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Int. j. med. surg. sci. (Print) ; 8(4): 1-9, dic. 2021. ilus
Article in English | LILACS | ID: biblio-1348234


Renal cell carcinoma accounts for 2-3% of all malignant neoplasms. Metastatic disease of the spine is common and 50% of bone metastases are already present at the time of primary diagnosis. Bone metastases from renal cell carcinoma are difficult to manage, especially vertebral localization.A 48-year-old woman was diagnosed with renal cell carcinoma in the context of low back pain. The patient presented two skeleton metastases at diagnosis (T11 and 5th rib). The patient received neoadjuvant treatment with cabozantinib, followed by removal of the renal tumor. Radiotherapy was administered for the lumbar lesion. In spite of the radiotherapy treatment, increased low back pain limiting mobility and ambulation. MRI showed an occupation of the spinal canal, without neurological lesion. The SINS scale revealed a score of 14 (vertebral instability). The patient's prognosis was greater than 12 months according to the Tokuhashi score. Based on clinical and mechanical criteria, surgical treatment of the vertebral lesion was decided. T11 vertebrectomy was performed, the reconstruction was made with an expandable cage, and T8 a L2 posterior spinal arthrodesis. A partial resection of the fifth rib was performed in order to remove the whole macroscopic tumor. After 3 months, she was diagnosed with a local infection, treated by irrigation, debridement and antibiotherapy, with good evolution. At 1-year follow-up, she has no low back pain or functional limitation. Follow-up chest-abdomen-pelvis computed CT scan showed absence of disease progression, furthermore, the vertebral arthrodesis shows fusion signs. At the time of this report, there are no clinical or radiological data of infection

El carcinoma de células renales representa el 2-3% de todas las neoplasias malignas. La enfermedad metastásica de la columna vertebral es frecuente y el 50% de las metástasis óseas ya están presentes en el momento del diagnóstico. Las metástasis óseas del carcinoma de células renales son difíciles de manejar, especialmente en localización vertebral.Una mujer de 48 años fue diagnosticada de carcinoma de células renales en el contexto de un dolor lumbar. La paciente presentaba dos metástasis óseas en el momento del diagnóstico (T11 y 5ª costilla). Inicialmente recibió tratamiento neoadyuvante con cabozantinib, seguido de la extirpación quirúrgica del tumor renal. Se administró radioterapia para la lesión lumbar. A pesar del tratamiento radioterápico, aumentó el dolor lumbar con limitación para la movilidad y la deambulación. La RM mostró una ocupación del canal espinal, sin lesión neurológica. La escala SINS reveló una puntuación de 14 (inestabilidad vertebral). El pronóstico de la paciente era superior a 12 meses según la puntuación de Tokuhashi. Basándose en criterios clínicos y mecánicos, se decidió el tratamiento quirúrgico de la lesión vertebral. Se realizó una vertebrectomía de T11, para la reconstrucción se usó una caja extensible, junto con una artrodesis vertebral T8-L2. Se realizó una resección parcial de la quinta costilla para eliminar todo el tumor macroscópico. A los 3 meses de la cirugía la paciente fue diagnosticada de infección local, tratada mediante irrigación, desbridamiento y antibioterapia, con buena evolución. Al año de seguimiento, no presenta dolor lumbar ni limitación funcional. La tomografía computarizada de tórax-abdomen-pelvis de seguimiento mostró ausencia de progresión de la enfermedad, además, la artrodesis vertebral muestra signos de fusión. En el momento de este informe, no hay datos clínicos ni radiológicos de infección.

Humans , Female , Middle Aged , Spinal Neoplasms/secondary , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/pathology , Kidney Neoplasms/surgery , Kidney Neoplasms/pathology , Spinal Neoplasms/surgery , Spinal Neoplasms/diagnostic imaging , Carcinoma, Renal Cell/diagnostic imaging , Magnetic Resonance Spectroscopy , Tomography, X-Ray Computed
Int. braz. j. urol ; 47(3): 566-573, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1154486


