Oncologic and functional outcomes of radical and partial nephrecotmy in PT3A patholigically upstaged renal cell carcinoma: A multi-instituitional analysis.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 685-685 ◽  
Author(s):  
Madhumitha Reddy ◽  
Ahmet Bindayi ◽  
Zachary Hamilton ◽  
Stephen Ryan ◽  
Kendrick Yim ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Functional Outcomes ◽  
Locally Advanced ◽  
Positive Margin ◽  
Standard Of Care ◽  
Oncologic Outcomes ◽  
Functional Benefit

685 Background: Radical Nephrectomy (RN) has been the standard of care for complex and locally advanced renal cell carcinoma (RCC). Efficacy of PN in the setting of pT3a pathologic upstaged disease is controversial. We compared oncologic and functional outcomes of RN and PN in patients with upstaged pT3a RCC. Methods: Multicenter retrospective analysis of patients with cT1−2N0M0 RCC undergoing RN or PN upstaged to pT3a postoperatively. Primary outcome was Overall Survival (OS), with secondary outcomes being Recurrence Free Survival (RFS) and eGFR < 60 at last follow-up. Results: 8185 patients were analyzed (mean follow up 48 months). 945 (11.5%) were upstaged to pT3a [686 (72.6%) RN, 243 (25.7%) PN]. Logistic regression analysis showed that increasing age, decreasing BMI, increasing intraoperative EBL, and positive margin increased the OR of all-cause mortality (all p < 0.05, Table). Kaplan Meier analysis (KMA) revealed 5−year OS for PN cT1→pT3a, RN cT1→pT3a, PN cT2→pT3a, RN cT2→pT3a of 64%, 65.2%, 56.4% and 55.2% respectively (p = 0.059). KMA revealed 5−year RFS for PN cT1→pT3a, RN cT1→pT3a, PN cT2→pT3a, RN cT2→pT3a of 79%, 74%, 70% and 51% respectively (p < 0.001). PN was associated with a decreased risk of GFR < 60 at follow up (39.6% vs. 59.5% for RN, p = 0.008) Conclusions: PN did not adversely affect oncologic outcomes in select patients who are upstaged to pT3a RCC from cT1 or cT2 disease, and may provide renal functional benefit. Improvements with respect to RFS for PN are most likely driven by selection bias. [Table: see text]

scholarly journals Follow-up guidelines after radical or partial nephrectomy for localized and locally advanced renal cell carcinoma

2013 ◽  
Vol 3 (1) ◽  
pp. 73 ◽  
Author(s):  
Wassim Kassouf ◽  
Robert Siemens ◽  
Christopher Morash ◽  
Louis Lacombe ◽  
Michael Jewett ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Partial Nephrectomy ◽  
Renal Cell ◽  
Locally Advanced ◽  
Advanced Renal Cell Carcinoma

Long-term durable oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 384-384 ◽  
Author(s):  
Sarah P. Psutka ◽  
Francis J. McGovern ◽  
Peter Mueller ◽  
W. Scott McDougal ◽  
Debra Gervais ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Radiofrequency Ablation ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Disease Free Survival ◽  
Oncologic Outcomes ◽  
Free Survival ◽  
Disease Free

384 Background: Long-term oncologic outcomes for radiofrequency ablation (RFA) of renal cell carcinoma (RCC) are limited. The objective of this study was to assess the long-term oncological efficacy of RFA for treatment of renal cell carcinoma. Methods: Between 1998 and 2008, 311 biopsy-proven RCC were treated with RFA in 274 patients. Exclusion criteria included history of prior RCC or known metastatic RCC at time of RFA (n=92). 26 patients were lost to follow-up prior to their 6-month imaging study. We retrospectively reviewed the long-term oncologic outcomes for 193 patients. Mean follow-up was 4.6 yrs (range 1–12, SD 2.3). Results: Median age was 71 years (IQR: 63 –79 years). Median Charlson Score was 5.46 (IQR: 5–6). Median size of tumor treated was 3 cm (IQR: 2–3.9 cm, range 1–7.1cm) and 64 of these tumors (33%) were endophytic. Tumor breakdown by stage was T1a: n=153 (79%), T1b: n=37 (19%), and T2: n=3 (2%). Initial treatment success rate was 89%. There were 6 local recurrences (3%) in 4 patients with T1b disease and 2 patients with T2 disease with an average time-to-recurrence of 2.9 years (SD 0.7). 95% of patients with T1a RCC were disease free at last follow-up, in comparison to 81% of those with T1b and 33% of those with T2 disease (p=0.008). At last follow-up 178 (92%) patients were disease-free. 16 (8.2%) developed metastatic disease and 4 patients (2%) died of RCC. Mean disease-free survival was 4.3 years (SD 2.4). Conclusions: In patients who are poor surgical candidates, RFA results in durable local control and a low risk of disease recurrence in T1 RCC. Higher stage, however, correlates with a decreased disease free survival and alternate treatments should be considered when counseling these patients.

