Partial Nephrectomy For Renal Cell Carcinoma Research Articles

The Prognostic Impact of the Surgical Margin in Renal Cell Carcinoma Treated with Partial Nephrectomy: A Multi-Center Study.

Background: Partial nephrectomy (PN) is the preferred treatment for small, localized kidney tumors. Incomplete resection resulting in positive surgical margins (PSM) can occur after PN. The impact of PSM on the risk of recurrence and survival outcomes is not fully understood. We aimed to explore the relationship between PSM, the risk of recurrence and impact on survival after PN in a large multicenter cohort from Denmark. Methods: This was a retrospective cohort study including patients who underwent PN for renal cell carcinoma (RCC) at three departments in Denmark between 2010 and 2016. Data including pathological features, surgical techniques, and patient follow-up was retrieved from electronic medical health records and national databases. We used a combination of descriptive statistics, comparative analysis (comparisons were carried out by Mann-Whitney Test, independent Student's t-test, or Pearson's chi-Square Test), univariate and multivariate logistic regression analyses, and survival analysis methods. Results: A total of 523 patients were included, of which 48 (9.1%) had a PSM. Recurrence was observed in 55 patients (10.5%). Median follow-up time was 75 months. We found a lower incidence of PSM with robot-assisted PN (p = 0.01) compared to open or laparoscopic PN. PSM was associated with a higher risk of recurrence compared to negative margins in univariate analysis, but not multivariate analysis. However, the study was underpowered to describe this association with other risk factors. Overall survival did not differ between patients with PSM and negative margins. Conclusions: Our study presents further evidence on the negative impact of PSM on recurrence after PN for RCC, highlighting the importance of achieving NSM, thus potentially improving clinical outcomes. A surgical approach was found to be the only predictive factor influencing the risk of PSMs, with a reduced risk observed with robot-assisted laparoscopy.

Nephrometry scores to predict oncological outcomes following partial nephrectomy (UroCCR Study 70).

Partial nephrectomy (PN) for large or complex renal tumors can be difficult and associated with a higher risk of recurrence than radical nephrectomy. We aim to evaluate the clinical useful of nephrometry scores for predicting oncological outcomes in a large cohort of patients who underwent PN for renal cell carcinomas. Our analysis included patients who underwent PN for renal cell carcinoma in 21 French academic centers (2010-2020). RENAL, PADUA, and SPARE scores were calculated based on preoperative imaging. Uni- and multivariate cox models were performed to identify predictors of recurrence-free survival and overall survival. The area under the curve (AUC) was used to identify models with the highest discrimination. Decision curve analyses (DCAs) determined the net benefit associated with their use. A total of 1927 patients were analyzed with a median follow-up of 32months (14-45). RENAL score (p = 0.01), age (p = 0.002), histological type (p = 0.001), high nuclear grade (p = 0.001), necrotic component (p < 0.001), and positive margins (p = 0.005) were significantly related to recurrence in multivariate analyses. The discriminative performance of the 3 radiological scores was modest (65, 63, and 63%, respectively). All 3 scores showed good calibration, which, however, deteriorated with time. Decision curve analysis of the three models for the prediction of overall and recurrence-free survival was similar for all three scores and of limited clinical relevance. The association between nephrometry scores and oncological outcomes after NP is very weak. The use of these scores for predicting oncological outcomes in routine practice is therefore of limited clinical value.

A comprehensive assessment of frailty status on surgical, functional and oncologic outcomes in patients treated with partial nephrectomy--A large, retrospective, single-center study.

Partial nephrectomy (PN) is a challenging procedure, which can be associated with severe complications. In consequence, the search for accurate and independent indicators of unfavorable surgical outcomes appears warranted. We aimed at evaluating the impact of frailty status on surgical, functional and oncologic outcomes in patients undergoing PN for renal cell carcinoma (RCC). A retrospective, single-center study including 1,282 patients treated with PN for clinically localized cT1 RCC was performed. The modified Frailty Index (mFI) was used to assess preoperative frailty. Multivariable logistic, Poisson and linear regression analyses(MVA) tested the effect of frailty on complications, acute kidney injury(AKI), renal function decline after PN. Cumulative incidence and competing-risk analyses investigated survival outcomes. Of 1,282 patients, 220 (17%) were frail. Overall, 982 (76%) vs. 123 (9.6%) vs. 171 (13%) patients underwent open vs. laparoscopic vs. robot-assisted PN. Median follow-up was 66 (IQR: 35-107) months. At MVA, frailty status predicted increased risk of complications [Odds ratio (OR): 1.46, 95%CI 1.17-1.84; P < 0.001]. Moreover, frail patients were at higher risk of postoperative AKI (OR: 1.95, 95%CI 1.13-3.35; P = 0.01). In frail patients, renal function permanently decreased over time (P = 0.01) without any renal function plateau or improvement during the follow-up, which were instead observed in the nonfrail cohort. At competing-risks analyses, frailty status predicted higher risk of other-cause mortality [Hazard ratio (HR): 1.67, 95%CI 1.05-2.66; P = 0.02], but not of cancer-specific mortality (P = 0.3). Frailty status predicts higher risk of adverse surgical outcomes after PN. Moreover, greater renal function decline was observed in frail patients, compared with nonfrail patients. Finally, the risk of OCM significantly overcomes the risk of dying due to RCC in frail patients.