ABSTRACT Background: Tyrosine kinase inhibitors (TKI) and immunotherapy improved survival in metastatic renal cell carcinoma (mRCC). Disparities in treatment access are present in healthcare systems globally. The aim of this study was to analyze survival outcomes of mRCC patients treated with first-line TKIs in the public (PHS) and private (PrS) health system in a Brazilian Cancer Center. Materials and Methods: Records from all mRCC patients treated with first-line TKIs from 2007-2018 were reviewed retrospectively. Categorial variables were compared by Fisher's exact test. Survival was estimated by Kaplan-Maier method and survival curves were compared using the log-rank test. Prognostic factors were adjusted by Cox regression model. Results: Of the 171 eligible patients, 37 (21.6%) were PHS patients and 134 (78.4%) were PrS patients. There were no difference in age, gender, or sites of metastasis. PHS patients had worse performance status (ECOG ≥2, 35.1% vs. 13.5%, p=0.007), poorer risk score (IMDC poor risk, 32.4% vs. 16.4%, p=0.09), and less nephrectomies (73% vs. 92.5%, p=0.003) than PrS patients. Median lines of therapy was one for PHS versus two for PrS patients (p=0.03). Median overall survival (OS) was 16.5 versus 26.5 months (p=0.002) and progression-free survival (PFS), 8.4 versus 11 months (p=0.01) for PHS and PrS patients, respectively. After adjusting for known prognostic factors on multivariate analysis, PHS patients still had a higher risk of death (HR: 1.61, 95% CI: 1.01-2.56, p=0.047). Conclusion: Patients with mRCC treated via the PHS had worse overall survival, possibly due to poorer prognosis at presentation and less drug access.

Humans , Carcinoma, Renal Cell/drug therapy , Kidney Neoplasms/drug therapy , Prognosis , Brazil , Retrospective Studies , Treatment Outcome , Disease-Free Survival , Sunitinib
Int. braz. j. urol ; 47(2): 333-349, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154476


ABSTRACT Purpose: Increased attention has been focused on the survival of renal cell carcinoma (RCC) patients with bone metastasis. This study proposed to establish and evaluate a nomogram for predicting the overall survival (OS) and cancer-specific survival (CSS) of RCC patients with bone metastasis. Materials and Methods: RCC patients with bone metastasis between 2010 and 2015 were captured from the surveillance, epidemiology and end results (SEER) database. Univariate and multivariate cox regressions were performed to assess the effects of clinical variables on OS and CSS. The nomogram based on the Cox hazards regression model was developed. Concordance index (C-index) and calibration curve were performed to evaluate the accuracy of nomogram models, receiver operating characteristic (ROC) curves and decision curve analysis (DCA) were conducted to assess the predict performance. Results: A total of 2.471 eligible patients were enrolled in this study. The patients were assigned to primary (n=1.672) and validation (n=799) cohorts randomly. The 1-, 2-, and 3-year OS and CSS nomogram models were constructed based on age at diagnosis, sex, marital status, pathological grade, T-stage, N-stage, brain/liver/lung metastasis, surgery, radiotherapy and chemotherapy. The c for OS and CSS prediction was 0.730 (95% confidence interval [CI]: 0.719-0.741) and 0.714 (95%CI:0.702-0.726). The calibration curves showed significant agreement between nomogram models and actual observations. ROC and DCA indicated nomograms had better predict performance. Conclusions: The nomograms for predicting prognosis provided an accurate prediction of OS and CSS in RCC patients with bone metastasis, and contributed clinicians to optimize individualized treatment plans.

Humans , Carcinoma, Renal Cell , Neoplasm Staging , SEER Program , Nomograms , Kidney Neoplasms
Int. braz. j. urol ; 47(1): 46-60, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1134331


