Recurrent Renal Cell Carcinoma Research Articles

PD16-12 IS CHEST IMAGING NEEDED AS PART OF T1A RENAL CELL CARCINOMA SURVEILLANCE AFTER SURGICAL RESECTION?

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD16)1 Sep 2021PD16-12 IS CHEST IMAGING NEEDED AS PART OF T1A RENAL CELL CARCINOMA SURVEILLANCE AFTER SURGICAL RESECTION? David Charles, John Fitzgerald, Brennen Cooper, Truman Landowski, Ray Yong, Ross Everett, Kenneth Jacobsohn, Scott Johnson, Bill See, and Peter Langenstroer David CharlesDavid Charles More articles by this author , John FitzgeraldJohn Fitzgerald More articles by this author , Brennen CooperBrennen Cooper More articles by this author , Truman LandowskiTruman Landowski More articles by this author , Ray YongRay Yong More articles by this author , Ross EverettRoss Everett More articles by this author , Kenneth JacobsohnKenneth Jacobsohn More articles by this author , Scott JohnsonScott Johnson More articles by this author , Bill SeeBill See More articles by this author , and Peter LangenstroerPeter Langenstroer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001998.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Following surgical excision of localized renal cell carcinoma (RCC), 20-30% will recur, with 50-60% being lung metastases. The NCCN and AUA guidelines recommend chest surveillance via chest x-ray (CXR) at least annually for five years. Two previous studies found extraordinarily low incidence of pulmonary recurrence in T1-T3 RCC after surgical excision. Despite this, National and International guidelines continue to recommend CXR for surveillance after localized RCC. To that end, we evaluated our cohort of pT1a patients to understand the value of follow up chest imaging in a low-risk population. METHODS: We performed retrospective analysis of unique patients who underwent surgical excision of T1a RCC between January 2000 and January 2020. We expanded the review of standard baseline demographics to include baseline pulmonary pathology, RCC pathology, and the most contemporary chest imaging. We excluded pathology other than RCC, and those patients with pulmonary nodules on baseline imaging. RESULTS: With over 20 years of data, we identified 463 unique patients (mean age 58.3 years, range 23-87) that underwent surgical excision of T1a RCC with mean follow-up of 47.6 months (range 1–201). On most recent pulmonary surveillance imaging, 72.4% (335/463) had CXR while 27.6% (128/463) had chest CT performed. Regardless of modality, pulmonary recurrence was not detected on any surveillance imaging (0/463) in patients without pulmonary nodules on preoperative imaging. CONCLUSIONS: With the prior studies in mind, in patients without baseline preoperative lung pathology, we further corroborate that there is minimal to no clinical value in surveillance for pulmonary recurrence after resection of T1a RCC. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e283-e283 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Charles More articles by this author John Fitzgerald More articles by this author Brennen Cooper More articles by this author Truman Landowski More articles by this author Ray Yong More articles by this author Ross Everett More articles by this author Kenneth Jacobsohn More articles by this author Scott Johnson More articles by this author Bill See More articles by this author Peter Langenstroer More articles by this author Expand All Advertisement Loading ...