Comparative analysis of mortality and progression to end-stage renal disease between surgically induced and medical chronic kidney disease: A study using the National Health Insurance customized database.

We aimed to compare the mortality rate and the risk for progression to end-stage renal disease (ESRD) and cardiovascular disease (CVD) between patients who underwent surgery for localized renal cell carcinoma (RCC) and those with chronic kidney disease (CKD) without surgery by investigating the National Health Insurance Service. The surgical group (CKD-S) included patients who underwent radical or partial nephrectomy for RCC from 2007 to 2009. Grades of surgical CKD were classified according to the estimated glomerular filtration rate (eGFR) measured at a health screening within 2 years after surgery. The nonsurgical group (CKD-M) was graded according to the eGFR in the 2009-2010 health screenings. We performed 1:5 propensity score matching for age, gender, diabetes, hypertension, Charlson comorbidity index, smoking, alcohol consumption, baseline eGFR, and body mass index. A total of 8,698 patients (CKD-S, n=1,521; CKD-M, n=7,177) were analyzed. The CKD-M group was at higher risk for progression to ESRD (hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.04-3.44, p=0.036) and CVD (HR 1.17, 95% CI 1.06-1.29, p=0.002) than the CKD-S group. In the group of patients with grade 3 disease or higher, the CKD-M group was at significantly higher risk for progression to ESRD (HR 2.21, 95% CI 1.47-3.31, p<0.001), CVD (HR 1.32, 95% CI 1.20-1.45, p<0.001), and overall mortality (HR 1.50, 95% CI 1.21-1.86, p<0.001). The risk for progression to ESRD, CVD, or mortality in patients with CKD-S may be lower than in patients with CKD-M.

P53 and survivin expression in renal cell carcinoma.

Mutation of p53 is detected in more than 50% of human cancers, expression of p53 has a potential prognostic value in patients with renal cell carcinoma (RCC). Survivin is a member of the inhibitor of apoptosis protein family, its overexpression is observed in many malignancies, including RCC. The aim of the study was to estimate a correlation between survivin and p53 expression in tumor samples and the histologic type of a tumor, tumor stage, tumor grade, and survival of patients. Tumor samples were collected from surgical specimens of 90 patients who underwent radical or partial nephrectomy for RCC between November 2017 and July 2020. Tumors were staged according to the UICC (The Union for International Cancer Control) TNM classification system and histopathologically graded according to Fuhrman nuclear grade system. Histopathological diagnosis was confirmed with standard light microscopic evaluation, using hematoxylin and eosin staining and standard p53 and survivin antibodies. Positive p53 staining was observed in 36.7% of tumor specimens and 24.4% were survivin positive. There was a statistically significant correlation between p53 or survivin expression and histologic subtype of clear cell RCC as well as Type I and II of papillary RCC. There was a statistically significant correlation between p53 expression and tumor size, stage, and grade. The p53 or survivin expression was related to lower overall survival. The results of this study suggest that p53 overexpression and survivin positivity in RCC patients could be associated with poor prognosis. Thus, these proteins could be used as prognostic markers in RCC.

PD33-10 NEPHROMETRY AND CUMULATIVE MORBIDITY AFTER PARTIAL NEPHRECTOMY: A STANDARDIZED ASSESSMENT OF COMPLICATIONS IN THE CONTEXT OF R.E.N.A.L. AND PADUA SCORES

