Percutaneous and laparoscopic-assisted cryoablation of small renal cell carcinomas.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 462-462
Author(s):  
Tommy Kjaergaard Nielsen ◽  
Oyvind Ostraat ◽  
Michael Borre ◽  
Truls E Bjerklund Johansen
Keyword(s):  
Complication Rate ◽  
Renal Cell ◽  
Residual Tumor ◽  
Observation Time ◽  
Treatment Modalities ◽  
Minor Bleeding ◽  
Renal Cell Carcinomas ◽  
Cancer Specific Survival ◽  
Co Morbidity

462 Background: To evaluate the complication rate and short term oncological outcome of small renal cell carcinomas treated with cryoablation. Methods: 91 biopsy verified renal cell carcinomas were cryoablated between 2006-11. Patients treated had primarily T1a tumors, but exceptions were made. Patients with tumors not directly accessible percutaneously were selected for laparoscopy. To ensure complete coverage of the tumor, cryoneedle placement and freezing procedure was peroperatively monitored by ultrasound in both modalities. Presice machine with Ice-Seet and Ice-Rod needles from Galil Medical was used. Treatment was considered successful when tumors gradually shrunk and showed no sign of contrast enhancement, assessed by CT or MRI. Results: Mean patient age and tumor size was 65 yr [17 - 83] and 26 mm [10 - 62], respectively [min-max]. Treatment modalities consisted of percutaneous route; n=34 (47%) and laparoscopic guided; n=39 (53%). The mean follow-up time was 19 months [1 - 56]. 18 patients were excluded from follow-up analysis (8 pt. with short observation time, 5 pt. treated despite severe co-morbidity with no planned follow-up, 3 pt. lost to follow-up, 1 pt. emigrated, 1 pt. died as a result of bleeding from perforation of iliac artery by troicar). Residual tumor was diagnosed by imaging in 10 patients (perc n=6 and lap n=4, p>0,05) after a mean follow-up time of 13 months [1 - 31]. Diagnosis was confirmed by biopsy in all but one case, in which the diagnosis was necrosis. Of the 10 patients with residual tumor, 8 patients were reablated and 2 patients were referred to oncological treatment. Cancer specific survival was 100%. Overall survival was 91%. Complications: 8 pt. had minor bleeding in relation to cryoneedle removal, requiring Tachosil. 1 pt. had subcutaneous bleeding, 2 pt. was readmitted due to pain and discharged the following day. No patients required blood transfusion. Conclusions: Although percutaneous and laparoscopic guided cryoablation are minimally invasive procedures and the overall complication rate is low, serious complications may occur. Close follow-up and continuous evaluation of criteria for patient selection and relapse is necessary. An international database is recommended.

Impact of Microvascular Invasion and Tumor Necrosis on the Prognosis of Korean Patients with pT1b Renal Cell Carcinoma

2014 ◽  
Vol 95 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Se Yun Kwon ◽  
Jun Nyung Lee ◽  
Bum Soo Kim ◽  
Young Hwii Ko ◽  
Phil Hyun Song ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Prognostic Factors ◽  
Renal Cell ◽  
Tumor Necrosis ◽  
Multivariate Analyses ◽  
Microvascular Invasion ◽  
Recurrence Free Survival ◽  
Cancer Specific Survival ◽  
Free Survival

Objectives: To evaluate prognostic factors in pT1b renal cell carcinoma (RCC) patients for which no specific studies have been conducted on. Methods: The data of 270 patients diagnosed with pT1bN0M0 RCC at 2 institutions between January 1998 and June 2010 were retrospectively analyzed. Univariate and multivariate analyses using Cox proportional hazard models were used to identify pathologic and clinical factors that influenced prognosis. Five-year recurrence-free survival and cancer-specific survival were analyzed using the Kaplan-Meier method. Results: The median follow-up period was 55.5 months, and the mean patient age was 55.2 years (range: 26-80). There were 12 cancer-related deaths, and tumor recurrence was noted in 22 patients between 8 and 120 months after surgery. Sites of metastases included the lung in 13 patients, bone in 5 patients, and other sites in 4 patients. Five-year recurrence-free survival and cancer-specific survival rates were 91.2 and 93.5%, respectively. Multivariate analyses revealed that the presence of microvascular invasion and tumor necrosis independently predicted prognosis. Conclusions: Microvascular invasion and tumor necrosis were found to be independent prognostic factors in pT1b RCC. This result will help urologists to provide patients with more accurate prognoses, and patients with confirmed microvascular invasion and tumor necrosis will require closer follow-up.

scholarly journals Altered Tissue and Plasma Levels of Fibroblast Activation Protein-α (FAP) in Renal Tumours

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3393
Author(s):  
Jon Danel Solano-Iturri ◽  
Peio Errarte ◽  
María C. Etxezarraga ◽  
Enrique Echevarria ◽  
Javier Angulo ◽  
...  
Keyword(s):  
Cancer Progression ◽  
Renal Cell ◽  
Complex Disease ◽  
Fibroblast Activation Protein ◽  
Response To Therapy ◽  
Renal Oncocytoma ◽  
Renal Cell Carcinomas ◽  
Cancer Specific Survival ◽  
Fibroblast Activation ◽  
Renal Tumours

