The aim of the present study is to evaluate the prognostic significance of the Glasgow Prognostic... more The aim of the present study is to evaluate the prognostic significance of the Glasgow Prognostic Score (GPS) in metastatic renal cell carcinoma (mRCC) patients treated with cytoreductive nephrectomy (CN) and the accuracy of the GPS as a prognostic factor. METHODS: We retrospectively analyzed the data of patients who underwent CN for mRCC between March 1984 and August 2015. In accordance with the GPS criteria, the patients were classified into three groups, as follows: GPS 0: CRP 1.0 mg/dl and albumin 3.5 g/ dl, GPS 1: CRP >1.0 mg/dl or albumin <3.5 g/dl, and GPS 2: CRP >1.0 mg/dl and albumin <3.5 g/dl. RESULTS: We enrolled 170 patients (72% male; median age, 63.5 years). Fifty-six (33%), 67 (39%), and 47 (28%) patients had GPSs of 0, 1, and 2, respectively. The median OSs after CN were 52.4, 19.1, and 8.9 months for patients with a GPS of 0, 1, and 2, respectively (P < 0.0001). In addition to the GPS, age, Eastern Cooperative Oncology Group performance status (ECOG-PS), histology, sarcomatoid change, clinical nodal stage, liver metastasis were included in the Cox hazards regression model. Multivariate analysis of these factors revealed that the GPS was an independent prognostic factor of OS (P < 0.0001). The Harrell's concordance index in the multivariate prognostic model based on age, ECOG-PS, histology, sarcomatoid change, clinical nodal stage, and liver metastasis was 0.662, which increased to 0.674 after the inclusion of GPS. CONCLUSIONS: GPS represents an independent prognostic factor for patients who undergo CN for mRCC.
and radical nephrectomy, with 5-year estimated survival of 98% [95% CI 97-99%] in partial nephrec... more and radical nephrectomy, with 5-year estimated survival of 98% [95% CI 97-99%] in partial nephrectomy, and 93% [95% CI 91-95%] in radical nephrectomy. On Cox proportional hazard analysis, the following covariates were independently associated with worse overall survival: Charlson Comorbidity Index (HR 1.42, 95% CI 1.11-1.82) and papillary histology (HR 1.73, 95% CI 1.04-2.90). Partial nephrectomy, on the other hand, was associated with better overall survival (HR 0.38, 95% CI 0.24-0.61). CONCLUSIONS: In younger patients presenting with cT1 renal masses, partial nephrectomy appears to be underutilized, with only 54.2% undergoing nephron-sparing surgery. This may reflect provider caution in treating these patients and desire to be oncologically aggressive. However, 5-year overall survival appears slightly better in those undergoing nephron preservation, which should be considered the first line treatment in this population when technically feasible.
Purpose: Sarcopenia is associated with decreased survival and increased complications in patients... more Purpose: Sarcopenia is associated with decreased survival and increased complications in patients with renal cell carcinoma. Readily identifying patients with low muscle composition that may experience worse outcomes or would benefit from preoperative intervention is of clinical interest. Traditional body composition analysis methods are resource intensive; therefore, linear segmentation with routine imaging has been proposed as a clinically practical alternative. This study assesses linear segmentation's prognostic utility in nonmetastatic renal cell carcinoma. A single institution retrospective analysis of patients that underwent nephrectomy for nonmetastatic renal cell carcinoma from 2005-2021 was conducted. Linear segmentation of the bilateral psoas/ paraspinal muscles was completed on preoperative imaging. Total muscle area and total muscle index associations with overall survival were determined by multivariable analysis.
Low creatinine to cystatin-C ratio (Cr/Cys-C) may be a biomarker for low-muscle mass. Furthermore... more Low creatinine to cystatin-C ratio (Cr/Cys-C) may be a biomarker for low-muscle mass. Furthermore, low Cr/Cys-C is associated with decreased overall survival (OS), but to date, has not been examined in patients with renal cell carcinoma (RCC). Our objective is to evaluate associations between low Cr/Cys-C ratio and OS and recurrence-free survival (RFS) in patients with RCC treated with nephrectomy. We performed a retrospective review of patients with RCC treated with nephrectomy. Patients with end-stage renal disease and less than 1-year follow up were excluded. Cr/Cys-C was dichotomized at the median for the cohort (low vs. high). OS and RFS for patients with high versus low Cr/Cys-C were estimated with the Kaplan-Meier method, and associations with the outcomes of interest were modeled using Cox proportional Hazards models. Associations between Cr/Cys-C and skeletal muscle mass were assessed with correlations and logistic regression. Results: A total of 255 patients were analyzed, with a median age of 64. Median (IQR) Cr/Cys-C was 1 (0.8-1.2). Low Cr/Cys-C was associated with age, female sex, Eastern Cooperative Oncology Group Performance Status ≥1, TNM stage, and tumor size. Kaplan-Meier and Cox regression analysis demonstrated an association between low Cr/Cys-C and decreased OS (HR = 2.97, 95%CI, 1.12-7.90, P =0.029) and RFS (HR = 3.31, 95%CI, 1.26-8.66, P = .015). Furthermore, a low Cr/Cys-C indicated a 2-3 increase in risk of radiographic sarcopenia. Conclusions: Lower Cr/Cys-C is associated with inferior oncologic outcomes in RCC and, pending validation, may have utility as a serum biomarker for the presence of sarcopenia in patients with RCC treated with nephrectomy.
