National Cancer Institute®
Last Modified: April 1, 2002
UI - 11534400
AU - Lopez-Costea MA; Gonzalez-Satue C; Franco Miranda E; Arbelaez Arango S;
TI - Riera Canals L; Prats de Puig JM; Serrallach Mila N [Partial nephrectomy in renal cell carcinoma]
SO - Actas Urol Esp 2001 Jul-Aug;25(7):482-8
AD - Servicio de Urologia, Ciutat Sanitaria i Universitaria de Bellvitge (CSUB), Barcelona.
INTRODUCTION AND OBJECTIVES: Renal Cell Carcinoma (RCC) represents 3% of all neoplasm. The growing incidental diagnosis of small renal tumor has allowed the application of nephron sparing surgery (NSS), even in those cases with a normal contralateral kidney. We present the results of NSS at our center in the last decade. MATERIAL AND METHODS: A retrospective analysis of all NSS that were made at our center in cases of renal masses. Difference is made between elective surgery (tumors less than 4 cm with a normal contralateral kidney) and obligatory surgery (all other cases). RESULTS: From 1990 since 2000 a total of 65 NSS were made from a total of 436 surgeries for renal tumors (14.9%). In 22 patients NSS was obligatory, while in 43 was elective. Mean (SD) age was 59.1 years (+/- 11.7), mean tumor size 3.4 cm (+/- 1.4), mean hospital staying was 9.2 days (+/- 7). Renal normothermic ischaemia was use during surgery in all cases, with a mean ischaemic time of 25.7 min. Nine tumors (13.8%) were benign. Morbidity: 10.8%. Mortality: 1.5%. The cancer specific survival at 36 months of follow-up (mean 37.4) is 98.4% and global survival is 90.3%. CONCLUSIONS: Nephron Sparing Surgery is a valid alternative in the treatment of RCC, specially for tumors less than 4 cm in diameter and having a normal contralateral kidney; NSS is also an effective technique for patients bearing renal tumors in a solitary kidney.
UI - 11851621
AU - Kamai T; Arai K; Koga F; Abe H; Nakanishi K; Kambara T; Furuya N; Tsujii
TI - T; Yoshida KI Higher expression of K-ras is associated with parathyroid hormone-related protein-induced hypercalcaemia in renal cell carcinoma.
SO - BJU Int 2001 Dec;88(9):960-6
AD - Department of Urology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan. firstname.lastname@example.org
OBJECTIVES: To determine whether the K-ras oncogene is associated with parathyroid hormone-related protein (PTHrP) production in renal cell carcinoma (RCC) and whether the serum value of PTHrP is related to the patients' survival. PATIENTS AND METHODS: The serum levels of PTHrP and corrected serum calcium levels were analysed in 51 consecutive patients (29 men and 22 women, mean age 63.7 years, range 33-82) with newly diagnosed RCC. Matched pairs were analysed of the mRNA levels of K-ras and PTHrP in tumour and in corresponding non-tumour tissue originating from the same patient, using the polymerase chain reaction after reverse transcription. RESULTS: Seven patients had elevated serum PTHrP values at the diagnosis of RCC. The mRNA expression of K-ras and PTHrP were detected in both tumour and non-tumour tissues, with K-ras mRNA levels being higher in the former than the latter (P < 0.05), and correlated with tumour stage (P < 0.05). There were no differences in PTHrP mRNA levels between the tissues. Furthermore, the mRNA levels of K-ras and PTHrP in seven tumours from patients with high serum values of PTHrP were higher than in tumours from those with normal values (both P < 0.01). The expression of mRNAs of K-ras and PTHrP was positively correlated (r = 0.771, P < 0.001). In seven patients with high serum PTHrP values the mRNA levels of PTHrP correlated with serum values of PTHrP and calcium (r = 0.875, P < 0.01 and r = 0.762, P < 0.05, respectively). Kaplan-Meier plots of survival rate in patients with elevated or normal serum PTHrP showed that high serum PTHrP was associated with a shorter overall survival (P < 0.05). The Cox proportional hazards model showed that serum PTHrP was an independent predictor of overall survival (P < 0.05). CONCLUSIONS: These findings suggest that K-ras may be associated with PTHrP-induced hypercalcaemia and that PTHrP levels may reflect the aggressiveness of tumour cells through the K-ras oncogene in RCC.
