Renal Cortical Tumors Research Articles

Polypoid Endometriosis Presenting as a Renal Cortical Tumor

A 41-year-old female patient presented with left-sided flank pain and gross hematuria temporally unrelated to her menstrual cycle. Abdominal computed tomography scan showed a large left-sided solid, enhancing kidney mass radiographically consistent with renal cell carcinoma. Following surgical resection, histopathological examination revealed polypoid endometriosis. Polypoid endometriosis is rare and mimics a neoplasm clinically, radiographically, and on gross examination. Patients with polypoid endometriosis often present with symptoms related to mass effect rather than classic endometriosis hallmark symptoms such as dyspareunia, dysmenorrhea, and cyclic abdominal pain. Treatment includes surgical resection.

TGR5 expression in normal kidney and renal neoplasms

BackgroundThe G protein-coupled bile acid receptor (TGR5) is a cell surface receptor which induces the production of intracellular cAMP and promotes epithelial-mesenchymal transition in gastric cancer cell lines. TGR5 is found in a wide variety of tissues including the kidney. However, the patterns of TGR5 expression have not been well characterized in physiologic kidney or renal neoplasms. We explore the expression of TGR5 in benign renal tissue and renal neoplasms and assess its utility as a diagnostic marker.MethodsSixty-one renal cortical neoplasms from 2000 to 2014 were retrieved. TGR5 protein expression was examined by immunohistochemistry. TGR5 mRNA was also measured by real-time PCR.ResultsIn normal renal tissue, TGR5 was strongly positive in collecting ducts, distal convoluted tubules and thin loop of Henle. Proximal convoluted tubules showed absent or focal weak staining. In clear cell renal cell carcinomas (RCCs), 25 of 27 cases (92%) were negative for TGR5 (p < 0.001). TGR5 mRNA was also significantly decreased in clear cell RCCs, suggesting that decreased TGR5 protein expression may be attributable to the downregulation of TGR5 mRNA in these tumors. All 11 papillary RCCs expressed TGR5 with 45% (5/11) exhibiting moderate to strong staining. All chromophobe RCCs and oncocytomas were positive for TGR5 with weak to moderate staining. TGR5 mRNA expression in these tumors was similar to normal kidney. All urothelial carcinomas of the renal pelvis strongly expressed TGR5 including a poorly differentiated urothelial carcinoma with sarcomatoid features.ConclusionTGR5 is strongly expressed in collecting ducts, distal convoluted tubules and thin loop of Henle. TGR5 protein and mRNA expression were notably decreased in clear cell RCCs and may be helpful in differentiating these tumors from other RCCs.

Chronic Kidney Disease Is More Common in Locally Advanced Renal Cell Carcinoma

To retrospectively evaluate clinical predictors of chronic kidney disease (CKD) in renal cell carcinoma (RCC) patients to identify associations between patient- and tumor-specific factors with poorer renal function. CKD and RCC are interrelated, with 26%-44% of RCC patients having concomitant CKD at diagnosis. Institutional registries from Spectrum Health and University of California, San Diego, were queried for preoperative glomerular filtration rate and proteinuria status before radical or partial nephrectomy. Preoperative clinical and tumor factors were recorded; proteinuria was classified as A1 (<30 mg), A2 (30-300 mg), and A3 (>300 mg). CKD was grouped by Kidney Disease Improving Global Outcomes classification (low, moderately increased, high, very high). We evaluated 1569 patients undergoing surgery for renal cortical tumors. CKD status was low risk in 860 (55%), moderately increased in 381 (24%), high in 194 (12%), and very high in 134 (9%) patients. Increased radius, exophytic or endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior or posterior, location relative to polar lines score, tumor size, and clinical tumor stage were strongly associated with increased CKD risk at baseline. Clinical stage T3/T4 disease had more at-risk patients than stages T2 and T1 disease (39.5% vs 22% and 19%, P = .0001). Clinical tumor stage and gender were the only predictors of proteinuria, lower glomerular filtration rate, and higher CKD risk group in both univariate and multivariate analyses. Forty-five percent of patients with RCC had moderate or higher CKD before treatment. A positive correlation between pretreatment CKD and locally advanced RCC (cT3/T4) was present. This likely relates to increased loss of functional parenchyma with increasing tumor size or stage, with important implications in patient management.

