Screening For Renal Cell Carcinoma Research Articles

Benefits of Routine Screening for Renal Cell Carcinoma of Native Kidney in Renal Transplant Recipients

Renal-cell carcinoma (RCC) is the most common solid organ cancer in kidney transplantation recipients (KTRs). Analyze the incidence, prognosis, and evolution of primitive kidney RCC in KTRs at our institution. Observational descriptive retrospective study in which all KTRs from January 2000 to December 2022 were included. We performed an annual abdominal ultrasound in all KTRs. Demographic and clinical data were collected. The surgical approach, location, size, histologic type, and tumor grade were analyzed. We assessed the coexistence of risk factors. We reported the appearance of tumors in other locations, changes in immunosuppressants (IS) after the diagnosis, and survival and recurrence rates observed during follow-up. Eighteen RCCs of native kidneys were diagnosed with an incidence in our population of 1.08%. The majority were men (77.8%), with a mean age of 59.9 years. The pathologic analysis revealed 11 clear cell carcinomas, 6 papillary carcinomas, and 1 chromophobe cell carcinoma. The median tumor size was 2.7 cm. TNM stage was T1aN0M0 in 15 cases. Laparoscopy was performed to remove the tumor in most cases. All our patients underwent changes in IS therapy, with conversion to mammalian target of rapamycin inhibitors when possible and reduction of IS in all of them. After a mean follow-up of 78.6 months, survival was 100% without tumor recurrence. Seven of the patients were diagnosed with a new tumor in another location. In our experience, annual abdominal ultrasound in KTRs may be an option for the early detection of RCC in native kidneys.

Screening for renal cell carcinoma in renal transplant recipients: a single-centre retrospective study

ObjectivesThe primary objective of our study was to evaluate the effectiveness of renal cell carcinoma (RCC) screening in renal transplant (RT) recipients.DesignSingle-centre retrospective study.Setting and participants1998 RT recipients who underwent...

Expert Elicitation to Inform a Cost-Effectiveness Analysis of Screening for Renal Cancer

BackgroundPopulation screening for renal cell carcinoma (RCC) using ultrasound has the potential to improve survival outcomes; however, a cost-effectiveness analysis (CEA) has yet to be performed. Owing to the lack of existing evidence, we performed structured expert elicitation to derive unknown quantities to inform the CEA. ObjectiveTo elicit the cancer stage distribution (proportion of individuals with each stage of cancer) for different RCC screening scenarios and the annual transition probabilities for undiagnosed disease becoming diagnosed in the National Health Service. MethodsThe study design and reporting adhered to the Reporting Guidelines for the Use of Expert Judgement in Model-Based Economic Evaluations. The elicitation was conducted face-to-face or via telephone between each individual expert and the facilitator, aided by online material. For multinomial data, Connor-Mosimann and modified Connor-Mosimann distributions were fitted for each expert and for all experts combined using mathematical linear pooling. ResultsA total of 24 clinical experts were invited, and 71% participated (7 urologists, 6 oncologists, 4 radiologists). The modified Connor-Mosimann distribution provided the best fit for most elicited quantities. Greater uncertainty was noted for the elicited transition probabilities compared with the elicited stage distributions. ConclusionWe performed the first expert elicitation of RCC screening parameters, crucial information that will inform the CEA of screening. In addition, the elicited quantities may enable future health economic evaluations assessing the value of diagnostic tools and pathways in RCC.

Renal imaging in 199 Dutch patients with Birt-Hogg-Dubé syndrome: Screening compliance and outcome.

Birt-Hogg-Dubé syndrome is associated with an increased risk for renal cell carcinoma. Surveillance is recommended, but the optimal imaging method and screening interval remain to be defined. The main aim of our study was to evaluate the outcomes of RCC surveillance to get insight in the safety of annual US in these patients. Surveillance data and medical records of 199 patients with Birt-Hogg-Dubé syndrome were collected retrospectively using medical files and a questionnaire. These patients were diagnosed in two Dutch hospitals and data were collected until June 2014. A first screening for renal cell carcinoma was performed in 172/199 patients (86%). Follow-up data were available from 121 patients. The mean follow-up period per patient was 4.2 years. Of the patients known to be under surveillance, 83% was screened at least annually and 94% at least every two years. Thirty-eight renal cell carcinomas had occurred in 23 patients. The mean age at diagnosis of the first tumour was 51. Eighteen tumours were visualized by ultrasound. Nine small tumours (7–27 mm) were visible on MRI or CT and not detected using ultrasound. Our data indicate that compliance to renal screening is relatively high. Furthermore, ultrasound might be a sensitive, cheap and widely available alternative for MRI or part of the MRIs for detecting clinically relevant renal tumours in BHD patients,but the limitations should be considered carefully. Data from larger cohorts are necessary to confirm these observations.

