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1.
Objective To determine the trend in the incidence of renal cell carcinoma in Ireland, and evaluate changes in the modes of presentation
and outcomes.
Methods Data on all histologically diagnosed renal cancers in Ireland over a 12-year period (1994–2005) were retrieved from the database
of the National Cancer Registry of Ireland. Data on all renal cancer deaths in Ireland in the period 1994–2004 were obtained
from the Central Statistics Office.
Results There were 2,485 cases of renal cell carcinoma from 1994 to 2005, of which 64% were in males and 36% in females. The average
age of females at diagnosis fell from 63 years in 1994 to 58 years in 2005, with little change in the average age in males.
The age-adjusted incidence of renal cell carcinoma per 100,000 person-year increased from 5.2 in 1994 to 6.8 in 2005, an annual
percentage change of +3.4%. The percentage of incidental renal cell carcinoma increased from 5% in 1999 to 21% in 2003. The
age-adjusted mortality rate for males increased from 4.8 per 100,000 person-year in 1994 to 7.3 in 2004, while that for females
decreased from 2.6 to 2.3 in the same period. There was no overall increase in survival over the study period.
Conclusion While the incidence of renal cell carcinoma is increasing in Ireland, largely, but not entirely, due to an increase in incidentally
diagnosed cancers, mortality is increasing in males only. 相似文献
2.
Marco Bianchi Giorgio Gandaglia Quoc-Dien Trinh Jens Hansen Andreas Becker Firas Abdollah Zhe Tian Giovanni Lughezzani Florian Roghmann Alberto Briganti Francesco Montorsi Pierre I. Karakiewicz Maxine Sun 《Urologic oncology》2014,32(1):46.e1-46.e7
ObjectivesVariability in survival after surgical treatment is observed in patients with renal cell carcinoma (RCC), thereby affirming the heterogeneity of the disease. The aim of our study was to provide a clinically relevant and detailed assessment of survival following surgical excision in patients with RCC of all stages according to age, stage, and grade.Materials and methodsA retrospective population-based analysis of 42,090 patients in the United States who were treated with partial nephrectomy (PN) or radical nephrectomy (RN) for RCC of all stages between the years 1988 and 2008 was performed. Competing-risks Poisson regression analyses focusing on cancer-specific mortality (CSM) or other-cause mortality (OCM) were executed. Stratification was performed according to age groups (≤59, 60–69, 70–79, and ≥80 y), the American Joint Committee on Cancer stage (I, II, III, and IV), and the Fuhrman grade (I–II and III–IV).ResultsIncreasing stage was associated with higher CSM rates (from 2%–9% to 54%–79% for stage I and IV), regardless of age. Similarly, high tumor grade was associated with higher CSM rates (from 2%–64% to 6%–79% for low and high grade). However, OCM was nonnegligible amongst persons aged 70 to 79 years (11%–24%) and ≥80 years (17%–44%), regardless of stage and grade. In subanalyses focusing on stage I RCC, CSM (3%–10%) rates were slightly higher for RN-treated patients, regardless of age and grade. However, in individuals aged 70 to 79 years with high-grade RCC, OCM rates were slightly higher for PN relative to RN (25.5% vs. 23.5%). In those aged ≥80 years, OCM rates were higher for PN compared with RN, both for low-grade (39.4% vs. 32.7%) and high-grade disease (52.0% vs. 42.8%).ConclusionsTumor grade and American Joint Committee on Cancer stage represent important prognostic factors for the prediction of CSM, despite adjustment for patient age. However, OCM rates were nonnegligible in elderly individuals (≥70 y) with low-grade and stage I to III RCC. 相似文献
3.