ABSTRACT Purpose: Radical nephrectomy (RN) is the standard surgical type for pathological stage T3a (pT3a) renal cell carcinoma (RCC). Recently, some studies have suggested equivalence between partial nephrectomy (PN) and RN for oncologic control and have shown the benefits of PN for better renal function. We conducted this meta-analysis to assess oncologic outcomes, perioperative outcomes and renal function between two groups among patients with pT3a RCC. Materials and methods: PubMed, Scopus, Web of Science, Science Direct, Ovid MEDLINE, The Cochrane Library, Embase and Google Scholar were searched for eligible articles. The endpoints of the final analysis included overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), surgical complications, operative time, estimated blood loss (EBL), serum creatinine and estimated glomerular filtration rate (eGFR). Results: Twelve studies of moderate to high quality, including 14.152 patients, were examined. PN showed superiority for renal functional preservation, providing higher eGFR (WMD=12.48mL/min; 95%CI: 10.28 to 14.67; P <0.00001) and lower serum creatinine (WMD=-0.31mg/dL; 95%CI: −0.40 to −0.21; P <0.00001). There were no significant differences between PN and RN regarding operative time, EBL, surgical complications, OS, RFS and CSS. Despite inherent selection bias, most pooled estimates were consistent in sensitivity analysis and subgroup analysis. More positive margins were found in the PN group (RR=2.42; 95%CI: 1.25-4.68; P=0.009). Conclusions: PN may be more suitable for treating pT3a RCC than RN because it provides a similar survival time (OS or RFS) and superior renal function. Nevertheless, this result is still disputed, and more high-quality studies are required.

Humans , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Retrospective Studies , Treatment Outcome , Margins of Excision , Glomerular Filtration Rate , Nephrectomy
Article in Chinese | WPRIM | ID: wpr-878727


Objective To investigate the clinicopathological features and prognosis of chromophobe renal cell carcinoma(ChRCC). Methods The clinical and pathological data of 126 patients with ChRCC treated in Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. Results The patients included 64 males and 62 females,with the age of 22-80 years(median of 52 years).The tumor was located on the right side in 70 cases and on the left side in 56 cases.Ultrasound,CT or magnetic resonance imaging(MRI)were performed.Of the 110 cases receiving ultrasound examination,63,23,13,10,and 1 cases showed hypoecho,hyperecho,isoecho,uneven or mixed echo,and dark hypoecho,respectively.Color Doppler flow imaging showed no blood flow signal in 42 cases and low blood flow signal in 60 cases out of 68 cases with blood flow signal.Among the 54 cases receiving CT,50 cases showed equal density or low density and 4 cases showed high density with clear boundary.The enhanced scanning showed mild to moderate uniform or non-uniform reinforcement,mostly below the renal parenchyma,and still showed reinforcement in the delayed period.Among the 97 cases receiving MRI,96 cases showed hypo-or isointense signals and 1 case showed hyperintense signal in T1 weighted images;71 cases showed hyper-or isointense signals and 26 cases showed hypo-or isointense signals in T2 weighted images;93 cases showed hyperintense signals with obvious limited diffusion and 4 cases showed unobvious limited diffusion in diffusion weighted images.Mild to moderate uniform or non-uniform reinforcement was observed in most of the enhanced scans.All the 126 patients underwent surgical treatment,including 64 cases of nephron sparing surgery and 62 cases of radical surgery.Pathological examinations confirmed ChRCC for all the patients,including 91 cases of T1N0M0,15 cases of T2N0M0,and 20 cases of T3N0M0.The immunohistochemical assay demonstrated the positive expression rate of 48.2%(54/112)for CD10,92.3%(96/104)for CD117,8.0%(9/112)for vimentin,85.6%(95/111)for CK7,and 97.6%(83/85)for colloidal iron.Conclusions ChRCC is less common,with low level of malignancy and good prognosis.Since the clinical symptoms of ChRCC are not typical,MRI is an important means of imaging differential diagnosis,and the disease can be confirmed depending on pathological diagnosis.Surgery is the preferred treatment method,and currently there is no standard treatment regimen for metastatic patients.

Adult , Aged , Aged, 80 and over , Carcinoma, Renal Cell/diagnostic imaging , Diagnosis, Differential , Female , Humans , Immunohistochemistry , Kidney Neoplasms/surgery , Male , Middle Aged , Retrospective Studies , Young Adult
Clin. biomed. res ; 41(3): 205-211, 20210000. tab, graf
Article in English | LILACS | ID: biblio-1343958


