Clear cell papillary renal cell carcinoma: Characteristics and survival outcomes from a large single institutional series.

OBJECTIVES: To investigate the clinical characteristics and survival outcomes of a large clear cell papillary renal cell carcinoma cohort. METHODS AND MATERIALS: A retrospective review of patients with clear cell papillary renal cell carcinoma at a single academic center was performed after Institutional Review Board approval. Patients underwent either partial or radical nephrectomy from September 2009 to July 2019. Demographic and clinical characteristics, recurrence, and cancer specific and overall survival were reported. RESULTS: A total of 90 patients were included in the study. Median follow up was 26.5 months. Median age was 61 (range 27 to 87). 47.8% of patients were African American. 26.7% of patients had end stage renal disease. 37.8% had multifocal renal tumors. 48.9% underwent partial nephrectomy, while the remainder underwent radical nephrectomy. 43.3% underwent an open surgical approach, 40.0% a robotic approach, and 16.7% a laparoscopic approach. Pathologic stage included T1a (90.0%), T1b (1.1%), and T2b (8.9%). Fuhrman grades 1-3 were present in 18.9%, 77.8%, and 3.3% of patients, respectively. There were no cancer specific deaths. There was one local recurrence and no metastases. The overall survival at a median follow up of 26.5 months was 92.1% (95% confidence interval 83.1%-96.4%). CONCLUSIONS: Clear cell papillary renal cell carcinoma typically presents at a low stage and grade and has favorable survival outcomes. A nephron-sparing approach to treatment should be considered when feasible due to the tumor's indolent nature and propensity towards multifocality.

Treatment Trends and Long-Term Survival Associated with Cryotherapy and Partial Nephrectomy for Small Renal Masses in the National Cancer Database Using Propensity Score Matching.

Objective: Trends in the utilization of ablative therapy are unknown for the treatment of small renal masses. Our goal is to utilize the National Cancer Database (NCDB) to both assess the utilization of ablative therapies and long-term survival. Materials and Methods: The NCDB captures 70% of all cancer cases in the United States and was queried between 1998 and 2012 for renal cell carcinomas that were treated with ablative therapy, partial nephrectomy (PN), or radical nephrectomy. The analysis was limited to clinical stage T1a. Propensity score matching was used in 1:1 fashion. Kaplan-Meier survival analysis and a Cox proportional hazards model were used to compare overall survival (OS) for cryotherapy and PN. Results: A total of 119,240 cases of clinical stage T1a renal masses were treated between 1998 and 2012. Cryotherapy peaked at 927 (9.1%) cases in 2010 and had 913 (8.4%) in 2012. PN accounted for 18% of the cases in 1998, but surpassed the utilization of nephrectomy in 2008. By 2012, PN accounted for 6766 (62%) of renal mass cases. After matching, Kaplan-Meier OS was lower for cryotherapy compared with PN at 24 (94.5% vs 96.5%), 48 (86.8% vs 90.9%), and 96 months (66.0% vs 74.9%). Cryotherapy also had a lower OS (hazard ratio 1.46; p < 0.001) on adjusted analysis. Conclusion: Cryotherapy for small renal masses plateaued at 9% utilization in 2009. Cryotherapy had a lower OS than PN for tumors >2 cm on adjusted analysis, but this result should be used with caution until confirmed in randomized studies.

Laparoscopic Renal Denervation for Uncontrolled Hypertension Due to Medication Intolerance: A Case Report.

Resistant hypertension is challenging to treat, and most patients with the condition fail to achieve blood pressure control, putting them at increased risk for adverse long-term outcomes. We present the case of a 59-year-old woman with resistant hypertension due to intolerance to nearly all antihypertensive medications. After failure to achieve blood pressure control over a 5-year period, with blood pressures as high as 220/110mmHg, the patient underwent surgical treatment with bilateral laparoscopic renal denervation. Immediately after the procedure, as well as at the 1-, 3-, 9-, and 12-month follow-ups, the patient's blood pressure was reduced to the range of 120-140/80-90mmHg.

Predictors of citations in the urological literature.

To assess the factors associated with increased citation rates in the urological literature by reviewing articles published in the four major urological journals to help authors improve the impact of their work. A random sample of 200 original research articles published between January and June 2004 was analysed from The Journal of Urology, Urology, European Urology and BJU International. Study information was abstracted by two independent reviewers and citation counts within 4 years of publication were collected using Web of Science(TM) . Study characteristics and citation rates were analysed using median and interquartile ranges (IQRs), and logistic regression analysis was used to evaluate which factors predicted greater citation rates. The overall median number of citations per published article was 6.0 (IQR 3-12). After univariate analysis, we found that study design, study topic, continent of origin and sample size were associated with greater median citation rates. In a multivariate linear regression model, study design and study topic (oncology) predicted increased citation rates. Randomized controlled trials were cited a median of 13.5 times and were the strongest predictor of citation rates with an odds ratio of 115.5 (95% confidence interval 9.4-1419.6). Citation rates are associated with study design and study topic in the urological literature. Authors may improve the impact of their work by designing clinical studies with greater methodological safeguards against bias.

Radical prostatectomy as initial monotherapy for patients with pathologically confirmed high-grade prostate cancer.

OBJECTIVE: To report the long-term outcome of high-grade prostate cancer treated with radical prostatectomy (RP) as initial monotherapy, analyse the effect of clinical and pathological variables on survival, and report cancer-related symptoms. PATIENTS AND METHODS: A retrospective chart review was conducted to identify patients with Gleason 8-10 prostate cancer found on pathological review in men undergoing RP as initial therapy for clinically localized disease between 1988 and 2005. Kaplan-Meier analysis was used to calculate event-free survival. Univariable and multivariable analyses were used to assess the effects of clinical and pathological variables on prostate-specific antigen (PSA) recurrence. RESULTS: After excluding 20 patients, 119 were identified with pathologically confirmed high-grade cancers at the time of RP. The overall median (interquartile range) follow-up was 73 (41-113) months. Twenty-four (20%) patients had organ-confined cancer, 60 (50%) had specimen-confined cancer, and 14 (12%) had nodal metastasis. Kaplan-Meier analysis showed overall survival rates at 5 and 10 years, respectively, of 90% and 75%, cancer-specific survival of 92% and 82%, and a PSA recurrence-free follow-up at 5 years of 31%. Using univariable analysis, preoperative PSA level, pathological Gleason score, pathological stage, surgical margin status and tumour volume were found to significantly affect the PSA recurrence-free follow-up. No variables were significant on multivariable analysis. Cancer-related symptoms were reported by only 14 patients, with a median time from surgery to first symptom of 43 months. CONCLUSION: High-grade prostate cancer can be treated with RP as initial monotherapy with an acceptable 10-year cancer-specific survival (82%). The PSA recurrence-free follow-up is poor (31% at 5 years). However, few patients progress to symptomatic recurrence after PSA relapse within the first 5 years.