PD45-07 RISK OF RECURRENCE AND SURVIVAL OF DIALYZED AND TRANSPLANT PATIENTS WITH RENAL CELL CARCINOMA OF NATIVE KIDNEYS

You have accessJournal of UrologyRenal Transplantation & Vascular Surgery II (PD45)1 Sep 2021PD45-07 RISK OF RECURRENCE AND SURVIVAL OF DIALYZED AND TRANSPLANT PATIENTS WITH RENAL CELL CARCINOMA OF NATIVE KIDNEYS Jorge Correia, Mariana Madanelo, Sofia Mesquita, Gonçalo Mendes, Avelino Fraga, and Miguel Silva-Ramos Jorge CorreiaJorge Correia More articles by this author , Mariana MadaneloMariana Madanelo More articles by this author , Sofia MesquitaSofia Mesquita More articles by this author , Gonçalo MendesGonçalo Mendes More articles by this author , Avelino FragaAvelino Fraga More articles by this author , and Miguel Silva-RamosMiguel Silva-Ramos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002059.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal transplantation requires immunosuppression, which was regarded as a risk factor for tumor progression in all types of malignancy. Therefore, until recently, based on the Cincinnati registry a waiting period before transplantation was mandatory in any patient with a history of cancer. However, this registry doesn’t take into account current staging, disease biology or advances in treatments, and there is growing evidence that the increased tumor risk by immunosuppression is restricted to particular subgroups of malignancy, whereas others such as renal cell carcinoma (RCC) are not negatively influenced. Our objective was to compare the risk of recurrence of RCC of native kidneys and death in patients with end-stage renal disease (ESRD), according to their dialysis or transplantation status. METHODS: We performed a retrospective analysis of all patients with ESRD diagnosed with RCC between 2010 and 2019 in our center, and stratified them according to their dialysis (D) or kidney transplantation (KT) status.Patients’ characteristics were compared by using Chi-square (or Fischer) and t-tests. Survival was assessed by Kaplan-Meier and Cox proportional hazards model. RESULTS: 40 patients were followed for a median of 41 months [IQR 22-71], 22 KT and 18 D. KT had a lower ASA score (p<0.001) and lower grade of tumor (p=0.014). All other clinical and pathological characteristics were similar between groups. The risk of RCC recurrence was similar between them (HR=0.402; p=0.458). 5-year recurrence-free survival was 96% in KT and 89% in D (p=0.443). All recurrences were on the contralateral kidney, without impact on patient or graft survival. In multivariable Cox regression analysis, no predictor was significantly associated with the risk of recurrence, including presence of KT. No cancer-related deaths were seen during follow-up, with the majority of deaths being related to cardiovascular disease (100% in KT and 60% in D). 5-year overall survival was 91% and 72% for KT and D, respectively (p=0.181). KT did not have a lower survival compared to D patients (HR=0.343; p=0.202). In multivariable analysis the presence of a renal transplant had no effect on survival (HR=0.002; p=0.167). Time on dialysis was the only independent predictor of overall survival (HR=1.058; p=0.049). CONCLUSIONS: Most RCCs in renal transplant recipients are low-grade and exhibit many favorable pathological characteristics. Immunosuppression doesn’t seem to have an impact on outcomes, but an increased time on dialysis seems to be associated with worse survival. As so, waiting time for low stage/low grade RCC could be reduced. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e744-e745 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jorge Correia More articles by this author Mariana Madanelo More articles by this author Sofia Mesquita More articles by this author Gonçalo Mendes More articles by this author Avelino Fraga More articles by this author Miguel Silva-Ramos More articles by this author Expand All Advertisement Loading ...

P53-2 A long-term response and metachronous tumor shrinkage in a recurrent renal cell carcinoma with nivolumab: A case report

P53-2 A long-term response and metachronous tumor shrinkage in a recurrent renal cell carcinoma with nivolumab: A case report

A Retrospective, Multicenter, Long-Term Follow-Up Analysis of the Prognostic Characteristics of Recurring Non-Metastatic Renal Cell Carcinoma After Partial or Radical Nephrectomy.

This study aimed to compare the cancer-specific survival (CSS) and overall survival (OS) of nephrectomized patients with non-metastatic renal cell carcinoma (nmRCC) and local recurrence without distant metastasis (LR group), those with metastasis without local recurrence (MET group), and those with both local recurrence and metastasis (BOTH group). This retrospective multicenter study included 464 curatively nephrectomized patients with nmRCC and disease recurrence between 2000 and 2012; the follow-up period was until 2017. After adjusting for significant clinicopathological factors using Cox proportional hazard models, CSS and OS were compared between the MET (n = 50, 10.7%), BOTH (n = 95, 20.5%), and LR (n = 319, 68.8%) groups. The CSS and OS rates were 34.7 and 6.5% after a median follow-up of 43.9 months, respectively. After adjusting for significant prognostic factors of OS and CSS, the MET group had hazard ratios (HRs) of 0.51 and 0.57 for OS and CSS (p = 0.039 and 0.103), respectively, whereas the BOTH group had HRs of 0.51 and 0.60 for OS and CSS (p < 0.05), respectively; LR was taken as a reference. The 2-year OS and CSS rates from the date of nephrectomy and disease recurrence were 86.9% and 88.9% and 63.5% and 67.8%, respectively, for the LR group; 89.5% and 89.5% and 48.06% and 52.43%, respectively, for the MET group; and 96.8% and 96.8% and 86.6% and 82.6%, respectively, for the BOTH group. Only the LR and BOTH groups had significant differences in the 2-year OS and CSS rates (p < 0.05). In conclusion, our study showed that the LR group had worse survival prognoses than any other group in nephrectomized patients with nmRCC.