UI - 11851623
AU - Miyata Y; Koga S; Nishikido M; Hayashi T; Kanetake H
TI - Relationship between serum ferritin levels and tumour status in patients with renal cell carcinoma.
SO - BJU Int 2001 Dec;88(9):974-7
AD - Department of Urology, Nagasaki University School of Medicine, Nagasaki city, Japan.
OBJECTIVE: To assess the relationship between serum ferritin levels (a useful marker for diagnosing and staging renal cell carcinoma, RCC) and tumour status in RCC of
UI - 11855835
AU - Teratani T; Watanabe T; Yamahara K; Kumagai H; Ishikawa A; Arai K;
TI - Nozawa R Restricted expression of calcium-binding protein S100A5 in human kidney.
SO - Biochem Biophys Res Commun 2002 Mar 1;291(3):623-7
AD - Laboratory of Host Defenses, University of Shizuoka, Shizuoka, Japan.
Reverse transcription--polymerase chain reaction (RT-PCR) identified the expression of calcium-binding protein S100A5 in the noncancerous parts of resected samples from renal cell carcinoma (RCC) patients (n = 7) but not in the carcinoma lesions. Rabbit anti-S100A5 antibody immunohistochemically detected the antigen in the thick ascending limb of Henle, distal convoluted tubule, and collecting duct system. No apparent immunopositivity was observed in the glomerulus, proximal tubules, interstitial cells, or RCC cells. Thus, it was suggested that S100A5 protein plays an inherent functional role to the post-thick ascending limb of Henle portion in the nephron. Further, the carcinomas tested were originated probably not in the S100A5-positive distal epithelium but in the -negative epithelium of proximal tubules. Then, total RNA was extracted by phenol/chloroform from 1 ml urine of healthy volunteers, and S100A5 was amplified by RT-PCR from all samples (n = 12), indicating that the transcript of S100A5 is detectable even in the cells released into urine. B)2002 Elsevier Science (USA).
UI - 11831831
AU - Little B; Young M; Ho KJ
TI - Current clinical practice of induction and maintenance immunotherapy for metastatic renal cell carcinoma.
SO - Int J Clin Pract 2002 Jan-Feb;56(1):36-9
AD - Department of Urology, Craigavon Area Hospital, Co Armagh, UK.
Current systemic treatment of metastatic renal cell carcinoma revolves around the use of interleukin-2 and interferon-alpha, often in combination with 5-fluorouracil. This article looks at the currently reported response rates for these modalities. It also looks at current practice as regards maintenance treatment, i.e. the continued therapeutic regimen following the initial response to the induction immunotherapy cycles.
UI - 11875741
AU - Sasamura H; Takahashi A; Miyao N; Yanase M; Masumori N; Kitamura H; Itoh
TI - N; Tsukamoto T Inhibitory effect on expression of angiogenic factors by antiangiogenic agents in renal cell carcinoma.
SO - Br J Cancer 2002 Mar 4;86(5):768-73
AD - Department of Urology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo 060-8543, Japan.
Since it has been widely recognised that renal cell carcinoma is refractory to standard therapies such as chemotherapy and radiotherapy, a new modality of treatment is needed. One of the potential alternative therapies for renal cell carcinoma may be inhibition of angiogenesis. In this study, we analysed the inhibitory effects of several potential agents on expression of angiogenic factors such as vascular endothelial growth factor and basic fibroblast growth factor, which are the main mediators in angiogenesis of renal cell carcinoma. We used medroxyprogesterone acetate, interferon-alpha, interferon-gamma, minocycline hydrochrolide and genistein, which are known to be antiangiogeneic. Northern blot analyses revealed that, among the five agents examined, genistein had a strong inhibitory effect on expression of vascular endothelial growth factor mRNA and basic fibroblast growth factor mRNA. Medroxyprogesterone acetate and interferon-alpha did not significantly decrease the level of either vascular endothelial growth factor mRNA or basic fibroblast growth factor mRNA. Interferon-gamma and minocycline had mild inhibitory effects on vascular endothelial growth factor mRNA and basic fibroblast growth factor mRNA expression. Genistein also inhibited both vascular endothelial growth factor mRNA and basic fibroblast growth factor mRNA expression after treatment with epidermal growth factor and hypoxia. These findings suggest that one of the mechanisms of the inhibition of angiogenesis by genistein is suppression of the expression of the angiogenic factors vascular endothelial growth factor and basic fibroblast growth factor in renal cell carcinoma. Copyright 2002 Cancer Research UK
UI - 11908255
AU - Wald M; Halachmi S; Amiel G; Madjar S; Mullerad M; Miselevitz I;
TI - Moskovitz B; Nativ O Bladder tumor antigen stat test in non-urothelial malignant urologic conditions.