Multipoint Thermal Sensors Associated with Improved Oncologic Outcomes Following Cryoablation.

Cryoablation (CA) is a minimally invasive modality for the management of small renal cortical neoplasms (RCN). Effective ablation is dependent on achieving target temperatures during CA that result in tumor cell death. We investigated long-term oncologic outcomes following CA using multipoint thermal sensors (MTS), which allow precise temperature determination at four points along the needle. We performed a retrospective review of 20 patients with <4 cm RCN who underwent de novo CA from 2005 to 2009. In 11 procedures, MTS needles were deployed with the goal of obtaining -20°C at the tumor margin, while 9 were done without MTS. Patient demographics, tumor characteristics, and CA procedure data were retrieved and analyzed. Follow-up CT or MRI was used to assess recurrence status. With a mean follow-up of 45 months, none of the 11 patients experienced a recurrence in the MTS group, compared with 4 of 9 (44.4%) patients in the non-MTS group (p = 0.026). Of the biopsy-confirmed renal cancers, none of the 6 in the MTS group, compared with 3 of 6 (50%) in the non-MTS group, recurred (p = 0.182). Age, tumor size, surgical approach, tumor histopathology, grade, follow-up time, and skin-to-tumor distance were similar between the MTS and non-MTS groups. The MTS group was also associated with increased total length of freeze (p = 0.041), procedure time (p = 0.020), cryoprobe utilization (p = 0.049), and a greater ratio of cryoprobes used per cm diameter of tumor (p = 0.003). In this small renal mass pilot study, the use of MTS needles to monitor temperature and guide cryoneedle deployment was associated with improved oncologic outcomes.

Differentiation of Clear Cell Renal Cell Carcinoma From Other Renal Cortical Tumors by Use of a Quantitative Multiparametric MRI Approach.

The purpose of this study was to develop a quantitative multiparametric MRI approach to differentiating clear cell renal cell carcinoma (RCC) from other renal cortical tumors. This retrospective study included 119 patients with 124 histopathologically confirmed renal cortical tumors who underwent preoperative MRI including DWI, contrast-enhanced, and chemical-shift sequences before nephrectomy. Two radiologists independently assessed each tumor volumetrically, and apparent diffusion coefficient values, parameters from multiphasic contrast-enhanced MRI (peak enhancement, upslope, downslope, AUC), and chemical-shift indexes were calculated. Univariate and multivariable logistic regression analyses were performed to identify parameters associated with clear cell RCC. Interreader agreement was excellent (intraclass correlation coefficient, 0.815-0.994). The parameters apparent diffusion coefficient (reader 1 AUC, 0.804; reader 2, 0.807), peak enhancement (reader 1 AUC, 0.629; reader 2, 0.606), and downslope (reader 1 AUC, 0.575; reader 2, 0.561) were significantly associated with discriminating clear cell RCC from other renal cortical tumors. The combination of all three parameters further increased diagnostic accuracy (reader 1 AUC, 0.889; reader 2, 0.907; both p ≤ 0.001), yielding sensitivities of 0.897 for reader 1 and 0.897 for reader 2, and specificities of 0.762 for reader 1 and 0.738 for reader 2 in the identification of clear cell RCC. With maximized sensitivity, specificities of 0.429 and 0.262 were reached for readers 1 and 2, respectively. A quantitative multiparametric approach statistically significantly improves diagnostic performance in differentiating clear cell RCC from other renal cortical tumors.