William P. Parker Christine M. Lohse Harras B. Zaid John C. Cheville Stephen A. Boorjian Bradley C. Leibovich R. Houston Thompson 《Urologic oncology》2017,35(1):36.e1-36.e6
Objectives
Beta-blocker use is associated with improved survival for multiple nonurologic malignancies. Our objective was to evaluate the association between beta-blocker use and survival among surgically managed hypertensive patients with clear-cell renal cell carcinoma (ccRCC).Methods
Hypertensive patients with ccRCC treated with either radical or partial nephrectomy between 2000 and 2010 were identified from our Nephrectomy Registry. Beta-blocker use within 90 days before surgery was identified. The associations between beta-blocker use and risk of disease progression, death from renal cell carcinoma (RCC), and all-cause mortality were assessed using Cox proportional hazards regression models.Results
In total, 913 hypertensive patients were identified who underwent either partial or radical nephrectomy for ccRCC. Of these, 104 (11%) had documented beta-blocker use within 90 days before surgery. At last follow-up (median 8.2 y among survivors), 258 patients showed progression (median 1.6 y following surgery), and 369 patients had died (median 4.1 y following surgery), including 138 who died of RCC. After adjusting for PROG (progression-free survival) and SSIGN (cancer-specific survival) scores, beta-blocker use was not significantly associated with the risk of disease progression (hazard ratio [HR] = 0.94; 95% CI: 0.61–1.47; P = 0.80) or the risk of death from RCC (HR = 0.74; 95% CI: 0.38–1.41; P = 0.35). Similarly, on multivariable analysis adjusting for clinicopathologic features, there was not a significant association between beta-blocker use and the risk of all-cause mortality (HR = 0.83; 95% CI: 0.59–1.16; P = 0.27).Conclusions
Beta-blocker use for hypertension within 90 days before surgery was not associated with the risk of progression, death from RCC, or death from any cause. 相似文献4.
Jacob Katsnelson Rebecca J. Barnes Hunaiz A. Patel Daphne Monie Theodor Kaufman Nicholas J. Hellenthal 《Urologic oncology》2017,35(9):541.e1-541.e6
Purpose
We sought to determine whether median household income (MHI) independently predicts surgical approach (partial vs. radical nephrectomy) and survival in patients with renal cell carcinoma.Methods
The U.S. Surveillance Epidemiology and End Results Database (1988–2011) was queried to examine kidney cancer cases and linked to the Area Health Resources File. We correlated surgical approach and survival, both overall and cancer-specific, with tumor stage, age, race, sex, and income data.Results
Of 152,589 patients diagnosed with renal cell carcinoma, 24,221 (16%) patients underwent partial nephrectomy, 102,771 (67%) patients underwent radical nephrectomy, and 25,597 (17%) patients had no surgery. There was no significant difference in stage of presentation between the wealthiest and poorest MHI quartiles, with approximately 35% of patients in each quartile presenting with T1aN0M0 disease and 17% of patients presenting with metastatic disease. Despite this, 18% of patients in the wealthiest quartile underwent partial nephrectomy compared to 14% of patients in the poorest quartile. Although the percentage of patients undergoing partial nephrectomy rose over the timeframe studied in both the wealthiest and poorest quartiles, the rate of rise was highest in the wealthier group. Those in the poorest quartile were 0.10 times more likely to die of all causes (95% CI: 1.09–1.11, P<0.001) and 0.09 times more likely to die of kidney cancer (95% CI: 1.05–1.10, P<0.001) than those in the wealthiest quartile over the timeframe studied.Conclusions
Despite presenting with similar stage, patients with lower MHI less commonly undergo partial nephrectomy and are more likely to die of kidney cancer than those in the highest MHIs. 相似文献5.
Sun M Abdollah F Bianchi M Trinh QD Jeldres C Tian Z Shariat SF Widmer H Zorn K Menon M Montorsi F Perrotte P Karakiewicz PI 《European urology》2011,60(6):1152-1159
Background
The association of advanced age and cancer control outcomes shows discordant findings.Objective
To evaluate the effect of age on cancer control outcomes in a large population-based cohort of patients diagnosed with renal cell carcinoma (RCC) of all stages.Design, setting, and participants
Using the Surveillance Epidemiology and End Results database, 36 333 patients with RCC were identified. The population was stratified according to age: < 50, 50–59, 60–69, 70–79, and ≥80 yr. The effect of age on cancer control outcomes was evaluated using competing-risks regression models. Analyses were repeated stage for stage and grade for grade.Measurements
Cancer-specific mortality (CSM) was measured.Results and limitations
Age categories 50–59, 60–69, 70–79, and ≥80 yr respectively portended a 1.4-, 1.5-, 1.6-, and 1.9-fold higher risk of CSM than age category <50 yr (all p < 0.001). The effect of advanced age was particularly detrimental in patients with stage I disease: 1.8-, 2.3-, 3.2-, and 3.8-fold higher CSM risk for the same age groups, respectively (all p < 0.001). The effect of age on CSM was at its peak in patients with stage I, low-grade RCC (1.6-, 2.2-, 3.6-, and 4.3-fold, respectively; all p < 0.001) and remained elevated in stage I, high-grade RCC (2.2-, 2.6-, 2.4-, and 3.0-fold higher, respectively; all p < 0.05). Conversely, its effect was virtually absent in patients with stage II–IV RCC.Conclusions
Our data suggest that stage I RCC may behave in a more aggressive fashion in elderly patients. Further studies are required to confirm the current findings. 相似文献6.