SO - Isr Med Assoc J 2002 Mar;4(3):174-5
AD - Department of Urology, Bnai Zion Medical Center, Haifa, Israel. email@example.com
BACKGROUND: The bladder tumor antigen stat is a simple and fast one-step immunochromatographic assay for the detection of bladder tumor-associated antigen in urine. OBJECTIVES: To evaluate the BTA stat in non-bladder cancer patients in order to identify the categories contributing to its low specificity. METHODS: A single voided urine sample was collected from 45 patients treated in the urology clinic for conditions not related to bladder cancer. Each urine sample was examined by the BTA stat test and cytology. RESULTS: The overall specificity of the BTA stat test was 44%, which was significantly lower than that of urine cytology, 90%. The false positive rates for the BTA stat test varied among the different clinical categories, being highest in cases of urinary tract calculi (90%), and benign prostatic hypertrophy (73%). Exclusion of these categories from data analysis improved BTA stat specificity to 66%. CONCLUSIONS: Clinical categories contributing to low BTA stat specificity can be identified, and their exclusion improves the specificity of this test.
UI - 11774101
AU - Wenzel C; Locker GJ; Schmidinger M; Mader R; Kramer G; Marberger M;
TI - Rauchenwald M; Zielinski CC; Steger GG Capecitabine in the treatment of metastatic renal cell carcinoma failing immunotherapy.
SO - Am J Kidney Dis 2002 Jan;39(1):48-54
AD - Department of Internal Medicine I, Division of Oncology, the Ludwig Boltzmann Institute for Clinical Oncology, University Hospital of Vienna, Austria.
Capecitabine is a novel fluoropyrimidine carbamate, orally administered and selectively activated to fluorouracil by a sequential triple-enzyme pathway in liver and tumor cells. This prospective trial aims to evaluate the therapeutic effects and systemic toxicities of capecitabine in patients with metastatic renal cell carcinoma in which immunotherapy failed. Twenty-six patients (median age, 58 years; range, 47 to 76 years) with disease in which first- or second-line immunotherapy treatment failed entered the trial. Median time of observation was 13+ months (range, 3 to 25+ months). Capecitabine was administered in the outpatient setting orally at a dose of 2,500 mg/m2/d divided into two daily doses for 14 days, followed by 7 days of rest. This schedule was repeated in 3-week intervals. Twenty-six patients are now assessable for toxicity, and 23 patients, for response. We observed a partial response to treatment in 2 patients (8.7%), minor response in 5 patients (21.7%), stable disease in 13 patients (56.5%), and continued disease progression despite treatment in only 3 patients (13.1%). Outpatient capecitabine therapy was well tolerated, and World Health Organization (WHO) grade III toxicity in these 26 patients consisted of hand-foot syndrome in 2 patients (7.7%) and anemia in 1 patient (3.8%). We did not observe WHO grade IV toxicity. Oral capecitabine appears to be a promising treatment with a favorable toxicity profile in patients with advanced renal cell carcinoma and should be evaluated in first- and second-line treatment schedules as monotherapy, as well as in combination with immunotherapy agents. Copyright 2002 by the National Kidney Foundation, Inc.
UI - 11247069
AU - Panchev P; Kumanov H; Yanev K
TI - [Urothelial tumors versus "endemic" nephropathy - myth or reality?]
SO - Khirurgiia (Sofiia) 1998;53(6):44-6
AD - "Aleksandrovska" Hospital, Higher Medical University, Urology Department, Sofia, Bulgaria.
