L. Cindolo

A preoperative clinical prognostic model for non-metastatic renal cell carcinoma.

Authors from Naples, Paris and Rennes describe their efforts to develop a model for the preoperative prediction of outcome for non‐metastatic renal cancer. It is valuable to both urologist and patient to develop such a model, particularly so on preoperative criteria. The results of their study are interesting, leading to possibly helpful findings.

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.

Prognostic variables to predict cancer‐related death in incidental renal tumours

To identify, in a large multicentre series of incidental renal tumours, the key factors that could predict cancer‐related deaths, as such tumours have a better outcome than symptomatic tumours and selected patients are increasingly being included in watchful‐waiting protocols.

Survival of patients with nonmetastatic pT3 renal tumours: a matched comparison of laparoscopic vs open radical nephrectomy.

To compare the oncological outcome of patients with pT3 renal tumours treated either by laparoscopic radical nephrectomy (LRN) or open RN (ORN).

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

PURPOSE We evaluated the prognosis, risk factors and relevance of the primary-free interval in a large cohort with metachronous bilateral renal cell carcinoma. MATERIALS AND METHODS We 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. RESULTS Median 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. CONCLUSIONS Long-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.

557 COLLECTING DUCT RENAL CELL CARCINOMA: A MATCHED ANALYSIS OF 41 CASES

OBJECTIVES Collecting duct renal cell carcinoma (CDRCC) is a rare but reportedly aggressive histologic subtype. We assessed the stage and histologic features of patients with CDRCC and compared cancer-specific mortality in CDRCC and matched patients with clear-cell renal cell carcinoma (CRCC). METHODS Forty-one (0.6%) patients with CDRCC and 5246 CRCC patients were identified within a cohort of 6608 patients treated with either radical or partial nephrectomy for renal cancer. Within the 5246 CRCC cases, 105 were matched with CDRCC cases for grade, tumour size, and T, N, and M stages. Kaplan-Meier and life table analyses addressed RCC-specific survival. RESULTS Of all CDRCC patients, 76% had pT3 disease at nephrectomy versus 37% for those with CRCC. The predominant Fuhrman grades were III (56%) and IV (22%) in CDRCC versus II (42%) and III (28%) for CRCC. Moreover, 49% of CDRCC patients were pN1-2 versus 8% for CRCC. Of CDRCC patients 19% had distant metastases at nephrectomy versus 14% for CRCC. Finally, 73% of CDRCC patients had either local or systemic symptoms versus 56% for CRCC. After matching, the RCC-specific mortality of CDRCC patients was no different from that for CRCC patients (RR=1.1; p=0.8). One- and 5-yr CDRCC-specific survival rates were 86% and 48%, respectively, versus 86% and 57% for matched CRCC controls. CONCLUSIONS CDRCC patients present with more advanced stage and with more aggressive disease compared with CRCC patients. After nephrectomy, when CDRCC cases were matched with CRCC, the same cause-specific survival was seen.