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- Abu-Ghanem, Yasmin, et al.
(author)
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Should patients with low-risk renal cell carcinoma be followed differently after nephron-sparing surgery vs radical nephrectomy?
- 2021
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In: BJU International. - : John Wiley & Sons. - 1464-4096 .- 1464-410X. ; 128:3, s. 386-394
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Journal article (peer-reviewed)abstract
- Objective: To investigate whether pT1 renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multicentre database (RECUR).Subjects: A retrospective study was conducted in 3380 patients treated for nonmetastatic RCC between January 2006 and December 2011 across 15 centres from 10 countries, as part of the RECUR database project. For patients with pT1 clear-cell RCC, patterns of recurrence were compared between RN and PN according to recurrence site. Univariate and multivariate models were used to evaluate the association between surgical approach and recurrence-free survival (RFS) and cancer-specific mortality (CSM).Results: From the database 1995 patients were identified as low-risk patients (pT1, pN0, pNx), of whom 1055 (52.9%) underwent PN. On multivariate analysis, features associated with worse RFS included tumour size (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14–1.39; P < 0.001), nuclear grade (HR 2.31, 95% CI 1.73–3.08; P < 0.001), tumour necrosis (HR 1.5, 95% CI 1.03–2.3; P = 0.037), vascular invasion (HR 2.4, 95% CI 1.3–4.4; P = 0.005) and positive surgical margins (HR 4.4, 95% CI 2.3–8.5; P < 0.001). Kaplan–Meier analysis of CSM revealed that the survival of patients with recurrence after PN was significantly better than those with recurrence after RN (P = 0.02). While the above-mentioned risk factors were associated with prognosis, type of surgery alone was not an independent prognostic variable for RFS nor CSM. Limitations include the retrospective nature of the study.Conclusion: Our results showed that follow-up protocols should not rely solely on stage and type of primary surgery. An optimized regimen should also include validated risk factors rather than type of surgery alone to select the best imaging method and to avoid unnecessary imaging. A follow-up of more than 3 years should be considered in patients with pT1 tumours after RN. A novel follow-up strategy is proposed.
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2. |
- Abu-Ghanem, Yasmin, et al.
(author)
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The Impact of Histological Subtype on the Incidence, Timing, and Patterns of Recurrence in Patients with Renal Cell Carcinoma After Surgery : Results from RECUR Consortium
- 2021
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In: European Urology Oncology. - : Elsevier. - 2588-9311. ; 4:3, s. 473-482
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Journal article (peer-reviewed)abstract
- Background: Current follow-up strategies for patients with renal cell carcinoma (RCC) after curative surgery rely mainly on risk models and the treatment delivered, regardless of the histological subtype.Objective: To determine the impact of RCC histological subtype on recurrence and to examine the incidence, pattern, and timing of recurrences to improve follow-up recommendations.Design, setting, and participants: This study included consecutive patients treated surgically with curative intention (ie, radical and partial nephrectomy) for nonmetastatic RCC (cT1–4, M0) between January 2006 and December 2011 across 15 centres from 10 countries, as part of the euRopEan association of urology renal cell carcinoma guidelines panel Collaborative multicenter consortium for the studies of follow-Up and recurrence patterns in Radically treated renal cell carcinoma patients (RECUR) database project.Outcome measurements and statistical analysis: The impact of histological subtype (ie, clear cell RCC [ccRCC], papillary RCC [pRCC], and chromophobe RCC [chRCC]) on recurrence-free survival (RFS) was assessed via univariate and multivariate analyses, adjusting for potential interactions with important variables (stage, grade, risk score, etc.) Patterns of recurrence for all histological subtypes were compared according to recurrence site and risk criteria.Results and limitations: Of the 3331 patients, 62.2% underwent radical nephrectomy and 37.8% partial nephrectomy. A total of 2565 patients (77.0%) had ccRCC, 535 (16.1%) had pRCC, and 231 (6.9%) had chRCC. The median postoperative follow-up period was 61.7 (interquartile range: 47–83) mo. Patients with ccRCC had significantly poorer 5-yr RFS than patients with pRCC and chRCC (78% vs 86% vs 91%, p = 0.001). The most common sites of recurrence for ccRCC were the lung and bone. Intermediate-/high-risk pRCC patients had an increased rate of lymphatic recurrence, both mediastinal and retroperitoneal, while recurrence in chRCC was rare (8.2%), associated with higher stage and positive margins, and predominantly in the liver and bone. Limitations include the retrospective nature of the study.Conclusions: The main histological subtypes of RCC exhibit a distinct pattern and dynamics of recurrence. Results suggest that intermediate- to high-risk pRCC may benefit from cross-sectional abdominal imaging every 6 mo until 2 yr after surgery, while routine imaging might be abandoned for chRCC except for abdominal computed tomography in patients with advanced tumour stage or positive margins.Patient summary: In this analysis of a large database from 15 countries around Europe, we found that the main histological subtypes of renal cell carcinoma have a distinct pattern and dynamics of recurrence. Patients should be followed differently according to subtype and risk score.
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- Fallara, Giuseppe, et al.