Introduction: Renal cell carcinoma (RCC) is one of the most prevalent kidney tumors. Inflammation is believed to be a key factor in its progression and spread since inflammatory markers are generally associated with poor prognosis in RCC patients. Cytokines are cell communication molecules involved in both healthy and pathological processes, including tumor growth and progression. Recent findings suggest that cytokine level measurements could be used for cancer monitoring and prognosis. Methods: This study characterized and compared the levels of different cytokines associated with the classical Th1, Th2, and Th17 immune responses in plasma samples from RCC patients (n = 25) and healthy controls (n = 29). Cytokine levels (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ, and IL-17A) were evaluated by flow cytometry using a BD Cytometric Bead Array (CBA) kit. Results: No statistical differences in systemic IL-2, IL-4, IL-10, IL-17A, TNF, and INF-γ levels were observed between RCC patients and controls (p > 0.05). However, higher systemic IL-6 levels were observed in RCC patients (p = 0.0034). Conclusions: This study highlights the importance of assessing the impact of IL-6 on RCC pathogenesis and its potential role as a biomarker of disease progression. (AU)

Humans , Male , Female , Adult , Middle Aged , Carcinoma, Renal Cell , Interleukin-6 , Interleukin-10 , Cytokinins/analysis , Inflammation
Clin. biomed. res ; 41(3): 262-263, 20210000. ilus
Article in English | LILACS | ID: biblio-1343186


We present a clinical, radiological, surgical, and pathological correlation case of a 49-year-old woman with a prior nephrectomy due to a clear cell renal cell carcinoma, who was then diagnosed with a multilocular cystic lesion in the pancreatic tail after a routine ultrasound. Computed tomography and magnetic resonance cholangiopancreatography showed a multilocular cystic lesion with a hypervascular wall nodule in the pancreas. The patient underwent a distal pancreatectomy and had a final diagnosis of pancreatic mucinous cystadenoma with an associated component of clear cell renal cell carcinoma (collision tumor of the pancreas). (AU)

Humans , Female , Middle Aged , Carcinoma, Renal Cell , Cystadenoma, Mucinous , Neoplasm Metastasis , Pancreatic Neoplasms , Kidney Neoplasms
Autops. Case Rep ; 11: e2020230, 2021. graf
Article in English | LILACS | ID: biblio-1142409


The modern era has brought an appreciation that renal cell carcinoma (RCC) includes diverse subtypes derived from the various parts of the nephron, each with its distinctive genetic basis and tumor biology. Carcinoma of the collecting ducts of Bellini (CDC) is a rare subtype of RCC, with a predictably poor prognosis. This rare subtype represents less than 1% of all kidney carcinomas. It derives from presumably numerous chromosomal losses. It is of chief importance to differentiate CDC from other types of renal cell cancer. Typically, it is characterized by a firm, centrally located tumor with infiltrative borders. Regarding the histopathologic characteristics, we can find complex, highly infiltrative cords with inflamed (desmoplastic) stroma, with high-grade nuclei and mitoses. Most reported cases of CDC had been high grade, advanced stage, and unresponsive to conventional therapies. This rare form of disease highlights the importance of multidisciplinary teams in the management of cancer patients.

Humans , Female , Adult , Carcinoma, Renal Cell/pathology , Kidney Neoplasms/pathology , Kidney Tubules, Collecting
Autops. Case Rep ; 11: e2020207, 2021. graf
Article in English | LILACS | ID: biblio-1142399


Renal cell carcinoma (RCC) is a malignant disease that is often diagnosed at a metastatic stage. The head and neck represent up to 3% of the metastatic RCC, and the paranasal sinus area is one of the least involved sites. Here, we introduce the case of a 74-year-old female patient who presented with a history of traumatic nasal bleed. A cranial computed tomography scan and magnetic resonance imaging showed a fronto-ethmoidal mass with pachymeningeal involvement. A nasal biopsy from the paranasal sinuses was taken. On histopathological examination, metastatic clear cell carcinoma was the main hypothesis, which later was confirmed to be RCC on immunohistochemistry. On further radiological examination, an exophytic mass was depicted in the kidney's upper and middle pole. The patient had no renal complaints and was asymptomatic. Fronto-ethmoidal sinus is a rare site for metastatic RCC, especially in cases where the patient is asymptomatic. Early detection by keeping RCC metastasis as the differential diagnosis in such cases can lead to early treatment and improve the overall survival of the patient.

