Global incidence and mortality of renal cell carcinoma in 2020 / 中华流行病学杂志

Objective: To analyze the global epidemiology of renal cell carcinoma (RCC) in 2020. Methods: The incidence and mortality data of RCC in the cooperative database GLOBOCAN 2020 of International Agency for Research on Cancer of WHO and the human development index (HDI) published by the United Nations Development Programme in 2020 were collated. The crude incidence rate (CIR), age-standardized incidence rate (ASIR), crude mortality rate (CMR), age-standardized mortality rate (ASMR) and mortality/incidence ratio (M/I) of RCC were calculated. Kruskale-Wallis test was used to analyze the differences in ASIR or ASMR among HDI countries. Results: In 2020, the global ASIR of RCC was 4.6/100 000, of which 6.1/100 000 for males and 3.2/100 000 for females and ASIR was higher in very high and high HDI countries than that in medium and low HDI countries. With the rapid increase of age after the age of 20, the growth rate of ASIR in males was faster than that in females, and slowed down at the age of 70 to 75. The truncation incidence rate of 35-64 years old was 7.5/100 000 and the cumulative incidence risk of 0-74 years old was 0.52%. The global ASMR of RCC was 1.8/100 000, 2.5/100 000 for males and 1.2/100 000 for females. The ASMR of males in very high and high HDI countries (2.4/100 000-3.7/100 000) was about twice that of males (1.1/100 000-1.4/100 000) in medium and low HDI countries, while the ASMR of female (0.6/100 000-1.5/100 000) did not show significant difference. ASMR continued to increase rapidly with age after the age of 40, and the growth rate of males was faster than that of females. The truncation mortality rate of 35-64 years old was 2.1/100 000, and the cumulative mortality risk of 0-74 years old was 0.20%. M/I decreases with the increase of HDI, with M/I as 0.58 in China, which was higher than the global average of 0.39 and the United States' 0.17. Conclusion: The ASIR and ASMR of RCC presented significant regional and gender disparities globally, and the heaviest burden was in very high HDI countries.

Técnicas de segmentación y procesamiento para la detección de Carcinomas Renales en imágenes de Tomografía Abdominal / Segmentation and processing techniques for the detection of Renal Carcinomas in Abdominal Tomography images

Una de las campañas más reconocidas en el mundo es la lucha contra el cáncer, siendo el sistema renal uno de los más afectados por esta patología. El carcinoma de células renales (CCR), el más común de cáncer renal en los adultos, representa la sexta causa de muerte por cáncer. Debido al aumento en el uso de las técnicas de diagnóstico por imagen, las lesiones renales pueden ser diagnosticadas en forma incidental aproximadamente en 50% de los casos. Cuba apuesta por el uso de la tecnología en la salud y en la Universidad de las Ciencias Informáticas (UCI) se ha desarrollado un sistema para el almacenamiento, transmisión y visualización de imágenes médicas (XAVIA PACS), el cual se encuentra implantado en varios hospitales del país, pero no cuenta con alternativas para realizar la detección del CCR en imágenes tomográficas, haciendo más lento el diagnóstico, lo que se traduce en menos posibilidades para el paciente. La presente investigación tiene como objetivo realizar un análisis sobre las principales técnicas de segmentación y procesamiento para la detección de carcinomas renales en imágenes de tomografías abdominal, que propicie a los equipos de desarrollo contar con la base teórica necesaria para enfrentar el problema en cuestión. Para ello se realizó un análisis documental sobre trabajos relacionados con la temática y que propician soluciones al problema. Se estudiaron algoritmos y técnicas computacionales efectivas para la segmentación y procesamiento de imágenes abdominales. Como resultado de la investigación se obtuvieron los algoritmos más acordes para el sistema XAVIA PACS y el contexto médico cubano(AU)

One of the most recognized campaigns in the world is the fight against cancer, the kidney system being one of the most affected by this pathology. Renal cell carcinoma (RCC), the most common form of kidney cancer in adults, represents the sixth leading cause of cancer death. Due to the increased use of diagnostic imaging techniques, kidney injuries can be diagnosed incidentally in approximately 50% of cases. Cuba is committed to the use of technology in health and a system for the storage, transmission and display of medical images (XAVIA PACS) has been developed at the University of Computer Sciences (UCI), which is implanted in several hospitals of the country, but it does not have alternatives to detect RCC in tomographic images, slowing down the diagnosis, which translates into fewer possibilities for the patient. The objective of this research is to carry out an analysis on the main segmentation and processing techniques for the detection of renal carcinomas in abdominal tomography images, which provides development teams with the theoretical basis necessary to face the problem in question. For this, a documentary analysis was carried out on works related to the subject and that provide solutions to the problem. Algorithms and effective computational techniques for the segmentation and processing of abdominal images were studied. As a result of the research, the most suitable algorithms for the XAVIA PACS system and the Cuban medical context were obtained(AU)

Masas renales pequeñas: predictores de malignidad en una serie de 10 años / Small renal masses: analysis of 152 cases