25 - Visceral adipose tissue and perirenal fat surface area as a predictor of renal cortical neoplasm histopathology

25 - Visceral adipose tissue and perirenal fat surface area as a predictor of renal cortical neoplasm histopathology

Surgical Treatment of Tumors Involving Kidneys With Fusion Anomalies: A Contemporary Series

To report a contemporary series of surgically treated patients with tumors involving kidneys with fusion anomalies. We retrospectively reviewed the medical records of all 10 patients treated at a single tertiary care institution for tumors involving kidneys with fusion anomalies between the years 2000 and 2015. One patient, diagnosed with lymphoma, did not undergo surgical treatment and was therefore excluded. Data regarding patient, tumor, and treatment characteristics were collected and described. The study cohort included 7 male and 2 female patients, at a median age of 52 years. Seven patients underwent open partial nephrectomy. Nephroureterectomy was performed on 2 patients; 1 open and 1 laparoscopic. All patients had localized disease at diagnosis. Tumor histologies were renal cell carcinoma in 5 patients, renal oncocytoma in 1 patient, urothelial carcinoma in 2 patients, and a well-differentiated liposarcoma involving the kidney in 1 patient. Accessory blood vessels were identified in 8 of 9 patients. Median estimated blood loss was 300 mL (interquartile range: 150-1000). Four patients had postoperative complications, including 3 major (Clavien grade ≥ 3) and 3 minor (Clavien grade ≤ 2) complications. During a median follow-up of 19.2 months (interquartile range: 3-34.8), 1 patient with urothelial carcinoma developed a bladder recurrence. None of the patients developed new-onset chronic kidney disease during the early postoperative period. Localized renal cortical tumors in kidneys with fusion anomalies may be treated with partial nephrectomy; however, complication rates are relatively high. Preoperative imaging of the blood vessels is necessary, as most patients have an accessory blood supply.

Technique for office‐based, ultrasonography‐guided percutaneous biopsy of renal cortical neoplasms using a novel transducer for facilitated ultrasound targeting

To help clarify which small renal cortical neoplasms (RCNs) require surgery by using office-based, ultrasonography-guided percutaneous renal biopsy. Biopsies were performed using facilitated ultrasound targeting (FUT) technology, which incorporates a needle guide and onscreen beam-steered technology to permit highly precise needle deployment. Patient and tumour characteristics, procedure time, complications and biopsy efficacy were documented. Wong-Baker pain levels were obtained before, during and 1h after the procedure. Seven patients underwent biopsy, six for RCNs and one for medical renal disease. The mean (range) patient age was 68.5 (54-79) years, and the mean (range) tumour diameter was 2.55 (2.0-2.9) cm. Mean pain levels before, during and 1h after the procedure were 0, 1.6 and 0.5, respectively. There were no intra- or post-procedural complications. Biopsy results were diagnostic in five of the six RCN cases and in the single case of medical renal disease. Our preliminary experience shows that office-based percutaneous renal biopsy using a novel transducer for FUT is safe and effective. An international multicentre study is planned to confirm these preliminary results.

Second primary malignancies in renal cortical neoplasms: an updated evaluation from a single institution.

To examine the incidence of secondary primary malignancies in patients with renal cortical neoplasms. Between January 1989 and July 2010, 3647 patients underwent surgery at our institution for a renal cortical neoplasm and were followed through 2012. Occurrence of other malignancies was classified as antecedent, synchronous, or subsequent. All patients with antecedent malignancies (n=498) and a randomly selected half of those with synchronous malignancies (n=83) were excluded. The expected number of second primaries was calculated by multiplying Surveillance, Epidemiology, and End Results Program incidence rates of renal cortical neoplasms by person-years at risk within categories of age, sex, and year of diagnosis. The standardized incidence ratio (SIR) was calculated as observed cancers divided by expected incidence of the cancer, with approximation to the exact Poisson test used to obtain confidence intervals (CI) and p values. Of 3066 patients with renal cortical neoplasms, 267 had a second primary cancer; the five most common in men were prostate, colorectal, bladder, lung, and non-Hodgkin's lymphoma; the five most common in women were breast, colorectal, lung, endometrium, and thyroid. Men demonstrated higher than expected thyroid cancer rate (SIR 5.0; 95% CI 1.83-10.88, p=0.002), and women had higher than expected rates of stomach cancer (SIR 5.0; 95% CI 1.61-11.67, p=0.004) and thyroid cancer (SIR 4.62; 95% CI 1.69-10.05, p=0.003). The incidence of certain types of second malignancies may be higher in patients after diagnosis of renal cortical neoplasms compared to the general population. These observations can inform clinical follow-up in kidney cancer survivorship and future research studies.

