In the last years the incidence of renal neoplasms has been steadily increasing, along with the average age of patients at the time of diagnosis. Surgical management for localized disease is becoming more challenging because of patients’ frailty. We conducted a multi-center prospective study to evaluate the role of the G8 as a screening tool in the assessment of intra and post-operative complications of elderly patients (≥70 y.o.) undergoing surgery for kidney cancer. A total of 162 patients were prospectively enrolled between January 2015 to January 2019 and divided into two study groups (frail vs. not-frail) according to their geriatric risk profile based on G8 score. Several factors (i.e., age, CCI, ASA score, preoperative anemia, RENAL score, surgical procedures, and techniques) were analyzed to identify whether any of them would configure as a statistically significant predictor of surgical complications. According to the G8 Score, 90 patients were included in the frail group. A total of 52 frail patients vs. 4 non-frail patients developed a postoperative complication of any kind (p < 0.001). Of these, 11 were major complications and all occurred in the frail group. Our results suggest that the G8 screening tool is an effective and useful instrument to predict the risk of overall complications in elderly patients prior to renal surgery.
Renal cell carcinoma (RCC) is the most common form of kidney cancer with 403,262 diagnoses and 170,000 deaths worldwide in 2018. Although partial or radical nephrectomy can be considered a successful treatment in early-stage or localized RCC, in advanced-stage disease, there is a high risk of metastasis or recurrence with a significantly poorer prognosis. Metastatic RCC is generally resistant to both chemotherapy and radiotherapy, and, despite several novel therapeutic agents, disease progression and mortality rates remain high. It is necessary to identify new diagnostic and therapeutic strategies for the management of this cancer. Knowledge of microRNA (miRNA) has consistently increased in the last year. miRNAs play an important role in several biological processes, such as cell proliferation, differentiation, and cell death. Due to this, miRNAs have been identified as an important key in different diseases, especially in cancer, and several studies show miRNAs as attractive tools and targets for novel therapeutic approaches. Recently several miRNAs (including miR-22, miR-203, miR-301 and miR-193a-3p) have been linked to dysregulated molecular pathways involved with the proliferation of cancerous cells and resistance to therapeutic agents. In the present study, recent data from studies assessing the application of miRNAs as biomarkers, therapeutic targets, or modulators of response to treatment modalities in RCC patients are analyzed.
Background and Objectives: To assess efficacy and safety of Percutaneous Cryoablation (PCA) of small renal masses (SRMs) using Trifecta outcomes in a large cohort of patients who were not eligible for surgery. Materials and methods: All PCAs performed in four different centers between September 2009 and September 2019 were retrospectively evaluated. Patients were divided in two different groups depending on masses dimensional criteria: Group-A: diameter ≤ 25 mm and Group-B: diameter > 25 mm. Complications rates were reported and classified according to the Clavien–Dindo system. The estimate glomerular filtration rate (eGFR) was calculated before PCA and during follow-up schedule. Every patient received a Contrast Enhanced Ultrasound (CEUS) evaluation on the first postoperative day. Radiological follow-up was taken at 3, 6, and 12 months for the first year, then yearly. Radiological recurrence was defined as a contrast enhancement persistence and was reported in the study. Finally, Trifecta outcome, which included complications, RFS, and preservation of eGFR class, was calculated for every procedure at a median follow-up of 32 months. Results: The median age of the patients was 74 years. Group-A included 200 procedures while Group-B included 140. Seventy-eight patients were eligible for Trifecta evaluation. Trifecta was achieved in 69.6% of procedures in Group-A, 40.6% in Group-B (p = 0.02). We observed an increased rate of complication in Group-B (13.0% vs. 28.6; p < 0.001). However, 97.5% were <II Clavien–Dindo grade. No differences were found between the two groups regarding eGFR before and after treatment. Further, 24-months RFS rates were respectively 98.0% for Group-A and 92.1% in Group-B, while at 36 months were respectively 94.5% and 87.5% (p = 0.08). Conclusions: PCA seems to be a safe and effective treatment for SRM but in the need of more strict dimensional criteria to achieve a higher possible success rate.
