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Chinese Journal of Surgery ; (12): 961-968, 2022.
Article in Chinese | WPRIM | ID: wpr-948624


Fumarate hydratase-deficient renal cell carcinoma (FH-RCC) is an independent pathological subtype of renal cell carcinoma with a clear driver gene and a high degree of malignancy. Recent studies have found that patients with somatic FH mutations have similar clinico-biological behavior and poor prognosis to patients with germline FH mutations. FH-RCC has the characteristics of early age of onset, atypical imaging manifestations, variable pathological patterns, difficult clinical diagnosis and poor effect on traditional drug treatment, thus greatly endangering the life and health of patients. Under the organization of the Rare Kidney Cancer Collaborative Group, Genitourinary Cancer Committee, China Anti-Cancer Association, this guideline was developed based on basic research, clinical cohort and evidence-based medicine evidence, including imaging manifestations, pathological diagnosis, genetic testing, surgical and systemic treatment options, and provided recommendations and references for the diagnosis and treatment norms.

Humans , Carcinoma, Renal Cell/therapy , Fumarate Hydratase/genetics , Consensus , Kidney Neoplasms/therapy , Immunohistochemistry
Article in Chinese | WPRIM | ID: wpr-953216


OBJECTIVE@#To investigate the treatment and prognosis of multiple primary malignant neoplasms (MPMN) complicated with renal cell carcinoma (RCC), and to make risk stratification.@*METHODS@#A retrospective study of 27 cases of MPMN with RCC in two centers, including the different tumors of MPMN, specific treatment methods, and the interval between primary cancers. At the same time, the survival conditions, including recurrence, metastasis and survival, were followed up for statistical analysis. The interval between the two kinds of primary cancer within 6 months was simultaneous MPMNs, and more than 6 months was metachronous MPMNs. For simple risk stratification of cases, as long as one of the MPMNs had a stage Ⅲ or higher malignancy, which was defined as high risk.@*RESULTS@#Among the 27 patients, 20 were male and 7 were female, with age at the time of diagnosis was 42-82 years, with an average age of (61.3±11.7) years. The age at the diagnosis of renal cancer was 43-87 years, with an average age of (66.0±11.3) years. There were 21 cases with duplex primary malignant neoplasms, 4 cases with triple primary malignant neoplasms, and 2 cases with quadruple primary malignant neoplasms. The interval between first cancer and second cancer was 0-360 months, with a median of 18 months. There were 17 cases of metachronous multiple primary malignant neoplasms and 10 cases of simultaneous multiple primary malignant neoplasms. The most common system of MPMN with comorbid RCC involved urologic system, digestive system and respiratory system. The most common locations of MPMN with comorbid RCC were bladder cancer, lung cancer and colon cancer. Follow-up time calcu- lated from the last cancer was 2-156 months, with a median of 32 months. And 14 cases survived and 13 cases died, with 11 cases being tumor related. Tumor stage was the risk factor of prognosis. Any kind of tumor stage in stage Ⅲ or above had a relatively poor prognosis.@*CONCLUSION@#MPMN complicated with RCC is relatively rare. Standard treatment should be used for each cancer type during the treatment process. The prognosis mainly depends on the highest stage of each tumor. Simple risk stratification shows that the prognosis of the high-risk group is worse. This simple stratification method may be helpful to predict the prognosis.

Aged , Carcinoma, Renal Cell/therapy , Female , Humans , Kidney Neoplasms/therapy , Male , Middle Aged , Neoplasms, Multiple Primary/therapy , Prognosis , Retrospective Studies
Article in Chinese | WPRIM | ID: wpr-953213


OBJECTIVE@#To establish a mutation prediction model for efficacy assessment, the genomic sequencing data of renal cancer patients from the MSKCC (Memorial Sloan Kettering Cancer Center) pan-cancer immunotherapy cohort was used.@*METHODS@#The genomic sequencing data of 121 clear cell renal cell carcinoma patients treated with immune checkpoint inhibitors (ICI) in the MSKCC pan-cancer immunotherapy cohort were obtained from cBioPortal database (<a href="" target="_blank"></a>) and they were analyzed by univariate and multivariate Cox regression analysis to identify mutated genes associated with ICI treatment efficacy, and we constructed a comprehensive prediction model for drug efficacy of ICI based on mutated genes using nomogram. Survival analysis and time-dependent receiver operator characteristic curves were performed to assess the prognostic value of the model. Transcriptome and genomic sequencing data of 538 renal cell carcinoma patients were obtained from the TCGA database (<a href="" target="_blank"></a>). Gene set enrichment analysis was used to identify the potential functions of the mutated genes enrolled in the nomogram.@*RESULTS@#We used multivariate Cox regression analysis and identified mutations in PBRM1 and ARID1A were associated with treatment outcomes in the patients with renal cancer in the MSKCC pan-cancer immunotherapy cohort. Based on this, we established an efficacy prediction model including age, gender, treatment type, tumor mutational burden (TMB), PBRM1 and ARID1A mutation status (HR=4.33, 95%CI: 1.42-13.23, P=0.01, 1-year survival AUC=0.700, 2-year survival AUC=0.825, 3-year survival AUC=0.776). The validation (HR=2.72, 95%CI: 1.12-6.64, P=0.027, 1-year survival AUC=0.694, 2-year survival AUC=0.709, 3-year survival AUC=0.609) and combination (HR=2.20, 95%CI: 1.14-4.26, P=0.019, 1-year survival AUC=0.613, 2-year survival AUC=0.687, 3-year survival AUC=0.526) sets confirmed these results. Gene set enrichment analysis indicated that PBRM1 was involved in positive regulation of epithelial cell differentiation, regulation of the T cell differentiation and regulation of humoral immune response. In addition, ARID1A was involved in regulation of the T cell activation, positive regulation of T cell mediated cyto-toxicity and positive regulation of immune effector process.@*CONCLUSION@#PBRM1 and ARID1A mutations can be used as potential biomarkers for the evaluation of renal cancer immunotherapy efficacy. The efficacy prediction model established based on the mutation status of the above two genes can be used to screen renal cancer patients who are more suitable for ICI immunotherapy.