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.

scholarly journals Randomized Phase III Trial of Adjuvant Pazopanib Versus Placebo After Nephrectomy in Patients With Localized or Locally Advanced Renal Cell Carcinoma

2017 ◽  
Vol 35 (35) ◽  
pp. 3916-3923 ◽  
Author(s):  
Robert J. Motzer ◽  
Naomi B. Haas ◽  
Frede Donskov ◽  
Marine Gross-Goupil ◽  
Sergei Varlamov ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Locally Advanced ◽  
Phase Iii ◽  
Advanced Renal Cell Carcinoma ◽  
Primary Analysis ◽  
Phase Iii Trial ◽  
Starting Dose

Purpose This phase III trial evaluated the efficacy and safety of pazopanib versus placebo in patients with locally advanced renal cell carcinoma (RCC) at high risk for relapse after nephrectomy. Patients and Methods A total of 1,538 patients with resected pT2 (high grade) or ≥ pT3, including N1, clear cell RCC were randomly assigned to pazopanib or placebo for 1 year; 403 patients received a starting dose of 800 mg or placebo. To address toxicity attrition, the 800-mg starting dose was lowered to 600 mg, and the primary end point analysis was changed to disease-free survival (DFS) for pazopanib 600 mg versus placebo (n = 1,135). Primary analysis was performed after 350 DFS events in the intent-to-treat (ITT) pazopanib 600 mg group (ITT600mg), and DFS follow-up analysis was performed 12 months later. Secondary end point analyses included DFS with ITT pazopanib 800 mg (ITT800mg) and safety. Results The primary analysis results of DFS ITT600mg favored pazopanib but did not show a significant improvement over placebo (hazard ratio [HR], 0.86; 95% CI, 0.70 to 1.06; P = .165). The secondary analysis of DFS in ITT800mg (n = 403) yielded an HR of 0.69 (95% CI, 0.51 to 0.94). Follow-up analysis in ITT600mg yielded an HR of 0.94 (95% CI, 0.77 to 1.14). Increased ALT and AST were common adverse events leading to treatment discontinuation in the pazopanib 600 mg (ALT, 16%; AST, 5%) and 800 mg (ALT, 18%; AST, 7%) groups. Conclusion The results of the primary DFS analysis of pazopanib 600 mg showed no benefit over placebo in the adjuvant setting.

Neoadjuvant temsirolimus in high-risk renal cell carcinoma: Results from a single-center prospective study.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 387-387
Author(s):  
A. A. Sheikh ◽  
A. Gharajeh ◽  
S. J. Hotte ◽  
J. H. Pinthus ◽  
A. Kapoor
Keyword(s):  
Renal Cell Carcinoma ◽  
High Risk ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Renal Mass ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Post Surgery

387 Background: The current first-line treatment for advanced renal cell carcinoma (RCC) includes targeted therapy with or without cytoreductive radical nephrectomy. There is a paucity of data as to the effectiveness of adjuvant and neoadjuvant treatment before radical nephrectomy for localized high-risk or advanced disease. We initiated a trial of neoadjuvant Temsirolimus before radical nephrectomy for locally advanced and metastatic RCC examining tumor response and survival. Methods: Patients who presented with advanced RCC were offered enrolment into a prospective, single-centre, ethics approved trial with 12 weeks of temsirolimus before radical nephrectomy. Biopsy tissue was obtained at enrollment and at time of cytoreductive nephrectomy for diagnosis. Patients were administered 25 mg in temsirolimus on a weekly basis for 12 weeks, and then underwent radical nephrectomy. Computed tomography scans and biomarkers were obtained on enrolment, 6 weeks and 12 weeks (before nephrectomy). Ongoing outcome and survival data were analyzed. Results: Eight patients were enrolled into the trial. Patient #1 (10-cm renal mass with bulky adenopathy T2N2M0) had no evidence of disease (NED) at 6 months post-nephrectomy. Patient #2 (9-cm renal mass, bulky adenopathy, pulmonary metastases T2N2M1) also had NED at 6 months postnephrectomy. Patients #3 and #4 experienced regression of the primary mass and have recently undergone uneventful surgery with follow-up pending. Patients #5 and #6 expired prior to the full course of therapy, but had diagnoses other than RCC. Patient #7 experienced disease progression, however, this patient's nephrectomy was delayed by 3 months due to an unrelated myocardial infarct. Patient #8 experienced adverse events. Conclusions: Our findings suggest that neoadjuvant temsirolimus before radical nephrectomy for advanced RCC may improve disease regression post-surgery, and may lead to disease resolution in patients with low-volume disease. Randomized studies with longer term follow-up is necessary to assess overall progression-free survival and overall survival. [Table: see text]

