Influence of venous tumour extension on local and remote recurrence of stage pT3a pN0 cM0 kidney tumours

Bernardos, G. Barbas; Amo, F. Herránz; Velasco, J. Caño; Gil, María José; Castro, J. Mayor de; Chamizo, J. Aragón; Pujol, L. Polanco; Fernández, C. Hernández

doi:10.1016/j.acuroe.2019.01.001

Cited by 3 publications

(5 citation statements)

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“…Such results allowed us to identify these indices as independent predictors of local kidney tumor recurrence. 68…”

Section: Resultsmentioning

confidence: 99%

“…21 Clear cell tumor type (p < 0.0001) and high stage (Fuhrman stage 4, p = 0.003 14 Fuhrman stage (HR = 2.75; p = 0.0001) and pTpN stage (HR = 2.19; p = 0.0001) 18 Sarcomatoid differentiation (HR = 1.60, 95% CI: 1.29-1.99, p < 0.001) 21 Rhabdoid differentiation (HR = 2.81: p = 0.0266) 22 Microvascular invasion (HR = 2.75; 95% CI 1.97-3.823, p < 0.001). 28 Collecting system invasion (HR = 4.26, p = 0.001) 32 Microvascular invasion (p = 0.001) and tumor necrosis (p = 0.0001) 68 Fuhrman III or IV stages (HR = 38.3, 95% CI 3.1-467, p = 0.004) 75 Anatomic factors associated with recurrence-free survival Tumor size >7 cm (HR = 3.27; p = 0.004) and inferior vena cava thrombosis (HR = 4.07, p = 0.0074) 32 Peritoneal/renal sinus/renal vein invasion (HR = 14.28, p = 0.0008) 33 Renal capsule involvement (p = 0.007), 31 (p < 0.001) 34 Tumor size (p < 0.05) 69 Clinical predictors of recurrence-free survival Body mass index (BMI) (p = 0.005), 39 (p = 0.004) 40 Thrombocytosis (p < 0.001) 41 -Nature of treatment as a predictor of recurrence-free survival Thermoablation (p < 0.05) 53 Thermoablation (locRFS 98.9% for surgical treatment vs. 93.0% thermoablation) 70 PSM as a predictor of recurrence-free survival PSM (95% CI 2.75-20.34, p < 0.001) for highly aggressive tumors (pT2-3a or Fuhrman III-IV) 74 PSM (HR = 4.8; 95% CI 2-11.6; p = 0.01) 7 PSM (p < 0.01) 73 Immunohistochemical markers as potential prognostic marker for recurrence-free survival PD-1(p = 0.0005) 58 High expression of immune checkpoint molecules in tumor-infiltrating lymphocytes (HR = 0.475, 95% CI 0.238-0.948, p = 0.035) 61 PD-L2 (p = 0.02) 62 -Genotype markers as potential prognostic marker for recurrence-free survival CD146 gene expression (p = 0.018) 65 in 2019, a group from the US proposed a definition of "true local recurrence" of RCC. Thus, they believe that a true local recurrence after kidney resection is a tumor nodule identified after radical removal of a primary tumor of the same histological type in the bed of the removed tumor.…”

Section: Discussionmentioning

confidence: 99%

“…Such results allowed us to identify these indices as independent predictors of local kidney tumor recurrence. 68 Anatomic predictors of local RCC recurrence. A Mayo Clinic retrospective study confirmed the role of tumor size as an anatomical factor in local RCC recurrence.…”