Objectives
The aim of the study was to assess the association between the progression-free survival (PFS) and perirenal fat thickness (PFT) in a population of histopathologically confirmed, localized clear cell renal cell carcinoma (ccRCC) patients.Methods
We retrospectively enrolled 174 patients with localized ccRCC at our center between December 2009 and December 2015. The preoperative visceral fat area (VFA), PFT, and subcutaneous fat area (SFA) were evaluated. Kaplan-Meier curves were used to assess the differences in PFS between the high and the low PFT groups within sexes. Potential independent prognostic factors of PFS were identified by univariable and multivariable Cox analyses.Results
During the follow-up period (median, 38 months), 27 patients (21 with high PFT and 6 with low PFT) experienced tumor progression. Kaplan-Meier curves revealed that high PFT was associated with a worse PFS than low PFT (P = 0.005). In the univariable Cox analyses, high VFA, high PFT, T stage, and the presence of sarcomatoid differentiation were significantly associated with a poor PFS. Moreover, both high PFT and VFA retained significance in the multivariable analysis.Conclusion
We first report the evidence that high PFT presents as an independent risk factor of tumor progression in localized ccRCC. We suggest that this noninvasive and readily available preoperative parameter may help in the risk stratification of ccRCC patients before surgery. 相似文献7.
Daniel M. Tennenbaum Brandon J. Manley Emily Zabor Maria F. Becerra Maria I. Carlo Jozefina Casuscelli Almedina Redzematovic Nabeela Khan Maria E. Arcila Martin H. Voss Darren R. Feldman Robert J. Motzer Nicole E. Benfante Jonathan A. Coleman Paul Russo James J. Hsieh Abraham Ari Hakimi 《Urologic oncology》2017,35(8):532.e7-532.e13
Purpose
To establish prognostic genomic biomarkers for patients with metastatic clear cell renal cell carcinoma (ccRCC).Materials and methods
We identified 60 patients who presented with metastatic ccRCC at our institution between 2001 and 2015 and had genomic sequencing on their primary tumor. We pooled these patients with 107 other patients with the same inclusion criteria from three well-known public databases. Five commonly mutated genes were chosen for analysis: VHL, PBRM1, BAP1, SETD2, and KDM5C. Overall survival (OS) was estimated using the Kaplan-Meier method and the log-rank test was used for comparisons between groups.Results
Median OS in the cohort was 2.5 years. Higher Fuhrman grade was associated with decreased median OS (P<0.001). Mutations in SETD2 (P = 0.027) and KDM5C (P = 0.019) were associated with reduced risk of death (hazard ratio [HR] = 0.58 [95% CI: 0.35–0.94] and HR = 0.43 [95% CI: 0.22–0.85], respectively). BAP1 mutations (P = 0.008) were associated with increased risk of death (HR = 1.81 [95% CI: 1.16–2.83]). There were significantly more female patients with a BAP1 mutation than females in the overall cohort (P = 0.001).Conclusions
Mutations in BAP1 negatively affected OS, whereas SETD2 and KDM5C mutations were associated with prolonged OS in our pooled cohort of 167 patients with metastatic ccRCC. Our results expand upon efforts at understanding genomic biomarkers in localized disease. Those efforts set the stage for our novel investigation examining associations of select recurrent somatic mutations in stage IV patients with ccRCC. 相似文献8.