Humans , Female , Aged , Paranasal Sinuses , Carcinoma, Renal Cell/complications , Kidney Neoplasms/pathology , Epistaxis/pathology , Diagnosis, Differential
Rev. méd. Urug ; 36(4): 445-448, dic. 2020. graf
Article in Spanish | LILACS, BNUY | ID: biblio-1144761


Resumen: Introducción: el cáncer de riñón frecuentemente se presenta con metástasis sincrónicas. Son excepcionales los casos comunicados en la literatura donde el diagnóstico de la enfermedad surge a partir de una metástasis muscular. Objetivo: el objetivo del trabajo es presentar un caso clínico de metástasis en músculo deltoides izquierdo como primera manifestación de un carcinoma de células claras de riñón. Caso clínico: paciente de 76 años, sexo masculino, que se operó con diagnóstico de tumoración de región delitoidea izquierda cuyo estudio anatomopatológico informó una metástasis muscular de un carcinoma renal de células claras. Se realizó una tomografía axial computarizada que evidenció una tumoración renal derecha, por lo cual se realizó una nefrectomía que confirmó el diagnóstico del tumor primario. Discusión: el diagnóstico de metástasis muscular de un carcinoma de células claras de riñón, cuando es la primera manifestación de la enfermedad, habitualmente se realiza con el estudio de la pieza de resección quirúrgica o bien a través de una biopsia. Si bien el tratamiento de la metástasis en general es paliativo, el control local de la enfermedad solo es posible cuando se realiza una resección quirúrgica con márgenes libres, ya que otros tratamientos oncológicos no han demostrado ser eficaces.

Summary: Introduction: most kidney cancer patients present with synchronous metastatic disease. A review of the literature reveals cases where the diagnosis is based on muscle metastasis are exceptional. Objective: the study aims to present the clinical case of metastasis to the left deltoid muscle as the initial presentation of renal cell carcinoma. Clinical case: 76 year old male patient who was operated upon diagnosis of tumour in the left deltoid region, the biopsy of which revealed muscle metastasis of clear cell renal cell carcinoma (RCC). Computerized axial tomography evidenced a tumorous formation in the right kidney. The patient underwent right-sided nephrectomy that confirmed the primary tumour diagnosis. Discussion: diagnosis of muscle metastasis of clear cell renal cell carcinoma, being it the initial presentation of the disease, is often done by analysing the surgical resection piece or by means of a biopsy. Despite treatment of metastasis is usually palliative, local control of the disease is only possible when tumour-free margins surgical resection is done, since other oncologic treatments have not proved effective.

Resumo: Introdução: o câncer renal frequentemente se apresenta com metástases sincrônicas. São excepcionais os casos relatados na literatura em que o diagnóstico da doença decorre de uma metástase muscular. Objetivo: o objetivo do trabalho é apresentar um caso clínico de metástase no músculo deltóide esquerdo como primeira manifestação de um carcinoma de células claras do rim. Caso clínico: paciente do sexo masculino, 76 anos, submetido à cirurgia com diagnóstico de tumor na região do deltóide esquerdo, cujo estudo anatomopatológico relatou metástase muscular de carcinoma renal de células claras. Foi realizada tomografia axial computadorizada que revelou tumor renal direito, sendo realizada nefrectomia que confirmou o diagnóstico do tumor primário. Discussão: o diagnóstico da metástase muscular do carcinoma de células claras do rim, quando é a primeira manifestação da doença, geralmente é feito com o estudo da peça de ressecção cirúrgica ou por meio de biópsia. Embora o tratamento das metástases em geral seja paliativo, o controle local da doença só é possível quando a ressecção cirúrgica é realizada com margens livres de patologia, uma vez que outros tratamentos oncológicos não têm se mostrado eficazes.

Humans , Male , Aged , Carcinoma, Renal Cell , Kidney Neoplasms , Neoplasm Metastasis , Muscle Neoplasms/secondary
Int. braz. j. urol ; 46(5): 705-715, Sept.-Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134219


