Risk factors for positive soft tissue surgical margins are female gender, locally advanced cancer, presence of vascular invasion and mixed histology. Patients with positive soft tissue surgical margins have poor prognosis, and positive soft tissue surgical margins were found to be independently associated with disease specific death.

Purpose-Use of partial nephrectomy for renal cortical tumors appears unacceptably low in the United States according to population-based data. We examined the use of partial nephrectomy at our tertiary care facility in the contemporary era.Methods-Using our prospectively maintained nephrectomy database, we identified 1,533 patients treated for a sporadic and localized renal cortical tumor between 2000 and 2007. Patients with bilateral disease or solitary kidneys were excluded and an elective operation required an estimated GFR ≥45 ml/min/1.73m 2 . Predictors of partial nephrectomy were evaluated using logistic regression models.Results-Overall, 854 (56%) and 679 (44%) patients were treated with partial and radical nephrectomy, respectively. Among the 820 patients treated electively for a tumor ≤4cm, the frequency of partial nephrectomy use steadily increased from 69% in the year 2000 to 89% in 2007. Among the 365 patients treated electively for a tumor 4-7cm, the frequency of partial nephrectomy use also steadily increased from 20% in the year 2000 to 60% in 2007. In a multivariate analysis, male gender (p=0.021), later year of surgery (p<0.001), younger age (p=0.004), smaller tumor size (p<0.001), and open surgery (p<0.001) were significant predictors of receiving a partial nephrectomy. ASA score, race, and body mass index were not significantly associated with type of treatment.Conclusions-Use of partial nephrectomy is increasing and is now utilized for ~90% of patients with T1a tumors at our institution. For reasons that remain unclear, certain groups of patients are less likely to be treated with partial nephrectomy.

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Epigenetic aberrations are prominent in bladder cancer (BC) and contribute to disease pathogenesis. We characterized histone deacetylase (HDAC) expression, a family of deacetylation enzymes, in both in vitro and in vivo BC model systems and analyzed expression data from The Cancer Genome Atlas (TCGA). Quantitative real-time polymerase chain reaction (qRT-PCR) and western blotting analysis was used to determine the expression status of Class I and II HDACs in ten human BC cell lines, while qRT-PCR was used to determine HDAC expression in 24 human tumor specimens. The TCGA cohort consists of 408 muscle invasive BC (MIBC) clinical samples and analysis of this data set identified expression of HDAC4 and -9 as being associated with basal–squamous disease. These findings agree with qRT-PCR results identifying increased expression of HDAC4, -7, and -9 in basal BC cell lines (p < 0.05; Kruskal–Wallis test) and in clinical specimens with invasive bladder cancer (not statistically significant). We also observed increased expression in Hdac4, -7, and -9 in commonly used BC mouse models. Here, we identify suitable preclinical model systems for the study of HDACs, and show increased expression of Class IIa HDACs, specifically HDAC4 and HDAC9, in basal BC cell lines and in invasive clinical specimens. These results suggest this class of HDACs may be best suited for targeted inhibition in patients with basal BC.

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