We evaluated the recurrence after radical and partial nephrectomy in patients with RENAL nephrometry score [RENAL] ≥ 10. A total of 474 patients (radical nephrectomy [RN, n = 236] & partial nephrectomy [PN, n = 238]) in a single tertiary referral institution from December 2003 to December 2019 were assessed. Functional outcomes, defined as estimated glomerular filtration rate changes, relapse pattern, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were evaluated using propensity score-matched analysis. The predictors of recurrence and survival were assessed by Cox-regression analysis. 44 patients in the RN group and 88 in the PN group were included without significant differences in preoperative clinical factors after matching. The PN patients achieved significantly higher renal function preservation rates (p < 0.001). There were five recurrences in RN and six in PN. The PN patients revealed 5-year RFS rate (86.8%), 5-year CSS rate (98.5%), and 5-year OS rate (98.5%) comparable to the RN patients (RFS: 88.7% [p = 0.780], CSS: 96.7% [p = 0.375], and OS: 94.3% [p = 0.248]). Patients with a body mass index (BMI) ≥ 23 had lower 5-year RFS rates (85.5%) and OS rates (95.6%) than those with BMI < 23 (RFS: 90.0% [p = 0.195], OS: 100% [p = 0.117]) without significance. The significant predictor of recurrence was the pathologic T stage (hazard ratio [HR] 3.99, 95% confidence [CI] 1.10–14.50, p = 0.036). The significant predictor of death was the R domain of the RENAL (HR 3.80, 95% CI 1.03–14.11, p = 0.046). PN, if technically feasible, could be considered to preserve renal function in patients with RENAL ≥ 10. Nonetheless, PN needs to be implemented with caution in some patients due to the higher potentiality for recurrence and poor survival.
Background We investigated prevalence of familial and hereditary prostate cancer (PCa) in Asian population, and compared clinical characteristics between familial and sporadic disease. Methods Pedigrees of 1102 patients who were treated for PCa were prospectively acquired. Clinical and pathologic characteristics and biochemical recurrence (BCR)‐free survival were compared between familial PCa and sporadic PCa in patients who underwent radical prostatectomy (RP; n = 751). Results The prevalence of familial, first‐degree familial, and hereditary PCa was found to be 8.4%, 6.7%, and 0.9%, respectively; similar result was obtained in patients who underwent RP (8.4%, 6.4%, and 0.9%). Patients with familial PCa were significantly younger than those with sporadic PCa (63.3 vs 65.6 years; P = .015). However, preoperative variables (prostate‐specific antigen, clinical stage, biopsy Gleason score [GS], and percentage of positive biopsy cores) and postoperative variables (surgical GS, upgrading rate, pathologic stage, and percentage of tumor volume) did not correlate with family history (P range: .114–.982). Kaplan‐Meier analysis of 5‐year BCR‐free survival revealed no significant difference between sporadic (82.7%), familial (89.4%; P = .594), and first‐degree familial (87.1%; P = .774) PCa. Analysis of p53, Bcl‐2, Ki67, and other immunohistochemistry biomarkers revealed that only increasing p53 expression and first‐degree familial PCa approached significance (P = .059). Conclusion The prevalence of familial PCa was somewhat lower in the Asian population than in other ethnic groups. Clinical and pathologic variables and selected histologic biomarker abnormalities were not significantly different in patients with and without a family history of PCa. BCR‐free survival following RP was also unaffected by family history.
INTRODUCTION AND OBJECTIVE: COVID-19 has caused significant disruption to the management of urological cancer, this study aims to assess 30-day postoperative outcomes for patients undergoing urological cancer surgery during the COVID-19 pandemic.METHODS: COVIDSurg study is the largest international, multicentre study of COVID-19 in surgical patients performed to date. COVIDSurg-Cancer explored the safety of performing elective cancer surgery during the pandemic. All bladder, kidney, UTUC and prostate cancer patients who underwent elective cancer surgery between March 2020 and July 2020 were included. Univariable and multivariable regression was performed to assess association of patient factors with mortality, respiratory complications and operative complications.RESULTS: A total of 1,902 patients from 36 countries were included. 658 (34.6%) patients had bladder cancer, 590 (31.0%) kidney cancer or UTUC, and 654 (34.4%) prostate cancer. These patients underwent elective curative surgery for their cancers (prostatectomies, nephrectomies, cystectomies, nephroureterectomy, TURBTs). 62% of sites were not designated "hot" COVID-19 sites (i.e. did not actively admit patients with COVID-19).A total of 42/1902 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay. 21 (0.1%) mortalities were observed; of those, 8 (38.1%) were diagnosed with COVID-19. Mortalities were found to be more likely in patients with concurrent COVID-19 infection (OR 31.7, 95% CI 12.4-81.42, p<0.001), aged over 80, ASA grade 3þ and ECOG grade 1þ. 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30 days of surgery. Respiratory complications were more likely in patients aged with concurrent COVID-19 infection (OR 40.6, p<0.001), over 70, from an area with high community risk or with a revised cardiac risk index of 1þ. There were 84 major complications (Clavien-Dindo score !3). Patients with a concurrent COVID-19 infection (OR 7.45, p<0.001) or aged 80 or above were more likely to experience major complications.CONCLUSIONS: Elective urological cancer surgeries are safe to perform during the COVID-19 pandemic. This study highlights important risk-factors associated with worse outcomes. Our data can inform health services to safely select patients for surgery during the pandemic. Patients with concurrent COVID-19 infection have a higher risk of mortality and respiratory complications and should not undergo surgery if possible.
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