(1) Background: Renal cell carcinoma (RCC) is a heterogeneous and complex disease with only partial response to therapy, high incidence of metastasis and recurrences, and scarce reliable biomarkers indicative of progression and survival. Cancer-associated fibroblasts (CAFs) play an important role supporting and promoting renal cancer progression. (2) Methods: In this study, we analysed fibroblast activation protein-α (FAP) immunohistochemical expression and its soluble isoform (sFAP) in tumour tissues and plasma from 128 patients with renal tumours. (3) Results: FAP is expressed in the cell surface of CAFs of the tumour centre and infiltrating front from clear cell renal cell carcinomas (CCRCC, n = 89), papillary renal cell carcinomas (PRCC, n = 21), and chromophobe renal cell carcinomas (ChRCC, n = 8), but not in the benign tumour renal oncocytoma (RO, n = 10). A high expression of FAP and low levels sFAP are significantly associated with high tumour diameter, high grade, and high pT stage, lymph node invasion, development of early metastases, and worse 5-year cancer specific survival of CCRCC patients. (4) Conclusions: These findings corroborate the potential usefulness of FAP immunohistochemistry and plasma sFAP as a biomarker of CCRCC progression and point to CAF-related proteins as promising immunohistochemical biomarkers for the differential diagnosis of ChRCC and RO.

Independent validation of the 2002 UICC TNM staging system for papillary renal cell carcinoma in a multicenter cohort

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5092-5092
Author(s):  
C. Wulfing ◽  
E. Herrmann ◽  
L. Trojan ◽  
A. Schrader ◽  
F. Becker ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Multivariate Analysis ◽  
Metastatic Disease ◽  
Renal Cell ◽  
Papillary Renal Cell Carcinoma ◽  
Staging System ◽  
Tnm Staging ◽  
Cancer Specific Survival ◽  
Tnm Staging System

5092 Background: Papillary renal cell carcinoma (pRCC) is the second most malignant histologic subtype in nephrectomy specimens. To date, the most recognized staging system to stratify renal cancer patients is the 2002 UICC TNM classification system. Its accuracy for predicting patient outcome for pRCC is unknown. Methods: From ten urologic institutions in Germany follow-up data on 675 patients with pRCC were collected. In most cases histologic slides were available and central pathologic review was performed. The Kaplan-Meier method was used to derive the cumulative cancer-specific survival. For multivariate analysis of prognostic factors, a Cox regression analysis was performed. Results: 498 (74.1%) patients had organ-confined tumor stages (≤pT2). Synchronous distant metastases in the entire group occurred in 58 (8.7%) patients and 69 (11.2%) others developed metastatic disease during follow-up. Cancer-specific survival (CSS) was significantly related to TNM stage and histologic grading in univariate as well as in multivariate analysis (all p < 0.0001). 5-year CSS in pT1b tumors (90.0%) was significantly shorter compared to pT1a tumors (98.3%) (p = 0.017). Patients with ≥pT3 were at high risk for metastases (50.6%), while metastatic disease associated with ≤pT2 tumors occurred in 7.8% (p < 0.0001). Once metastatic disease was present, prognosis was poor (5-year CSS: 7.2%). Age was associated with a worse prognosis in the subgroup of ≥pT3 tumors in univariate (p = 0.026), but not in multivariate analysis. Conclusions: The 2002 UICC TNM staging system is applicable for pRCC. Clinical and radiologic follow-ups should be offered in frequent intervals to patients with venous thrombus and/or locally advanced disease. The role of age remains unclear, but should not be underestimated at risk stratification after tumor resection. No significant financial relationships to disclose.

The Extent of Lymphadenectomy does Affect Cancer Specific Survival in Pathologically Confirmed T4 Renal Cell Carcinoma

2012 ◽  
Vol 79 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Umberto Capitanio ◽  
Rayan Matloob ◽  
Nazareno Suardi ◽  
Firas Abdollah ◽  
Fabio Castiglione ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Cox Regression ◽  
Locally Advanced ◽  
Survival Rates ◽  
Cancer Specific Survival ◽  
Retroperitoneal Lymphadenectomy ◽  
Fuhrman Grade

