Renal Tumours Of Non-Clear Cell Histology; 10 Years' Experience In A Specialized Centre.

BACKGROUND: Non-clear cell renal cell carcinomas are uncommon renal tumours with diverse histologically and genetically defined entities. Due to limited clinical outcomes data, no standardized management approach can be offered to these patients. This study aimed to analyse outcomes of non clear cell renal cell carcinoma after surgical resection of localized renal tumours in our population. METHODS: Patients with renal tumours who underwent partial or radical nephrectomy at the Department of Urology, from January 2010 to December 2019 were identified and evaluated, in terms of prevalence, presentation, recurrence, and survival outcome. RESULTS: Non-clear cell tumours were found in one-fourth of the total number of nephrectomies performed during this period for renal cell carcinoma (RCC). The mean age was 50.48±14.76 years (range 18-89 years) with 57% being of the male gender. The predominant types were chromophobe RCC, papillary RCC, and sarcomatoid RCC, in all non-clear cell renal tumours. Mean Recurrence Free Survival (RFS) for all tumours was 75.26±2.7 months. The projected 5 years RFS of papillary RCC, chromophobe RCC and sarcomatoid RCC were 94.2%, 84.3% and 62.5% respectively. CONCLUSIONS: RCC of non-clear-cell histology depicts excellent survival in patients with localized renal tumours. Furthermore, sarcomatoid RCC has worse recurrence free survival followed by chromophobe RCC and papillary RCC, in our population subset.

Outcomes of Uretero-ileal Anastomosis in Bladder Cancer Cystectomies: Bricker vs. Wallace 1.

Background The two commonly used methods for uretero-ileal anastomosis (UIA) during radical cystectomy for muscle-invasive bladder cancer (MIBC) are the Bricker and Wallace 1 techniques. Published data on the incidence of strictures at anastomotic sites is limited. This study compares both anastomotic techniques in terms of uretero-ileal stricture (UIS) rates and the factors that govern it in the patient group. Material and methods Records of all patients presenting with bladder cancer who underwent radical cystectomy at the department of uro-oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) Lahore, Pakistan, from January 1, 2009, to December 31, 2018, were reviewed retrospectively, and all adult patients aged >18 years out of them were selected for the study. Results With a total of 116 patients, the mean age was 54.37 ± 11.16 and a male majority (83.6%). Urinary diversion using ileal conduit was performed in 70 (60.3%) patients and the rest of them i.e. 46 (39.7%) had neobladder formation. Amongst them, uretero-ileal anastomosis was constructed via Bricker and Wallace 1 in 73 (62.9%) patients and 43 (37.1%) patients respectively. Pelvic radiotherapy was received by 13 (11.2%) patients. Anastomotic stricture developed in 19 (16.4%) cases. A relatively similar proportion of stricture rate was found in Bricker and Wallace 1 technique (10% vs 13%). Body mass index (BMI) was found to be significantly higher in patients who developed UIS. Incidence of stricture formation was more on the left than right side i.e. 12 (63.2%) vs five (26.3%) while two (10.5%) patients developed bilateral strictures. Conclusion No significant difference in stricture formation was noted between Bricker and Wallace 1 technique. High BMI and anastomotic leaks were the contributory factors for this complication during our experience.

Comparison of Outcomes Between Radical Radiotherapy and Radical Cystectomy in Muscle Invasive Bladder Cancer in a Cancer Specialized Unit of a Developing Country.

Introduction Radical cystectomy (RC) is the current standard of care for treating muscle-invasive bladder cancer (MIBC), however bladder preservation by offering radical radiotherapy (RT) is gaining interest for improving the quality of life while maintaining a reasonable oncological outcome. In this study, we have compared outcomes of the two treatment options. Materials and methods This is a 10-year retrospective cohort study that included all patients who were treated for histologically proven muscle-invasive bladder cancer in the department of uro-oncology at Shaukat Khanum Memorial Cancer Hospital and Research Centre from January 2005 to January 2015. Data was analysed using Statistical Product and Service Solutions (SPSS), version 21 (IBM Corp., Armonk, NY). The primary end point of our study was to calculate the three- and five-year disease-free survival (DFS) and overall survival (OS). Results A total of 230 patients were included in the study with male gender predominating (88%). The mean and standard deviation for age was 58.32+11.128. Radical cystectomy was performed in 119 patients while 111 received RT. Clinically, 34% had stage 2 disease, while 66 % had stage 3 cancer. The median follow-up duration was 41 months (range: 2-155). During follow-up 57.4% of patients showed no recurrence. Local recurrence was found in 9.6% patients and distant metastasis in 32.2%. The three-year DFS of RC was 63% and that of RT was 57% while the five-year DFS for RC and RT were 60% and 49%, respectively (p=0.196). The three-year OS of RC was 64% and that for RT was 58%. On further analysis the five-year OS of RC was 53% and that for RT was 50% (p=0.98). Upon stage-based comparisons, we found no statistically significant difference between the three- and five-year DFS and OS of stage 2 and stage 3 when treated with either modality. Conclusion Most studies favor RC and consider it as the gold standard treatment for muscle-invasive bladder tumor treatment. The current study reveals that bladder preservation approach by chemo radiotherapy is a viable treatment option, having comparable oncological outcomes with patients receiving radical cystectomy, and can be offered to patients having muscle-invasive urothelial bladder cancer.

Oncological Outcomes of Non-Urothelial Bladder Cancers in a Specialized Cancer Hospital of a Developing Country.