Section: Histological Predictors Of Local Rcc Recurrencementioning

confidence: 99%

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Markers of local kidney cancer recurrence: A surgeon’s mistake or a pattern? Review

et al. 2022

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The influence of various morphological, anatomical, genetic and other factors on the local recurrence-free survival of patients who have undergone different renal cell cancer (RCC) treatment is still a rather complex, ambiguous and controversial issue for practicing oncourologists. This review evaluates the effect of several factors on both recurrence-free survival and local recurrence-free survival. The review includes articles, clinical cases, literature reviews, and meta-analyses highlighting the analysis of independent and interrelated predisposing factors for developing local recurrence of RCC from 1984 to 2020. The PubMed, Web of Science, and Scopus databases were searched in English, Spanish, and German. A review of the literature showed the role of the following indices in the local recurrence RCC: microvascular invasion ( p = 0.001), tumor necrosis ( p = 0.0001), high malignancy (Fuhrman III or IV) (HR = 38.3, 95% CI 3.1–467, p = 0.004) as histological factors, tumor size as an anatomical factor. Thus, the authors state that every centimeter of the tumor increases the risk of local recurrence ( p < 0.05). A group from the Mayo Clinic showed the equivalence of different treatment methods in local RCC recurrence. Thus, in the group of patients with cT1a stage kidney cancer, the 5-year local recurrence-free survival rates were 97.7% (96.7–98.6), 95.9% (92.3–99.6), and 95.9% (92.3–99.6) for renal resection, RFA, and cryoablation, respectively. Surgical margin status is the most studied and controversial marker of local renal cell carcinoma recurrence. Researchers found a direct effect of PSM on the risk of local RCC recurrence ( p < 0.01). The personalized approach with the search and evaluation of predisposing factors for the local recurrence, as well as further selection of the most optimal treatment, will allow oncourologists to improve both the effectiveness of primary treatment and the recurrence-free survival of patients.

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“…Such results allowed us to identify these indices as independent predictors of local kidney tumor recurrence. 68…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Markers of local kidney cancer recurrence: A surgeon’s mistake or a pattern? Review

et al. 2022

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“…Zhao et al examined 139 RCC patients and aimed to explore the relationship between clinical and pathologic features with prognostic factors and indicated that microvascular invasion was a significant predictor of prognosis (24). Bernardos et al retrospectively analyzed 153 pT3apN0cM0 kidney cancer patients and indicated that tumor necrosis and microvascular invasion were associated with tumor recurrence (25). Kim et al reviewed 406 patients with localized or locally advanced ccRCC who underwent curative surgery and were followed up for >2 years after surgery and indicated that tumor necrosis and MVI were independent risk factors for postoperative recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Bernardos et al. retrospectively analyzed 153 pT3apN0cM0 kidney cancer patients and indicated that tumor necrosis and microvascular invasion were associated with tumor recurrence ( 25 ). Kim et al.…”

Section: Discussionmentioning

confidence: 99%

Arterial Spin Labeling MRI for Predicting Microvascular Invasion of T1 Staging Renal Clear Cell Carcinoma Preoperatively

et al. 2021

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BackgroundMicrovascular invasion (MVI) is a valuable factor for T1 staging renal clear cell carcinoma (ccRCC) operation strategy decision, which is confirmed histopathologically post-operation. This study aimed to prospectively evaluate the performance of arterial spin labeling (ASL) MRI for predicting MVI of T1 staging ccRCC preoperatively.Methods16 volunteers and 39 consecutive patients were enrolled. MRI examinations consisted of ASL (three post label delays separately) of the kidney, followed by T1 and T2-weighted imaging. Two sessions of ASL were used to evaluate the reproducibility on volunteers. Renal blood flow of renal cortex, medulla, the entire and solid part of the tumor were measured on ASL images. Conventional imaging features were extracted. MVI and WHO/ISUP classification were evaluated histopathologically. A paired t‐test was used to compare the renal cortex and medulla between ASL 1 and ASL 2. The reproducibility was assessed using the intraclass correlation. Differences in mean perfusion between the entire and the solid parts of tumors with or without MVI were assessed separately using Student’s t test. The diagnostic performance was assessed. Logistic regression analysis was used to indicate the independent prediction index for MVI.ResultsThe two sessions of ASL showed no significant difference between the mean cortex values of RBF. The cortical RBF measurements demonstrated good agreement. 12 ccRCCs presented with MVI histopathologically. Mean perfusion of the solid part of tumors with MVI were 536.4 ± 154.8 ml/min/100 g (PLD1), 2912.5 ± 939.3 ml/min/100 g (PLD2), 3280.3 ± 901.2 ml/min/100 g (PLD3). Mean perfusion of the solid part of tumors without MVI were 453.5 ± 87.2 ml/min/100 g (PLD1), 1043.6 ± 695.8 ml/min/100 g (PLD2), 1577.6 ± 1085.8 ml/min/100 g (PLD3). These two groups have significant difference at all the PLDs (p < 0.05). The RBF of PLD1 of the solid part of tumor perfusion showed well diagnostic performance for predicting MVI: sensitivity 75%, specificity 100%, positive predictive value 66.7%, and negative predictive value 95.7%. The maximum diameter of the tumor, ill-defined margin, and the solid part of tumor perfusion were the independent prediction index for MVI.ConclusionASL MR imaging has good reproducibility for renal cortex, and good diagnostic performance for predicting MVI for ccRCC.