Malignant tumors of the renal pelvis account for over 78 per cent of all malignant tumors of the kidney, and less than 1 per cent of all urogenital neoplasms. At the time of diagnosing, almost one third of these patients present with tumor of the ipsilateral ureter or bladder, and 40-50 per cent have ureteral tumor located elsewhere (D. Crawford, S. Das, 1990). After World War Two, the frequency of publications on cases of primary tumors of the pelvis show a noticeable increase, e.g. in Yugoslavia and Bulgaria the ratio of parenchymatous renal tumors to those of the renal pelvis is conspicuously altered. S. Petcovic (1970) and S. Lambrev (1972) attribute this fact to the existence of endemic "nephropathy" foci. It is the purpose of this work to analyze twenty-nine patients presenting carcinoma of the upper urinary ways, studied in the Chair of Urology in the period 1991 through 1997. Of them only four come from "endemic" regions. Over the period 1972-1975, fifty-nine patients with the same condition undergo treatment in the aforementioned Chair. It is worth noting that patients from the so-called "endemic" regions lack the typical signs of "endemic" nephropathy. The assumption is warranted that "endemic" nephropathy is a still not well enough clarified nosological entity, bearing resemblance to contamination with radioactive elements with a "boom" during the half-life period gradually subsiding.
UI - 11905872
AU - Goldberg BB; Pollack HM
TI - Differentiation of renal masses using A-mode ultrasound. 1971.
SO - J Urol 2002 Feb;167(2 Pt 2):1022-6; discussion 1027
UI - 11905873
AU - Sagel SS; Stanley RJ; Levitt RG; Geisse G
TI - Computed tomography of the kidney. 1977.
SO - J Urol 2002 Feb;167(2 Pt 2):1028-38; discussion 1039
UI - 11905913
AU - Harrison JH; Botsford TW; Tucker MR
TI - The use of the smear of the urinary sediment in the diagnosis and management of neoplasm of the kidney and bladder. 1951.
SO - J Urol 2002 Feb;167(2 Pt 2):864-71; discussion 872
UI - 11905914
AU - Robson CJ; Churchill BM; Anderson W
TI - The results of radical nephrectomy for renal cell carcinoma. 1969.
SO - J Urol 2002 Feb;167(2 Pt 2):873-5; discussion 876-7
UI - 11905915
AU - Novick AC; Streem S; Montie JE; Pontes JE; Siegel S; Montague DK;
TI - Goormastic M Conservative surgery for renal cell carcinoma: a single-center experience with 100 patients. 1989.
SO - J Urol 2002 Feb;167(2 Pt 2):878-82; discussion 883
UI - 11905916
AU - Lerner SE; Hawkins CA; Blute ML; Grabner A; Wollan PC; Eickholt JT;
TI - Zincke H Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. 1996.
SO - J Urol 2002 Feb;167(2 Pt 2):884-9; discussion 889-90
UI - 11902528
AU - Nathan PD; Eisen TG
TI - The biological treatment of renal-cell carcinoma and melanoma.
SO - Lancet Oncol 2002 Feb;3(2):89-96
AD - Medical Oncology at the Royal Free Hospital, London, UK.
Biological therapies are claiming a place in the routine management of some solid tumours. In this review we focus on the biological treatment of melanoma and renal-cell carcinoma, identifying the background to current practice and areas of promise that may be in routine clinical use in the near future. Melanomas and renal-cell carcinomas are particularly resistant to chemotherapy and radiotherapy and are characterised by the host immune response to the tumours. For this reason there has been particular interest in the biological therapy of these diseases. Biological therapies differ from chemotherapeutic approaches in their mechanism of action, time to response, and side-effect profiles. Although biological treatment has a long history, it is only with recent advances in immunology and molecular biology that progress has been made. In the next few years investigators expect to build on their research experience with biotherapeutic agents to provide tangible benefits for patients.
UI - 11692915
AU - Panchev P; Ianev K; Georgiev M; Kirilov S; Kumanov Kh
TI - ["Fossa" carcinoma - a relapse or "rest" carcinoma of the kidney?]