Background: Small renal masses (SRM) are defined as complex organ-confined solid or cystic lesions < 4 cm. Up to 20% of these can be benign. A conservative management with active surveillance can be done in some patients. However, it is difficult to identify patients with a higher risk of malignancy. Aim: To characterize the clinical, radiological and histopathological aspects of patients with SRM, analyzing predictive factors for tumor aggressiveness. Material and Methods: Retrospective analysis of a cohort of patients undergoing partial or total nephrectomy for renal tumors between 2006 and 2016. All tumors of 4 cm or less were included. Four histological groups were defined: benign, favorable, intermediate and unfavorable. Two categories of risk were also defined: low and high. Preoperative clinical and radiological variables of these patients were analyzed. Results: Data of 152 patients were analyzed. Six percent had a benign histology, and the majority was of intermediate risk (74%). According to histological type, clear cell carcinoma was the most common type (74%). Three percent were benign angiomyolipomas. No malignancy predictive variable was identified. Conclusions: In these patients, the percentage of benign SRM was low. No variable that could predict the presence of a benign or malignant lesion in the definitive biopsy was identified.

Tumores renales pediátricos y su posible asociación con poblaciones endogámicas en el centro de Argentina / Pediatric renal tumors and their possible relation with endogamous populations in central Argentina

Introducción: Existen pocas investigaciones sobre factores de riesgo de tumores renales pediátricos. Objetivo: Caracterizar en detalle regiones geográficas de alta incidencia de tumores renales pediátricos en el centro de Argentina y su posible vinculación con factores de riesgo genéticos. Métodos: El área de estudio comprendió la provincia de Córdoba (Argentina). Se generó una base de datos de incidencia del cáncer renal infantil con información del Registro Provincial de Tumores. Se realizaron análisis de conglomerados espaciotemporales. En localidades dentro de los conglomerados, se llevaron a cabo entrevistas en profundidad a informantes claves. Resultados: Se registraron 56 casos de tumores renales pediátricos en el Registro en el periodo 2004-2013. Se detectó un conglomerado espacial significativo que abarca siete departamentos de la provincia. En esa región se concretaron seis entrevistas en profundidad a informantes claves. Los entrevistados resaltaron la mayor frecuencia de enfermedad genética de Sandhoff y las prácticas de endogamia (corroboradas en numerosos resultados científicos). A partir de estos datos se determinaron zonas de superposición de tumores renales y de la enfermedad de Sandhoff. Conclusiones: Se detectó una región particular de la provincia con alta frecuencia de tumores renales pediátricos y de la enfermedad de Sandhoff. Numerosos estudios científicos determinan que la endogamia es el factor de riesgo que aumenta la frecuencia de esta enfermedad en esta región. En futuras investigaciones se deberá corroborar si la endogamia también actúa aumentando la incidencia de tumores renales infantiles(AU)

Introduction: There is little research on risk factors of pediatric renal tumors. Objective: To characterize in detail the geographic regions of greatest incidence of pediatric renal tumors in central Argentina and exploring their possible link to genetic risk factors. Methods: The study area comprised the province of Córdoba (Argentina), and a database of pediatric renal tumors incidence was generated with information from the Provincial Tumor Registry. Analyses of spatio-temporal clusters were performed. In-depth interviews with key informants were carried out at localities within the conglomerates. Results: 56 cases of pediatric renal tumors were registered in the Provincial Registry of Tumors between 2004 and 2013. A significant spatial conglomerate was detected, covering seven districts of the province. In that region, six in-depth interviews were conducted with key informants. Interviewees highlighted the increased frequency of Sandhoff genetic disease and endogamous practices (corroborated in numerous scientific results). From these data, zones of overlap of renal tumors and of Sandhoff disease were determined. Conclusions: A particular region of the province was detected with high frequency of pediatric renal tumors and Sandhoff disease. Numerous scientific studies have determined that endogamy is the risk factor that increases the frequency of Sandhoff disease in this region. In future research, it should be confirmed whether it also acts by increasing the incidence of renal tumors in children(AU)

Influencia del estadio tumoral inicial en la sobrevida de pacientes con adenocarcinoma renal / Initial tumor stage influence on survival of patients with renal adenocarcinoma

Introducción: el adenocarcinoma renal representa hasta el 80 por ciento de los tumores sólidos de este órgano, además de ser el de peor pronóstico. Objetivo: analizar la influencia del estadio tumoral inicial en la sobrevida de pacientes con adenocarcinoma renal. Métodos: se realizó un estudio descriptivo en una muestra de 69 pacientes con diagnóstico de adenocarcinoma renal, atendidos en el Hospital Militar Central Dr. Luis Díaz Soto de enero de 2005 a diciembre de 2014. Las variables estudiadas fueron: edad, sexo, signos y síntomas, exámenes imaginológicos utilizados, estadio tumoral, modalidades terapéuticas empleadas, complicaciones presentadas y la sobrevida posterior al tratamiento. Resultados: prevaleció el grupo de edades de 60-69 años con 46 pacientes (66,7 por ciento) y del sexo masculino con 42 para un 61 por ciento. Predominó el diagnóstico incidental en 52 pacientes (75,4 por ciento). El ultrasonido se empleó en la totalidad de los casos y fue positivo en el 98,6 por ciento. Preponderaron las lesiones en el estadio I en 32 pacientes (46,3 por ciento). La modalidad terapéutica más empleada fue el tratamiento quirúrgico en 65 pacientes (94,2 por ciento), al ser la nefrectomía total por vía lumbar la más practicada con 44 pacientes (63,8 por ciento). La sobrevida a los 5 años fue del 93,7 por ciento. Conclusiones: El diagnóstico del adenocarcinoma renal en estadios iniciales, posibilitó mejor pronóstico y mayor sobrevida de los pacientes. Existió relación directa entre los factores pronósticos, clínicos y tumorales, con la evolución y la mortalidad por adenocarcinoma renal(AU)