targeted therapy initially, only 8.1% underwent deferred CN. On multivariable analysis, upfront C... more targeted therapy initially, only 8.1% underwent deferred CN. On multivariable analysis, upfront CN was associated with improved survival (HR 0.57 95% CI 0.44, 0.74). On propensity matched analysis, upfront CN was associated with a significant survival advantage of 4.7 months (95% CI 1.7,11.8). CONCLUSIONS: Upfront CN is associated with a survival advantage compared with initial targeted therapy in a contemporary cohort of clear cell mRCC patients that resembles the treatment groups in ongoing randomized trials on the surgical management of mRCC.
Background: Several markers of inflammation have been associated with oncologic outcomes. Prognos... more Background: Several markers of inflammation have been associated with oncologic outcomes. Prognostic markers are not well-defined for renal cell carcinoma (RCC). We sought to investigate the association of preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis ratio with mortality in RCC. Methods: Multi-center retrospective analysis of patients undergoing surgery for RCC. Primary outcome of interest was all-cause mortality (ACM). Secondary outcomes were non-cancer mortality (NCM) and cancer-specific mortality (CSM). Elevated NLR was defined as ≥2.27, elevated PLR as ≥165, and elevated De Ritis ratio as ≥ 2.72. Multivariable cox regression analysis (MVA) was conducted to elucidate risk factors for primary and secondary outcomes, and Kaplan-Meier analysis (KMA) was used to evaluate survival outcomes comparing elevated and non-elevated NLR, PLR, and De Ritis ratio. Results: 2656 patients were analyzed (874 patients had elevated NLR; 480 patients had elevated PLR and 932 patients had elevated De Ritis).
666 Background: Functional decline is an important consideration in the surgical treatment of ren... more 666 Background: Functional decline is an important consideration in the surgical treatment of renal cell carcinoma (RCC). While radical nephrectomy (RN) may be associated with increased risk of functional decline compared to partial nephrectomy (PN), the modifying effect of DM, an independent risk factor of chronic kidney disease (CKD), is not completely understood. We investigated the relationship between DM and decline in kidney function following surgery for RCC, and impact on overall survival (OS) in patients with RCC. Methods: A multicenter dataset of RCC patients undergoing PN and RN was utilized. The cohort was divided based on DM status [DM vs No DM (NDM)]. Multivariable analysis (MVA) elucidated potential variables associated with decline in kidney function [de novo estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73m2 and de novo eGFR < 30 ml/min/1.73m2] and worse all-cause mortality (ACM). Kaplan-Meier analysis (KMA) was used to investigate OS rates in DM a...
ObjectivesTo develop a risk classifier using urine‐derived extracellular vesicle (EV)‐RNA capable... more ObjectivesTo develop a risk classifier using urine‐derived extracellular vesicle (EV)‐RNA capable of providing diagnostic information on disease status prior to biopsy, and prognostic information for men on active surveillance (AS).Patients and MethodsPost‐digital rectal examination urine‐derived EV‐RNA expression profiles (n = 535, multiple centres) were interrogated with a curated NanoString panel. A LASSO‐based continuation ratio model was built to generate four prostate urine risk (PUR) signatures for predicting the probability of normal tissue (PUR‐1), D'Amico low‐risk (PUR‐2), intermediate‐risk (PUR‐3), and high‐risk (PUR‐4) prostate cancer. This model was applied to a test cohort (n = 177) for diagnostic evaluation, and to an AS sub‐cohort (n = 87) for prognostic evaluation.ResultsEach PUR signature was significantly associated with its corresponding clinical category (P < 0.001). PUR‐4 status predicted the presence of clinically significant intermediate‐ or high‐risk ...