SO - Khirurgiia (Sofiia) 2000;56(3-4):33-4
The local relapse represents a unique variant of the advanced stage of a disease (A Esrig et 1992). Presumably, "fossa" carcinoma may result from incomplete resection or persisting tumor in the regional contiguous lymph nodes (JB D Kernion 1978). The average time interval for a relapse to occur is 31 months after nephrectomy, and in most patients it becomes manifest with symptoms, such as losing weight, fatigability and lumbar discomfort (D Esrig et al 1992). In cases with local recurrence a long-term survivorship may be attained by resorting to aggressive surgical intervention (S Tanguag et al 1996). This is a report on twenty-three patients with "fossa" carcinoma covering the period 1994 through 1999, with a total of 425 patients with renal carcinoma operated during the same period of time. All patients undergo operation--lumbar access is used in 22 cases, and transperitoneal--in one. In one patients resection of colon is necessitated, whereas in five the neoplastic mass hardly lends itself to complete excision, with enucleation alone being done. At follow-up study the survival terms are as follows: up to 1 year--18 patients, up to 3 year--16 patients, up to 5 year--12 patients.
UI - 11870181
AU - Zisman A; Pantuck AJ; Dorey F; Chao DH; Gitlitz BJ; Moldawer N;
TI - Lazarovici D; deKernion JB; Figlin RA; Belldegrun AS Mathematical model to predict individual survival for patients with renal cell carcinoma.
SO - J Clin Oncol 2002 Mar 1;20(5):1368-74
AD - Division of Urologic Oncology, Department of Urology, University of California School of Medicine, Los Angeles, CA 90095-1738, USA.
PURPOSE: To develop a multivariate model and mathematical formula capable of calculating personalized survival for renal cell carcinoma (RCC) patients with clinically available variables. PATIENTS AND METHODS: A total of 477 patients out of 661 undergoing nephrectomy at the University of California Los Angeles between 1989 and 1999 were eligible for evaluation and formed the analyzed cohort for this retrospective study. Time to death was the primary end point assessed. Univariate analysis for 14 to 20 variables was conducted, followed by a multivariate Cox analysis. The variables that provided independent information as to the time of death for metastatic and nonmetastatic patients were coded and incorporated into a function based on the Nadas equation principle. RESULTS: For nonmetastatic patients, the significant variables in the multivariate analysis were Fuhrman's grade and Eastern Cooperative Oncology Group performance status. For the metastatic patients, Fuhrman's grade, 1997 classification T stage, number of symptoms, nodal involvement, and immunotherapy were independent predictors for survival. These variables, based on the Cox multivariate regression model, were implanted into an exponential Nadas equation. The expected survival predicted by use of the Nadas equations faithfully describes the actual survival based on Kaplan-Meier curves. CONCLUSION: We have developed mathematical equations for estimating survival after radical nephrectomy for RCC. The resulting formulas are capable of better tailoring survival estimates for a specific patient and are based on widely accepted clinical prognostic variables. On validation with external data, this type of representation can be used as a tool for the determination of personalized prognosis and may be useful for patient education and counseling.
UI - 11870194
AU - Nathan PD; Gore ME; Eisen TG
TI - Unexpected toxicity of combination thalidomide and interferon alpha-2a treatment in metastatic renal cell carcinoma.
SO - J Clin Oncol 2002 Mar 1;20(5):1429-30
UI - 11875714
AU - Brinckmann A; Axer S; Jakschies D; Dallmann I; Grosse J; Patzelt T;
TI - Bernier T; Emmendoerffer A; Atzpodien J Interferon-alpha resistance in renal carcinoma cells is associated with defective induction of signal transducer and activator of transcription 1 which can be restored by a supernatant of phorbol 12-myristate 13-acetate stimulated peripheral blood mononuclear cells.
SO - Br J Cancer 2002 Feb 1;86(3):449-55
AD - Department of Hematology and Oncology, Medizinische Hochschule, Hannover, Germany.
Therapy of selected human malignancies with interferon-alpha is widely accepted but often complicated by the emergence of interferon-alpha resistance. Interferon is a pleiotropic cytokine with antiproliferative, antitumour, antiviral and immunmodulatory effect; it signals through the Jak-STAT signal transduction pathway where signal transducer and activator of transcription 1 plays an important role. Here we report both, a lack of signal transducer and activator of transcription induction in interferon-alpha resistant renal cell carcinoma cells and signal transducer and activator of transcription 1 reinduction of phorbol 12-myristate 13-acetate-stimulated peripheral blood mononuclear cells supernatant. Preliminary experiments on the identification of the molecules that reinducing signal transducers and activators of transcription 1 indicate that interferon-gamma may be the responsible candidate cytokine, but several others may be involved as well. This work provides the basis for therapeutic strategies directed at the molecular modulation of interferon-alpha resistance in human neoplasms. Copyright 2002 The Cancer Research Campaign
UI - 11908479
AU - Nortier J
TI - [Renal interstitial fibrosis and urotelial carcinomas after ingestion of a Chinese herb (Aristolochia fangchi)]
SO - Nephrologie 2002;23(1):37-8
AD - Departement de nephrologie, dialyse et transplantation, CUB Hopital Erasme, Bruxelles, Belgium. firstname.lastname@example.org.