Biomarkers, Tumor/genetics , Carcinoma, Renal Cell/therapy , Humans , Immunotherapy/methods , Kidney Neoplasms/therapy , Mutation
Article in Chinese | WPRIM | ID: wpr-927880


Renal cell carcinoma (RCC) is a common lethal urological cancer,the distant metastasis of which is the leading cause of death.Although targeted agents have remarkably improved the overall prognosis of RCC patients,nearly all the patients eventually acquire therapeutic resistance.With the advent of immune checkpoint inhibitors,immunotherapy based on tumor microenvironment (TME) has shown a broad scope in clinical application.The deepening understanding of TME leads to the changes of therapeutic strategies for advanced RCC,and the combination of targeted therapy and immunotherapy is exhibiting a promising prospect.Herein,we reviewed the TME characteristics,candidate predictive biomarkers,and possible targets for future development of drugs against RCC.

Carcinoma, Renal Cell/therapy , Female , Humans , Immune Checkpoint Inhibitors , Immunotherapy , Kidney Neoplasms/therapy , Male , Tumor Microenvironment
Article in Chinese | WPRIM | ID: wpr-879829


OBJECTIVE@#To study the long-term clinical effect of multicenter multidisciplinary treatment (MDT) in children with renal malignant tumors.@*METHODS@#A retrospective analysis was performed on the medical data of 55 children with renal malignant tumors who were diagnosed and treated with MDT in 3 hospitals in Hunan Province from January 2015 to January 2020, with GD-WT-2010 and CCCG-WT-2016 for treatment regimens. A Kaplan-Meier survival analysis was used to analyze the survival of the children.@*RESULTS@#Of the 55 children, 10 had stage I tumor, 14 had stage Ⅱ tumor, 22 had stage Ⅲ tumor, 7 had stage IV tumor, and 2 had stage V tumor. As for pathological type, 47 had FH type and 8 had UFH type. All children underwent complete tumor resection. Of the 55 children, 14 (25%) received preoperative chemotherapy. All children, except 1 child with renal cell carcinoma, received postoperative chemotherapy. Among the 31 children with indication for radiotherapy, 21 (68%) received postoperative radiotherapy. One child died of postoperative metastasis. The incidence rate of FH-type myelosuppression was 94.4%, and the incidence rate of UFH-type myelosuppression was 100%. The median follow-up time was 21 months and the median survival time was 26 months for all children, with an overall survival rate of 98% and an event-free survival rate of 95%.@*CONCLUSIONS@#Multicenter MDT has the advantages of high success rate of operation and good therapeutic effect of chemotherapy in the treatment of children with renal malignant tumors, with myelosuppression as the most common side effects, and radiotherapy is safe and effective with few adverse events. Therefore, MDT has good feasibility, safety, and economy.

Child , Family , Humans , Kidney Neoplasms/therapy , Progression-Free Survival , Retrospective 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
Int. j. morphol ; 38(1): 208-214, Feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1056423


