Objectives: To examine the medium‐term functional outcomes of partial nephrectomy for clinical T1b renal cell carcinoma, and to compare them with those of radical nephrectomy for clinical T1b and ...with those of partial nephrectomy for clinical T1a tumors.
Methods: The participants of this study were patients operated for clinical T1a and clinical T1b tumors operated at Tokyo Women's Medical University, Tokyo, Japan, between January 1979 and June 2011. A total of 67 patients underwent partial nephrectomy for clinical T1b tumor, 195 patients underwent radical nephrectomy for clinical T1b tumors and 324 underwent partial nephrectomy for clinical T1a tumors. The outcomes of these three groups were compared.
Results: Partial nephrectomy provided better preservation of residual renal function compared with radical nephrectomy for clinical T1b, and the postoperative estimated glomerular filtration rate was similar in the patients who underwent partial nephrectomy for clinical T1b and those who underwent partial nephrectomy for clinical T1a. Postoperative renal function was steadily maintained after partial nephrectomy during the medium‐term follow up. The probability of freedom from new onset of chronic kidney disease after partial nephrectomy for clinical T1b tumors was significantly higher from that after radical nephrectomy for clinical T1b tumors, and similar to that after partial nephrectomy for clinical T1a tumors.
Conclusions: The higher anatomical complexity of clinical T1b tumors is unlikely to provide a significant influence on postoperative renal function after partial nephrectomy, when compared with the clinical T1a tumors. These findings support the beneficial role of partial nephrectomy in the preservation of renal function of clinical T1b renal cell carcinoma patients undergoing surgery.
Mannitol has been administered during partial nephrectomy as a renal protective agent for ischemic damage. However, we do not have any high‐level clinical evidence of its effectiveness. The aim of ...the present study was to evaluate the effect of mannitol during open partial nephrectomy by comparing the postoperative renal function of patients who received it and those who did not. We retrospectively reviewed the records of 55 patients who underwent open partial nephrectomy for renal cancer in a solitary kidney from January 1990 to December 2012, and who were followed up postoperatively for at least 6 months. Of the 55 patients, mannitol was given to 20 patients (group M+) and not to the other 35 patients (group M−). We compared not only the postoperative estimated glomerular filtration rate, but also its decrease rate and the incidence of acute kidney injury requiring dialysis in the two groups. There were no significant differences in perioperative patient characteristics between the two groups. Mannitol made no significant difference in both the postoperative estimated glomerular filtration rate and its decrease rate at any point within 6 months of the postoperative period. The incidence of acute kidney injury requiring dialysis was one (5.0%) in group M+ and two (5.7%) in group M−. These findings suggest that there might be no advantage from the administration of mannitol during open partial nephrectomy.
The potential role of chemokines in clinical tumors remains poorly understood. Recent investigations have shown the differential expression of chemokine receptors on lymphocytes mediating Th1‐ and ...Th2‐type immune responses. We examined Th1‐ and Th2‐associated cytokines and chemokines, as well as the expression of their receptors in tumor‐infiltrating lymphocytes in renal cell carcinoma (RCC). Sixty‐seven patients with sporadic RCC were analyzed for the expression of Th1‐ and Th2‐associated genes using real‐time polymerase chain reaction. Tumor infiltration by CXC chemokine receptor 3 (CXCR3)‐positive and CC chemokine receptor 5 (CCR5)‐positive cells was detected by immunohistochemistry and by flow cytometry. The expression of Th1‐associated genes was significantly increased in tumors compared to normal kidney tissues. The expression of interferon‐γ correlated positively with that of Th1 chemokines. Tumors expressing higher Th1 chemokines did not recur after curative surgery. Multivariate analysis showed that increased monokine induced by interferon (IFN)‐γ (MIG) expression was an independent favorable prognostic factor. Immunohistochemistry showed that the degree of CXCR3‐positive cell infiltration significantly correlated with IFN‐γ inducible protein 10, MIG and IFN‐γ‐inducible T cell a chemoattractant expression (I‐TAC). Flow cytometric analysis showed increased expression of CXCR3 and CCR5 in tumor‐infiltrating T lymphocytes compared to that in peripheral blood T cells. These results suggest that upregulation of the Th1‐type immune response in RCC tumors with a favorable prognosis may be mediated by Th1‐associated chemokines. Integrity of the Th1‐type immune response seems to be required for tumor regression, suggesting that detection and correction of a defect in the Th1‐type response cascade would thus be one of the main targets for tailor‐made immunotherapy and gene therapy in RCC. (Cancer Sci 2006; 97: 780–786)
Background
Our previous nonrandomized prospective study showed that template-based lymphadenectomy improved survival among patients with renal pelvic cancer but not among patients with ureteral ...cancer. However, regional node sites vary according to the tumor’s location in relation to the ureter. Therefore, this retrospective study examined the therapeutic role of lymphadenectomy for ureteral cancer according to tumor location.