UI - 11724120
AU - Doehn C; Fornara P; Fricke L; Jocham D
TI - Laparoscopic nephroureterectomy to exclude upper urinary tract malignancy associated with analgesic nephropathy.
SO - J Endourol 2001 Oct;15(8):809-14
AD - Department of Urology, Medical University of Lubeck, Germany. email@example.com
BACKGROUND AND PURPOSE: Analgesic abuse is a potential cause of end-stage renal disease. Such patients bear an elevated risk of developing malignancies, predominantly transitional-cell carcinoma. We report our experience with laparoscopic nephroureterectomy carried out in patients with analgesic nephropathy to exclude upper urinary tract malignancy. All patients were scheduled to be put on the waiting list for cadaveric renal transplantation. PATIENTS AND METHODS: Since 1996, nine women and two men with a long-term history of analgesic abuse have undergone laparoscopic nephroureterectomy at our hospital. The median age was 63 years (range 51-70 years). All patients had developed end-stage renal failure secondary to heavy analgesic abuse with a median duration of 14 years (range 7-40 years). The median interval from the beginning of hemodialysis to laparoscopic nephroureterectomy was 36 months (range 6-76 months). RESULTS: The median operative time was 99 minutes (range 55-170 minutes). There were no conversions to open surgery. Two complications occurred, and three patients required blood transfusions. The median hospital stay lasted 5 days (range 2-12 days), and the median convalescence was 20 days (range 6-44 days). In seven patients, histopathologic examination of the kidney revealed changes attributable to analgesic abuse. None of the patients had a transitional-cell carcinoma, but in two patients, a renal-cell carcinoma stage pT1cN0cM0 grade 2 was detected. CONCLUSION: Patients with analgesic nephropathy bear an elevated risk for the development of transitional-cell or renal-cell carcinoma. In these patients, laparoscopic nephroureterectomy combines minimally operative invasiveness with a maximum of diagnostic safety.
UI - 11194631
AU - Al-Khalil N; Panchev P; Kumanov Kh
TI - [History of nephrectomy]
SO - Khirurgiia (Sofiia) 1999;55(5):38-9
AD - Government University Hospital "Aleksandrovska," Department of Urology, Sofia, Bulgaria.
Following animal experiments (Combair 1803, Prevost and Dumas 1823) and accidental removal of the kidney in humans (Spillgellberg 1867, Peaslee 1868, Wolcott 1886), it has been established that elimination of a single kidney does not lead mandatorily to fatal outcome if the second functioning kidney is preserved. The chronology of nephrectomy development on a worldwide scale, and in Bulgaria as well, after the first routinely scheduled nephrectomy performed by Gustav Simon (2 Aug 1869), is presented. In 1897, almost 30 years later, Ivan Mikhaylovsky from the Plovdiv Hospital performed the first nephrectomy in this country. In the late 19th and early 20th century, nephrectomy becomes one of the most often used kidney operations (H Kumill, 1913--49.3 per cent), but gradually parallel to improving the diagnostic technique it is less frequently applied (W Lutzer et al, 1976--28 per cent) at the expense of organ-salvaging interventions. The last decade marks the introduction of laparoscopic nephrectomy (RV Clayman et al, 1991, AD Joce et al, 1992, JJ Rassweller et al, 1993, Sy Nakada et al, 1996, CC Abbou et al, 1998) which is a safe procedure even in patients with malignant renal pathology and adequately selected cases presenting various urological diseases.
UI - 11597529
AU - Nakada SY; Fadden P; Jarrard DF; Moon TD
TI - Hand-assisted laparoscopic radical nephrectomy: comparison to open radical nephrectomy.