MP19-07 THREE-DIMENSIONAL EVALUATION OF PERIRENAL ADIPOSE TISSUE VOLUME PREDICTS RENAL CORTICAL NEOPLASM HISTOPATHOLOGY

INTRODUCTION AND OBJECTIVES: Contemporary imaging technology allows for three-dimensional (3D) visualization of human anatomy. Volumetric data acquisition allows for 3D imaging and accurate estimation of organ sizes and volumes. Visceral and perirenal adipose tissue (PAT) have been shown to be metabolically active. Previously, we have demonstrated that linear two-dimensional PAT measurements are associated with more aggressive renal cell carcinoma (RCC) subtypes. In this study, we evaluated total PAT volume as a predictor of renal tumor histopathology using novel 3D imaging software. METHODS: We retrospectively evaluated patients who underwent laparoscopic radical or partial nephrectomy for renal cortical neoplasms (RCN). We measured the PAT volume through post-processing of preoperative CT images using Vitrea software (Vital Images, Inc., Minnetonka, MN). We measured the total perirenal space volume by manual contouring. We subtracted out the structures with densities greater than adipose tissue using organ segmentation, thereby yielding only a total PAT volume. We recorded and analyzed demographic, clinical and operative parameters, PAT volume, and their association with tumor histopathology. RESULTS: In this pilot analysis, a total of 102 patients with 104 tumors were included: 50 (49%) men and 52 (51%) women with a median body mass index (BMI) of 28.5 kg/m. The median tumor size for overall cohort was 2.7 cm (0.9-4.4 cm), and the median PAT volume was 395.4 cm. Mean PAT for malignant and benign histopathology was 436.7 cm and 269.3 cm respectively (p1⁄40.002). The mean PAT for each subtype showed 396.8, 633.3, 119.8, and 269.3 cm for clear cell (n1⁄457), papillary (n1⁄413), chromophobe (n1⁄45), and benign (n1⁄425) tumors, respectively (p1⁄40.000). To date, a total of 42 patients underwent bilateral PAT volume determination. The mean PAT volume was 19.6% higher on the tumor side (p1⁄40.001). CONCLUSIONS: In this preliminary pilot analysis, increased PAT volume is a significant predictor of RCC histopathology for small RCN. Similarly, there was a significant direct correlation for tumor laterality and PAT volume versus the contralateral kidney for the individual patient. Further data is being collected.

Renal cell carcinoma: A nomogram for the CT imaging-inclusive prediction of indolent, non-clear cell renal cortical tumours

AimTo develop a nomogram from clinical and computed tomography (CT) data for pre-treatment identification of indolent renal cortical tumours. Patients and methodsA total of 1201 consecutive patients underwent dedicated contrast-enhanced CT prior to nephrectomy for a renal cortical tumour between January 2000 and July 2011. Two radiologists evaluated all tumours on CT for size, necrosis, calcification, contour, renal vein invasion, collecting system invasion, contact with renal sinus fat, multicystic tumour architecture, nodular enhancement, and the degree of nephrographic phase enhancement. CT and clinical predictors (gender, body mass index [BMI], age) were incorporated into the nomogram. We employed multivariable logistic regression analysis to predict tumour type and internally validated the final model using the data from reader 1. External validation was performed by using all data from reader 2. We applied Wilcoxon rank sum test and Fisher’s exact test to investigate for differences in tumour size, BMI, age, and differences in CT imaging features between patients with aggressive and those with indolent tumours. Results63.6% (764/1201) of patients had clear-cell or other aggressive non-clear-cell RCC (i.e. papillary RCC type 2, unclassified RCC) and 36.4% (437/1201) had indolent renal cortical tumours (i.e. papillary RCC type 1, chromophobe RCC, angiomyolipoma, or oncocytoma). On CT, indolent tumours were significantly smaller (p < 0.001) than aggressive tumours and significantly associated with well-defined tumour contours (p < 0.001). Aggressive RCC were significantly associated with necrosis, calcification, renal vein invasion, collecting system invasion, contact with renal sinus fat, multicystic tumour architecture, and nodular enhancement (all, p < 0.001). The nomogram’s concordance index (C-index) was 0.823 after internal and 0.829 after external validation. Concluding statementWe present a nomogram based on 1201 patients combining CT features with clinical data for the prediction of indolent renal cortical tumours. When externally validated, this nomogram resulted in a C-index of 0.829.

