best papers on kidney cancer vincenzo ficarra direttore clinica di urologia azienda ospedaliera...
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Best Papers on Kidney Cancer
Vincenzo FicarraDirettore Clinica di Urologia Azienda Ospedaliera Universitaria di Udine
Uro-oncological topicsUro-oncological topics
• Renal Tumor biopsyRenal Tumor biopsy
• Positive Surgical Margins after PNPositive Surgical Margins after PN
• Expanding indications for PNExpanding indications for PN
• Relapses after nephrectomyRelapses after nephrectomy
• Cytoreductive nephrectomyCytoreductive nephrectomy
Tsivian M. et al. BJU Inter 2014; doi:10.1111/bju.12470
Tsivian M. et al. BJU Inter 2014; doi:10.1111/bju.12470
Topics and discussed items
Tsivian M. et al. BJU Inter 2014; doi:10.1111/bju.12470
RTB: indications
Tsivian M. et al. BJU Inter 2014; doi:10.1111/bju.12470
RTB: technical aspects
Tsivian M. et al. BJU Inter 2014; doi:10.1111/bju.12470
RTB: pathological interpretation
Uro-oncological topicsUro-oncological topics
• Renal Tumor biopsy
• Positive Surgical Margins after PN
• Expanding indications for PN
• Relapses after nephrectomy
• Cytoreductive nephrectomy
Presence of cancer cells at the level of inked parenchymal excision surface
Ani I. et al. BJU Inter 2014; doi:10.1111/j.1464-410X.2012.11675.x
• Ontario Cancer Registry• Pathology reports on 664 were reviewed • Partial nephrectomy for RCC between 1995 and 2004• Seventy-one patients with PSMs (10.7%)
Ani I. et al. BJU Inter 2014; doi:10.1111/j.1464-410X.2012.11675.x
PSMs after PN: overall survival
NSM: 91.9%PSM: 90.9%
Ani I. et al. BJU Inter 2014; doi:10.1111/j.1464-410X.2012.11675.x
PSMs after PN: cancer-specific survival
NSM: 88.6%PSM: 84.4%
Khalifeh A. et al. J Urol 2013; 190: 1674-79
• Prospective, multicenter study (5 US institutions)• 943 RAPN• 21 (2.2%) cases with positive surgical margins
Khalifeh A. et al. J Urol 2013; 190: 1674-79
Recurrence-free survival Metastasis-free survival
HR 18.4 95%CI 2.27-110 – p <0.01) HR 78 95%CI 2.31-3,967 – p <0.0001)
PSMs after PN: management
Management
Radical Nephrectomy 1. Residual tumor present in 7-15% of the cases2. Increased risk of CKD
Repeat Partial Nephrectomy 1. Technically demanding procedure2. Intraoperative bleeding3. Complications
Ablative therapies 1. No tissue is retrieved for histologic evaluation2. Follow-up is hampered by artificial tissue alterations
Observation (watchful waiting) 1. Intensive follow-up is needed2. No validated follow-up scheme exists
Uro-oncological topicsUro-oncological topics
• Renal Tumor biopsyRenal Tumor biopsy
• Positive Surgical Margins after PNPositive Surgical Margins after PN
• Expanding indications for PNExpanding indications for PN
• Relapses after nephrectomyRelapses after nephrectomy
• Cytoreductive nephrectomyCytoreductive nephrectomy
Expanding indications for PNExpanding indications for PN
Expanding indications for PNExpanding indications for PN
Radical and Partial Nephrectomy for Clinical T2 Renal Tumors
Kopp R. et al. BJU Inter 2014; (available online)
Radical and Partial Nephrectomy for Clinical T2 Renal Tumors
Kopp R. et al. BJU Inter 2014; (available online)
Radical and Partial Nephrectomy for Clinical T2 Renal Tumors
Kopp R. et al. BJU Inter 2014; (available online)
Babaian K et al. J Urol 2014; 192: 1-7
• Retrospective analysis • consecutive cohort of 33 patients with metastatic
renal cell carcinoma • partial nephrectomy at a single institution • 1996 and 2011
Babaian K et al. J Urol 2014; 192: 1-7
Partial Nephrectomy for metastatic Renal Cell Carcinoma
Babaian K et al. J Urol 2014; 192: 1-7
Partial Nephrectomy for metastatic Renal Cell Carcinoma
Uro-oncological topicsUro-oncological topics
• Renal Tumor biopsy
• Positive Surgical Margins after PN
• Expanding indications for PN
• Relapses after nephrectomy
• Cytoreductive nephrectomy
Brookman S. et al. BJU Inter 2013; 112: 909-916
Brookman S. et al. BJU Inter 2013; 112: 909-916
Time to recurrence and CSS Time to recurrence and CSS
Brookman S. et al. BJU Inter 2013; 112: 909-916
Time to recurrence and CSS Time to recurrence and CSS
Brookman S. et al. Eur Urol 2013; 64: 472-477
Brookman S. et al. Eur Urol 2013; 64: 472-477
Late relapses after NephrectomyLate relapses after NephrectomyEvaluated period: 1992-2010
Brookman S. et al. Eur Urol 2013; 64: 472-477
Late relapses after NephrectomyLate relapses after Nephrectomy
Brookman S. et al. Eur Urol 2013; 64: 472-477
Late relapses after NephrectomyLate relapses after Nephrectomy
Kroeger N. et al. Eur Urol 2014; 65: 1086-1092
Kroeger N. et al. Eur Urol 2014; 65: 1086-1092
Treatment outcomes after late relapsesTreatment outcomes after late relapses
Kroeger N. et al. Eur Urol 2014; 65: 1086-1092
Treatment outcomes after late relapsesTreatment outcomes after late relapses
Kroeger N. et al. Eur Urol 2014; 65: 1086-1092
Treatment outcomes after late relapsesTreatment outcomes after late relapses
Uro-oncological topicsUro-oncological topics
• Renal Tumor biopsyRenal Tumor biopsy
• Positive Surgical Margins after PNPositive Surgical Margins after PN
• Expanding indications for PNExpanding indications for PN
• Relapses after nephrectomyRelapses after nephrectomy
• Cytoreductive nephrectomyCytoreductive nephrectomy
Aizer AA et al. BJU Inter 2014; BJU Int 2014; 113: 67–74
• SEER programme to identify a population-based sample of 4914 patients diagnosed with metastatic RCC between 2000 and 2009.
• 591 had non-clear-cell histology.• Median follow-up was 20 months.• Primary outcome measure was RCC-specific
mortality
Aizer AA et al. BJU Inter 2014; BJU Int 2014; 113: 67–74
CN in non-clear-cell RCCCN in non-clear-cell RCC
Aizer AA et al. BJU Inter 2014; BJU Int 2014; 113: 67–74
CN in non-clear-cell RCCCN in non-clear-cell RCC
Aizer AA et al. BJU Inter 2014; BJU Int 2014; 113: 67–74
CN in non-clear-cell RCCCN in non-clear-cell RCC
• Patients from the SEER programme with metastatic non-clear-cell RCC, including those treated in the targeted therapy era, appear to derive a survival benefit from CN, an association which remained significant regardless of histological subtype
• This observation suggests that CN should remain standard in patients with advanced RCC who are deemed to be surgical candidates