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1. Practical identifiability analysis of a mechanistic model for the time to distant metastatic relapse and its application to renal cell carcinoma

Author: Arturo Álvarez-Arenas, Wilfried Souleyreau, Andrea Emanuelli, Lindsay S. Cooley, Jean-Christophe Bernhard, Andreas Bikfalvi, Sebastien Benzekry, Modélisation Mathématique pour l'Oncologie (MONC), Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Institut Bergonié [Bordeaux], UNICANCER-UNICANCER-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), Laboratoire Angiogenèse et Micro-environnement des Cancers (LAMC), Université Sciences et Technologies - Bordeaux 1 (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), service d'urologie [CHU Bordeaux], CHU Bordeaux [Bordeaux], Méthodes computationnelles pour la prise en charge thérapeutique en oncologie : Optimisation des stratégies par modélisation mécaniste et statistique (COMPO), Inria Sophia Antipolis - Méditerranée (CRISAM), Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Centre de Recherche en Cancérologie de Marseille (CRCM)
Subjects: [STAT.AP]Statistics [stat]/Applications [stat.AP], Ecology, [SDV.CAN]Life Sciences [q-bio]/Cancer, Survival Analysis, [INFO.INFO-MO]Computer Science [cs]/Modeling and Simulation, Kidney Neoplasms, Receptors, G-Protein-Coupled, Cellular and Molecular Neuroscience, Computational Theory and Mathematics, Modeling and Simulation, Genetics, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Humans, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Neoplasm Recurrence, Local, Carcinoma, Renal Cell, Molecular Biology, Ecology, Evolution, Behavior and Systematics, [PHYS.PHYS.PHYS-DATA-AN]Physics [physics]/Physics [physics]/Data Analysis, Statistics and Probability [physics.data-an]
Abstract: Distant metastasis-free survival (DMFS) curves are widely used in oncology. They are classically analyzed using the Kaplan-Meier estimator or agnostic statistical models from survival analysis. Here we report on a method to extract more information from DMFS curves using a mathematical model of primary tumor growth and metastatic dissemination. The model depends on two parameters, α and μ, respectively quantifying tumor growth and dissemination. We assumed these to be lognormally distributed in a patient population. We propose a method for identification of the parameters of these distributions based on least-squares minimization between the data and the simulated survival curve. We studied the practical identifiability of these parameters and found that including the percentage of patients with metastasis at diagnosis was critical to ensure robust estimation. We also studied the impact and identifiability of covariates and their coefficients in α and μ, either categorical or continuous, including various functional forms for the latter (threshold, linear or a combination of both). We found that both the functional form and the coefficients could be determined from DMFS curves. We then applied our model to a clinical dataset of metastatic relapse from kidney cancer with individual data of 105 patients. We show that the model was able to describe the data and illustrate our method to disentangle the impact of three covariates on DMFS: a categorical one (Führman grade) and two continuous ones (gene expressions of the macrophage mannose receptor 1 (MMR) and the G Protein-Coupled Receptor Class C Group 5 Member A (GPRC5a) gene). We found that all had an influence in metastasis dissemination (μ), but not on growth (α).
Published: 2022

2. Nivolumab, nivolumab–ipilimumab, and VEGFR-tyrosine kinase inhibitors as first-line treatment for metastatic clear-cell renal cell carcinoma (BIONIKK): a biomarker-driven, open-label, non-comparative, randomised, phase 2 trial

Author: Yann-Alexandre Vano, Réza Elaidi, Mostefa Bennamoun, Christine Chevreau, Delphine Borchiellini, Diane Pannier, Denis Maillet, Marine Gross-Goupil, Christophe Tournigand, Brigitte Laguerre, Philippe Barthélémy, Elodie Coquan, Gwenaëlle Gravis, Nadine Houede, Mathilde Cancel, Olivier Huillard, Philippe Beuzeboc, Laure Fournier, Arnaud Méjean, Xavier Cathelineau, Nicolas Doumerc, Philippe Paparel, Jean-Christophe Bernhard, Alexandre de la Taille, Karim Bensalah, Thibault Tricard, Thibaut Waeckel, Géraldine Pignot, Elena Braychenko, Stefano Caruso, Cheng-Ming Sun, Virginie Verkarre, Guillaume Lacroix, Marco Moreira, Maxime Meylan, Antoine Bougouïn, Letuan Phan, Christelle Thibault-Carpentier, Jessica Zucman-Rossi, Wolf Herman Fridman, Catherine Sautès-Fridman, Stéphane Oudard, Cancer Research and Personalized Medicine - CARPEM [Paris], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie [Paris] (ARTIC), Institut Mutualiste de Montsouris (IMM), Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Service d'Oncologie Médicale [Centre hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Hôpital Saint-André, Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Eugène Marquis (CRLCC), Institut de Cancérologie de Strasbourg Europe (ICANS), Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut de Cancérologie du GARD ICG - CHU Nîmes (Instit Cancéro - GARD), Clinique d'Oncologie et de Radiothérapie [Tours] (CORAD), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau, Hôpital Foch [Suresnes], Service des Explorations Fonctionnelles Physiologiques [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hospices Civils de Lyon (HCL), Nouvel Hôpital Civil de Strasbourg, Service de Néphrologie-Dialyse-Transplantation rénale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)
Subjects: MESH: Humans, MESH: Carcinoma, Renal Cell / drug therapy, MESH: Angiogenesis Inhibitors / adverse effects, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH: Neoplasm Staging, MESH: Male, MESH: Prospective Studies, MESH: Ipilimumab, MESH: Lipase, Oncology, MESH: Tumor Microenvironment, MESH: Sunitinib, MESH: Biomarkers, MESH: Antineoplastic Combined Chemotherapy Protocols / adverse effects, MESH: Female, MESH: Nivolumab / adverse effects, MESH: Protein Kinase Inhibitors / adverse effects
Abstract: International audience; Background: We previously reported a 35-gene expression classifier identifying four clear-cell renal cell carcinoma groups (ccrcc1 to ccrcc4) with different tumour microenvironments and sensitivities to sunitinib in metastatic clear-cell renal cell carcinoma. Efficacy profiles might differ with nivolumab and nivolumab-ipilimumab. We therefore aimed to evaluate treatment efficacy and tolerability of nivolumab, nivolumab-ipilimumab, and VEGFR-tyrosine kinase inhibitors (VEGFR-TKIs) in patients according to tumour molecular groups.Methods: This biomarker-driven, open-label, non-comparative, randomised, phase 2 trial included patients from 15 university hospitals or expert cancer centres in France. Eligible patients were aged 18 years or older, had an Eastern Cooperative Oncology Group performance status of 0-2, and had previously untreated metastatic clear-cell renal cell carcinoma. Patients were randomly assigned (1:1) using permuted blocks of varying sizes to receive either nivolumab or nivolumab-ipilimumab (ccrcc1 and ccrcc4 groups), or either a VEGFR-TKI or nivolumab-ipilimumab (ccrcc2 and ccrcc3 groups). Patients assigned to nivolumab-ipilimumab received intravenous nivolumab 3 mg/kg plus ipilimumab 1 mg/kg every 3 weeks for four doses followed by intravenous nivolumab 240 mg every 2 weeks. Patients assigned to nivolumab received intravenous nivolumab 240 mg every 2 weeks. Patients assigned to VEGFR-TKIs received oral sunitinib (50 mg/day for 4 weeks every 6 weeks) or oral pazopanib (800 mg daily continuously). The primary endpoint was the objective response rate by investigator assessment per Response Evaluation Criteria in Solid Tumors version 1.1. The primary endpoint and safety were assessed in the population who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT02960906, and with the EU Clinical Trials Register, EudraCT 2016-003099-28, and is closed to enrolment.Findings: Between June 28, 2017, and July 18, 2019, 303 patients were screened for eligibility, 202 of whom were randomly assigned to treatment (61 to nivolumab, 101 to nivolumab-ipilimumab, 40 to a VEGFR-TKI). In the nivolumab group, two patients were excluded due to a serious adverse event before the first study dose and one patient was excluded from analyses due to incorrect diagnosis. Median follow-up was 18·0 months (IQR 17·6-18·4). In the ccrcc1 group, objective responses were seen in 12 (29%; 95% CI 16-45) of 42 patients with nivolumab and 16 (39%; 24-55) of 41 patients with nivolumab-ipilimumab (odds ratio [OR] 0·63 [95% CI 0·25-1·56]). In the ccrcc4 group, objective responses were seen in seven (44%; 95% CI 20-70) of 16 patients with nivolumab and nine (50% 26-74) of 18 patients with nivolumab-ipilimumab (OR 0·78 [95% CI 0·20-3·01]). In the ccrcc2 group, objective responses were seen in 18 (50%; 95% CI 33-67) of 36 patients with a VEGFR-TKI and 19 (51%; 34-68) of 37 patients with nivolumab-ipilimumab (OR 0·95 [95% CI 0·38-2·37]). In the ccrcc3 group, no objective responses were seen in the four patients who received a VEGFR-TKI, and in one (20%; 95% CI 1-72) of five patients who received nivolumab-ipilimumab. The most common treatment-related grade 3-4 adverse events were hepatic failure and lipase increase (two [3%] of 58 for both) with nivolumab, lipase increase and hepatobiliary disorders (six [6%] of 101 for both) with nivolumab-ipilimumab, and hypertension (six [15%] of 40) with a VEGFR-TKI. Serious treatment-related adverse events occurred in two (3%) patients in the nivolumab group, 38 (38%) in the nivolumab-ipilimumab group, and ten (25%) patients in the VEGFR-TKI group. Three deaths were treatment-related: one due to fulminant hepatitis with nivolumab-ipilimumab, one death from heart failure with sunitinib, and one due to thrombotic microangiopathy with sunitinib.Interpretation: We demonstrate the feasibility and positive effect of a prospective patient selection based on tumour molecular phenotype to choose the most efficacious treatment between nivolumab with or without ipilimumab and a VEGFR-TKI in the first-line treatment of metastatic clear-cell renal cell carcinoma.
Published: 2022

3. Cancer-associated fibroblasts in renal cell carcinoma: implication in prognosis and resistance to anti-angiogenic therapy

Author: Christopher Montemagno, Gilles Pagès, Renaud Grépin, Arnaud Borderie, Michael Coutts, Delphine Borchiellini, Damien Ambrosetti, Charlotte Paoli, Matthieu Durand, Jean-Christophe Bernhard, Nathalie Rioux-Leclercq, Olivia Rastoin, Maeva Dufies, Institut de Recherche sur le Cancer et le Vieillissement (IRCAN), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice (CHU Nice), Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), Laboratoire International Associé Réponse des Organismes et Populations face au Stress Environnemental - Université Côte d’Azur - Centre Scientifique de Monaco (LIA ROPSE), Université Côte d’Azur - Centre Scientifique de Monaco, Centre Scientifique de Monaco (CSM), CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Bordeaux [Bordeaux], Fondation de France, Ligue Nationale contre le Cancer (Equipe Labellisee 2019), French National Institute for Cancer Research (INCA), Cordon de vie Foundation, l'Institut National du Cancer (INCa) Institut National du Cancer (INCA) France, Government of the Principality of Monaco, FX Mora Foundation, Université Nice Sophia Antipolis (... - 2019) (UNS), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Fondation de FranceFondation de France, and l'Institut National du Cancer (INCa)Institut National du Cancer (INCA) France
Subjects: Male, #uroonc, anti-angiogenic treatment, [SDV]Life Sciences [q-bio], Angiogenesis Inhibitors, clear cell renal cell carcinoma, Nephrectomy, Metastasis, chemistry.chemical_compound, Mice, 0302 clinical medicine, Renal cell carcinoma, Cell Movement, Sunitinib, Medicine, Cytotoxic T cell, Lymphangiogenesis, Aged, 80 and over, 0303 health sciences, Neovascularization, Pathologic, Cell migration, Cell Differentiation, Middle Aged, Kidney Neoplasms, Neoadjuvant Therapy, 3. Good health, Vascular endothelial growth factor, Survival Rate, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Female, cancer-associated fibroblasts, Adult, Urology, Antineoplastic Agents, [SDV.CAN]Life Sciences [q-bio]/Cancer, Disease-Free Survival, resistance, 03 medical and health sciences, Cell Line, Tumor, Endopeptidases, Biomarkers, Tumor, Animals, Humans, Carcinoma, Renal Cell, 030304 developmental biology, Aged, Retrospective Studies, #kcsm, business.industry, Membrane Proteins, medicine.disease, Actins, Capillaries, Clear cell renal cell carcinoma, chemistry, Drug Resistance, Neoplasm, fibroblast-associated protein, #KidneyCancer, Cancer research, Cancer-Associated Fibroblasts, business, Transcriptome, prognostic marker
Abstract: International audience; Objectives: To investigate the role of cancer-associated fibroblasts (CAFs) in clear cell renal cell carcinoma (ccRCC) with respect to tumour aggressiveness, metastasis development, and resistance to anti-angiogenic therapy (vascular endothelial growth factor receptor-tyrosine kinase inhibitors [VEGFR-TKI]).Patients and methods: Our study involved tissue samples from three distinct and independent cohorts of patients with ccRCC. The presence of CAFs and tumour lymphangiogenesis was investigated, respectively, by transcriptional signatures and then correlated with tumour development and prognosis. The effect of these CAFs on tumour cell migration and VEGFR-TKI resistance was analysed on co-cultures of ccRCC cells with CAFs.Results: Results from our cohorts and from in silico investigations showed that VEGFR-TKI significantly increase the number of CAFs in tumours. In the same populations of patients with ccRCC, the proportion of intra-tumoral CAFs correlated to shorter disease-free and overall survival. The presence of CAFs was also correlated with lymphangiogenesis and lymph node metastasis. CAFs increased the migration and decreased the VEGFR-TKI-dependent cytotoxic effect of tumour cells.Conclusions: Our results show that VEGFR-TKI promote the development of CAFs, and CAFs favour tumour aggressiveness, metastatic dissemination, and resistance to treatment in ccRCC. CAFs could represent a new therapeutic target to fight resistance to treatment of ccRCC. Targeting CAF and immunotherapies combination are emerging as efficient treatments in many types of solid tumours. Our results highlight their relevance in ccRCC.
Published: 2022