What Is The Value of Routine Ultrasonographic Screening for Renal Cell Carcinoma in Patients Currently Listed for Kidney Transplantation?

What Is The Value of Routine Ultrasonographic Screening for Renal Cell Carcinoma in Patients Currently Listed for Kidney Transplantation?

当院における透析腎癌症例の検討

Because of a higher incidence in dialysis patients, regular screening for renal cell carcinoma (RCC) is considered beneficial in this population. RCC is associated with a high incidence of acquired cystic disease of the kidney (ACDK), and it has been suggested that these conditions are related. This study was designed to examine the efficacy of RCC screening for dialysis patients and the relationship between RCC and ACDK. This study enrolled 624 dialysis patients treated between August 2005 and June 2011 at our hospital. Screening for RCC was performed by annual abdominal ultrasonography. Factors analyzed were as follows: RCC morbidity, incidence, diagnostic method, and survival rate; and the RCC and ACDK comorbidity rate. RCC was diagnosed in 12 patients. RCC morbidity and incidence rates were 2.08% and 0.33%, respectively. Diagnosis of RCC was made by abdominal ultrasonography screening (N = 7, group A), abdominal ultrasonography or computed tomography for other disease (N = 2, group B) or detailed examination after appearance of symptoms (N = 3, group C). With the exception of one death from other disease, all group A and group B patients survived the follow-up period. In contrast, all group C patients died of RCC within 6 months of diagnosis; only one of these patients underwent RCC screening. The RCC/ACDK comorbidity rate was 91.7% (p = 0.0026). Results indicate that regular screening of dialysis patients for RCC is beneficial. RCC was associated with a high incidence of ACDK, indicating that there is a relationship between these two diseases.

Renal Cell Carcinoma of Native Kidney After Renal Transplantation: Clinical Relevance of Early Detection

Background Life expectancy after transplantation has improved, and cancer may soon be the leading cause of late death after transplantation. The guidelines of the American and European societies of nephrology and urology have not yet established the optimal frequency for screening for renal cell carcinoma (RCC) of native kidneys in patients who have undergone renal transplantation. Objective To evaluate the prevalence, prognosis, and risk factors of RCC in a series of patients followed up for 16 years in our transplantation unit. Materials and Methods Our study is a follow-up observational cohort study conducted in 694 consecutive renal transplant recipients admitted to our institution from July 1991 through July 2007. At our institution, ultrasound studies of the native kidneys were performed every 6 months after renal transplantation. Results In the patient cohort studied, 10 patients developed a renal tumor (1.6% incidence). Three patients died of causes other than recurrence of RCC. Seven patients are alive with no evidence of RCC recurrence or metastatic disease after a mean (range) follow-up of 41 (12–96) months. Acquired cystic kidney disease and dialysis duration were positively associated with development of RCC. Conclusions The incidence of RCC in the literature varies between 0.3% and 4.8%. The variability depends on the timing of follow-up, with a higher incidence in prospective studies with strict follow-up. We advise ultrasound studies performed by specialized physicians every 6 months after transplantation. More detailed guidelines designed by the major international transplantation societies are necessary.