PSMA-PET/CT in Patients with Recurrent Clear Cell Renal Cell Carcinoma: Histopathological Correlations of Imaging Findings.

PET/CT with prostate-specific membrane antigen (PSMA)-targeted tracers has been used in the diagnosis and staging of patients with clear cell renal cell carcinoma (ccRCC). For ccRCC primary tumors, PET parameters were shown to predict histologic grade and features. The aim of this study was to correlate PSMA PET/CT with histopathological findings in patients with metastatic recurrence of ccRCC. Patients with ccRCC who underwent PSMA-targeted PET/CT and subsequent histopathological evaluation of suspicious lesions were included. Specimens underwent immunohistochemical marking. Lesion diameter, volume and tracer uptake were correlated with the extent and intensity of molecular PSMA expression and with clinical findings. Twelve PET-positive lesions of nine patients were evaluated. Eleven ccRCC metastases and one prostate carcinoma were detected histopathologically. Molecular PSMA expression was detected in all lesions, which intensity and distribution did not correlate with PET parameters. PSMA-targeted PET/CT is a feasible tool for the evaluation of patients with ccRCC but cannot reliably predict histologic features of metastases. PSMA may also be expressed in malignant lesions other than ccRCC, leading to incidental detection of these tumors.

Fat Necrosis Mimicking Renal Cell Carcinoma Recurrence Following Cryotherapy, Partial Nephrectomy, and Nephrectomy

ObjectiveTo present our experience with three patients surgically treated for suspected recurrent renal cell carcinoma whose final pathology was consistent with tumefactive fat necrosis. MethodsThree patients underwent definitive therapy for biopsy proven renal cell carcinoma (cryoablation, partial nephrectomy, and nephrectomy) and later demonstrated evidence of recurrent renal cell carcinoma on follow up imaging. All three patients underwent surgical resection of the suspected recurrences with final pathology consistent with tumefactive fat necrosis. ResultsThe three patients were 60, 74, and 39-years old, respectively. The previous definitive therapies for renal cell carcinoma were percutaneous ablation, RAPN, and nephrectomy. Each patient had previous surgical pathology that confirmed prior renal cell carcinoma. Signs of recurrence on diagnostic imaging occurred 2 years, 23 months, and 8 months post-definitive therapy. ConclusionIn patients with a history of renal cell carcinoma, consideration of fat necrosis should be taken into account upon seeing imaging concerning for tumor recurrence. Continued analysis of cases with such a diagnosis will be beneficial in recognizing this possibility to avoid unnecessary surgery or therapy when possible.

Fumarate Hydratase Deficiency Should be Considered in the Differential Diagnosis of Uterine and Extrauterine Smooth Muscle Tumors of Uncertain Malignant Potential (STUMP).

Fumarate hydratase-deficient leiomyomas (dFH leiomyomas) often display atypical pathologic features yet exhibit a benign clinical course. Recent data suggest that dFH leiomyomas may be misclassified as smooth muscle tumors of uncertain malignant potential, a category that encompasses a heterogenous subgroup of uterine neoplasms with smooth muscle differentiation and atypical features that impart ambiguity regarding their expected clinical behavior. dFH leiomyomas can be seen in the context of hereditary leiomyomatosis and renal cell carcinoma syndrome or in the sporadic setting. In this retrospective study, we sought to examine the prevalence and clinicopathologic characteristics of dFH leiomyomas in 48 tumors previously diagnosed as smooth muscle tumors of uncertain malignant potential from 38 patients. Of these 48 tumors, 3 (6.3%) occurring in 2 patients were found to be deficient for FH by immunohistochemistry, including 1 uterine and 2 extrauterine (abdominopelvic) tumors. The 3 tumors showed histologic features typical of dFH leiomyomas, including hemangiopericytoma-like vessels, edema, macronucleoli, and atypia. Neither patient developed recurrent leiomyomas or renal cell carcinoma, and both were alive without disease at last follow-up. Our data suggest that dFH leiomyomas should be considered in the differential diagnosis of smooth muscle tumors of uncertain malignant potential, even in the context of extrauterine disease. Identification of FH deficiency in these tumors supports their classification as dFH leiomyomas despite their atypical morphologic features and/or clinical presentation. Importantly, detection of dFH in these cases may identify women at increased risk for hereditary leiomyomatosis and renal cell carcinoma who would benefit from genetic counseling and consideration for FH germline testing.

