Stage T1 Renal Cell Carcinoma Research Articles

Renal functional outcomes after robot-assisted partial nephrectomy and percutaneous cryoablation of clinical T1 renal cell carcinoma - A prospective study.

The objective of this study was to investigate renal function after robot-assisted partial nephrectomy (RAPN) and percutaneous cryoablation (PCA) in clinical stage T1 (cT1) renal cell carcinoma (RCC) and evaluate the relationship between baseline renal function and renal functional outcome. Patients with cT1 RCC treated with RAPN or PCA were prospectively enrolled between June 2019 and January 2021. Renal function was evaluated using estimated glomerular filtration rate, Tc-99m diethylenetriamine-pentaacetate plasma clearance, Tc-99m mercaptoacetyltriglycine renography, and renal volume at baseline and 6 months after treatment. Fifty-six patients were included (18 RAPN, 38 PCA). PCA patients had a significantly higher age (68.5 years; P = 0.019) and Charlson comorbidity index (3.0; P = 0.007). Tumor characteristics did not differ significantly between RAPN and PCA. Total renal volume decreased significantly after PCA (-18.2 cm3; P = 0.001). Baseline chronic disease stage IIIb-IV leads to a greater reduction in renal volume (-31.8 cm3; P = 0.003) but not other renal function measures. Renal function declined significantly after either treatment without significant differences between RAPN and PCA. This study found a small, similar decrease in renal function 6 months after RAPN or PCA, despite significant differences in baseline patient characteristics. Reduced renal function at baseline did not lead to a worse renal functional outcome.

Abstract No. 55 Thermal ablation of kidney cancer in the elderly: a feasibility, safety and 5-year outcome analysis

When renal cell carcinoma (RCC) is diagnosed in patients of advanced age, patient co-morbidities may limit treatment option to active surveillance only. This study assessed the technical results, procedural complications and survival outcome of thermal ablation in patients greater than 80 years of age diagnosed with stage T1 RCC.

Prognostic significance of subclassifying stage pT3a renal tumors with fat invasion: a retrospective study of 99 patients.

PurposeTo analyze the recurrence in patients with clinic stage T1 renal cell carcinoma (RCC) who were upstaged to stage T3a after partial nephrectomy (PN) using a new sub-classification criterion.MethodsA retrospective study of pathological characteristics was performed in patients who were upstaged to pT3a on the basis of fat invasion (FI).ResultsAfter analyzing the pathological findings, we proposed the following new sub-classification criteria for pT3a RCC with FI: (1) renal tumor invades the pseudo-capsule and contacts the perinephric adipose tissue directly or the tumor protrudes into the perinephric adipose tissue like a tongue (Type A); and (2) tumor nodules are distributed in perinephric adipose tissues (Type B). A significant difference was observed in the recurrence rate between the two subtypes A and B. For Type B, the recurrence rate after radical nephrectomy (RN) and PN was 15.79% and 63.64%, respectively. The recurrence rates for Types A and B after PN were 11.11% and 63.64%, respectively.ConclusionsT3a RCC with tumor nodules in perinephric adipose and/or an irregular tumor protruding into the adipose tissues lead to a higher recurrence rate. We recommend that T3a RCC be carefully analyzed and patients be treated on an individual basis.

Added Value of Systemic Inflammation Markers in Predicting Clinical Stage T1 Renal Cell Carcinoma Pathologically Upstaged to T3a.

