[Active surveillance in prostate cancer: Assessment of MRI in the selection and follow-up of patients]. / Surveillance active dans le cancer de prostate : évaluation de l'IRM dans la sélection et le suivi des patients.

AIM: To evaluate the contribution of multiparametric MRI (MRI) and targeted biopsies (TB) in the selection and follow-up of patients under active surveillance (AS). METHODS: A single-center, retrospective cohort study on 131 patients in AS, with following criteria:≤cT2 stage, PSA≤15ng/mL, Gleason score≤6,≤3 positive biopsies and maximum tumor length≤5mm. Patients' selection and follow-up was performed by the combination of systemic biopsies (SB) and mpMRI±TB. Reclassification was defined by a Gleason score>6 and/or a maximum tumor length>5mm. RESULTS: Overall, 29 patients (22.1 %) were reclassified. Reclassification free survival rate was 93 % and 70 % at 1 year and 4 years respectively. Reclassification independent risk factors were: PSA density>0.15ng/mL/cm3 (RR=2.75), PSA doubling time<3 years (RR=9.28), suspicious lesion on MRI diagnosis (RR=2.79) and occurrence of MRI progression during follow-up (RR=2). Sensitivity, specificity, PPV and NPV of MRI to assess progression for reclassification were 61 %, 69 %, 45 % and 81 %, respectively. CONCLUSION: For patients under AS, mpMRI decreases reclassification rates over time through better initial detection of significant cancers. Its high NPV makes it an efficient monitoring tool to distinguish patients with low risk of reclassification. LEVEL OF EVIDENCE: 4.

[Pathology findings after radical prostatectomy for prostate cancer in patients eligible for active surveillance: Contribution of multiparametric MRI to treatment decision]. / Résultats anatomopathologiques après prostatectomie totale pour cancer chez des patients éligibles à une surveillance active : apport de l'IRM multiparamétrique dans la décision de traitement.

OBJECTIVES: To analyze, in patients with prostate cancer (PC) potentially eligible for active surveillance (AS), whether multiparametric-MRI (mp-MRI) predicts presence of clinically significant cancer on radical prostatectomy (RP) specimen. METHODS: We identified 77 men with PC eligible for AS (PSA≤15ng/mL, stage≤T2a, Gleason score≤6, up to 3 positive cores, maximal cancer core length≤5mm) who underwent RP between 01/2008 and 08/2015. All patients had prebiopsy mp-MRI followed by systematic±targeted biopsies. For each patient, the likelihood of the presence of cancer on mp-MRI was assigned using Likert scale (1 to 5). The predictive factors for the presence of significant cancer on RP specimen (Gleason score≥7 and/or tumoral maximal diameter>10mm) were evaluated using logistic regression. RESULTS: Median age was 61 and median PSA was 6.7ng/mL. Overall, 49 (64%) patients had a positive mp-MRI (score≥3). Clinically significant cancer on RP specimen was found in 45 (58%) patients (69% in MRI-positive patients vs 39% in MRI-negative patients). In multivariate analysis, a positive MRI was a predictive factor for the presence of significant cancer on the surgical specimen (OR=3.0; CI95% [1.01-8.88]; P=0.04), as was age (OR=1.17; CI95% [1.05-1.31]; P=0.004) and PSAD (OR=1.10; CI95% [1.01-1.20]; P=0.02). CONCLUSION: Mp-MRI is a useful exam for selecting patients eligible for AS even if the situation remains unclear after prostate biopsies including targeted biopsies. Upon confirmation by further studies, mp-MRI should be considered as an independent criterion before entering an AS program. LEVEL OF EVIDENCE: 4.

Radical prostatectomy for locally advanced and high-risk prostate cancer: A systematic review of the literature.

