Patterns and Predictors of Recurrence after Partial Nephrectomy for Kidney Tumors (original) (raw)
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Anticancer research, 2014
We investigated the clinicopathological features in patients with recurrent RCC within 5 years or more than 5 years after nephrectomy and determined predictors of survival and response treatment after recurrence. We retrospectively evaluated 144 patients with disease recurrence; 73 had recurrence more than 5 years after radical nephrectomy. We compared clinicopathological characteristics in patients with disease recurrence before vs. after 5 years. In addition, we investigated predictors of survival and response to treatment after recurrence. Seventy-one patients (49%) were diagnosed with recurrence within 5 years after radical nephrectomy (early recurrence) and 73 patients (51%) were diagnosed with recurrence more than 5 years after radical nephrectomy (late recurrence). Fuhrman grade, tumor necrosis and lymphovascular invasion were statistically significantly different between the two groups (p<0.001, p=0.013, p=0.026, respectively). The late recurrence patients were significan...
European Urology, 2004
Objectives: Staging of the primary tumour is accepted as the most important prognostic factor in organ confined renal cell carcinoma. Methods: The outcome of 286 patients with non-metastatic RCC treated by radical nephrectomy at our institution between 1968 and 1992 was evaluated retrospectively. The median follow-up was 114 AE 62.6 months. In T1/T2 tumours, the validity of tumour size cutoff points for predicting survival outcome was tested. Results: According to the 1997 TNM classification, 168 patients (59%) showed pathological stage T1 (72 stage T1a, 96 stage T1b), 30 (10%) showed stage T2, 84 patients (29%) demonstrated T3 tumours (53 stage T3a, 31 stage T3b), and 4 patients (2%) presented with T4 tumours. The median survival estimated by Kaplan-Meier analysis for T1a, T1b, T2, T3a, T3b and T4 tumours was over 300 months, 187.0 AE 32.76; 177.0 AE 1.21; 121.0 AE 2.57; 124.0 AE 11.82 and 52.0 AE 18.38 months, respectively. Regarding survival in T1/T2 tumours Cox regression analysis yielded the highest significance level for a tumour size cutoff point at 4 cm (p ¼ 0.003; 95%CI 1.511-6.991), but no prognostic value for a cutoff point at 7 cm (T1 vs. T2) (p ¼ 0.375; 95%CI 0.655-3.071). Conclusions: Tumour size is an important prognostic factor in patients with organ confined RCC. The recently specified new cutoff point of 4 cm for T1a/T1b tumours is feasible for separating groups with different survival after tumour nephrectomy and should be considered as the new boundary between T1 and T2 stages. Hence, a more accurate prediction of prognostic differences between these groups should be possible.
Long-Term Oncologic Outcomes of Minimally Invasive Partial Nephrectomy for Renal-Cell Carcinoma
Journal of Endourology, 2014
Purpose: To report the long-term oncologic outcomes and survival estimates associated with minimally invasive partial nephrectomy (MIPN) and to determine factors associated with those outcomes and survival estimates. Patients and Methods: A single-institution, retrospective review was performed on all patients undergoing MIPN for renal-cell carcinoma between 1998 and 2011 with minimum 1-year follow-up. Bivariate and multivariate analyses were performed to assess associations between demographic, perioperative, and tumor factors with recurrence and survival. Survival was estimated using the Kaplan-Meier method. Results: Of 417 patients undergoing MIPN, median overall and oncologic follow-up were 3.3 and 2.9 years, respectively. The mean patient age was 63 years (standard deviation [SD]-13.4). The mean tumor size was 2.9 cm (SD-1.48). Only 6.7% of patients had a pathologic stage T 2 or greater. There was only one cancerrelated death. Estimates for overall survival at 2, 5, and 10 years were 95.6%, 89.1%, and 70.7%, respectively. Estimates for recurrence-free survival (any recurrence) at 2, 5, and 10 years were 98.2%, 93.5%, and 88.3%, respectively. On multivariate analysis, only tumor stage was associated with recurrence, and only patient age and American Society of Anesthesiologists score were associated with overall survival. Technical aspects of the procedure, such as positive margins or use of enucleation, did not influence recurrence or survival. Conclusions: Cancer recurrence after MIPN, in a cohort of patients with mostly pT 1 tumors, is rare. Recurrence and overall survival are associated with nonmodifiable factors rather than technical ones.