4. Towards automatic recognition of pure and mixed stones using intra‐operative endoscopic digital images

Author: Michel Daudon, Baudouin Denis de Senneville, Emmanuel Richard, Grégoire Robert, Jean-Christophe Bernhard, V. Estrade, Franck Bladou, Denis De Senneville, Baudouin, CHU de Bordeaux Pellegrin [Bordeaux], Maladies rénales fréquentes et rares : des mécanismes moléculaires à la médecine personnalisée (CoRaKID), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Biothérapies des maladies génétiques et cancers, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Bordeaux [Bordeaux], Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), Modélisation Mathématique pour l'Oncologie (MONC), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Institut Bergonié [Bordeaux], UNICANCER-UNICANCER-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), PlaFRIM (https://www.plafrim.fr), Common and Rare Kidney Diseases = Maladies Rénales Fréquentes et Rares: des Mécanismes Moléculaires à la Médecine Personnalisée (CORAKID), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Intra operative, EndoUrology, Urology, 030232 urology & nephrology, Mixed Stone, Mixed type, 03 medical and health sciences, Digital image, UroStone, 0302 clinical medicine, Medicine, endoscopic diagnosis, [SPI.SIGNAL] Engineering Sciences [physics]/Signal and Image processing, business.industry, Morphological type, Calcium oxalate dihydrate, deep learning, aetiological lithiasis, medicine.disease, morpho-constitutional analysis of urinary stones, 030220 oncology & carcinogenesis, KidneyStones, Kidney stones, automatic recognition, Nuclear medicine, business, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, CALCIUM OXALATE MONOHYDRATE
Abstract: International audience; Objective: To assess automatic computer-aided in situ recognition of the morphological features of pure and mixed urinary stones using intra-operative digital endoscopic images acquired in a clinical setting.Materials and methods: In this single-centre study, a urologist with 20 years' experience intra-operatively and prospectively examined the surface and section of all kidney stones encountered. Calcium oxalate monohydrate (COM) or Ia, calcium oxalate dihydrate (COD) or IIb, and uric acid (UA) or IIIb morphological criteria were collected and classified to generate annotated datasets. A deep convolutional neural network (CNN) was trained to predict the composition of both pure and mixed stones. To explain the predictions of the deep neural network model, coarse localization heat-maps were plotted to pinpoint key areas identified by the network.Results: This study included 347 and 236 observations of stone surface and stone section, respectively; approximately 80% of all stones exhibited only one morphological type and approximately 20% displayed two. A highest sensitivity of 98% was obtained for the type 'pure IIIb/UA' using surface images. The most frequently encountered morphology was that of the type 'pure Ia/COM'; it was correctly predicted in 91% and 94% of cases using surface and section images, respectively. Of the mixed type 'Ia/COM + IIb/COD', Ia/COM was predicted in 84% of cases using surface images, IIb/COD in 70% of cases, and both in 65% of cases. With regard to mixed Ia/COM + IIIb/UA stones, Ia/COM was predicted in 91% of cases using section images, IIIb/UA in 69% of cases, and both in 74% of cases.Conclusions: This preliminary study demonstrates that deep CNNs are a promising method by which to identify kidney stone composition from endoscopic images acquired intra-operatively. Both pure and mixed stone composition could be discriminated. Collected in a clinical setting, surface and section images analysed by a deep CNN provide valuable information about stone morphology for computer-aided diagnosis.
Published: 2022

5. Postoperative outcomes of elderly patients undergoing partial nephrectomy

Author: Sophie Duc, Hervé Baumert, Nicolas Doumerc, Charles Dariane, Jean-Alexandre Long, Jean-Jacques Patard, Hervé Lang, Jose Batista Da Costa, François Henon, Marie-Neige Videau, Morgan Rouprêt, Arnaud Mejean, Alexandre de la Taille, Alexandre Ingels, Thibaut Waeckel, Jean-Christophe Bernhard, Karim Bensalah, Philippe Paparel, Laurent Salomon, Pierre Bigot, Cedric Lebacle, François-Xavier Nouhaud, Jean-Baptiste Beauval, CHU Henri Mondor, CHU Bordeaux [Bordeaux], CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Clinique La Croix du Sud, CHU Mont de Marsan, CHU Strasbourg, CHU Rouen, Normandie Université (NU), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre hospitalier Saint-Joseph [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre Hospitalier Universitaire [Grenoble] (CHU), CHU Lille, and CHU Toulouse [Toulouse]
Subjects: Male, medicine.medical_specialty, Multivariate analysis, medicine.medical_treatment, Science, 030232 urology & nephrology, Protective factor, Renal function, Logistic regression, Nephrectomy, Article, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Blood loss, Robotic Surgical Procedures, medicine, Humans, Aged, Cancer, Aged, 80 and over, Multidisciplinary, Tumor size, business.industry, Odds ratio, Kidney Neoplasms, 3. Good health, Surgery, Tumor Burden, Renal cancer, 030220 oncology & carcinogenesis, Medicine, Female, Laparoscopy, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: To describe clinical outcomes of patients aged 75 years and above after partial nephrectomy (PN), and to assess independent factors of postoperative complications. We retrospectively reviewed information from our multi-institutional database. Every patient over 75 years old who underwent a PN between 2003 and 2016 was included. Peri-operative and follow up data were collected. Multivariate logistic regression was performed to determine independent predictive factors of postoperative complications. We reviewed 191 procedures including 69 (40%) open-surgery, and 122 (60%) laparoscopic procedures, of which 105 were robot-assisted. Median follow-up was 25 months. The mean age was 78 [75–88]. The American Society of Anesthesiologist’s score was 1, 2, 3 and 4 in 10.5%, 60%, 29% and 0.5% of patients respectively. The mean tumor size was 4.6 cm. Indication of PN was elective in 122 (65%) patients and imperative in 52 patients (28%). The median length of surgery was 150(± 60) minutes, and the median estimated blood loss 200 ml. The mean glomerular filtration rate was 71.5 ml/minute preoperatively, and 62 ml/min three months after surgery. The severe complications (Clavien III-V) rate was 6.2%. On multivariate analysis, the robotic-assisted procedure was an independent protective factor of medical postoperative complications (Odds Ration (OR) = 0.31 [0.12–0.80], p = 0.01). It was adjusted for age and RENAL score, robotic-assisted surgery (OR = 0.22 [0.06–0.79], p = 0.02), and tumor size (OR = 1.13 [1.02–1.26], p = 0.01), but the patients age did not forecast surgical complications. Partial nephrectomy can be performed safely in elderly patients with an acceptable morbidity, and should be considered as a viable treatment option. Robotic assistance is an independent protective factor of postoperative complications.
Published: 2021

6. External Validation of the ASSURE Model for Predicting Oncological Outcomes After Resection of High-risk Renal Cell Carcinoma (RESCUE Study: UroCCR 88)

Author: Umberto Capitanio, Karim Bensalah, Alessandro Larcher, Romain Boissier, Francesco Montorsi, Idir Ouzaid, Pierre Bigot, Morgan Rouprêt, Jean-Christophe Bernhard, Zine-Eddine Khene, Nathalie Rioux-Leclercq, François-Xavier Nouhaud, Alexandre de la Taille, Nicolas Doumerc, Philippe Barthélémy, CHU Pontchaillou [Rennes], IRCCS San Raffaele Scientific Institute [Milan, Italie], CHU Bordeaux [Bordeaux], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Rouen, Normandie Université (NU), Aix Marseille Université (AMU), CHU Henri Mondor [Créteil], CHU Strasbourg, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Toulouse [Toulouse], CHU Henri Mondor, Service d'Urologie [CHU Pitié-Salpêtrière], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Oncology, medicine.medical_specialty, Survival, Urology, medicine.medical_treatment, Population, 030232 urology & nephrology, Risk groups, Nephrectomy, Resection, 03 medical and health sciences, 0302 clinical medicine, Renal cell carcinoma, Internal medicine, Brief Correspondence, medicine, education, RC254-282, education.field_of_study, business.industry, External validation, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Kidney cancer, medicine.disease, Prognosis, Diseases of the genitourinary system. Urology, 3. Good health, 030220 oncology & carcinogenesis, Cohort, RC870-923, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; A prognostic model based on the population of the ASSURE phase 3 trial has recently been described. The ASSURE model stratifies patients into risk groups to predict survival after surgical resection of intermediate-and high-risk localised kidney cancer. We evaluated this model in an independent cohort of 1372 patients using discrimination, calibration, and decision curve analysis. Regarding diseasefree survival, the ASSURE model showed modest discrimination (65%), miscalibration, and poor net benefit compared with the UCLA Integrated Staging System (UISS) and Leibovich 2018 models. Similarly, the ability of the ASSURE model to predict overall survival was poor in terms of discrimination (63%), with overestimation on calibration plots and a modest net benefit for the probability threshold of between 10% and 40%. Overall, our results show that the performance of the ASSURE model was less optimistic than expected, and not associated with a clear improvement in patient selection and clinical usefulness in comparison to with available models. We propose an updated version using the recalibration method, which leads to a (slight) improvement in performance but should be validated in another external population. Patient summary: The recent ASSURE model evaluates survival after surgery for nonmetastatic kidney cancer. We found no clear improvement in patient classification when we compared ASSURE with older models, so use of this model for patients with nonmetastatic kidney cancer still needs to be clarified.
Published: 2021

7. Metastatic Clear-cell Renal Cell Carcinoma With a Long-term Response to Sunitinib A Distinct Phenotype Independently Associated With Low PD-L1 Expression

Author: Karim Bensalah, S. Bayat, Mathilde Lefort, Alain Ravaud, Solène-Florence Kammerer-Jacquet, Mokrane Yacoub, Angélique Brunot, Benoit Peyronnet, Romain Mathieu, Marc-Antoine Belaud-Rotureau, Jean-Christophe Bernhard, Brigitte Laguerre, Alexandra Lespagnol, Jean Mosser, Gregory Verhoest, Nathalie Rioux-Leclercq, Frantz Dupuis, Service d'anatomie et cytologie pathologiques [Rennes] = Anatomy and Cytopathology [Rennes], CHU Pontchaillou [Rennes], Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre Eugène Marquis (CRLCC), École des Hautes Études en Santé Publique [EHESP] (EHESP), Hôpital Saint-André, CHU de Bordeaux Pellegrin [Bordeaux], Service de Cytogénétique et de Biologie Cellulaire, Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Institut National Du CancerLigue Contre le Cancer, Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université d'Angers (UA)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Male, Oncology, 030232 urology & nephrology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, B7-H1 Antigen, Metastasis, chemistry.chemical_compound, 0302 clinical medicine, Renal cell carcinoma, PD-1, Sunitinib, Neoplasm Metastasis, Aged, 80 and over, Liver Neoplasms, Kidney cancer, Middle Aged, Primary tumor, Kidney Neoplasms, 3. Good health, Gene Expression Regulation, Neoplastic, Vascular endothelial growth factor, Phenotype, Treatment Outcome, Von Hippel-Lindau Tumor Suppressor Protein, 030220 oncology & carcinogenesis, Disease Progression, Immunohistochemistry, Female, Checkpoint inhibitors, medicine.drug, Adult, medicine.medical_specialty, Urology, Down-Regulation, [SDV.CAN]Life Sciences [q-bio]/Cancer, 03 medical and health sciences, Long-term responders, Internal medicine, medicine, Humans, Carcinoma, Renal Cell, Aged, Retrospective Studies, business.industry, medicine.disease, Survival Analysis, Clear cell renal cell carcinoma, chemistry, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, business
Abstract: International audience; BACKGROUND: Long-term responders (LTRs) are defined by at least 18 months of response to sunitinib in metastatic clear-cell renal cell carcinoma (ccRCC). Well-described by clinical studies, the phenotype of these tumors has never been explored.PATIENTS AND METHODS: In a retrospective and multicenter study, 90 ccRCCs of patients with metastatic disease were analyzed. Immunohistochemistry (carbonic anhydrase IX, vascular endothelial growth factor, c-MET, programmed death-ligand 1 [PD-L1], and PD-1) and VHL status were performed. Progression-free survival and overall survival were calculated from sunitinib introduction and from progression. LTRs and their corresponding tumors were compared with others using univariate and multivariate analysis.RESULTS: Twenty-eight patients were LTRs. They had a median progression-free survival of 28 months versus 4 months for other patients (P < .001). Similarly, LTRs had a median overall survival of 49 months versus 14 months (P < .001), even from progression (median, 21 vs. 7 months; P = .029). They were associated with a favorable or intermediate risk (International Metastatic Renal Cell Carcinoma Database Consortium model) (P = .007) and less liver metastasis (P = .036). They experienced more frequent complete or partial responses at the first radiologic evaluation (P = .035). The corresponding ccRCCs were associated with less nucleolar International Society for Urological Pathology grade 4 (P = .037) and hilar fat infiltration (P = .006). They were also associated with low PD-L1 expression (P = .02). Only the International Metastatic Renal Cell Carcinoma Database Consortium model and PD-L1 expression remained significant after multivariate analysis (P = .014 and P = .029, respectively).CONCLUSION: Primary tumor characteristics of LTRs were studied for the first time and demonstrated a different phenotype. Interestingly, they were characterized by low expression of PD-L1, suggesting a potentially lower impact of targeted immunotherapy in these patients.
Published: 2019

8. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : prise en charge du cancer du rein

Author: Jean-Alexandre Long, François-Xavier Nouhaud, P. Gimel, Laurence Albiges, Idir Ouzaid, Jean-Christophe Bernhard, Arnaud Mejean, Karim Bensalah, T. Bodin, Nathalie Rioux-Leclercq, Jean-Michel Correas, Pierre Bigot, J.-F. Hetet, Romain Boissier, Institut de Génétique et Développement de Rennes (IGDR), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Nutriments Lipidiques et Prévention des Maladies Métaboliques, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université de la Méditerranée - Aix-Marseille 2, Department of Adult Radiology, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Médecine Générale Avicenne [Cabestany], Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique (LHEEA), École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Service d'urologie, CHU Grenoble-Hôpital Michallon, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], centre international de recherche sur l'environnement et le développement (CIRED), Centre National de la Recherche Scientifique (CNRS)-École des Ponts ParisTech (ENPC)-École des hautes études en sciences sociales (EHESS)-AgroParisTech-Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de la Méditerranée - Aix-Marseille 2-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-École des hautes études en sciences sociales (EHESS)-AgroParisTech-École des Ponts ParisTech (ENPC)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Centre International de Recherche sur l'Environnement et le Développement (CIRED), and Centre National de la Recherche Scientifique (CNRS)-École des Ponts ParisTech (ENPC)-Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-École des hautes études en sciences sociales (EHESS)-AgroParisTech
Subjects: Gynecology, Cancer du rein, medicine.medical_specialty, business.industry, Urology, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Kidney cancer, Classification, 3. Good health, Targeted therapy, 03 medical and health sciences, 0302 clinical medicine, Thérapies ciblées, 030220 oncology & carcinogenesis, Medicine, Surgery, business, Chirurgie, ComputingMilieux_MISCELLANEOUS
Abstract: Resume Objectif Proposer une mise a jour des recommandations de la prise en charge des cancers du rein. Methodes Une revue systematique de la litterature a ete faite sur la periode allant de 2015 a 2018. Les articles juges les plus pertinents concernant le diagnostic, la classification, le traitement chirurgical, le traitement medical et le suivi du cancer du rein ont ete selectionnes et incorpores aux recommandations. Les recommandations ont ainsi ete actualisees en specifiant le niveau de preuve. Resultats L’examen de reference pour faire le diagnostic et le bilan d’extension des cancers du rein est le scanner thoraco-abdominal injecte. L’IRM et l’echographie de contraste sont indiquees dans certains cas particuliers. La biopsie percutanee est recommandee dans les situations ou ses resultats influenceront la decision therapeutique. Les tumeurs du rein doivent etre classees selon la classification pTNM 2017 et le grade nucleolaire de l’ISUP. Les cancers du rein metastatiques doivent etre classes selon les criteres de l’IMDC. La nephrectomie partielle est le traitement de references des tumeurs T1a et peut etre faite par voie ouverte, laparoscopique ou robotique. Les therapies ablatives et la surveillance active sont des options chez les patients âges avec des comorbidites. Les tumeurs T1b doivent etre traitees par nephrectomie partielle ou totale en fonction de la complexite tumorale. La nephrectomie totale est le traitement de premiere intention des cancers localement avances localises. Chez les patients metastatiques : la nephrectomie est recommandee en cas de bon pronostic ; le traitement medical doit etre propose en premiere intention en cas de pronostic mauvais ou intermediaire. Le traitement chirurgical ou local des metastases peut etre propose en cas de lesion unique ou d’oligo-metastases. Les molecules recommandees en premiere ligne chez les patients metastatiques sont le sunitinib, le pazopanib et l’association nivolumab/ipililumab. Le cabozantinib peut etre propose en option chez les patients de risque intermediaire et mauvais. Les tumeurs kystiques doivent etre classees selon la classification de Bosniak. L’exerese chirurgicale doit etre proposee en priorite aux lesions Bosniak III et IV. Il est recommande de suivre les patients sur les plans cliniques et radiologiques en adaptant les modalites a l’agressivite tumorale. Conclusion L’actualisation des recommandations doit permettre aux praticiens francais et francophones d’encadrer au mieux leur prise en charge des cancers du rein.
Published: 2018

9. Sunitinib Alone or after Nephrectomy in Metastatic Renal-Cell Carcinoma

Author: Christian Beisland, Jean-Christophe Bernhard, B. Laguerre, Stéphane Oudard, Marine Gross-Goupil, Alain Ravaud, Arnaud Mejean, Marc-Olivier Timsit, Lionnel Geoffrois, Claude Linassier, Frederic Rolland, Luc Cormier, Laurent Guy, Karim Bensalah, Jacques Hubert, Sandra Colas, Christine Theodore, Eric Lechevallier, Laurence Albiges, Simon Thezenas, Jean-Baptiste Beauval, Bernard Escudier, Thierry Lebret, Michael Aitchison, Jean-Jacques Patard, Herve Lang, Antoine Thiery-Vuillemin, Christine Chevreau, G. Gravis, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital Saint-André, UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle (ICM), CRLCC Val d'Aurelle - Paul Lamarque, URC, hôpital Necker Enfants Maladies, Paris, CHU Pontchaillou [Rennes], Département d’Oncologie Médicale [Vandoeuvre Les Nancy], Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), UNICANCER-UNICANCER, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098) (RIGHT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service d'Urologie [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Solvay Silica, Solvay (France), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre de Recherche en Cancérologie de Marseille (CRCM), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Aix Marseille Université (AMU), CHU Marseille, Hôpital Foch [Suresnes], Institut Claudius Regaud, Service de radiothérapie, CRLCC Eugène Marquis (CRLCC), Université libre de Bruxelles (ULB), Comité de Cancérologie (CCAFU), Association Française d'Urologie, Oncologie génito-urinaire, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), UNICANCER - Institut régional du Cancer [Montpellier] (ICM), Institut de Cancérologie de Lorraine - Alexis Vautrin (ICL), Développement et amélioration des plantes (UMR DAP), Centre National de la Recherche Scientifique (CNRS)-Université Montpellier 2 - Sciences et Techniques (UM2)-Institut National de la Recherche Agronomique (INRA)-Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad), CRLCC Institut Claudius Regaud, Université Libre de Bruxelles [Bruxelles] (ULB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS BFC)-Université de Franche-Comté (UFC), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, and Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Adult, Male, medicine.medical_specialty, Indoles, Randomization, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Urology, Antineoplastic Agents, urologic and male genital diseases, Nephrectomy, Risk Assessment, law.invention, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, law, Renal cell carcinoma, Sunitinib, medicine, Carcinoma, Humans, Pyrroles, Carcinoma, Renal Cell, Aged, Neoplasm Staging, Aged, 80 and over, business.industry, Patient Selection, Cancer, General Medicine, Middle Aged, Prognosis, medicine.disease, Combined Modality Therapy, Survival Analysis, Kidney Neoplasms, 3. Good health, Clinical trial, 030220 oncology & carcinogenesis, Female, business, Follow-Up Studies, medicine.drug
Abstract: International audience; BACKGROUND Cytoreductive nephrectomy has been the standard of care in metastatic renal-cell carcinoma for 20 years, supported by randomized trials and large, retrospective studies. However, the efficacy of targeted therapies has challenged this standard. We assessed the role of nephrectomy in patients with metastatic renal-cell carcinoma who were receiving targeted therapies. METHODS In this phase 3 trial, we randomly assigned, in a 1: 1 ratio, patients with confirmed metastatic clear-cell renal-cell carcinoma at presentation who were suitable candidates for nephrectomy to undergo nephrectomy and then receive sunitinib (standard therapy) or to receive sunitinib alone. Randomization was stratified according to prognostic risk (intermediate or poor) in the Memorial Sloan Kettering Cancer Center prognostic model. Patients received sunitinib at a dose of 50 mg daily in cycles of 28 days on and 14 days off every 6 weeks. The primary end point was overall survival. RESULTS A total of 450 patients were enrolled from September 2009 to September 2017. At this planned interim analysis, the median follow-up was 50.9 months, with 326 deaths observed. The results in the sunitinib-alone group were noninferior to those in the nephrectomy-sunitinib group with regard to overall survival (stratified hazard ratio for death, 0.89; 95% confidence interval, 0.71 to 1.10; upper boundary of the 95% confidence interval for noninferiority
Published: 2018

10. Partial nephrectomy versus ablative therapy for the treatment of renal tumors in an imperative setting

Author: François-Xavier Nouhaud, Idir Ouzaid, Karim Bensalah, Jérôme Rigaud, Laurent Salomon, Christian Sengel, Y. Grassano, Pierre Bigot, François Cornelis, P. Gimel, Nathalie Rioux-Leclercq, Gregory Verhoest, Quentin-Côme Le Clerc, C. Lanchon, Arnaud Mejean, Jean-Christophe Bernhard, Jean-Luc Descotes, Philippe Paparel, Romain Boissier, V. Comat, Nicolas Grenier, Laurence Albiges, Valentin Arnoux, Alexandra Masson-Lecomte, Morgan Rouprêt, Thomas Bodin, Jean-Alexandre Long, Centre Hospitalier Universitaire [Grenoble] (CHU), Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Service d'urologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Oncologie génito-urinaire, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Centre d'Urologie Prado Louvain [Marseille], UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU), Chirurgie urologique et transplantation rénale [Hôpital de la Conception - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Polyclinique Médipôle Saint-Roch [Cabestany], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Henri Mondor [Créteil], Imagerie moléculaire et fonctionnelle: de la physiologie à la thérapie, Université Bordeaux Segalen - Bordeaux 2-IFR8-Centre National de la Recherche Scientifique (CNRS), Modélisation Mathématique pour l'Oncologie (MONC), Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Institut Bergonié [Bordeaux], UNICANCER-UNICANCER-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), CHU Bordeaux [Bordeaux], Centre hospitalier universitaire de Nantes (CHU Nantes), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service central de radiologie et d'imagerie médicale, CHU Grenoble-Hôpital Michallon, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Pontchaillou [Rennes], Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), CHU Henri Mondor, Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Institut Bergonié [Bordeaux], Service d'Urologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Nephrology, Ablation Techniques, Male, Percutaneous, Radiofrequency ablation, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Comorbidity, Kidney, Cryosurgery, Nephrectomy, law.invention, Neoplasms, Multiple Primary, 0302 clinical medicine, Postoperative Complications, Robotic Surgical Procedures, law, Partial nephrectomy, Cryoablation, Middle Aged, Kidney Neoplasms, 3. Good health, Tumor Burden, Treatment Outcome, Renal cancer, 030220 oncology & carcinogenesis, Catheter Ablation, Female, Kidney Diseases, Glomerular Filtration Rate, medicine.medical_specialty, Urology, Renal function, Imperative indication, Disease-Free Survival, Congenital Abnormalities, 03 medical and health sciences, Internal medicine, medicine, Humans, Blood Transfusion, Renal Insufficiency, Chronic, Carcinoma, Renal Cell, Dialysis, Aged, Retrospective Studies, business.industry, Nephrons, Length of Stay, medicine.disease, Surgery, Radiofrequency, Multivariate Analysis, Laparoscopy, business, Organ Sparing Treatments, Kidney disease
Abstract: International audience; Purpose - To compare partial nephrectomy (PN) and percutaneous ablative therapy (AT) for renal tumor in imperative indication of nephron-sparing technique (NST). Materials and methods - Between 2000 and 2015, 284 consecutive patients with a kidney tumor in an imperative indication of NST were retrospectively included in a multicenter study. PN [open (n = 146), laparoscopic (n = 9), or robotic approach (n = 17)] and AT [radiofrequency ablation (n = 104) or cryoablation (n = 8)] were performed for solitary kidney (n = 146), bilateral tumor (n = 78), or chronic kidney disease (CKD) (n = 60). Results - Patients in the PN group had larger tumors and a higher RENAL score. There were no differences between the two groups with respect to age, reasons for imperative indication, and preoperative eGFR. Patients in the AT group had a higher ASA and CCI. PN had worse outcomes than AT in terms of transfusion rate, length of stay, and complication rate. Local radiological recurrence-free survival was better for PN, but metastatic recurrence was similar. Percentage of eGFR decrease was similar in the two groups. Temporary or permanent dialysis was not significantly different. On multivariate analysis, PN and AT had a similar eGFR change when adjusted for tumor complexity, reason of imperative indication and CCI. Conclusion - In imperative indication of nephron-sparing treatment for a kidney tumor, either PN or AT can be proposed. PN offers the ability to manage larger and more complex tumors while providing a better local control and a similar renal function loss.
Published: 2017