ABSTRACT Sarcopenia, a concept reflecting the loss of skeletal muscle mass, was reported to be associated with the prognosis of several tumors. However, the prognostic value of sarcopenia in patients with renal cancer remains unclear. We carried out this metaanalysis and systematic review to evaluate the prognostic value of sarcopenia in patients with renal cell carcinomas. We comprehensively searched PubMed, Embase, and Cochrane Library from inception to December 2018. Hazard ratio (HR) and 95% confidence interval (CI) were pooled together. A total of 5 studies consisting of 771 patients were enrolled in this quantitative analysis, 347 (45.0%) of which had sarcopenia. Patients with sarcopenia had a worse OS compared with those without sarcopenia (HR=1.76; 95%CI, 1.35-2.31; P <0.001). In the subgroup of patients with localized and advanced/metastatic diseases, sarcopenia was also associated with poor OS (HR=1.48, P=0.039; HR=2.14, P <0.001; respectively). With a limited sample size, we did not observe difference of PFS between two groups (HR=1.56, 95% CI, 0.69-3.50, P=0.282). In the present meta-analysis, we observed that patients with sarcopenia had a worse OS compared with those without sarcopenia in RCC. Larger, preferably prospective studies, are needed to confirm and update our findings.

Humans , Carcinoma, Renal Cell/complications , Sarcopenia/complications , Kidney Neoplasms/complications , Prognosis , Prospective Studies
Int. braz. j. urol ; 46(supl.1): 69-78, July 2020. tab
Article in English | LILACS | ID: biblio-1134299


ABSTRACT Introduction: Recently the COVID-19 pandemic became the main global priority; main efforts and health infrastructures have been prioritized in favor of COVID-19 battle and the treatment of benign diseases has been postponed. Renal cell cancer (RCC) patients configure a heterogenous populations: some of them present indolent cases which can safely have postponed their treatments, others present aggressive tumors, deserving immediate care. These scenarios must be properly identified before a tailored therapeutic choice. Objectives We propose a risk- based approach for patients with RCC, to be used during this unprecedented viral infection time. Materials and Methods: After a literature review focused in COVID-19 and current RCC treatments, we suggest therapeutic strategies of RCC in two sections: surgical approach and systemic therapy, in all stages of this malignance. Results: Patients with cT1a tumors (and complex cysts, Bosniak III/IV), must be put under active surveillance and delayed intervention. cT1b-T2a/b cases must be managed by partial or radical nephrectomy, some selected T1b-T2a (≤7cm) cases can have the surgery postponed by 60-90 days). Locally advanced tumors (≥cT3 and or N+) must be promptly resected. As possible, minimally invasive surgery and early hospital discharge are encouraged. Upfront cytoreduction, is not recommendable for low risk oligometastatic patients, which must start systemic treatment or even could be put under surveillance and delayed therapy. Intermediate and poor risk metastatic patients must start target therapy and/or immunotherapy (few good responders intermediate cases can have postponed cytoreduction). The recommendation about hereditary RCC syndromes are lacking, thus we recommend its usual care. Local or loco regional recurrence must have individualized approaches. For all cases, we suggest the application of a specific informed consent and a shared therapeutic choice. Conclusion: In the pandemic COVID -19 times, a tailored risk-based approach must be used for a safe management of RCC, aiming to not compromise the oncological outcomes of the patients.

Humans , Pneumonia, Viral/epidemiology , Carcinoma, Renal Cell/therapy , Coronavirus Infections/epidemiology , Kidney Neoplasms/therapy , Pandemics , Betacoronavirus , SARS-CoV-2 , COVID-19 , Neoplasm Recurrence, Local , Nephrectomy
Rev. argent. cir ; 112(3): 333-336, jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1279748


RESUMEN Las metástasis pancreáticas por carcinoma renal de células claras son excepcionales; en general, se presentan como tumores asintomáticos de diagnóstico incidental. Caso clínico: hombre de 61 años, nefrectomizado hace 10 años; durante el seguimiento se detecta una masa pancreática distal de 3 cm, hipervascular. Se realiza pancreatectomía corporocaudal laparoscópica, confirmándose la presencia de una metástasis de carcinoma renal. Las metástasis pancreáticas del carcinoma renal suelen apare cer en forma asintomática y metacrónica. La resección quirúrgica logra buenos resultados oncológicos y debe intentarse siempre que sea posible. En este caso destacamos que se pudo realizar una exéresis radical mediante abordaje mínimamente invasivo.

