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