Urologic oncology, 2017
Although partial nephrectomy (PN) is the standard treatment for localized clinical T1a renal cell carcinoma (RCC), treatment of larger renal tumors is controversial. We evaluated the oncological outcomes and perioperative complications after radical and PN for RCC ≥4cm. We retrospectively analyzed the data of 2,373 patients surgically treated for nonmetastatic RCC with clinical T1b or T2 (≥4cm). The propensity scores for surgery type were calculated, and the partial group was matched to the radical group in a 1:3 ratio. The oncological outcomes were compared using Kaplan-Meier analysis and multivariate Cox regression models were used to identify the independent predictors of progression-free, cancer-specific, and overall survival. All differences in preoperative clinical characteristics disappeared after matching. There were no significant differences in progression-free, cancer-specific, or overall survival between the partial and radical groups in the matched cohort. The patients&...
Outcome of Stage T2 or Greater Renal Cell Cancer Treated With Partial Nephrectomy
The Journal of Urology, 2010
Partial nephrectomy for stage T1 renal cell carcinoma is oncologically efficacious and safe, and may have survival advantages. We describe our experience with partial nephrectomy for T2 or greater renal cell cancer. Materials and Methods: Between 1970 and 2008 approximately 2,300 partial nephrectomies were done at our institution, including 69 for sporadic unilateral advanced stage tumors (pT2 in 32, pT3a in 28 and pT3b in 9). We reviewed outcomes in these patients compared to those in 207 treated with radical nephrectomy matched 3:1 for stage, tumor size, baseline renal function, age and gender. Results: The risk of cancer specific (HR 0.80, 95% CI 0.43-1.50, p ϭ 0.489) and overall (HR 1.11, 95% CI 0.72-1.71, p ϭ 0.642) death was similar for partial nephrectomy. At a median of 3.2 years of followup 15 patients (22%) with partial nephrectomy had metastatic disease vs 69 (33%) with radical nephrectomy (HR 0.74, 95% CI 0.42-1.29, p ϭ 0.29). Four patients (6%) with partial nephrectomy had isolated local recurrence vs 7 (3%) with radical nephrectomy (HR 2.11, 95% CI 0.62-7.22, p ϭ 0.234). In the partial nephrectomy group 12 (17%) and 2 cases (3%) were complicated by urine leak and retroperitoneal bleeding requiring intervention, respectively. The median serum creatinine increase was 9.5% (IQR 0-22) vs 33% (IQR 20-47) for partial vs radical nephrectomy (p Ͻ0.001). Conclusions: Partial nephrectomy for T2 or greater renal cell carcinoma preserves renal function and appears to achieve oncological outcomes similar to those of radical nephrectomy. The role of partial nephrectomy in patients with T2-3 tumors and a normal contralateral kidney deserves further consideration and study.
Surgical Management of Local Recurrences of Renal Cell Carcinoma
Surgery Research and Practice, 2016
Surgical resection either in the form of radical nephrectomy or in the form of partial nephrectomy represents the mainstay options in the treatment of kidney cancer. In most instances, resecting the tumor bearing kidney or the tumor itself provides durable cancer specific survival rates. However, recurrences may rarely develop in the renal fossa or remnant kidney. Despite its rarity, locally recurrent RCC is a challenging condition in terms of the possible management options and relatively poor prognosis. If technically feasible, wide surgical excision and ensuring negative surgical margins are the most effective treatment options. Repeat surgeries (completion nephrectomy, excision of locally recurrent tumor, or repeat partial nephrectomy) may often be complicated, and perioperative morbidity is a major concern. Open approach has been extensively applied in this context and 5-year cancer specific survival rates have been reported to be around 50%. The roles of minimally invasive sur...
Journal of Urological Surgery, 2020
The goal of this study is to evaluate the risk factors that cause positive surgical margin (PSM) after partial nephrectomy (PN) and the effect of PSM on oncological outcomes in a single-centre cohort. Materials and Methods: Patients with PSM (group 1) were identified and contrasted with the negative surgical margin (group 2). Further, the Kaplan-Meier curves and Cox regression models were used to estimate the differences in survival analysis. Results: A total of 302 patients had PN, of which 38 (12.6%) had PSM. In addition, the non-ischaemic procedures in group 1 were higher (p<0.001). Multivariate analysis showed that RENAL nephrometry score (OR: 1.438, p=0.037) and C-index value (OR: 0.224, p=0.012) were important predictive factors for PSM. Moreover, the recurrence rate was 7.9% for group 1 at a median follow-up of 85.2 months and 3.4% for group 2 at a median follow-up of 83.7 months (p=0.181). In a multivariate analysis, the overall survival decreased with co-morbidity index (HR: 1.343, p<0.001) and high tumour stage (HR: 3.886, p=0.003), while cancer-specific survival decreased with mid-renal tumours (HR: 4.157, p=0.007), high tumour stage (HR: 6.274, p=0.017) and recurrence (HR: 5.038, p=0.018). Furthermore, pathological T stage and C-index value were independent risk factors influencing recurrence-free survival. Conclusion: C-index and RENAL nephrometry score are independent risk factors for PSM. Additionally, PSM does not affect the recurrence or survival outcomes.