《Urologic oncology》2015,33(2):68.e17-68.e23
ObjectivesTo evaluate the clinical use of recently published RNA-based molecular subtyping algorithms. Patients who undergo surgery for clinically localized clear cell renal cell carcinoma can experience very different outcomes, representing a longstanding challenge for the practicing urologist. Two recent publications suggest that molecular subtyping based on the expression of large panels of genes can help clinically localized clear cell renal cell carcinoma prognostication; however, the analyses was not adjusted for routinely collected clinicopathologic indices.Methods and materialsWe obtained level 3 RNA-seq RPKM data and corresponding clinicopathologic features from The Cancer Genome Atlas (TCGA) and assigned patients to the TCGA subtypes as well as to the ccA/ccB subtypes. To determine the prognostic ability of molecular subtyping after adjusting for variables that are collected as routine medical care, we used Cox models and adjusted for the composite Mayo stage, size, grade, and necrosis (SSIGN) score.ResultsBoth the TCGA and the ccA/ccB subtypes are significantly associated with tumor size, category, grade, and presence of necrosis. The association of these subtypes with overall survival is markedly attenuated following adjustment for the composite Mayo SSIGN score.ConclusionsBoth the TCGA and the ccA/ccB subtypes are associated with overall survival after adjusting for the Mayo SSIGN score. However, the effect sizes are similar to what has been reported for single markers, and thus the clinical use and cost-effectiveness of these RNA-based whole-genome signatures are questionable. 相似文献
9.
Background
Epidemiologic studies on testicular cancer have focused primarily on European countries. Global incidence and mortality have been less thoroughly evaluated.Objective
Our goal was to gain a better understanding of the most recent global age-standardized incidence and mortality rates for testicular cancer and to use these values to estimate a region's health care quality.Design, setting, and participants
Age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) for testicular cancer were obtained for men of all ages in 172 countries by using the GLOBOCAN 2008 database, reflecting the annual rate of cancer incidence and mortality per 100 000 men. These data were evaluated on a regional level to compare incidence and mortality rates. Global plots of these values were constructed to better visualize geographic distributions. Finally, the ratio of ASIR to ASMR was calculated as a method to assess each region's proficiency in diagnosing and effectively treating testicular cancer.Measurements
ASIR and ASMR were analyzed by region, and each region's ratio of ASIR to ASMR was calculated.Results and limitations
Testicular cancer ASIR is highest in Western Europe (7.8%), Northern Europe (6.7%), and Australia (6.5%). Asia and Africa had the lowest incidence (<1.0%). ASMR was highest in Central America (0.7%), western Asia (0.6%), and Central and Eastern Europe (0.6%). Mortality was lowest in North America, Northern Europe, and Australia (0.1-0.2%). The ASIR-ASMR ratio was highest in Australia (65.0%) and lowest in western Africa (1.0%). National reporting systems varied by country, and data quality may have fluctuated between regions.Conclusions
Testicular cancer incidence remains highest in developed nations with primarily Caucasian populations. Variable ASIR-ASMR ratios suggest markedly different geographic-specific reporting mechanisms, access to care, and treatment capabilities. 相似文献10.
Firas Abdollah Nazareno Suardi Umberto Capitanio Rayan Matloob Nicola Fossati Fabio Castiglione Ettore Di Trapani Dario Di Trapani Andrea Russo Cristina Carenzi Francesco Montorsi Patrizio Rigatti Roberto Bertini 《Urologic oncology》2014,32(1):43.e9-43.e16
IntroductionIn surgically treated patients with renal cell carcinoma (RCC), the progression-free survival (PFS) rate may significantly change according to the progression-free postoperative period. To test this hypothesis, we set to evaluate the conditional PFS rate in surgically treated patients with RCC.MethodsWe evaluated 1,454 patients with RCC, surgically treated between 1987 and 2010, at a single institution. Cumulative survival estimates were used to generate conditional PFS rates. Separate Cox regression models were fitted to predict clinical-progression risk in patients who were progression free from 1 to 10 years after surgery.ResultsDuring the immediate postoperative period, the 5-year PFS rate was 88%, and it increased to 92%, 94%, and 97% in patients who remained progression free at, respectively, 1, 5, and 10 years after surgery. At multivariable analyses, where patients with stage I disease were considered as a reference, the highest clinical-progression risk was observed at the eighth postoperative year in patients with stage II disease (hazard ratio [HR]: 2.9) and during the immediate postoperative period in patients with stage III to IV disease (HR: 5.5). In comparison with patients with grade I disease, the highest clinical-progression risk was observed at the fourth (as well as eighth) postoperative year in patients with grade II disease (HR: 5.7), sixth postoperative year in patients with grade III disease (HR: 7.2), and during the immediate postoperative period in patients with grade IV disease (HR: 8.5).ConclusionsThe postoperative progression-free period has an important effect on the subsequent clinical-progression risk. This aspect should be considered along with tumor characteristics to plan the most cost-effective follow-up scheme for surgically treated patients with RCC. 相似文献
11.