Background Controversies exist regarding the effect of lymphadenectomy (LND) in renal cell carcinoma (RCC). We hypothesized that patients with locally advanced cancer invading beyond Gerota's fascia (pT4 Nany Many RCC) might benefit from an extended LND not only for staging but also for survival purposes. Materials and Methods Clinical and pathologic data were prospectively gathered in 1.847 patients treated at a single Academic Center, between 1987 and 2011. Only patients with pT4 RCC (TNM 2009, n=44, 2.4%) were included. Univariable (UVA) and multivariable (MVA) Cox regression analyses targeted the association between the number of lymph nodes removed and cancer specific mortality (CSM). Analyses were adjusted for age, Fuhrman grade, symptoms at presentation, metastases at diagnosis, ECOG performance status, tumor size, number of positive nodes, and presence of necrosis or sarcomatoid features. Results Mean number of nodes removed was 11.8 (median 8, range 1–37). Mean number of positive nodes was 4.8 (median 2, range 0–36). Cancer-specific survival rates at 1, 2 and 3 years of follow-up were 39.3%, 25.0% and 8.6%, respectively. When stratified for nodal status, cancer-specific survival rates at 1, 2 and 3 years of follow-up were 65.0, 36.1, and 9.0% vs. 13.3, 13.0, and 6.7%, for pN0 vs. pN+ cases, respectively (p=0.004). At MVA, after adjusting for all the possible confounders, the number of positive nodes resulted independently associated with CSM (HR 1.25, p=0.001). Interestingly, at MVA, the number of nodes removed achieved the independent predictor status, as well (HR 0.84, p=0.007) showing a protective effect on survival. The risk of dying increased of 16% every positive node found (p<0.001), and decreased of 8% every node removed (p=0.02) (Table II). Conclusions A more extended retroperitoneal lymphadenectomy at the time of nephrectomy statistically significantly decreased CSM in pT4 cases.

Incidence of Multiple Sporadic Renal Cell Carcinomas in Patients Referred for Renal Radiofrequency Ablation: Implications for Imaging Follow-Up

2011 ◽  
Vol 197 (3) ◽  
pp. 671-675 ◽  
Author(s):  
Michael D. Beland ◽  
Farrah J. Wolf ◽  
David J. Grand ◽  
Damian E. Dupuy ◽  
William W. Mayo-Smith
Keyword(s):  
Radiofrequency Ablation ◽  
Renal Cell ◽  
Renal Cell Carcinomas

scholarly journals Repeat Percutaneous Radiofrequency Ablation of T1 Renal Cell Carcinomas is Safe in Patients with Von Hippel–Lindau Disease

2021 ◽  
Author(s):  
Joel Wessendorf ◽  
Alexander König ◽  
Hendrik Heers ◽  
Andreas H. Mahnken
Keyword(s):  
Radiofrequency Ablation ◽  
Renal Cell ◽  
Case Series ◽  
Progression Free Survival ◽  
Renal Cell Carcinomas ◽  
Ct Guided ◽  
Free Survival ◽  
Von Hippel Lindau ◽  
Von Hippel Lindau Disease

Abstract Purpose Patients with Von Hippel-Lindau disease often develop multifocal, metachronous renal cell carcinomas which require therapy. The purpose of this retrospective single-center study is to evaluate the outcomes of radiofrequency ablation (RFA) in the treatment of renal cell carcinomas in patients with Von Hippel-Lindau disease. Materials and Methods 9 patients (4 male, 5 female, 47.9 ± 10.7 y/o) with Von Hippel-Lindau disease underwent 18 CT-guided percutaneous RFA procedures for the treatment 21 renal cell carcinomas (largest diameter: 32.9 ± 8.6 mm, cT1a: 16, cT1b: 5). Seven patients were previously treated either by partial or radical nephrectomy. Technical success, effectiveness, safety, progression-free survival, overall survival and tumor characteristics were analyzed. Results All RFA procedures were technically successful without major complications. There were 5 minor complications. No residual or recurrent tumor was seen in the ablation zone during a follow-up of 34.0 ± 18.1 months (0–58 months). No patient required dialysis during follow-up. One patient died after 63 months after the first treatment due to complications from a cerebellar hemangioblastoma. No endpoint was reached for overall or progression-free survival. Conclusions The results from this limited case series suggest that RFA of RCCs in patients with VHL is a safe and effective therapy, which can preserve sufficient renal function even after renal surgery.

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

2021 ◽  
Vol 11 ◽  
Author(s):  
Sung Han Kim ◽  
Boram Park ◽  
Eu Chang Hwang ◽  
Sung-Hoo Hong ◽  
Chang Wook Jeong ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Local Recurrence ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Disease Recurrence ◽  
Cancer Specific Survival ◽  
Hazard Ratios ◽  
Long Term Follow Up

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

scholarly journals Organizing Pneumonia Induced by Ablative Radioembolization for the Treatment of Hepatic Metastatic Renal Cell Carcinoma

2019 ◽  
Vol 9 ◽  
pp. 42
Author(s):  
Zlatko Devcic ◽  
Carlos A. Rojas ◽  
Mohamed Elboraey ◽  
Beau Toskich
Keyword(s):  
Computed Tomography ◽  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
External Beam Radiotherapy ◽  
Residual Tumor ◽  
Organizing Pneumonia ◽  
Parenchymal Disease

Organizing pneumonia is a recognized complication after external beam radiotherapy of breast and lung cancer but has not been described after radioembolization. A 67-year-old female who underwent ablative trans-arterial radioembolization for the treatment of hepatic metastatic renal cell carcinoma adjacent to the diaphragm presented with computed tomography findings of asymptomatic organizing pneumonia in the lower lobes. A follow-up computed tomography 8 months after conservative management demonstrated near-total resolution of the previous pulmonary parenchymal disease. The patient continues to remain asymptomatic and shows no evidence of residual tumor 10 months after radioembolization.

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