Comparison of aggressiveness in central versus peripheral T1a clear-cell renal cell carcinoma.

PURPOSE: This study aimed to estimate the difference between peripheral and central small renal lesions in terms of their oncologic potential. METHODS: Cross-sectional retrospective analysis of patients with small renal masses (T1a) who underwent surgical treatment between January 2008 and July 2019 at the affiliated hospital. Only patients with ccRCC pathology were included. Cases were divided into 2 groups depending on tumor location (central or peripheral) based on the R.E.N.A.L and local nephrometry scoring. Presence of nodal involvement, distant metastases, ISUP grade and endophytic growth were defined as aggressiveness predictors. Statistical analyses was performed using a standard statistical software (IBM SPPS Statistics Ver. 22), with P < 0.05 considered statistically significant. Associations between tumor location and Fuhrman grade, exo-/endophytic growth, TNM classification, and type of operation were tested using the Pearson χ² test and 1-way ANOVA test. RESULTS: Patients with centrally located tumors had a higher incidence of clinical and pathological lymph node involvement (P = 0.02, χ2 = 5.1). Patients in both groups had an equal number of distant metastases at the time of diagnosis (P = 0.3, χ2 = 0.8). The operation time was significantly longer in patients with central lesions, which obviously showed higher tumor complexity in this group (P < 0.005). Pathological evaluation revealed differences between ISUP grades in both groups (P < 0.005, χ2 = 29.9). Central masses were characterized by higher aggressiveness, indicating a worse prognosis. Furthermore, the cases in the first group were more often endophytic (P = 0.03, χ2 = 0.9). Nevertheless, this did not affect the surgical strategy in most cases with a tendency toward partial nephrectomy. Eventually, organ-sparing treatment was preferable in both groups (P = 0.13, χ2 = 2.29). CONCLUSION: Centrally located kidney cancer has showed in present study a higher incidence of high ISUP grade, regional nodal involvement and endophytic growth type. Endophytic growth type was associated with worse ISUP grading. Distribution of ISUP grade was not age depended, thus showing no difference by this criterion, when comparing different age groups. Higher ISUP grade was strongly associated with presence of distant metastases in T1a kidney tumors. Further analysis is needed to investigate aggressiveness of centrally located T1a RCC, as it may influence current conservative management options.

Advantages of organ-sparing treatment approaches in metastatic kidney cancer.

PURPOSE: This study analyzed oncological outcomes of patients with metastatic clear-cell renal cell carcinoma (ccRCC) treated with cytoreductive partial nephrectomy or nephrectomy. METHODS: This prospective non-randomized cohort study included 109 patients with metastatic ccRCC who underwent surgical treatment between 2011 and 2020. Patients were stratified into cytoreductive partial nephrectomy or nephrectomy groups. Survival curves were estimated, and Cox-regression analysis was performed to identify factors affecting potential lethality. RESULTS: The groups differed significantly in terms of T stage and International metastatic RCC database consortium (IMDC) risk groups, but not international society of urological pathology (ISUP) grading. The average blood loss volume was higher in the partial nephrectomy group. In contrast, the duration of post-operative stay, complication rate; and 30-day hospital readmission rate were similar between two groups. There was a significant difference in overall survival in favor of the partial nephrectomy group, who had better 7-year survival rates. Standardization based on the clinical complexity of the patients showed that cytoreductive partial nephrectomy was associated with a lower risk of death compared to nephrectomy. CONCLUSION: Partial nephrectomy is a safe method of choice in patients with metastatic ccRCC. Kidney preservation in a metastatic setting can play a role in reducing potential adverse systemic therapy events and in decreasing the risk for concomitant pathology deterioration.

Immune Microenvironment of Muscular-Invasive Urothelial Carcinoma: The Link to Tumor Immune Cycle and Prognosis.

In this study, we investigated the relationship between the tumor immune microenvironment (TIME), histological differentiation and hypoxia in patients with muscular-invasive urothelial carcinomas (MIUC) after radical cystectomy. Forty-two cases of pT2-3N0M0 MIUCs underwent clinical, histological and immunohistochemical evaluation by counting CD8+, FOXP3+, CD68+, CD163+ cells and polymorphonuclear leukocytes (PMN) in intra-tumoral and peritumoral areas, assessing PD-L1 and GLUT1 expression for defining the impact of tumor immune contexture on patients' outcomes. Five-year survival rates and overall survival were calculated. Most of the MIUCs demonstrated the immune-desert or immune-excluded TIME, reflecting altered mechanisms of T-cells' activation or traffic into tumors. Tumor immune contexture was closely related to histological differentiation. CD8+ cells were scant in MIUCs with papillary and squamous differentiation, while basal-like or mesenchymal-like histological differentiation was associated with increased density of CD8+ cells. A high rate of PD-L1 expression (47.6%) was not related to immune cell infiltration. M2-macrophages predominated under CD8+ lymphocytes. The abundance of PMN and CD163+ macrophages in MIUCs was associated with high GLUT1 expression. CD8+, CD68+, FOXP3+ cells and PD-L1 status did not affect patients' outcomes, while high CD163+ density and PMN infiltration were associated with the unfavorable outcome of patients with MIUC. These data drive the hypothesis that in MIUC, immune escape mechanisms are shifted towards the role of the innate immunity cells rather than CD8+ lymphocytes' functioning.

Transperitoneal uretercutaneostomy with use of mesosigmoid colon peritoneum in patients with bladder cancer after radical cystectomy.

OBJECTIVE: The aim of the study was to we describe the new surgical approach of constructing single site transperitoneal cutaneostomy with the use of sigmoid colon accompanied by skin modified fixation technique and its clinical outcomes. PATIENTS AND METHODS: Materials and methods: 89 patients were included in a single center study from January 2015 to May 2019. All patients underwent single-site modified transperitonial ureterocutanesotomy. Clinical and surgical data were analyzed. Statistical analyses were performed using SPSS 22.0. RESULTS: Results: Majority of the patients had a low performance status and rationale for cystectomy was palliative cytoreduction. Almost half of the patients had upper tract obstruction at diagnosis with 40% of patients presenting with a decreased kidney function. Surgical procedure was safe taking to account locally advanced. All the surgeries were performed with acceptable complications rate. Blood loss didn't exceeded 1000 ml and median operation time was 194 minutes. Early and late postoperative complications were analyzed and stomal stenosis that needed continuous restenting or reoperation was seen in 20% of cases. CONCLUSION: Conclusions: Single-site modified transperitonial ureterocutanesotomy is safe and effective surgical approach with acceptable complication rates and duration. Such surgery may be used as a major urinary diversion approach in advanced bladder cancer patients with severe symptoms and low-performance status. Further external validation studies needed to evaluate efficacy of the proposed technique.