A population-based study of renal cell carcinoma and prostate cancer in the same patients

OBJECTIVE: To investigate the incidence of prostate cancer in men with renal cell carcinoma (RCC) and the incidence of RCC in men with prostate cancer. METHODS: We evaluated the database of the Surveillance, Epidemiology and End Results Program of the National Cancer Institute from 1973 to 1996, to calculate the incidence of RCC in men with prostate cancer and the incidence of prostate cancer in men with RCC. The standardized incidence ratio (SIR, observed/expected) was calculated for each of the scenarios of interest, as well as for RCC and prostate cancer in men with other common malignancies. Lung/bronchus cancer, colon/rectal cancer, and non-Hodgkin lymphoma were selected for the control scenarios because they are the most common non-urological cancers among men in the USA. RESULTS: There was a higher incidence of RCC in men with prostate cancer (SIR 1.25, P < 0.01). RCC incidence was also higher in men with each of the other malignancies. Prostate cancer incidence was higher in men with RCC (SIR 1.42, P < 0.001), but was not significantly elevated for any of the control scenarios. CONCLUSIONS: The incidence of RCC is higher in men with each of the index cancers, whereas that for prostate cancer was higher only in men with RCC. A common aetiological factor is possible. However, it is also possible that detection bias explains these findings. Serial imaging might increase the detection of RCC among patients with a variety of index malignancies. Patients with RCC who are followed by a urologist might be screened more rigorously for prostate cancer than patients with other primary malignancies, leading to increased detection in these men.     

Multiple primary malignancies in patients with renal cell carcinoma: a national population-based cohort study

OBJECTIVE: To determine the possibly greater occurrence of multiple malignancies in patients with renal cell carcinoma (RCC). PATIENTS AND METHODS: In the 7-year period 1987-93, all 1425 patients aged 15-70 years with registered histopathologically verified RCC in Norway were included in the study. All clinical and histopathology reports were checked manually, to verify the registered diagnosis and to ensure that no tumour was a metastasis from another. After this process, 257 patients (287 tumours other than RCC) with multiple primary malignancies were identified. The primary tumours other than RCC were classified as antecedent, synchronous and subsequent. For the subsequently occurring tumours, the expected number of different tumour types was calculated according to age group, gender and observation time. RESULTS: Of the 1425 patients, 228 (16%) had one, 23 (1.6%) had two, three (0.2%) had three and one (0.07%) had four other primary malignancies. In all, 100 (34.8%) of the other tumours were diagnosed as antecedent, 53 (18.7%) as synchronous and 134 (46.7%) as subsequent to the RCC. Cancer in the prostate, bladder, lung, breast, colon and rectal cancer, malignant melanomas (MM) and non-Hodgkin's lymphomas (NHL) were the most common other malignancies. The observed overall number of subsequent other malignant tumours was 22% higher than the expected number. The observed number of subsequent tumours was significantly higher for bladder cancer, NHL and MM. The estimated 15-year cumulative risk for patients with RCC and no previous or synchronous other malignancy for developing a later second cancer was 26.6% in men, and 15.5% in women (statistically significant, P = 0.04). Patients with antecedent or synchronous other cancer had significantly poorer overall survival than those without. CONCLUSIONS: Patients with RCC seem to have a significantly higher risk of developing other subsequent primary malignancies. This should be considered during the follow-up of patients with RCC.     

Trends and outcomes of lymphadenectomy for nonmetastatic renal cell carcinoma: A propensity score-weighted analysis of the National Cancer Database

Purpose

Lymph node (LN) involvement in renal cell carcinoma (RCC) is associated with a poor prognosis. While lymph node dissection (LND) may provide diagnostic information, its therapeutic benefit remains controversial. Thus, the aim of our study is to analyze survival outcomes after LND for nonmetastatic RCC and to characterize contemporary practice patterns.

Spontaneous regression of biopsy proven primary renal cell carcinoma: A case study

Spontaneous regression of renal cell carcinoma (RCC) is a well-recognized and interesting phenomenon that is poorly understood and rarely documented. There are very few reported cases of spontaneously regressed primary RCC. We present a 63-year-old male with a biopsy-proven RCC that regressed with complete resolution of symptoms.     

A population-based evaluation of tunica vaginalis mesothelioma: An analysis of the National Cancer Database

PurposePrimary mesothelioma of the tunica vaginalis (TVM) is a rare and poorly understood malignancy with insufficient population-level data to guide management decisions.Materials and MethodsA retrospective analysis of TVM cases recorded in the National Cancer Database from 2004 to 2015 was performed. Cases were identified using International Classification of Diseases for Oncology histology codes. Associations between demographic, clinical and therapeutic factors were analyzed using Kaplan-Meier survival estimates for overall survival (OS) and Cox proportional hazard modeling. Propensity score matching for receipt of systemic chemotherapy was performed to assess the impact on OS.ResultsOne hundred fifty-one men with a median age of 65 years (interquartile range [IQR] 51–78) were included. Median OS from diagnosis was 72.5 months (IQR 20.2–Not Reached [NR]) after a median follow up of 34.9 months. Multivariate analysis demonstrated an increased risk of death for patients in the fourth quartile of age (hazard ratio [HR] 5.57, 95% confidence interval [CI] 1.70–18.17, P = 0.004), those with biphasic or fibrous histology (HR 2.59, 95% CI 1.15–6.42, P = 0.04) and positive surgical margins (HR 3.27, 95% CI 1.61–6.63, P = 0.001). There was no significant difference in OS associated with receiving chemotherapy (P = 0.5) even after propensity score matching (P = 0.07).ConclusionsMargin-negative surgical resection is paramount to improving OS. There are insufficient data to recommend for or against adjuvant systemic chemotherapy or RT, although the limited available data does not suggest apparent benefit in terms of OS.     