95% CI 1. 63-4.16; p<0.001) were significant predictive factors of PSM. Conversely, hilar clampin... more 95% CI 1. 63-4.16; p<0.001) were significant predictive factors of PSM. Conversely, hilar clamping, robotic versus open approach and PADUA score were significantly associated with PSM, but were not independent at multivariable analysis. CONCLUSIONS: The early oncological goal of PN is to achieve negative margins. In our multi-institutional report, CCI, laparoscopic approach, enucleoresection technique, lymphovascular invasion and tumor upstaging were independent predictors of PSM in patients treated with PN for localized RCC.
and <28 days for >/[T1b asymptomatic renal masses. Few reports have examined the effect of prolon... more and <28 days for >/[T1b asymptomatic renal masses. Few reports have examined the effect of prolonged SWT for renal cancer surgery on oncologic outcomes, and those that exist were conducted on a single institution level. We aimed to evaluate whether SWT is associated with treatment outcomes for renal masses on a multi-institution level. METHODS: The Canadian Kidney information system (CKCis) is a national multi-institution database of patients with kidney tumors. This database was used to identify a historical cohort of patients who underwent surgery for >/[ clinical stage T1b renal cell carcinoma (RCC) from 2011 onwards. Time from final imaging prior to surgery to the date of surgery was used as a measure of SWT. Oncologic outcomes such as recurrence-free survival, cancer-specific survival, and overall survival were stratified by clinical stage and SWT to assess for associations between SWT and outcomes. RESULTS: Of 1,395 patients included in the analysis, 664 (47.6%) were categorized as stage cT1b, 387 (27.7%) as stage cT2, and 344 (24.7%) as stage cT3/4. Mean follow-up duration was 28.80 months. Mean SWT was 61.6 days, 39.3 days, and 31.5 days for stage cT1b, cT2, and cT3/4, respectively. Among cT1b, cT2, and cT3/4 patients, SWT exceeded 12 weeks in 27.4%, 11.6%, and 8.1% of patients, respectively. There was no association between SWT and recurrence-free survival, margin status, or lymph node status for tumors of all clinical stages. CONCLUSIONS: Mean SWTs for renal cancer surgery appear to be within recommendations, though a significant proportion of cT1b patients are experiencing prolonged wait times. Patients who had longer SWTs in this study did not experience negative oncologic outcomes such as positive margins, positive lymph nodes, or worse recurrence free survival among all clinical stages.
INTRODUCTION AND OBJECTIVES: Von Hippel-Lindau (VHL) disease is a hereditary cancer syndrome with... more INTRODUCTION AND OBJECTIVES: Von Hippel-Lindau (VHL) disease is a hereditary cancer syndrome with poor survival. The current recommendations have proposed uniform surveillance strategies for all patients, which neglected the obvious inter and intra familial phenotypic varieties. In this study, we aim to confirm the phenotypic heterogeneity in VHL disease and the underlying mechanism. METHODS: A total of 151 parent-child pairs were enrolled for genetic anticipation analysis, and 77 sibling pairs for birth order effect analysis. Four statistical methods were used to compare the onset age of patients among different generations and different birth orders. RESULTS: The average onset age was 18.9 years earlier in children than that in their parents, which was statistically significant in paired t test (p<0.001), RY1 (p<0.05), RY2 (p<0.01) and CPH model (p<0.001). Furthermore, the first-born siblings were affected 8.3 years later than the other ones among the maternal patients. Telomere shortening was confirmed to be associated with genetic anticipation in VHL families, while it failed to explain the birth order effect. Moreover, no significant difference was observed for overall survival between parents and children (p[0.834) and between the first-born patients and the other siblings (p[0.390). CONCLUSIONS: This study provides definite evidence and possible mechanisms of intra-familiar phenotypic heterogeneity in VHL families, which is helpful to the update of surveillance guidelines.
95% CI 1. 63-4.16; p<0.001) were significant predictive factors of PSM. Conversely, hilar clampin... more 95% CI 1. 63-4.16; p<0.001) were significant predictive factors of PSM. Conversely, hilar clamping, robotic versus open approach and PADUA score were significantly associated with PSM, but were not independent at multivariable analysis. CONCLUSIONS: The early oncological goal of PN is to achieve negative margins. In our multi-institutional report, CCI, laparoscopic approach, enucleoresection technique, lymphovascular invasion and tumor upstaging were independent predictors of PSM in patients treated with PN for localized RCC.
cancerous endothelium. After 24 hours, laser ablation of prostate tumors was performed using an e... more cancerous endothelium. After 24 hours, laser ablation of prostate tumors was performed using an electromagnetically tracked MR/US fusion guided transperineal approach. The near-infrared laser wavelength used was converted to heat by the GSN (residing within prostate tumors) while healthy tissue was not affected. Side effects within the 30-day postoperative period and change in IPSS, QoL, and SHIM scores at 1, 3, 6, and 12-months follow-up were recorded. RESULTS: We report the results from the first 11 patients enrolled at our institution. The median PSA was 6.15 (range: 0.82-11.96), the median size of the lesions treated was 0.475 (range: 0.06-1.56), and the median duration of the procedure was 224 min (range 115-345). One patient experienced self-resolving epigastric-subcostal pain during GNS infusion, and did not complete treatment. The remaining patients completed treatment in the outpatient setting. Self-resolving CTCAE grade I/II hematuria was universally experienced by all 10 patients. 4 of 10 failed the trial of void and a Foley catheter was left in place for 1-2 days (CTCAE grade II). The mean IPSS, QoL, and SHIM scores are recorded at baseline, 1, 3, 6, and 12 months in Table , and graphed in Figure . No significant difference in functional outcome was observed between baseline and follow up at 12 months. CONCLUSIONS: GNS laser ablation is a novel FT modality for ablation of prostate tumors and demonstrates a favorable side effect profile and improved functional outcomes.