Introduction: the renal adenocarcinoma represents until 80 percent of the solid tumors of this organ, besides being that of worse prognosis. Objective: to analyze the influence of the initial tumoral stage in the survival of patient with renal adenocarcinoma. Methods: A descriptive was carried in to sample of 69 patients with diagnosis of renal adenocarcinoma, assisted in the Central Military Hospital Dr. Luis Díaz Soto from January of 2005 to December of 2014. The studied variables were: age, sex, signs and symptoms, imaginologic exams used, tumoral stage, therapeutic modalities employed, complications and the survival later to the treatment. Results: the group of 60-69 year-old ages prevailed with 46 patients (66.7 percent) and of the masculine sex with 42 for 61 percent. The incidental diagnosis prevailed in 52 patients (75.4 percent). The ultrasound was used in the entirety of the cases and it was positive in 98.6 percent. Prevailed the lesions in the I stage in 32 patients (4.3 percent). The therapeutic modality more employed was the surgical treatment in 65 patients (94.2 percent), being the total nephrectomy for lumbar via were practiced in 44 patients (63.8 percent). The survival to the 5 years was of the one 93.7 percent. Conclusions: The diagnosis of the renal adenocarcinoma, in initial stages, facilitates a better prognosis and a bigger survival of the patients. Direct relationship exists among the prognostic factors, clinical and tumoral, with the evolution and the mortality for renal(AU)

Carcinomas renales múltiples como manifestación inicial del Síndrome de Von Hippel Lindau. Presentación de caso / Multiple renal carcinoma as a clinical manifestation of Von Hippel Lindau Syndrome. Case presentation

Introducción: El Síndrome de Von Hippel Lindau es una afección neoplásica multisistémica, heredada de manera autosómica dominante y con alta penetrancia. Su expresividad clínica es muy diversa,oscilando la incidencia entre 1/35000 y 1/36000 nacidos vivos. Esta enfermedad usualmente se diagnostica entre los 20 y 30 años, pero los síntomas pueden aparecer en la infancia. La lesión clínica inicial más común y precoz es el hemangioblastoma de la retina y/o del sistema nervioso central. Objetivo: Presentar un caso de un paciente con carcinomas renales múltiples como manifestación inicial de un Síndrome de Von Hippel Lindau. Presentación del Caso: Paciente masculino de 59 años, con antecedentes de salud, quien acude a urgencias por cuadro febril de 3 días de evolución, que fue interpretado como Dengue; se le realizó, dentro de los complementarios, ultrasonido abdominal, donde se descubrió masa sólida a nivel del polo superior del riñón derecho, asociado a existencia de otra en polo inferior de este mismo riñón, así como de 2 más en el contralateral. Además, se encontraron varios quistes pancreáticos y 2 renales izquierdos corticales. El paciente fue intervenido quirúrgicamente; se corroboró el diagnóstico de carcinomas renales de células claras. El examen oftalmológico reveló la presencia de un hemangioblastoma retiniano derecho; en tanto la tomografía computarizada simple de cráneo y la resonancia magnética espinal no mostraron alteraciones. Conclusiones: Este síndrome es una rara, pero grave afección genética, caracterizada por un alto riesgo de desarrollar enfermedades neoplásicas, lo que hace que sea aún más importante conocerlo, para poder identificar y tratar a tiempo sus temidas complicaciones(AU)

Introduction: Von Hippel Lindau Syndrome is a multisystem neoplastic affection, which is inherited as an autosomal dominant trait, with high penetrance. Its clinical expressivity is very diverse, ranging its incidence between 1/35000 and 1/36000 born alive. This disease is usually diagnosed between the 20 and 30 years of age, but its symptoms can appear in childhood. The most common and early initial clinical lesion is the hemangioblastoma of the retina and/or central nervous system. Objective:To present a case of a patient with multiple renal carcinoma as initial manifestation of Von Hippel Lindau Syndrome. Case presentation: 59 years old male patient with a history of good health who comes to the Emergency Room because of febrile clinical state of 3 days´ evolution, that was interpreted as dengue. Abdominal ultrasound was included in the complementary studies, in which a solid mass at level of upper pole of right kidney was observed, associated with the existence of another one in lower pole of the same kidney, as well as two others in contralateral. Also, multiple pancreatic cysts and two left cortical renal ones were found. The patient underwent surgery, and the diagnosis of clear cells renal carcinoma was corroborated. The ophthalmological exam revealed the presence of a right retinal hemangioblastoma whereas the plain skull CT-scan, and the magnetic resonance imaging of the lumbar spine did not show any alterations. Conclusions:This syndrome is a rare, but a serious genetic affection, characterized by a high risk to develop neoplastic diseases; that´s one reason why it is very important to know about it in order to identify, and treat its feared complications in time(AU)

Comparative study of quality of life of adult survivors of childhood acute lymphocytic leukemia and Wilms’ tumor / Estudo comparativo da qualidade de vida de adultos sobreviventes de leucemia linfocítica aguda e tumor de Wilms na infância