Anaesthesia for nephrectomy

### Key points This paper will summarize the perioperative anaesthetic considerations for patients undergoing nephrectomy for both non-neoplastic and neoplastic disease of the kidney. It does not include the management of patients undergoing living donor nephrectomy. Nephrectomy for patients with renal cell carcinoma (RCC) was first described in 1969.1 Surgical treatment varies with the pathology. Simple nephrectomy is the preferred option for those with non-neoplastic disease (e.g. trauma, non-functioning kidney with chronic infection) with radical nephrectomy being preferred in those with neoplastic disease. Radical nephrectomy implies resection of the whole of Gerota's fascia, including the perinephric fat, lymphatics, and the ipsilateral adrenal gland. The vast majority (∼90%) of solid renal masses are RCC; the remainder comprising mainly of transitional cell carcinoma or Wilm's tumour (in children). RCC accounts for between 1% and 3% of all visceral malignancies. It is twice as common in men when compared with women and most commonly presents in the seventh decade of life. The main environmental risk factor is cigarette smoking, contributing to one-third of all cases. Other important risk factors include obesity, hypertension, asbestos exposure, and acquired polycystic kidney disease. If symptomatic, presentation is usually with haematuria, loin pain, and a palpable mass. Non-specific symptoms such as malaise, …

Anthropometric Renal Anatomic Alterations Between Supine and Prone Positions in Percutaneous Renal Ablation for Renal Cortical Neoplasms.

To establish patterns of anatomic changes relevant to the kidney and colon during positional change between the supine and prone positions as noted on CT scans performed during percutaneous cryoablation for renal cortical neoplasms (RCN). Nineteen patients undergoing percutaneous cryoablation for RCN with abdominal CT scan in both the supine and prone positions were included in the study. We documented the anterior/posterior, medial/lateral, and cranial/caudal anatomic changes of the kidney, kidney rotation, and the proportion of the kidney whose access was limited by the liver, spleen, and lung. We also calculated the length of the percutaneous access tract and the distance between the colon and kidney in hilar position as well as the anterior/posterior location of the colon relative to the kidney. In the prone position, the kidney lies significantly more anteriorly on both sides: 4.7 cm vs 4.3 cm (L) and 4.4 cm vs 4.1 cm (R) (p = 0.02 and p = 0.03, respectively). On prone CT images, both kidneys are more cranial when compared with the supine position: 80.4 mm vs 60.8 mm (L) and 87.2 mm vs 57.4 mm (R) (p = 0.002 and p < 0.001, respectively). The skin to tumor distance is significantly shorter in the prone position (p < 0.0001 [L], p = 0.005 [R]). The colon lies closer to the hilum of the kidney and is more posteriorly located in the prone position: 1.21 cm vs 1.04 cm (L) and 0.80 cm vs 0.70 cm (R) (p = 0.005 and p = 0.005, respectively). In the prone position, the lung covers a significantly larger proportion of the right kidney (27.3 mm vs 6.05 mm, p = 0.0001). We documented clinically significant anatomic alterations between supine and prone CT imaging. The changes associated with the prone position modify percutaneous access, particularly for right upper pole tumors. Prone imaging before surgery may be helpful in selected cases.

Use of DWI in the Differentiation of Renal Cortical Tumors.

