Bilateral renal cancers: oncological and functional outcomes

Berczi, Csaba; Ben, Thomas; Bacsó, Zsolt; Flaskó, Tibor

doi:10.1007/s11255-016-1354-4

Cited by 8 publications

(7 citation statements)

References 21 publications

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“…It is more difficult to establish AS protocols for patients with multifocal SRMs than for patients with solitary SRMs. Indeed, there is no consensus in this regard in urological guidelines, and there is scarce literature about the clinical behavior of these masses, with only short series having been evaluated [63][64][65][66]. However, there is a real increase in the prevalence of multifocal renal tumors [67].…”

Section: Multifocal Small Renal Masses and Active Surveillancementioning

confidence: 99%

Active surveillance of small renal masses

et al. 2020

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Most renal masses incidentally detected by cross-sectional images are benign, being mainly cysts, and if they are malignant, they are indolent in nature with limited metastatic potential. Enhanced renal masses less than 4 cm in size are known as small renal masses (SRMs), and their growth rate (GR) and the possibility of developing metastasis are extremely low. Delayed intervention of SRMs by closed and routine imaging follow-up known as active surveillance (AS) is now an option according to urological guidelines. Radiologists have a key position in AS management of SRMs even unifocal and multifocal (sporadic or associated with genetic syndromes) and also in the follow-up of complex renal cysts by Bosniak cyst classification system. Radiologists play a key role in the AS of both unifocal and multifocal (sporadic or associated with genetic syndromes) SRMs as well as in the follow-up of complex renal cysts using the Bosniak cyst classification system. Indeed, radiologists must determine which patients with SRMs or complex renal cysts can be included in AS, establish the follow-up radiological test algorithm to be used in different scenarios, perform measurements in follow-up tests, and decide when AS should be discontinued. The purpose of this article is to review the indications and management of AS in SRMs, especially focused on specific scenarios, such as complex renal cysts and multifocal renal tumors (sporadic or hereditary). In this work, the authors aimed to provide a thorough review of imaging in the context of active surveillance of renal masses.

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Section: Multifocal Small Renal Masses and Active Surveillancementioning

confidence: 99%

Active surveillance of small renal masses

et al. 2020

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“…They reported significant postoperative renal function deterioration (44.8% eGFR decrease for synchronous (mostly RN → PN) and 30.4% decrease for metachronous tumor (all RN → PN) after the second operation, respectively), but hemodialysis was rarely required. Compared to their results, we showed more eGFR preservation if RN → PN (23.1% decrease) is performed respectively even though their cohort characteristics are slightly different [ 32 ].…”

Section: Discussionmentioning

confidence: 71%

Evaluation of functional outcome of bilateral kidney tumors after sequential surgery

Kim

Lee

et al. 2021

BMC Cancer

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Background There are limited data concerning patients treated with sequential bilateral kidney surgery. Current guidelines still lack an optimal surgical sequencing approach. We evaluated renal functional outcomes after sequential partial nephrectomy (PN) and radical nephrectomy (RN) in patients with bilateral renal cell carcinoma (RCC). Methods A propensity score matched cohort of 267 patients (synchronous bilateral RCCs, N = 44 [88 lesions]; metachronous bilateral, N = 45 [90 lesions]; unilateral, N = 178) from two tertiary institutions were retrospectively analyzed. Synchronous bilateral RCCs were defined as diagnosis concomitantly or within 3 months of former tumor. Renal functional outcomes were defined as estimated glomerular filtration rate (eGFR) changes and de novo chronic kidney disease (CKD, stage ≥3) after surgery. Renal functional outcomes and clinical factors predicting de novo CKD were assessed using descriptive statistics and Cox regression analysis. Results In subgroup of bilateral RCCs, patients underwent sequential PN (N = 48), PN followed by RN (N = 8), or RN followed by PN (N = 25). Final postoperative estimated glomerular filtration rates (eGFRs) were 79.4, 41.4, and 61.2 ml/minute/1.73 m2, respectively (p = 0.003). There were significant differences in eGFR decline from baseline and de novo chronic kidney disease (CKD stage ≥ III) among groups, with PN followed by RN group showing the worst functional outcomes (all p < 0.05). Moreover, sequential PN subgroup in bilateral RCC showed significantly higher rate of de novo CKD than unilateral RCC group (13.8% vs. 6.9%, p = 0.016). On multivariate analysis, hypertension (p = 0.010) and surgery sequence (PN followed by RN, p < 0.001) were significant predictors of de novo CKD. Conclusions The surgery sequence should be prudently determined in bilateral renal tumors. PN followed by RN showed a negative impact on renal functional preservation. Nephron-sparing surgery should be considered for all amenable bilateral RCCs.

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“…In the present study, we reported the CSS difference between synchronous bilateral renal cancer group and metachronous bilateral renal cancer group. And in previous studies, Csaba Berczi showed that the 5-year CSS were 86% in synchronous bilateral renal cancer while 75% in metachronous group [4]. Singer EA showed that overall survival was 88% and CSS was 97% after a minimum of 10-year follow-up for patients with bilateral renal cancer [5].…”

Section: Discussionmentioning

confidence: 87%

Prognosis of the Metachronous and Synchronous Bilateral Renal Cancer and Second Primary Cancer After the Bilateral Renal Cancer: a Population-Based Analysis

Abudurexiti

Wang

Shao

et al. 2019

SN Compr. Clin. Med.

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It is essential to summarize independent prognostic factors of bilateral kidney cancer and to clarify how the second primary cancer develops under these prognostic factors. Patients first diagnosed with bilateral renal cancer between 1973 and 2015 were abstracted from the SEER database. The Kaplan-Meier survival curves were conducted to depict survival difference and the logrank tests were used to determine statistical significance. Multivariate Cox proportion hazard regression analyses were established to evaluate statistical significance for survival probability of each substage. The data of the second primary cancer after bilateral renal cancer were collected by MP-SIR session. There were 847 cases of synchronous bilateral renal cancer and 1218 cases of metachronous bilateral renal cancer. The 5-year cancer-specific survival (CSS) rate of the synchronous bilateral renal cancer is 51.5% and it is 93.6% in the metachronous group. In the synchronous group, there exists a CSS difference among the age subgroups (p < 0.001), the behavior subgroups (p < 0.001), the tumor size subgroups (p = 0.044), and the stage subgroups (p < 0.001). And in the metachronous group, there was a statistical significance among the age subgroups (p < 0.001), the tumor size subgroups (p = 0.015), and the stage subgroups (p < 0.001). Only 5 cases were observed in the synchronous group as the second primary cancer, while 268 cases were discovered in the metachronous group. Compared with synchronous bilateral renal cancer, metachronous bilateral renal cancer had a better CSS. And the incidence of second primary cancer is higher in the metachronous group than in the synchronous group. Further studies should be conducted.

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Bilateral renal cancers: oncological and functional outcomes

Abstract: In patients with bilateral renal carcinomas, the histologic concordance was 93.6 %. The bilateral partial nephrectomies or unilateral nephrectomy and contralateral resection provided acceptable oncological and functional outcomes.

Cited by 8 publications

References 21 publications

Active surveillance of small renal masses

Active surveillance of small renal masses

Evaluation of functional outcome of bilateral kidney tumors after sequential surgery

Prognosis of the Metachronous and Synchronous Bilateral Renal Cancer and Second Primary Cancer After the Bilateral Renal Cancer: a Population-Based Analysis

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