11. Correlation of c-MET Expression with PD-L1 Expression in Metastatic Clear Cell Renal Cell Carcinoma Treated by Sunitinib First-Line Therapy

Author: B. Laguerre, Angélique Brunot, Alain Ravaud, Marc-Antoine Belaud-Rotureau, Alexandra Lespagnol, Gregory Verhoest, Mokrane Yacoub, Frédéric Dugay, Benoit Peyronnet, Jean-Christophe Bernhard, Solène-Florence Kammerer-Jacquet, Frantz Dupuis, Jean Mosser, Karim Bensalah, Romain Mathieu, Sarah Medane, Nathalie Rioux-Leclercq, Service de Pathologie [Rennes] = Pathology [Rennes], CHU Pontchaillou [Rennes], Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Service d'Oncologie Médicale [Bordeaux], Institut Bergonié [Bordeaux], UNICANCER-UNICANCER, French Network for Research on Kidney Cancer (UroCCR), CHU de Bordeaux Pellegrin [Bordeaux], Hôpital Saint-André, Institut des Sciences Cognitives (ISC), Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Université de Rennes (UNIV-RENNES), CRLCC Eugène Marquis (CRLCC), Département d'oncologie médicale [Rennes], Service de Cytogénétique et de Biologie Cellulaire, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Novartis, Ligue Contre le Cancer, CORECT, CHU de Rennes, l'Institut National du Cancer (INCa), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR), and Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes]
Subjects: 0301 basic medicine, Oncology, Male, Cancer Research, Indoles, Gene Dosage, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Tyrosine-kinase inhibitor, B7-H1 Antigen, chemistry.chemical_compound, 0302 clinical medicine, Sunitinib, Pharmacology (medical), In Situ Hybridization, Fluorescence, Aged, 80 and over, education.field_of_study, medicine.diagnostic_test, Middle Aged, Proto-Oncogene Proteins c-met, Prognosis, Immunohistochemistry, 3. Good health, 030220 oncology & carcinogenesis, Female, medicine.drug, Adult, medicine.medical_specialty, C-Met, Cabozantinib, medicine.drug_class, Population, Antineoplastic Agents, [SDV.CAN]Life Sciences [q-bio]/Cancer, 03 medical and health sciences, [SDV.SP.MED]Life Sciences [q-bio]/Pharmaceutical sciences/Medication, Internal medicine, medicine, Carcinoma, Humans, Pyrroles, education, Carcinoma, Renal Cell, Aged, business.industry, medicine.disease, Clear cell renal cell carcinoma, 030104 developmental biology, chemistry, business, Fluorescence in situ hybridization
Abstract: International audience; Background: Clear cell renal cell carcinoma (ccRCC) is highly metastatic. Cabozantinib, an anti-angiogenic tyrosine kinase inhibitor that targets c-MET, provided interesting results in metastatic ccRCC treatment.Objective: To understand better the role of c-MET in ccRCC, we assessed its status in a population of patients with metastatic ccRCC. Patients and Methods For this purpose, tumor samples were analyzed for c-MET expression by immunohistochemistry (IHC), for c-MET copy number alterations by fluorescence in situ hybridization (FISH), and for c-MET mutations by next generation sequencing (NGS) in a retrospective cohort of 90 primary ccRCC of patients with metastases treated by first-line sunitinib. The expression of c-MET was correlated with pathological, immunohistochemical (VEGFA, CAIX, PD-L1), clinical, and molecular criteria (VHL status) by univariate and multivariate analyses and to clinical outcome using Kaplan-Meier curves compared by log-rank test.Results: Of ccRCC, 31.1% had low c-MET expression (absent to weak intensity by IHC) versus 68.9% with high expression (moderate to strong intensity). High expression of c-MET was associated with a gain in FISH analysis (p=0.0284) without amplification. No mutations were detected in NGS. Moreover, high c-MET expression was associated with lymph node metastases (p=0.004), sarcomatoid component (p=0.029), VEGFA (p=0.037), and PD-L1 (p=0.001) overexpression, the only factor that remained independently associated (p
Published: 2017

12. Off-Clamp versus On-Clamp Robotic Partial Nephrectomy: A Multicenter Match-Paired Case-Control Study

Author: Mathieu Roumiguié, Stéphane Droupy, Alexandre de la Taille, Benoit Peyronnet, Benjamin Pradere, Nicolas Doumerc, Y. Grassano, Karim Bensalah, Hervé Baumert, Gregory Verhoest, Jean-Baptiste Beauval, Thomas Seisen, Franck Bruyère, Christophe Vaessen, Jean-Christophe Bernhard, Zine-Eddine Khene, Morgan Rouprêt, Alexandra Masson-Lecomte, Herrada, Anthony, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'urologie [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau, Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), service d'urologie [CHU Bordeaux], CHU Bordeaux [Bordeaux], Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Saint-Joseph, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Université de Montpellier (UM), Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Service d'urologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Hôpital Bretonneau-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service d'urologie et transplantation rénales [CHU Pitié-Salpêtrière], and Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: medicine.medical_specialty, Time Factors, Urology, medicine.medical_treatment, 030232 urology & nephrology, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Robotic Surgical Procedures, Blood loss, Risk Factors, medicine, Humans, Partial nephrectomy, Warm Ischemia, Laparoscopy, Retrospective Studies, medicine.diagnostic_test, business.industry, technology, industry, and agriculture, Surgical technique, Constriction, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Tumor Burden, Surgery, body regions, Treatment Outcome, Clamp, 030220 oncology & carcinogenesis, Clinical Competence, France, business, Kidney neoplasms, human activities
Abstract: Introduction: The aim of this study was to compare the outcomes of on-clamp and off-clamp robotic partial nephrectomy (RPN). Materials and Methods: The charts of all patients who underwent an RPN at 8 institutions between 2010 and 2014 were retrospectively reviewed. The patients who underwent an off-clamp RPN were matched to on-clamp RPN in a 1-4 fashion according to the following variables: RENAL score, tumor size and surgeon's experience. Pre-, intra-, and postoperative data were compared between both groups. Results: Among 525 RPN, 26 were performed off-clamp (5%). They were matched to 104 on-clamp RPN. The complications rate (15.5 vs. 7.7%, p = 0.53), major complications rate (4.9 vs. 3.9%; p = 0.82), and transfusions rate (0 vs. 4.9%; p = 0.58) did not differ significantly between the clamped and unclamped groups. Conversely, estimated blood loss was higher in the off-clamp group (266.4 vs. 284.6 mL, p = 0.048) and so was the rate of conversion to radical nephrectomy (0 vs. 7.7%, p = 0.04). Postoperative preservation of renal function was comparable in both groups. Conclusion: Off-clamp RPN is feasible for a small subgroup of renal tumors without increased risk of postoperative complications but at the cost of higher estimated blood loss and increased risk of conversion to radical nephrectomy.
Published: 2017

13. MP64-16 COMPARISON OF 1,800 ROBOTIC AND OPEN PARTIAL NEPHRECTOMIES FOR RENAL TUMORS

Author: Y. Grassano, François-Xavier Nouhaud, Julie Carrouget, Pierre Bigot, Jean-Baptiste Beauval, Arnaud Mejean, Thomas Seisen, Morgan Rouprêt, Anthony Giwerc, Thibaut Benoit, Karim Bensalah, Jean-Jacques Patard, Nicolas Doumerc, Jean-Christophe Bernhard, Benoit Peyronnet, Benjamin Pradere, Christophe Vaessen, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Urologie, andrologie et transplantation rénale, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Service d'Urologie - Transplantation Rénale - Andrologie, Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'urologie, Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital Bicêtre, Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] ( CIC ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service d'urologie et transplantation rénales [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Université d'Angers ( UA ) -CHU Angers, Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Bicêtre, Laboratoire Traitement du Signal et de l'Image ( LTSI ), and Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM )
Subjects: medicine.medical_specialty, 030219 obstetrics & reproductive medicine, business.industry, Urology, medicine.disease, 3. Good health, 030218 nuclear medicine & medical imaging, Surgery, 03 medical and health sciences, Surgical therapy, 0302 clinical medicine, medicine, [SDV.IB]Life Sciences [q-bio]/Bioengineering, [ SDV.IB ] Life Sciences [q-bio]/Bioengineering, business, Kidney cancer, ComputingMilieux_MISCELLANEOUS
Abstract: International audience; no abstract
Published: 2016

14. Unique Transcriptomic Profile of Collecting Duct Carcinomas Relative to Upper Tract Urothelial Carcinomas and other Kidney Carcinomas

Author: Jean Luc Descotes, Eva Comperat, Jean Philippe Spano, Roger Mouawad, Chad J. Creighton, Morgan Rouprêt, Hui Yao, Xavier Leroy, Philippe Barthélémy, Linda Dainese, Mokrane Yacoub, Xiaoping Su, Nathalie Rioux-Leclercq, Marion Classe, Gabriel G. Malouf, Virginie Verkarre, Véronique Lindner, Jean-Christophe Bernhard, David Khayat, Service d'Oncologie médicale [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Universitaire de Cancérologie [Paris] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Service de pathologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), MD Anderson Cancer Center [Houston], The University of Texas Health Science Center at Houston (UTHealth), Service de pathologie [CHU Strasbourg], CHU Strasbourg, Service de pathologie [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de pathologie [CHU HEGP], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de pathologie [CHU Trousseau], CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'urologie [CHU Grenoble], Centre Hospitalier Universitaire [Grenoble] (CHU), Service d'oncologie médicale [CHU Strasbourg], Service d'Oncologie Médicale [Bordeaux], Institut Bergonié [Bordeaux], UNICANCER-UNICANCER, French Network for Research on Kidney Cancer (UroCCR), Service d'Urologie [CHU Pitié-Salpêtrière], service d'urologie [CHU Bordeaux], CHU Bordeaux [Bordeaux], Baylor College of Medicine (BCM), Baylor University, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Institut Universitaire de Cancérologie [Sorbonne Université] (IUC)
Subjects: Adult, Male, 0301 basic medicine, Urologic Neoplasms, Pathology, medicine.medical_specialty, Adolescent, [SDV.CAN]Life Sciences [q-bio]/Cancer, Biology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Transcriptome, Young Adult, 03 medical and health sciences, Collecting duct carcinoma, 0302 clinical medicine, Renal cell carcinoma, [SDV.BBM.GTP]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN], Biomarkers, Tumor, Carcinoma, medicine, Genetics, Humans, Carcinoma, Renal Cell, health care economics and organizations, Aged, Kidney, Multidisciplinary, Tumor-infiltrating lymphocytes, Middle Aged, medicine.disease, Phenotype, Kidney Neoplasms, 3. Good health, 030104 developmental biology, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Female, Kidney cancer
Abstract: Collecting duct carcinoma (CDC) is a kidney cancer subtype that is thought to arise from principal cells in distal parts of the collecting ducts. Some studies suggested an overlap of CDC with upper tract urothelial carcinoma (UTUC), making the pathological diagnosis challenging. Herein, we performed for the first time transcriptome sequencing of CDC and compared them to UTUC and renal cell carcinoma subtypes. We discovered that CDC displays a unique transcriptomic signature among kidney cancer subtypes, with a putative cell of origin in the distal convoluted tubules. Hierarchical unsupervised clustering reveals that the CDC signature is closer to that of other RCC subtypes than to UTUC, which is similar to that of bladder carcinoma. CDC is characterized by a metabolic shift, with impairment of oxidoreductase activity, pyruvate metabolism and the tricarboxlyic acid cycle, as well as an immunogenic response consistent with increased tumor infiltrating lymphocytes, particularly within metastatic cases. In addition, pathways differentially altered between CDC and UTUC point to a basal-like phenotype of CDC in contrast to the luminal-like signature of UTUC. We conclude that CDC harbors a pathognomonic transcriptomic signature characterized by immunogenic and a metabolic aberrations, indicating that targeting these processes might provide therapeutic options for patients.
Published: 2016

15. The subclassification of papillary renal cell carcinoma does not affect oncological outcomes after nephron sparing surgery