CONTEXT: The role of radical prostatectomy (RP) in high-risk prostate cancer (PCa) is increasing. PURPOSE: To review the existing literature and determine the value of RP in high-risk and locally advanced PCa. DOCUMENTARY SOURCE: MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from 01/2000 through 05/2016 according to the PRISMA guidelines. SELECTION OF STUDIES: Forty-two studies describing outcomes of RP among 52,546 patients with high-risk and locally advanced PCa. RESULTS: Mortality was approximately 0-1% and Clavien≥3 complications ranged from 1.8% to 12%. Biochemical recurrence-free and metastasis-free survival ranged from 40 to 94% and 90 to 96.1% at 5 years and from 27 to 68% and 64.4 to 85.1% at 10 years, respectively. Overall and cancer specific survival ranged from 55.2 to 98.6% and 89.8 to 100% at 5 years and from 58 to 84% and 65 to 96% at 10 years, respectively. The 12-mo continence rates ranged from 32% to 96.2% and the erectile function recovery ranged from 60% to 64%. LIMITS: Studies were heterogeneous especially regarding the definition of high-risk disease and the use of adjuvant treatments. CONCLUSIONS: The utilization of RP in high-risk and locally advanced PCa is increasing. Existing data support the advantages of RP in this group of patients. However, uniformity in definitions and indications are a prerequisite in order to establish its role as an important therapeutic arm in a multimodality management strategy.

[French ccAFU guidelines - Update 2018-2020: Prostate cancer]. / Recommandations françaises du Comité de Cancérologie de l'AFU ­ Actualisation 2018­2020 : cancer de la prostate.

OBJECTIVE: The purpose of the guidelines national committee ccAFU was to propose updated French guidelines for prostate cancer. METHODS: A Medline search was achieved between 2016 and 2018, as regards diagnosis, options of treatment and follow-up of prostate cancer, and to evaluate the different references specifying their levels of evidence. RESULTS: Epidemiology, classification, staging systems, diagnostic evaluation of prostate cancer are reported. Disease management options are detailed. Recommandations are reported according to the different clinical situations. Active surveillance is a major option in low risk PCa. Radical prostatectomy remains a standard of care of localized PCa. The three-dimensional conformal radiotherapy is the technical standard. A dose of≥76Gy is recommended. Moderate hypofractionation provides short-term biochemical control comparable to conventional fractionation. In case of intermediate risk PCa, radiotherapy can be combined with short-term androgen deprivation therapy (ADT). In case of high-risk disease, long-term ADT remains the standard of care. ADT is the backbone therapy of metastatic disease. In men with metastases at first presentation, upfront chemotherapy combined with ADT should be considered as a standard. In this situation, the combination of ADT and abiraterone acetate also becomes a new standard. In case of metastatic castration-resistant PCa (mCRPC), new hormonal treatments and chemotherapy provide a better control of tumor progression and increase survival. CONCLUSION: These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment for prostate cancer.

RETRACTED: Recommandations françaises du Comité de Cancérologie de l'AFU ­ Actualisation 2018­2020 : cancer de la prostate French ccAFU guidelines ­ Update 2018­2020: Prostate cancer / Recommandations françaises du Comité de Cancérologie de l'AFU ­ Actualisation 2018­2020 : cancer de la prostate.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations. Le nouvel article est disponible à cette adresse: DOI:10.1016/j.purol.2019.01.007. C'est cette nouvelle version qui doit être utilisée pour citer l'article. This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published. The replacement has been published at the DOI:10.1016/j.purol.2019.01.007. That newer version of the text should be used when citing the article.

[Salvage radical prostatectomy for recurrent prostate cancer. Morbidity, oncological and functional results]. / Prostatectomie totale de rattrapage après échec de traitement local pour cancer de prostate : morbidité, résultats oncologiques et fonctionnels.

INTRODUCTION: Salvage radical prostatectomy (sRP) for radiorecurrent prostate cancer (PCa) is a challenging procedure. To report our experience with sRP for selected patients with local recurrence after primary treatment for localised PCa. METHODS: From 2005 to 2015, 24 patients underwent sRP for recurrent PCa in our center and were included in this retrospective study. Local recurrence was suspected by PSA increase>nadir+2ng/mL and was confirmed by biopsy. Perioperative complications according to Clavien-Dindo classification, oncological and functional results were analysed. RESULTS: Overall, 24 patients with a median age of 59 years (IQR: 55-60) were included. Median follow-up was 25 months (IQR: 9-26). Procedures were performed with open-retropubic approach in 50 % and robot-assisted laparoscopic approach in 50 %. Overall, 5 (21 %) and 2 (8 %) patients experienced grade≤IIIa and grade≥IIIb postoperative complication, respectively. Surgical margins were positive in 46 % of cases. Three out of 4 patients with postoperatively detectable PSA (>0.2ng/mL) had positive surgical margins. Seven patients experienced biochemical recurrence in a median delay of 19 months (9-62). Seventy-one percent (5) of these patients experienced clinical recurrence in a median delay of 24 months (10-113). Severe urinary incontinence (≥3 pads/day) and erectile dysfunction were reported in 25 % and 63 %, respectively. CONCLUSION: sRP for patients is a feasible procedure with encouraging local control rate and acceptable morbidity. This technique should be discussed as a treatment option for locally recurrent PCa in well-selected patients. LEVEL OF EVIDENCE: 4.