Magnus Lindskog Thomas Wahlgren Rickard Sandin Jan Kowalski Maria Jakobsson Sven Lundstam Börje Ljungberg Ulrika Harmenberg 《Urologic oncology》2017,35(9):541.e15-541.e22
12.
Matvey Tsivian Michael R. Abern Efrat Tsivian Christina Sze Ghalib Jibara Edward N. Rampersaud Thomas J. Polascik 《Urologic oncology》2018,36(8):362.e1-362.e7
Objective
To assess the associations between perioperative allogeneic blood transfusions (ABTs) and recurrence, overall and renal cell carcinoma (RCC)-specific survival in patients undergoing surgical treatment for clinically localized disease.Materials and methods
We performed a retrospective review of 1,056 consecutive patients undergoing surgical treatment (radical or partial nephrectomy) for clinically localized RCC between 2000 to 2010. Demographic (age, race, and sex) clinical (preoperative hemoglobin and hematocrit, type of surgery [partial or radical nephrectomy]), and pathological (T and N stages, RCC histotype, grade) data were compared between patients receiving perioperative (intraoperative or postoperative) blood transfusions and those who are not. Distant and local recurrence-free survival, overall survival, RCC-specific survival were recorded and Kaplan-Meier survival curves as well as multivariable proportional regression models adjusted for clinical and pathological characteristics were produced.Results
On multivariable analyses adjusted for clinical and pathological characteristics, the receipt of ABTs was associated with lower recurrence-free (HR = 1.86, P = 0.002), overall (HR = 1.83, P = 0.016), and RCC-specific survival (HR = 2.12, P = 0.031). The negative effect of ABTs was apparent for distant (HR = 2.24, P<0.001) but not local recurrences (HR = 0.78, P = 0.643). Limitations include retrospective nature and lack of uniform criteria for blood transfusion during the study period.Conclusions
In this study, perioperative ABTs were independently associated with worse oncological outcomes in patients with clinically localized RCC. Receipt of ABT was associated with roughly a 2-fold increase in the hazard of metastatic progression, all-cause and RCC-specific mortality. Further research is needed on the mechanisms of transfusion-induced immunomodulation, alternative transfusion protocols and methods for autologous blood transfusion and recovery. 相似文献13.
Angela B. Smith Erzsébet Horvath-Puhó Matthew E. Nielsen Timothy L. Lash John A. Baron Henrik T. Sørensen 《Urologic oncology》2014,32(4):466-472
PurposeVenous thromboembolism (VTE) is associated with renal cell carcinoma (RCC), but data on the effect of comorbidities are limited. Therefore, our purpose was to determine the effect of comorbidity on VTE risk among patients with RCC.Materials and methodsA population-based cohort of all patients with RCC (n = 8,633) diagnosed in Denmark between 1995 and 2010 and a comparison cohort selected from the general population and matched on age, sex, and comorbidities (n = 83,055) were identified. Risk of subsequent VTE was estimated with 95% CI for the first 3 months, 1 year, and 5 years following cancer diagnosis. We stratified by Charlson comorbidity index (CCI) scores to estimate excess risk in patients with RCC vs. the comparison cohort within comorbidity strata. We also performed subanalyses for postoperative VTE and metastases.ResultsVTE risk was higher in the RCC compared with comparison cohort, particularly during the initial year following diagnosis (risk difference = 9.9 per 1,000 persons [95% CI: 7.7–12.2]). After stratifying by CCI, excess risk declined with increasing comorbidities. The risk difference was 12.3 per 1,000 persons (95% CI: 9.1–15.5) for CCI = 0 and 0.5 (95% CI: 6.0–7.0) for CCI = 4. Excess risk also declined with increasing comorbidities among patients with postoperative VTE and among those with metastases.ConclusionsRCC is associated with increased risk of VTE when compared with a matched general population cohort. Risk did not appear to increase with added comorbidity burden. Clinical attention to VTE risk in patients with RCC is appropriate regardless of the presence or absence of comorbidities. 相似文献
14.