AbbreviationsAKI = acute kidney injury BMI = body mass index CKD = chronic kidney disease DM = diabetes mellitus PN = partial nephrectomy PPV = positive predictive value RN = radical nephrectomy RPN = robotic partial nephrectomy WIT = warm ischemia time
BaCKgroUNd: The impact of warm ischemia time (WiT) on renal functional recovery remains controversial. We examined the length of WiT>30 min on the long-term renal function following on-clamp partial nephrectomy (pN). MeThodS: data from 23 centers for patients undergoing on-clamp pN between 2000 and 2018 were analyzed. We included patients with two kidneys, single tumor, cT1, minimum 1-year follow-up, and preoperative eGFR≥60 mL/
Introduction: Fournier’s Gangrene (FG) has still a mortality rate up to 45%. Several studies identified prognostic factors but there is a knowledge gap concerning procalcitonin (PCT) levels and mortality risk in FG. This study is aimed to assess the role of PCT as prognostic factor in FG. Materials and methods: The medical records of 20 male FG patients admitted at the Department of Urology of “Cattinara” Hospital, University of Trieste between January 2019 and November 2020 were retrospectively reviewed. Clinical, demographic, microbiological data were collected. The Fournier’s Gangrene Severity Index (FGSI) was calculated for each patient. Results: Thirteen (65%) of 20 patients survived. Median age was 58 years (IQR 51–88), 15 patients (75%) had a Charlson Comorbidity Index (CCI) score ⩾2, 1 (5%) equal to 0, 4 to 1 (20%). Median FGSI score was 6 (IQR 2–12) and median PCT 0.8 ng/ml (IQR 0.04–2.12). At multivariate analysis PCT levels >0.05 ng/ml were associated with an increased overall mortality risk (OR 2.14, CI 1.25–4.27, p = 0.002). CCI score ⩾2 (OR 1.51, CI 1.01–2.59, p = 0.04), Streptococcical etiology (OR 3.41, CI 2.49–4.61, p = 0.002) and FGSI score >9 (OR 1.41, CI 1.19–2.21, p = 0.004) were associated with unfavorable outcome. Conclusion: PCT might be a prognostic factor in FG. CCI and FGSI are useful tools in mortality risk stratification. Streptococcical etiology is associated with unfavorable outcome. Further larger clinical trials are pending.
The molecular mechanisms of muscle invasion in bladder cancer (BC) are still unknown. Based on the microRNA (miRNA) signature of BC by deep sequencing, we recently found that several double-stranded mature miRNAs derived from the same pre-miRNAs acted as tumor suppressors by regulating common target genes. In this study, we focused on miR-199 family members (miR-199a-3p/-5p and miR-199b-3p/-5p) that were downregulated in the signature. The aim of this study was to investigate the functional role of miR-199 family members and to identify molecular targets that contribute to tumor invasion in BC.METHODS: Expression levels of these miRNAs in 32 BC clinical samples and 12 normal bladder epithelia (NBE) and cell lines (T24 and BOY) were evaluated by qRT-PCR. Cell proliferation, migration, and invasion assays were performed in these miRNAs transfected BC cells. In silico analysis by using TargetScan and GEO database were applied to identify candidate target genes of these miRNAs. Luciferase reporter assays were carried out to determine whether these miRNAs directly bind to the target gene. We performed loss-of-function studies by using si-RNA transfectants to evaluate the functional role of target gene. We confirmed the target gene expression and the correlations between miR-199 family and the target gene expression by The Cancer Genome Atlas (TCGA) database (408 BCs and 19 NBE).RESULTS: The expression levels of these miRNAs were significantly reduced in clinical BCs (P < 0.005). Restoration of these miRNAs significantly inhibited cell migration and invasion in BC cells (P < 0.0001). Luciferase reporter assays identified integrin a3 (ITGA3) as a target gene directly regulated by these miRNAs. TCGA database showed that ITGA3 expression was significantly upregulated in BC compared with NBE (P ¼ 0.0063) and there were significant negative correlations between ITGA3 and miR-199 family expression (P < 0.05). Immunohistochemistry demonstrated ITGA3 expression was significantly upregulated in BCs compared with NBE (P ¼ 0.0038) and highly expressed in patients with advanced tumor stage (T2 or more) (P ¼ 0.048). Loss-of-function study showed that cell migration and invasion were significantly inhibited in si-ITGA3 transfectans (P < 0.0001).CONCLUSIONS: Recent studies showed that ITGA3 functions as extracellular matrix (ECM) receptor and contributes to cancer cell migration and invasion. Our data suggested that ITGA3 was directly regulated by miR-199 family and could be a novel therapeutic target in BC.
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