Abstract Objective To analyze and compare the health-related quality of life of adult survivors of acute lymphocytic leukemia and Wilms’ tumor amongst themselves and in relation to healthy participants. Methods Ninety participants aged above 18 years were selected and divided into three groups, each comprising 30 individuals. The Control Group was composed of physically healthy subjects, with no cancer history; and there were two experimental groups: those diagnosed as acute lymphocytic leukemia, and those as Wilms’ Tumor. Quality of life was assessed over the telephone, using the Medical Outcomes Study 36-Item Short Form Health Survey. Results Male survivors presented with better results as compared to female survivors and controls in the Vitality domain, for acute lymphocytic leukemia (p=0.042) and Wilms’ tumor (p=0.013). For acute lymphocytic leukemia survivors, in Social aspects (p=0.031), Mental health (p=0.041), and Emotional aspects (p=0.040), the latter also for survivors of Wilms’ tumor (p=0.040). The best results related to the Functional capacity domain were recorded for the experimental group that had a late diagnosis of acute lymphocytic leukemia. There were significant differences between groups except for the Social and Emotional domains for self-perceived health, with positive responses that characterized their health as good, very good, and excellent. Conclusion Survivors of acute lymphocytic leukemia showed no evidence of relevant impairment of health-related quality of life. The Medical Outcomes Study 36-Item Short Form Health Survey (via telephone) can be a resource to access and evaluate survivors.

Resumo Objetivo Analisar e comparar a qualidade de vida relacionada à saúde de sobreviventes adultos de leucemia linfocítica aguda e tumor de Wilms entre si, e em relação a participantes sadios. Métodos Foram selecionados noventa participantes, acima de 18 anos, os quais foram divididos em três grupos, sendo cada um com 30 sujeitos: Grupo Controle, que contou com indivíduos fisicamente saudáveis, sem histórico oncológico; grupo experimental formado por pacientes que tiveram diagnóstico de leucemia linfocítica aguda; e grupo experimental formado por pacientes que tiveram diagnóstico de Tumor de Wilms. A avaliação da qualidade de vida foi realizada por telefone e utilizou o Medical Outcomes Study 36-Item Short Form Health Survey. Resultados Os sobreviventes do sexo masculino apresentaram melhores resultados em relação aos do sexo feminino e controles no Aspecto vitalidade, para leucemia linfocítica aguda (p=0,042) e tumor de Wilms (p=0,013). Para os sobreviventes de leucemia linfocítica aguda nos Aspectos sociais (p=0,031), Saúde mental (p=0,041) e Aspectos emocionais (p=0,040), neste último também para as sobreviventes de Tumor de Wilms (p=0,040). Os melhores resultados relacionados ao domínio Capacidade funcional foram registrados para o grupo experimental de pacientes que tiveram diagnóstico tardio de leucemia linfocítica aguda. Observaram-se diferenças significativas entre os grupos, exceto para os domínios Aspectos sociais e emocionais para a percepção da própria saúde, que teve respostas de cunho positivo, que qualificavam a própria saúde como boa, muito boa e excelente. Conclusão O grupo experimental de pacientes que tiveram diagnóstico de leucemia linfocítica aguda não apresentou evidências de comprometimento relevante da qualidade de vida relacionada à saúde. O Medical Outcomes Study 36-Item Short Form Health Survey (via telefone) pode ser um recurso de acesso e avaliação de sobreviventes.

Formas actuales de presentación del tumor renal

El objetivo del trabajo es describir las características epidemiológicas de la población con tumores renales en nuestra institución, la estrategia de diagnóstico y tratamiento y los hallazgos anatomo-patológicos. Se realizó una recolección prospectiva de datos epidemiológicos, de diagnóstico y tratamiento, así como también de los resultados patológicos en un período de 4.5 años, desde enero de 2010 a junio de 2014. En ese lapso 819 casos (796 pacientes) fueron tratados por masa renal. La edad media: 60.7 años (DE 13.1), 553 (69.5%) fueron hombres. El 29% (230) presentó obesidad (IMC ≥ 30). El diagnóstico fue incidental en 653 casos (79.7%). Un 48.8% (388 pacientes) presentó uno o más factores de riesgo, siendo el tabaquismo el más frecuente (34%). En 238 pacientes (29.9%) se presentó más de una comorbilidad. El 18% presentó creatinina preoperatoria ≥ a 1.3 mg/dl. El 45% de las lesiones fueron ≤ a 4 cm (cT1a). El 10.8% (86) de los pacientes presentaron metástasis al diagnóstico. El 93.5% de las lesiones fueron resecadas y el 6.5% fueron vigiladas activamente (no resecadas). Se utilizó la nefrectomía radical en el 51.5% y cirugía renal conservadora en el 48.5% de los pacientes operados. El abordaje laparoscópico fue utilizado en el 56.2%. El tumor renal se caracteriza en la actualidad por un diagnóstico incidental en estadios patológicos iniciales. La cirugía renal conservadora es la primera opción en casi la mitad de los pacientes. La vigilancia activa ha sido utilizada en un porcentaje mayor a lo comunicado en la literatura.