Andrew T. Lenis Amirali H. Salmasi Nicholas M. Donin Izak Faiena David C. Johnson Alexandra Drakaki Kiran Gollapudi Jeremy Blumberg Arie S. Belldegrun Allan J. Pantuck Karim Chamie 《Urologic oncology》2018,36(2):78.e21-78.e28
Purpose
Cytoreductive radical nephrectomy (cRN) improves survival in select patients with metastatic renal cell carcinoma (mRCC). It is unclear, however, whether cytoreductive partial nephrectomy (cPN) compromises oncologic efficacy. We evaluated trends in utilization of cPN and compared overall survival (OS) in patients who underwent cRN or cPN for mRCC.Materials and methods
We queried the National Cancer Database from 2006 to 2013 and identified patients who underwent cPN and cRN for mRCC. We analyzed rates of cPN over time. Logistic regression identified predictors of cPN. We matched patients based on propensity score for treatment. We used matched Kaplan-Meier survival analyses to compare OS, stratified by tumor size. We used multivariable Cox proportional hazards models to determine the effect of cPN and cRN on OS.Results
A total of 10,144 patients met inclusion criteria, with 9,764 (96.2%) undergoing cRN and 381 (3.8%) undergoing cPN. Rates of cPN increased over time from 1.8% to 4.3% over the study period. Treatment at an academic/research facility, papillary and chromophobe histology, and more recent year of treatment were associated with increased odds of cPN. In a matched survival analysis, cPN was associated with improved OS compared with cRN (log rank, P = 0.001). This effect was limited to primary tumors<4 cm. In a propensity-score adjusted multivariable Cox model, cPN was associated with improved OS (hazard ratio = 0.81; 95% CI: 0.71–0.93; P = 0.002).Conclusions
The use of cPN in patients with mRCC is increasing. cPN is associated with improved OS in patients with mRCC, although this effect is limited to patients with primary tumors<4 cm. 相似文献15.
Arnav Srivastava Hiten D. Patel Gregory A. Joice Alice Semerjian Michael A. Gorin Michael H. Johnson Mohamad E. Allaf Phillip M. Pierorazio 《Urologic oncology》2018,36(1):12.e7-12.e13
Background
The use of partial nephrectomy (PN) to treat renal cell carcinoma has grown to include larger, more complex tumors. Such tumors are more likely to be up-staged to pT3a and generate controversy regarding the oncologic safety of PN. We aimed to estimate the proportion of patients up-staged to T3a disease after PN, stratified by clinical stage, and characterize their survival.Methods
From 1998 to 2013, pT1-pT3aN0M0 kidney cancer patients undergoing PN or radical nephrectomy (RN) were identified from the Surveillance Epidemiology and End Results registries. Cox proportional hazards models compared cancer-specific (CSS) and overall survival (OS) for PN patients with pT1a, pT1b, and pT2 disease to stratified, up-staged pT3a patients undergoing PN. Also, we compared PN patients with up-staged pT3a disease to RN patients with pT3a disease.Results
From the 28,854 patients undergoing PN, the estimated proportion up-staged to pT3a was 4.2%, 9.5%, and 19.5% for cT1a, cT1b, and cT2, respectively. OS was worse for tumors up-staged from cT1a to pT3a, but not for cT1b or cT2 tumors. Up-staged pT3a tumors across all stage strata demonstrated worse CSS, with worse survival for larger tumors. Analysis revealed no difference in OS or CSS for up-staged pT3a PN patients compared to pT3a RN patients.Conclusions
A greater proportion of patients experience T3a up-staging after PN with increasing initial T stage. Up-staged pT3a patients have worse CSS across all clinical tumor stages after PN. However, our results do not demonstrate that patients up-staged after PN have compromised oncologic outcomes compared to all-comers with pT3a disease receiving RN. 相似文献16.