El Tumor de Wilms (TW) es el tumor renal más frecuente entre los 1 y 5 años de edad. La evidencia existente respecto de aspectos clínicos, terapéuticos y de supervivencia (SV) del TW es escasa. El objetivo de este estudio fue determinar diferencias en la SV actuarial global (SVAG) y SV libre de enfermedad (SVLE) a 5 años en pacientes con TW tratados con quimioterapia neoadyuvante (QTNA) y cirugía inicial (CI). Serie de casos. Se incluyeron pacientes con TW de 11 meses y 13 años de edad, tratados en el Instituto del Cáncer SOLCA, Cuenca (1994-2019). Las variables resultado fueron SVAG y SVLE a 5 años. Otras variables de interés fueron: localización, estadio, histología, seguimiento y remisión completa (RC). Una vez concluidos sus tratamientos, los pacientes fueron sometidos a un seguimiento clínico. Se utilizó estadística descriptiva (medidas de tendencia central y dispersión) y analítica (Chi2, exacto de Fisher y corrección por continuidad). Se realizaron análisis de SV con curvas de Kaplan Meier y log-rank. Se reclutaron 36 pacientes (52,8 % hombres), con una mediana de edad de 44 meses; 55,5 % de ellos tuvieron histología favorable. La localización y estadio más frecuente fue riñón izquierdo (55,5 %) y I (33,3 %) respectivamente. El 58,3 % fueron sometidos a CI y el 41,7 % QTNA. Luego de aplicados los tratamientos 21 pacientes (58,3 %), alcanzaron RC. La SVAG y SVLE general a 5 años fue 72,0 % y 69,0 % respectivamente. Al comparar los subgrupos con QTNA y CI; se verificaron SVAG y SVLE a 5 años de 60,0 % y 81,0 % (p=0,118); y de 66,7 % y 71,4 % (p=0,536) respectivamente. La SVAG y SVLE verificadas son similares a las reportadas en otros estudios. No se evidenciaron diferencias de éstas con los tratamientos QTNA y CI.

Wilms tumor (WT) is the most common pediatric kidney tumor between 1 and 5 years of age. The existing evidence regarding clinical, therapeutic and survival (SV) aspects of TW is scarce. The aim of this study was to determine differences in 5-year overall survival (OS) and 5-year disease-free survival (DFS), in patients treated by WT with neoadjuvant chemotherapy (NACT) and initial surgery (IS). Case series. Patients with TW between 11 months and 13 years of age, treated at SOLCA Cancer Institute, Cuenca, Ecuador (1994-2019) were included. The outcome variables were OS and DFS. Once their treatments were completed, patients were followed clinically. Descriptive (measures of central tendency and dispersion) and analytical (Chi2, Fisher's exact and continuity correction) statistics were applied. SV analysis with Kaplan Meier curves and log-rank were performed. 36 patients (52.8 % men), with a median age of 44 months; 55.5 % of which had favorable histology were recruited. The most frequent location and stage was left kidney (55.5 %) and I (33.3 %) respectively. 58.3 % underwent IC and 41.7 % QTNA. After treatments, 21 patients (58.3 %) achieved complete remission. General OS and DFS were 72.0 % and 69.0 % respectively. When comparing subgroups with QTNA and CI. When comparing the subgroups with QTNA and CI, OS and DFS of 60.0 % and 81.0 % were verified (p=0.118); and of 66.7 % and 71.4 % (p=0.536) respectively. General OS and DFS observed are similar to those reported in other studies. No differences were evidenced with QTNA and CI treatments.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Wilms Tumor/mortality , Wilms Tumor/therapy , Kidney Neoplasms/mortality , Kidney Neoplasms/therapy , Remission Induction , Survival Analysis , Follow-Up Studies , Chemotherapy, Adjuvant , Combined Modality Therapy , Wilms Tumor/surgery , Wilms Tumor/drug therapy , Disease-Free Survival , Kidney Neoplasms/surgery , Kidney Neoplasms/drug therapy
Rev. chil. ortop. traumatol ; 61(3): 108-111, 2020. ilus
Article in Spanish | LILACS | ID: biblio-1177822


El carcinoma de células renales es el 7mo cáncer en frecuencia a nivel mundial con más de 300.000 casos nuevos al año y es la 3era malignidad genitourinaria más frecuente. El sitio más común de metástasis es el pulmón mientras que el esqueleto ocupa el segundo lugar con una frecuencia que varía entre un 20% a un 35%. Se ha reportado una sobrevida de 12 meses en promedio luego de la aparición de metástasis óseas. Reporte del caso de un paciente con diagnóstico de cáncer renal de células claras y metástasis óseas (en columna, pelvis y ambos húmeros), que evoluciona con fractura de ambos brazos. El paciente es aceptado en un ensayo clínico de tratamiento con inmunoterapia y además se somete a una reducción y osteosíntesis bilateral de húmero con clavo endomedular, logrando la consolidación de ambas fracturas y, por ende, la regresión de la enfermedad.

Renal cell carcinoma is ranked 7th in frequent cancer worldwide with more than 3000.000 new cases per year, as well as it's ranked 3rd in frequent genitourinary malignancy. The most common area of metastases is lung followed by skeleton in second place. The frequency of skeleton metastases varies from 20% to 35%. A survival average time of 12 months is generally observed after the appearance of bone metastases. This case report is about a patient diagnosed with clear cell renal cancer and bone metastases (in the spine, pelvis and both humerus) that evolves with fracture of both arms. The patient undergoes a clinical trial with immunotherapy and also a reduction and osteosynthesis of both arms with intramedullary nail, achieving consolidation of both fractures and regression of the disease.