ObjectivesWe aimed to determine preoperative risk factors associated with pathologic T3a (pT3a) upstaging of clinical T1 (cT1) renal cell carcinomas (RCCs) and develop a novel model capable of accurately identifying those patients at high risk of harboring occult pT3a characteristics.MethodsA retrospective analysis of 1324 cT1 RCC patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) was performed. The study cohort was divided into training and testing datasets in a 70:30 ratio for further analysis. Univariable and multivariable logistic regression analyses were performed to identify predictors associated with cT1 to pT3a upstaging and subsequently, those significant risk factors were used to construct models. We used the area under the curve (AUC) to determine the model with the highest discrimination power. Decision curve analyses (DCAs) were applied to evaluate clinical net benefit associated with using the predictive models.ResultsThe rates of upstaging were 6.1% (n = 81), 5.8% (n = 54) and 6.8% (n = 27) in the total population, training cohort and validation cohort, respectively. Tumor size, clinical T stage, R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior) nephrometry score, lymphocyte to monocyte ratio (LMR), prognostic nutrition index (PNI) and albumin to globulin ratio (AGR) were significantly associated with pT3a upstaging. The model that consisted of R.E.N.A.L. score, LMR, AGR and PNI achieved the highest AUC of 0.70 in the validation cohort and yielded the highest net benefit. In the subpopulation with complete serum lipid profile, the inclusion of low-density lipoprotein cholesterol (LDL-C) and Castelli risk index-I (CRI-I) significantly improved the discrimination of model (AUC = 0.86).ConclusionsOur finding highlights the importance of systemic inflammation response markers and serum lipid parameters in predicting pT3a upstaging. Our model had relatively good discrimination in predicting occult pT3a disease among patients with cT1 renal lesions, and the use of the model may be greatly beneficial to urologists in risk stratification and management decisions.

Renal function after nephron-sparing surgery versus radical nephrectomy in localized renal cell carcinoma (T1)

Objective: To evaluate renal function (GFR) after radical nephrectomy compared to partial nephrectomy in stage T1 renal cell carcinoma patients between 2005 and 2015. Material and Method: Retrospective chart review of 409 patients who were diagnosed with renal cell carcinoma (T1) and treated with radical nephrectomy (RN) or partial nephrectomy (PN) between 2005 and 2015 (RN=136, PN=92); 228 patients with pathologically confirmed pT1 remained for analysis and were then evaluated for their estimated glomerular filtration rate (eGFR) after the surgery. Results: There were a total of 228 (149 males and 79 females) T1 RCC patients; 136 patients were T1a with RN (57.8%) and 92 with PN (42.2%). Median follow-up was 58 months and 35 months for the RN and PN groups. From the analysis, post-operative eGFR of the RN group was decreased from 77.49 to 59.61 ml/min/1.73m2 and the PN group was decreased from 78.85 to 69.9 ml/min/1.73m2. The comparative eGFR between the 2 groups at 1 month had a significant difference (p-value<0.05). eGFR at 3 months (50.24 in RN vs 64.67 in PN), 6 months (47.98 vs 64.51), 3 years (48.79 vs 67.22) and 5 years (52.63 vs 73.59) were also significantly altered between the 2 groups. The tumor recurrence rate was not significantly different between RN and PN. Conclusion: We found that patients treated with PN had superior post-operative renal function compared with RN. However, there was no difference in the tumor recurrence rate between the 2 groups after a follow-up of 10 years.

Integrative Radiogenomics Approach for Risk Assessment of Post-Operative Metastasis in Pathological T1 Renal Cell Carcinoma: A Pilot Retrospective Cohort Study.

Despite the increasing incidence of pathological stage T1 renal cell carcinoma (pT1 RCC), postoperative distant metastases develop in many surgically treated patients, causing death in certain cases. Therefore, this study aimed to create a radiomics model using imaging features from multiphase computed tomography (CT) to more accurately predict the postoperative metastasis of pT1 RCC and further investigate the possible link between radiomics parameters and gene expression profiles generated by whole transcriptome sequencing (WTS). Four radiomic features, including the minimum value of a histogram feature from inner regions of interest (ROIs) (INNER_Min_hist), the histogram of the energy feature from outer ROIs (OUTER_Energy_Hist), the maximum probability of gray-level co-occurrence matrix (GLCM) feature from inner ROIs (INNER_MaxProb_GLCM), and the ratio of voxels under 80 Hounsfield units (Hus) in the nephrographic phase of postcontrast CT (Under80HURatio), were detected to predict the postsurgical metastasis of patients with pathological stage T1 RCC, and the clinical outcomes of patients could be successfully stratified based on their radiomic risk scores. Furthermore, we identified heterogenous-trait-associated gene signatures correlated with these four radiomic features, which captured clinically relevant molecular pathways, tumor immune microenvironment, and potential treatment strategies. Our results of accurate surrogates using radiogenomics could lead to additional benefit from adjuvant therapy or postsurgical metastases in pT1 RCC.

