RESUMO
INTRODUCTION: Classification TNM 1997 defines renal cell carcinoma smaller than 7 cm and confined to the kidney as stage T1. Our goal is to discuss if tumors smaller than 4 cm have the same behavior characteristics then tumors between 4 and 7 cm, to compose the same stage of the disease. MATERIALS AND METHODS: Retrospective assessment of 138 patients in stage T1 (TNM - 97), divided into 2 groups; group-1: composed of 65 patients (47 percent) with tumors < 4 cm, and group-2: composed of 73 patients (53 percent) with tumors between 4 and 7 cm. The following prognostic factors were assessed in the recurrence of the disease and survival of patients: nuclear degree, microvascular invasion, sarcomatous degeneration, and involved lymph nodes. Statistical evaluation has been accomplished through the log rank test, chi-square test, and Fishers exact text. RESULTS: Average tumor size was 2.5 cm for group-1, and 5.3 cm for group-2. In group-2, there was the predominance of worse prognostic factors, with high-grade tumors (p = 0.01) and presence of microvascular invasion (p = 0.001). Sarcomatous tumors and involvement of lymph nodes did only happen in group-2. Disease-free survival for group-1, analyzed in the median period of 36 months, was 100 percent, and for group 2, in the median period of 31 months, was 81 percent (p = 0.008). CONCLUSION: The results obtained allow the conclusion that the present stage T1 for renal cell carcinoma gathers tumors of different evolution, being therefore recommendable the stratification in T1a for tumors smaller than 4 cm, and T1b for tumors between 4 and 7 cm
RESUMO
INTRODUCTION: Classification TNM 1997 defines renal cell carcinoma smaller than 7 cm and confined to the kidney as stage T1. Our goal is to discuss if tumors smaller than 4 cm have the same behavior characteristics then tumors between 4 and 7 cm, to compose the same stage of the disease. MATERIALS AND METHODS: Retrospective assessment of 138 patients in stage T1 (TNM - 97), divided into 2 groups; group-1: composed of 65 patients (47%) with tumors < 4 cm, and group-2: composed of 73 patients (53%) with tumors between 4 and 7 cm. The following prognostic factors were assessed in the recurrence of the disease and survival of patients: nuclear degree, microvascular invasion, sarcomatous degeneration, and involved lymph nodes. Statistical evaluation has been accomplished through the log rank test, chi-square test, and Fisher's exact text. RESULTS: Average tumor size was 2.5 cm for group-1, and 5.3 cm for group-2. In group-2, there was the predominance of worse prognostic factors, with high-grade tumors (p = 0.01) and presence of microvascular invasion (p = 0.001). Sarcomatous tumors and involvement of lymph nodes did only happen in group-2. Disease-free survival for group-1, analyzed in the median period of 36 months, was 100%, and for group 2, in the median period of 31 months, was 81% (p = 0.008). CONCLUSION: The results obtained allow the conclusion that the present stage T1 for renal cell carcinoma gathers tumors of different evolution, being therefore recommendable the stratification in T1a for tumors smaller than 4 cm, and T1b for tumors between 4 and 7 cm.
RESUMO
OBJECTIVE: An attempt is made to evaluate the incidence of prostate cancer in patients who have previously undergone a kidney transplant surgery and to determine the best therapeutic approach to this target group. MATERIAL AND METHODS: All kidney transplant male patients over 40 years of age were studied with respect to diseases unrelated to the transplants, which later affected them, mainly focusing on neoplastic disease and, more specifically, prostate cancer. RESULTS: Of 397 kidney-transplanted patients, 146 (37%) were males, at least 40 years old. Among the 10 of them (6.8%) who developed neoplastic diseases, there were two cases (1.4%) of prostatic cancer. Both were treated with a radical retropubic prostatectomy with no technical difficulty, in spite of the presence of a graft in one of the iliac fossa. CONCLUSIONS: Prostate cancer incidence in kidney transplant patients is still low (1.8%), but it will certainly heighten as transplants are performed in increasingly older people and as better immunosuppressive drugs are introduced to lengthen the survival of grafts and patients. Because these cancers are expected to be more aggressive as a consequence of continuous immunosuppression, early diagnosis is of critical importance, and those patients should be made aware of the need for frequent screening for prostate cancer.