[Factors influencing the choice of nondonor families in a French organ-harvesting center]. / Analyse des raisons motivant le refus du don d'organes par les familles de patients en état de mort encéphalique dans un centre régional de prélèvement.

OBJECTIVES: Report the reasons that lead families to refuse organ donation during their close solicitation by hospital coordination. MATERIAL AND METHODS: A retrospective study was conducted between 2012 and 2015, including 148 (34%) refusal of organ donation among 426 patients identified in a state of brain death. A questionnaire of the family was completed for each interview. Collected data concerned patient characteristics, cause of death, description of the interview and reasons for refusal. A descriptive statistical analysis was performed. RESULTS: The median age of patients was 50 years with a sex ratio of 1.4 men to 1 woman. The most common reason for non-donor family was the desire to maintain the integrity of the body of the patient (28%) followed by a religious order pattern (11%), brutality and suddenness of death (9%), the denial of death (6%) and early age of the donor (5%). In 39% of cases, the family said that the donor had expressed a written or oral refusal in his lifetime. CONCLUSION: A better understanding of the reasons leading to the refusal of non-donor family could provide assistance to the medical team on actions to general public with the aim to reduce the refusal rate. LEVEL OF EVIDENCE: 4.

[CCAFU french national guidelines 2016-2018 on prostate cancer]. / Recommandations en onco-urologie 2016-2018 du CCAFU : Cancer de la prostate.

OBJECTIVES: The purpose of the guidelines national committee CCAFU was to propose updated french guidelines for localized and metastatic prostate cancer (PCa). METHODS: A Medline search was achieved between 2013 and 2016, as regards diagnosis, options of treatment and follow-up of PCa, to evaluate different references with levels of evidence. RESULTS: Epidemiology, classification, staging systems, diagnostic evaluation are reported. Disease management options are detailed. Recommandations are reported according to the different clinical situations. Active surveillance is a major option in low risk PCa. Radical prostatectomy remains a standard of care of localized PCa. The three-dimensional conformal radiotherapy is the technical standard. A dose of > 74Gy is recommended. Moderate hypofractionation provides short-term biochemical control comparable to conventional fractionation. In case of intermediate risk PCa, radiotherapy can be combined with short-term androgen deprivation therapy (ADT). In case of high risk disease, long-term ADT remains the standard of care. ADT is the backbone therapy of metastatic disease. In men with metastases at first presentation, upfront chemotherapy combined with ADT should be considered as a new standard. In case of metastatic castration-resistant PCa (mCRPC), new hormonal treatments and chemotherapy provide a better control of tumor progression and increase survival. CONCLUSIONS: These updated french guidelines will contribute to increase the level of urological care for the diagnosis and treatment for prostate cancer. © 2016 Elsevier Masson SAS. All rights reserved.

[Lynch syndrome and risk of prostate cancer; review of the literature]. / Syndrome de Lynch et risque de cancer de la prostate; revue de la littérature.

INTRODUCTION: The association between Lynch syndrome and prostate cancer has been studied. Recent studies report an association between these two diseases. MATERIAL AND METHODS: Literature review based on PubMed search was performed using the following keywords: Lynch syndrome and prostate cancer. RESULTS: Eight articles analyzing cohorts of subjects carrying Lynch syndrome were analysed including 6786 patients with 175 cancers. Prostate cancers were more frequent with a standardized incidence ratio (SIR) from 0.93 (95% CI: 0.19-2.7) and 5.9 (95% CI 4.1-17.1) and occurs at a younger age than in the general population mainly for mutations in the MSH2 gene. CONCLUSION: Prostate cancer seem more frequent and occur earlier in individuals harboring a mutation in the MSH2 gene while it does not appear to be any difference compared to the general population for other mutations in Lynch syndrome.

