suPARnostic: an advanced predictive tool for detecting recurrence in renal cell carcinoma.

BACKGROUND: Plasma soluble urokinase-type Plasminogen Activator Receptor (suPAR) predicts disease aggressiveness in renal cell carcinoma (ccRCC), but its prognostic accuracy has not been investigated. To investigate the prognostic accuracy of preoperative plasma suPAR in patients who received curative treatment for initially localized ccRCC. METHODS: We retrospectively analyzed plasma samples stored in the Danish National Biobank between 2010 and 2015 from 235 patients with ccRCC at any stage. Relationships with outcome analyzed using univariate and multiple logistic Cox regression analysis. RESULTS: There were 235 patients with ccRCC. The median follow-up period was 7.7 years. In univariate analysis suPAR ≥ 6 ng/mL was significantly associated with overall survival (OS) and recurrence-free survival (RFS). Patients with elevated suPAR were more likely to recur, with a Hazard Ratio (HR) of 2.3 for RFS. In multiple logistic regression, suPAR ≥ 6 ng/mL remained a negative predictor of OS and RFS. Limitations include retrospective study design, wide confidence intervals, and tumor subtype heterogeneity bias. CONCLUSIONS: ccRCC patients with high plasma suPAR concentrations are at an elevated risk of disease recurrence and see lower OS. suPAR is a promising surveillance tool to more precisely follow up with ccRCC patients and detect future recurrences. In this study, we showed that new type of liquid marker in blood plasma, called suPAR, is associated to a higher risk of kidney cancer recurrence when elevated above 6ng/mL. We also showed suPAR to independently be able to predict patients overall and recurrence free survival in patient with any stage of kidney cancer.

The Prognostic Impact of the Surgical Margin in Renal Cell Carcinoma Treated with Partial Nephrectomy: A Multi-Center Study.

Background: Partial nephrectomy (PN) is the preferred treatment for small, localized kidney tumors. Incomplete resection resulting in positive surgical margins (PSM) can occur after PN. The impact of PSM on the risk of recurrence and survival outcomes is not fully understood. We aimed to explore the relationship between PSM, the risk of recurrence and impact on survival after PN in a large multicenter cohort from Denmark. Methods: This was a retrospective cohort study including patients who underwent PN for renal cell carcinoma (RCC) at three departments in Denmark between 2010 and 2016. Data including pathological features, surgical techniques, and patient follow-up was retrieved from electronic medical health records and national databases. We used a combination of descriptive statistics, comparative analysis (comparisons were carried out by Mann-Whitney Test, independent Student's t-test, or Pearson's chi-Square Test), univariate and multivariate logistic regression analyses, and survival analysis methods. Results: A total of 523 patients were included, of which 48 (9.1%) had a PSM. Recurrence was observed in 55 patients (10.5%). Median follow-up time was 75 months. We found a lower incidence of PSM with robot-assisted PN (p = 0.01) compared to open or laparoscopic PN. PSM was associated with a higher risk of recurrence compared to negative margins in univariate analysis, but not multivariate analysis. However, the study was underpowered to describe this association with other risk factors. Overall survival did not differ between patients with PSM and negative margins. Conclusions: Our study presents further evidence on the negative impact of PSM on recurrence after PN for RCC, highlighting the importance of achieving NSM, thus potentially improving clinical outcomes. A surgical approach was found to be the only predictive factor influencing the risk of PSMs, with a reduced risk observed with robot-assisted laparoscopy.

Unilateral Ultrasound-Guided Transversus Abdominis Plane Block After Nephrectomy; Postoperative Pain and Use of Opioids.

BACKGROUND: Pain has a wide spectrum of effects on the body and inadequately controlled postoperative pain may have harmful physiologic and psychological consequences and increase morbidity. In addition, opioid anesthetic agents in high doses can blunt endocrine and metabolic responses following surgery and are associated with side effects including dizziness, nausea, vomiting, constipation, and respiratory depression. OBJECTIVES: The current study aimed to investigate if unilateral ultrasound-guided transverse abdominal plane block (TAP-block) could reduce pain and postoperative use of patient requested analgesics following nephrectomy compared to local injection of the same ropivacaine dose in the surgical wound. PATIENTS AND METHODS: Retrospective chart reviews were performed in 42 consecutive patients who received TAP-block in conjunction with nephrectomy from November 2013 to August 2014 (group A). For comparison, data were used from 40 other nephrectomy patients registered as part of a previous study (group B). In this group the patients had received local ropivacaine injection in the surgical wound. On univariate analyses, the groups were compared by t-test and the Fisher exact test. Multivariate analyses were conducted by multiple linear regression. RESULTS: Mean surgical time was 162 minutes in group A and 92 minutes in group B (P < 0.0001). The means of visual analogue scale (VAS) were 3.05 and 1.55 in A and B groups, respectively (P = 0.001). The means of morphine consumption were 5.2 mg and 5.9 mg in groups A and B, respectively (P = 0.58); while the means of sufentanil use were 9.8 µg and 6.0 µg in groups A and B, respectively (P = 0.06). When controlling for age, tumor size and American society of anesthesiologists classification (ASA) score on multivariate analysis, TAP-block was associated with a significant increase in VAS (+1.4 [95% CI, 0.6 - 2.3], P = 0.001) and sufentanil use (+6.2 µg [95% CI, 2.3 - 10.2], P = 0.003). There was no difference in morphine use on multivariate analysis (P = 0.99). CONCLUSIONS: TAP-block in conjunction with laparoscopic nephrectomy did not reduce pain or opioid consumption. On the contrary, it seemed to prolong surgical time.