Author: C. Lenormand, İlker Gökçe, Nam Son Vuong, N. Koutlidis, Jean Jacques Patard, Jérôme Rigaud, Yvonne Chowaniec, Abdel Rahmene Azzouzi, Alexandre Ingels, Jean Baptiste Beauval, Toru Matsugasumi, Pierre Bigot, Guillaume Ploussard, Masatoshi Eto, Morgan Rouprêt, Eduard Baco, Arnaud Mejean, Jean François Hetet, A. Schneider, B. Reix, Philippe Sebe, Michel Soulié, Jean-Christophe Bernhard, Arnaud Doerfler, Stéphane Larré, Adnan El Bakri, Gregory Verhoest, Inderbir S. Gill, Karim Bensalah, Evren Süer, Christian Pfister, Xavier Tillou, Vincent Flamand, Priscilla Léon, Aurélien Descazeaud, François Xavier Nouhaud, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service d'urologie, Centre hospitalier universitaire de Nantes (CHU Nantes), Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Universitaire de Cancérologie [Paris] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Service d'Urologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service de Néphrologie, Dialyse, Transplantations [CHU Limoges], CHU Limoges, Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Cancer Center Amsterdam, Amsterdam Public Health, Urology, Université d'Angers ( UA ) -CHU Angers, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut de Génétique et Développement de Rennes ( IGDR ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Centre National de la Recherche Scientifique ( CNRS ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), Centre de Recherche en Cancérologie / Nantes - Angers ( CRCNA ), CHU Angers-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Hôpital Laennec-Centre National de la Recherche Scientifique ( CNRS ) -Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes ( CHU Nantes ), Service d'urologie et transplantation rénales [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Institut Universitaire de Cancérologie, Université Pierre et Marie Curie - Paris 6 ( UPMC ), Service d'Urologie [Caen], Université de Caen Normandie ( UNICAEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -CHU Caen, Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Laboratoire Traitement du Signal et de l'Image ( LTSI ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Universitaire de Cancérologie [Sorbonne Université] (IUC), Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, Oncology, Prognostic factor, medicine.medical_specialty, medicine.medical_treatment, Urology, 030232 urology & nephrology, Medical Oncology, urologic and male genital diseases, Affect (psychology), Nephrectomy, Oncologic outcomes, Papillary renal cell carcinoma, Disease-Free Survival, Article, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Humans, Medicine, [ SDV.IB ] Life Sciences [q-bio]/Bioengineering, Carcinoma, Renal Cell, Neoplasm Staging, Retrospective Studies, Papillary renal cell carcinomas, business.industry, Nephrons, Middle Aged, Prognosis, United States, Kidney Neoplasms, 3. Good health, Survival Rate, Nephrology, 030220 oncology & carcinogenesis, Nephron sparing surgery, Disease Progression, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, France, business
Abstract: International audience; Objectives To evaluate the oncological outcomes of papillary renal cell carcinoma (pRCC) following nephron sparing surgery (NSS) and to determine whether the subclassification type of pRCC could be a prognostic factor for recurrence, progression, and specific death. Materials and methods An international multicentre retrospective study involving 19 institutions and the French network for research on kidney cancer was conducted after IRB approval. We analyzed data of all patients with pRCC who were treated by NSS between 2004 and 2014. Results We included 486 patients. Tumors were type 1 pRCC in 369 (76 %) cases and type 2 pRCC in 117 (24 %) cases. After a mean follow-up of 35 (1–120) months, 8 (1.6 %) patients experienced a local recurrence, 12 (1.5 %) had a metastatic progression, 24 (4.9 %) died, and 7 (1.4 %) died from cancer. Patients with type I pRCC had more grade II (66.3 vs. 46.1 %; p \textless 0.001) and less grade III (20 vs. 41 %; p \textless 0.001) tumors. Three-year estimated cancer-free survival (CFS) rate for type 1 pRCC was 96.5 % and for type 2 pRCC was 95.1 % (p = 0.894), respectively. Three-year estimated cancer-specific survival rate for type 1 pRCC was 98.4 % and for type 2 pRCC was 97.3 % (p = 0.947), respectively. Tumor stage superior to pT1 was the only prognostic factor for CFS (HR 3.5; p = 0.03). Conclusion Histological subtyping of pRCC has no impact on oncologic outcomes after nephron sparing surgery. In this selected population of pRCC tumors, we found that tumor stage is the only prognostic factor for cancer-free survival
Published: 2016

16. Postoperative drainage does not prevent complications after robotic partial nephrectomy

Author: Alexandre de la Taille, Morgan Rouprêt, Hervé Baumert, Jean-Christophe Bernhard, Karim Bensalah, Franck Bruyère, Arnaud Mejean, Nicolas Doumerc, Benoit Peyronnet, Benjamin Pradere, Christophe Vaessen, Stéphane Droupy, Service d'urologie, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Institut Mondor de Recherche Biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Service d'urologie [Tours], Hôpital Bretonneau-CHRU Tours, Université des Antilles et de la Guyane ( UAG ) -CHU Pointe-à-Pitre/Abymes [Guadeloupe], Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ), Service d'urologie et transplantation rénales [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Hôpital Saint-Joseph, Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Laboratoire Traitement du Signal et de l'Image ( LTSI ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau, Université des Antilles et de la Guyane (UAG)-CHU Pointe-à-Pitre/Abymes [Guadeloupe], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10, Service d'Urologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Nephrology, Male, medicine.medical_specialty, Urinary Fistula, Urology, Fistula, medicine.medical_treatment, renal tumors, 030232 urology & nephrology, perspective, outcomes, Nephrectomy, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Robotic Surgical Procedures, Internal medicine, medicine, Humans, Treatment Failure, [ SDV.IB ] Life Sciences [q-bio]/Bioengineering, Drainage, Retrospective Studies, Postoperative Care, business.industry, nephron-sparing surgery, Retrospective cohort study, cohort, Middle Aged, medicine.disease, 3. Good health, Surgery, 030220 oncology & carcinogenesis, Anesthesia, Cohort, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Female, business, Complication, radical nephrectomy
Abstract: International audience; Objectives - We aimed to assess the impact of a postoperative drainage after RPN. Methods - A retrospective multicentric study included RPN performed at eight centers between 2010 and 2014. Three centers stopped using postoperative drainage early in their RPN experience, whereas other institutions systematically left a drain. Preoperative characteristics, complication rates, need for postoperative imaging or procedure (surgical or radiological) and length of hospital stay were compared between the two groups [drainage (D) and no drainage (ND)]. Results - Among 636 RPNs, 140 were done without drainage (22 %). In the ND group, surgeons were more experienced (>50 cases: 55.7 vs. 15.1 %; p
Published: 2016

17. Nephrectomy improves overall survival in patients with metastatic renal cell carcinoma in cases of favorable MSKCC or ECOG prognostic features

Author: Jérôme Rigaud, François Audenet, Jean-Jacques Patard, Laurent Zini, Abdel Rahmene Azzouzi, J. Berger, Alexandre Ingles, Herve Lang, Géraldine Pignot, Laurent Guy, Karim Bensalah, Laurent Salomon, Romain Mathieu, Alain Ravaud, Pierre Bigot, Pierre-Olivier Fais, Michael Staehler, Florence Joly, François Kleinclauss, Maxime Crepel, Morgan Rouprêt, Eric Lechevallier, Christian Pfister, Jean-Marie Ferriere, Bertrand Vayleux, Jean-Pascal Machiels, Aurélien Descazeaud, Jean-Christophe Bernhard, Christine Chevreau, Gwenaelle Gravis, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Hôpital Bicêtre, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Cancers et préventions, Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Clermont-Ferrand, CHU Bordeaux [Bordeaux], Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Institut Claudius Regaud, Hôpital Claude Huriez [Lille], CHU Lille, CHU Strasbourg, Service d'urologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Hôpital Dupuytren [CHU Limoges], Centre hospitalier universitaire de Nantes (CHU Nantes), Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Néphrologie, Dialyse, Transplantations [CHU Limoges], CHU Limoges, Cliniques Universitaires Saint-Luc [Bruxelles], Ludwig Maximilian University [Munich] (LMU), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098) (RIGHT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS BFC)-Université de Franche-Comté (UFC), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté]), Hôpital Saint-Jacques-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), UCL - SSS/IREC/MIRO - Pôle d'imagerie moléculaire, radiothérapie et oncologie, UCL - (SLuc) Unité d'oncologie médicale, and UCL - (SLuc) Centre du cancer
Subjects: Oncology, Adult, Male, medicine.medical_specialty, Survival, Urology, medicine.medical_treatment, Population, 030232 urology & nephrology, ECOG Performance Status, Subgroup analysis, Nephrectomy, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Renal cell carcinoma, Internal medicine, Carcinoma, medicine, Humans, Renal cell, Neoplasm Metastasis, education, Carcinoma, Renal Cell, Aged, Retrospective Studies, Aged, 80 and over, education.field_of_study, Performance status, business.industry, Retrospective cohort study, Middle Aged, medicine.disease, Prognosis, Survival Analysis, Kidney Neoplasms, 3. Good health, Surgery, 030220 oncology & carcinogenesis, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, business
Abstract: International audience; Objectives : The role of cytoreductive nephrectomy (CN) in the treatment of patients harboring metastatic renal cell carcinoma (mRCC) has become controversial since the emergence of effective targeted therapies. The aim of our study was to compare the overall survival (OS) between CN and non-CN groups of patients presenting with mRCC in the era of targeted drugs and to assess these outcomes among the different Memorial Sloan-Kettering Cancer Center (MSKCC) and The Eastern Cooperative Oncology Group (ECOG) performance status subgroups. Methods and materials A total of 351 patients with mRCC at diagnosis recruited from 18 tertiary care centers who had been treated with systemic treatment were included in this retrospective study. OS was assessed by the Kaplan-Meier method according to the completion of a CN. The population was subsequently stratified according to MSKCC and ECOG prognostic groups. Results Median OS in the entire cohort was 37.1 months. Median OS was significantly improved for patients who underwent CN (16.4 vs. 38.1 months, P
Published: 2015

18. Neoadjuvant targeted molecular therapies in patients undergoing nephrectomy and inferior vena cava thrombectomy: is it useful?

Author: Evanguelos Xylinas, Nathalie Rioux-Leclercq, Jean-François Hetet, Jean-Baptiste Beauval, Karim Bensalah, Samuel Lagabrielle, Myriam Ammi, Bernard Escudier, Jean-Jacques Patard, Pierre Bigot, Philippe Paparel, Abdel-Rahmène Azzouzi, Morgan Rouprêt, Tarek Fardoun, Jean-Christophe Bernhard, Michel Soulié, Hervé Baumert, J. Berger, Nicolas Grenier, Jean-Alexandre Long, Souhil Lebdai, Service d'urologie, Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Département d'Informatique [Bruxelles] (ULB), Faculté des Sciences [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire d'Angers (CHU Angers), Hôpital Saint-Joseph, Oncologie génito-urinaire, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Imagerie moléculaire et fonctionnelle: de la physiologie à la thérapie, Université Bordeaux Segalen - Bordeaux 2-IFR8-Centre National de la Recherche Scientifique (CNRS), Service d'Imagerie Diagnostique et Interventionnelle de l'Adulte, CHU Bordeaux [Bordeaux], Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), CHU Grenoble-Hôpital Michallon, Service d'urologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service de Génétique Moléculaire, Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)
Subjects: Male, Indoles, medicine.medical_treatment, Comorbidity, Nephrectomy, Renal cell carcinoma, Sunitinib, Molecular Targeted Therapy, Neoadjuvant therapy, Thrombectomy, Middle Aged, Sorafenib, Primary tumor, Combined Modality Therapy, Kidney Neoplasms, Neoadjuvant Therapy, 3. Good health, Treatment Outcome, medicine.vein, cardiovascular system, Female, Radiology, France, medicine.drug, Adult, Niacinamide, medicine.medical_specialty, Urology, Antineoplastic Agents, Vena Cava, Inferior, Inferior vena cava, medicine, Humans, Pyrroles, cardiovascular diseases, Thrombus, Carcinoma, Renal Cell, Aged, Retrospective Studies, [SDV.GEN]Life Sciences [q-bio]/Genetics, Dose-Response Relationship, Drug, business.industry, Phenylurea Compounds, Thrombosis, medicine.disease, Clear cell renal cell carcinoma, business, human activities
Abstract: International audience; OBJECTIVE: To assess the effect of neoadjuvant targeted molecular therapies (TMTs) on size and level of inferior vena cava tumor thrombi and to evaluate their impact on surgical management. METHODS: We retrospectively analyzed the data of 14 patients treated for a clear cell renal cell carcinoma with inferior vena cava thrombi by neoadjuvant TMT before nephrectomy. Clinical, pathological and perioperative data were gathered retrospectively at each institution. The primitive tumor size and the thrombus size were defined by computed tomography before TMT. The tumor thrombus level was defined according to the Novick's classification. RESULTS: Before TMT, thrombus level was staged I for 1 (7%), II for 10 (72%) and III (21%) for 3 patients. First-line therapy was sunitinib in 11 cases and sorafenib in 3 cases. Median therapy duration was two cycles (1-5). Three patients experienced major adverse effects (grade III) during TMT. Following TMT, 6 (43%) patients had a measurable decrease, 6 (43%) had no change, and 2 (14%) had an increase in the thrombus. One patient (7%) had a downstage of thrombus level, 12 (85%) had stable thrombi, and 1 (7%) had an upstage. Regarding primary tumor, 7 (50%), 5 (36%) and 2 (14%) patients had a decrease, stabilization and an increase in tumor size, respectively. CONCLUSION: Neoadjuvant TMT appears to have limited effects on renal tumor thrombi. This retrospective study failed to demonstrate a significant impact of neoadjuvant TMT on surgical management of clear cell renal cell carcinoma with inferior vena cava tumor thrombi.
Published: 2014

19. Nephron-sparing surgery for renal tumors measuring more than 7 cm: morbidity, and functional and oncological outcomes