[Testicular nodules of infertile men and contrast enhanced ultrasonography: preliminary study]. / Nodules testiculaires de l'homme infertile et échographie de contraste: étude préliminaire.

INTRODUCTION: The incidence of testicular nodules discovered during infertility evaluation is increasing. These nodules are suspicious of malignancy. There is no paraclinical examination which allows histological orientation to these nodules. The recommendations propose priority treatment by total orchidectomy. PATIENTS AND METHODS: Through a retrospective cohort study of infertile patients, our goal is to study the enhancement of testicular nodules after injection of ultrasound contrast. The secondary objective is to determine whether CEUS may argue in favor of conservative treatment. From june 2010 to march 2013, 24 patients had underwent ultrasound contrast study of abnormal testicular parenchyma detected prior to infertility evaluation carried ultrasound. The characteristics of ultrasound enhancement were correlated with the pathological findings of surgical patients and proposed treatments (surgery or surveillance). RESULTS: Fifteen patients were followed up, 9 were operated (7 partial orchidectomies, 2 total orchidectomies). Histological analysis found four Leydig cell tumors, 2 Sertoli cell tumors and 3 seminomas. No adverse changes were noted during the follow-up. This study showed a typical semiology of early, intense and homogeneous enhancement with a phenomenon of wash in 100% of Leydig cell tumors. All Leydig cell tumors have been treated by partial orchidectomy. Seminomas have intense enhancement in 100% of cases. There was a phenomenon of wash in 2 out of 3 cases. When a wash in was described, it was always described as heterogeneous. All seminomas were finally treated by total orchidectomy. The sensitivity and positive predictive value of ultrasound intense enhancement for the diagnosis of testicular cancer was 89% (Se) and 80% (PPV). CONCLUSION: There is a semiology of ultrasound enhancement of testicular nodules with features that can guide in favor of a malignant tumor, seminoma or Leydig cell tumor. If a prospective study was undertaken, these arrangements could guide us to treatments promoting preservation of the testicular parenchyma.

[Long term biochemical recurrence free survival after radical prostatectomy for cancer: comparative analysis according to surgical approach and clinicopathological stage]. / Survie sans récidive biologique à long terme après prostatectomie totale pour cancer: analyse comparative selon la voie d'abord et le stade clinico-pathologique.

OBJECTIVE: To assess long term biochemical recurrence free survival after radical prostatectomy according to open, laparoscopic and robot-assisted surgical approach and clinicopathological stage. MATERIAL AND METHODS: A cohort study of 1313 consecutive patients treated by radical prostatectomy for localized or locally advanced prostate cancer between 2000 and 2013. Open surgery (63.7%), laparoscopy (10%) and robot-assisted laparoscopy (26.4%) were performed. Biochemical recurrence was defined by PSA>0,1ng/mL. The biochemical recurrence free survival was described by Kaplan Meier method and prognostic factors were analysed by multivariable Cox regression. RESULTS: Median follow-up was 57 months (IQR: 31-90). Ten years biochemical recurrence free survival was 88.5%, 71.6% and 53.5% respectively for low, intermediate and high-risk D'Amico groups. On multivariable analysis, the worse prognostic factor was Gleason score (P<0.001). Positive surgical margins rate was 53% in pT3 tumours and 24% in pT2 tumours (P<0.001). Biochemical recurrence free survival (P=0.06) and positive surgical margins rate (P=0.87) were not statistically different between the three surgical approaches. CONCLUSION: Biochemical recurrence free survival in our study does not differ according to surgical approach and is similar to published series. Ten years biochemical recurrence free survival for high-risk tumours without hormone therapy is 54% justifying the role of surgery in the therapeutic conversations in this group of tumours. LEVEL OF EVIDENCE: 3.

[Azoospermia and a history of inguinal hernia repair in adult]. / Azoospermie et antécédent de cure de hernie inguinale chez l'adulte.