nephrectomy within 70 days of diagnosis. Patients (n [ 3,340) who had a delay of 10 weeks were mo... more nephrectomy within 70 days of diagnosis. Patients (n [ 3,340) who had a delay of 10 weeks were more likely to die compared with patients who had definitive surgery within 70 days (adjusted hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.15-1.33). This risk was not markedly attenuated after adjusting for confounding variables, including age, Charlson-Deyo score, pathologic stage, grade, and surgical margin status (adjusted HR 1.13; 95% CI 1.04-1.24). In multivariate linear regression analysis, treatment in academic or integrated network cancer center, lack of insurance, and median household income less than $38,000 are more like to have a delay greater than 70 days. CONCLUSIONS: The vast majority of pT3 patients underwent radical or partial nephrectomy within 70 days. Delayed definitive surgery for more than 10 weeks is associated with decreased five-year OS. Treatment in academic or integrated network cancer center, lack of insurance, and low median household income are more like to have a delayed definitive surgery.
OS after subdivision, where pT1 was 89.9%, while cT1/pT3a correlated with pT2 (79.8% and 83.1%, p... more OS after subdivision, where pT1 was 89.9%, while cT1/pT3a correlated with pT2 (79.8% and 83.1%, p[0.640) and cT2/pT3a correlated with cT3a/pT3a 67.0% and 64.2%; p[0.893). CONCLUSIONS: Risk of upstaging to pT3a disease and subsequent recurrence is proportional to clinical stage at presentation. Patients with cT1/pT3a have outcomes more similar to pT2, while patients with cT2/pT3a align more closely to cT3a/pT3a. Future refinements of the TNM staging system for RCC should consider regrouping cT1/pT3a into the pT2 group.
The aim of the present study is to evaluate the prognostic significance of the Glasgow Prognostic... more The aim of the present study is to evaluate the prognostic significance of the Glasgow Prognostic Score (GPS) in metastatic renal cell carcinoma (mRCC) patients treated with cytoreductive nephrectomy (CN) and the accuracy of the GPS as a prognostic factor. METHODS: We retrospectively analyzed the data of patients who underwent CN for mRCC between March 1984 and August 2015. In accordance with the GPS criteria, the patients were classified into three groups, as follows: GPS 0: CRP 1.0 mg/dl and albumin 3.5 g/ dl, GPS 1: CRP >1.0 mg/dl or albumin <3.5 g/dl, and GPS 2: CRP >1.0 mg/dl and albumin <3.5 g/dl. RESULTS: We enrolled 170 patients (72% male; median age, 63.5 years). Fifty-six (33%), 67 (39%), and 47 (28%) patients had GPSs of 0, 1, and 2, respectively. The median OSs after CN were 52.4, 19.1, and 8.9 months for patients with a GPS of 0, 1, and 2, respectively (P < 0.0001). In addition to the GPS, age, Eastern Cooperative Oncology Group performance status (ECOG-PS), histology, sarcomatoid change, clinical nodal stage, liver metastasis were included in the Cox hazards regression model. Multivariate analysis of these factors revealed that the GPS was an independent prognostic factor of OS (P < 0.0001). The Harrell's concordance index in the multivariate prognostic model based on age, ECOG-PS, histology, sarcomatoid change, clinical nodal stage, and liver metastasis was 0.662, which increased to 0.674 after the inclusion of GPS. CONCLUSIONS: GPS represents an independent prognostic factor for patients who undergo CN for mRCC.
and radical nephrectomy, with 5-year estimated survival of 98% [95% CI 97-99%] in partial nephrec... more and radical nephrectomy, with 5-year estimated survival of 98% [95% CI 97-99%] in partial nephrectomy, and 93% [95% CI 91-95%] in radical nephrectomy. On Cox proportional hazard analysis, the following covariates were independently associated with worse overall survival: Charlson Comorbidity Index (HR 1.42, 95% CI 1.11-1.82) and papillary histology (HR 1.73, 95% CI 1.04-2.90). Partial nephrectomy, on the other hand, was associated with better overall survival (HR 0.38, 95% CI 0.24-0.61). CONCLUSIONS: In younger patients presenting with cT1 renal masses, partial nephrectomy appears to be underutilized, with only 54.2% undergoing nephron-sparing surgery. This may reflect provider caution in treating these patients and desire to be oncologically aggressive. However, 5-year overall survival appears slightly better in those undergoing nephron preservation, which should be considered the first line treatment in this population when technically feasible.