Humans , Male , Middle Aged , Bone Neoplasms/secondary , Carcinoma, Renal Cell/secondary , Humeral Fractures/etiology , Kidney Neoplasms/pathology , Bone Neoplasms/complications , Carcinoma, Renal Cell/complications , Carcinoma, Renal Cell/therapy , Fracture Fixation, Internal , Humeral Fractures/surgery , Humeral Fractures/diagnostic imaging , Immunotherapy , Kidney Neoplasms/therapy
Rev. bras. ginecol. obstet ; 41(3): 199-202, Mar. 2019. graf
Article in English | LILACS | ID: biblio-1003539


Abstract Angiomyolipomas (AMLs) are rare benign tumors derived from mesenchymal tissue and composed of varying degrees of adipose tissue, muscle and blood vessels. Renal AMLs (RAMLs) are the result of a sporadic event, and, in most of cases, the diagnosis is usually incidental, but hemorrhage and shock may be present. During pregnancy, the size of AMLs may increase and they may rupture, probably due to the high expression of hormone receptors, and the increase in maternal circulation and abdominal pressure. The authors present a case of a woman with ruptured RAML submitted to urgent endovascular treatment four days after giving birth by cesarean section.

Resumo Angiomiolipomas (AMLs) são tumores benignos raros derivados do tecido mesenquimal, compostos em graus variados de tecido adiposo, muscular e de vasos sanguíneos. Os AMLs renais (AMLRs) resultam de um evento esporádico e, na maioria dos casos, o diagnóstico costuma ser fortuito, mas quadros de hemorragia e choque podem estar presentes. Durante a gestação, os AMLs podem aumentar de tamanho e romper, provavelmente pela altaexpressãodereceptoreshormonais,epeloaumentodacirculaçãomaternaedapressão abdominal. Os autores apresentam um caso de uma paciente com AMLR roto submetida a tratamento endovascular de urgência no quarto dia pós-operatório de uma cesariana.

Humans , Female , Pregnancy , Adult , Pregnancy Complications, Neoplastic/therapy , Cesarean Section , Angiomyolipoma/therapy , Embolization, Therapeutic , Kidney Neoplasms/therapy , Rupture, Spontaneous/therapy , Postoperative Hemorrhage/etiology , Postoperative Hemorrhage/therapy , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/therapy
Article in Chinese | WPRIM | ID: wpr-941871


OBJECTIVE@#To summarize the experience of diagnosis and surgical treatment of renal oncocytoma, and to evaluate the surgical results based on follow-up results, in order to find the best strategy.@*METHODS@#In the study, 21 cases with renal oncocytoma from December 2003 to April 2016 in Peking University Third Hospital were retrospectively analyzed, including 4 males, and 17 females, with 10 cases on the right side and 11 cases on the left side. Their age was between 15 to 80 years (average: 58 years). Ultrasound or CT examination after admission was conducted. Ultrasound examination showed solid nodules. CT manifestations were solid masses with enhancement, and the tumor size was between 1.5 cm to 6.5 cm (average: 3.3 cm). Of the 21 cases, 9 were located in the middle of kidney, 7 were located in the upper pole, and 5 were located in the lower pole. After preoperative examination, according to the size and location of the tumor, laparoscopic partial nephrectomy or laparoscopic nephrectomy was performed, respectively.@*RESULTS@#All the operations were successful, in which 17 cases underwent laparoscopic partial nephrectomy (including 3 cases which were converted to open surgery), and 4 cases underwent laparoscopic radical nephrectomy. The operation time ranged from 75 to 274 min (mean: 144 min), and the blood loss ranged from 10 to 1 000 mL (mean: 115 mL). The postoperative hospital stay time ranged from 6 to 13 d (average: 8.2 d). The pathological results were all renal oncocytoma. In the study, 17 cases were followed up while 4 cases were lost to follow-up. The follow-up time ranged from 12 to 175 months (mean: 44 months). One case died in 20 months after operation with unknown reason, and there were no recurrence or metastasis in the other 16 cases.@*CONCLUSION@#Renal oncocytoma is a benign tumor with good prognosis. Enhanced CT is an effective diagnostic method in assistant examination, but it is difficult to differentiate clear cell carcinoma only from the naked eye. It is worthwhile to measure CT value at different stages of the tumor by picture archiving and communication systems (PACS), and to compare with CT value of adjacent kidney tissue may improve the diagnostic efficiency of CT. Laparoscopic surgery is an effective treatment for renal oncocytoma. We recommend laparoscopic partial nephrectomy for the patients with renal oncocytoma as the best choice if conditions permit.

