Objective: To examine the association between kidney size and renal cell carcinoma (RCC) death among patients with Stage pT1 clear cell RCC undergoing surgery.
Methods: We used a case-cohort design and evaluated 191 patients from our Nephrectomy Registry who had undergone open radical nephrectomy for unilateral, sporadic, Stage pT1N0/NxM0, noncystic clear cell RCC from 1989 to 2004. Of these, 47 patients died of RCC ("cases") and 144 patients were alive at the last follow-up visit or had died of other causes ("cohort").
Chromosomal rearrangements involving the anaplastic lymphoma kinase gene (ALK) at 2p23 result in fusion with various partner genes leading to aberrant production of oncogenic protein products in multiple tumor types. Recently, the ALK protein inhibitor crizotinib was shown to be an effective therapy in patients with ALK-rearranged non-small cell lung cancer. The goal of this study was to determine the frequency of ALK alterations in adult renal cell carcinoma (RCC) and define associated clinicopathologic features and outcome.
View Article and Find Full Text PDFPurpose: The relative effectiveness of partial vs radical nephrectomy remains unclear in light of the recent phase 3 European Organization for the Research and Treatment of Cancer trial. We performed a systematic review and meta-analysis of partial vs radical nephrectomy for localized renal tumors, considering all cause and cancer specific mortality, and severe chronic kidney disease.
Materials And Methods: Cochrane Central Register of Controlled Trials, MEDLINE®, EMBASE®, Scopus and Web of Science® were searched for sporadic renal tumors that were surgically treated with partial or radical nephrectomy.
Unlabelled: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Postoperative complications for open radical nephrectomy (ORN), laparoscopic radical nephrectomy (LRN), and open partial nephrectomy (OPN) and its relationship with hospitalisation costs and mortality remain poorly described. The present population-based study suggests modest differences in postoperative complications estimated at 27%, 23%, and 24% among patients with kidney cancer undergoing ORN, LRN, and OPN, respectively. Moreover, postoperative complications were associated with higher mortality, length of stay and total costs of hospitalisation.
View Article and Find Full Text PDFPurpose: To determine whether renal cell carcinoma (RCC) thrombi that reach the vena cava from the left kidney are associated with a greater risk of RCC death than equivalent thrombi from the right kidney.
Methods: Two hundred and fifty-nine patients treated with radical nephrectomy (1970-2006) for unilateral, sporadic RCC with level 1-4 RCC tumor thrombus were identified. Clinicopathologic features between patients with right-sided (N = 183) and left-sided (N = 76) thrombus were compared utilizing Wilcoxon rank sum and Fisher's exact tests.
Objective: To describe the growth rates of oncocytomas before treatment with surgical resection or percutaneous ablation.
Patients And Methods: This single-institution retrospective study included 33 consecutive, pathologically proven renal oncocytomas with serial contrast-enhanced computed tomography scans spanning at least 1 year before intervention, from 2000 to 2009. Tumours were measured by two radiologists, and growth rates and interobserver variability were calculated.
Objective: To evaluate the activity of exisulind against prostate cancer (CaP) in vivo through a prospective study of neoadjuvant exisulind in patients undergoing radical prostatectomy (RP). Exisulind and its analogs have been shown to induce apoptosis in vitro in many cancer cell lines, including CaP cell lines without affecting normal human cells.
Methods: Men with biopsy-proven, localized CaP (Gleason score ≥6) amenable to RP were offered enrollment into the trial.
Unlabelled: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: There is great variability in the utilization of partial nephrectomy, but the causes of these variations are not well understood. The present study underscores the already observed phenomenon of surgical volume influencing surgical planning and outcomes, but it gets at why this might be so. We observe that high-volume renal surgeons have different thresholds of 'technical feasibility'.
View Article and Find Full Text PDFRenal cell carcinoma (RCC) with chromosomal rearrangement of transcription factor for immunoglobulin heavy-chain enhancer 3 (TFE3) at Xp11.2 is a distinct subtype that was initially described in children and has been reported to display an indolent course. Recent reports have identified RCC with TFE3 rearrangements in adults and have suggested a more aggressive course in this population.
View Article and Find Full Text PDFIt has been reported that Fuhrman grading is not appropriate for chromophobe renal cell carcinoma (RCC). The objective of this study was to determine whether nucleolar grading and the recently described chromophobe RCC grading system by Paner and colleagues provide prognostic information. Pathologic features of 185 patients with chromophobe RCC treated surgically between 1970 and 2006 were reviewed, including nucleolar grade, chromophobe RCC grade, the 2010 TNM groupings, sarcomatoid differentiation, and coagulative tumor necrosis.
View Article and Find Full Text PDFPurpose: To determine whether a combination of magnetic resonance (MR) parameters can help differentiate small angiomyolipomas (AMLs) without visible fat from renal cell carcinomas (RCCs).
Materials And Methods: This HIPAA-compliant retrospective study received institutional review board approval; 69 men and 42 women (mean age, 59.7 years) with 15 AMLs without visible fat and 104 RCCs underwent MR.
Objective: To evaluate the effects of warm ischemia time (WIT) and quantity and quality of kidney preserved on renal functional recovery after partial nephrectomy (PN). The effect of WIT relative to these other parameters has recently been challenged.
