European temporal trends in the use of lymph node dissection in patients with renal cancer.

BACKGROUND: The role of lymph node dissection (LND) in renal cell carcinoma (RCC) is still under debate. We aimed to assess the utilization rates of LND over time in Europe. METHODS: A multi-institutional database of 13,581 RCC patients who underwent radical nephrectomy (RN) or nephron sparing surgery (NSS) between 1988 and 2014 was created within an European consortium. We analysed temporal trends in the frequency of LND by using Joinpoint regression. Logistic regression models were used to identify predictors of LND. RESULTS: Overall, 5114 patients (42.7%) underwent LND. Lymph node invasion was recorded in 566 cases (11% of LND patients) which represents 4.7% of the whole study cohort. A gradual decline in the use of LND started in the 1990s. After 2008 LND decreased significantly by 21.5% per year (95%CI -33.3 to -7.5, p < 0.01) until 2011 and stabilized thereafter (Annual Percentage Change 4.9%, 95%CI -3.4 to 13.8, p = 0.2). At multivariable analyses, patient age (OR 0.98, p < 0.0001), type of surgery (RN vs. NSS: OR 5.46, p < 0.0001), surgical approach (open vs. minimally invasive: OR 1.75, p < 0.0001), T stage (T2 vs. T1: OR 1.57; T3-4 vs. T1: OR 1.44, p < 0.0001), clinical tumour size (OR 1.14, p < 0.0001), and year of surgery (OR 0.95, p < 0.0001) were associated with higher probability of LND at nephrectomy. CONCLUSIONS: A trend towards lower LND was observed over time for RCC patients who underwent RN or NSS. LND is more frequently performed in younger patients, locally advanced diseases and in case of open surgery.

Management of localized and locally advanced renal tumors. A contemporary review of current treatment options.

About 70% of patients with renal cell carcinoma present with localized or locally advanced disease at primary diagnosis. Whereas these patients are potentially curable by surgical treatment alone, a further 20% to 30% of patients are diagnosed with primary metastatic disease. Although over the past years medical treatment for metastatic patients has nearly completely changed from immunotherapy to effective treatment with targeted agents, metastatic disease still represents a disease status which is not curable. Also in patients with metastatic disease, surgical treatment of the primary tumor plays an important role, since local tumor related complications can be avoided or minimized by surgery. Furthermore, also improvement of overall survival has been proven for surgery in metastatic patients when combined with cytokine treatment. Hence, surgical combined with systemic treatment as a multi-modal, adjuvant, and neo-adjuvant treatment is also required in patients with advanced or metastatic disease. A growing number of elderly and comorbid patients are currently diagnosed with small renal masses, which has led to increased attention paid to alternative ablative treatment modalities as well as active surveillance strategies, which are applied in order to avoid unnecessary overtreatment in these patients. Since surgical treatment also might enhance the risk of chronic kidney disease with consecutive cardiac disorders as well as reduced overall survival, ablative techniques and active surveillance are increasingly applied. In this review article we focus on current surgical and none-surgical treatment options for the management of patients with localized, locally advanced, and metastatic renal cell carcinoma.

[Inflammation and benign prostatic hyperplasia: cause or consequence?]. / Inflammation et hyperplasie bénigne de la prostate : cause ou conséquence ?

INTRODUCTION AND OBJECTIVES: Although benign prostatic hyperplasia (BPH) is the most frequent disease in elderly men, only a few predictive factors have been clearly identified. Recently, chronic prostatic inflammation has emerged as one of them. This review aims at describing the scientific proof of a relationship between chronic prostatic inflammation and BPH. MATERIAL AND METHOD: Searching in the PubMed database identified clinical studies and basic research experiments in relation with the role of inflammation in BPH. RESULTS: Large clinical studies recently highlighted a relationship between chronic prostatic inflammation and prostate volume or urinary symptoms. Microscopic studies also found numerous inflammatory cells infiltrating BPH tissues. Immune cells are releasing cytokines and growth factors to modulate the immune response but evidences are also showing that they are promoting the epithelial and stromal prostatic cells growth. Moreover, prostatic cells by themselves are able to secrete inflammatory mediators and finally to stimulate their own growth. Once the vicious circle has started, it appears that feedback controls can be overwhelmed and that prostate volume progressively increases. CONCLUSION: BPH is a complex disease but chronic prostatic inflammation is one of the mechanisms leading to prostatic enlargement and urinary symptoms.

Cytogenetic analysis of renal angiomyolipoma.

Chromosome analysis of a benign, unilateral, renal angiomyolipoma revealed the karyotype 44,XX,-8, -12, -14, -21, +der (8q14q), + der(12)(12pter----12q14-15::12q24----12q14-15::+ ++21q21----21qter). This indicates that structural changes of 12q13-15, which are so frequently observed in the common malignant and benign lipogenic tumors, may also occur in the rarer variants of these neoplasms.