Long-term oncological outcomes of cystic renal cell carcinoma according to the Bosniak classification.

OBJECTIVES: To evaluate the prognostic role of the Bosniak classification on the long-term oncological outcomes of cystic renal cell carcinomas. MATERIAL AND METHOD: In a national multicentric retrospective study, we included patients treated surgically for localized cystic RCC from 2000 to 2010. Patients with a follow-up of less than 4 years, benign tumors, and ablative treatments were excluded. The primary outcome was disease-free survival. RESULTS: 152 patients met the inclusion criteria: Bosniak II (6%), III (53%), IV (41%), with a median follow-up of 61 (12-179) months. Characteristics of the population and the tumors were [median, (min-max)] age 57 (25-84) years old, tumor size 43 mm (20-280), RENAL score 7 (4-12), PADUA score 8 (5-14). Treatments were 55% partial nephrectomy, 45% radical nephrectomy, 74% open surgery, and 26% laparoscopy. In pathological report, cystic RCC were mainly of low grade (1-2, 77%) and low stage (pT1, 81%). The two main histological subtypes were conventional (56%) and papillary (23%) RCC. Staging at presentation and histological characteristics were similar between Bosniak III and IV, except for high grade which was more common in Bosniak IV (12 vs 36%, p < 0.01). The Bosniak classification was not predictive of the recurrence, as 5- and 10-year disease-free survival were similar in Bosniak III and IV (92% vs 92% and 84% vs 83%, p = 0.60). CONCLUSION: The Bosniak classification is predictive of the risk of malignancy but not of the oncological prognosis. Regardless of the initial Bosniak categories, almost all cystic RCCs were of low stage/grade and had low long-term recurrence rate.

Open prostatectomy versus 180-W XPS GreenLight laser vaporization: Long-term functional outcome for prostatic adenomas>80 g.

INTRODUCTION: GreenLight photoselective vaporisation of the prostate (PVP) offers an endoscopic alternative to open prostatectomy (OP) for treatment of large adenomas. This study compares long-term functional outcome of both techniques in patients with Benign prostatic obstruction (BPO)>80g. MATERIAL AND METHOD: Data from patients who underwent surgical treatment for BPO>80g from January 2010 to February 2015 at our institution were retrospectively collected and compared according to surgical technique. Patient's demographics, surgeon's experience, operative data and long-term functional results were analyzed, using IPSS and International continence society (ICS) male questionnaire associated with Quality of life scores (IPSS-QL and ICS-QL). Predictors of long-term outcome were also assessed. RESULTS: In total, 111 consecutive patients, 57 PVP and 54 OP, were included in the study with a mean follow-up of 24 and 33 month respectively. Patient's age, Charlson score, preoperative IPSS and urinary retention rates were similar. Mean prostatic volume was superior in the OP group (142 versus 103g, P<0.001). Transfusion rate was lower after PVP (P=0.02), despite a more frequent anticoagulant use. Length of hospital stay and urinary catheterization were shorter after PVP (P<0.001), with however a higher rate of recatheterization (RR=4.74) and rehospitalization (RR=10.42). Long-term scores were better after OP for IPSS (1 versus 5, P<0.001), IPSS-QL, ICS, ICS-QL. On multivariate analysis, prostatic residual volume was the only predictor of long-term IPSS but not ICS. CONCLUSION: Long-term functional outcome are better after OP compared to PVP. However, PVP offers good results, allowing to safely operate patients taking anticoagulants, regardless of prostatic volume. Endoscopic enucleation may the compromise between both techniques. LEVEL OF EVIDENCE: 4.