A. De La Taille

45 Chromophobe renal cell carcinoma: A comprehensive analysis of 104 cases from a multicentric European database

bjectives. To analyze the clinical behavior of chromophobe renal cell carcinoma (CRCC), we retrospecively evaluated the data from six European centers. In 1985, CRCC was identified as a new RCC histologic ubtype. Because of its low frequency, only few large CRCC series are available. ethods. We created a renal cancer database including 3228 patients who underwent surgery between 986 and 2002 in six European centers. The relevant clinical and pathologic data were extracted from the linical charts at each institution and collected into a unique database. esults. Of the 3228 patients, 104 (3.2%) affected by CRCC were identified. The mean age at diagnosis was 7.6 years (range 22 to 83). Of the 104 patients, 51 (49%) were men and 53 (51%) were women. The mean umor size was 6.4 3.6 cm. An incidental diagnosis accounted for 61.5% of the cases. Radical nephrecomy was performed in 88 patients (85%). After a median follow-up of 38 months (mean 44, range 1 to 153), o local recurrence was observed. The 5-year overall survival rate for CRCC was 81%. Of the 104 patients, (4.8%) and 9 (8.6%) died of unrelated causes and renal cancer, respectively. onclusions. Our series confirmed a favorable outcome for the CRCC subtype with little local aggressiveess and a low propensity for progression and death from cancer. UROLOGY 65: 681–686, 2005.

156 METACHRONOUS BILATERAL RENAL CELL CARCINOMA: RISK ASSESSMENT, PROGNOSIS AND RELEVANCE OF THE PRIMARY-FREE INTERVAL

PURPOSEnWe evaluated the prognosis, risk factors and relevance of the primary-free interval in a large cohort with metachronous bilateral renal cell carcinoma.nnnMATERIALS AND METHODSnWe studied 120 patients with metachronous, bilateral renal cell carcinoma who were treated at 12 international academic centers. Logistic regression was performed to evaluate risk factors for contralateral metachronous renal cell carcinoma during followup. Disease specific survival was evaluated with univariate and multivariate analysis.nnnRESULTSnMedian age at diagnosis of the first and second renal cell carcinomas was 54 and 62 years, respectively. The most common histological subtype was bilateral clear cell renal cell carcinoma (89% of cases). Familial renal cell carcinoma was found in 14% of patients, von Hippel-Lindau disease was found in 4% and nonfamilial renal cell carcinoma was found in 81%. The 15-year disease specific survival rates for the first and second renal cell carcinomas were 66% and 44%, respectively. Logistic regression revealed von Hippel-Lindau disease, a family history of renal cell carcinoma, multifocal first renal cell carcinoma and young patient age as independent risk factors for contralateral renal cell carcinoma after surgery for unilateral renal cell carcinoma. A longer primary-free interval was associated with a better prognosis. When calculating disease specific survival from the diagnosis of the first renal cell carcinoma, the primary-free interval was an independent prognostic factor.nnnCONCLUSIONSnLong-term survival rates of metachronous, bilateral renal cell carcinoma are moderate. von Hippel-Lindau disease, a family history of renal cell carcinoma, multifocal first renal cell carcinoma and young patient age are independent risk factors for contralateral renal cell carcinoma. These risk factors support close and extended abdominal surveillance following nephrectomy for unilateral renal cell carcinoma. Patients with a longer primary-free interval have a more favorable prognosis.

MORBIDITY AND CLINICAL OUTCOME OF NEPHRON-SPARING SURGERY IN RELATION TO TUMOUR SIZE AND INDICATION

OBJECTIVEnTo analyse through a large multicentre series, morbidity of nephron-sparing surgery (NSS) in relation to tumour size and surgical indication.nnnMETHODSnThe study included patients from eight international academic centres. Age, sex, TNM stage, tumour size, Fuhrman grade, Eastern Cooperative Oncology Group performance status (ECOG-PS), surgical margins, local and distant recurrences, and overall and cancer-specific survival rates were collected and analysed. Indication for elective or mandatory NSS, medical and surgical complication rates, mean blood loss, blood transfusion, and length of hospital stay were specifically recorded for the purpose of this study. Groups were compared for qualitative and quantitative variables by using chi(2) (Fischer exact test) and Student t tests, respectively.nnnRESULTSnA total of 1048 NSS procedures were included in this study. Mean tumour size was 3.4+/-2.1cm. In 730 elective procedures mean operative time (p=0.002), mean blood loss (p=0.01), the need for blood transfusion (p=0.001), and urinary fistula rate (p=0.01) were significantly increased for tumours >4 cm. However, these differences did not result in significantly increased medical (p=0.4), surgical complication rates (p=0.6), or length of hospital stay (p=0.9). Finally, in elective procedures for malignant tumours, positive surgical margins, local or distant recurrence rates, and cancer-specific survival were not significantly different in tumours < or =4 cm and >4 cm.nnnCONCLUSIONnExcellent cancer control and outcomes can be achieved with NSS in carefully selected patients with tumours >4 cm. Expanding the size indication of elective NSS results in an increased but acceptable morbidity.