Prognostic factors and long-term survival in renal cell cancer patients

Sunela, Kaisa; Kataja, Matti; Lehtinen, E; Salminen, Tapio; Kujala, Paula; Virman, Juha; Kellokumpu‐Lehtinen, Pirkko‐Liisa

doi:10.1080/00365590903286697

Cited by 3 publications

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“…[14][15][16] Although large tumors were traditionally surgically removed, SRMs allow multiple treatment options, given the hypothesis that small tumors might represent a slow and indolent disease. 3,4 This was particularly relevant for older patients with multiple complex medical conditions who might prefer a conservative management. The rapidly aging society in many developed countries, coupled with rising incidence of SRMs, presented a challenging conundrum for clinicians, and current treatment options for SRMs include surgical extirpation, tumor ablation or active surveillance/ watchful waiting depending on tumor profile, patients' conditions and preferences.…”

Section: Discussionmentioning

confidence: 99%

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Are small renal masses all the same?

et al. 2020

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Abbreviations & Acronyms CT = computed tomography EAU = European Association of Urology IQR = interquartile range LVI = lymphovascular invasion MRI = magnetic resonance imaging RCC = renal cell carcinoma SEER = Surveillance, Epidemiology and End Results SRM = small renal mass Objectives: To evaluate variables that can predict synchronous metastasis in patients presenting with small renal masses. Methods: We reviewed our institution's prospectively maintained database of 565 patients diagnosed with small renal masses (≤4 cm) over a 16-year period. Variables associated with synchronous metastasis and subsequent relapse were analyzed using v 2 and logistic regression models. Results: A total of 16 patients (2.7%) presented with synchronous metastasis. Just three patients with tumor size <3 cm had metastatic disease at presentation. On multivariate analyses, tumor size >3 cm, symptomatic cancer, age >65 years and ipsilateral synchronous tumors were independent predictors of M1 renal cell carcinoma. A weighted predictive model (concordance index 0.786) showed that a score ≥2 significantly increases the risk of synchronous metastasis (7.9% vs <1% for score <2, P < 0.01, hazard ratio 12.56, 95% confidence interval 5.52-22.85). A total of 498 (90.7%) patients underwent nephrectomies, 27 (4.9%) had ablative therapies and 24 (4.4%) continued on active surveillance/watchful waiting. Over a median follow-up period of 62.8 months, 30 patients (6.1%) had disease recurrence. On multivariate analyses, higher Fuhrman grade and lymphovascular invasion were independent predictors of recurrence. A separate predictive model (concordance index 0.723) showed that either pathological outcome increases recurrence risk up to 15% (P < 0.01, hazard ratio 11.83, 95% confidence interval 5.82-18.76). Conclusions: Several clinical variables can better identify the metastatic potential of small renal masses. The two proposed predictive models can be valuable tools in future clinical practice.

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Section: Discussionmentioning

confidence: 99%

“…Currently, the prevailing paradigm is that the risk of synchronous metastasis in SRMs is low. 3,4 Traditionally, the widely used American Joint Committee on Cancer staging system correlates tumor size to prognosis and outcomes. 5,6 In fact, a number of studies have found that the risk of metastasis is extremely low in tumor sizes <3 cm.…”

Section: Introductionmentioning

confidence: 99%

Are small renal masses all the same?

et al. 2020

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“…The probability of recurrence at 5 years was 6% for males versus no recurrence for females (P =.011). Sunela et al [20] also found better survival rates in female patients.…”

Section: Discussionmentioning

confidence: 90%

Tumor Recurrence Following Nephron-Sparing Surgery for Renal Cancer: Rate, Patterns, and Predictors