The aim of the present study is to evaluate the prognostic significance of the Glasgow Prognostic... more The aim of the present study is to evaluate the prognostic significance of the Glasgow Prognostic Score (GPS) in metastatic renal cell carcinoma (mRCC) patients treated with cytoreductive nephrectomy (CN) and the accuracy of the GPS as a prognostic factor. METHODS: We retrospectively analyzed the data of patients who underwent CN for mRCC between March 1984 and August 2015. In accordance with the GPS criteria, the patients were classified into three groups, as follows: GPS 0: CRP 1.0 mg/dl and albumin 3.5 g/ dl, GPS 1: CRP >1.0 mg/dl or albumin <3.5 g/dl, and GPS 2: CRP >1.0 mg/dl and albumin <3.5 g/dl. RESULTS: We enrolled 170 patients (72% male; median age, 63.5 years). Fifty-six (33%), 67 (39%), and 47 (28%) patients had GPSs of 0, 1, and 2, respectively. The median OSs after CN were 52.4, 19.1, and 8.9 months for patients with a GPS of 0, 1, and 2, respectively (P < 0.0001). In addition to the GPS, age, Eastern Cooperative Oncology Group performance status (ECOG-PS), histology, sarcomatoid change, clinical nodal stage, liver metastasis were included in the Cox hazards regression model. Multivariate analysis of these factors revealed that the GPS was an independent prognostic factor of OS (P < 0.0001). The Harrell's concordance index in the multivariate prognostic model based on age, ECOG-PS, histology, sarcomatoid change, clinical nodal stage, and liver metastasis was 0.662, which increased to 0.674 after the inclusion of GPS. CONCLUSIONS: GPS represents an independent prognostic factor for patients who undergo CN for mRCC.
and radical nephrectomy, with 5-year estimated survival of 98% [95% CI 97-99%] in partial nephrec... more and radical nephrectomy, with 5-year estimated survival of 98% [95% CI 97-99%] in partial nephrectomy, and 93% [95% CI 91-95%] in radical nephrectomy. On Cox proportional hazard analysis, the following covariates were independently associated with worse overall survival: Charlson Comorbidity Index (HR 1.42, 95% CI 1.11-1.82) and papillary histology (HR 1.73, 95% CI 1.04-2.90). Partial nephrectomy, on the other hand, was associated with better overall survival (HR 0.38, 95% CI 0.24-0.61). CONCLUSIONS: In younger patients presenting with cT1 renal masses, partial nephrectomy appears to be underutilized, with only 54.2% undergoing nephron-sparing surgery. This may reflect provider caution in treating these patients and desire to be oncologically aggressive. However, 5-year overall survival appears slightly better in those undergoing nephron preservation, which should be considered the first line treatment in this population when technically feasible.
Purpose: Sarcopenia is associated with decreased survival and increased complications in patients... more Purpose: Sarcopenia is associated with decreased survival and increased complications in patients with renal cell carcinoma. Readily identifying patients with low muscle composition that may experience worse outcomes or would benefit from preoperative intervention is of clinical interest. Traditional body composition analysis methods are resource intensive; therefore, linear segmentation with routine imaging has been proposed as a clinically practical alternative. This study assesses linear segmentation's prognostic utility in nonmetastatic renal cell carcinoma. A single institution retrospective analysis of patients that underwent nephrectomy for nonmetastatic renal cell carcinoma from 2005-2021 was conducted. Linear segmentation of the bilateral psoas/ paraspinal muscles was completed on preoperative imaging. Total muscle area and total muscle index associations with overall survival were determined by multivariable analysis.
Low creatinine to cystatin-C ratio (Cr/Cys-C) may be a biomarker for low-muscle mass. Furthermore... more Low creatinine to cystatin-C ratio (Cr/Cys-C) may be a biomarker for low-muscle mass. Furthermore, low Cr/Cys-C is associated with decreased overall survival (OS), but to date, has not been examined in patients with renal cell carcinoma (RCC). Our objective is to evaluate associations between low Cr/Cys-C ratio and OS and recurrence-free survival (RFS) in patients with RCC treated with nephrectomy. We performed a retrospective review of patients with RCC treated with nephrectomy. Patients with end-stage renal disease and less than 1-year follow up were excluded. Cr/Cys-C was dichotomized at the median for the cohort (low vs. high). OS and RFS for patients with high versus low Cr/Cys-C were estimated with the Kaplan-Meier method, and associations with the outcomes of interest were modeled using Cox proportional Hazards models. Associations between Cr/Cys-C and skeletal muscle mass were assessed with correlations and logistic regression. Results: A total of 255 patients were analyzed, with a median age of 64. Median (IQR) Cr/Cys-C was 1 (0.8-1.2). Low Cr/Cys-C was associated with age, female sex, Eastern Cooperative Oncology Group Performance Status ≥1, TNM stage, and tumor size. Kaplan-Meier and Cox regression analysis demonstrated an association between low Cr/Cys-C and decreased OS (HR = 2.97, 95%CI, 1.12-7.90, P =0.029) and RFS (HR = 3.31, 95%CI, 1.26-8.66, P = .015). Furthermore, a low Cr/Cys-C indicated a 2-3 increase in risk of radiographic sarcopenia. Conclusions: Lower Cr/Cys-C is associated with inferior oncologic outcomes in RCC and, pending validation, may have utility as a serum biomarker for the presence of sarcopenia in patients with RCC treated with nephrectomy.