You have accessJournal of UrologyCME1 May 2022PD33-10 NEPHROMETRY AND CUMULATIVE MORBIDITY AFTER PARTIAL NEPHRECTOMY: A STANDARDIZED ASSESSMENT OF COMPLICATIONS IN THE CONTEXT OF R.E.N.A.L. AND PADUA SCORES Dejan K. Filipas, Hang Yu, Clemens Spink, Michael Rink, Silke Riechardt, Philipp Gild, Phillip Marks, Margit Fisch, Roland Dahlem, Christian P. Meyer, and Malte W. Vetterlein Dejan K. FilipasDejan K. Filipas More articles by this author , Hang YuHang Yu More articles by this author , Clemens SpinkClemens Spink More articles by this author , Michael RinkMichael Rink More articles by this author , Silke RiechardtSilke Riechardt More articles by this author , Philipp GildPhilipp Gild More articles by this author , Phillip MarksPhillip Marks More articles by this author , Margit FischMargit Fisch More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Christian P. MeyerChristian P. Meyer More articles by this author , and Malte W. VetterleinMalte W. Vetterlein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002584.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephrometry scores aid in clinical decision-making and improve preoperative risk assessment in patients with renal masses scheduled for surgery. However, there is a lack of knowledge whether nephrometry scores are correlated with cumulative morbidity after partial nephrectomy (PN). We aimed to evaluate the association of PADUA and R.E.N.A.L. scores with the 30-d Comprehensive Complication Index (CCI®) after PN for renal masses. METHODS: Patients undergoing PN between 01/2019-08/2020 with preoperative imaging were included. R.E.N.A.L. and PADUA scores were calculated for each patient and 30-d complications were extracted from digital charts according to both a procedure-specific predefined catalog and the EAU Guidelines on Reporting and Grading of Complications. Pearson correlation was performed to evaluate the relationship between R.E.N.A.L/PADUA scores with the CCI®, which reflects cumulative morbidity on a scale from 0-100 and is based on the validated Clavien-Dindo classification. RESULTS: Of 122 patients, 101 (83%) underwent open and 21 (17%) robot-assisted PN for renal cell carcinoma, benign lesions, or other malignancies in 85 (70%), 29 (24%), and 8 (6.6) of the cases, respectively. Median PADUA and R.E.N.A.L. scores were 9 (IQR 8-10) and 8 (IQR 6-9), respectively. Overall, 218 complications were captured in 92 patients (75%), of which 95% were classified as Clavien-Dindo ≤IIIa. Overall median CCI® was 8.7 (IQR 0.50-15). In PADUA low (score 6-7), moderate (score 8-9), and high complexity (score 10-14) groups there was a difference in median CCI® (8.7 vs. 8.7 vs. 12; p=0.002), which was not confirmed for R.E.N.A.L low (score 4-6), moderate (score 7-9), and high complexity (score 10-12) groups (8.7 vs. 12 vs. 10; p=0.074). There was a small positive correlation between PADUA or R.E.N.A.L. score with CCI® (Figure 1), explaining only 4.7% and 4.1% of the variation in CCI®, respectively. CONCLUSIONS: In a tertiary referral center, PN can be safely performed with low short-term morbidity. Increasing tumor complexity as measured by validated nephrometry scores does not negatively impact perioperative complications when employing a standardized complication assessment and using the novel CCI® to capture comprehensive, cumulative morbidity. Source of Funding: n/a © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e556 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dejan K. Filipas More articles by this author Hang Yu More articles by this author Clemens Spink More articles by this author Michael Rink More articles by this author Silke Riechardt More articles by this author Philipp Gild More articles by this author Phillip Marks More articles by this author Margit Fisch More articles by this author Roland Dahlem More articles by this author Christian P. Meyer More articles by this author Malte W. Vetterlein More articles by this author Expand All Advertisement PDF DownloadLoading ...

Oncologic outcomes and predictive factors for progression in pT3a renal cell carcinoma

We aimed to evaluate oncologic outcomes of pT3a renal cell carcinoma (RCC) patients that treated with radical or partial nephrectomy and identify clinical or pathological factors that predict local recurrence or metastasis.In this single center, retrospective study, we evaluated medical records of 856 patients who underwent radical or partial nephrectomy for RCC. Patients who had pT3aN0M0 RCC in final pathology and at least 6 months of follow-up included in the study. Patients' demographic characteristics, laboratory parameters, tumor characteristics and oncological outcomes were recorded. Cancer specific and overall survivals were our primary outcomes. Multivariate analysis was performed to identify factors affecting oncologic outcomes.A total of 86 pT3aN0M0 RCC patients were included final analysis of our study. During the mean 60.75 months follow up, 3 patients (3.5%) had experienced local recurrence and 19 patients (22.1%) had experienced metastasis. Total of 24 patients (27.9%) had died during the follow up. In this population 10-year OS was 70.8%, 10-year PFS was 61.3% and 10-year CSS was 78.4%. In multivariate analysis, chronic renal failure (CRF) was an independent worse prognostic factor for overall survival (p=0.03). Besides this sarcomatoid differentiation was an independent prognostic factor for PFS, CSS and OS (p=<0.001).Our study investigated the predictive factors for worse oncologic outcomes in pT3aN0M0 RCC patients. Although many factors have predictive value in univariate analysis, only sarcomatoid differentiation have independent predictive value for worse CSS, PFS and OS. Besides sarcomatoid differentiation, CRF is an independent prognostic factor for poor OS.