Trends in Percutaneous Thermal Ablation Therapies in the Treatment of T1a Renal Cell Carcinomas Rather than Partial Nephrectomy/Radical Nephrectomy.

With the increased incidence of stage T1a renal cell carcinoma (RCC) has come the recognition that these lesions tend to be low grade and slow growing, with low probability of metastasis not necessarily requiring surgery. As alternatives to surgery, both active surveillance and ablation have been advocated for the management of selected patients with stage T1a renal cancers due to slow rate of tumor growth and low metastatic potential based on recent epidemiological studies. Thermal ablation also has consistently reported favorable complication and renal preservation rates compared with surgical approaches. However, most studies are single-center case series and meta-analysis of these series and comparative prospective series with long-term follow-up are lacking. The purpose of this article is to review the principal thermal ablation modalities and oncological outcomes for the treatment of stage T1 RCCs with long-term follow-up.

Renal volume matters: Assessing the association between excisional volume loss and renal function after partial nephrectomy

To investigate the oncological and functional outcomes after partial nephrectomy for clinical stage T1 (cT1) renal cell carcinoma (RCC), and assess the association between excisional volume loss (EVL) and postoperative renal function. We retrospectively reviewed 150 patients with cT1 RCC undergoing partial nephrectomy from 2002 to 2016. End-point evaluation was assessed by recurrence free survival (RFS), overall survival (OS), stage III and stage IV chronic kidney disease (CKD). Regression models were used to determine the risk factors of CKD after surgery. The relationship between EVL and renal function decline was evaluated using Spearman correlation method. Ninety patients with clinical stage T1a (cT1a) tumors and 60 patients with clinical stage T1b (cT1b) tumors were included. There were no differences in RFS, OS, and risk of stage III and stage IV CKD between the two groups. In Cox regression models, multivariate analysis showed that preoperative estimated glomerular filtration rate (eGFR) was an independent risk factor for developing stage III (hazard ratio 0.937, P<0.001) and stage IV CKD (hazard ratio 0.929, P=0.027). EVL was significantly associated with postoperative eGFR decrease. (Correlation Coefficient=0.325, P=0.003). Patients with cT1a and cT1b RCC have comparable oncological and functional outcome after partial nephrectomy, and preoperative eGFR is an independent factor to predict developing CKD. EVL has influence on the postoperative renal function decline.

Dichotomous sized-based clinical staging of localized renal masses affects management but not clinical outcomes.

670 Background: Clinical staging of localized renal masses is assigned according to radiographic tumor diameter cut-offs, with T1 masses defined as 7 cm or less and T2 greater than 7cm. However, it is unknown if tumors with infinitesimal size differences exhibit oncologic behavior to warrant different surgical management. Arbitrarily dichotomizing otherwise similar tumors to different stage groups may inappropriately influence the management of renal tumors and affect patient outcomes. We evaluated differences in management and outcomes in otherwise similarly sized tumors among patients that differ only in clinical T stage. Methods: Data from the National Cancer Center Database was extracted on all patients with a diagnosis of stage T1 or T2 clear cell renal cell carcinoma (RCC). Analyses were limited to tumors on the cusp of T1/T2 staging to include: 69 mm, 70 mm, and 71 mm. Clinical data were compared and Kaplan-Meier and Cox proportional hazards survival modeling were performed. Results: A total of 2815 patients were included. There were 1882 stage T1 and 933 stage T2 tumors; there were no differences in demographics or comorbidity scores. Of 171 tumors reported to be 69 mm, 132 (77.2%) were staged as T1. Of 2339 70 mm tumors, 1686 (72%) were staged as T1. Of 305 71 mm tumors, 64 (21%) were staged as T1. For management, 11.7% of T1 masses were treated with partial nephrectomy vs 7.3% of T2 masses and 75.8% of T1 masses were treated with radical nephrectomy vs 80.7% of T2 masses (p&lt;0.001). T2 masses were more likely to have lymph node dissection than T1 masses (15.1% vs 9.9%, p&lt;0.001), but pathologic N and M staging was similar. On survival analyses, there was no difference in survival between T1 and T2 masses. Conclusions: In this analysis, tumors of similar size but different clinical stage exhibited similar survival, yet were managed differently according to assigned clinical T stage. Patients with large T1 or small T2 masses may be managed inappropriately if the treatment is based on dichotomized clinical staging alone. When possible, risk calculation using precise parameters such as tumor size as part of a prediction model is preferable to dichotomized rules of thumb when determining optimal treatment courses.