BACKGROUND: Inguinal hernia repair is one of the most performed surgeries in the world. It is recognized that any surgery of the pelvic floor may represent a risk factor of male infertility. METHOD: Retrospective study of patients with azoospermia and a history of adult inguinal hernia repair surgery and referred to our center between January 1990 and January 2011 for infertility. RESULTS: Among 69 azoospermia patients with history of adult inguinal hernia repair surgery, 60 patients underwent surgical extraction of sperm that was successful in 75% (45/60). Positive extraction rate decreases in the subgroup of patients with risk factors for infertility (61.4%) as well as in the group with bilateral inguinal hernia (67.9%). There was no statistically significant difference in the positive rate of sperm retrieval according to surgical technique or according to the use of polypropylene mesh (P>0.05). CONCLUSION: The obstruction of the vas deferens due to an inguinal hernia repair was a potential iatrogenic cause of male infertility that was rare and underestimated. The influence of using a polypropylene mesh was not clearly demonstrated. The management of these patients is based on prevention in order to identify patients with risk factors of infertility in order to propose a presurgery cryopreservation of sperm. LEVEL OF EVIDENCE: 5.

[Epidemiology and risk factors of upper urinary tract tumors: literature review for the yearly scientific report of the French National Association of Urology]. / Épidémiologie et facteurs de risque des tumeurs de la voie excrétrice urinaire supérieure: revue de la littérature pour le rapport annuel de l'Association française d'urologie.

AIM: To describe the epidemiology, the risk and genetic factors involved in carcinogenesis pathways of upper urinary tumors UTUCs. MATERIAL: A systematic review of the scientific literature was performed from the database Medline (National Library of Medicine, PubMed) and websites of the HAS and the ANSM using the following keywords: epidemiology; risk factor; tobacco; aristolochic acid; urothelial carcinoma; ureter; renal pelvis. The search was focused on the characteristics, the mode of action, the efficiency and the side effects of the various drugs concerned. RESULTS: The estimated UTUC incidence is 1.2 cases/100,000 inhabitant per year in Europe. The incidence of renal pelvis tumor has been stable for 30years, while the frequency of ureteric locations has increased over time. Locally advanced stage and high grade are more frequent at the time of diagnosis. The median age for diagnosis is 70-years-old. Male-to-female ratio is nearly 2. Main carcinogenic factors are tobacco consumption and occupational exposure. There are specific risk factors for UTUC such acid aristolochic (balkan's nephropathy and Chinese herbs nephropathy). Familial cases are distinct from sporadic cases. UTUCs belong to the HNPCC syndrome and they rank third in its tumor spectrum. CONCLUSION: UTUCs are scarce tumors with specific epidemiologic characteristics. UTUCs share common risk factors with other urothelial carcinomas such as bladder tumors but have also specific risk factors that clinicians should know.

Significance of ADC value for detection and characterization of urothelial carcinoma of upper urinary tract using diffusion-weighted MRI.

PURPOSE: To evaluate utility of diffusion-weighted magnetic resonance imaging (DWI) to detect and predict the histological characteristics of upper urinary tract urothelial carcinomas (UTUCs). MATERIALS AND METHODS: We retrospectively evaluated 20 suspicious lesions from 19 patients. MRI study included conventional sequences and DWI with apparent diffusion coefficient (ADC) maps calculated between b = 0 and b = 1,000. ADC values were measured within two different regions of interest (ROI): a small identical ROI placed in the most restrictive part of the tumour and a larger ROI covering two-thirds of the mass surface. The mean ADC values of the tumours were compared with that of normal renal parenchyma using an unpaired Student's t test. Association between ADC values and histological features was tested using non-parametric tests. RESULTS: Overall, 18 tumours were confirmed histologically as UTUCs. DWI failed to detect two cases of UTUCs (one CIS and one small tumour of 5 mm). There was no statistically significant difference in ADC values measured with the small or large ROI (p = 0.134). The mean ADC value of UTUC was significantly lower than that of the normal renal parenchyma (p < 0.001). No statistical association was found between ADC values and pathological features (location, p = 0.35; grade, p = 0.98; muscle-invasive disease, p = 0.76 and locally advanced stage, p = 0.57). CONCLUSION: DWI may be interesting tool for detecting UTUCs regarding the difference of ADC values between the tumours and surrounding healthy tissues. In regard to low frequency of UTUCs, the association of ADC values and histological characteristics need further investigations in a large prospective multi-institutional study.