Contemporary outcomes of pT3 renal cell carcinoma: A Canadian multi-institutional experience.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 434-434
Author(s):  
Jasmir Nayak ◽  
Clare Gardiner ◽  
Zhihui Liu ◽  
Simon Tanguay ◽  
Anil Kapoor ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Disease ◽  
Renal Cell ◽  
Locally Advanced ◽  
Staging System ◽  
Tnm Staging ◽  
Cancer Information ◽  
Oncological Outcomes

434 Background: A large, multi-institutional analysis was undertaken to examine the pathological and oncological outcomes for patients with pT3 renal cell carcinoma (RCC) treated surgically. Materials and Methods: Institutional databases on patients surgically treated for RCC were obtained from 14 centers across 6 Canadian provinces forming the Canadian Kidney Cancer Information System (CKCis) database. Data were collected on 2204 patients and included patient characteristics, peri-operative information, pathological and oncological outcomes. Results: Of the 2,204 patients, 498 (22.6%) patients had pT3 disease according to the 2009 TNM staging system. Mean pathological tumor size was 8.6 cm. 443 (89.0%) patients underwent a radical nephrectomy (RN) and 55 (11.0%) underwent a partial nephrectomy (PN). Of those treated with RN, 247 (55.8%) were open, 159 (35.9%) laparoscopic and 1 (0.2%) robotic. In the PN group, 37 (67.3%), 14 (25.5%) and 4 (7.3%) patients were treated open, laparoscopic and robotically, respectively. Average operative time was 184 mins, with an average blood loss of 650 cc. Of the pT3 lesions, 365 (73.3%) were pT3a, 97 (19.5%) pT3b and 12 (2.4%) pT3c. 109 (22%) patients had a metastatic diagnosis before or at the time of nephrectomy. Of the remaining 389 patients, 68.9% remained free of disease after a median follow-up of 1.3 years. Common sites of metastatic disease included lung, lymph nodes and bone (77%, 35%, and 25%, respectively). Clear cell RCC was the predominant histopathology (74%). There were no peri-operative (<30 days) mortalities. Complications were found in 14.1% of patients. Systemic therapy was initiated in 132 (26.5%) of patients, most commonly with Sunitinib in 106 (80%) patients. Conclusions: Locally advanced, pT3 renal cell carcinoma is an aggressive disease that is associated with high rates of metastatic disease. Despite this, a significant portion remained disease free at the time of our follow-up.

scholarly journals Long-Term Oncologic Outcomes After Laparoscopic and Robotic Tumor Enucleation for Renal Cell Carcinoma

2021 ◽  
Vol 10 ◽  
Author(s):  
Wen Dong ◽  
Xiong Chen ◽  
Ming Huang ◽  
Xu Chen ◽  
Ming Gao ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Local Recurrence ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Oncologic Outcomes ◽  
Perioperative Outcomes ◽  
Robotic Approach ◽  
Tumor Enucleation

ObjectivesTumor enucleation (TE) optimizes parenchymal preservation with promising short-term oncologic outcomes compared with standard partial nephrectomy (SPN). However, researches/literatures about long-term oncologic outcomes for TE after minimally invasive surgery are scarce. We aim to analyze long-term oncologic outcomes after laparoscopic and robotic tumor enucleation for renal cell carcinoma (RCC).Patients and MethodsWe retrospectively analyzed 146 patients who underwent TE with either laparoscopic or robotic approach for localized RCC in our center. Local recurrence, cancer specific survival (CSS), recurrence free survival (RFS), and overall survival (OS) were the main outcomes. Survival curves were generated using a Kaplan-Meier method. Perioperative outcomes and pathological outcomes were also analyzed.ResultsOverall, 98 male and 48 female patients were eligible for the study. The median tumor size was 3.4 cm with a median R.E.N.A.L. score of seven. Warm ischemia was used in 143 patients with a median ischemia time of 20 min and three patients had zero ischemia. Five patients (3.4%) had major complications (&gt; Clavien IIIa) and only two were related to urinary system. The median global glomerular filtration rate (GFR) preserved after surgery was 93%. Pseudocapsule invasion was reported in 50 tumors (34%) and positive surgical margins were found in 3/146 (2.1%) tumors. At a median follow-up of 66 months, local recurrence happened in two patients (1.4%), and systemic recurrence happened in six patients (4.2%). The 5-year CSS, RFS, OS were 95.7, 89.6, and 91.9%, and the 10-year CSS, RFS, OS were 93.8, 89.6, and 90.0%, respectively.ConclusionThis study indicates that tumor enucleation with laparoscopic or robotic approach in experienced hands for the treatment of RCC appears oncologically safe with a median follow-up of more than 5 years. Prospective studies with more patients and longer follow-up will be required to further evaluate oncologic safety after TE.

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