Author: Idir Ouzaid, Yann Neuzillet, Michel Soulié, Vincent Ravery, Guillaume Ploussard, Hervé Baumert, Evanguelos Xylinas, Morgan Rouprêt, Tarek Fardoun, Nicolas Grenier, Olivier Merigot de Treigny, Karim Bensalah, Laurent Bellec, Denis Chautard, Gregory Verhoest, Edouard Robine, Laurent Brureau, Pierre Bigot, Jean-Jacques Patard, Bernard Escudier, C. Maurin, Jean-François Hetet, Jean-Christophe Bernhard, Abdel-Rahmène Azzouzi, Marc Zerbib, Thomas Bessede, Souhil Lebdai, Jean-Alexandre Long, Nathalie Rioux-Leclercq, Jean Rouffilange, Philippe Paparel, François Audenet, Jérôme Rigaud, N. Hoarau, Laurence Bastien, Pierre Mongiat-Artus, Géraldine Pignot, Service d'urologie, Université d'Angers ( UA ) -CHU Angers, Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Institut Mondor de Recherche Biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), INSERM U955, équipe 7, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Institut Mondor de Recherche Biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10, Service d'urologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications [Grenoble] ( TIMC-IMAG ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut polytechnique de Grenoble - Grenoble Institute of Technology ( Grenoble INP ) -IMAG-Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ), CHU Grenoble-Hôpital Michallon, CHU Angers, Service d'urologie et transplantation rénales [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Institut Mondor de recherche biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), FLIRT, Fédération pour L'étude de l'Ischémie Reperfusion en Transplantation, Service d'Urologie [CHU Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut de Génétique et Développement de Rennes ( IGDR ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Centre National de la Recherche Scientifique ( CNRS ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), urology, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Hôtel-Dieu, Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Hôpital Saint-Joseph, Oncologie génito-urinaire, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy ( IGR ) -Institut Gustave Roussy ( IGR ), Service d'urologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Imagerie moléculaire et fonctionnelle: de la physiologie à la thérapie, Université Bordeaux Segalen - Bordeaux 2-IFR8-Centre National de la Recherche Scientifique ( CNRS ), Service d'Imagerie Diagnostique et Interventionnelle de l'Adulte, CHU Bordeaux [Bordeaux], Service de Génétique Moléculaire, Jonchère, Laurent, Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire d'Angers (CHU Angers), Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Université Bordeaux Segalen - Bordeaux 2-IFR8-Centre National de la Recherche Scientifique (CNRS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)
Subjects: Adult, Male, medicine.medical_specialty, Survival, Urology, medicine.medical_treatment, Population, 030232 urology & nephrology, Renal function, [SDV.GEN] Life Sciences [q-bio]/Genetics, Malignancy, Nephrectomy, Disease-Free Survival, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Renal cell carcinoma, Risk Factors, medicine, Humans, Risk factor, education, Carcinoma, Renal Cell, Aged, Retrospective Studies, Aged, 80 and over, education.field_of_study, [SDV.GEN]Life Sciences [q-bio]/Genetics, business.industry, Hazard ratio, Perioperative, Nephrons, Robotics, Middle Aged, medicine.disease, Kidney Neoplasms, 3. Good health, Survival Rate, Treatment Outcome, Oncology, 030220 oncology & carcinogenesis, Female, Laparoscopy, Neoplasm Recurrence, Local, business, [ SDV.GEN ] Life Sciences [q-bio]/Genetics
Abstract: International audience; BACKGROUND: The purpose of this study was to evaluate morbidity, functional, and oncological outcomes after NSS in renal tumors \textgreater 7 cm. MATERIALS AND METHODS: We retrospectively analyzed data from 168 patients with tumors \textgreater 7 cm who were treated using NSS between 1998 and 2012. RESULTS: Imperative and elective indications accounted for 76 (45.2%) and 92 (54.8%) patients, respectively. Major perioperative complications and renal function deterioration occurred in 33 (19.6%) and 51 patients (30.4%), respectively. In multivariate analysis, age older than 60 years (P = .001; hazard ratio [HR], 5) and tumor malignancy (P = .014; HR, 6.7) were prognostic factors for renal function deterioration whereas imperative indication was a risk factor for major postoperative complications (P = .0019; HR, 2.7). In 126 (75%) patients with malignant tumors, after a median follow-up of 30 months (range, 1-254 months), 25 patients (20.2%) died. In multivariate analysis, imperative indication (P = .023; HR, 4.2), positive surgical margin (P = .021; HR, 3.3), and Fuhrman grade \textgreater II (P = .013; HR, 3.7) were prognostic indicators for cancer-free survival (CFS). Imperative indication (P = .04; HR, 8.5) and Fuhrman grade \textgreater II (P = .04; HR, 3.9) were predictive factors of cancer-specific survival (CSS). In case of elective indication, positive surgical margin, local recurrence, and cancer-related death occurred in 4 (7.6%), 1 (1.1%), and 1 (1.1%) cases, respectively. For elective indication, 5-year estimates of CFS, CSS, and overall survival rates were: 85.7%, 98%, and 93.9%, respectively. CONCLUSION: In this selected population, imperative vs. elective indication status seems to play a critical role in oncologic outcomes. Oncologic results for elective indications are close to those reported with radical nephrectomy.
Published: 2014

20. Renal cell carcinoma (RCC) in patients with end-stage renal disease exhibits many favourable clinical, pathologic, and outcome features compared with RCC in the general population

Author: Laurent Salomon, Lionel Badet, Georges Karam, Jacques Tostain, Pierre Bigot, Nathalie Rioux-Leclercq, Sébastien Barbet, Jean-Etienne Terrier, Bernard Escudier, Michel Soulié, Hicham Elkentaoui, Abdel-Rahmène Azzouzi, Fabrice Dugardin, Yann Neuzillet, Jean-Christophe Bernhard, Jacques Hubert, Aurélien Descazeaux, Karim Fehri, Nicolas Brichart, Philippe Paparel, J.M. Boutin, Laurent Guy, Baptiste Tisserand, Arnaud Mejean, Ismaël Galliot, Marc-Olivier Timsit, Laurence Bastien, Jérôme Rigaud, Antoine Valeri, Jacques Petit, Laurent Zini, Benoit Barrou, Christian Pfister, Xavier Tillou, Franck Bruyère, Fabien Saint, Herve Lang, Jean-Jacques Patard, Marie-Dominique Azemar, Denis Chautard, Julien Branchereau, Hervé Wallerand, Pascal Rischmann, Laura Poissonnier, Charles Deruelle, Lucille Martin, Laurence Albiges, Jacques Irani, Arnauld Villers, Thierry Lebret, Hervé Baumert, François Kleinclauss, Nicolas Terrier, Jean-Alexandre Long, Pierre-Etienne Theveniaud, M. Gigante, Frédéric Staerman, Jean-Marie Ferriere, Romain Mathieu, Morgan Rouprêt, F. Sallusto, Benoit Feuillu, Service d'urologie, Hôpital Foch [Suresnes], CHU Amiens-Picardie, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], CHU Grenoble-Hôpital Michallon, Service d'urologie-andrologie, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] ( UJM ) -Hôpital nord, Service d'urologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Hôpital Saint-Joseph, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy ( IGR ), CHU Strasbourg, Service d'anatomie et cytologie pathologiques [Rennes], Université d'Angers ( UA ) -CHU Angers, Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Institut Mondor de recherche biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Service d'urologie [Tours], Hôpital Bretonneau-CHRU Tours, Hôtel-Dieu, Service d'Urologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Service de Chirurgie urologique et andrologie [CHU Limoges], CHU Limoges, Service d'urologie et transplantation rénales [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Service de Néphrologie et Urologie, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Service d'urologie [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Université de Reims Champagne-Ardenne ( URCA ), Centre hospitalier universitaire de Poitiers ( CHU Poitiers ) -Hôpital La Milétrie, Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Descartes - Paris 5 ( UPD5 ) -CHU Necker - Enfants Malades [AP-HP], Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], CHU Clermont-Ferrand-Hôpital Gabriel Montpied, Université de Brest ( UBO ) -Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Bicêtre, members of the Comité de Transplantation de l'Association Française d'Urologie, the Comité de Cancérologie de l'Association Française d'Urologie, Service d'urologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Hôpital nord, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Institut Gustave Roussy (IGR), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Bretonneau-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'urologie et transplantation rénales [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Université de Reims Champagne-Ardenne (URCA), Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Hôpital La Milétrie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'anatomie et cytologie pathologiques [Rennes] = Anatomy and Cytopathology [Rennes], CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau, Service d'Urologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, De Villemeur, Hervé, CHU Saint-Etienne-Université Jean Monnet - Saint-Étienne (UJM)-Hôpital nord, Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)
Subjects: Male, [ SDV.MHEP.UN ] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Chi-Square Distribution, Time Factors, MESH : Retrospective Studies, 030232 urology & nephrology, MESH : Aged, Kaplan-Meier Estimate, MESH: Risk Assessment, urologic and male genital diseases, Gastroenterology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH: Proportional Hazards Models, MESH : Carcinoma, Renal Cell, 0302 clinical medicine, Renal cell carcinoma, MESH: Risk Factors, Risk Factors, MESH : Female, MESH : Neoplasm Staging, MESH : Risk Assessment, MESH: Treatment Outcome, MESH: Aged, education.field_of_study, Univariate analysis, MESH: Middle Aged, MESH: Carcinoma, Renal Cell, MESH: Neoplasm Staging, Middle Aged, MESH : Adult, MESH : Survival Rate, MESH : Risk Factors, Kidney Neoplasms, 3. Good health, Survival Rate, Treatment Outcome, MESH: Kidney Failure, Chronic, 030220 oncology & carcinogenesis, Female, France, MESH : Time Factors, Adult, medicine.medical_specialty, MESH: Survival Rate, Urology, MESH : Male, Population, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH : Treatment Outcome, Risk Assessment, MESH : Kidney Failure, Chronic, End stage renal disease, MESH : Kaplan-Meier Estimate, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, medicine, Humans, MESH : Middle Aged, education, MESH : France, Survival rate, Carcinoma, Renal Cell, MESH: Kaplan-Meier Estimate, Aged, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, MESH: Humans, Chi-Square Distribution, MESH : Chi-Square Distribution, business.industry, MESH: Time Factors, MESH : Humans, MESH: Adult, MESH: Retrospective Studies, medicine.disease, MESH : Proportional Hazards Models, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Male, MESH : Kidney Neoplasms, Surgery, Transplantation, MESH: France, Kidney Failure, Chronic, MESH: Kidney Neoplasms, business, Kidney cancer, MESH: Female, Kidney disease
Abstract: International audience; BACKGROUND: Patients with end-stage renal disease (ESRD) are at risk of developing renal tumours. OBJECTIVE: Compare clinical, pathologic, and outcome features of renal cell carcinomas (RCCs) in ESRD patients and in patients from the general population. DESIGN, SETTING, AND PARTICIPANTS: Twenty-four French university departments of urology participated in this retrospective study. INTERVENTION: All patients were treated according to current European Association of Urology guidelines. MEASUREMENTS: Age, sex, symptoms, tumour staging and grading, histologic subtype, and outcome were recorded in a unique database. Categoric and continuous variables were compared by using chi-square and student statistical analyses. Cancer-specific survival (CSS) was assessed by Kaplan-Meier and Cox methods. RESULTS AND LIMITATIONS: The study included 1250 RCC patients: 303 with ESRD and 947 from the general population. In the ESRD patients, age at diagnosis was younger (55 ± 12 yr vs 62 ± 12 yr); mean tumour size was smaller (3.7 ± 2.6 cm vs 7.3 ± 3.8 cm); asymptomatic (87% vs 44%), low-grade (68% vs 42%), and papillary tumours were more frequent (37% vs 7%); and poor performance status (PS; 24% vs 37%) and advanced T categories (≥ 3) were more rare (10% vs 42%). Consistently, nodal invasion (3% vs 12%) and distant metastases (2% vs 15%) occurred less frequently in ESRD patients. After a median follow-up of 33 mo (range: 1-299 mo), 13 ESRD patients (4.3%), and 261 general population patients (27.6%) had died from cancer. In univariate analysis, histologic subtype, symptoms at diagnosis, poor PS, advanced TNM stage, high Fuhrman grade, large tumour size, and non-ESRD diagnosis context were adverse predictors for survival. However, only PS, TNM stage, and Fuhrman grade remained independent CSS predictors in multivariate analysis. The limitation of this study is related to the retrospective design. CONCLUSIONS: RCC arising in native kidneys of ESRD patients seems to exhibit many favourable clinical, pathologic, and outcome features compared with those diagnosed in patients from the general population.
Published: 2011