targeted therapy initially, only 8.1% underwent deferred CN. On multivariable analysis, upfront C... more targeted therapy initially, only 8.1% underwent deferred CN. On multivariable analysis, upfront CN was associated with improved survival (HR 0.57 95% CI 0.44, 0.74). On propensity matched analysis, upfront CN was associated with a significant survival advantage of 4.7 months (95% CI 1.7,11.8). CONCLUSIONS: Upfront CN is associated with a survival advantage compared with initial targeted therapy in a contemporary cohort of clear cell mRCC patients that resembles the treatment groups in ongoing randomized trials on the surgical management of mRCC.
Background: Several markers of inflammation have been associated with oncologic outcomes. Prognos... more Background: Several markers of inflammation have been associated with oncologic outcomes. Prognostic markers are not well-defined for renal cell carcinoma (RCC). We sought to investigate the association of preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis ratio with mortality in RCC. Methods: Multi-center retrospective analysis of patients undergoing surgery for RCC. Primary outcome of interest was all-cause mortality (ACM). Secondary outcomes were non-cancer mortality (NCM) and cancer-specific mortality (CSM). Elevated NLR was defined as ≥2.27, elevated PLR as ≥165, and elevated De Ritis ratio as ≥ 2.72. Multivariable cox regression analysis (MVA) was conducted to elucidate risk factors for primary and secondary outcomes, and Kaplan-Meier analysis (KMA) was used to evaluate survival outcomes comparing elevated and non-elevated NLR, PLR, and De Ritis ratio. Results: 2656 patients were analyzed (874 patients had elevated NLR; 480 patients had elevated PLR and 932 patients had elevated De Ritis).
666 Background: Functional decline is an important consideration in the surgical treatment of ren... more 666 Background: Functional decline is an important consideration in the surgical treatment of renal cell carcinoma (RCC). While radical nephrectomy (RN) may be associated with increased risk of functional decline compared to partial nephrectomy (PN), the modifying effect of DM, an independent risk factor of chronic kidney disease (CKD), is not completely understood. We investigated the relationship between DM and decline in kidney function following surgery for RCC, and impact on overall survival (OS) in patients with RCC. Methods: A multicenter dataset of RCC patients undergoing PN and RN was utilized. The cohort was divided based on DM status [DM vs No DM (NDM)]. Multivariable analysis (MVA) elucidated potential variables associated with decline in kidney function [de novo estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73m2 and de novo eGFR < 30 ml/min/1.73m2] and worse all-cause mortality (ACM). Kaplan-Meier analysis (KMA) was used to investigate OS rates in DM a...
ObjectivesTo develop a risk classifier using urine‐derived extracellular vesicle (EV)‐RNA capable... more ObjectivesTo develop a risk classifier using urine‐derived extracellular vesicle (EV)‐RNA capable of providing diagnostic information on disease status prior to biopsy, and prognostic information for men on active surveillance (AS).Patients and MethodsPost‐digital rectal examination urine‐derived EV‐RNA expression profiles (n = 535, multiple centres) were interrogated with a curated NanoString panel. A LASSO‐based continuation ratio model was built to generate four prostate urine risk (PUR) signatures for predicting the probability of normal tissue (PUR‐1), D'Amico low‐risk (PUR‐2), intermediate‐risk (PUR‐3), and high‐risk (PUR‐4) prostate cancer. This model was applied to a test cohort (n = 177) for diagnostic evaluation, and to an AS sub‐cohort (n = 87) for prognostic evaluation.ResultsEach PUR signature was significantly associated with its corresponding clinical category (P < 0.001). PUR‐4 status predicted the presence of clinically significant intermediate‐ or high‐risk ...