Renal Cell Carcinoma Detected by Screening Shows Better Patient Survival Than That Detected Following Symptoms in Dialysis Patients

There is an apparent advantage to early or incidental diagnosis of renal cell carcinoma in the general population. We investigated whether the prognosis of dialysis patients with renal cell carcinoma is better if renal cell carcinoma is detected by screening of patients without symptoms rather than by examination after the appearance of the symptoms. Two groups in which renal cell carcinomas were detected by screening (N = 721) and by symptoms (n = 76) were compared. The model tested consisted of patient age and duration of dialysis in addition to the detection by screening or symptoms. Cox proportional hazard model was used to compare survival rates between the groups. The hazard ratio of death from all causes in patients with renal cell carcinoma detection by screening was 0.653 and the risk of death was reduced by 35%, compared with that in the group with detection due to symptoms. Moreover, the 50% survival rate in the group detected by symptoms was 80 months and the ratio of those detected by screening was 119 months. Therefore, screening provided a survival benefit of 39 months (3.3 years) in death from all causes after adjustment for age and duration of dialysis. The survival rate was best in young patients with a short duration of dialysis and renal cell carcinoma detected by screening. In dialysis patients with renal cell carcinoma, the survival rate in the group detected by screening was better than that in the group detected by symptoms. Especially, there was a large effect of screening for renal cell carcinoma in the young dialysis patients.

Screening for renal cell carcinoma using ultrasonography: a feasibility study.

To assess the practicability and efficacy of systematic screening for renal cell carcinoma (RCC) by ultrasonography (US), as more small RCCs are being detected incidentally by US. A 2-year screening programme for RCC was established for the general population (aged >or= 40 years) in two German cities, Mainz and Wuppertal. In cooperation with different health insurers, the organisers recruited general practitioners, internists and urologists in private practice who were experienced in and equipped to conduct renal US. The screening was offered in the form of cost-free renal US in the first year and a re-examination in the second. For any equivocal or positive renal mass, a reference ultrasonogram was provided by the urology departments at the two university hospitals. In all, 9959 volunteers participated in the screening programme (49% men, 51% women, mean age 61 years, range 40-94) in the first year. Of these participants, 79% returned for re-examination in the second year. Thirteen (0.1%) subjects were found to have a renal mass, of which nine were RCC. The sensitivity of the programme was 82% (at the 1-year follow-up), and the predictive value 2% for equivocal findings on initial examination and 50% for positive findings. The incidence of other abnormal findings was 12%. The screening programme was well accepted by physicians in private practice and by the eligible population. The method was effective, especially if equivocal findings were re-assessed by reference US before using further imaging studies, e.g. computed tomography or magnetic resonance imaging.

Ultrasound screening of renal cell carcinomas

The increasing number of incidentally by ultrasound detected small renal cell carcinomas raises the question of the practicability and efficacy of a systematic screening for renal cell carcinoma by ultrasound. A two year screening program for renal cell carcinoma (RCC) was established for the general population (age > 40 years) in two cities, Mainz and Wuppertal. In cooperation with different health insurers, the organizers recruited general practitioners, internists and urologists in private practice who were experienced in and equipped for performing renal ultrasound. The screening was offered in the form of a cost free renal ultrasound in the first year and a re-examination in the second year. For any equivocal/positive renal mass, a reference ultrasound was provided the urology departments at the two university hospitals. 9959 volunteers participated in the screening program (49% male, 51% female) in the first year. The mean age was 61 (40-94) years. 79% of these participants returned for re-examination in the second year. Thirteen (0.1%) subjects were found to have a renal mass, of which nine were RCC. The sensitivity of the program was 82% (one year of follow-up). The predictive value was 2% for equivocal findings on initial exam and 50% for positive findings. The incidence of other abnormal findings was 12%. The screening program was well accepted by physicians in private practice and by the eligible population. The method proved effective, especially if equivocal findings were re-studied by reference sonography before further imaging studies such as CT and MRI were performed.

Pilot study on early diagnosis of renal cell carcinoma by sonography

The goal of this study was to investigate the practicability and effectiveness of a systematic screening for renal cell carcinoma by ultrasound in the course of the established German Health Ministry screening programs. In two centers (Mainz and Wuppertal) a screening program for renal cell carcinoma for all citizens (age > 40 years) was established. The screening was divided into two phases (time period 1 year): (1) All citizens over 40 years could attend voluntarily a cost-free ultrasound investigation. (2) A follow-up investigation for the entire screening population was provided. Ten thousand volunteers attended the screening program. Mean age was 60 years. Thirteen renal cell carcinomas were detected. The incidence of other findings was 15%; none of those required further treatment. Systematic screening for renal cell carcinoma by ultrasound is cost-effective and showed high acceptance and practicability in a German population. The rate of detection of renal cell carcinoma was higher than initially statistically calculated.