prognostik Veriler Açısından İleri Yaşın Öneminin Değerlendirilmesi

Kidney tumors are more common in males, and are often considered to be in the category of older-age tumors. In this study, it was aimed to evaluate the importance of age in terms of histopathological prognostic data for kidney tumors, with many defined histopathological prognostic parameters. Twenty–four patients &amp;gt;75 years, who were diagnosed with kidney cancer with nephrectomy between 2010 and 2020, were included in study. The relation between histological features as histological subtype, grade of the tumor, presence of lymphovascular, perineural, hilar and perirenal adipose tissue invasion, necrosis, and the state of surgical margins were determined. Twenty-three tumor samples were classified as renal cell carcinoma (RCC). One sample was classified as multilocular cystic renal cell neoplasm with low malignancy potential. The histopathological subtypes of RCC were; clear cell RCC (n=19), chromophobe RCC (n=2), Type 1 papillary RCC (n=1), and Type 2 papillary RCC (n=1), respectively. Among the histopathological data, renal vein invasion showed statistical significance in terms of survival (p=0.002). In addition, a significant relationship was observed between increasing tumor grade and LVI (p=0.009). Tumor size, and grade, presence of necrosis, lymph node metastasis, perirenal adipose tissue and renal vein invasion are among the prognostic markers for RCC. However, in our series of advanced age cases, only renal vein invasion was found to be prognostic for survival, while other identified markers did not have a significant effect on this age group. This phenomenon indicates that advanced age tumors may differ from tumors in other ages, and the data used routinely may therefore be insufficient to predict the course of the disease.

Tumor Size Significantly Affects Prognosis in Pathological T3a Renal Cell Carcinoma.

To evaluate the prognostic value of tumor size in patients with pathological T3aN0M0 renal cell carcinoma (RCC) postoperatively. We retrospectively reviewed charts of patients with pathological T2N0M0 and T3aN0M0 RCC undergoing radical or partial nephrectomy at our Institution from 2000-2020. Survival analysis using Kaplan-Meier analysis and multivariate Cox regression was performed. A total of 165 patients were included and analyzed. We found that patients with pT3a RCC >7 cm experienced worse 5-year recurrence-free survival (43.8% versus 77.3%, p=0.006) and cancer-specific survival (67.6 versus 94%, p=0.003) compared with those with pT3a RCC ≤7 cm. However, there was no significant difference in recurrence-free and cancer-specific survival between patients with pT2 and pT3a RCC ≤7 cm. Based on multivariate analysis, tumor size >7 cm was an independent factor for tumor recurrence and cancer-related death [hazard ratio(HR)=2.654, p=0.005; and HR=5.016, p=0.005, respectively]. Renal vein invasion was associated with poorer 5-year recurrence-free survival than fat invasion (48.1% versus 70.9%, p=0.032) and was a predictor for tumor recurrence (HR=1.987, p=0.043). Tumor size has a significant impact on prognosis for patients with pathological T3aN0M0 RCC and should be taken into consideration when staging disease and predicting outcomes for these patients.

Association of Extrarenal Invasion Patterns and Tumor Size with the Differences in Survival Outcomes of T3a Renal Cell Carcinoma: A Proposal Modified T3a Stage System is Needed.

ObjectiveT3a renal cell carcinoma (RCC) did not consider tumor size and different extrarenal invasion patterns in the current TNM staging system. Here, we want to investigate the association of survival outcomes with different extrarenal invasion patterns and tumor size of T3a RCC.MethodsWe identified T3a RCC patients from the Surveillance, Epidemiology, and End Results database in 2004–2015. The extrarenal invasion patterns included renal vein invasion, renal sinus/peri-sinus fat invasion, or perinephric fat invasion. Cox proportional hazards models and Fine and Gray models were used to estimate overall survival (OS) and cancer-specific survival (CSS), and the hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. C-index is used to evaluate the predictive ability of the model. Restricted cubic splines were used to estimate the HRs of tumor size on the risk of OS and CSS.ResultsIn total, 4834 T3a RCC patients were included in the analysis. Of them, 1403 (29%) present isolated extrarenal invasion pattern, while 1403 (71%) were any combined invasion pattern, which was associated with a higher risk of lymph-node/distant metastasis and a worse OS and CSS compared with isolated extrarenal invasion pattern, but a comparable CSS and OS were observed between each isolated invasion pattern. In restricted cubic splines, a non-linear shape was observed for the association between the tumor size and OS and CSS, compared with the smallest tumor size group (≤4cm), the adjusted HR of the largest tumor size group (≥10cm) was 1.59 for all-cause mortality, and 2.27 for tumor-specific mortality, respectively. However, in a cohort of T3a RCC with a combined invasion pattern, tumor size is not an independent risk factor for prognosis. Finally, the model added two covariates of tumor size and invasion patterns that could improve the predictive ability of OS and CSS for T3a patients (c-index: +1.2%, +1.3%, respectively).ConclusionTumor size and extrarenal invasion type are valid parameters of the OS and CSS for T3a RCC patients and need to be considered for the next generation of the T-stage system.