Associations between T cell infiltration, T cell receptor clonality, histology and recurrence in renal cell carcinoma.

Renal cell carcinoma (RCC) is comprised of clear-cell (ccRCC) and non-clear-cell (nccRCC) tumors. Despite definitive surgical resection in localized disease, recurrence often occurs. A commercial method based on a multiplex polymerase chain reaction (PCR) assay exclusively targets rearranged T cell receptor (TCR) genes to generate high-throughput sequencing-based data, allowing characterization of the immune repertoire within tumors. In this study we performed a retrospective analysis on archived tumor samples from patients with recurring versus non-recurring T3 ccRCC and on samples from early nccRCC versus ccRCC. Following genomic DNA extraction and multiplex PCR, the fraction of T cells within tumors, the number of unique receptors ('richness') and their relative abundances ('clonality') were calculated. Statistical significance and correlations were calculated using Student's t-test and Spearman's rho, respectively. Average fraction and clonality of T cells in tumors from non-recurring patients was 2.5- and 4.3-fold higher than in recurring patients (P=0.025 and P=0.043, respectively). A significant positive correlation was found between T cell fraction and clonality (Spearman's rho=0.78, P=0.008). The average fraction of T cells in ccRCC tumors was 2.8-fold higher than in nccRCC tumors (P=0.015). Clonality and estimated richness were similar between ccRCC and nccRCC tumors. In summary, recurrence of ccRCC is associated with a lower fraction and clonality of T cells within tumors; nccRCC tumors are more 'deserted' than ccRCC, but similar in their ability to generate a clonal T cell repertoire. Our work suggests associations between the characteristics of T cell infiltrate, histology and tumor recurrence.

PCN40 Economic and Clinical Burdens of Recurrence Following Nephrectomy for Intermediate-High or High-Risk Renal Cell Carcinoma (RCC): A Retrospective Administrative Claims Analysis

Economic and clinical impacts of post-nephrectomy recurrence of RCC have not been reported in the literature. This study aims to assess the impact of RCC recurrence on healthcare resource utilization (HRU), healthcare costs, and overall survival (OS) in the US.

Complete Resection of the Inferior Vena Cava Using a Robot

Isolated intrainferior vena cava (IVC) recurrence of renal cell carcinoma (RCC) is a rare presentation. In this investigator-initiated intervention, we present our novel experience, with first of kind—a robotic suprarenal cavectomy without reconstruction for an isolated RCC recurrence, occurring 3 years postright radical nephrectomy. The patient's procedure was undertaken with a Da Vinci Xi Surgical System®. As step 1, the patient was positioned right lateral side up and routine right nephrectomy port placement was undertaken, followed by side docking. As step 2, the right colon and duodenum were medialized. During step 3, the IVC was identified and en bloc retroperitoneal dissection was performed to fully expose all aspects of the IVC. A significant pericaval fibrotic rind was excised to allow exposure of the true IVC surface. Step 4 involved identification of the left renal vein, with preservation. For step 5, the suprarenal IVC was dissected circumferentially with lumbar veins clipped as necessary. The position and superior margin of the tumor thrombus were constantly confirmed with both transesophageal and robotic intraoperative sonography. Step 6 consisted of further intrahepatic caval dissection, performed to completely expose the suprarenal IVC. For step 7, a rummel-style tourniquet was placed below the level of the thrombus, and the superior margin of the IVC was secured using a Vicryl tie. Step 8 involved caval dissection, with adequate margin of IVC taken proximal to the superior border of the tumor (~2 cm). Once the mass was isolated, step 9 utilized a robotic 60 mm vascular stapler to divide the intrahepatic IVC above the mass and similarly below the mass. This wedge of IVC was collected with thrombus in situ and sent for histopathology. Hemostasis was achieved and port sites were closed in the usual manner. Tumor was confirmed as clear cell RCC (ISUP nucleolar grade 2), in keeping with the man's prior diagnosis. The tumor mass was clear of margins, and a lymph node isolated as part of the specimen demonstrated no evidence of malignancy. Patient progress since discharge has been unremarkable, with no evidence of lower limb edema, clinical or radiologic recurrence of malignancy 3 months since operation. A robot-assisted caval resection for isolated renal carcinoma recurrence within the IVC is a minimally invasive option that can facilitate complete resection with negative surgical margins and minimization of morbidity. Patient Consent Statement: Informed consent was obtained from the patient for publication of this case and accompanying images and video. The authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. No competing financial interests exist. Runtime of video: 5 mins 59 mins