The aim of this paper is to describe the epidemiological characteristics, clinical management and pathologic patterns in a population with renal tumors in our institution. Prospective data collection was performed over a period of 4.5 years, from January 2010 to June 2014. A total of 819 cases (796 patients) were treated for renal mass during this period. The mean age was 60.7 years (SD 13.1). There were 553 (69.5%) males (male to female ratio: 2.2: 1). Twenty nine per cent (230 patients) were obese (BMI ≥ 30). The diagnosis was incidental in 653 cases (79.7%), 48.8% presented one or more risk factors, being smoking the most frequent (34%). In 238 patients (29.9%) there was more than one comorbidity; 18% had preoperative creatinine ≥ 1.3 mg/dl. Lesions were ≤ 4 cm (cT1a) in 45% of the patients, and 10.8% (86) had metastases at diagnosis. The lesions were resected in 93.5% and actively monitored in 6.5% (not resected). In surgery treated patients, radical nephrectomy was performed in 51.5% of cases, and nephron sparing surgery in 48.5% of them. The laparoscopic approach was used in 56.2%. The pattern of presentation of renal masses is characterized by incidental diagnosis in early disease stages. Nephron sparing surgery is the first choice in nearly half of patients. Active surveillance has been used in a greater percentage than previously reported.

Incidence of kidney, bladder, and prostate cancers in Korea: An update

The incidence of cancer is sharply increasing. Cancer is a leading cause of death as well as a significant burden on society. The incidence of urological cancer has shown a higher than average increase and will become an important concern in the future. Therefore, an overall and accurate understanding of the incidence of urological cancer is essential. In this study, which was based on the Korea National Cancer Incidence Database, annual incident cases, age-standardized incidence rates, annual percentage change (APC), and distribution by age group were examined in kidney, bladder, and prostate cancers, respectively. From 1999 to 2011, the total number of each type of urological cancer was as follows: kidney cancer (32,600 cases, 25.5%), bladder cancer (37,950 cases, 29.7%), and prostate cancer (57,332 cases, 44.8%). The age-standardized incidence rates of prostate cancer showed a significant increase with an APC of 12.3% in males. Kidney cancer gradually increased with an APC of 6.0% for both sexes and became the second most frequent urological cancer after 2008. Bladder cancer showed no significant change with an APC of -0.2% for both sexes and has decreased slightly since 2007. The distribution of kidney cancer according to age showed two peaks in the 50- to 54-year-old and 65- to 69-year-old age groups. Bladder and prostate cancers occurred mostly in the 70- to 74-year-old age group. The proportions of male to female were 2.5:1 in kidney cancer and 5.6:1 in bladder cancer. We have summarized the incidence trends of kidney, bladder, and prostate cancers and have provided useful information for screening and management of these cancers in the future.

Incidence of childhood cancer in Kingston and St Andrew, Jamaica, 1983-2002 / Incidencia de cáncer infantil en Kingston y Saint Andrew, Jamaica, 1983-2002

OBJECTIVES: There have been several modifications to the classification of childhood cancers since the first report (1968-1981) specific to the Jamaican paediatric population was published in 1988. This paper reports on paediatric cancer incidence in Kingston and St Andrew, Jamaica, for the 20-year period 1983-2002 based on these modifications. METHODS: All cases of cancer diagnosed in children (0-14 years), between 1983 and 2002 were extracted from the Jamaica Cancer Registry archives and classified using the International Classification of Childhood Cancer, third edition. Incidence figures were calculated as per the International Agency for Research on Cancer (IARC) reporting format for childhood cancer. RESULTS: There were 272 cases (133 males, 139 females) of childhood cancer identified in the 20-year period. The overall age standardized rate (ASR) was 69.4 per million; that for males was 67.8 per million, and for females, 70.9 per million. The three most common malignancies overall were leukaemia (21.3%), lymphoma (15.8%) and brain and spinal neoplasms (14.0%). In males, the highest ASRs were seen for leukaemia (14.8 per million), lymphoma (12.7 per million), and brain and spinal neoplasms (8.2 per million), and in females, leukaemia (14.4 per million), nephroblastoma (11.3 per million), and brain and spinal neoplasms (10.6 per million). CONCLUSIONS: The rankings of the most common childhood malignancies in Jamaica (leukaemia, brain and spinal neoplasms and lymphomas) have shown few changes since the last review. However, there are differences in frequency and gender distribution of nephroblastoma and brain and spinal neoplasms.