Risk Assessment of Chronic Kidney Disease following Microwave Ablation for Stage T1 Renal Cell Carcinoma

PurposeTo assess safety and renal-function outcomes after microwave (MW) ablation of localized stage T1 renal cell carcinoma (RCC). Materials and MethodsA retrospective review was conducted of 38 patients (28 men; mean age, 69 y; range, 51–88 y) who underwent computed tomography (CT)–guided MW ablation for stage T1N0M0 RCC. Baseline and follow-up renal function surrogates including creatinine level and estimated glomerular filtration rate (eGFR) were statistically compared. Peri- and postoperative complication rates, technical success, and treatment response were also assessed. ResultsA total of 44 biopsy-proven stage T1N0M0 RCCs measuring 1.2–6.9 cm (mean, 2.5 cm) were treated, and renal function was measured 1 mo after treatment. Mean eGFRs were 60 mL/min/1.73 m2 at baseline and 59 mL/min/1.73 m2 at 1 month after ablation. At 1-year and last follow-ups, the means of difference were 3.3% (95% confidence interval, −4.4 to 4.3; P = .99) and 3.3% (95% confidence interval, −4.3 to 4.8; P = .91), respectively. The 2-years freedom from eGFR decrease to < 60 mL/min/1.73 m2 was 2% (P = .91). Among the 5 patients (13%) with preexisting stage 4 chronic kidney disease (CKD; eGFR < 30 mL/min/1.73 m2) before ablation, there was no significant postablative onset of decline or CKD upstaging (P = .001). There were no major complications, and 5 patients (13%) had small asymptomatic perinephric hematomas (Society of Interventional Radiology minor complication, class A/B) that were managed conservatively. ConclusionsAt 2-year follow-up, CT-guided percutaneous MW ablation is safe and well-tolerated and achieves nephron preservation similar to existing ablative modalities.

Outcomes of pathologic stage T3a renal cell carcinoma up-staged from small renal tumor: emphasis on partial nephrectomy

BackgroundThe prognosis of patients with pathologic stage T3a renal cell carcinoma (RCC) that is up-staged from a small renal tumor remains controversial. We evaluated the prognosis of patients with RCC who were up-staged from clinical stage T1 to pathologic stage T3a.MethodsWe retrospectively reviewed the data of 3431 patients who were surgically treated for clinical stage T1 RCC. The survival outcomes were compared using Kaplan-Meier and Cox proportional analyses.ResultsAmong the clinical stage T1 patients, 215 (6.3%) were finally up-staged to pathologic stage T3a. Patient age (HR 1.302, 95% CI 1.018–1.046, p < 0.001), tumor diameter (HR 1.686, 95% CI 1.551–1.834, p < 0.001), and hilar location (HR 1.765, 95% CI 1.147–2.715, p = 0.010) were significantly associated with upstaging. Kaplan-Meier analyses showed significantly shorter recurrence-free, cancer-specific and overall survivals (all p < 0.001) in patients who were up-staged. Multivariate Cox analyses revealed pathologic upstaging as an independent predictor of shorter recurrence-free (HR 2.195, 95% CI 1.459–3.300, p < 0.001), cancer-specific (HR 2.238, 95% CI 1.252–4.003, p = 0.007), and overall survivals (HR 1.632, 95% CI 1.029–2.588, p = 0.037). Subgroup analysis of pathologic stage T3a showed no significant difference in survival of the partial nephrectomy group when compared to the radical nephrectomy group (all p > 0.5).ConclusionsPatients up-staged from clinical stage T1 to pathologic stage T3a RCC showed shorter survival outcomes than those without upstaging. However, partial nephrectomy, compared with radical nephrectomy, showed comparable outcomes in patients who were up-staged.