The purpose of this study was to differentiate clear cell renal cell carcinoma (RCC) from other common renal cortical tumors by use of DWI. The study included 117 patients (mean age, 60 years) with 122 histopathologically confirmed renal cortical tumors who underwent 1.5-T MRI that included DWI before they underwent nephrectomy between 2006 and 2013. For each tumor, two radiologists independently evaluated apparent diffusion coefficient (ADC) values on the basis of a single ROI in a nonnecrotic area of the tumor and also by assessment of the whole tumor. The concordance correlation coefficient (CCC) was calculated to assess interreader agreement. The mean ADC values of clear cell RCC and every other tumor subtype were compared using an exact Wilcoxon rank sum test. Interreader agreement was excellent and higher in whole-tumor assessment (CCC, 0.982) than in single-ROI analysis (CCC, 0.756). For both readers, ADC values for clear cell RCC found on single-ROI assessment (2.19 and 2.08 × 10(-3) mm(2)/s) and whole-tumor assessment (2.30 and 2.32 × 10(-3) mm(2)/s) were statistically significantly higher than those for chromophobe, papillary, or unclassified RCC (p < 0.05) but were similar to those for oncocytoma found on single-ROI assessment (2.14 and 2.32 × 10(-3) mm(2)/s) and whole-tumor assessment (2.38 and 2.24 × 10(-3) mm(2)/s). ADC values were also higher for clear cell RCC than for angiomyolipoma, but the difference was statistically significant only in whole-tumor assessment (p < 0.03). ADC values were statistically significantly higher for clear cell RCC than for chromophobe, papillary, or unclassified RCC subtypes; however, differentiating clear cell RCC from oncocytoma by use of DWI remains especially challenging, because similar ADC values have been shown for these two tumor types.

Editorial Comment

The article by Mashni et al looks at more than 2100 patients with clinically localized renal tumors with a normal serum creatinine level and a normal contralateral kidney on imaging. The authors update their previous experience from 2006 1 Huang W.C. Levey A.S. Serio A.M. et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006; 7: 735-740 Abstract Full Text Full Text PDF PubMed Scopus (1316) Google Scholar with larger numbers and longer follow-up, and are now using the more accurate CKD-EPI equation for estimation of glomerular filtration rate (GFR). The basic findings are that 30% of the study population had pre-existing chronic kidney disease (CKD) despite a “normal” serum creatinine, and that radical nephrectomy (RN) was associated with a much greater incidence of de novo CKD after surgery when compared with partial nephrectomy (PN). Overall survival in the RN group was also significantly lower than overall survival in the PN group on multivariable analysis, with a 61% increased risk of death per year in the RN cohort. As such, Mashni et al's article further substantiates their previous work, which increased awareness about the high incidence of unrecognized CKD in the renal cancer population, and highlighted the potential deleterious effects of RN. Their previous article was often quoted and represents one of the landmark studies in the field. 1 Huang W.C. Levey A.S. Serio A.M. et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006; 7: 735-740 Abstract Full Text Full Text PDF PubMed Scopus (1316) Google Scholar

New Chronic Kidney Disease and Overall Survival After Nephrectomy for Small Renal Cortical Tumors

To evaluate kidney functional and overall survival (OS) outcomes in a cohort of patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) for tumors ≤4 cm. We performed a retrospective study on 2110 patients who underwent PN or RN with normal contralateral kidneys and normal serum creatinine from 1989 through 2012. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Primary end points were baseline incidence of CKD, OS, and new onset of eGFR ≤60 and ≤45 mL/min/1.73 m(2). Preoperatively, 30% and 8% of the cohort had eGFR ≤60 and ≤45 mL/min/1.73 m(2), respectively. Five-year freedom from eGFR ≤60 mL/min/1.73 m(2) was 24% (95% confidence interval [CI], 19%-30%) and 76% (95% CI, 72%-78%) for RN and PN, respectively, and 5-year freedom from eGFR ≤45 mL/min/1.73 m(2) was 51% (95% CI, 45%-56%) and 91% (95% CI, 89%-93%) for RN and PN, respectively. On multivariable analysis, hazard ratio for RN vs PN was 4.98 (95% CI, 4.11-6.04, P <.0001) for new onset of eGFR ≤60 mL/min/1.73 m(2) and 9.28 (95% CI, 7.26-11.86, P <.0001) for new onset of eGFR ≤45 mL/min/1.73 m(2). The RN group had a higher rate of death per year than the partial group (hazard ratio = 1.61, 95% CI, 1.24-2.08, P = .0003). The present study confirms published works demonstrating that a significant proportion of patients have pre-existing CKD. In patients with normal kidney function, RN is associated with a significantly higher risk for developing CKD and worse OS than PN.