ABSTRACT Pancreatic metastases from clear cell renal carcinoma are very rare, and generally present as incidental asymptomatic tumors. Case report: a 61-year-old male patient with a history of nephrectomy 10 years before presented a 3-cm hypervascular mass in the distal pancreas during follow-up. A laparoscopic distal pancreatectomy was performed, confirming the presence of metastasis from a renal cell carci noma. Pancreatic metastases from renal cell carcinoma are usually metachronous and asymptomatic. Surgical resection is associated with favorable oncological results and, if possible, should be attempted. In our case, a successful oncological resection could be performed through a minimally invasive ap proach.

Humans , Male , Middle Aged , Pancreatectomy , Carcinoma, Renal Cell/surgery , Neoplasms, Second Primary/surgery , Pancreatic Neoplasms/surgery , Splenectomy/methods , Magnetic Resonance Spectroscopy , Tomography, X-Ray Computed , Neoplasm Metastasis/diagnosis
Int. braz. j. urol ; 46(3): 328-340, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1090598


ABSTRACT Purpose: To explore the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model application for predicting outcome of patients with metastatic renal cell carcinoma using targeted agents. Materials and Methods: We performed a literature review of 989 articles. The selecting process used preferred reporting items for systematic reviews and meta-analyses (PRISMA). All included studies were assessed by Newcastle-Ottawa scale. Results of individual studies were pooled using Stata 14.0 software. Results: A total of 17 articles were included. Most articles provided univariate and multivariate analysis of IMDC model prognosis. Combined HRs were 1.58 (95% CI 1.34-1.82) and 3.74 (95% CI 2.67-4.81) for univariate PFS of intermediate to favorable and poor to favorable respectively. In the category of multivariate PFS, combined HRs were 1.27 (95% CI 0.99-1.56) and 2.29 (95% CI 1.65-2.93) with intermediate to favorable and poor to favorable respectively. Regarding univariate OS, combined HRs were 1.93 (95% CI 1.62-2.24) and 6.25 (95% CI 4.18-8.31) with intermediate to favorable and poor to favorable respectively. With multivariate OS, combined HRs were 1.32 (95%CI 1.04-1.59) and 2.35 (95%CI 1.69-3.01) with intermediate to favorable and poor to favorable respectively. Conclusion: In summary, analysis of currently available clinical evidence indicated that IMDC model could be applied to classify patients with metastatic renal cell carcinoma using targeted agents. However, different types of targeted agents and various areas could affect the accuracy of the model. There was also a difference in predicting patients' PFS and OS.

Humans , Carcinoma, Renal Cell , Kidney Neoplasms , Prognosis , Multivariate Analysis , Retrospective Studies , Databases, Factual
Int. braz. j. urol ; 46(3): 341-350, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1090605


ABSTRACT Purpose: This study aims to evaluate the oncological and functional results of open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) at the T1b clinical stage, which constitutes 25% of renal cell carcinomas (RCC) at diagnosis. Materials and Methods: The characteristics of 63 patients with stage T1b solitary tumor who underwent OPN (41) or LPN (22) were compared. The survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the factors affecting disease-free survival. Potential predictive factors, which might affect the postoperative glomerular filtration rate (GFR), were evaluated using multivariate linear regression analysis. Results: No differences were observed between OPN and LPN groups regarding patient and tumor characteristics. Although the warm ischemia time, intraoperative estimated blood loss, and operation duration were higher in the LPN group, no differences were noted between the two techniques regarding complication rates (p<0.001, p=0.023, p≤0.001, and p=0.190, respectively). The median hospitalization time was shorter in the LPN group than that in the OPN group (4 and 5 days, respectively), with less severe complications. No intergroup differences were observed regarding cancer-specific survival (CSS), disease-free survival (DFS), and overall survival (OS). The evaluation of the factors affecting DFS showed that age was an effective parameter (RR = 1.112, 95% CI: 1.010-8.254), but the surgical technique was not. Conclusion: No differences were observed between OPN and LPN techniques between oncological and functional outcomes in patients with clinical stage T1b RCC.