Adenoma, Oxyphilic/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma, Renal Cell , Female , Humans , Kidney Neoplasms/therapy , Laparoscopy , Male , Middle Aged , Nephrectomy , Retrospective Studies , Young Adult
Prensa méd. argent ; 104(9): 463-464, nov 2018.
Article in Spanish | LILACS, BINACIS | ID: biblio-1047097


Isolated pancreatic metastases of clear cell renal carcinoma are rare. Clear cell renal carcinoma (CCRC) is responsible for approximately 20-30 % of cases that present metastases at diagnosis. Despite that pancreatic involvement is inusual, this is an organ were particularly and frequently place as the only dissemination site. The aim of this report was to evaluate the surgical and oncological results of patients submitted to pancreatectomy consecutively to a CCRC. Patients with pancreatectomy because of metastases were selected in a 10 -year period. Clear cell renal carcinoma spreads both by direct perinephric extension and by hematogenous and lymphatic routed. The treatment of localized CCRC is surgical. For patients with metastatic CCRC, no efficacious agent has ever been identified, and there is no standard or accepted therapy. The results of this study are presented and discussed

Humans , Pancreatic Neoplasms/surgery , Survival Analysis , Indicators of Morbidity and Mortality , Evaluation Studies as Topic , Kidney Neoplasms/therapy , Medical Oncology/trends , Neoplasm Metastasis
Article in Chinese | WPRIM | ID: wpr-941707


OBJECTIVE@#To summarize the experience of flexible ureteroscopic holmium laser resection in treatment of renal pelvic carcinoma and to evaluate its value in treatment of renal pelvic carcinoma.@*METHODS@#The clinical data of 6 patients with renal pelvic carcinoma treated in Peking University Third Hospital from January 2015 to January 2017 were retrospectively analyzed. The 6 patients were treated by the same experienced urologist and by flexible ureteroscopic holmium laser resection of renal pelvic tumors under general anesthesia. Regarding the intensity of the holmium laser, 10-30 W was generally used with settings of 0.5-1.5 J and 10-20 Hz. In general, a 200 μm end-firing holmium laser fiber was used. Narrow-band imaging (NBI) technique was applicated to search for tumors and check whether the excision was satisfactory. Routine "second flexible ureteroscopy" was performed after 4-6 weeks, and suspected lesions were referred for a biopy, then vaporized and cauterized. The ureteroscopy was examined every 6 months after operation, and color Doppler ultrasound, computed tomography urography (CTU) or magnetic resonance urography (MRU) were performed at the same time. The urine tumor cells were examined for 3 days before the operation, and the urine tumor markers, such as urinary nuclear matrix protein 22 (NMP22) were tested. For cases with highisk urothelial carcinoma and normal renal function, and 6 cycles of systemic adjuvant chemotherapy were performed after operation.@*RESULTS@#All of the cases were successfully treated. The data were as follows: the operation time 77.5 min (45-115 min), the blood loss 10 mL (5-20 mL), and hospital stay after surgery 3 days (2-5 days). After 13-34 months' followp, two patients had recurrent tumor recurrence and underwent resection operation. Two patients received systemic adjuvant chemotherapy after operation. Case 5 was histopathologically high grade urothelial carcinoma, and 6 cycles of systemic chemotherapy were given after operation. Local recurrence occurred during chemotherapy, and then endoscopic operation was performed, and no recurrence occurred in the follow-up for 12 months after reoperation. In case 6, the pathology was low grade urothelial carcinoma, but the case was multiple tumors in the right renal calyx and the lower calyx. Then 6 cycles of systemic chemotherapy were given, and no recurrence was found in the followp for 13 months.@*CONCLUSION@#Transurethral flexible ureteroscopic holmium laser resection is relatively safe for the treatment of renal pelvic carcinoma. It is suitable for special cases of solitary kidney and renal dysfunction, as well as for patients with low risk urinary tract epithelial tumors, but the recurrence rate is high, and the indications need to be strictly controlled. Patients with high-risk urothelial carcinoma who underwent endoscopic resection are advised to receive systemic adjuvant gemcitabine and cisplatin (GC) regimen after surgery, in order to increase the overall survival rate. Systemic chemotherapy combined with endoscopic operation may become a new treatment for upper tract urothelial carcinoma (UTUC).

Humans , Kidney Neoplasms/therapy , Kidney Pelvis/pathology , Laser Therapy , Lasers, Solid-State , Neoplasm Recurrence, Local , Retrospective Studies , Ureteroscopy
Int. braz. j. urol ; 43(3): 432-439, May.-June 2017. tab, graf
Article in English | LILACS | ID: biblio-840840


ABSTRACT Objectives To further elucidate which patients with metastatic renal cell carcinoma (mRCC) may benefit from cytoreductive nephrectomy (CN) before targeted therapy (TT), and to assess the overall survival of patients undergoing CN and TT versus TT alone. Materials and Methods We identified 88 patients who underwent CN at our institution prior to planned TT and 35 patients who received TT without undergoing CN. Preoperative risk factors described in the literature were assessed in our patient population (serum albumin, liver metastasis, symptomatic metastasis, clinical ≥T3 disease, retroperitoneal and supradiaphragmatic lymphadenopathy). Patients were stratified by number of pretreatment risk factors and overall survival (OS) was compared. Results TT patients had significantly more risk factors compared to CN patients (3.06 vs. 2.11, p<0.01). Patients who received TT alone had median OS of 5.8 months. All but one patient receiving TT alone had two or more risk factors. A comparison of the CN and TT groups was performed by constructing Kaplan-Meier curves. There was no significant difference in median OS for those patients with exactly two risk factors (447 vs. 389 days, p=0.24), and those with three or more risk factors (184 vs. 155 days, p=0.87). Conclusions Using previously described pretreatment risk factors we found that patients with two or more risk factors derived no significant survival advantage from CN in the TT era. These risk factors should be incorporated in the assessment of patients for CN.