21. Predictive factors for ipsilateral recurrence after nephron-sparing surgery in renal cell carcinoma

Author: Karim Bensalah, Laurent Salomon, Clement Claude Abbou, Allan J. Pantuck, Maxime Crepel, Grégoire Robert, Laurent Bellec, Jacques Tostain, Jean-Marie Ferriere, B. Albouy, Michel Soulié, Arie S. Belldegrun, Jean-Christophe Bernhard, Bertrand Lacroix, D. Lopes, Sylvie Maurice-Tison, Christian Pfister, Jean-Jacques Patard, Alexandre de la Taille, Marc Colombel, Hervé Wallerand, Rodolphe Thuret, Gilles Pasticier, Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Department of Urology, University of California [Los Angeles] (UCLA), University of California-University of California, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Service d'information médicale, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Service d'urologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'urologie-andrologie, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Hôpital nord, Service Urologie [Lapeyronie], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Service d'urologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), University of California (UC)-University of California (UC), Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Saint-Etienne-Université Jean Monnet - Saint-Étienne (UJM)-Hôpital nord, De Villemeur, Hervé, Service d'urologie [Rennes], Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes]
Subjects: Male, MESH: Tumor Burden, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, 030232 urology & nephrology, Nephrectomy, Surgery, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Proportional Hazards Models, 0302 clinical medicine, Renal cell carcinoma, Risk Factors, MESH: Risk Factors, Local recurrence, Multicenter Studies as Topic, MESH: Aged, MESH: Middle Aged, MESH: Carcinoma, Renal Cell, MESH: Neoplasm Staging, Middle Aged, Prognosis, Kidney Neoplasms, Tumor Burden, 030220 oncology & carcinogenesis, Female, Nephron sparing surgery, MESH: Neoplasm Recurrence, Local, medicine.medical_specialty, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, MESH: Prognosis, 03 medical and health sciences, Text mining, [SDV.CAN] Life Sciences [q-bio]/Cancer, Carcinoma, medicine, Humans, In patient, Carcinoma, Renal Cell, Aged, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, MESH: Humans, business.industry, Proportional hazards model, fungi, Retrospective cohort study, MESH: Retrospective Studies, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Male, MESH: Nephrectomy, MESH: Multicenter Studies as Topic, Neoplasm Recurrence, Local, MESH: Kidney Neoplasms, business, MESH: Female
Abstract: Ipsilateral recurrence after nephron-sparing surgery (NSS) is rare, and little is known about its specific determinants.To determine clinical or pathologic features associated with ipsilateral recurrence after NSS performed for renal cell carcinoma (RCC).We analysed 809 NSS procedures performed at eight academic institutions for sporadic RCCs retrospectively.Age, gender, indication, tumour bilaterality, tumour size, tumour location, TNM stage, Fuhrman grade, histologic subtype, and presence of positive surgical margins (PSMs) were assessed as predictors for recurrence in univariate and multivariate analysis by using a Cox proportional hazards regression model.Among 809 NSS procedures with a median follow-up of 27 (1-252) mo, 26 ipsilateral recurrences (3.2%) occurred at a median time of 27 (14.5-38.2) mo. In univariate analysis, the following variables were significantly associated with recurrence: pT3a stage (p=0.0489), imperative indication (p0.01), tumour bilaterality (p0.01), tumour size4cm (p0.01), Fuhrman grade III or IV (p=0.0185), and PSM (p0.01). In multivariate analysis, tumour bilaterality, tumour size4cm, and presence of PSM remained independent predictive factors for RCC ipsilateral recurrence. Hazard ratios (HR) were 6.31, 4.57, and 11.5 for tumour bilaterality, tumour size4cm, and PSM status, respectively. The main limitations of this study included its retrospective nature and a short follow-up.RCC ipsilateral recurrence risk after NSS is significantly associated with tumour size4cm, tumour bilaterality (synchronous or asynchronous), and PSM. Careful follow-up should be advised in patients presenting with such characteristics.
Published: 2010

22. Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery

Author: Romain Spie, Jérôme Rigaud, Jacques Tostain, Michel Soulié, Bastien Rambeaud, Hendrik Van Poppel, Alfredo Aguilera, Maxime Crepel, Laurent Zini, Ofer Nativ, Jean Marie Ferriere, Luis Martinez Pineiro, Steven Joniau, Patrick J. Bastian, Rodolphe Thuret, Jean Jacques Patard, Stefan C. Müller, Frédéric Pouliot, Jean-Christophe Bernhard, Amnon Zisman, Andreas H. Wille, Christian Pfister, Pascal Rischmann, Nicolas Mottet, Laurent Bellec, Alexandre de la Taille, Allan J. Pantuck, Laurent Guy, Thierry Dujardin, R. Avakian, Jan Roigas, François Richard, Nathalie Rioux-Leclercq, Christian Doehn, Pierre I. Karakiewicz, Arie S. Belldegrun, Roberto Bertini, Orit E. Raz, Karim Bensalah, Laurent Salomon, B. Albouy, T. Culty, Thierry Lebret, Morgan Rouprêt, A. Villers, Francesco Montorsi, Fabien Saint, Herve Lang, Roy Farfara, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Department of Urology, University of California [Los Angeles] (UCLA), University of California-University of California, Service Urologie [Lapeyronie], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Department of urology, Università Vita-Salute San Raffaele, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Cancer Prognostics and Health Outcome Unit, Service d'urologie-andrologie, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Hôpital nord, Université Jean Monnet [Saint-Étienne] (UJM), Service d'urologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), National and Kapodistrian University of Athens (NKUA), Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Université Fédérale Toulouse Midi-Pyrénées, Université de Nantes (UN), Service d'urologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Image Science for Interventional Techniques (ISIT), Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS)-Clermont Université, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Hôpital Foch [Suresnes], Université de Picardie Jules Verne (UPJV), Assaf Harofeh Medical Centre, Tel Aviv University [Tel Aviv]-Assaf Harofeh Medical Centre, CHU Strasbourg, Berlin Charity Hospital, La Paz University Hospital, Bnai Zion Hospital, Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Lubeck University Hospital, Bonn University Hospital, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS), University of California (UC)-University of California (UC), CHU Saint-Etienne-Université Jean Monnet - Saint-Étienne (UJM)-Hôpital nord, Université Jean Monnet - Saint-Étienne (UJM), Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université-Centre National de la Recherche Scientifique (CNRS), Tel Aviv University (TAU)-Assaf Harofeh Medical Centre, Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), De Villemeur, Hervé, Bensalah, Karim, Pantuck Allan, J., Rioux Leclercq, Nathalie, Thuret, Rodolphe, Montorsi, Francesco, Karakiewicz Pierre, I., Mottet, Nicola, Zini, Laurent, Bertini, Roberto, Salomon, Laurent, Villers, Arnaud, Soulie, Michel, Bellec, Laurent, Rischmann, Pascal, De La Taille, Alexandre, Avakian, Raffi, Crepel, Maxime, Ferriere Jean, Marie, Bernhard Jean, Christophe, Dujardin, Thierry, Pouliot, Frederic, Rigaud, Jerome, Pfister, Christian, Albouy, Baptiste, Guy, Laurent, Joniau, Steven, van Poppel, Hendrik, Lebret, Thierry, Culty, Thibault, Saint, Fabien, Zisman, Amnon, Raz, Orit, Lang, Herve, Spie, Romain, Wille, Andrea, Roigas, Jan, Aguilera, Alfredo, Rambeaud, Bastien, Martinez Pineiro, Lui, Nativ, Ofer, Farfara, Roy, Richard, Francoi, Roupret, Morgan, Doehn, Christian, Bastian Patrick, J., Muller Stefan, C., Tostain, Jacque, Belldegrun Arie, S., Patard Jean, Jacques, Service d'Urologie - Andrologie [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM), Université de Toulouse (UT), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and University Hospital Bonn
Subjects: Surgical margin, medicine.medical_specialty, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, MESH: Survival Rate, Urology, medicine.medical_treatment, 030232 urology & nephrology, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Renal cell carcinoma, Predictive Value of Tests, medicine, Humans, Survival rate, Carcinoma, Renal Cell, MESH: Nephrons, Retrospective Studies, MESH: Humans, MESH: Middle Aged, Proportional hazards model, business.industry, Retrospective cohort study, MESH: Retrospective Studies, Nephrons, MESH: Carcinoma, Renal Cell, Middle Aged, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Kidney Neoplasms, MESH: Predictive Value of Tests, 3. Good health, Surgery, Survival Rate, MESH: Nephrectomy, 030220 oncology & carcinogenesis, Predictive value of tests, MESH: Kidney Neoplasms, business, Kidney cancer
Abstract: International audience; BACKGROUND: The occurrence of positive surgical margins (PSMs) after partial nephrectomy (PN) is rare, and little is known about their natural history. OBJECTIVE: To identify predictive factors of cancer recurrence and related death in patients having a PSM following PN. DESIGN, SETTING, AND PARTICIPANTS: Some 111 patients with a PSM were identified from a multicentre retrospective survey and were compared with 664 negative surgical margin (NSM) patients. A second cohort of NSM patients was created by matching NSM to PSM for indication, tumour size, and tumour grade. MEASUREMENTS: PSM and NSM patients were compared using student t tests and chi-square tests on independent samples. A Cox proportional hazards regression model was used to test the independent effects of clinical and pathologic variables on survival. RESULTS AND LIMITATIONS: Mean age at diagnosis was 61+/-12.5 yr. Mean tumour size was 3.5+/-2 cm. Imperative indications accounted for 39% (43 of 111) of the cases. Some 18 patients (16%) underwent a second surgery (partial or total nephrectomy). With a mean follow-up of 37 mo, 11 patients (10%) had recurrences and 12 patients (11%) died, including 6 patients (5.4%) who died of cancer progression. Some 91% (10 of 11) of the patients who had recurrences and 83% of the patients (10 of 12) who died belonged to the group with imperative surgical indications. Rates of recurrence-free survival, of cancer-specific survival, and of overall survival were the same among NSM patients and PSM patients. The multivariable Cox model showed that the two variables that could predict recurrence were the indication (p=0.017) and tumour location (p=0.02). No other variable, including PSM status, had any effect on recurrence. None of the studied parameters had any effect on the rate of cancer-specific survival. CONCLUSIONS: PSM status occurs more frequently in cases in which surgery is imperative and is associated with an increased risk of recurrence, but PSM status does not appear to influence cancer-specific survival. Additional follow-up is needed.
Published: 2010

23. Enseignement et perception de l’urologie à la fin du deuxième cycle des études médicales : état des lieux

Author: M. Orsat, Evanguelos Xylinas, Morgan Rouprêt, Jean-Christophe Bernhard, S. Beley, Isabelle Richard, Pierre Bigot, B. Campillo, S. Lebdai, Romain Mathieu, Jean-Paul Saint-André, Abdel Rahmene Azzouzi, N. Koutlidis, Laboratoire d'Ergonomie et d'Épidémiologie en Santé au Travail (LEEST), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Université d'Angers (UA)-Institut de Veille Sanitaire (INVS), Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), and Université d'Angers (UA)
Subjects: Medical student, business.industry, Urology, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, 03 medical and health sciences, 0302 clinical medicine, Medical study, 030220 oncology & carcinogenesis, Medicine, business, Urologie, Humanities, Étudiants en médecine, Étude médicale
Abstract: International audience; ObjectifsDéterminer la perception de l’urologie par les étudiants en fin de deuxième cycle des études médicales (DCEM) et connaître leurs supports d’enseignement.Matériel et méthodesUn auto-questionnaire a été diffusé par internet à 1600 étudiants de 16 facultés au cours de leur dernier semestre de DCEM.RésultatsAu total, 590 réponses ont été reçues (36,8 %). Dans notre population, 70,2 % des étudiants étaient des femmes. Parmi eux, 24,1 % avaient fait un stage en urologie. L’urologie était considérée comme une discipline médicale, chirurgicale et médicochirurgicale, respectivement par 3,7 %, 37,8 % et 58 % d’entre eux. L’urologie était considérée comme une discipline très importante, importante, peu importante et pas importante par 5,1 %, 54,4 %, 37,5 % et 2,4 % d’entre eux. Les supports d’enseignement les plus utilisés pour préparer l’examen national classant (ENC) étaient les polycopiés d’internat (45,3 %), les conférences d’internat (43,7 %), le polycopié national du collège d’Urologie (38,6 %) et les cours dispensés à la faculté (32 %). Les items d’urologie les mieux assimilés étaient les pathologies lithiasiques (86,3 %), les troubles urinaires du bas appareil (76,3 %) et les cancers urologiques (56,7 %). À l’inverse, seulement 34,7 % et 28 % considéraient leurs connaissances suffisantes sur la dysfonction érectile et la transplantation rénale. Enfin, 7,5 % exprimaient le souhait de devenir urologue. La réalisation d’un stage en urologie était associée au sentiment d’avoir acquis les connaissances pour débuter l’internat (p
Published: 2010

24. Targeted therapies in non-muscle-invasive bladder cancer according to the signaling pathways

Author: Robert E. Reiter, Hervé Wallerand, Philippe Ballanger, Jean-Marie Ferriere, Grégoire Robert, Jean-Christophe Bernhard, Stéphane Culine, Alain Ravaud, Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'oncologie médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Institut Mondor de Recherche Biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), and Assistance publique - Hôpitaux de Paris (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]-Université Paris Diderot - Paris 7 ( UPD7 )
Subjects: Oncology, medicine.medical_specialty, Urology, medicine.medical_treatment, [SDV.CAN]Life Sciences [q-bio]/Cancer, Disease, medicine.disease_cause, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, 03 medical and health sciences, Therapeutic approach, 0302 clinical medicine, Internal medicine, medicine, Carcinoma, Humans, Neoplasm Invasiveness, 030304 developmental biology, 0303 health sciences, Bladder cancer, business.industry, Immunotherapy, medicine.disease, 3. Good health, Surgery, Urinary Bladder Neoplasms, 030220 oncology & carcinogenesis, Signal transduction, business, Non muscle invasive, Carcinogenesis, Signal Transduction
Abstract: International audience; With 300,000 annually new cases worldwide, urothelial-cell carcinoma of the bladder (UCCB) is the second most common urologic neoplasm after prostate carcinoma. Non-muscle-invasive bladder cancer (NMIBC), which is not immediately life-threatening, represents 70% to 80% of these initial cases. Despite optimal treatment (transurethral resection with intravesical chemo- or immunotherapy), 70% of these NMIBC will recur, and 10% to 20% will progress, highlighting the need for a new therapeutic approach. Indeed, the identification of patients at high risk of disease recurrence and progression would be beneficial in predicting which patients with NMIBC would benefit from strict follow-up and which would benefit from a more aggressive therapy. To date, conventional treatment remains disappointing in terms of oncologic results and morbidity. The growing understanding in tumor biology has enabled the signaling pathways involved in bladder tumorigenesis and progression to be identified, but few molecular targets have been available until now. The encouraging results seen in various human carcinomas suggests that these new agents should become part of the arsenal of drugs available in the treatment of NMIBC, alone or in combination with already known agents. In this article, we have tried to highlight the main molecular signaling pathways involved in NMIBC tumorigenesis and progression, and the potential targets useful for improving the treatment of NMIBC.
Published: 2009