95% CI 1. 63-4.16; p<0.001) were significant predictive factors of PSM. Conversely, hilar clampin... more 95% CI 1. 63-4.16; p<0.001) were significant predictive factors of PSM. Conversely, hilar clamping, robotic versus open approach and PADUA score were significantly associated with PSM, but were not independent at multivariable analysis. CONCLUSIONS: The early oncological goal of PN is to achieve negative margins. In our multi-institutional report, CCI, laparoscopic approach, enucleoresection technique, lymphovascular invasion and tumor upstaging were independent predictors of PSM in patients treated with PN for localized RCC.
and <28 days for >/[T1b asymptomatic renal masses. Few reports have examined the effect of prolon... more and <28 days for >/[T1b asymptomatic renal masses. Few reports have examined the effect of prolonged SWT for renal cancer surgery on oncologic outcomes, and those that exist were conducted on a single institution level. We aimed to evaluate whether SWT is associated with treatment outcomes for renal masses on a multi-institution level. METHODS: The Canadian Kidney information system (CKCis) is a national multi-institution database of patients with kidney tumors. This database was used to identify a historical cohort of patients who underwent surgery for >/[ clinical stage T1b renal cell carcinoma (RCC) from 2011 onwards. Time from final imaging prior to surgery to the date of surgery was used as a measure of SWT. Oncologic outcomes such as recurrence-free survival, cancer-specific survival, and overall survival were stratified by clinical stage and SWT to assess for associations between SWT and outcomes. RESULTS: Of 1,395 patients included in the analysis, 664 (47.6%) were categorized as stage cT1b, 387 (27.7%) as stage cT2, and 344 (24.7%) as stage cT3/4. Mean follow-up duration was 28.80 months. Mean SWT was 61.6 days, 39.3 days, and 31.5 days for stage cT1b, cT2, and cT3/4, respectively. Among cT1b, cT2, and cT3/4 patients, SWT exceeded 12 weeks in 27.4%, 11.6%, and 8.1% of patients, respectively. There was no association between SWT and recurrence-free survival, margin status, or lymph node status for tumors of all clinical stages. CONCLUSIONS: Mean SWTs for renal cancer surgery appear to be within recommendations, though a significant proportion of cT1b patients are experiencing prolonged wait times. Patients who had longer SWTs in this study did not experience negative oncologic outcomes such as positive margins, positive lymph nodes, or worse recurrence free survival among all clinical stages.
INTRODUCTION AND OBJECTIVES: Von Hippel-Lindau (VHL) disease is a hereditary cancer syndrome with... more INTRODUCTION AND OBJECTIVES: Von Hippel-Lindau (VHL) disease is a hereditary cancer syndrome with poor survival. The current recommendations have proposed uniform surveillance strategies for all patients, which neglected the obvious inter and intra familial phenotypic varieties. In this study, we aim to confirm the phenotypic heterogeneity in VHL disease and the underlying mechanism. METHODS: A total of 151 parent-child pairs were enrolled for genetic anticipation analysis, and 77 sibling pairs for birth order effect analysis. Four statistical methods were used to compare the onset age of patients among different generations and different birth orders. RESULTS: The average onset age was 18.9 years earlier in children than that in their parents, which was statistically significant in paired t test (p<0.001), RY1 (p<0.05), RY2 (p<0.01) and CPH model (p<0.001). Furthermore, the first-born siblings were affected 8.3 years later than the other ones among the maternal patients. Telomere shortening was confirmed to be associated with genetic anticipation in VHL families, while it failed to explain the birth order effect. Moreover, no significant difference was observed for overall survival between parents and children (p[0.834) and between the first-born patients and the other siblings (p[0.390). CONCLUSIONS: This study provides definite evidence and possible mechanisms of intra-familiar phenotypic heterogeneity in VHL families, which is helpful to the update of surveillance guidelines.
95% CI 1. 63-4.16; p<0.001) were significant predictive factors of PSM. Conversely, hilar clampin... more 95% CI 1. 63-4.16; p<0.001) were significant predictive factors of PSM. Conversely, hilar clamping, robotic versus open approach and PADUA score were significantly associated with PSM, but were not independent at multivariable analysis. CONCLUSIONS: The early oncological goal of PN is to achieve negative margins. In our multi-institutional report, CCI, laparoscopic approach, enucleoresection technique, lymphovascular invasion and tumor upstaging were independent predictors of PSM in patients treated with PN for localized RCC.
cancerous endothelium. After 24 hours, laser ablation of prostate tumors was performed using an e... more cancerous endothelium. After 24 hours, laser ablation of prostate tumors was performed using an electromagnetically tracked MR/US fusion guided transperineal approach. The near-infrared laser wavelength used was converted to heat by the GSN (residing within prostate tumors) while healthy tissue was not affected. Side effects within the 30-day postoperative period and change in IPSS, QoL, and SHIM scores at 1, 3, 6, and 12-months follow-up were recorded. RESULTS: We report the results from the first 11 patients enrolled at our institution. The median PSA was 6.15 (range: 0.82-11.96), the median size of the lesions treated was 0.475 (range: 0.06-1.56), and the median duration of the procedure was 224 min (range 115-345). One patient experienced self-resolving epigastric-subcostal pain during GNS infusion, and did not complete treatment. The remaining patients completed treatment in the outpatient setting. Self-resolving CTCAE grade I/II hematuria was universally experienced by all 10 patients. 4 of 10 failed the trial of void and a Foley catheter was left in place for 1-2 days (CTCAE grade II). The mean IPSS, QoL, and SHIM scores are recorded at baseline, 1, 3, 6, and 12 months in Table , and graphed in Figure . No significant difference in functional outcome was observed between baseline and follow up at 12 months. CONCLUSIONS: GNS laser ablation is a novel FT modality for ablation of prostate tumors and demonstrates a favorable side effect profile and improved functional outcomes.