PD-L1 Expression and Clinicopathological Factors in Renal Cell Carcinoma: A Comparison of Antibody Clone 73-10 With Clone 28-8

Expression of programmed death ligand-1 (PD-L1) is associated with poor prognosis in renal cell carcinoma (RCC). Although a new antibody clone for immunohistochemical assay, 73-10, has shown greater sensitivity than other assays (28-8, 22C3, SP142, and SP263) in non-small cell lung cancer, PD-L1 expression using 73-10 has never been assessed in RCC. Therefore, this study aimed to evaluate the association of clinicopathological factors with PD-L1 expression detected by clone 73-10 and compare it with that detected by 28-8. Tissue microarray samples from 582 patients who underwent radical or partial nephrectomy for RCC were immunohistochemically assessed using clones 73-10 and 28-8. The positivity for PD-L1 expression in RCC by 73-10 was higher than that of 28-8 and significantly associated with worse pathological factors and a higher risk of cancer-specific mortality. Positivity for PD-L1 expression by 73-10, as compared to 28-8, was associated with worse clinicopathological factors and prognosis for patients with RCC.

Low Preoperative Mean Platelet Volume/Platelet Count Ratio Indicates Worse Prognosis in Non-Metastatic Renal Cell Carcinoma.

Objectives: Multiple blood parameters are used to determine the prognosis of renal cell carcinoma (RCC). Mean platelet volume/platelet count (MPV/PC) ratio is related to disease progression in various cancers. Our study tried to evaluate the prognostic value of the MPV/PC ratio in RCC patients who underwent surgery. Methods: We retrospectively reviewed 89 patients who underwent radical or partial nephrectomy for RCC in a single institution. Baseline characteristics and MPV/PC ratios were analyzed. The optimal cut-off value of the MPV/PC ratio was determined by a receiver operating characteristic (ROC) curve, and our patients were divided into low and high MPV/PC ratio groups. The Kaplan–Meier survival curve and Cox proportional hazards model were applied for progression-free survival (PFS) and overall survival (OS) analyses. Harell’s C-index was used to compare the prognostic values of the MPV/PC ratio, MPV and PC. Results: Lower MPV/PC ratios were correlated with more advanced tumor stages and worse outcomes. The optimal cut-off value of the preoperative MPV/PC ratio was 0.034 (sensitivity 84.6%, specificity 56.6%). The Kaplan–Meier survival curve revealed that low MPV/PC ratios were associated with worse PFS (p = 0.007) and OS (p = 0.017). Multivariate analysis showed that low MPV/PC ratios were an independent unfavorable factor for PFS (p = 0.044) and OS (p = 0.015). Harell’s C-indexes showed that the prognostic value of the MPV/PC ratio was significantly better than MPV and PC (p < 0.001). Conclusion: Low MPV/PC ratios are an independent, unfavorable risk factor for disease progression and overall survival in patients undergoing surgery for RCC.

Prognostic Evaluation of the Site of Invasion in Pathological Stage T3a Renal Cell Carcinoma.

To investigate the prognostic values of fat invasion (FI) and renal vein invasion (RVI) in pT3a renal cell carcinoma (RCC), as single factors or concomitant presence. We retrospectively reviewed the data of 173 patients who underwent radical or partial nephrectomy for RCC in our Institution. At a median follow-up time of 48 months, patients with RVI showed significantly increased risk of disease recurrence and worse cancer-specific survival (CSS) when compared to those with FI (p=0.007, p=0.022, respectively). Having combined RVI and FI did not show inferior prognosis compared to those with RVI only. In multivariable analysis, RVI was an independent factor for disease recurrence (HR=2.06, 95% CI=1.10-3.87, p=0.024) and CSS (HR=2.46, 95% CI=1.01-6.0, p=0.048). For patients with T3a renal tumors, RVI was associated with inferior prognosis compared to those with FI.

Outcome of renal cell carcinoma in patients on dialysis compared to non-dialysis patients.

To investigate the impact of hemodialysis on survival in renal cell carcinoma (RCC) patients. We studied 388 patients who underwent radical or partial nephrectomy for RCC at Toranomon Hospital from 2005 to 2013. Survival curves were drawn according to the Kaplan-Meier method and compared with the log-rank test. Multivariate analysis was performed using the Cox proportional hazards regression model to assess the prognostic influence of hemodialysis on cancer-specific survival. Of the 388 patients, 66 were on hemodialysis and 322 were not on dialysis. In the hemodialysis patients, incidental diagnosis of RCC was less frequent than in the non-dialysis patients. In addition, RCC was more likely to be multicentric (41% vs 1.2%), bilateral (14% vs 0.6%), and papillary (18% vs 7%) in hemodialysis patients. Moreover, tumors were smaller, the stage was lower, and the Fuhrman nuclear grade was higher in the patients on hemodialysis. The 5-year cancer-specific survival rate was 82.8% for hemodialysis patients and 93.5% for nondialysis patients. Multivariate analysis indicated that hemodialysis, stage, and Fuhrman nuclear grade were independent prognostic factors for RCC. This study suggested that hemodialysis was an independent prognostic factor for cancer-specific survival in RCC patients, along with the tumor stage and Fuhrman nuclear grade.