Humans , Male , Female , Carcinoma, Renal Cell , Laparoscopy , Kidney Neoplasms , Retrospective Studies , Treatment Outcome , Nephrectomy
J. bras. econ. saúde (Impr.) ; 12(1): 39-55, Abril/2020.
Article in Portuguese | LILACS, ECOS | ID: biblio-1096409


Objetivo: Este trabalho teve por objetivo determinar o custo-efetividade e o impacto orçamentário do cabozantinibe para o sistema de saúde suplementar no Brasil, no tratamento de carcinoma de células renais (RCC) avançado ou metastático, após falha de tratamento com inibidor do fator de crescimento endotelial vascular (VEGF), quando comparado ao atual tratamento aprovado: nivolumabe. Métodos: Foram utilizados custos referentes ao uso de recursos, tratamento médico, eventos adversos e qualidade de vida, calculados por estado de saúde. Foi considerado o tempo horizonte de 20 anos para análise de custo-efetividade e 5 anos para impacto orçamentário, e foi realizado um cenário alternativo comparando o cabozantinibe ao nivolumabe e axitinibe. Resultados: O cabozantinibe apresentou eficácia superior quando comparado ao nivolumabe e ao axitinibe e representa uma redução de custos comparado ao nivolumabe. Em relação aos eventos adversos, o cabozantinibe apresenta redução dos gastos quando comparado ao nivolumabe. Conclusão: Esses resultados mostram um potencial de economia ao sistema de saúde suplementar com a adoção do cabozantinibe no tratamento para RCC avançado ou metastático em segunda linha no Brasil.

Objective: This study aimed to determine the cost-effectiveness and budgetary impact of cabozantinib for the supplementary health system in Brazil, in the treatment of advanced or metastatic renal cell carcinoma (RCC) after treatment failure with vascular endothelial growth factor (VEGF) inhibitor, when compared current approved treatment: nivolumab. Methods: Costs related to the use of resources, medical treatment, adverse events and quality of life were used, calculated by health status. The horizon time of 20 years was considered for cost-effectiveness analysis and 5 years for budgetary impact, and an alternative scenario was carried out comparing cabozantinib to nivolumab and axitinib. Results: Cabozantinib showed superior efficacy when compared to nivolumab and axitinib and represents a cost reduction compared to nivolumab. In relation to adverse events, cabozantinib shows a reduction in costs when compared to nivolumab. Conclusion: These results show a potential savings for the supplementary health system with the adoption of cabozantinib in the treatment for advanced or metastatic second-line RCC in Brazil.

Carcinoma, Renal Cell , Cost-Benefit Analysis , Supplemental Health , Analysis of the Budgetary Impact of Therapeutic Advances
Int. braz. j. urol ; 46(2): 234-241, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090590


ABSTRACT Purpose Preoperative computed tomography or magnetic resonance (MR) imaging are commonly used for radiological evaluation of renal cell carcinoma (RCC) before radical nephrectomy or nephron sparing surgery(NSS). This study aimed to assess the role of MRI for predicting postoperative renal function by preoperative estimation of renal parenchymal volume and correlation with glomerular filtration rate (GFR). Materials and Methods A prospective observational study was conducted from February 2015 to October 2016 at a tertiary care hospital in northern India. MR imaging was done on 3 Tesla MR scanner (Signa Hdxt General Electrics, Milwaukee, USA). MR volumetry was used to estimate the renal parenchymal volume. GFR was measured in all patients using Tc99m Diethyl-triamine-penta-acetic acid using Russell's algorithm. Such measurement was done preoperatively, and postoperatively 3 months after surgery. Results 30 patients with suspected RCC underwent NSS (n=10) and radical nephrectomy (n=20). Median tumour volume was 175.7cc (range: 4.8 to 631.8cc). The median volume of the residual parenchyma on the affected side was 84.25±41.97cc while that on the unaffected side was 112.25±26.35cc. There was good correlation among the unaffected kidney volume and postoperative GFR for the radical nephrectomy group (r=0.83) as well as unaffected kidney volume, total residual kidney volume and residual volume of affected kidney with postoperative GFR for the NSS group (r=0.71, r=0.73, r=0.79 respectively; P <0.05). Conclusion Preoperative residual parenchymal volume on MR renal volumetry correlates well with postoperative GFR in patients with RCC undergoing radical nephrectomy or NSS.

Humans , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/diagnostic imaging , Kidney Neoplasms/surgery , Kidney Neoplasms/diagnostic imaging , Nephrectomy/methods , Nephrons/surgery , Postoperative Period , Prognosis , Magnetic Resonance Imaging , Prospective Studies , Glomerular Filtration Rate , Middle Aged