Recurrence rates and survival in a Danish cohort with renal cell carcinoma.

INTRODUCTION: Patients with localised and locally advanced renal cancer experience about 20% recurrence during a five-year follow-up period. The aim of the present study was to report recurrence rates and survival in a Danish population with renal cancer. METHODS: Data on patients diagnosed with renal cell carcinoma (RCC) at our institute from January 2005 to December 2013 were collected retrospectively. RESULTS: Overall, 367 patients were diagnosed with RCC during the period, and 78 patients (21%) presented with metastasis. The mean follow-up period for all patients was 41 months (standard deviation = 29, 95% confidence interval: 38-44). The total recurrence rates (RRs) at one, three and five years were 4.5%, 13.5% and 22.3%, respectively. Overall survival rates in the patients who underwent surgery with localised and locally advanced disease were 96.1%, 88.2% and 78.3% for one, three and five years, respectively. The mean time to first recurrence was 26.6 months. The one-year RR was 1.2%, 5.5% and 13.8% for low, intermediate and high-risk Leibovich scores, respectively. The three-year RR was 8.3%, 14.1% and 29.6% for low, intermediate and high-risk Leibovich scores, respectively; and the five-year RR was 12.0%, 26.6% and 52.9% for low, intermediate and high-risk Leibovich scores, respectively. CONCLUSIONS: RRs after localised and locally advanced RCC was 22%. According to the risk of recurrence, we recommend a follow-up programme after nephrectomy with computed tomography every second year for low-risk patients, annually for intermediate-risk patients and every six months for high-risk patients. FUNDING: none. TRIAL REGISTRATION: none.

[Breast carcinoma metastasis to the gastrointestinal tract and tumour-to-tumour metastasis to renal cell carcinoma]. / Mammakarcinom med metastase til ventriklen og tumor til tumor-metastase til renalcellekarcinom

Breast carcinoma metastasis to the gastrointestinal tract and tumour-to-tumour metastasis is rare. We describe a case of a 71-year-old woman with previous breast cancer presenting with dyspepsia, nausea and weight-loss. Biopsies from the pylorus revealed what appeared to be a gastric carcinoma. A CT scan showed large kidney mass and biopsies revealed clear cell renal cell carcinoma with areas of poorly differentiated adenocarcinoma. Subsequent immunohistochemical analysis revealed the presence of breast carcinoma in both locations.

[Emphysematous pyelonephritis in a non-diabetic patient with a kidney tumour]. / Emfysematisk pyelonefritis hos en patient med nyretumor og uden diabetes

Emphysematous pyelonephritis (EPN) is a potentially life-threatening infection, where gas produced by bacteria accumulates in the kidney and the surrounding tissue. Although EPN usually presents in diabetic women, it is also associated with urinary tract obstruction and kidney tumours in non-diabetic patients. We present a case of EPN in a non-diabetic patient with a known kidney tumour, successfully treated with double-J catheter, antibiotics and delayed nephrectomy.

Eosinophilic cystitis: three cases, and a review over 10 years.

Eosinophilic cystitis (EC) is a rare disease. We describe three cases, where presentations of the disease are similar. To highlight probable causes of the disease, symptoms, clinical findings and treatment modalities, we reviewed 56 cases over a 10-year period. The most common symptoms were frequency, dysuria, urgency, pain and haematuria. Common clinical findings were presence of bladder mass, peripheral eosinophilia and thickened bladder wall. A variety of medical treatments were used, most frequently steroids, antibiotics and antihistamines. Recurrence occurred in patients on tapering or discontinuing prednisone, among other reasons. There is no consensus about the treatment of EC, but In light of our findings in this review, the treatment of choice in our department will be tapered prednisone over 6-8 weeks in combination with antihistamine.

[Fallopian tube prolapse and Chlamydia peritonitis after vaginal hysterectomy]. / Tubaprolaps og klamydiaperitonitis efter hysterektomi.

Fallopian tube prolapse and tuboovarian abscess are both uncommon complications to hysterectomy. A 42 year-old woman who had undergone vaginal hysterectomy two years prior, presented with pain, fever, and tender polyp-like mass in the vaginal vault and pelvic mass. Surgery revealed a tuboovarian abscess. A histological examination of the mass excised from the vaginal vault confirmed presence of fallopian tube epithelium. A polymerase chain reaction analysis of the peritoneal fluid revealed the presence of Chlamydia.