Relationship Between Preoperative C-Reactive Protein and Fuhrman Nuclear Grade in Stage T1 Renal Cell Carcinoma: A Short-Term Update

Relationship Between Preoperative C-Reactive Protein and Fuhrman Nuclear Grade in Stage T1 Renal Cell Carcinoma: A Short-Term Update

Partial Nephrectomy is Associated with Higher Risk of Relapse Compared with Radical Nephrectomy for Clinical Stage T1 Renal Cell Carcinoma Pathologically Up Staged to T3a

We studied recurrence-free survival after partial vs radical nephrectomy for clinical stage T1 renal cell carcinoma in all patients and in those up staged to pathological stage T3a. We retrospectively reviewed the records of 1,250 patients who underwent partial or radical nephrectomy for clinically localized T1 renal cell carcinoma between 2006 and 2014. Recurrence-free survival was estimated using the Kaplan-Meier method and evaluated as a function of nephrectomy type with the log rank test and Cox models, adjusting for clinical, radiological and pathological characteristics. A total of 86 recurrences (7%) were observed during a median followup of 37 months. No difference in recurrence-free survival between partial and radical nephrectomy was found among all clinical stage T1 renal cell carcinomas. T3a up staging was noted in 140 patients (11%) and recurrent disease was observed in 44 (31.4%) during a median followup of 38 months. Among up staged T3a cases partial nephrectomy was associated with shorter recurrence-free survival compared to radical nephrectomy on univariable analysis (recurrence HR 2.04, 95% CI 1.12-3.68, p = 0.019) and multivariable analysis (recurrence HR 5.39, 95% CI 1.94-14.9, p = 0.001). In a subgroup of patients clinically staged T1 renal cell carcinoma will be pathologically up staged to T3a. Among these patients those who undergo partial nephrectomy appear to have inferior recurrence-free survival relative to those who undergo radical nephrectomy.

MP78-18 THE RELATIONSHIP BETWEEN PREOPERATIVE C - REACTIVE PROTEIN AND FUHRMAN NUCLEAR GRADE IN STAGE T1 RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging II1 Apr 2016MP78-18 THE RELATIONSHIP BETWEEN PREOPERATIVE C - REACTIVE PROTEIN AND FUHRMAN NUCLEAR GRADE IN STAGE T1 RENAL CELL CARCINOMA Rishi Sekar, Dattatraya Patil, Jeffrey Pearl, Yoram Baum, Stephanie Spetka, Meherdad Alemozaffar, Christopher Filson, John Pattaras, Kenneth Ogan, and Viraj Master Rishi SekarRishi Sekar More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Jeffrey PearlJeffrey Pearl More articles by this author , Yoram BaumYoram Baum More articles by this author , Stephanie SpetkaStephanie Spetka More articles by this author , Meherdad AlemozaffarMeherdad Alemozaffar More articles by this author , Christopher FilsonChristopher Filson More articles by this author , John PattarasJohn Pattaras More articles by this author , Kenneth OganKenneth Ogan More articles by this author , and Viraj MasterViraj Master More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1974AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In an era of active surveillance for small renal masses (SRMs), non-invasive predictors of tumor aggressiveness may be helpful in identifying high-risk patients for surgical intervention. In this study, we evaluate the predictive value of preoperative C-reactive protein (CRP) on Furhman Nuclear Grade (FNG) in patients with stage T1 renal cell carcinoma (RCC). METHODS Patients who underwent nephrectomy for stage T1 RCC with documented preoperative CRP within 15 days prior to the surgery were included in the study. Surgical pathology reports were used to determine TNM stage and FNG. Receiver operating characteristic (ROC) analysis, sensitivity-specificity analysis, and Youden index were used to determine the optimal threshold of preoperative CRP in predicting FNG 4 disease versus FNG 1-3 disease. Logistic regression analysis was then performed to assess the significance and independence of preoperative CRP in predicting FNG 4 disease. RESULTS 351 patients were included in the study. On ROC analysis, area under the curve (AUC) was 0.7576. The optimal threshold of preoperative CRP was found to be 4.8 mg/dL. On multivariate logistic regression, CRP≥4.8 mg/dL was found to be a significant and independent predictor of FNG 4 disease (OR 9.9, 95%CI: 1.95-51.7, p=0.006) while adjusting for age, gender, race, BMI. CONCLUSIONS Our data show that preoperative CRP≥4.8 mg/dL is a significant and independent predictor of FNG 4 disease in patients with stage T1 RCC. These findings suggest that a standardized, cost-effective, and non-invasive preoperative laboratory value can provide crucial prognostic information in patients undergoing active surveillance for SRMs, allowing for improved patient selection for definitive surgical therapy. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1033 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Rishi Sekar More articles by this author Dattatraya Patil More articles by this author Jeffrey Pearl More articles by this author Yoram Baum More articles by this author Stephanie Spetka More articles by this author Meherdad Alemozaffar More articles by this author Christopher Filson More articles by this author John Pattaras More articles by this author Kenneth Ogan More articles by this author Viraj Master More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP64-14 MAYO ADHESIVE PROBABILITY (MAP) SCORE IS ASSOCIATED WITH LOCALIZED RENAL CELL CARCINOMA PROGRESSION FREE SURVIVAL