MP21-15 PREDICATIVE FACTORS AND ONCOLOGICAL OUTCOMES OF POSITIVE SURGICAL MARGINS FOLLOWING PARTIAL NEPHRECTOMY- WITH AN EMPHASIS ON SURGICAL EXPERIENCE

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP21)1 Apr 2020MP21-15 PREDICATIVE FACTORS AND ONCOLOGICAL OUTCOMES OF POSITIVE SURGICAL MARGINS FOLLOWING PARTIAL NEPHRECTOMY- WITH AN EMPHASIS ON SURGICAL EXPERIENCE Yasmin Abu-Ghanem*, Zohar Dotan, Issac Kaver, Dorit Zilberman, Edi Fridman, Jacob Ramon, and Ramat Gan Israel Yasmin Abu-Ghanem*Yasmin Abu-Ghanem* More articles by this author , Zohar DotanZohar Dotan More articles by this author , Issac KaverIssac Kaver More articles by this author , Dorit ZilbermanDorit Zilberman More articles by this author , Edi FridmanEdi Fridman More articles by this author , Jacob RamonJacob Ramon More articles by this author , and Ramat Gan IsraelRamat Gan Israel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000854.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The clinical significance of a positive surgical margin (PSM) following partial nephrectomy (PN) remains controversial. The purpose of the current study was to examine the predictive factors for PSM and its association with disease recurrence and mortality following PN for renal-cell carcinoma (RCC). METHODS: Study included 643 patients who underwent partial nephrectomy for RCC between the years 1988-2013. Survival was estimated using the Kaplan-Meier method and was compared with the log-rank test. Cox proportional hazard regression models were used to evaluate the association of PSM with outcome, controlling for clinicopathologic variables. RESULTS: PSM was encountered in 30 (4.7%) patients. On multivariable analysis, tumor size (P=0.01) and central lesions (P=0.04) were found to be associated with PSM. A positive margin was also associated with an increased risk of local recurrence on multivariable analysis (HR 5.8, 95% CI 1.01–33.2, P=0.04). In a stratified analysis based on surgical experience (first 0-150 cases, 150-300, 300-450 and above 450); the rate of PSM significantly decreased over the years (7.1%, 5.2% and 2.4% respectively), but slightly increased again in the last group of case up to 3.8%. Still, the incidence PSM was significantly lower in this group in comparison to the first (P=0.02). Further analysis revealed that patients included in the last group had also significantly larger tumours (P=0.01) and shorter ischemia time (P=0.01). CONCLUSIONS: Lesion size and central renal lesions are independent pre-operative risk factors for PSM in patients undergoing PN. The rate of PSM tends to decrease with increasing experience, yet it is still associated with increased risk of disease recurrence. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e323-e323 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yasmin Abu-Ghanem* More articles by this author Zohar Dotan More articles by this author Issac Kaver More articles by this author Dorit Zilberman More articles by this author Edi Fridman More articles by this author Jacob Ramon More articles by this author Ramat Gan Israel More articles by this author Expand All Advertisement PDF downloadLoading ...

Renal capsular invasion is a prognostic biomarker in localized clear cell renal cell carcinoma

Renal capsular invasion (RCI) and lymphovascular invasion (LVI) are potential prognostic factors of significance in renal cell carcinoma (RCC). We evaluated the independent prognostic implications of RCI and LVI in localized clear cell RCC based on a large multi-institutional cohort. 6, 849 patients who had undergone radical or partial nephrectomy for RCC were included. Associations between recurrence and RCI or LVI were analyzed by constructing statistical models that combined Cox proportional hazard regression and propensity score matching. To analyze RCI, 2, 733 patients including 603 patients with RCI were enrolled. To analyze LVI, 3, 586 patients including 121 patients with LVI were enrolled. Recurrence was observed in 75 (12.4%) patients with RCI and 134 (6.3%) patients without RCI. In all statistical models, RCI was significantly associated with an increased risk of recurrence. Recurrence was observed 29 (24.0%) patients with LVI and 207 (6.0%) patients without LVI. LVI was significantly associated with an increased risk of recurrence only in non-adjusted univariate models, but not in multivariate adjusted analysis or propensity score matching models. In conclusion, these findings suggest that RCI could be a significant risk factor for localized clear cell RCC recurrence. In contrast to RCI, LVI cannot be an independent prognostic variable.

Prognostic Significance of Preoperative Anemia in Patients Undergoing Surgery for Renal Cell Carcinoma: A Meta-analysis.