Humans , Carcinoma, Renal Cell/therapy , Molecular Targeted Therapy , Cytoreduction Surgical Procedures , Kidney Neoplasms/therapy , Nephrectomy/methods , Preoperative Care , Carcinoma, Renal Cell/secondary , Retrospective Studies , Risk Factors , Combined Modality Therapy , Kaplan-Meier Estimate , Middle Aged
Int. braz. j. urol ; 43(2): 202-208, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-840824


ABSTRACT Purpose Renal cell carcinoma (RCC) is a malignant tumor that metastasizes early, and patients often present with metastatic disease at the time of diagnosis. The aim of our evaluation was to assess the diagnostic and differential diagnostic relevance of metastatic renal cell carcinoma (RCC) with particular emphasis on head and neck manifestations in a large patient series. Patients and methods We retrospectively evaluated 671 consecutive patients with RCC who were treated in our urology practice between 2000 and 2013. Results Twenty-four months after diagnosis, 200/671 (30%) of RCC had metastasized. Distant metastases were found in 172 cases, with 22 metastases (3.3%) in the head and neck. Cervical and cranial metastases were located in the lymph nodes (n=13) and in the parotid and the thyroid gland, tongue, the forehead skin, skull, and paranasal sinuses (n=9). All head and neck metastases were treated by surgical excision, with 14 patients receiving adjuvant radiotherapy and 9 patients receiving chemotherapy or targeted therapy at some point during the course of the disease. Five patients (23%) survived. The mean time of survival from diagnosis of a head and neck metastasis was 38 months, the shortest period of observation being 12 months and the longest 83 months. Discussion and conclusion Our findings show that while RCC metastases are rarely found in the neck, their proportion among distantly metastasized RCC amounts to 13%. Therefore, the neck should be included in staging investigations for RCC with distant metastases, and surgical management of neck disease considered in case of resectable metastatic disease. Similarly, in patients presenting with a neck mass with no corresponding tumor of the head and neck, a primary tumor below the clavicle should be considered and the appropriate staging investigations initiated.

Humans , Male , Female , Adult , Aged , Aged, 80 and over , Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/secondary , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/secondary , Kidney Neoplasms/pathology , Time Factors , Carcinoma, Renal Cell/mortality , Carcinoma, Renal Cell/therapy , Retrospective Studies , Diagnosis, Differential , Neoplasm Grading , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/therapy , Kidney Neoplasms/mortality , Kidney Neoplasms/therapy , Lymphatic Metastasis , Middle Aged , Nephrectomy
Int. braz. j. urol ; 42(1): 29-36, Jan.-Feb. 2016. tab, graf
Article in English | LILACS | ID: lil-777317


ABSTRACT Purpose Among renal malignancies, renal cell carcinoma (RCC) accounts for 85% of cases. Stage is a relevant prognostic factor; 5-year survival ranges from 81% to 8% according to the stage of disease. The treatment is based on surgery and molecularly targeted therapy has emerged as a choice for metastatic disease. Materials and Methods Retrospective study by reviewing the medical records of patients with RCC treated in the last 10 years at UNIFESP. The primary end point of this trial was to evaluate the overall survival (OS) of the patients. The secondary end point was to evaluate the progression-free survival (PFS) after nephrectomy. Results 118 patients with RCC were included. The mean age was 58.3 years, 61.9% men; nephrectomy was performed in 90.7%, clear cell was the histology in 85.6%, 44 patients were classified as stage IV at diagnosis. Among these, 34 had already distant metastasis. 29 patients were treated with sunitinib. The median OS among all patients was 55.8 months. The median PFS after nephrectomy was 79.1 months. Sarcomatoid differentiation HR29.74 (95% CI, 4.31-205.26), clinical stage IV HR1.94 (95% CI, 1.37-2.75) and nephrectomy HR0.32 (95% CI, 0.15-0.67) were OS prognostic factors. Sunitinib had clinical activity. Conclusions Patients treated in our hospital achieved median OS compatible with literature. Nevertheless, this study has shown a high number of patients with advanced disease. For patients with advanced disease, treatment with sunitinib achieved median OS of 28.7 months, consistent with the literature.