Improved survival after cytoreductive nephrectomy for metastatic renal cell carcinoma in the contemporary immunotherapy era: An analysis of the National Cancer Database

ObjectivesDespite immune checkpoint inhibitor (ICI) approval for metastatic renal cell carcinoma (mRCC) in 2015, cytoreductive nephrectomy (CN) is guided by extrapolation from earlier classes of therapy. We evaluated survival outcomes, timing, and safety of combining CN with modern immunotherapy (IO) for mRCC.MethodsFrom 96,329 renal cancer cases reported to the NCDB between 2015 and 2016, we analyzed 391 surgical candidates diagnosed with clear cell mRCC treated with IO ± CN and no other systemic therapies. Primary outcome was overall survival (OS) stratified by the performance of CN (CN + IO vs. IO alone). Secondary outcomes included OS stratified by the timing of CN, pathologic findings, and perioperative outcomes.ResultsOf 391 patients, 221 (56.5%) received CN + IO and 170 (43.5%) received IO only. Across a median follow-up of 14.7 months, patients who underwent CN + IO had superior OS (median NR vs. 11.6 months; hazard ratio 0.23, P < 0.001), which was upheld on multivariable analyses. IO before CN resulted in lower pT stage, grade, tumor size, and lymphovascular invasion rates compared to upfront CN. Two of 20 patients (10%) undergoing CN post-IO achieved complete pathologic response in the primary tumor (pT0). There were no positive surgical margins, 30-day readmissions, or prolonged length of stay in patients undergoing delayed CN.ConclusionUsing a large, national, registry-based cohort, we provide the first report of survival outcomes in mRCC patients treated with CN combined with modern IO. Our findings support an oncologic role for CN in the ICI era and provide preliminary evidence regarding the timing and safety of CN relative to IO administration.     

Esophagectomy versus endoscopic resection for patients with early-stage esophageal adenocarcinoma: A National Cancer Database propensity-matched study

Objectives

Endoscopic resection has been rapidly adopted in the treatment of early-stage esophageal tumors. We compared the outcomes after esophagectomy or endoscopic resection for stage T1a adenocarcinoma.

Impact of body mass index on perioperative outcomes of laparoscopic radical nephrectomy in Japanese patients with clinically localized renal cell carcinoma

Objective: The aim of this study was to review the association between body mass index (BMI) and perioperative outcomes of laparoscopic radical nephrectomy (LRN) in Japanese patients with renal cell carcinoma (RCC). Methods: This study included 108 consecutive Japanese patients undergoing LRN for RCC between April 2001 and March 2009. These patients were divided into the following two groups according to BMI: the non‐obese group (n= 58, BMI 25 kg/m² or less) and the obese group (n= 50, BMI greater than 25 kg/m²). Perioperative outcomes between these two groups were retrospectively compared. Results: There were no significant differences in clinicopathological parameters other than BMI between the non‐obese and obese groups. There were no significant differences in operative time, estimated blood loss during LRN, and the incidences of open conversion and postoperative complications between these two groups. In addition, there were no significant differences in parameters related to postoperative recovery, including time to walk, time to oral intake and time until permission for discharge, between these two groups. However, significant trends toward a prolonged operative time (P= 0.0050) and increased blood loss (P= 0.012) during LRN in relation to BMI were documented by linear regression analyses. Conclusions: Although the degree of obesity in patients included in this study was comparatively slight, these findings suggest that LRN can be safely performed for patients with RCC irrespective of BMI. However, the difficulty of LRN may increase with BMI considering the trends toward longer operative time as well as greater blood loss.     

Impact of nephron-sparing surgery on quality of life in patients with localized renal cell carcinoma

OBJECTIVES: The aim of the study is to evaluate the impact of nephron-sparing surgery on postoperative quality of life (QOL) in patients with localized renal cell carcinoma, compared with radical nephrectomy. METHODS: From 1986 to 1996, a total of 66 patients with localized small renal cell carcinoma <4 cm in diameter and a functioning contralateral renal unit underwent radical nephrectomy (n = 51) or nephron-sparing surgery (n = 15). Of these, 50 patients evaluated various dimensions of QOL using standardized self-rating questionnaires, EORTC QLQ-C30. RESULTS: There is no significant difference in 5-year overall survival between the nephron-sparing surgery group and the radical nephrectomy group. With regard to postoperative QOL, patients who underwent nephron-sparing surgery showed a significantly higher score on physical function than patients treated with radical nephrectomy (p<0.05). Nephron-sparing surgery was additionally superior to radical nephrectomy in terms of fatigue, sleep disturbance, pain and constipation. CONCLUSION: Selected patients with localized, small, unilateral renal cell carcinoma and a normal contralateral kidney will benefit from nephron-sparing surgery.     

Analysis of long-term survival in patients with localized renal cell carcinoma: laparoscopic versus open radical nephrectomy

Objectives  

To assess the impact of surgical approaches and clinico-pathological parameters on the prognosis of localized renal cell carcinoma (RCC) after laparoscopic radical nephrectomy (LRN) or open radical nephrectomy (ORN).