To better evaluate the association between preoperative anemia and outcomes in patients following radical or partial nephrectomy for renal cell carcinoma (RCC). A meta-analysis of hazard ratios (HR) was conducted to measure the association between preoperative anemia and all-cause mortality (ACM), cancer-specific mortality (CSM), and disease recurrence (DR) in patients who underwent surgery for RCC. A total of 14 studies (8,673 patients) met the eligibility criteria. All studies reported survival outcomes using the multivariable Cox proportional hazards model. Pooled results showed that preoperative anemia was associated with increased ACM [HR=2.13, 95% Confidence Interval (CI)=1.48-3.06], CSM (HR=1.91, 95% CI=1.26-2.90), and DR (HR=1.67, 95% CI=1.16-2.40). This meta-analysis indicates that preoperative anemia appears to be associated with earlier recurrence and shorter survival of patients undergoing radical or partial nephrectomy for RCC. Our findings, however, still need to be validated by well-designed prospective studies with larger sample sizes and well-controlled confounding factors.

MP55-14 THE ABILITY OF THREE COMORBITY INDECES TO PREDICT POSTOSPERATIVE MORTALITY IN RENAL CELL CARCINOMA PATIENTS: THE IMPENDING NEED OF A NEW DISEASE-SPECIFIC INDEX

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III1 Apr 2017MP55-14 THE ABILITY OF THREE COMORBITY INDECES TO PREDICT POSTOSPERATIVE MORTALITY IN RENAL CELL CARCINOMA PATIENTS: THE IMPENDING NEED OF A NEW DISEASE-SPECIFIC INDEX Paolo Dell'Oglio, Alessandro Larcher, Fabio Muttin, Francesco Cianflone, Alessandro Nini, Zachary Hamilton, Ithaar Derweesh, Francesco Trevisani, Cristina Carenzi, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Roberto Bertini, and Umberto Capitanio Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Fabio MuttinFabio Muttin More articles by this author , Francesco CianfloneFrancesco Cianflone More articles by this author , Alessandro NiniAlessandro Nini More articles by this author , Zachary HamiltonZachary Hamilton More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , Francesco TrevisaniFrancesco Trevisani More articles by this author , Cristina CarenziCristina Carenzi More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , and Umberto CapitanioUmberto Capitanio More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1707AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To date no studies assessed whether Charlson Comorbidy Index (CCI), American Society of Anesthesiologists score (ASA) and Eastern Cooperative Oncology Group performance status (ECOG) have the same ability to predict postoperative mortality in renal cell carcinoma (RCC) patients who undergo radical (RN) or partial nephrectomy (PN). The aim of the study was to assess the predictive ability of these indeces on other cause mortality (OCM) in patients treated with surgery for kidney cancer. METHODS We identified 2,648 T1-T4 patients treated with RN or PN for RCC between 1987 and 2014 at a single centre. Patients with distant metastases at diagnosis, with multiple lesions and with Von Hippel Lindau were excluded. Four multivariable Cox regression analyses (MVA) were performed to assess OCM predictors. Predictors included in Model 1 were age at surgery and gender (basic model). Predictors in Model 2, 3 and 4 were the same included into Model 1 plus CCI, ASA and ECOG, respectively. The discrimination of the accuracy of each model was quantified using the receiver operating characteristic-derived area under the curve with a time frame at 3-year. Decision curve analyses were performed to evaluate and compare the net-benefit associated with the use of the 3 indeces relative to the basic model. RESULTS 249 patients (9.4%) died of other causes. Overall, 82 (3.1%) patients died within 3 years after surgery. The median follow-up in patients who survived was 63 months (IQR 30-118). At MVA of Model 1, age (HR 1.1) and gender (HR 1.5) were independent predictors of OCM (all p0.004). At MVA of Model 2, 3 and 4, age and gender remained independent predictors of OCM (all p0.04). Furthermore, at MVA of model 2, 3 and 4 CCI (HR 1.3), ASA (HR 1.09) and ECOG (HR 1.9) reached the independent predictor status (all p<0.001). The accuracy of Model 1, 2, 3 and 4 were 74.5 vs 77.6 vs 76.3 vs 76.3. After decision curve analyses, there was no superior net-benefit of one model relative to the others. CONCLUSIONS We provided evidence that the difference in accuracy between the CCI, ASA and ECOG is clinically negligible. Interestingly, the increase in accuracy relative to the basic model of all three index is limited and there is no superior net-benefit of any of the examined indeces relative to the basic model. These findings suggest that there is an impending need of a disease-specific index to predict OCM in RCC patients submitted to surgery. At the moment, clinicians may use any of these indeces for RCC patients counselling to predict postoperative mortality after surgery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e736 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Paolo Dell'Oglio More articles by this author Alessandro Larcher More articles by this author Fabio Muttin More articles by this author Francesco Cianflone More articles by this author Alessandro Nini More articles by this author Zachary Hamilton More articles by this author Ithaar Derweesh More articles by this author Francesco Trevisani More articles by this author Cristina Carenzi More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Roberto Bertini More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Can partial nephrectomy provide equal oncological efficiency and safety compared with radical nephrectomy in patients with renal cell carcinoma (≥4 cm)? A propensity score–matched study