SO - Urology 2001 Oct;58(4):517-20
AD - Department of Surgery, Division of Urology, University of Wisconsin Medical School, Madison, Wisconsin 53792-3236, USA.
OBJECTIVES: Hand-assisted laparoscopic surgery is easier to learn than standard laparoscopy and simplifies intact specimen removal. We present our experience performing hand-assisted laparoscopic radical nephrectomy (HALRN) and compare it with contemporary open radical nephrectomy performed at our institution. METHODS: We performed 18 HALRNs for renal tumors ranging in size from 2 to 11 cm (average 4.5). Patients ranged in age from 40 to 83 years (average 62.9). All patients underwent HALRN with intact removal through a 7 to 8-cm vertical midline incision through an impermeable wound protector. Two or three working ports were used. We retrospectively compared our results with the results of 18 open radical nephrectomies performed during the same period, with the patients matched for age, body mass index, and American Society of Anesthesiologists' score. RESULTS: In the HALRN group, the average operating room time was 220.5 minutes, average length of stay 3.9 days, average time to return to normal activity 15.8 days, and average time to return to work 26.8 days. The median time to return to 100% normal was 28.0 days. No conversions or re-explorations were necessary in the HALRN series. The final pathologic examination revealed renal cell carcinoma in 15, oncocytoma in 1, angiomyolipoma in 1, and a complex cyst in 1. At a maximum of 48 months of follow-up (average 12.2), no recurrences were identified. Three deaths occurred in the series; 2 patients died with no evidence of disease and 1 patient died of metastatic disease (the nephrectomy was palliative). In the open group, the average operating room time was 117.8 minutes, average length of stay 5.1 days, average time to return to normal activity 23.5 days, and average time to return to work 52.2 days. The median time to return to 100% normal was 150 days, with 3 patients never returning to 100% normal. CONCLUSIONS: Our series demonstrated that HALRN is a safe, effective, minimally invasive option for treating renal cell carcinoma and provides a shorter hospital stay (P = 0.02), earlier return to work (P = 0.04), and earlier return to 100% normal (P = 0.0002) than open radical nephrectomy.
UI - 11927308
AU - Lau WK; Cheville JC; Blute ML; Weaver AL; Zincke H
TI - Prognostic features of pathologic stage T1 renal cell carcinoma after radical nephrectomy.
SO - Urology 2002 Apr;59(4):532-7
AD - Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
OBJECTIVES: To assess the effect of renal cell carcinoma (RCC) subtype, tumor size, and Fuhrman grade on clinical outcome in patients with pathologic T1 (pT1) RCC treated with radical nephrectomy. METHODS: Between 1970 and 1998, 840 patients underwent radical nephrectomy for pT1 RCC. Tumors were subtyped and graded. Univariate and multivariate Cox proportional hazards models were fitted to assess the features associated with metastasis-free survival (MFS) and cancer-specific survival (CSS). We identified a range of tumor sizes of clear cell RCC in which a transition occurred from low to high risk. Cox proportional hazards models were then fitted by using size cutoffs. RESULTS: The mean follow-up (+/- SD) was 9.4 +/- 6.6 years among the patients alive at latest follow-up. At 10 years, the CSS and MFS for clear cell RCC (n = 682) were 89.1% and 88.6%, respectively; for papillary RCC (n = 122), they were 95.5% and 93.8%; and for chromophobe RCC (n = 33), they were both 100%. The differences in CSS (P = 0.013) and MFS (P = 0.023) between clear cell RCC and the other subtypes were statistically significant. For clear cell RCC, tumor size and Fuhrman grade were independently associated with CSS and MFS (P <0.001). A transition in risk occurred for tumor sizes between 4.5 and 5.0 cm, and the tumor size cutoff of 5.0 cm had the highest concordance index for predicting CSS and MFS. CONCLUSIONS: RCC subtype is a strong independent prognostic variable for patients with pT1 RCC treated with radical nephrectomy. For clear cell RCC, Fuhrman grade and tumor size are independently associated with CSS and MFS.
UI - 11927323
AU - Pautler SE; Harrington FS; McWilliams GW; Walther MM
TI - A novel laparoscopic specimen entrapment device to facilitate morcellation of large renal tumors.