PD07-09 ADRENOCORTICAL CARCINOMA WITH VENOUS TUMOR INVASION. IS THERE A ROLE FOR MINI-INVASIVE SURGERY?

You have accessJournal of UrologyAdrenal (PD07)1 Sep 2021PD07-09 ADRENOCORTICAL CARCINOMA WITH VENOUS TUMOR INVASION. IS THERE A ROLE FOR MINI-INVASIVE SURGERY? Alberto Olivero, Kan Liu, Enrico Checcucci, Lei Liu, Lulin Ma, Guoliang Wang, Guglielmo Mantica, Stefano Tappero, Daniele Amparore, Michele Sica, Cristian Fiori, Quingbo Huang, Shaoxi Niu, Baojun Wang, Xin Ma, Xiaofei Hou, Francesco Porpiglia, Carlo Terrone, and Xu Zhang Alberto OliveroAlberto Olivero More articles by this author , Kan LiuKan Liu More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Lei LiuLei Liu More articles by this author , Lulin MaLulin Ma More articles by this author , Guoliang WangGuoliang Wang More articles by this author , Guglielmo ManticaGuglielmo Mantica More articles by this author , Stefano TapperoStefano Tappero More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Michele SicaMichele Sica More articles by this author , Cristian FioriCristian Fiori More articles by this author , Quingbo HuangQuingbo Huang More articles by this author , Shaoxi NiuShaoxi Niu More articles by this author , Baojun WangBaojun Wang More articles by this author , Xin MaXin Ma More articles by this author , Xiaofei HouXiaofei Hou More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Carlo TerroneCarlo Terrone More articles by this author , and Xu ZhangXu Zhang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001975.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Venous invasion(VI) from adrenocortical carcinoma(ACC) is a rare presentation of a very rare malignancy and is a poor prognostic feature. There is limited evidence in the treatment of advanced adrenal carcinoma using a mini-invasive(MI) approach. This study aims is to investigate early oncologic outcomes in patients with ACC with VI accordingly to the surgical approach applied. METHODS: We conducted a retrospective analysis of 4 international referral centers databases, including all the patients undergoing Adrenalectomy for ACC with VI from 2007 to March 2020. Patients’ demographics, lesion characteristics, perioperative, pathology, and oncological data were analyzed. From the preoperative imaging, we classified the thrombus invasion in 4 levels: 1 Adrenal vein invasion; 2 Renal vein invasion; 3 infra-hepatic IVC; 4 retro-hepatic IVC. We divided our patients into 2 groups: patients undergone open surgery and patients treated with MI surgery. A Kaplan–Meier plot was used to describe the disease-free(DFS) and overall survival(OS) between the groups. RESULTS: We identified 20 patients with a median follow-up of 12 months. Nine were male with a median age of 51 years. Nine patients (45%) presented a right disease. The median tumor size was 110 mm. ENSAT stage was II in 4 patients, III in 13 patients, and IV in 3 patients. Tumor thrombus extended in the adrenal vein(n=5), renal vein(n=1), infra-hepatic IVC(n=9) or into the retro-hepatic IVC(n=5). Ten patients were treated with MI approach (5 robotic and 5 laparoscopic). A worse disease was reported in the open group. The two groups did not differ in terms of surgical margins, surgical time, blood losses, complications, and length of stay. Accordingly to the more aggressive disease, the prognosis was worse in the open group. Full patients’ characteristics and outcomes are reported in the Table.Kaplan-Meier analysis indicated a difference in OS for the patients stratified by ENSAT stage (p=0.011), we also reported a difference in DFS for patient stratified for thrombus extension(p=0.004) and ENSAT stage(p <0.001). CONCLUSIONS: The DFS of patients with VI from ACC is influenced by the staging and the extension of the venous invasion; the OS is influenced by the staging. The MI approach seems to be feasible and safe in selected patients without influence oncological outcomes. Source of Funding: - © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e108-e109 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Olivero More articles by this author Kan Liu More articles by this author Enrico Checcucci More articles by this author Lei Liu More articles by this author Lulin Ma More articles by this author Guoliang Wang More articles by this author Guglielmo Mantica More articles by this author Stefano Tappero More articles by this author Daniele Amparore More articles by this author Michele Sica More articles by this author Cristian Fiori More articles by this author Quingbo Huang More articles by this author Shaoxi Niu More articles by this author Baojun Wang More articles by this author Xin Ma More articles by this author Xiaofei Hou More articles by this author Francesco Porpiglia More articles by this author Carlo Terrone More articles by this author Xu Zhang More articles by this author Expand All Advertisement Loading ...