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III1 Apr 2016MP64-14 MAYO ADHESIVE PROBABILITY (MAP) SCORE IS ASSOCIATED WITH LOCALIZED RENAL CELL CARCINOMA PROGRESSION FREE SURVIVAL David Thiel, Andrew Davidiuk, Camille Meschia, Daniel Serie, Kaitlynn Custer, Steven Petrou, and Alex Parker David ThielDavid Thiel More articles by this author , Andrew DavidiukAndrew Davidiuk More articles by this author , Camille MeschiaCamille Meschia More articles by this author , Daniel SerieDaniel Serie More articles by this author , Kaitlynn CusterKaitlynn Custer More articles by this author , Steven PetrouSteven Petrou More articles by this author , and Alex ParkerAlex Parker More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.964AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Mayo Adhesive Probability (MAP) score is a validated scoring system derived from cross-sectional imaging measurements of perinephric fat thickness and stranding used to predict adherent perinephric fat. Given previously studied links between inflammation and RCC tumorigenesis, we hypothesized that higher MAP scores are associated with poor renal cell carcinoma (RCC) outcomes. We assessed the association of MAP score and progression free survival (PFS) in patients with RCC. METHODS We identified 456 patients from a prospective registry surgically treated for localized RCC between 2002 and 2014. A single reviewer calculated pre-operative MAP scores (0-5) for each patient with pre-operative imaging. Kaplan-Meier (KM) curves were utilized to estimate PFS. Univariate and multi-variate cox proportional hazards models were used to estimate the association of MAP score with risk of progression, with adjustment for covariates such as age, body mass index (BMI), and SSIGN (Size, Stage, Grade, Necrosis) scores. RESULTS Patients with high MAP scores (4-5) were more likely to be male, older, have higher BMI, and larger tumor size (all p <0.01). High MAP scores are not associated with nodal status (p=0.28), tumor necrosis (p=0.37), sarcomatoid differentiation (p=0.33), or type of surgery ((nephrectomy vs. partial nephrectomy) p=0.71). Of our total cohort, 405 patients had MAP scores and follow up data to assess PFS. Dichotomizing MAP scores into high (MAP 4-5) and low (MAP 0-3) yields a hazard ratio of 2.16 for the 4-5 group versus 0-3 group (95% CI: 1.15-4.06, p=0.017). Adjustment for BMI did not alter the association (BMI-adjusted HR = 2.20 [1.07-4.52], p=0.032). Of interest, the association with MAP and PFS remains consistent among pathologic stage T1 RCC patients (n=287 (HR = 3.46 [1.06-11.24], p=0.039). CONCLUSIONS High MAP scores (4-5) are associated with decreased PFS in patients surgically treated for clinically localized RCC compared to patients with lower MAP scores (0-3). These findings indicate RCC aggressiveness may be associated with perinephric fat thickness and stranding. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e835 Advertisement Copyright & Permissions© 2016MetricsAuthor Information David Thiel More articles by this author Andrew Davidiuk More articles by this author Camille Meschia More articles by this author Daniel Serie More articles by this author Kaitlynn Custer More articles by this author Steven Petrou More articles by this author Alex Parker More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The relationship between preoperative c-reactive protein and Fuhrman nuclear grade in stage T1 renal cell carcinoma.