目的探讨分化抑制因子-1（Id-1）蛋白在肾透明细胞癌（RCCC）中的表达及其临床意义。方法应用免疫组化二步法检测76例RCCC组织、29例癌旁正常组织中Id-1蛋白的表达情况,分析Id-1蛋白与患者临床病理特征及术后生存率之间的关系。结果 Id-1在RCCC组织和癌旁正常组织中的阳性表达率分别为90.8%、17.2%,二者比较差异有统计学意义（P〈0.05）,且Id-1的表达程度与肿瘤的病理分级、TNM分期相关（P〈0.05）,但与患者性别、年龄、有无复发等无明显相关性（P〉0.05）;生存分析显示Id-1表达阳性和阴性患者的5年生存率分别为23.5%、56.0%,两组生存率差异有统计学意义（P=0.017）。结论 Id-1的表达在RCCC中增高,Id-1阳性患者的预后较差,Id-1可作为RCCC诊断和预后判断的有效辅助指标。 相似文献
17.
Karakiewicz PI Trinh QD Bhojani N Bensalah K Salomon L de la Taille A Tostain J Cindolo L Altieri V Ficarra V Schips L Zigeuner R Mulders PF Valeri A Descotes JL Mejean A Patard JJ 《European urology》2007,51(6):1616-1624
OBJECTIVES: Outcome of patients with exclusive renal cell carcinoma (RCC) nodal metastases without distant metastases is not extensively described. We explored the ability of standard risk factors such as tumour size, Fuhrman grade, histologic subtype and symptom classification to predict renal cell carcinoma-specific survival (RCC-SS). METHODS: Analyses targeted 171 patients with RCC nodal metastases and absence of distant metastases. Univariable, multivariable, and predictive accuracy analyses addressed RCC-SS with the intent of identifying independent and most informative predictors of RCC-SS in this cohort of patients. RESULTS: Median RCC-SS was 2.3 yr. Symptom classification (61.3%, p<0.001) demonstrated the highest univariable accuracy. In multivariable analyses, symptom classification contributed the most to the combined predictive accuracy of all variables (+4.2%, p<0.001), followed by Fuhrman grade (+2.3%) and histologic subtype (+1.0%). CONCLUSIONS: Renal cell carcinoma-specific survival of patients with exclusive nodal metastases may show important variability. In presence of systemic symptoms, survival is extremely poor. Substantially better survival may be expected in patients with local or no symptoms. This observation has important implications when adjuvant therapies are considered. 相似文献
18.
Kevin A. Nguyen Srinivas Vourganti Jamil S. Syed Randy Luciano Steven C. Campbell Brian Shuch 《Urologic oncology》2017,35(8):529.e1-529.e7
Objectives
Loss of renal parenchyma after surgery may contribute to chronic kidney disease; however, the long-term consequences of chronic kidney disease may differ by cause. We analyzed the outcomes of patients with end-stage renal disease (ESRD) based on various medical and surgical causes.Materials and methods
In the United States Renal Data System from the period 1983 to 2007, patients with renal tumors, traumatic surgical loss, diabetes, or other known causes were identified. The annual incidence, prevalence, and influence of age, race, sex, and primary cause on survival were evaluated.Results
Of 1.3 million patients, 6,812 (0.49%) had renal malignancy–related ESRD (RM-ESRD). An increased over time was noted in the standardized incidence rates of patients with RM-ESRD (R2 = 0.973, P<0.0001). Patients with RM-ESRD had a worse median survival (1.9 vs. 3.4 y, P<0.0001), whereas those with ESRD related to nonmalignant surgical loss had improved survival (3.8 y) compared to diabetic ESRD (P<0.0001). The 5-year cancer-specific mortality was higher for RM-ESRD (30.9% vs. 5.5%, P<0.0001) compared to ESRD from other known causes; however, the non–cancer-specific mortality was improved compared to patients with ESRD with diabetic causes (P<0.0001). Limitations include retrospective analysis and lack of specific clinical data, such as cancer grade.Conclusions
The incidence of RM-ESRD is increasing, possibly owing to the increased rate of renal cell carcinoma treatment. Although overall survival for RM-ESRD was worse than either that of nonmalignant surgical loss or other known causes, non–cancer-specific mortality was decreased compared to diabetic causes, likely due to systemic effects by cause of ESRD. 相似文献19.