ObjectiveAlthough partial nephrectomy (PN) is the standard treatment for localized clinical T1a renal cell carcinoma (RCC), treatment of larger renal tumors is controversial. We evaluated the oncological outcomes and perioperative complications after radical and PN for RCC ≥4cm. Patients and methodsWe retrospectively analyzed the data of 2,373 patients surgically treated for nonmetastatic RCC with clinical T1b or T2 (≥4cm). The propensity scores for surgery type were calculated, and the partial group was matched to the radical group in a 1:3 ratio. The oncological outcomes were compared using Kaplan-Meier analysis and multivariate Cox regression models were used to identify the independent predictors of progression-free, cancer-specific, and overall survival. ResultsAll differences in preoperative clinical characteristics disappeared after matching. There were no significant differences in progression-free, cancer-specific, or overall survival between the partial and radical groups in the matched cohort. The patients’ age, tumor size, cellular grade, and pathologic stage were independent predictors for all 3 survival outcomes. However, early complications (<30d postoperative) were significantly more common in the partial group (P<0.001). In a subgroup analysis of the patients with clinical T2 stage, there were no significant differences in all 3 survival outcomes. ConclusionsThe partial and radical nephrectomy groups had equivalent oncological outcomes. Although the early complication rate was significantly higher after PN, it should be considered as a valuable treatment option even in patients with clinical T1b or higher RCC.

Perioperative Allogenic Blood Transfusion in Renal Cell Carcinoma: Risk Factors and Effect on Long-term Outcomes.

We sought to create a preoperative model to predict the risk of perioperative blood transfusion (PBT) in patients with renal cell carcinoma (RCC) undergoing nephrectomy and to evaluate the effect of PBT on long-term outcomes. The present retrospective study included 648 consecutive patients who had undergone radical or partial nephrectomy for RCC at a single institution. The risk factors for PBT were analyzed using logistic regression analysis. Cox proportional hazards models addressed the effect of PBT on overall and RCC-specific mortality. A total of 62 patients (10%) received a median of 2 red blood cell units (interquartile range, 2-3; range 1-20). On multivariable logistic regression analysis, 2 preoperative factors were independently associated with receipt of PBT: preoperative anemia (odds ratio, 6.28; P< .001) and open surgery (odds ratio, 3.40; P< .001). The risk of receiving PBT was high with both risk factors present (34%), intermediate with 1 risk factor present (7%-12%), and low with 0 risk factors present (2%). Within a median follow-up period of 63 months (interquartile range, 32-91), 108 patients (17%) had died of RCC and 177 (27%) had died of any cause. In the multivariable Cox models, PBT remained independently associated with overall mortality (hazard ratio [HR], 1.86; P= .004) and RCC-specific mortality (HR, 1.79; P= .007). A dose-dependent association of PBT with RCC-specific mortality was observed (HR, 1.14; P= .01). In patients undergoing surgery for RCC, PBT was associated with adverse overall and RCC-specific mortality. Patients with preoperative anemia and those scheduled to undergo open surgery are at an increased risk of PBT and could be candidates for perioperative optimization techniques.

MP78-11 DO SARCOMATOID AND RHABDOID DIFFERENTIATION HAVE SIMILAR PROGNOSTIC EFFECTS FOR PATIENTS WITH GRADE 4 RENAL CELL CARCINOMA?