Methods
Between January 1988 and September 2015, we performed nephroureterectomy for 154 patients with nonmetastatic urothelial carcinoma of the ureter at two Japanese institutions. The tumors’ locations were classified as the lower ureter or the upper/middle ureter (before the cranial crossing of the common iliac artery). The appropriate regional nodes were identified based on our previous mapping study. Dissection was classified as complete lymphadenectomy (all regional sites were dissected), incomplete lymphadenectomy (not all sites were dissected), or no lymphadenectomy. We focused the analyses on patients with ≥pT2 disease to clarify the effect of the lymphadenectomy.
Results
Among the 48 patients with upper/middle ureteral cancer, recurrence-free and cancer-specific survival were significantly higher in the complete lymphadenectomy group (vs. the incomplete or no lymphadenectomy groups). However, there were no differences in recurrence-free and cancer-specific survivals among the 56 patients with lower ureteral cancer. In the patients with upper/middle ureteral cancer, multivariate analysis revealed that template-based lymphadenectomy was independently associated with a reduced risk of cancer-specific mortality.
Conclusions
Template-based lymphadenectomy has a therapeutic benefit for treating patients with upper/middle ureteral cancer but not for treating patients with lower ureteral cancer.
It remains unclear whether lymphadenectomy alters regional node recurrence after nephroureterectomy in patients with urothelial carcinoma of the renal pelvis. The predictive factors for regional node ...recurrence are still unclear. In this study, we retrospectively examined how the extent of lymphadenectomy influences regional node recurrence in patients with urothelial carcinoma of the renal pelvis.
From January 1988 through July 2013, we performed nephroureterectomy in 180 patients with non-metastatic (cN0M0) urothelial carcinoma of the renal pelvis at two Japanese institutes. Regional nodes were determined according to our previous mapping study: complete lymphadenectomy designates that all regional sites were dissected; incomplete lymphadenectomy that all sites were not dissected. A third group included those without lymphadenectomy.
The 5-year cancer-specific and recurrence-free survival was significantly higher in the complete lymphadenectomy group than in the incomplete lymphadenectomy or without lymphadenectomy groups (P = 0.03). The incidence of regional node recurrence was significantly lower in the complete lymphadenectomy group at 2.9% (2/67) than in the incomplete lymphadenectomy at 18.1% (4/22) or without lymphadenectomy at 10.9% (10/91) groups (P = 0.03). In patients with incomplete lymphadenectomy, 75% of regional node recurrence occurred outside of the dissected sites. Complete lymphadenectomy is shown to be a likely predictive factor of reduced risk of recurrence at the regional nodes by multivariate analysis, after adjusting for patient age, pathological T stage, and pathological nodal metastases.
This study shows that template-based lymphadenectomy reduced the risk of regional node recurrence in patients with urothelial carcinoma of the renal pelvis and appears to result in improved survival.
Objective
We compared the clinical features and prognosis of renal cell carcinoma (RCC) between patients on hemodialysis (RCC-HD) and those in the general population (RCC-general).
Methods
We ...included a total of 1,794 patients who underwent surgery (RCC-HD, 408; RCC-general, 1,386) and analyzed the clinical characteristics and oncological outcomes using a stage-for-stage analysis between the two groups.
Results
In the RCC-HD group, the mean duration of dialysis before surgery was 120 months. Compared to the RCC-general group, the RCC-HD group tended to be younger (55 vs. 60 years,
p
< 0.0001) and more predominately male (84 % vs. 70 %,
p
< 0.0001), and the tumor size was smaller in this group (39 vs. 49 mm,
p
< 0.0001). The pathological characteristics of the RCC-HD group included a higher frequency of papillary tumors (22 % vs. 5 %,
p
< 0.0001) and stage I tumors (82 % vs. 68 %,
p
< 0.0001). During the follow-up period, 39 of patients (10 %) in the RCC-HD group and 193 patients (14 %) in the RCC-general group died of cancer. The patients on hemodialysis had better cancer-specific survival (CSS) than their counterparts (
p
= 0.0292) in the univariable analysis, but no significance was found in the multivariable analysis. In the stage-for-stage analysis, the 5-year CSS was similar between the two groups for each stage.
Conclusions
CSS appeared to be better in the RCC-HD group than in the RCC-general group, which may be associated with the higher incidence of stage I disease in the RCC-HD group. The comparable CSS between the groups in the stage-for-stage analysis supports this finding.
This study aimed to compare the outcomes of laparoscopic radical nephrectomy (LRN) between patients undergoing dialysis for ≤240 and >240 months. Data from all dialysis patients with non‐metastatic ...renal cell carcinoma (RCC) treated with LRN between 2008 and 2015 in our hospital were evaluated retrospectively. Patients were divided into two groups, shorter‐ and longer‐term dialysis patients, according to the preoperative duration of dialysis (≤240 vs. >240 months). Of 174 patients, 58 (33.3%) were on longer‐term dialysis. Perioperative minor complications were significantly more frequent in the longer‐term dialysis patients (P = 0.03). There was no significant difference between the two groups in other perioperative outcomes. Patients on longer‐term dialysis more frequently had pathologically advanced RCC (P = 0.009) with poorer prognosis (P = 0.005). LRN for RCC in longer‐term dialysis patients appears to be safe and feasible; however, careful follow‐up is needed because these patients tend to have poorer prognosis.