593 Background: In an era of active surveillance for small renal masses (SRMs), non-invasive predictors of tumor aggressiveness may be helpful in identifying high-risk patients for surgical intervention. In this study, we evaluate the predictive value of preoperative C-reactive protein (CRP) on Furhman Nuclear Grade (FNG) in patients with stage T1 renal cell carcinoma (RCC). Methods: Patients who underwent nephrectomy for stage T1 RCC with documented preoperative CRP within 15 days of surgery were included in the study. Surgical pathology reports were used to determine TNM stage and FNG. Receiver operating characteristic (ROC) analysis, sensitivity-specificity analysis, and Youden index were used to determine the optimal threshold of preoperative CRP in predicting FNG 4 disease versus FNG 1-3 disease. Logistic regression analysis was then performed to assess the significance and independence of preoperative CRP in predicting FNG 4 disease. Results: 351 patients were included in the study. On ROC analysis, area under the curve (AUC) was 0.7576. The optimal threshold of preoperative CRP was determined to be 4.8 mg/dL. On univariate and multivariate analysis, CRP ≥ 4.8 mg/dL was found to be a significant and independent predictor of FNG 4 disease (log-rank, p=0.014, p=0.006, respectively). Conclusions: Our data show that preoperative CRP ≥ 4.8 mg/dL is a significant and independent predictor of FNG 4 disease in patients with stage T1 RCC. These findings suggest that a standardized and cost-effective preoperative laboratory value can provide crucial prognostic information in patients undergoing active surveillance for SRMs, allowing for improved patient selection for definitive surgical therapy. [Table: see text]

Follow-up imaging in the first two years after nephrectomy for T1 RCC: Over-use or necessary care?

Objective: We sought to study patterns of imaging for follow-up after surgery for stage T1 renal cell carcinoma (RCC) at a single institution. We hypothesised that there would be significant variation in the use of surveillance imaging. Methods and materials: We evaluated the two-year follow-up of 317 consecutive patients undergoing radical or partial nephrectomy who were found to have pT1 RCC. Follow-up imaging data were collected. Surgical characteristics and tumour pathology data were analysed via a Poisson regression model to evaluate the incidence rate ratio for frequency of imaging based on each variable. Logistic regression was used to evaluate factors correlated with concordance with current imaging guidelines. Results: A total of 1016 imaging exams were performed after surgery on 268 patients. These studies identified four tumour recurrences: two local and two lung. The overall recurrence rate was 1.49%. Three recurrences were found within a two-year postoperative window, and one was recorded on the patient’s last clinic note after two years. Of 66 imaging exams with findings suspicious for recurrence, 62 were found to be false positives. All statistical analyses on a subgroup of 162 patients with full two-year follow-up failed to demonstrate any correlation between clinicopathologic variables and the frequency of abdominal imaging or concordance with current imaging guidelines. Conclusions: Frequent follow-up imaging studies were obtained despite a low recurrence rate. There was a high rate of false-positive findings on routine exams. No clinicopathologic criteria were identified that were correlated with increased imaging frequency.

Increased Expression of Androgen Receptor mRNA in Human Renal Cell Carcinoma Cells is Associated with Poor Prognosis in Patients with Localized Renal Cell Carcinoma

The role of androgen receptor in renal cell carcinoma is not well understood. In this study the correlation between androgen receptor mRNA expression and clinicopathological features in patients with localized renal cell carcinoma was investigated. Additionally, human renal cell carcinoma cell lines were examined for the presence and effect of androgen receptor. Androgen receptor mRNA expression was evaluated by quantitative real-time polymerase chain reaction in 115 tumor samples from patients with primary pathological stage T1 or T2 (pT1/pT2) renal cell carcinoma and 57 specimens of corresponding normal kidney tissue. Reverse transcriptase-polymerase chain reaction and Western blot were done to examine the expression of androgen receptor in human renal cell carcinoma cell lines. Effects on cellular proliferation were investigated after activating and blocking androgen signaling in tissue culture. Androgen receptor mRNA expression levels were significantly higher inpatients with pT2 tumors than in those with pT1 tumors (p = 0.011). Kaplan-Meier estimates revealed significant differences in time to progression and cancer specific survival between low and high androgen receptor mRNA expression groups regardless of gender. Multivariate Cox regression analysis demonstrated that the level of androgen receptor expression was an independent predictor of cancer specific survival (HR 15.546, 95% CI 1.320-183.131, p=0.029). In tissue culture treatment with dihydrotestosterone caused proliferation in androgen receptor positive cell lines while enzalutamide resulted in reduced cell viability in a dose dependent manner. In patients with localized renal cell carcinoma the androgen receptor mRNA expression level is associated with prognosis. In addition, cell culture data suggest that enzalutamide may have an effect in limiting the growthof androgen receptor positive renal cell carcinoma.