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging II1 Apr 2016MP78-11 DO SARCOMATOID AND RHABDOID DIFFERENTIATION HAVE SIMILAR PROGNOSTIC EFFECTS FOR PATIENTS WITH GRADE 4 RENAL CELL CARCINOMA? Onder Kara, Homayoun Zargar, Matthew Maurice, Hiury Andrade, Oktay Akca, Peter Caputo, Daniel Ramirez, Ercan Malkoc, Brian Rini, and Jihad Kaouk Onder KaraOnder Kara More articles by this author , Homayoun ZargarHomayoun Zargar More articles by this author , Matthew MauriceMatthew Maurice More articles by this author , Hiury AndradeHiury Andrade More articles by this author , Oktay AkcaOktay Akca 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 , Brian RiniBrian Rini More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1967AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The presence of sarcomatoid or rhabdoid elements within RCC has been reported to be associated with clinically poor outcomes. We aim to examine the impact of rhabdoid and sarcomatoid differentiation on cancer-specific survival (CSS) in patients with grade 4 renal cell carcinoma (RCC) undergoing extirpative surgery. METHODS We retrospectively analyzed our IRB-approved database of 1176 consecutive patients who underwent radical or partial nephrectomy for RCC between 2005 and 2013. We identified patients with Fuhrman grade IV RCC. The study cohort was divided into four groups: Grade IV without differentiation, Grade IV with rhabdoid features, Grade IV with sarcomatoid features, and Grade IV sarcomatoid and rhabdoid (mixed) features. The primary outcome was CSS, which was plotted by the Kaplan-Meier method and analyzed using the log-rank test and Cox proportional hazards modeling. RESULTS Of 264 patients with grade IV RCC, 159 (60.2%) had tumor differentiation, including 45 (28.3%) with rhabdoid only, 87 (54.7%) with sarcomatoid only, and 27 (16.9%) with both rhabdoid and sarcomatoid features (Table 1). Median CSS for the Grade IV group without tumor differentiation was 3.3 years (3.2-4.5) vs. 3.8 years (0.7-6.9) for the Grade IV-rhabdoid group (p=0.55). Median CSS for the Grade IV-sarcomatoid group and for the Grade IV-mixed group was 1.1 years (0.7-1.4) and 0.9 years (0.6-1.2), respectively, vs. 3.8 years (0.7-6.9) for the Grade IV-rhabdoid group (p=0.01 and p<0.01, respectively)(Figure 1). On multivariable analysis, there was a significant association between sarcomatoid differentiation and RCC death (HR 1.94; 95% CI 1.4-2.69; p<0.01); however, rhabdoid differentiation was no longer significant (HR 1.16; 95% CI 0.73-1.61; p=0.45). CONCLUSIONS Grade IV RCC with sarcomatoid differentiation is associated with worse CSS than grade IV RCC alone. Alternatively, rhabdoid differentiation does not appear to confer additional mortality risk for patients with grade 4 RCC. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1029-e1030 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Onder Kara More articles by this author Homayoun Zargar More articles by this author Matthew Maurice More articles by this author Hiury Andrade More articles by this author Oktay Akca 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 Brian Rini More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinicohistological characteristics of renal cell carcinoma in children: A multicentre study.

In this retrospective multicentre study, we compared the clinicohistological characteristics of renal cell carcinoma (RCC) between pediatric and adult patients. Data for patients who underwent radical or partial nephrectomy for RCC between 1988 and 2014 at multiple institutions were collected. Patients were divided into 2 groups according to age at diagnosis: pediatric patients (age ≤18 years) and adult patients (age ≥40 years). The groups were compared for clinical and pathologic variables, and survival analysis was performed. The median follow-up period was 64 (range: 30-91) months for pediatric patients versus 44 (range: 19-59) months for adult patients (p = 0.026). Pediatric patients were mostly female (p = 0.003), had symptoms at presentation (p < 0.001), and had a high-stage tumour (p = 0.014) than adult patients. Among the symptomatic patients, gross hematuria was the most common symptom. The median tumour size was not different between groups. Regarding histologic types, pediatric patients had more papillary tumours (p < 0.001), more unclassified tumours (p < 0.001), and fewer clear cell carcinomas (p < 0.001). Five-year cancer-specific survival rates were 85% and 87.4% in pediatric and adult patients, respectively (log rank p = 0.901). Recurrence-free survival was better in adult patients, although this did not reach statistical significance (log rank p = 0.272). This study has several limitations, including its retrospective nature and the relatively small number of pediatric RCC cases. RCC in children is rare and is characterized by features that differ from those in adult RCC. Prognosis did not differ between groups.

Volumetric measurement of compensatory hypertrophy in the contralateral normal kidney by the tumor growth.

We evaluated the association between tumor size and preoperative volumetric kidney parameters measured with CT in patients with renal cell carcinoma (RCC). We prospectively identified 1118 patients who underwent radical or partial nephrectomy for RCC between 2011 and 2014. Contrast-enhanced CT was performed within three months before surgery. Kidney volume was measured using a tissue segmentation tool program from CT images. We classified patients into three groups depending on tumor size (A: ≤4cm, B: 4-7cm, C: >7cm). The preoperative volumetric kidney parameters were compared and multivariable linear regression was used to analyze potential factors associated with compensatory hypertrophy of the contralateral normal kidney before surgery. Patients in group C had a significantly larger contralateral normal kidney volume than patients in A and B (A: 170.0mL, B: 171.7mL, C: 187.2mL, p<0.001). The contralateral kidney volume was not significantly different between groups A and B (p>0.05). However, tumor-side real kidney volume in group C was significantly smaller than that of groups A and B (A: 168.8mL, B: 164.9mL, C: 150.9mL, p<0.001). On multivariable analysis, increased contralateral kidney volume was positively associated with male gender, higher BMI, DM, higher preoperative GFR, and tumor size (>7cm), and negatively associated with older age (p<0.05). Tumor size had the strongest positive association with contralateral kidney volume (>7cm, partial regression coefficient=30.2). Tumor size (>7cm) is the strongest factor associated with compensatory hypertrophy in the contralateral normal kidney before surgery.