Methods: We identified 362 consecutive patients with a solitary kidney who had undergone PN using warm ischemia.
Unlabelled: Study Type - Prognosis (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The positive association of tumour size (largest tumour dimension on pathology review) and risk of RCC progression and survival following nephrectomy is well documented. Moreover, several clinicopathological scoring systems (i.
View Article and Find Full Text PDFNeosporosis caused by Neospora caninum has global economic, clinical, and epidemiological impacts, mainly in the cattle industry. Currently, there is no useful drug for treatment of neosporosis. This publication is the first to describe the significant benefits that artemisone has on Neospora infections both in vitro and in vivo.
View Article and Find Full Text PDFPurpose: We determined the clinical and pathological features associated with death from papillary renal cell carcinoma in 395 surgically treated patients.
Materials And Methods: Papillary renal cell carcinoma tissue slides from each patient were reviewed for type (1 or 2), grade, TNM stage, coagulative tumor necrosis and sarcomatoid differentiation. Associations of clinical and pathological features with death from renal cell carcinoma were evaluated using Cox proportional hazards regression models and summarized by the HR and 95% CI.
Purpose: To review complications related to percutaneous renal tumor ablation.
Materials And Methods: Prospectively collected data related to renal radiofrequency (RF) ablation and cryoablation procedures performed from May 2000 through November 2010 were reviewed. This included 573 renal ablation procedures performed in 533 patients to treat 633 tumors.
Purpose: Despite benefits in functional renal outcome and the similar oncological efficacy of partial nephrectomy for renal cell carcinoma, previous studies show marked underuse of partial nephrectomy. We describe national trends in partial and radical nephrectomy using a contemporary, population based cohort.
Materials And Methods: Using the 2003 to 2008 Nationwide Inpatient Sample we identified 188,702 patients treated with partial or radical nephrectomy for renal cell carcinoma at a total of 1,755 hospitals.
Purpose: Partial nephrectomy is the recommended management for small renal masses. Percutaneous ablation is safe and effective with comparable short-term cancer specific survival. Currently to our knowledge data are lacking on the impact of thermal ablation on renal function preservation.
View Article and Find Full Text PDFObjective: To characterize the incidence and clinicopathologic factors associated with late recurrence after surgical resection for renal cell carcinoma (RCC) because the recurrence patterns >5 years after nephrectomy have been poorly described.
Methods: We identified 1454 patients treated with nephrectomy for localized RCC from 1970 to 2000 who had remained free of disease for 5 years. Subsequent tumor recurrence was classified as renal recurrence and distant metastasis.
Purpose: The nephrometry score was introduced in 2009 as a way to quantify renal tumor complexity in a systematic way. However, the reproducibility of scoring has not been rigorously validated across specialty or level of training, nor has it been evaluated with regard to meaningful clinical outcomes.
Materials And Methods: We identified 95 consecutive patients with a solid renal mass treated surgically.
Context: Although an ever-increasing number of patients are being incidentally diagnosed with small renal masses, there is still a sizable portion of patients with renal cell carcinoma (RCC) who present with locally advanced or metastatic disease. Those with locally advanced disease present a challenge because they may be difficult to distinguish from those with organ-confined disease at the time of diagnosis. However, this distinction is important because they may require a different management strategy.
View Article and Find Full Text PDFBackground: Although a role for resection of solitary metastases from renal cell carcinoma (RCC) has been described, the utility of surgery in patients with multiple sites of disease has been less well defined. The authors report the survival of patients who underwent complete metastasectomy for multiple RCC metastases.
Methods: The authors identified 887 patients who underwent nephrectomy for RCC between 1976 and 2006 who developed multiple metastatic lesions.
Unlabelled: What's known on the subject? and What does the study add? One of two problems plagues virtually are existing post-prostatectomy prediction tools: either (1) they predict PSA recurrences (which are of unclear importance) or (2) the predictions they make are anchored at the date of surgery and are not updated based on how patients evolve over the postoperative years. Our prediction tool is a significant improvement over existing prediction tools in that it predicts the development of metastases which is a very important clinical endpoint that indicates incurable prostate cancer. Additionally, our tool allows for updated predictions at any point following radical prostatectomy by considering commonly available postoperative information (postoperative serum PSA and use of adjuvant therapies) to modify its risk predictions.
View Article and Find Full Text PDFObjective: To determine the metastatic potential of renal masses based on original tumour size.
Materials And Methods: We identified 2651 patients who had undergone surgical resection for a unilateral, sporadic renal tumour between 1990 and 2006. Associations of tumour size with synchronous metastasis at presentation [M1 renal cell carcinoma (RCC)] and development of metastases, death from RCC, and death from any cause after surgery were evaluated using logistic and Cox proportional hazards regression.
Background: The indications for the removal of the ipsilateral adrenal gland in patients with renal cell carcinoma (RCC) and the long-term outcomes have not been well studied.
Objective: We evaluated the risk of synchronous and asynchronous adrenal involvement in patients with RCC and the effect of adrenalectomy on recurrence and survival in a large, single-institution cohort.
Design, Setting, And Participants: From 1970 to 2006, 4018 consecutive patients with RCC treated by surgical extirpation (radical nephrectomy [RN]: 3107; partial nephrectomy [PN]: 911) from Mayo Clinic were studied for adrenal involvement.