Humans , Male , Female , Adult , Aged , Aged, 80 and over , Young Adult , Carcinoma, Renal Cell/mortality , Kidney Neoplasms/mortality , Time Factors , Brazil/epidemiology , Carcinoma, Renal Cell/pathology , Carcinoma, Renal Cell/therapy , Retrospective Studies , Treatment Outcome , Disease-Free Survival , Kaplan-Meier Estimate , Hospitals, Public , Hospitals, University , Kidney Neoplasms/pathology , Kidney Neoplasms/therapy , Middle Aged , Neoplasm Staging , Nephrectomy/statistics & numerical data , Antineoplastic Agents/therapeutic use
Rev. latinoam. enferm. (Online) ; 23(4): 571-577, July-Aug. 2015. tab
Article in English | LILACS, BDENF | ID: lil-761703


AbstractObjective: to analyze the process of tissue repair in patients with venous ulcers using inelastic compression therapy (the Unna Boot), in comparison with the use of the elastic bandage.Method: a controlled randomized clinical trial in which the patients (n=18) were allocated to two groups, those who used the Unna Boot (group B) and those who used the elastic bandage (group A). The study's follow-up period was 13 weeks.Results: a significant reduction took place, at the level of 5%, in the area, in square centimeters, of the ulcers of group B (p<0.0001) throughout the treatment, and there was a tendency of group A for reduction in the area of the ulcer, in centimeters squared (p=0.06), only after the fifth week.Conclusion: the treatment with the Unna Boot presented better results in venous ulcers with areas over 10cm², and the elastic bandage with Petrolatum(r) gauze in venous ulcers below 10cm². Brazilian Clinical Trials Register: Trial (req: 195) and WHO UTN U1111-1122-5489.

ResumoObjetivo:analisar o processo de reparo tecidual de pacientes com úlcera venosa em uso da terapia compressiva inelástica (Bota de Unna), em comparação ao uso da bandagem elástica.Método:ensaio clínico controlado randomizado em que os pacientes (n=18) foram alocados em dois grupos, os que utilizavam a Bota de Unna (grupo B) e os que utilizavam a atadura elástica (grupo A). O tempo de seguimento da pesquisa foi de treze semanas.Resultados:ocorreu redução significativa, no nível de 5%, na área, em centímetros quadrados, das úlceras do grupo B (p<0,0001) ao longo de todo o tratamento, e tendência do grupo A à redução, na área da úlcera, em centímetros quadrados (p=0,06), apenas após a quinta semana.Conclusão:o tratamento com a Bota de Unna apresentou melhor resultado em úlceras venosas com áreas superiores a 10cm², e a atadura elástica com a gaze Petrolatum(r)em úlceras venosas inferiores a 10cm². Registro Brasileiro de Ensaios Clínicos: Trial (req: 195) e WHO UTN U1111-1122-5489.

ResumenObjetivo:analizar el proceso de reparación del tejido de pacientes con úlcera venosa que usan la terapia compresiva inelástica (Bota de Unna), en comparación con el uso del vendaje elástico.Método:ensayo clínico controlado aleatorio en que los pacientes (n=18) fueron designados en dos grupos, los que utilizaban la Bota de Unna (grupo B) y los que utilizaban el vendaje elástico (grupo A). El tiempo de duración de la investigación fue de trece semanas.Resultados:se constató reducción significativa, al nivel de 5%, en el área, en centímetros cuadrados, de las úlceras del grupo B (p<0,0001) a lo largo de todo el tratamiento; y tendencia del grupo A a la reducción, en el área de la úlcera, en centímetros cuadrados (p=0,06), solamente después de la quinta semana.Conclusión:el tratamiento con la Bota de Unna presentó mejor resultado en úlceras venosas con áreas superiores a 10cm², y el vendaje elástico con la gasa Petrolatum(r)en úlceras venosas inferiores a 10cm². Registro Brasileño de Ensayos Clínicos: Trial (req: 195) y WHO UTN U1111-1122-5489.

Animals , Female , Mice , Graft vs Host Disease , Kidney Neoplasms , Lymphocyte Transfusion , Stem Cell Transplantation , Allografts , Cell Line, Tumor , Graft vs Host Disease/immunology , Graft vs Host Disease/pathology , Graft vs Host Disease/therapy , Kidney Neoplasms/immunology , Kidney Neoplasms/pathology , Kidney Neoplasms/therapy , Mice, Inbred BALB C , Mice, Inbred DBA , Neoplasm Metastasis
Rev. chil. urol ; 79(1): 24-29, 2014. ilus, tab, graf
Article in Spanish | LILACS | ID: lil-783414


La embolización renal es un procedimiento intervencionista, cuyas aplicaciones terapéuticas han variado a lo largo del tiempo. Realizamos una revisión retrospectiva de 48 embolizaciones, analizando las causas y complicaciones asociadas a esta técnica. Nuestra indicación principal fue la embolización prequirúrgica de tumores renales de gran tamaño, aunque la indicación de mayor relevancia clínica actual es el tratamiento conservador de fístulas arterio-venosas iatrogénicas, angiomiolipomas o traumatismos renales con sangrado activo. La complicación menor más frecuente es el síndrome post-embolización (52.8 por ciento), situación que remite fácilmente con tratamiento médico. Como complicaciones mayores destacan la sepsis y la migración de material embolígeno, ambos muy poco frecuentes en nuestra serie...