Partial and Radical Nephrectomy for Unilateral Synchronous Multifocal Renal Cortical Tumors

To evaluate clinicopathologic characteristics and treatment outcomes of patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN) for unilateral synchronous multifocal renal tumors. We retrospectively reviewed medical records for 128 patients with nonmetastatic, unilateral, synchronous, multifocal renal tumors who underwent surgical resection at our institution from 1995 to 2012. Five patients with hereditary renal cell carcinoma were excluded. Differences between patient and tumor characteristics from the 2 nephrectomy groups were evaluated. Outcomes in terms of recurrence-free survival, overall survival, and chronic kidney disease upstaging were estimated using Kaplan-Meier methods. The log-rank test was used for group comparisons. The study cohort included 78 PN patients (63%) and 45 RN patients (37%); 17 of 95 planned PN (18%) were converted to RN. Tumor diameter and RENAL nephrometry scores were greater in RN patients (P <.0001 and P = .0002, respectively). Pathologic stage T3 was seen in 40% of RN patients and 10% of PN patients (P = .0002). Histologic concordance was apparent in 60 of 123 patients (49%). Median follow-up for patients alive without a recurrence was 4 years. Five-year recurrence-free survival was 98% for PN and 85% for RN. Five-year overall survival was 96% for PN and 86% for RN (P = .5). Five-year freedom from chronic kidney disease upstaging was 74% for PN and 55% for RN (P = .11). Partial nephrectomy for the treatment of unilateral, synchronous, multifocal, renal tumors with favorable characteristics was associated with a low recurrence rate. These findings suggest PN is an appropriate management strategy for this group of carefully selected patients.

Renal functional outcomes after surgery for renal cortical tumors.

Historically, radical nephrectomy represented the gold standard for the treatment of small (≤ 4cm) as well as larger renal masses. Recently, for small renal masses, the risk of ensuing chronic kidney disease and end stage renal disease has largely favored nephron-sparing surgical techniques, mainly partial nephrectomy. In this review, we surveyed the literature on renal functional outcomes after partial nephrectomy for renal tumors. The largest randomized control trial comparing radical and partial nephrectomy failed to show a survival benefit for partial nephrectomy. With regards to overall survival, surgically induced chronic kidney disease (GFR < 60 ml/min/ 1.73m2) caused by nephrectomy might not be as deleterious as medically induced chronic kidney disease. In evaluating patients who underwent donor nephrectomy, transplant literature further validates that surgically induced reductions in GFR may not affect patient survival, unlike medically induced GFR declines. Yet, because patients who present with a renal mass tend to be elderly with multiple comorbidities, many develop a mixed picture of medically, and surgically-induced renal disease after extirpative renal surgery. In this population, we believe that nephron sparing surgery optimizes oncological control while protecting renal function.

MP44-09 DOES WARM ISCHEMIC TIME REALLY AFFECT THE LATE KIDNEY FUNCTION AND OVERALL SURVIVAL AFTER PARTIAL NEPHRECTOMY?