SO - Urology 2002 Apr;59(4):591-3
AD - Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
A reusable laparoscopic instrument consisting of a flexible deployment ring and a barrel was fabricated, and an impermeable sac was sutured to the flexible ring before entrapment of the specimen and morcellation. The laparoscopic specimen entrapment device facilitated placement of large renal tumors within a sac for morcellation.
UI - 11927338
AU - Uchida T; Gao JP; Wang C; Jiang SX; Muramoto M; Satoh T; Minei S;
TI - Shimura S; Irie A; Kameya T; Baba S Clinical significance of p53, mdm2, and bcl-2 proteins in renal cell carcinoma.
SO - Urology 2002 Apr;59(4):615-20
AD - Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan.
OBJECTIVES: To improve our understanding of the clinical relevance of p53, mdm2, and bcl-2 protein overexpression in renal cell carcinoma, we retrospectively investigated the immunohistochemical expression of p53, murine double minute 2 (mdm2), and bcl-2 and the relationship of this expression to clinicopathologic characteristics. p53 regulates the transcription of downstream effectors such as the oncoprotein mdm2, and bcl-2 has been shown to inhibit apoptosis triggered by wild-type p53. METHODS: The expression of p53, mdm2, and bcl-2 protein was studied by immunohistochemical methods in paraffin-embedded nephrectomy specimens from 112 patients whose clinicopathologic data confirmed renal cell carcinoma. RESULTS: The expression of the p53 and bcl-2 protein was recognized in 15 (13.4%) and 52 (42.0%) cases, respectively; the expression of the mdm2 protein, however, was seen in only 2 cases (1.8%). No correlation was noted between these three proteins and any clinicopathologic parameters, except p53 expression and Stage T1-2/T3-4 (P = 0.0208). However, in multivariate analysis, stage (hazard ratio 3.586; P = 0.0002), expression of p53 (hazard ratio 6.090; P = 0.0126) and of mdm2 (hazard ratio 22.016; P = 0.0156), and coexpression of p53/mdm2 (hazard ratio 6.146; P = 0.0005) demonstrated a statistically significant effect on prognosis by proportional hazards regression tests. CONCLUSIONS: Our results indicate that stage, p53 expression, mdm2 expression, and coexpression of p53/mdm2 are useful to predict the clinical outcome in patients with renal cell carcinoma.
UI - 11798900
AU - Zhang Q; Zhang Z; Chen L
TI - [Cloning and identifying renal cell carcinoma differentially expressed genes and their significance]
SO - Zhonghua Yi Xue Za Zhi 2001 Mar 25;81(6):356-9
AD - Department of Urology, The First Hospital, Peking University, Beijing 100034, China.
OBJECTIVE: To Clone study the differentially expressed new genes in renal cell carcinoma (RCC). METHODS: Using a technique known as suppression subtractive hybridization to construct the library which contains the differently expressing cDNAs between RCC and normal kidney cells. Then the RCC specifically expressed genes were cloned. RESULTS: Human RCC subtractive library with high subtractive efficiency was set up successfully. The amplified library contained 350 positive clones. Sequence analysis were performed for 5 clones. All the sequences were unknown previously and the cDNA insert GYLZ-RCC18 had three copies. Northern blot analysis showed that GYLZ-RCC18 cDNA expressed highly in RCC, but no signal could be detected in normal kidney. Using SMART RACE technique, the full length of novel gene of GYLZ-RCC18 was obtained. CONCLUSIONS: The highly efficient cDNA subtractive library may have formed solid foundation for screening and cloning new and specific oncogenes or tumor suppressor genes of RCC. The novel differentially expressed genes may provide an important clue for studying the mechanism of occurrence and development of RCC.
UI - 11890234
AU - Masood J; Lane T; Koye B; Vandal M T; Barua J M; Hill J T
TI - Renal cell carcinoma: incidental detection during routine ultrasonography in men presenting with lower urinary tract symptoms.
SO - BJU Int 2001 Nov;88(7):671-4
AD - Department of Urology, Harold Wood Hospital, Romford. Essex, UK.
OBJECTIVE: To compare renal cell carcinomas (RCCs) presenting incidentally in patients referred for lower urinary tract symptoms (LtJTS) with those presenting symptomatically, by stage, intervention and outcome. PATIENTS AND METHODS: The case notes of all male patients (100) diagnosed with RCC between 1991 and 1998 were reviewed an