Renal oncocytoma with adverse pathologic features: a clinical and pathologic study of 50 cases.

Renal oncocytoma is the most common benign epithelial renal neoplasm. Several adverse features that would typically increase the stage of renal cell carcinomas are not uncommon in renal oncocytoma, including perinephric, sinus fat, or renal vein invasion. Herein, we report the largest single institutional series of renal oncocytoma with adverse pathologic features. The cohort comprised 50 patients, 38 were men (76%) and 12 were women (24%), with a mean age of 68 years (range, 50-87 years). All cases were diagnosed on nephrectomy specimens. No laterality predilection was noted. The tumors ranged in size from 1.5-15.7 cm (mean, 5.3 cm). Adverse pathologic features included perinephric fat invasion (n = 25; 50%), renal sinus fat invasion (n = 9; 18%), and renal vein invasion (n = 5; 10%). More than one adverse feature was seen in 11 tumors (22%). All tumors showed diffuse reactions to KIT (n = 40; 100%) and cyclin D1 (n = 27; 100%). Keratin 7 highlighted rare (<5%) scattered cells, as well as entrapped renal tubules (n = 21; 100%). Reaction to DOG1 was patchy in three tumors (n = 27; 11%) while reactions to vimentin (n = 31) and Hale colloidal iron special stain (n = 30) were negative. On follow-up, no tumor recurrence or metastasis was observed over a follow-up range of 1-144 months (mean, 54 months; median, 60 months). Our data suggest that adverse pathologic features in renal oncocytoma do not alter their benign course.

How accurate is radiological imaging for perirenal fat and renal vein invasion in renal cell carcinoma?

To evaluate the accuracy of radiological staging, especially renal venous and perirenal fat invasion, in renal cell carcinoma (RCC). Data of 4823 renal tumour patients from Renal Tumor Database of Association of Uro-oncology in Turkey were evaluated. Of 4823 patients, 3309 RCC patients had complete radiological, and histopathological data were included to this study. The Pearson chi-squared test (χ2 ) was used to compare radiological and histopathological stages. The mean (SD) age of 3309 patients was 58 (12.3). Preoperative radiological imaging was performed using computed tomography (CT) (n=2510, 75.8%) or magnetic resonance imaging (MRI) (n=799, 24.2%). There was a substantial concordance between radiological and pathological staging (к=0.52, P<.001). Sensitivities of radiological staging in stages I, II, III and IV were 90.7%, 67.3%, 27.7% and 64.2%, respectively. The sensitivity in stage III was lower than the other stages. Subanalysis of stage IIIa cases revealed that, for perirenal fat invasion and renal vein invasion, sensitivity values were 15.4% and 11.3%, respectively. There was a substantial concordance between radiological (CT and/or MRI) and pathological T staging in RCC. However, this is not true for T3 cases. Sensitivity of preoperative radiological imaging in patients with pT3a tumours is insufficient and lower than the other stages. Consequently, preoperative imaging in patients with T3 RCC has to be improved, in order to better inform the patients regarding prognosis of their disease.

To stage or not to stage: determining the true clinical significance of the biopsy tract through perinephric fat in assessing renal cell carcinoma.

Perinephric fat invasion (PFI) is a key component of renal cell carcinoma (RCC) staging, but there are limited data pertaining to biopsy tract seeding (BTS) resulting in perirenal tissue involvement [BTS with perinephric fat invasion (BTS-P)].The aim is to correlate clinical outcomes with pathologic stage to determine whether the presence of BTS-P should be considered a criterion to stage RCC as part of the pT3a category in the absence of any other upstaging variables. We identified 304 renal biopsies from patients with subsequent nephrectomies for RCC; 33 of the tumours contained PFI. Each case was reviewed to determine the presence of BTS-P and other forms of invasion [e.g. non-BTS-P PFI, sinus fat invasion (SFI), and/or renal vein invasion (RVI)], and these findings were compared with survival outcomes. Ten (30%) of 33 tumours with PFI showed BTS-P as the only finding, and were otherwise pT1 tumours; six (60%) patients were alive without disease (AWOD) (mean, 77.5months), three were lost to follow-up (LTF), and one died of other disease (DOOD). Two patients showed true PFI plus BTS-P; one was LTF and one is AWOD at 107months. Ten (43%) of 23 patients with tumours with true invasion (PFI±SFI and/or RVI) are AWOD (mean, 97.7months), eight (35%) died of disease (DOD), four were LTF, and one DOOD. Kaplan-Meier survival curves showed that the cancer-specific survival was significantly worse in patients with true invasion (P=0.044) than in those with BTS-P as the sole finding. Patients with tumours showing BTS-P only appear to have better outcomes than those with other non-PFI invasion, suggesting that this finding should not be upstaged to pT3a. Additional studies are needed to corroborate the significance of our observations.