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging II1 Apr 2015MP44-09 DOES WARM ISCHEMIC TIME REALLY AFFECT THE LATE KIDNEY FUNCTION AND OVERALL SURVIVAL AFTER PARTIAL NEPHRECTOMY? Jae Seung Chung, Seok-Soo Byun, Sang Eun Lee, Sung Kyu Hong, Sang Chul Lee, Cheol Kwak, Sung Hoo Hong, Yong June Kim, and Seok-Ho Kang Jae Seung ChungJae Seung Chung More articles by this author , Seok-Soo ByunSeok-Soo Byun More articles by this author , Sang Eun LeeSang Eun Lee More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , Sang Chul LeeSang Chul Lee More articles by this author , Cheol KwakCheol Kwak More articles by this author , Sung Hoo HongSung Hoo Hong More articles by this author , Yong June KimYong June Kim More articles by this author , and Seok-Ho KangSeok-Ho Kang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1551AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We evaluate longitudinal changes in renal function according to warm ischemic time (WIT) after partial nephrectomy (PN). METHODS The study population consisted of 1416 consecutive patients who were treated at multiple institutions by PN for renal cortical tumor between 1999 and 2011. We excluded the patients with preoperative eGFR less than 60 mL/min/1.73m2. To investigate the effect of warm ischemia on kidney function and overall survival (OS) according to ischemia time, we divided the patients into two subgroups (Group A: 0≤WIT< 20, Group B: 20≤WIT). To account for inherent differences between the groups, we used propensity score matching to adjust for age, gender, tumor size, comorbidities (diabetes, hypertension), and preoperative kidney function (eGFR). We measured the serial change in estimated glomerular filtration rate (eGFR) during a 5-year follow-up period. The changes in eGFR over time from 9 month after surgery were analyzed using a general linear model. The independent prognostic value of WIT on the last postoperative eGFR was ascertained by multivariate regression model. The probabilities of freedom from chronic kidney disease (CKD stage III) and 5-year OS were estimated using the Kaplan-Meier method. RESULTS After propensity matching, 339 group A patients were matched with 339 group B patients. The median follow-up duration in the group A and B was 41.2 and 39.8 months, respectively. Overall, there was a subsequent decrease in renal function to the 9 months after PN in both groups. However, renal function recovered from 12months after surgery in group A. Kidney function was significantly better preserved in the group A than in the group B. The slopes for the relationship between the eGFR and time since PN were 0.1871 (95% confidence interval [CI], 0.092 – 0.247; P=0.023) and 0.0037 (95% CI, -0.076 – 0.084; P=0.921) in both group, respectively. WIT was a significant prognostic factor for predicting the last postoperative eGFR in multivariate analysis. The probabilities of freedom from CKD III after PN were 95.9% for group A versus 92.6% for group B (p=0.017). The 5-year OS rates were 99.7% for group A versus 97.9% for group B (p=0.030). CONCLUSIONS Our data suggest that WIT have an effect on late kidney function. In addition, short duration of WIT (0≤WIT<20) did lead to better overall survival rate. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e529-e530 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jae Seung Chung More articles by this author Seok-Soo Byun More articles by this author Sang Eun Lee More articles by this author Sung Kyu Hong More articles by this author Sang Chul Lee More articles by this author Cheol Kwak More articles by this author Sung Hoo Hong More articles by this author Yong June Kim More articles by this author Seok-Ho Kang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 May 2015This Month in Adult Urology William D. Steers William D. SteersWilliam D. Steers More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.01.108AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Adult Urology." The Journal of Urology, 193(5), pp. 1455–1456 References 1 : A genomic algorithm for the molecular classification of common renal cortical neoplasms: development and validation. J Urol2015; 193: 1479. Link, Google Scholar 2 : Comparison of baseline urological symptoms in men and women in the MAPP Research Cohort. J Urol2015; 193: 1554. Link, Google Scholar 3 : Multi-institutional validation of the predictive value of Ki-67 in patients with high grade urothelial carcinoma of the upper urinary tract. J Urol2015; 193: 1486. Link, Google Scholar 4 : Mortality after radical cystectomy: impact of obesity versus adiposity after adjusting for skeletal muscle wasting. J Urol2015; 193: 1507. Link, Google Scholar 5 : Impact of the U.S. Preventive Services Task Force recommendations against prostate specific antigen screening on prostate biopsy and cancer detection rates. J Urol2015; 193: 1519. Link, Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 5May 2015Page: 1455-1456 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information William D. Steers More articles by this author Expand All Advertisement PDF downloadLoading ...