Synergic role of dual tracer PET/CT with 18F-FDG and 68Ga-PSMA in the detection of papillary renal cell carcinoma recurrence

Synergic role of dual tracer PET/CT with 18F-FDG and 68Ga-PSMA in the detection of papillary renal cell carcinoma recurrence

Leibovich score is the optimal clinico-pathological system associated with recurrence of non-metastatic clear cell renal cell carcinoma

PurposeTo determine the optimal post-operative risk stratification system associated with survival following surgery for clear cell renal cell carcinoma (ccRCC): tumour grade, tumour stage, Leibovich 2003, Leibovich 2018, Kattan, Stage, size, grade and necrosis (SSIGN) or UCLA Integrated Staging System (UISS) scores. Methods542 patients with non-metastatic ccRCC who underwent nephrectomy 2008−2018 were reviewed. Primary outcome was recurrence-free survival (RFS), with secondary outcomes cancer-specific survival (CSS) and overall survival (OS). ResultsAll systems were significantly associated with RFS, CSS and OS by Kaplan-Meier and unadjusted Cox-regression. ROC analysis identified that Leibovich 2003, Leibovich 2018A or B and SSIGN were optimally association with 5year RFS (AUC (Area under curve) 0.87, 0.86, 0.86 and 0.86), but Leibovich 2003 or 2018A offered additional information on adjusted regression analysis (HR 1.24, P = 0.02; HR 1.17, P = 0.04). ROC analysis identified that Leibovich 2018B, Leibovich 2003, SSIGN and UISS were equally associated with 5 year OS (AUC 0.76, 0.74, 0.73 and 0.72). UISS added additional explanation of the variance in OS on adjusted regression analysis (HR 1.96, P = 0.002). A novel combination of Leibovich 2003 score and Eastern Co-operative Oncology Group (ECOG) performance status improved 5 year OS association compared to the Leibovich 2003 alone (AUC 0.78, P = 0.001), without affecting association with 5year RFS (AUC 0.87, P = 0.75). ConclusionsAll systems were robust tools associated with RFS, CSS and OS in ccRCC. In our cohort, the Leibovich 2003 and Leibovich 2018A scores may be better associated with RFS compared to other strategies. The UISS, Leibovich 2018B or Leibovich 2003 combined with ECOG performance status may stratify OS better than other modalities.

左腎細胞癌局所再発が主膵管内進展を来して膵炎を繰り返した1例

左腎細胞癌局所再発が主膵管内進展を来して膵炎を繰り返した1例

Abstract No. 587 Magnetic resonance imaging–guided cryoablation of de novo solitary pathologically proven T1a renal tumors

To evaluate the long-term oncologic efficacy and survival rates of MRI-guided cryoablation ablation (PCA) for pathologically proven T1a Renal cell carcinoma (RCC). we retrospectively reviewed our renal ablation data base between January 2007 and December 2019, we included only patients with solitary de novo histologically diagnosed T1a RCC (≤4 cm) who underwent MRI-guided Cryoablation. Patient with recurrent or bilateral RCC, genetic syndromes, patient not pathologically proven to be RCC (benign lesions or nondiagnostic) and patients who underwent CT-guided cryoablation or Radiofrequency ablation were excluded. For each patient, we recorded: Demographics, tumor size and histology, complications, recurrence at ablation site, development of metastases, history of another malignancy, survival/death and cause of death. survival outcome were estimated using Kaplan and Meier product-limit estimator. Twenty-three MRI-guided procedures were performed for 23 lesions in 23 patients (13 males and 10 females, average age 70 years (50–92 years). Average tumor size was 2.1cm (range, 1–3.4 cm). The average follow-up for all subjects was 3.6 years (range: 0.18–9.73 years). Only 1 patient (4.3%) developed grade III complication according to the Clavien-Dindo classification. The most common pathology was clear cell RCC (n = 17) and 6 lesions were papillary RCC. Furhman grading was obtained in 21 lesion (grade I = 5 and grade II = 16) None of the patients developed local recurrence at the ablation site, elsewhere in the kidneys or metastasis from RCC. Fifteen patients had another primary malignancy other than RCC. The local recurrence free-, Disease free-, Metastasis free- and cancer specific survival (CSS) were 100 %. MRI-guided cryoablation is a safe and highly efficacious modality for treatment of small renal tumors. Long-term follow-up data reveals long standing oncologic control with low complication rate.