Halachmi¹,

xMoskovitz²,

Nativ³

2010

UIJ

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KEYWORDS: Renal cell carcinoma; Nephron-sparing surgery; Cancer recurrence CORRESPONDENCE: Sarel Halachmi MD, INTRODUCTION:Tumor recurrence following nephron-sparing surgery (NSS) for renal carcinoma is a major concern.The aim of this retrospective study was to assess the rate, patterns, and predictors of tumor recurrence in patients following NSS for renal cancer. METHODS: Between 1993 and 2008, 229 patients underwent NSS via flank incision for renal cell carcinoma. Patients without metastases at diagnosis (using CT and bone scan) were included in the outcome analysis. Categorical variables were compared with the Fisher-Irwin exact test. Kaplan-Meier was used to determine the probability of overall survival and probability of recurrence curves; significance was tested with the log-rank. The Cox hazard survival model was used to identify whether any of the demographic or clinical variables were predictive of the probability of recurrence. RESULTS: During a mean (SD) follow-up time of 45 (34) months, tumor recurrence was observed in 13 patients (5.6%). Mean follow-up time for detection of oncological failure was 51 months. All patients with oncological failure were males, with a mean age of 61 years (median 58; range, 51-74 years). The average size of the enucleated lesion was 5 cm (range, 4-7 cm). Intraoperative frozen sections and postoperative pathological examination of the surgical margins were negative in all cases. Predictors of oncological failure included: warm ischemia time > 20 minutes (P = .012), tumor size ≥ 4 cm (P = .001), central tumor location (P = .015), multifocal tumors (P =.001), and male gender (P = .01). The probability of overall disease recurrence at 12 and 60 months was 1.8% and 4.0%, respectively. The overall cancer-specific survival rate was 93.8%. The 12-month and 60-month metastasisfree survival rates were 99.1% and 98.4%, respectively. Recurrence was due to surgeon-related and tumor-related patterns. CONCLUSIONS: NSS is an effective surgery with satisfactory long-term cancer control. Predictors of recurrence were consistent with previous literature except for warm ischemia time > 20 minutes (noted for the first time). Reasons for cancer relapse include seeding during surgery, residual disease, distant dissemination, and new tumor growth. Careful tumor handling and extensive perirenal fat resection are within the surgeon's control and may reduce failure rates. UroToday International Journal ® UI J

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“…First, although our data set was population-based, it only represents approximately 7% of the Japanese population in one geographic region, and our obtained pathology diagnoses were not based on a central pathology review. In addition, other relevant outcomes (eg, relative survival) 28 were not evaluated, and complete data were limited for histology and other prognostic variables (including stage) because of missing data, thereby limiting internal and external generalizability. However, our sensitivity analyses with multiple imputation and complete data yielded almost identical results.…”

Section: Discussionmentioning

confidence: 99%

“…19 Third, because of the limitation of the data, we were not able to classify histological subtypes further (such as type 1 and type 2 papillary RCC). 28 Since patients with type 2 papillary RCC tend to have poorer prognosis, 29 future studies focusing on sex differences in papillary RCC subtypes are needed.…”

Section: Discussionmentioning

confidence: 99%

Sex‐specific analysis of renal cell carcinoma histology and survival in Japan: A population‐based study 2004 to 2016

Zaitsu

Toyokawa

Takeuchi

et al. 2019

Health Science Reports

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Background and aims In Western countries, sex differences in renal cell carcinoma (RCC) histology and survival have been previously described: compared with men, clear cell subtype is more common but overall prognosis is better among women. The goal of the present study was to examine sex differences in RCC histology and survival in Japan, using a large‐scale population‐based data set. Methods With the use of a population‐based cancer registry in Japan (2004‐2016), patients with primary RCC were followed for 5 years (median follow‐up time 2.1 years). We distinguished histological subtypes of clear cell, papillary, and chromophobe from “others” subtype. Sex‐specific prevalence ratio (PR) for each histological subtype was estimated by Poisson regression with robust variance, adjusted for age and year of diagnosis. Sex‐specific survival rates were estimated by Cox proportional hazard regression, adjusted for age, year of diagnosis, histological subtypes, and other prognostic variables, with multiple imputation. Results The prevalence of clear cell and “others” subtypes was similar between men and women among all the 5265 study subjects during the 12 years of study (clear cell, male 88.6% vs female 87.1%; “others“, male 5.3% vs female 5.3%). However, papillary subtype was less common among women than men (male 4.6% vs female 2.8%; PR = 0.63; 95% CI, 0.45‐0.88), while chromophobe subtype was more common among women (male 1.6% vs female 4.8%; PR = 3.18; 95% CI, 2.26‐4.47). Although “others” subtype (but not papillary/chromophobe subtypes) independently predicted prognosis (HR = 1.74; 95% CI, 1.32‐2.30), no sex differences were observed in RCC survival. Conclusion We did not observe a statistically significant difference in the prevalence of clear cell subtype between men and women in Japan, which differs from the pattern previously described in Western countries. Sex differences in RCC histology may not affect RCC survival in this population.

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Prognostic factors and long-term survival in renal cell cancer patients

Cited by 3 publications

References 0 publications

Are small renal masses all the same?

Are small renal masses all the same?

Tumor Recurrence Following Nephron-Sparing Surgery for Renal Cancer: Rate, Patterns, and Predictors

Sex‐specific analysis of renal cell carcinoma histology and survival in Japan: A population‐based study 2004 to 2016

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