Influence of preoperative hydronephrosis on the outcome of urothelial carcinoma of the upper urinary tract after nephroureterectomy: the results from a multi-institutional French cohort.

OBJECTIVES: Recent publications have assessed the prognostic significance of hydronephrosis in the outcome of upper tract urothelial carcinoma (UUT-UC). Our study sought to determine the prognostic impact of hydronephrosis on UUT-UC survival and its relationship to the clinicopathological features. MATERIALS AND METHODS: A retrospective, multi-institutional French study was conducted on 401 patients who underwent radical nephroureterectomy for non-metastatic UUT-UC. Hydronephrotic status was determined using preoperative imaging reports. Univariate and multivariate analyses were conducted to identify factors associated with survival. RESULTS: Preoperative hydronephrosis was present in 74 patients. Median follow-up was 26 months. Hydronephrosis was associated only with ureteral localisation (p < 0.001). No difference was observed in 5-year cancer-specific survival (CSS) between the hydronephrosis group (80.1 %) and the no hydronephrosis group (83.6 %) (p > 0.05). Only age (p = 0.02) and pT stage (p = 0.01) were independent predictors of CSS. Hydronephrosis was not a significant predictor of CSS in the univariate and multivariate analyses (p = 0.87 and p = 0.66). No significant difference was observed for 5-year metastasis-free survival (MFS) between the hydronephrosis group (69.8 % ± 6.6 %) and the no hydronephrosis group (80.5 % ± 3 %) (p = 0.052). Hydronephrosis was not a significant predictor of MFS in the univariate and multivariate analyses (p = 0.16 and p = 0.36). Multifocality (p = 0.02), pT stage (p < 0.001) and positive surgical margins (p = 0.02) were independent predictors of MFS. For the pelvic tumours subgroup, hydronephrosis was an independent predictor of MFS (p = 0.01) but not CSS (p = 0.86). CONCLUSION: Preoperative hydronephrosis was not associated with survival. However, among tumours presenting with hydronephrosis, pelvicalyceal tumours appear to have a worse prognosis than ureteral tumours.

Is there a role for radical prostatectomy in the management of oligometastatic prostate cancer? A systematic review.

CONTEXT: There is a growing interest about the role of radical prostatectomy (RP) in local cancer control in oligometastatic prostate cancer (PCa). PURPOSE: To evaluate the oncological and functional outcomes of RP in the management of oligometastatic PCa through a systematic review. METHODS: A systematic review search was performed and the following bibliographic databases were accessed: PubMed, Scopus, Embase and the Cochrane central register of controlled trials were searched from January 2000 to November 2022. This was carried out by the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. RESULTS: Based on the literature search of 384 articles, 11 (511 patients) met the inclusion criteria (mean age: 65.5 yr.). Positive surgical margins were 59%. Median follow-up ranged from 13 to 64 months. Clinical progression-free survival ranged from 56% at 3 years to 45% at 7 years. Specific and overall survival rates ranged from 60 to 80.5% and 78 to 80% at 5 years, respectively. Clavien ≥3 complications ranged from 0 to 21%. The urinary incontinence rate was 14.5%. CONCLUSIONS: Similar to published studies, RP of oligometastatic PCa appears to be safe with acceptable morbidity in selected patients. The lack of a consensual definition, the low level of evidence and the bias of the comparative and retrospective studies available do not allow practical recommendations to be made. There is currently no place for metastatic surgery outside of participation in a clinical trial.

Cancer-specific survival after radical nephroureterectomy for upper urinary tract urothelial carcinoma: proposal and multi-institutional validation of a post-operative nomogram.

