1. Clinical And Pathological Prognosis Factors Found In Renal Cell Carcinoma.
- Author
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Sandu, B. Ş., Raşcu, Ş., Costache, M., Bădescu, D., Rădăvoi, D., Costache, S., Sin, A., Dragomirişteanu, I., Nedelea, S., Borcăiaş, R., Călinoiu, P., Ionel, I. P., and Jinga, V.
- Subjects
RENAL cell carcinoma ,PROGNOSIS ,KIDNEY tumors ,ADIPOSE tissues ,SURGICAL complications ,PARANEOPLASTIC syndromes - Abstract
Introduction and objectives. Renal cell carcinoma (RCC) is one of the most important urological pathologies, being correlated with high morbidity, poor prognosis and outcome. Kidney tumors can be heterogeneous comprehending several histological types. Diagnosis of RCC usually results in most cases from incidental findings, although in some cases, due to paraneoplastic syndromes, patients present with symptoms caused by hormones or cytokines excreted by the tumor cells or by a systemic immune response against the tumor. The treatment of choice for RCC is mainly surgical, involving partial or radical nephrectomy, either open or laparoscopic, while the oncological results depend on a series of prognostic factors among which the tumor pathological stage, the presence of lymphovascular or perineural invasion, presence of tumor necrosis or sarcomatoid and rhabdoid changes. The objective of our study was to try and determine correlations between the clinical and the histopathological aspects of renal cell carcinoma patients that might be used as prognostic factors for the evolution of the disease. Materials and Methods. We conducted a retrospective study involving 50 patients treated for renal cell carcinoma, who underwent radical or partial nephrectomy in 2019 in a urology tertiary care center. The demographic data, clinical and histopathological data were gathered into a database for the study group. Our goal was to determine key prognostic factors that could be related to the oncological outcomes and the surgical results for patients with renal cell carcinoma who underwent curative intent treatment. Results. The mean patient's age was 65 years, ranging from 46 to 81 years. In the study groups, there were 32 laparoscopic nephrectomies and 18 through an open approach. In most of the cases the tumor size varied between 4 and 7 cm. In terms of pathological prognosis factors, tumor necrosis was found in 21 cases, 14 of them had Fuhrman grade 3 and 5 cases presented with Fuhrman grade 4. Only 2 cases found to have low Fuhrman grade (2) associated with tumoral necrosis. Patients with larger tumors tended to present with a higher Fuhrman grade. Fatty tissue involvement was found in 15 cases, from which 12 presented with Fuhrman grade 3 and 3 cases with grade 4. Capsular invasion was found in 9 cases and 7 cases had positive lymph nodes. Only one case presented sarcomatoid changes. In terms of intraoperative surgical decision making out of 24 cases of tumors measuring 7 cm or less, 15 of them had the tumor situated at one of the poles, 12 of them without touching the renal collecting system feasible for partial nephrectomy. Due to intraoperative complications and aspects, regarding the surgical dissection and the increased bleeding, in seven of these cases, the surgeon's decision was towards radical nephrectomy. Out of these seven cases the histopathological report following radical nephrectomy revealed a Fuhrman grade 3, with five tumors with a diameter of less than 5.5 cm and two cases with tumor dimensions below 4 cm, all situated at one of the poles. Conclusion. Patients with larger tumors presented with higher Fuhrman grades and more tumor necrosis, most of them invading the collecting system (p<0,05). Small tumors, less than 4 cm, were more likely to be feasible for nephron sparing surgery. Although 15 cases in our study were suitable for partial nephrectomy, in 7 cases the decision of radical nephrectomy was made intra-operatively and found to have Fuhrman grade 3 and tumor necrosis, in three cases the renal collective system was involved. Modern approach regarding surgical treatment of RCC depends on the tumor location, size, the relationship with urinary tract, blood vessels and the surrounding organs. Although novel oncologic markers emerge every year and become available for RCC patients, the use of predictive biomarkers for clinical stratification and management still awaits validation studies. [ABSTRACT FROM AUTHOR]
- Published
- 2020