OBJETIVOS: Ha habido varias modificaciones a la clasificación de los cánceres infantiles desde que el primer informe (1968-1981) específico para la población pediátrica jamaicana fue publicado en 1988. Este artículo reporta la incidencia de cáncer pediátrico en Kingston y Saint Andrew, Jamaica, en el período de 20 años de1983-2002, basado en estas modificaciones. MÉTODOS: Todos los casos de cáncer diagnosticados en niños (0-14 años) entre 1983 y 2002 fueron extraídos de los archivos del Registro de Cáncer en Jamaica, y clasificados utilizando la tercera edición de la Clasificación Internacional del Cáncer Infantil. Las cifras de incidencia fueron calculas siguiendo el formato de reporte de cáncer infantil de la Agencia Internacional para la Investigación del Cáncer (IARC, siglas en inglés). RESULTADOS: Hubo 272 casos de cáncer infantil (133 varones y 139 hembras) identificados en el período de 20 años. La tasa general de incidencia estandarizada por edad (ASR. siglas en inglés) fue 69.4 por millón; para los varones fue 67.8 por millón, y para las hembras, 70.9 por millón. En general, los tres tumores malignos más comunes fueron la leucemia (21.3%), el linfoma (15.8%) y las neoplasias del cerebro y la médula espinal (14.0%). En los varones, las tasas de ASR más altas fueron las observadas en relación con la leucemia (14.8 por millón), los linfomas (12.7 por millón), y las neoplasias del cerebro y la médula (8.2 por millón); en las hembras, la leucemia (14.4 por millón), los nefroblastomas (11.3por millón), y las neoplasias de cerebro y médula (10.6por millón). CONCLUSIÓN: Las clasificaciones por nivel de incidencia de los tumores malignos infantiles más comúnes en Jamaica (la leucemia, las neoplasias del cerebro y la médula espinal, y los linfomas) han mostrado pocos cambios desde la última revisión. Sin embargo, existen diferencias en la frecuencia así como en la distribución por sexo con respecto a los nefroblastomas y las neoplasias del cerebro y la médula.

Clinical characteristics and outcomes in renal transplant recipients with renal cell carcinoma in the native kidney

BACKGROUND/AIMS: We investigated the incidence and clinical characteristics of renal cell carcinoma (RCC) in the native kidney of renal transplant recipients. METHODS: Between 1991 and 2010, 1,425 patients underwent kidney transplantation at our institution. We retrospectively evaluated the clinical features and outcomes in renal transplant patients with RCC in the native kidney after renal transplantation. RESULTS: The patients included three males and two females with a mean age of 63 years (range, 52 to 74). The incidence of RCC was 0.35%. The median interval between renal transplantation and RCC occurrence was 16.2 years (range, 9 to 20). All of our patients with RCC had developed renal cysts either before (n = 3) or after (n = 2) renal transplantation. The mean duration of dialysis was 12 months (range, 2 to 39). Of the five patients, four underwent dialysis treatment for less than 8 months. All the RCCs were low grade at the time of diagnosis. Four patients underwent radical nephrectomy, and one patient refused the operation. The four patients who underwent radical nephrectomy showed no evidence of local recurrence or distant metastasis during the median follow-up of 2.9 years. However, the patient who did not undergo surgery developed spinal metastasis from the RCC 6 years later. CONCLUSIONS: This study suggests that the follow-up period is an important factor for the development of RCC in renal transplant recipients, and more vigorous screening with a longer follow-up period is required in renal transplant recipients.

Mucinous tubular and spindle cell carcinoma of kidney: A clinicopathologic study of six cases.

Background: Mucinous tubular and spindle carcinoma (MTSCC) of kidney is a rare, low-grade polymorphic tumor. Recent studies have described a wide morphology spectrum of this tumor. Aim: To report the clinico-pathologic features of six cases of MTSCC of kidney. Materials and Methods: Six cases of MTSCC of kidney were studied and literature was reviewed. Immunohistochemistry was done by Envision method. Results: The age of the patients ranged from 44 to 84 years (mean 58.5 years). Four patients were males and two were females. The tumor was located in the left kidney in four cases and in the right kidney in two cases. The tumor size ranged from 4.5 to 15 cm (mean 6.4 cm). All tumors exhibited an admixture of tubules, spindle cells, and mucinous stroma in variable proportions. Tubules were predominant in five cases and spindle cells in one case. Psammomatous calcifications, papillations, and necrosis were seen in two cases. Collections of foamy histiocytes were noted in four cases. Cytoplasmic vacuoles and osseous metaplasia were seen in one case each. All cases were Fuhrman's nuclear grade II. Five cases were of stage pT1, and one was pT3. All cases stained positive for alcian blue at pH 2.5. Immunohistochemical stain CK7 was positive in all cases and CD10 was positive in 1/1 case. All patients were alive and well at follow-up of 12-59 months (mean 33.5 months). No metastases were detected. Conclusions: We report six cases of MTSCC of kidney, a rare distinct variant of RCC, with a favorable prognosis. A male predominance was seen in our cases. MTSCC shares histologic and immunohistochemical overlap with papillary renal cell carcinoma (PRCC) and cytogenetic analysis should be performed in difficult cases to avoid a misdiagnosis.

Le cancer du rein de l'adulte : 25 observations

Objectifs : analyser les aspects épidémiologiques, cliniques, para cliniques, anatomopathologiques, thérapeutiques et évolutifs des cancers du rein pris en charge dans le service d'urologie - andrologie du CHU de Brazzaville. Matériel et méthodes : étude rétrospective de 25 tumeurs malignes du rein, colligées durant une période de 9 ans (2000-2008). Le diagnostic était retenu sur des arguments cliniques, radiologiques et anatomopathologiques. Les aspects épidémiologiques, cliniques, para cliniques, anatomopathologiques, thérapeutiques et évolutifs ont été analysés. Résultats : Le cancer du rein a représenté 0,01% des hospitalisations. L'âge moyen des patients était de 47,6 ans, (extrêmes 19 et 80 ans). Il s'agissait de 16 hommes et 9 femmes. La douleur lombaire était présente chez 8 patients. La triade clinique lombalgie-hématurie-masse palpable était présente chez 3 patients. L'échographie a permis d'évoquer le diagnostic dans tous les cas et la TDM dans 10 cas. Le traitement a consisté en une néphrectomie élargie (n=9), une néphrectomie élargie associée à une chimiothérapie (n=3), et une néphrectomie élargie associé à une chimio-immunothérapie (n=1). L'abstention thérapeutique a été décidée dans 12 cas du fait d'un stade avancé de la tumeur. L'adénocarcinome à cellules claires était la forme histologique la plus fréquente. La rémission a été complète chez 3 patients.Conclusion : Le cancer du rein de la l'adulte est rare dans notre contexte. Le diagnostic est souvent tardif, justifiant ainsi l'abstention thérapeutique dans beaucoup de cas. Le pronostic reste mauvais