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Predictors of local recurrence of renal cell cancer. Our experience

et al. 2022

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Risk factors for renal cell cancer (RCC) recurrence, including its local form, include stage and high Fuhrman grading system score, regional lymph node involvement, microvascular invasion, tumor necrosis, positive surgical margin, and sarcomatoid or rhabdoid tumor differentiation. Objective. The study analyzes data from Moscow Research Oncological Institute named by PA Herzen to determine the predictors of local recurrence of kidney cancer based on the data from surgically treated patients with local recurrent RCC. Material and methods. We analyzed retrospectively data from 87 patients who were divided into 2 groups: 1-st, patients with detected local recurrence of kidney cancer (n=43), and 2-nd, control group (n=44). The following predictors were evaluated: tumor size, tumor histotype, tumor stage, Fuhrman grading system, surgical margin status, tumor necrosis, sarcomatoid and rhabdoid changes, microvascular invasion, hemorrhage and invasion of collecting system components (CSS), renal capsule, and perirenal cellular tissue and primary treatment. Results. The risk of local recurrence was higher in the primary tumor, over 40 mm in diameter (OR=5.8, p<0.001), as well as microvascular invasion and focal hemorrhage (OR=15.1, p=0.001 and OR=3.3, p=0.008, respectively). Both univariate and multivariate analyses showed a negative effect on the risk of local RCC recurrence only for tumor necrosis (OR=15.4, p<0.001 and OR=53.6, p=0.002, respectively) and high Fuhrman grade (OR=10.9, p=0.042 and OR=5.7, p=0.032, respectively). The most significant predictors of local renal cancer recurrence are tumor necrosis (p<0.001), microvascular invasion (p=0.019), positive surgical margin (p=0.009), and high Fuhrman grade (p=0.04). High Fuhrman grade (3–4) of malignancy (HR=1.9, p=0.042), tumor diameter (HR=1.0, p=0.054), positive surgical margin (HR=3.5, p=0.001), and tumor necrosis (HR=2.3, p=0.029) were found to be the most significant factors influencing 5-year local recurrence-free survival rate. Conclusion. The course of renal cell cancer is determined by multiple interrelated and independent prognostic factors.

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Influence of venous tumour extension on local and remote recurrence of stage pT3a pN0 cM0 kidney tumours

Cited by 3 publications

References 18 publications

Markers of local kidney cancer recurrence: A surgeon’s mistake or a pattern? Review

Markers of local kidney cancer recurrence: A surgeon’s mistake or a pattern? Review

Arterial Spin Labeling MRI for Predicting Microvascular Invasion of T1 Staging Renal Clear Cell Carcinoma Preoperatively

Predictors of local recurrence of renal cell cancer. Our experience

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