Algaba F Akaza H López-Beltrán A Martignoni G Moch H Montironi R Reuter V 《European urology》2011,60(4):634-643
Context
Renal cell carcinoma (RCC) in adults comprises a heterogeneous group of tumours with variable clinical outcomes that range from indolent to overtly malignant. The application of molecular genetic techniques to the study of renal neoplasms has resulted in an improved classification of these entities and a better understanding of the biologic mechanisms responsible for tumour development and progression. The current 2004 World Health Organisation classification of adult renal epithelial neoplasms has expanded rapidly with new categories recently incorporated.Objective
To review and evaluate the evidence implicating pathologic features and classification of RCC in adults as a tool to approach patients’ prognosis and modulate current therapy.Evidence acquisition
Members of Committee 3: Pathology, under the auspices of the International Consultation on Urological Diseases and the European Association of Urology (ICUD-EAU) International Consultation on Kidney Cancer, performed a systematic review using PubMed. Participating pathologists discussed pathologic categories and diagnostic features of RCC in adults.Evidence synthesis
We reviewed and discussed articles and the personal experiences of participating uropathologists.Conclusions
The conclusions reached by the ICUD-EAU 2010 International Consultation on Kidney Cancer emphasise the appropriate pathologic diagnosis of RCC in adults as a tool to approach patients’ prognosis and modulate current therapy. Further emphasis should be placed on defining risk groups of RCC and diagnostic features of unusual tumours such as familial RCC, translocation RCC, and tubular mucinous and spindle cell carcinoma. A number of recently described entities and morphologic variants of classical categories deserves recognition because they can be important in differential diagnosis and therapy. 相似文献20.
Association of EMMPRIN and fascin expression in renal cell carcinoma: correlation with clinicopathological parameters 总被引：1，自引：0，他引：1
EMMPRIN and fascin are important factors in tumor invasion and progression. We tested the hypothesis that expression of EMMPRIN
and fascin correlate with clinicopathological parameters of renal cell carcinoma (RCC). Immunohistochemical analysis of EMMPRIN
and fascin were performed in tissue microarrays of 100 surgical specimens, including 35 clear-cell RCC (CRCC), 21 clear-cell
RCC with granular differentiation (GRCC), 12 chromophobe RCC (ChRCC), 8 papillary RCC (PRCC), 9 carcinoma of the collecting
duct of Bellini (CDC), 10 clear-cell RCC with sarcomatoid differentiation (SRCC), and 6 metastatic RCC. Average immunoscores
of EMMPRIN were 100.8 in CRCC, 195.2 in GRCC, 298.4 in ChRCC, 219.2 in PRCC, 186.1 in CDC, 226.9 in SRCC, and 151.7 in metastatic
RCC. Among all included cases, average EMMPRIN immunoscores were 84.6 in grade I, 130.4 in grade II, 184.3 in grade III, and
223.5 in grade IV. Additionally, average immunostaining scores of fascin were 53.6 in CRCC, 289.3 in GRCC, 193.3 in ChRCC,
151.8 in PRCC, 181.3 in CDC, 275.4 in SRCC, and 131.7 in metastatic RCC. Average fascin immunoscores were 59.3 in grade I,
91.6 in grade II, 130.2 in grade III, and 194.7 in grade IV. Higher EMMPRIN and fascin immunoscores also correlated significantly
with TNM stages and survival rates in RCC. Significant correlation was found between EMMPRIN and fascin expression. In conclusion,
higher expression of EMMPRIN and fascin correlate significantly with histological grades, clinical stages, and survival rates
of RCC 相似文献