Perfil clínico, epidemiológico y quirúrgico de pacientes operados por cáncer renal en el Hospital Naval Almirante Nef / Clinical, epidemiological and surgical profile of renal cancer patients at Hospital Naval Almirante Nef

Introducción: El cáncer renal ocupa el tercer lugar dentro de los tumores genitourinarios y el 3 por ciento de los tumores malignos primarios, siendo el cáncer urológico con mayor mortalidad y cuya incidencia ha aumentado a nivel mundial. Material y método: Revisión retrospectiva de las fichas de todos los pacientes con diagnóstico de cáncer renal que fueron nefrectomizados o tumorectomizados entre los años 1999 y 2009 en el Hospital Naval Almirante Nef de Viña del Mar, con un total de 135 pacientes. Resultados: Observamos un aumento importante en el número de casos el año 2009, siendo más frecuente en hombres durante los diez años revisados. La media de la edad fue de 61,81 años y la mayoría no presentaba factores de riesgo. Cuarenta y ocho por ciento de los casos diagnosticados fueron hallazgos y 60 por ciento de éstos se encontraban en etapa I. El síntoma más frecuente fue el dolor abdominal. Setenta por ciento de los casos fueron diagnosticados por ecotomografía abdominal y 12 por ciento por pielotac. El 11 por ciento de los pacientes presentaron metástasis posquirúrgicas, siendo la mayoría a pulmón seguido de hígado. De éstos, 20 por ciento habían presentado tumores primarios menores de 7 cm. Conclusión: La incidencia del cáncer renal va en aumento y el diagnóstico precoz de lesiones asintomáticas y de bajo volumen que presentan un porcentaje no despreciable de infiltración tumoral, sugieren un manejo quirúrgico agresivo.

Introduction: Renal cancer represents the third most common cancer within genitourinary tumors and3 percent of all primary malignant tumors. It is the urological cancer with the most mortality rate and it´s incidence has increased worldwide. Methods: Restrospective review of the medical records of every patient diagnosed with renal cancer who where nephrectomized or tumorectomized between the years 1999 and 2009 at Hospital Naval Almirante Nef, Viña del Mar, with a total of 135 patients. Results: There was an important increase in the number of cases in 2009. The higher frequency in men was maintained during the years studied. The mean age was 61.81 years and most of the patients didn’t have any risk factors. 40 percent of the diagnosed cases were asymptomatic findings and 60 percent of them where on stage I. The most frequent symptom was abdominal pain. 70 percent of all cases where diagnosed by abdominal ecotomography and 12 percent CT without contrast. 11 percent of the patients presented post-surgical metastasis, most of them to lung followed by liver. 20 percent of them had primary tumors smaller than 7 cm. Conclusion: The incidence of renal cancer is increasing and the early diagnosis of asymptomatic and small lesions which in an important percentage have tumoral infiltration suggest an aggressive surgical treatment.

Egresos hospitalarios por cáncer genitourinario en Chile: tercera parte / Hospital discharges because of genitourinary cancer: third part

El objetivo del presente trabajo fue actualizar el análisis de los egresos hospitalarios (EH) de cáncer genitourinario (CGU), específicamente cáncer de próstata, testículo, vejiga y riñón, en nuestro país. Para estos efectos se obtuvieron los datos del boletín de egresos hospitalarios del Ministerio de Salud (MINSAL) del año 2005, utilizándose los códigos de la clasificación internacional de enfermedades de la OMS (CIE-10). Los distintos diagnósticos fueron caracterizados según su composición geográfica y demográfica, comparándose con la información publicada en los reportes anteriores. La proporción de patología oncológica genitourinaria dentro de los egresos hospitalarios por patología genitourinaria ha experimentado un alza sostenida, correspondiendo 10,9 por ciento a cáncer de próstata, 4,28 por ciento a cáncer de testículo, 3,92 por ciento a cáncer de vejiga, y 2,2 por ciento a cáncer renal. El presente reporte constituye una aproximación a nuestro quehacer como urólogos en nuestro país, y al mismo tiempo grafica la necesidad de crear herramientas de registro epidemiológico más efectivas.

The aim of the study was to update the analysis of hospital discharges because of genitourinary cancer in our country. For these purposes, data were obtained from the registers of the Chilean Ministry of Health. Diseases were codified according to the WHO ICD-10 classification. Hospital discharges because of genitourinary cancer has shown a steady increase since 1993.According to the last register (2005), 10.9 percent corresponds to prostate cancer, 4.28 percent to testicular cancer,3.92 percent to bladder cancer and 2.2 percent to renal cell cancer. The present analysis is a rough estimation of our activity in urological oncology. However, more accurate epidemiological tools are needed.