25. Partial versus radical nephrectomy in patients with adverse clinical or pathologic characteristics

Author: Pierre I. Karakiewicz, Jacques Tostain, Karim Bensalah, Herve Lang, Luca Cindolo, B. Albouy, Alexandre de la Taille, Jean Marie Ferriere, Nazareno Suardi, Vincenzo Ficarra, Umberto Capitanio, Jean-Christophe Bernhard, Maxime Crepel, Claudio Jeldres, Didier Jacqmin, Arnaud Mejean, Paul Perrotte, Jean Jacques Patard, Christian Pfister, Marc Colombel, Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Service d'urologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Department of Oncological and Surgical Sciences, Universita degli Studi di Padova, G. Rummo Hospital, Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'urologie-andrologie, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Hôpital nord, Service d'urologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service d'urologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service d'urologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Strasbourg, Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Università degli Studi di Padova = University of Padua (Unipd), De Villemeur, Hervé, Université de Montréal, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] ( UJM ) -Hôpital nord, CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), and Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Descartes - Paris 5 ( UPD5 ) -CHU Necker - Enfants Malades [AP-HP]
Subjects: [ SDV.MHEP.UN ] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Nephrology, Male, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, MESH : Aged, 030232 urology & nephrology, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH : Carcinoma, Renal Cell, 0302 clinical medicine, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, MESH : Female, [ SDV.MHEP.CHI ] Life Sciences [q-bio]/Human health and pathology/Surgery, Young adult, Stage (cooking), Aged, 80 and over, MESH: Aged, MESH: Middle Aged, MESH: Carcinoma, Renal Cell, MESH : Adult, Middle Aged, MESH : Survival Rate, MESH : Risk Factors, Kidney Neoplasms, 3. Good health, Survival Rate, MESH: Young Adult, 030220 oncology & carcinogenesis, Female, Adult, medicine.medical_specialty, MESH: Survival Rate, MESH : Male, Urology, MESH : Young Adult, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 03 medical and health sciences, Young Adult, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, medicine, Carcinoma, Humans, MESH : Middle Aged, MESH : Aged, 80 and over, Survival rate, Carcinoma, Renal Cell, Aged, MESH: Humans, business.industry, MESH : Humans, MESH : Nephrectomy, Histology, MESH: Adult, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH : Kidney Neoplasms, MESH: Male, Surgery, MESH: Nephrectomy, T-stage, MESH: Kidney Neoplasms, business, MESH: Female
Abstract: International audience; OBJECTIVES: To assess cancer-specific survival of partial nephrectomy (PN) patients with >or= 7-cm lesions or unfavorable pathology (stage T3a or Fuhrman grades III-IV). MATERIAL AND METHODS: At 13 participation centers, 4072 partial or radical nephrectomies (RN) were performed for RCC between 1984 and 2001. Of all procedures, 925 (22.7%) were for tumors > 7 cm, 973 (23.9%) had Fuhrman grades III or IV, and 861 (21.1%) had stage pT3a. None had nodal or distant metastases. Matched (age, gender, tumor size, T stage, histologic subtype, and Fuhrman grade [FG]) survival analyses addressed the effect of nephrectomy type (partial vs radical) on cancer-specific mortality. RESULTS: Partial nephrectomy for tumors > 7 cm was associated with higher mortality than RN (HR = 5.3; P = .025). No significant cancer-specific survival differences were recorded after PN for FG III-IV (HR = 0.7, P = .5) or for pT3a lesions (HR = 2.5, P = .9). CONCLUSIONS: Partial nephrectomy may undermine cancer control in patients with tumors > 7 cm. Conversely, after PN, the same cancer control rates as after RN may be expected in patients with Fuhrman grades III-IV or with pT3a histology.
Published: 2009

26. Update on the medical treatment of metastatic renal cell carcinoma

Author: Stéphane Culine, Karim Bensalah, Hervé Wallerand, Jean-Christophe Bernhard, Jean-Jacques Patard, Patricia Fergelot, Alain Ravaud, Endocrinologie moléculaire et cellulaire des cancers, Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département d'oncologie Médicale, CRLCC Val d'Aurelle - Paul Lamarque, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)
Subjects: Vascular Endothelial Growth Factor A, Sorafenib, Oncology, medicine.medical_specialty, Urology, medicine.medical_treatment, Population, 030232 urology & nephrology, Antineoplastic Agents, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Targeted therapy, 03 medical and health sciences, 0302 clinical medicine, Renal cell carcinoma, Internal medicine, medicine, Humans, education, Carcinoma, Renal Cell, education.field_of_study, Everolimus, Sunitinib, business.industry, medicine.disease, Cell Hypoxia, Kidney Neoplasms, Temsirolimus, 3. Good health, Surgery, 030220 oncology & carcinogenesis, business, Kidney cancer, medicine.drug
Abstract: International audience; CONTEXT: Metastatic renal cell carcinoma (mRCC) has long been treated only by immunotherapy with good results only in a small population of patients. In recent years, major improvements in treatment possibilities have occurred with the advent of anti-angiogenic drugs. In the past 2 yr, pivotal phase III trials have confirmed this major breakthrough by increasing the progression-free survival rates and/or overall survival rates provided by sunitinib, sorafenib, and bevacizumab, and more recently by the mTOR (mammalian target of rapamycin) inhibitors temsirolimus and everolimus. OBJECTIVE: To update the previous review on smart drugs published in the European Journal in 2006 (Patard JJ, et al. Understanding the importance of smart drugs in renal cell carcinoma. Eur Urol 2006; 49:633-43). EVIDENCE ACQUISITION: Critical review of published literature 2006-2008 (Pubmed website search words: renal cell carcinoma and/or targeted therapy and prospective trials) and more recent meeting abstracts (American Society of Clinical Oncology 2007). Quality assessment included prospective phase I-III trials and critical evaluations with low numbers of patients, retrospective analyses, and slide presentations of meeting abstracts. EVIDENCE SYNTHESIS: This review presents the current situation and provides more recent data on sequential treatment, the association of targeted drugs, and the treatment of non-clear-cell histologies. CONCLUSIONS: Treatment of mRCC with targeted therapy centers on at least two major pathways: angiogenesis and mTOR involving inhibiting drugs that may be used alone, in combination, or sequentially.
Published: 2008

27. Impact pronostique des rapports neutrophiles/lymphocytes pré-opératoire et post-opératoire dans le cancer du rein non métastatique (UroCCR n°61)

Author: Allenet, Clément, Université de Bordeaux (UB), Jean-Christophe Bernhard, and UB, Médecine
Subjects: [SDV] Life Sciences [q-bio], [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, UISS, [SDV]Life Sciences [q-bio], fungi, Lymphocytes, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Introduction: the neutrophil to lymphocyte ratio (NLR) is an established marker of systemic inflammation and its value as a biomarker has been reported in other cancers. The aim of this study was to assess the prognostic value of pre- and post-operative NLR in non-metastatic kidney cancer. Its ease of obtaining could improve follow-up recommendations. Material and Methods: single-center retrospective study from cases prospectively included after written consent in the French UroCCR database (CNIL DR 2013-206; NCT03293563). We included patients operated on for stage pT1-4N0M0 kidney cancer between May 2000 and January 2019. The associations between clinical, biological, pathological variables and pre- and post-operative NLRs were assessed in univariate and multivariate analyzes. An analysis of recurrence-free survival according to Kaplan Meier as a function of the pre- and post-operative NLR was performed and then stratified by the SSIGN and UISS score. Results: a total of 789 patients were included. The mean follow-up on the cohort was 57.5 ± 35 months and 137 patients presented with local or distant recurrence. The mean preoperative NLR was 4.2 ± 4 in the recurrence group vs. 2.5 ± 1.7 (p 2.7 was an independent risk factor for recurrence (OR 2.9 [1.1-7.8] p = 0.034). We assessed recurrence-free survival based on NLR and it was significantly unfavorable when NLR was> 2.7 preoperatively and postoperatively (p 2.7 was significantly independently associated with the risk of disease recurrence. Moreover, the NLR was significantly increased on recurrence. It could therefore be a biomarker, economical and easy to use., Introduction : le rapport neutrophiles/lymphocytes (NLR) est un marqueur établi de l’inflammation systémique et son intérêt comme biomarqueur a été rapporté dans d’autres cancers. Le but de cette étude était d’évaluer la valeur pronostique du NLR pré et post-opératoire dans le cancer du rein non métastatique. Sa simplicité d’obtention pourrait permettre d’améliorer les recommandations de suivi. Matériel et Méthodes : étude rétrospective monocentrique issue de cas inclus prospectivement après consentement écrit dans la base de données française UroCCR (CNIL DR 2013-206 ; NCT03293563). Nous avons inclus les patients opérés d’un cancer du rein de stade pT1-4N0M0 entre Mai 2000 et Janvier 2019. Les associations entre les variables cliniques, biologiques, anatomopathologiques et les NLR pré et post-opératoires ont été évaluées en analyses univariées et multivariées. Une analyse de survie sans récidive selon Kaplan Meier en fonction du NLR pré et post opératoire a été réalisée puis stratifiée au score SSIGN et UISS. Résultats : un total de 789 patients a été inclus. Le suivi moyen sur la cohorte était de 57,5 ± 35 mois et 137 patients ont présenté une récidive locale ou à distance. Le NLR moyen pré-opératoire était de 4,2 ± 4 dans le groupe récidive vs 2,5 ± 1,7 (p 2,7 était un facteur de risque indépendant de récidive (OR 2,9 [1,1-7,8] p=0,034). Nous avons évalué la survie sans récidive en fonction du NLR et elle était significativement défavorable lorsque le NLR était > 2,7 en pré-opératoire et en post-opératoire (p 2,7 était significativement associé de façon indépendante au risque de récidive de la maladie. Par ailleurs, le NLR était significativement augmenté à la récidive. Il pourrait donc s’agir d’un biomarqueur, économique et facile d’utilisation.
Published: 2020

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27 results on '"Jean-Christophe Bernhard"'

1. Practical identifiability analysis of a mechanistic model for the time to distant metastatic relapse and its application to renal cell carcinoma

2. Nivolumab, nivolumab–ipilimumab, and VEGFR-tyrosine kinase inhibitors as first-line treatment for metastatic clear-cell renal cell carcinoma (BIONIKK): a biomarker-driven, open-label, non-comparative, randomised, phase 2 trial

3. Cancer-associated fibroblasts in renal cell carcinoma: implication in prognosis and resistance to anti-angiogenic therapy

4. Towards automatic recognition of pure and mixed stones using intra‐operative endoscopic digital images

5. Postoperative outcomes of elderly patients undergoing partial nephrectomy

6. External Validation of the ASSURE Model for Predicting Oncological Outcomes After Resection of High-risk Renal Cell Carcinoma (RESCUE Study: UroCCR 88)

7. Metastatic Clear-cell Renal Cell Carcinoma With a Long-term Response to Sunitinib A Distinct Phenotype Independently Associated With Low PD-L1 Expression

8. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : prise en charge du cancer du rein

9. Sunitinib Alone or after Nephrectomy in Metastatic Renal-Cell Carcinoma

10. Partial nephrectomy versus ablative therapy for the treatment of renal tumors in an imperative setting

11. Correlation of c-MET Expression with PD-L1 Expression in Metastatic Clear Cell Renal Cell Carcinoma Treated by Sunitinib First-Line Therapy

12. Off-Clamp versus On-Clamp Robotic Partial Nephrectomy: A Multicenter Match-Paired Case-Control Study

13. MP64-16 COMPARISON OF 1,800 ROBOTIC AND OPEN PARTIAL NEPHRECTOMIES FOR RENAL TUMORS

14. Unique Transcriptomic Profile of Collecting Duct Carcinomas Relative to Upper Tract Urothelial Carcinomas and other Kidney Carcinomas

15. The subclassification of papillary renal cell carcinoma does not affect oncological outcomes after nephron sparing surgery

16. Postoperative drainage does not prevent complications after robotic partial nephrectomy

17. Nephrectomy improves overall survival in patients with metastatic renal cell carcinoma in cases of favorable MSKCC or ECOG prognostic features

18. Neoadjuvant targeted molecular therapies in patients undergoing nephrectomy and inferior vena cava thrombectomy: is it useful?

19. Nephron-sparing surgery for renal tumors measuring more than 7 cm: morbidity, and functional and oncological outcomes

20. Renal cell carcinoma (RCC) in patients with end-stage renal disease exhibits many favourable clinical, pathologic, and outcome features compared with RCC in the general population

21. Predictive factors for ipsilateral recurrence after nephron-sparing surgery in renal cell carcinoma

22. Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery

23. Enseignement et perception de l’urologie à la fin du deuxième cycle des études médicales : état des lieux

24. Targeted therapies in non-muscle-invasive bladder cancer according to the signaling pathways

25. Partial versus radical nephrectomy in patients with adverse clinical or pathologic characteristics

26. Update on the medical treatment of metastatic renal cell carcinoma

27. Impact pronostique des rapports neutrophiles/lymphocytes pré-opératoire et post-opératoire dans le cancer du rein non métastatique (UroCCR n°61)

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