BACKGROUND: Owing to the scarcity of upper urinary tract urothelial carcinoma (UUT-UC) it is often necessary for investigators to pool data. A patient-specific survival nomogram based on such data is needed to predict cancer-specific survival (CSS) post nephroureterectomy (NU). Herein, we propose and validate a nomogram to predict CSS post NU. PATIENTS AND METHODS: Twenty-one French institutions contributed data on 1120 patients treated with NU for UUT-UC. A total of 667 had full data for nomogram development. Study population was divided into the nomogram development cohort (397) and external validation cohort (270). Cox proportional hazards regression models were used for univariate and multivariate analyses and to build a nomogram. A reduced model selection was performed using a backward step-down selection process, and Harrell's concordance index (c-index) was used for quantifying the nomogram accuracy. Internal validation was performed by bootstrapping and the reduced nomogram model was calibrated. RESULTS: Of the 397 patients in the nomogram development cohort, 91 (22.9%) died during follow-up, of which 66 (72.5%) died as a consequence of UUT-UC. The actuarial CSS probability at 5 years was 0.76 (95% CI, 71.62-80.94). On multivariate analysis, T stage (P<0.0001), N status (P=0.014), grade (P=0.026), age (P=0.005) and location (P=0.022) were associated with CSS. The reduced nomogram model had an accuracy of 0.78. We propose a nomogram to predict 3 and 5-year CSS post NU for UUT-UC. CONCLUSION: We have devised and validated an accurate nomogram (78%), superior to any single clinical variable or current model, for predicting 5-year CSS post NU for UUT-UC.

[Small renal masses: 10 years of treatment in a tertiary referral center in cancer research]. / Cancer du rein de moins de 4cm : traitement dans un centre de référence régional en cancérologie.

OBJECTIVES: To analyze the impact of preoperative clinical data that could influence the undertaking of small renal masses (size<4cm) and to direct patients towards surgery or observance or radiofrequency. PATIENTS AND METHODS: From January 2000 to December 2010, 253 small renal masses were included in a retrospective study. Renal masses less than 3cm were compared to the 3 to 4cm masses. Clinical data, pathological data and follow-up was noted prospectively on the database and we analyzed it according to the treatment done (surgery, radiofrequency or observation). RESULTS: Surgical treatment, radiofrequency and observation were performed for 214 (86.4%), 15 (5.9%), and 24 (9.5%) patients respectively. The treatments of the patients differed in the two groups (<3cm vs. 3-4cm) and the appeal to radiofrequency and observation was more frequent for elder patients (>65years old) and for those whom performance status (ECOG status) greater or equal to 1. Cancer specific survival was not statistically different for the two groups (average: 87.5% after 5years, mean 33months follow-up, P=0.7). Independent risk factors of recurrence were Fuhrman grade, synchronous tumors, noddles invasion and metastatic progression. Positive surgical margins were not a risk factor of recurrence (P=0.6). CONCLUSION: Age and performance status are the two main clinical data, which influence the treatment for patients with small renal masses. Radiofrequency and observation were undertaken more regularly for elder and altered ones. The use of scales as Charlson Index or Lee scale could help to choose more easily according to global morbidity and mortality.

[Renal cell carcinoma of patients younger than 40 years old]. / Le carcinome à cellules rénales du sujet de moins de 40ans.

CONTEXT: Clinical and pathological characteristics of renal cell carcinoma (RCC) of patients younger than 40 years old are not well known. The objective of this study was to analyze these characteristics by comparison to a group of patients aged 58 to 62. METHODS: Retrospective study of a group of patients aged less than 40 years old (group 1, n=44) and a group of patients aged 58 to 62 years old (group 2; n=106) treated surgically for a renal mass from January 2000 to July 2009. A comparative analysis of clinical, pathological characteristics and of cancer-specific survival was performed. Specific survival was calculated with the Kaplan-Meier method and compared with the Log-Rank test. Univariate and multivariable analysis were performed to assess and quantify the effect of age on cancer-specific survival. Covariates were gender, age group, tumor size, pT stage, histological sub-type and Fuhrman grade. RESULTS: Clinical and pathological characteristics were similar in both groups (P>0.05) except for histological sub-type (56% of clear cell RCC for group 1 versus 82% for group 2). In the group of patients younger than 40 years, translocation RCC represented 23% of all RCCs. Cancer-specific survival at five years was similar in both groups (80% and 76% for group 1 and 2 respectively, P>0.58). Fuhrman grade was the only independent prognostic factor of cancer-specific survival (P=0.001). CONCLUSION: Patients younger than 40 years were more likely to have a translocation RCC than their older counterparts for who clear cell RCC represented the main histological sub-type. Cancer-specific survival was similar between both groups. Only a systematic specific immunostaining for TFE3 or TFEB will allow to assess the exact incidence and prognosis of this entity.