Comparative Outcome of Computed Tomography-guided Percutaneous Radiofrequency Ablation, Partial Nephrectomy or Radical Nephrectomy in the Treatment of Stage T1 Renal Cell Carcinoma.

Renal cell carcinoma (RCC) accounts for 3% of all cancers in adults. The indications for Radiofrequency Ablation (RFA) for renal carcinomas include T1a (tumor 4 cm or less, limited to the kidney), elderly patients, renal impairment, comorbidities, poor surgical candidate, and multiple bilateral renal masses. We retrospectively reviewed medical records, specifically investigating the indications, complications and outcomes of RFA and nephrectomy for treatment of RCC in a tertiary medical center with a predominantly Hispanic patient population. Forty-nine patients with RCC were evaluated. Nine patients had RFA, 9 had partial nephrectomy and 31 had radical nephrectomy. All patients among the 3 groups had stage T1N0M0 RCC at diagnosis. Tumor recurrence was observed in 2 (22%) patients that had RFA, one (11%) patient that had partial nephrectomy and no patients that had radical nephrectomy. One patient had recurrence of the tumor at the opposite kidney pole from the initial RFA site 4 years later. This particular patient did not have any tumor recurrence at the site of the initial RFA. A second RFA was performed on the recurrent tumor with no recurrence upon subsequent follow up visits. The second patient had recurrence of the RCC on 1 year follow that was discovered to be sarcomatoid RCC, which is an aggressive type with a poor prognosis. Our results support the clinical utility of RFA in patients with stage T1 RCC who are poor surgical candidates or those with reduced renal function. The clinical utility of RFA as an equally effective approach when compared to partial nephrectomy in patients with stage T1 RCC that meet strict indications for the procedure. The treatment choice should be individualized and based on the characteristics of the renal tumor such as size, location and histological type of RCC. We conclude that RFA presents a safe treatment choice for patients with RCC if long term follow up is maintained.

Renal Cell Recurrence for T1 Tumors After Laparoscopic Partial Nephrectomy

There is lack of consensus in the Urology community regarding surveillance after laparoscopic partial nephrectomy (LPN), particularly for patients with stage I tumors. The purpose of this article is to characterize the rate of recurrence after partial nephrectomy in a low risk cohort. Data were collected on all laparoscopic partial nephrectomies performed at a single institution from January 2006 through May 2011. Patients without at least 1 year of follow-up information were excluded from examination. Patients were stratified based on the pathologic tumor stage at the time of partial nephrectomy. Patients with stage I (a and b) tumors were then examined for recurrence. A total of 639 patients underwent LPN during the time period. Of this, 360 patients had stage T1 renal cell carcinoma (RCC) (302 with pT1a and 58 with pT1b) and met research criteria. There were 8 recurrences (2.2%) within this cohort ( Table 1 ). All of the tumors were of clear cell histology and none had Furhman grade 1 histology. Only one of these patients had a positive margin at the time of partial nephrectomy and all patients had negative biopsy of the tumor resection bed. A majority of the recurrences occurred locally in the ipsilateral kidney or retroperitoneum. Most of the recurrences occurred within 1-2 years postoperatively. Approximately 2% of patients who underwent LPN for RCC with resultant low risk, stage I tumor pathology developed metastasis. There were no recurrences in nonclear cell pathologies and no recurrences with Furhman grade 1 or tumors smaller than 3 cm.