Renal tumors presentation: Changing trends over two decades.

Purpose: We have analyzed the changing trends in surgical treatment of renal tumors over the last 2 decades with regard to age incidence, presentation, incidental detection, and histopathology. Materials and Methods: Records of renal tumors were analyzed from January 1, 1988 to December 31, 2007. Data were split into 4 parts based on a 5-year time period, 1 for each cohort of patients: cohort 1 (1988-1992)-103 patients, cohort 2 (1993-1997)-161 patients, cohort 3 (1998-2002)-243 patients, and cohort 4 (2003-2007)-304 patients. A comparative study was performed with regard to age incidence, presentation, incidentallomas, histopathology, and management with statistical analysis. Results: Out of 811 renal tumors, 17.63% cases were benign and 82.37% were malignant. In the first cohort, 34.95% cases were detected in the seventh decade as compared with cohort 4 in which these were detected in the sixth (34.86%) and fifth decades (21.38%). Incidentallomas increased from 11 (10.67%) in cohort 1 to 84 (27.63%) in cohort 4 (P = 0.001). The cases of surgically treated tumors increased in number from 103 to 304 in cohort 4. Among the presenting features, incidence of weight loss, flank pain, and lump decreased while other clinical syndromes were constant. Only open radical nephrectomy was performed in the first 2 consecutive timeperiods. Laparoscopic radical nephrectomy was increasingly used in cohort 4 as compared with cohort 3 (121 vs 32, respectively). Similarly, open nephron sparing surgery (NSS) was increasingly used in cohort 4 as compared with cohort 3. Among the histopathologies, clear cell carcinoma was most common (73.35 %), but Fuhrman grading showed a trend toward more cases detected with grade 1 and 2 in cohort 4; 23.73% and 61.86%, respectively, as compared with 15.85% and 45.12% in cohort 1 (P = 0.001); more T1 tumors were detected (63.42% in cohort 4 as compared with 41.46% in cohort 1). Conclusions: A majority of renal tumors presented as symptomatic tumors. Recently, tumors are being detected at an early stage and grade; in the younger patients, with an increasing trend of laparoscopic and open NSS.

Radical nephrectomy and nephroureterectomy in patients over 80 years old

PURPOSE: The aim of this study was to discover if elderly patients exhibit comparable outcomes and survival benefits to those achieved in younger patients. MATERIALS AND METHODS: We assessed 35 patients over 80 years old treated by radical nephrectomy or nephroureterectomy for malignant and inflammatory conditions within the previous 4 years. A multivariate analysis regarding survival and recovery was conducted and included various preoperative parameters. The subjective opinion of patients or patient's relatives (in cases where the patient had past away) was estimated by answering the following questions: (a) are you satisfied with your decision to undergo the operation? (b) would you undergo it once more if needed? (c) would you advise it to a patient your age? RESULTS: The median age was 83.5 years. Radical nephrectomy with a flank approach was performed in 65.7 percent of cases and nephroureterectomy with a transabdominal approach in 34.3 percent of cases. The median recovery was 13 weeks. During a median follow-up of 31 months (range 12 to 53), 80 percent of patients were disease free. The remaining 20 percent passed away demonstrating a median survival of 25 months (range 13-38). Eighty-eight percent of patients were satisfied with their decision to undergo the operation, 91.4 percent would undergo it once more if needed and 91.4 percent would advise it to a patient their age. CONCLUSIONS: Radical nephrectomy and nephroureterectomy are safe and effective in well-selected patients over 80 years old. Elderly patients exhibit comparable preoperative outcomes and survival benefits to those achieved in younger patients. Various preoperative clinical variables that effect the survival of patients but not their recovery could be identified.

Epidemiologic characteristics of renal cell carcinoma in Brazil

PURPOSE: In Brazil, National data regarding the epidemiology of renal cell carcinoma (RCC) are scarce. The aim of this study was to describe the demographic, clinical, and pathologic characteristics of RCC diagnosed and treated by members of the SBU - Brazilian Society of Urology. MATERIALS AND METHODS: For this cross-sectional study, data were collected through an on line questionnaire available to the members of the Brazilian Society of Urology (SBU). Between May 2007 and May 2008, voluntary participant urologists collected data on demographic, clinical and pathological characteristics from patients diagnosed with RCC in their practice. RESULTS: Fifty SBU affiliated institutions contributed with patient information to the study. Of the 508 patients, 58.9 percent were male, 78.9 percent were white, and the mean age was 59.8 years. Smoking history, high blood pressure and a body mass index above 30 kg/m2 were present in 14.8 percent, 46.1 percent and 17.9 percent of the patients, respectively. Abdominal ultrasound and computed tomography were the main diagnostic methods. The majority of the cases were localized tumors and metastasis were presented in 9.5 percent of the patients; 98.4 percent underwent nephrectomy. Clear cell carcinoma was the most common histological type. In comparison with private institutions, stage IV disease was less frequent among patients treated at public health services (P = 0.033). CONCLUSIONS: RCC in Brazil is more common in white men in their sixth decade of life. Ultrasound is the main diagnostic tool for the diagnosis of clear cell carcinoma and we found that localized disease was predominant. A national registry of RCC is feasible and may provide valuable information.