Objectives: To assess the predictors of postoperative renal insufficiency after open partial nephrectomy.
Methods: A total of 195 patients who underwent open partial nephrectomy were the ...participants in this study. Patients with a decrease in the estimated glomerular filtration rate of >25% from baseline were evaluated on the basis of multiple factors including patient‐specific, surgical, tumor and postoperative factors. Postoperative estimated glomerular filtration rate data were recorded between 3 and 6 months after surgery.
Results: Of the 195 patients, 18 (9%) had a decrease in estimated glomerular filtration rate of >25%. Percentage of preserved renal parenchyma (P = 0.0078), nearness of tumor to renal sinus (P = 0.0108), location of tumor to middle part of kidney (P = 0.0112), postoperative highest lactase dehydrogenase (P < 0.0001), postoperative body temperature (P = 0.0314) and postoperative acute kidney injury (P < 0.0001) were significantly different between patients with a decrease in estimated glomerular filtration rate of >25% and those with a decrease in estimated glomerular filtration rate ≤25% on univariate analysis. Multivariate analysis showed that postoperative highest lactase dehydrogenase (P = 0.0408) and acute kidney injury (P = 0.0002) were independent predictors for decrease of estimated glomerular filtration rate >25%. In contrast, patient characteristic factors (chronic kidney disease stage), surgical factors (clamping time and PPRP) and tumor factors (radius, endophytic/exophytic, nearness and location component) were not significant predictors.
Conclusions: Postoperative factors, lactase dehydrogenase and acute kidney injury, were strong predictors for renal insufficiency after open partial nephrectomy. Thus, a strict follow up is advisable in patients showing high postoperative levels of these two biomarkers.
Objectives
To investigate the impact of histological subtypes on the survival of patients presenting with renal cell carcinoma extending into the inferior vena cava.
Methods
From January 1985 until ...October 2011, 68 patients with renal cell carcinoma extending into the inferior vena cava underwent radical nephrectomy and inferior vena cava thrombectomy at Tokyo Women's Medical University, Tokyo, Japan. Their clinical and pathological parameters were reviewed from the medical charts.
Results
The median follow up was 19 months (range 0.1–144 months). The tumor thrombus level was I in four patients (6%), II in 38 patients (56%), III in 12 patients (18%) and IV in 14 patients (20%). Papillary histological subtype was found in seven patients (10%), and clear cell in 61 patients (90%). Patients with a papillary subtype had a significantly worse survival outcome than the patients with the clear cell subtype (median survival time 9.0 vs 36.1 months, P < 0.001). Multivariate analysis also showed that the papillary subtype was the only independent prognostic factor for unfavorable cancer‐specific survival (P = 0.03). When the patients presented with metastases to lymph nodes or distant metastases, the median survival of the patients with a papillary subtype was extremely short, at just 5.2 months compared with those with a clear cell subtype (24.0 months, P = 0.001).
Conclusions
Patients with renal cell carcinoma extending into the inferior vena cava with a papillary subtype show a considerably shorter survival compared with those with a clear cell subtype. The papillary renal cell carcinoma extending into the inferior vena cava patient might be an inappropriate candidate for extensive surgery when metastases to nodes or distant organs are found.
We assessed whether adequately functioning parenchyma is preserved in patients with pre‐existing chronic kidney disease (CKD) after partial nephrectomy (PN) compared with those who underwent radical ...nephrectomy (RN). A total of 95 patients with pre‐existing CKD who underwent curative surgery for pathological T1a‐T2N0M0 renal cell carcinoma with a follow‐up period of 12 months or more were the subject of the present study. Of these, 51 patients underwent RN, and 44 PN. Renal function was assessed by using the estimated glomerular filtration rate (e‐GFR). We classified the subjects into two groups according to the preoperative e‐GFR: preoperative e‐GFR 45–59 mL/min/1.73 m2 (68 patients); and 30–44 mL/min/1.73 m2 (27 patients). In the former group, the probability of freedom from new onset of e‐GFR <45 mL/min/1.73 m2 stemmed from the significant difference between the PN and RN groups (P = 0.006; PN: 2 years 64%; RN: 2 years 22%). In contrast, in the latter group, the probability of freedom from new onset of e‐GFR <30 mL/min/1.73 m2 was not associated with a significant difference between PN and RN group (P = 0.80). Overall survival and the number of the patients who went on to develop end‐stage renal disease requiring renal replacement therapy between PN and RN were not significantly different in each group. Death from renal cell carcinoma was not noted in either group. PN could significantly prevent development to late‐stage CKD in patients with preoperative e‐GFR 45–59 mL/min/1.73 m2 compared with RN. Patients with preoperative e‐GFR 30–44 mL/min/1.73 m2 should be reviewed in a more strict study.
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