Renal embolization is an interventional procedure, whose therapeutic applications have varied over time. We conducted a retrospective review of 48 embolizations, analyzing the causes and complications associated with this technique. Our main indication was the preoperative embolization of large renal tumors, although the most relevant indication today is the conservative treatment of iatrogenic arteriovenous fistula, angiomyolipomas or renal trauma with active bleeding. The most common minor complication is post-embolization syndrome (52.8 percent), a situation that is easily managed with medical treatment. Major complications include sepsis and migration of embolic material and both are very rare in our series...

Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Embolization, Therapeutic , Arteriovenous Fistula/therapy , Kidney Neoplasms/therapy , Renal Artery , Preoperative Care , Embolization, Therapeutic/adverse effects , Retrospective Studies
Article in English | WPRIM | ID: wpr-109964


OBJECTIVE: To evaluate the safety and efficacy of transarterial nephrectomy, i.e., complete renal artery embolization, as an alternative to surgical nephrectomy. MATERIALS AND METHODS: This retrospective study included 11 patients who underwent transarterial nephrectomy due to a high risk of surgical nephrectomy or their refusal to undergo surgery during the period from April 2002 to February 2013. Medical records and radiographic images were reviewed retrospectively to collect information regarding underlying etiologies, clinical presentations and embolization outcomes. RESULTS: The underlying etiologies for transarterial nephrectomy included recurrent hematuria (chronic transplant rejection [n = 3], arteriovenous malformation or fistula [n = 3], angiomyolipoma [n = 1], or end-stage renal disease [n = 1]), inoperable renal or ureteral injury (n = 2), and ectopic kidney with urinary incontinence (n = 1). The technical success rate was 100%, while clinical success was achieved in eight patients (72.7%). Subsequent surgical nephrectomy was required for three patients due to an incomplete nephrectomy effect (n = 2) or necrotic pyelonephritis (n = 1). Procedure-related complications were post-infarction syndrome in one patient and necrotic pyelonephritis in another patient. Of four patients with follow-up CT, four showed renal atrophy and two showed partial renal enhancement. No patient developed a procedure-related hypertension. CONCLUSION: Transarterial nephrectomy may be a safe and effective alternative to surgical nephrectomy in patients with high operative risks.

Adult , Aged , Angiomyolipoma/therapy , Arteriovenous Malformations/therapy , Child , Embolization, Therapeutic/adverse effects , Female , Graft Rejection/therapy , Hematuria/etiology , Humans , Infarction/etiology , Kidney/blood supply , Kidney Diseases/surgery , Kidney Failure, Chronic/therapy , Kidney Neoplasms/therapy , Male , Middle Aged , Nephrectomy/adverse effects , Renal Artery/abnormalities , Retrospective Studies , Young Adult
Rev. cuba. oftalmol ; 26(1): 180-188, ene.-abr. 2013.
Article in Spanish | LILACS | ID: lil-683105


La endoftalmitis endógena puede ocurrir en aquellos casos de inflamación de los tejidos oculares internos secundaria a infección intraocular, resultado de la diseminación hematógena de los microorganismos desde un foco distal al ojo. Es el grupo menos frecuente de todas las endoftalmitis (5 por ciento), es preferentemente unilateral, y en la mayoría de los pacientes se aprecia al menos un foco extraocular infeccioso. Aunque puede darse en pacientes sanos inmunocompetentes, esta enfoftalmitis afecta fundamentalmente a pacientes con uno o más factores de riesgo, entre ellos, enfermedades crónicas, procedimientos quirúrgicos, neoplasias, usuarios de drogas administradas por vía parenteral, inmunodeficiencias, catéteres intravenosos. Se presenta un caso de una paciente diabética con una endoftalmitis endógena secundaria a un tumor renal, cuyo cuadro inicial apuntaba hacia un coma diabético y en la medida que evolucionó y a través del estudio oftalmológico se logró un completo diagnóstico y tratamiento de su problema de salud

The endogenous endophthalmitis may occur in cases of internal tissue inflammation secondary to intraocular infection, as a result of the hematogenous dissemination of microorganisms from a distal focus to the eye. It is the less frequent group of all types of endophthalmitis (5 percent), preferably unilateral, and most of the cases present with an extraocular infectious focus. Although it may appear in healthy immuno competent patients, this endophthalmitis mainly affects patients with one or more risk factors such as chronic illnesses, surgical procedures, neoplasias, parenterally administered drug users, immunodeficiencies and intravenous catheters. A case of a diabetic female patient with endogenous endophthalmitis secondary to a renal tumor was presented. Her initial clinical picture pointed to diabetic coma, but as the disease evolved and based on the ophthalmological study, it was possible to reach a complete diagnosis and to apply a treatment for her health problem

Humans , Female , Aged , Endophthalmitis/diagnosis , Endophthalmitis/etiology , Endophthalmitis/therapy , Kidney Neoplasms/complications , Kidney Neoplasms/therapy , Nephrectomy