Recurrence of renal cell carcinoma with local invasion of the splenic flexure.

Recurrence of renal cell carcinoma with local invasion of the splenic flexure.

Local and Regional Recurrences of Clinically Localized Renal Cell Carcinoma after Nephrectomy: A 15 Year Institutional Experience with Prognostic Features and Oncologic Outcomes

ObjectiveTo evaluate outcomes for patients with local recurrence (LR) of clinically localized renal cell carcinoma (RCC) without concurrent systemic metastasis from our institution, an event that occurs rarely (1%-3%) after surgery. LR may be a harbinger of poor outcomes, and the best management of these patients is unclear. Materials/MethodsWe retrospectively reviewed patients surgically treated for clinically localized RCC (cT1-2N0M0) with subsequent LR (in the partial or radical nephrectomy bed) and/or regional recurrence (RR; in the abdomen distant from the direct site of surgery) without concurrent metastasis from our institutional database (2004-2018). Comparative and survival analyses were performed. ResultsOut of 3038 total patients, 1895 had clinically localized RCC, with 30 patients (1.6%) having isolated LR/RR. Median time to recurrence was 26.5 months (IQR:16-35). Of 26 patients treated with local therapy, 14 (53.8%) recurred over a median follow-up time of 29.5 months (IQR:12-45). The 1-year and 2-year secondary recurrence-free survival rates are 60.7% and 49.7%, respectively. Two or more sites of locoregional recurrence significantly predicted secondary recurrence/metastasis after local therapy for local recurrence (hazard ratio: 2.22, P= .04). ConclusionOur results suggest local therapy is appropriate for select patients with LR/RR, with almost 50% of patients undergoing a second local therapy remaining alive with “local cure” and no secondary recurrence. The number of sites of recurrence can be used to better select patients that will benefit from local therapy or systemic/combination therapy. This work provides a framework onto which further studies regarding local therapy and locoregional recurrence of RCC can be performed.

Outcomes of systemic targeted therapy in recurrent renal cell carcinoma treated with adjuvant sunitinib.

To assess the efficacy and tolerability of rechallenge with sunitinib and other targeted therapies (TTs) in patitents with relapsed recurrent renal cell carcinoma (RCC) in the advanced setting. In this multi-institutional retrospective study, patients with relapsed RCC were rechallenged with sunitinib or other systemic TTs as a first-line therapeutic approach after failed adjuvant sunitinib treatment. Patient characteristics, treatments and clinical outcomes were recorded. The primary endpoint was progression-free survival (PFS). Secondary endpoints were objective response rate (ORR) and overall survival (OS). A total of 34 patients with relapses were recorded, and 25 of these (73.5%) were men. Twenty-five patients were treated with systemic TT: 65% of patients received TT against the vascular endothelial growth factor pathway (including sunitinib), 21.7% received mammalian target of rapamycin inhibitors and 13% received immunotherapy. The median (interquartile range) time to relapse was 20.3 (5.2-20.4)months from diagnosis, and 7.5months (1.0-8.5) from the end of adjuvant suntinib treatment. At a median follow-up of 23.5months, 24 of the 25 patients had progressed on first-line systemic therapy. The median PFS was 12.0months (95% confidence interval [CI] 5.78-18.2). There were no statistical differences in PFS between different treatments or sunitinib rechallenge. PFS was not statistically different in patients relapsing on or after adjuvant suntinib treatment (≤ 6 or >6months after adjuvant suntinib ending). The ORR was 20.5%. The median OS was 29.1months (95% CI 16.4-41.8). Rechallenge with sunitinib or other systemic therapies is still a feasible therapeutic option that provides patients with advanced or metastastic RCC with additional clinical benefits with regard to PFS and OS after failed response to adjuvant sunitinib.