(author)
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Recurrence pattern in localized RCC : results from a European multicenter database (RECUR)
- 2022
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In: Urologic Oncology. - : Elsevier. - 1078-1439 .- 1873-2496. ; 40:11, s. 494.e11-494.e17
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Journal article (peer-reviewed)abstract
- Introduction: The impact of open versus minimally invasive surgery on recurrence pattern in the management of localized renal cell carcinoma (RCC) remains uncertain. We thus aimed to determine the impact of surgical approach on survival and recurrence pattern.Material and methods: This is a multi-institutional, matched cohort study on patients with pT1-3aN0M0 RCC from the RECUR database. After propensity score matching between open and minimally invasive surgery, disease-free (DFS) survival and risk of first recurrence according to recurrence site, namely local recurrence, abdominal/retroperitoneal, thoracic/mediastinal or uncommon site metastases were investigated with Cox regression analysis. Overall (OS) and Cancer Specific Survival (CSS) were also assessed.Results: After matching, 1,019 patients who underwent open and 1,019 who underwent minimally invasive surgery were included (of which 70 robot-assisted). At 5.2 years of median follow-up, 130 patients in open and 125 in minimally invasive group experienced disease progression. A higher risk of local recurrence (HR 2.06; 95% CI 1.18–3.58, P-value = 0.01) and uncommon site metastases (HR 1.09; 95% CI 1.01–1.16; P-value = .04) was found for minimally invasive surgery relative to open surgery, while no difference was found in terms of DFS (HR 0.83; 95% CI 0.64–1.06; P-value = .14). No differences were found in terms of OS and CSS. Main limitation is the retrospective nature of the study.Conclusions: The risk for local recurrence and uncommon site metastases was higher for minimally invasive surgery compared to open surgery, although no differences were found for OS, CSS, and DFS.
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4. |
- Lund, Lars, et al.
(author)
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Use of venous-thrombotic-embolic prophylaxis in patients undergoing surgery for renal tumors : a questionnaire survey in the Nordic countries (The NORENCA-2 study)
- 2018
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In: Research and Reports in Urology. - : DOVE Medical Press Ltd.. - 2253-2447. ; 10, s. 181-187
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Journal article (peer-reviewed)abstract
- Purpose: To examine the variation in venous thromboembolism prophylactic treatment (VTEP) among renal cancer patients undergoing surgery.Materials and methods: An Internet-based questionnaire on renal tumor management before and after surgery was mailed to all Nordic departments of urology. The questions focused on the use of VTEP and were subdivided into different surgical modalities.Results: Questionnaires were mailed to 91 institutions (response rate 53%). None of the centers used VTEP before surgery, unless the patient had a vena caval tumor thrombus. Overall, the VTEP utilized during hospitalization for patients undergoing renal surgery included early mobilization (45%), compression stockings (52%) and low-molecular-weight heparin (89%). In patients undergoing open radical Nx, 80% of institutions used VTEP during their hospitalization (23% compression stockings and 94% low-molecular-weight heparin). After leaving the hospital, the proportion and type of VTEP received varied considerably across institutions. The most common interval, used in 60% of the institutions, was for a period of 4 weeks. The restriction to the Nordic countries was a limitation and, therefore, may not reflect the practice patterns elsewhere. It is a survey study and, therefore, cannot measure the behaviors of those institutions that did not participate.Conclusion: We found variation in the type and duration of VTEP use for each type of local intervention for renal cancer. These widely disparate variations in care strongly argue for the establishment of national and international guidelines regarding VTEP in renal surgery.
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- Lund, Lars, et al.
(author)
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Use of venous-thrombotic-embolic (vte) prophylaxis in patients undergoing surgery for renal tumors in Nordic countries (the Norenca-II study)
- 2017
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In: Scandinavian journal of urology. - : Taylor & Francis. - 2168-1805 .- 2168-1813. ; 51:Suppl. 220, s. 48-48
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Journal article (other academic/artistic)abstract
- Introduction: Development of venous thromboembolism (VTE) is due to a homeostatic imbalance in the interaction between the vessel wall, flow and blood composition. Reduced flow is a wellknown risk factor for VTE. Cancer patients often have reduced flow, particularly associated with prolonged immobilization or by direct compression of the veins by a growing tumor.Objectives: The purpose of the study is to examine whether renal cancer patients in the five Nordic countries undergoing surgery receive VTE prophylactic treatment (VTEP).Methods: A 21-question internet based questionnaire on renal tumor management before and after surgery was mailed to all Nordic departments performing renal cancer surgery. The questions were subdivided into the different surgical modalities and the use of VTEP. Descriptive statistics were performed.Results: The questionnaires were posted to 91 institutions of which 6 did not perform renal surgery in 2016. We received responses from 45 of 85 hospitals performing renal surgery (response rate 53%). None of the centers used VTEP before surgery unless the patient had a vena caval tumor thrombus. Overall, VTEP in the hospital for patients undergoing renal surgery included 47% using early mobilization, 53% compression stocking and 88% low molecular weight heparin (LMWH). In patients undergoing open radical or partial Nx, 79% received VTEP (24% compression stockings, 2% subcutaneous heparin and 94% LMWH). After leaving the hospital the proportion of patients received VTEP for differing periods (6% for one week, 35% for 2 weeks, and 59% for four weeks). In patients undergoing robotic radical Nx 19% received VTEP for one week, 44% for 2 weeks and 37% for 4 weeks. For those who underwent Lap/robotic partial Nx, 69% received VTEP. In these, in total 30% had compression stockings, 10% subcutaneous heparin and 87% received LMWH. VTEP was continued for one week, 2 weeks and four weeks for 20%, 50% and 30% of the patients respectively. Five centers performed lap/robotic thermal ablation of tumors and overall 57% used compression stockings and 71% LMWH. Two centers continued VTEP for one week (40%) and three for 2 weeks (60%). Two centers performed percutaneous ablation.Conclusion: We found differences in duration of VTEP use by type of operation and across differing facilities. Given the highly varied approach to VTEP, the presented data suggests a need for national and international guidelines to help reduce the variations in care regarding VTE prophylaxis in renal surgery.