Background Non-urothelial bladder cancers (NUBCs) constitute only 5% of all bladder cancers. Because of the scarcity of data, no standardized treatment can be offered to these patients. Surgical treatment can be offered to patients with localized disease; however, generally, the prognosis is unfavorable. Methodology Patients with histology-proven NUBC presenting to the Department of Uro-oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan, from January 2002 to July 2017 were identified and assessed retrospectively. Results A total of 20 patients with a median presenting age of 52 years (range: 34-87 years) were identified. Clinically, T3 was the commonest stage of presentation, i.e., in 11 (55%), whereas 1 (7.1%) patient had metastatic disease. Four types of NUBCs were identified: adenocarcinoma, squamous cell carcinoma, small cell carcinoma, and inflammatory myofibroblastic tumor. Most of the patients with adenocarcinoma were offered surgical treatment in the form of either partial (64.3%) or radical (28.6%) cystectomy. Two patients with small cell carcinoma and two of the three patients with SCC could only be offered palliative chemotherapy. During a median follow-up of 40 months, 14 (70%) patients developed disease progression or recurrence. All these patients succumbed to their disease during a median period of 37.5 months (range: 5-84 months). Furthermore, three- and five-year disease-free survival was 60% and 51%, respectively, and overall survival was 65% and 31%, respectively. Conclusions NUBC is a rare but aggressive disease that presents at an advanced stage in many cases. Treatment protocols are not uniform; therefore, further collaborative research is needed to improve survival outcomes.

Implications of miscoding urological procedures in an era of financial austerity - 'Every Penny Counts'.

OBJECTIVES: The study aimed to find out any inaccuracy in coding of elective urology procedures and associated financial implications. DESIGN: Retrospective audit and re-audit. SETTINGS: Introduction of payment by results was introduced in the NHS in England in 2002. This meant that hospitals are paid on individual patient basis according to their human resource group (HRG) rather than a block contract. Current coding system uses office of population census and surveys classification. These along with other variables determine the final human resource group code defining final payment. PARTICIPANTS: None. MAIN OUTCOME MEASURE: Retrospective analysis of coding for all inpatient urological procedures was performed over a period of two months. All documented Office of Population Census and Surveys codes were recorded and reviewed by urology trainee along with the head of professional coders. As a result of first analysis the deficiencies were identified and revised Office of Population Census and Surveys codes were used to generate the final human resource group codes. After six months a re-audit was done. RESULTS: In the initial study, 121 cases were reviewed. Twenty per cent of these cases were miscoded. The revised Office of Population Census and Surveys codes led to change of final human resource group code and hence recovery of a payment of £10,716. Analysis after six months showed a considerable improvement with incorrect coding reduced to 11%. CONCLUSION: Our findings highlight potential discrepancies in coding which can lead to significant financial loss. It is important that surgeons involve and train the coding department so that coding errors can be avoided. This will put us in better position to deal with Nicolson Challenge.

A single United Kingdom center experience of open partial nephrectomy using regional ischemia.

INTRODUCTION: Different techniques are used in open partial nephrectomy (OPN) for localized renal cancer, with variable impact on renal function. Regional renal ischemia technique by using different clamps and without the need to occlude renal vessels is gaining popularity. In our study, we present the largest international series; and the first in the United Kingdom; describing OPN using soft bowel clamp. We study the impact of this regional ischemia innovative technique on renal function, postoperative complications and oncological outcomes. MATERIALS AND METHODS: We retrospectively analyzed the first 100 OPN cases done between 2001 and 2011. All available data on the hospital databases were analyzed; recording patient demographics, tumor characteristics, operative procedure details, histopathology results and long term follow up. RESULTS: A direct comparison with other studies that have used different clamps to achieve regional ischemia was performed. Our technique has the advantage of being used for interpolar and hilar/central tumors. Our mean tumor size was higher at 4.1 cm. Our positive margin rate for malignant tumors was comparable with other studies, same for mean operative time and hospital stay. None had significant deterioration in renal function that required renal replacement therapy. Median blood loss was 400 mL. Our series has the advantage of showing the long term follow up data. CONCLUSION: We believe the technique we have developed using soft bowel clamp to produce regional renal ischemia is practical and successful. It can be applied safely in all OPN cases, with excellent oncological outcome and clinically acceptable renal function preservation.

Expression of the cancer-testis antigen BORIS correlates with prostate cancer.

BACKGROUND: BORIS, a paralogue of the transcription factor CTCF, is a member of the cancer-testis antigen (CT) family. BORIS is normally present at high levels in the testis; however it is aberrantly expressed in various tumors and cancer cell lines. The main objectives of this study were to investigate BORIS expression together with sub-cellular localization in both prostate cell lines and tumor tissues, and assess correlations between BORIS and clinical/pathological characteristics. METHODS: We examined BORIS mRNA expression, protein levels and cellular localization in a panel of human prostate tissues, cancer and benign, together with a panel prostate cell lines. We also compared BORIS levels and localization with clinical/pathological characteristics in prostate tumors. RESULTS: BORIS was detected in all inspected prostate cancer cell lines and tumors, but was absent in benign prostatic hyperplasia. Increased levels of BORIS protein positively correlated with Gleason score, T-stage and androgen receptor (AR) protein levels in prostate tumors. The relationship between BORIS and AR was further highlighted in prostate cell lines by the ability of ectopically expressed BORIS to activate the endogenous AR mRNA and protein. BORIS localization in the nucleus plus cytoplasm was also associated with higher BORIS levels and Gleason score. CONCLUSIONS: Detection of BORIS in prostate tumors suggests potential applications of BORIS as a biomarker for prostate cancer diagnosis, as an immunotherapy target and, potentially, a prognostic marker of more aggressive prostate cancer. The ability of BORIS to activate the AR gene indicates BORIS involvement in the growth and development of prostate tumors.