Splenic metastasis from recurrent chromophobe renal cell carcinoma 12\xa0years post-nephrectomy: a case report

BackgroundRenal cell carcinoma metastases to the spleen are rare. At the time of this report, only 20 cases of splenic metastases from RCC have been published in the literature. To our knowledge, our report is the first splenic metastasis from a chromophobe RCC.Case presentationA 44-year-old woman presented with clinical and radiological features of splenic metastasis from RCC, 12 years after radical nephrectomy for chromophobe RCC. Computed tomography, laparotomy and splenectomy revealed metastases to the spleen and retroperitoneal lymph nodes.ConclusionSplenic metastasis from RCC is uncommon, and rarer still from a chromophobe subtype of RCC. Surgical management of the metastasis is recommended.

Role of positron emission tomography/computed tomography in the evaluation of renal cell carcinoma.

Introduction:Positron emission tomography (PET) is not a standard recommendation in most of the major guidelines for the evaluation of renal cell carcinoma (RCC). Earlier studies evaluating PET scan in patients with RCC have provided discordant results. However, with the advent of newer hybrid PET/computed tomography (CT) scanning systems, this modality has shown increased efficacy in the evaluation of primary renal masses along with the detection of extrarenal metastases, restaging recurrent RCC, and also in monitoring response to targeted therapy. We performed a systematic review of the existing literature on the role of PET scan in the evaluation of RCC.Methodology:We systematically searched the databases of PubMed/Medline, Embase, and Google Scholar to identify studies on the use of PET scan in RCC. Using Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 94 full-text articles were selected, of which 54 relevant articles were then reviewed, after a consensus by the authors.Results:Several studies have shown similar sensitivity and specificity of fluoro-2-deoxy-2-d-glucose-PET (FDG-PET) scan as compared to conventional CT scan for the initial diagnosis of RCC, and an improved sensitivity and specificity for the detection of metastases and recurrences following curative therapy. The PET scan may also play a role in predicting the initial tumor biology and pathology and predicting the prognosis as well as the response to therapy.Conclusion:The current guidelines do not recommend PET scan in the staging armamentarium of RCCs. However, FDG-PET scan is as efficacious, if not better than conventional imaging alone, in the evaluation of the primary and metastatic RCC, as well as in evaluating the response to therapy, due to its ability to pick up areas of increased metabolic activity early on. Newer tracers such as Ga68 prostate specific membrane antigen-labeled ligands may help in opening up newer avenues of theragnostics.

Safety and oncological outcome following radiofrequency ablation of small renal masses in a single center

Objective To evaluate the safety and efficacy of percutaneous CT-guided radiofrequency ablation (RFA) for small renal masses (SRMs) at a large single-institution center during a period of 12 years. Materials and methods A total of 118 patients underwent RFA for SRM between July 2006 and July 2018 at our institution. We included demographic information, comorbidity, procedural details, and oncological outcome in the analysis. Survival analysis was performed using competing risk. Results 87 males and 31 females with median age 66 years underwent RFA. Median tumor size was 23 mm. Tumor biopsy was performed in 94% of cases, of which 56% were confirmed renal cell carcinoma (RCCs). Twenty-eight patients had benign tumors or underwent treatment for recurrence of prior RCC. Median follow-up of 5 years. Median Charlson Comorbidity Index was 5. Major complications occurred in 1.7%. No change in kidney function was observed. The initial treatment response was 98%. Among patients treated for newly diagnosed radiological suspected RCC without Von Hippel-Lindau or benign biopsy (90 pts), the cumulative incidence of radiological recurrence after 5 and 10 years was 6.6% (95% CI: 0.8–12%) and 16% (95% CI: 4.2–28%), respectively. Three patients died of RCC during follow-up. The cumulative incidence of kidney cancer death was 4.5% (95% CI: 4.3–13%) after 10 years. The incidence of other-cause mortality was 50% (95% CI: 34–67%). Conclusion CT-guided RFA is a safe and effective treatment option for patients unsuitable for surgery. RFA is a good alternative to partial or radical nephrectomy for SRMs, although randomized trials comparing surgery to minimally invasive thermal ablation techniques are missing.