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7. |
- Nisen, Harry, et al.
(author)
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Contemporary treatment of renal tumors : a questionnaire survey in the Nordic countries (the NORENCA-I study)
- 2017
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In: Scandinavian journal of urology. - : Taylor & Francis. - 2168-1805 .- 2168-1813. ; 51:5, s. 360-366
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The five Nordic countries comprise 25 million people, and have similar treatment traditions and healthcare systems. To take advantage of these similarities, a collaborative group (Nordic Renal Cancer Group, NORENCA) was founded in 2015.MATERIALS AND METHODS: A questionnaire of 17 questions on renal tumor management and surgical education was designed and sent to 91 institutions performing renal tumor surgery in 2015. The response rate was 68% (62 hospitals), including 28 academic, 25 central and nine district hospitals. Hospital volume was defined as low (LVH: < 20 operations), intermediate (IVH: 20-49 operations), high (HVH: 50-99) and very high (VHVH: ≥ 100). Descriptive statistics were performed.RESULTS: Fifteen centers were LVH, 16 IVH, 21 HVH and 10 VHVH. Of all 3828 kidney tumor treatments, 55% were radical nephrectomies (RNs), 37% partial nephrectomies (PNs) and 8% thermoablations. For RN and PN, the percentages of open, laparoscopic and robotic approaches were 47%, 40%, 13% and 47%, 20%, 33%, respectively. The mean complication rate (Clavien-Dindo 3-5) was 4.9%, and 30 day mortality (TDM) was 0.5%. The median length of hospital stay was 4 days. Training with a simulator, black box or animal laboratory was possible in 48%, 74% and 21% of institutions, respectively.CONCLUSIONS: Despite some differences between countries, the data suggest an overall general common Nordic treatment attitude for renal tumors. Furthermore, the data demonstrate high adherence to international standards, with a high proportion of PN and acceptable rates for major complications and TDM.
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8. |
- Pedersen, Torben Brochner, et al.
(author)
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Use of Tromboprophylaxis in Renal Surgery in the Nordic Countries
- 2019
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In: Scandinavian journal of urology. - : Taylor & Francis. - 2168-1805 .- 2168-1813. ; 53:Suppl. 221, s. 37-37
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Journal article (other academic/artistic)abstract
- Introduction: In 2017 a work panel under the European Association of Urology (EAU) pubslished the first comprehensive guideline specific to urology. The guideline offers practical evidence based guidance on use of tromboproprophylaxis (TP). Prior to this guideline publication, a previous questionaire (The NoRenCa-2 study) suggested a high degree of variation in TP practice in renal surgery across the nordic countries. We sought to examine the current practice at different urological departments accross the nordic region.Materials and Method: A questionaire was distrubuted by e-mail to urological departments performing renal surgery. The questionnaire addressed familiarity with The American College of Chest Physicians (AACP), The National Institute for Health and Care Excellence (NICE), EAU, local and national guidelines and adressed TP practice specific for renal surgical procedures.Results: Eighty-four sites were invited to complete the questionarie (reponse rate 45.9%). Participants expressed familiarity with the local (71.8%) guidelines followed by EAU (61.5%), National (41.0%) and AACP (7.7%) guidelines. Local (64.1%) guidelines was adhered to the most followed by EAU (43.6%) and National (23.1%) guidelines. For open nephrectomy, with no known risk factor for thrombosis, 94.9% offered Low Molecular Weight Heparin followed by early ambulation (69.2%), Graduated compression stockings (48.7%), Intermittent Pneumatic Compressionstockings (5.1%) and unfractionated Heparin (5.1%). A duration of 28 days (30.8%) was suggested by a majority while the remainder continued prophylaxis until discharge (20.5%), 10-14 days (5.1%), other duration (5.1%), 14-21 days (2.6%), 21-27 days (2.6%) and until ambulation(2.6%). Pharmacological TP was initiated postoperatively (56.4%) rather than preoperatively (37.2%)Conclusion: TP is used widely across the nordic countries in a majority of renal procedures. Timing, duration and type of TP nevertheless varies greatly among sites
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