nephrectomy within 70 days of diagnosis. Patients (n [ 3,340) who had a delay of 10 weeks were mo... more nephrectomy within 70 days of diagnosis. Patients (n [ 3,340) who had a delay of 10 weeks were more likely to die compared with patients who had definitive surgery within 70 days (adjusted hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.15-1.33). This risk was not markedly attenuated after adjusting for confounding variables, including age, Charlson-Deyo score, pathologic stage, grade, and surgical margin status (adjusted HR 1.13; 95% CI 1.04-1.24). In multivariate linear regression analysis, treatment in academic or integrated network cancer center, lack of insurance, and median household income less than $38,000 are more like to have a delay greater than 70 days. CONCLUSIONS: The vast majority of pT3 patients underwent radical or partial nephrectomy within 70 days. Delayed definitive surgery for more than 10 weeks is associated with decreased five-year OS. Treatment in academic or integrated network cancer center, lack of insurance, and low median household income are more like to have a delayed definitive surgery.
OS after subdivision, where pT1 was 89.9%, while cT1/pT3a correlated with pT2 (79.8% and 83.1%, p... more OS after subdivision, where pT1 was 89.9%, while cT1/pT3a correlated with pT2 (79.8% and 83.1%, p[0.640) and cT2/pT3a correlated with cT3a/pT3a 67.0% and 64.2%; p[0.893). CONCLUSIONS: Risk of upstaging to pT3a disease and subsequent recurrence is proportional to clinical stage at presentation. Patients with cT1/pT3a have outcomes more similar to pT2, while patients with cT2/pT3a align more closely to cT3a/pT3a. Future refinements of the TNM staging system for RCC should consider regrouping cT1/pT3a into the pT2 group.
The aim of the present study is to evaluate the prognostic significance of the Glasgow Prognostic... more The aim of the present study is to evaluate the prognostic significance of the Glasgow Prognostic Score (GPS) in metastatic renal cell carcinoma (mRCC) patients treated with cytoreductive nephrectomy (CN) and the accuracy of the GPS as a prognostic factor. METHODS: We retrospectively analyzed the data of patients who underwent CN for mRCC between March 1984 and August 2015. In accordance with the GPS criteria, the patients were classified into three groups, as follows: GPS 0: CRP 1.0 mg/dl and albumin 3.5 g/ dl, GPS 1: CRP >1.0 mg/dl or albumin <3.5 g/dl, and GPS 2: CRP >1.0 mg/dl and albumin <3.5 g/dl. RESULTS: We enrolled 170 patients (72% male; median age, 63.5 years). Fifty-six (33%), 67 (39%), and 47 (28%) patients had GPSs of 0, 1, and 2, respectively. The median OSs after CN were 52.4, 19.1, and 8.9 months for patients with a GPS of 0, 1, and 2, respectively (P < 0.0001). In addition to the GPS, age, Eastern Cooperative Oncology Group performance status (ECOG-PS), histology, sarcomatoid change, clinical nodal stage, liver metastasis were included in the Cox hazards regression model. Multivariate analysis of these factors revealed that the GPS was an independent prognostic factor of OS (P < 0.0001). The Harrell's concordance index in the multivariate prognostic model based on age, ECOG-PS, histology, sarcomatoid change, clinical nodal stage, and liver metastasis was 0.662, which increased to 0.674 after the inclusion of GPS. CONCLUSIONS: GPS represents an independent prognostic factor for patients who undergo CN for mRCC.
and radical nephrectomy, with 5-year estimated survival of 98% [95% CI 97-99%] in partial nephrec... more and radical nephrectomy, with 5-year estimated survival of 98% [95% CI 97-99%] in partial nephrectomy, and 93% [95% CI 91-95%] in radical nephrectomy. On Cox proportional hazard analysis, the following covariates were independently associated with worse overall survival: Charlson Comorbidity Index (HR 1.42, 95% CI 1.11-1.82) and papillary histology (HR 1.73, 95% CI 1.04-2.90). Partial nephrectomy, on the other hand, was associated with better overall survival (HR 0.38, 95% CI 0.24-0.61). CONCLUSIONS: In younger patients presenting with cT1 renal masses, partial nephrectomy appears to be underutilized, with only 54.2% undergoing nephron-sparing surgery. This may reflect provider caution in treating these patients and desire to be oncologically aggressive. However, 5-year overall survival appears slightly better in those undergoing nephron preservation, which should be considered the first line treatment in this population when technically feasible.
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Papers by Dattatraya Patil