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1.
Urologia ; 88(1): 3-8, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33632087

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic has dramatically hit all Europe and Northern Italy in particular. The reallocation of medical resources has caused a sharp reduction in the activity of many medical disciplines, including urology. The restricted availability of resources is expected to cause a delay in the treatment of urological cancers and to negatively influence the clinical history of many cancer patients. In this study, we describe COVID-19 impact on uro-oncological management in Piedmont/Valle d'Aosta, estimating its future impact. METHODS: We performed an online survey in 12 urological centers, belonging to the Oncological Network of Piedmont/Valle d'Aosta, to estimate the impact of COVID-19 emergency on their practice. On this basis, we then estimated the medical working capacity needed to absorb all postponed uro-oncological procedures. RESULTS: Most centers (77%) declared to be "much"/"very much" affected by COVID-19 emergency. If uro-oncological consultations for newly diagnosed cancers were often maintained, follow-up consultations were more than halved or even suspended in around two out of three centers. In-office and day-hospital procedures were generally only mildly reduced, whereas major uro-oncological procedures were more than halved or even suspended in 60% of centers. To clear waiting list backlog, the urological working capacity should dramatically increase in the next months; delays greater than 1 month are expected for more than 50% of uro-oncological procedures. CONCLUSIONS: COVID-19 emergency has dramatically slowed down uro-oncological activity in Piedmont and Valle d'Aosta. Ideally, uro-oncological patients should be referred to COVID-19-free tertiary urological centers to ensure a timely management.


Assuntos
/epidemiologia , Continuidade da Assistência ao Paciente , Acesso aos Serviços de Saúde , Oncologia/estatística & dados numéricos , Pandemias , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologia/estatística & dados numéricos , Agendamento de Consultas , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Itália/epidemiologia , Neoplasias Renais/epidemiologia , Neoplasias Renais/cirurgia , Masculino , Oncologia/organização & administração , Utilização de Procedimentos e Técnicas , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/cirurgia , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/cirurgia , Neoplasias Urológicas/epidemiologia , Neoplasias Urológicas/cirurgia , Urologia/organização & administração
2.
JAMA Netw Open ; 4(1): e2021869, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33475752

RESUMO

Importance: There exists considerable biological and clinical variability between histologic variants of metastatic renal cell carcinoma (mRCC). Data reporting on patterns of metastasis in histologic variants of mRCC are sparse. Objective: To characterize sites of metastasis and their association with survival across the 3 most common histologic variants of mRCC: clear cell (ccRCC), papillary (pRCC), and chromophobe (chrRCC). Design, Setting, and Participants: In this multicenter, international cohort study, the International mRCC Database Consortium (IMDC) database was used to identify consecutive patients starting systemic therapy for mRCC between 2002 and 2019. Patients with mixed histologic subtype were excluded. Statistical analysis was performed from February to June 2020. Exposures: Data regarding histologic subtype and sites of metastatic involvement at the time of first systemic therapy initiation were collected. Main Outcomes and Measures: The primary outcomes were prevalence of metastatic site involvement and overall survival (OS) from time of systemic therapy initiation. Patients with multiple sites of metastatic involvement were included in analyses of all groups to which they had metastases. Results: A total of 10 105 patients were eligible for analysis. Median (interquartile range) age at diagnosis was 60 (53-67) years, 7310 (72.4%) were men and 8526 (84.5%) underwent nephrectomy. Of these, 9252 (92%) had ccRCC, 667 (7%) had pRCC, and 186 (2%) had chrRCC. The median number of sites of metastasis was 2 (range, 0-7). In ccRCC, the most common sites of metastasis were lung (70%; 6189 of 8804 patients [448 missing]), lymph nodes (45%; 3874 of 8655 patients [597 missing]), bone (32%; 2847 of 8817 patients [435 missing]), liver (18%; 1560 of 8804 [448 missing]), and adrenal gland (10%; 678 of 6673 patients [2579 missing]). Sites of metastasis varied between subtypes. Lung, adrenal, brain, and pancreatic metastases were more frequent in ccRCC, lymph node involvement was more common in pRCC, and liver metastases were more frequent in chrRCC. Median OS for ccRCC varied by site of metastatic involvement, ranging between 16 months (95% CI, 13.7-18.8 months) for the pleura and 50 months (95% CI, 41.1-55.5 months) for the pancreas. Compared with ccRCC, patients with pRCC tended to have lower OS, regardless of metastatic site. Conclusions and Relevance: Sites of metastatic involvement differ according to histologic subtype in mRCC and are associated with OS. These data highlight the clinical and biological variability between histologic subtypes of mRCC. Patterns of metastatic spread may reflect differences in underlying disease biology. Further work to investigate differences in immune, molecular, and genetic profiles between metastatic sites and histologic subtypes is encouraged.


Assuntos
Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Idoso , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/terapia , Estudos de Coortes , Feminino , Humanos , Neoplasias Renais/epidemiologia , Neoplasias Renais/terapia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Nefrectomia
3.
Maturitas ; 143: 190-196, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33308628

RESUMO

BACKGROUND: Many studies have reported a positive association between diabetes and kidney cancer. However, it is unclear whether diabetes is a risk factor for kidney cancer independent of other risk factors, such as obesity and hypertension. We comprehensively examined the association of diabetes and its duration with incident kidney cancer in the prospective cohort Iowa Women's Health Study (1986-2011). METHODS: Diabetes status was self-reported at baseline (1986) and on five follow-up questionnaires. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of baseline and time-dependent diabetes with the risk of incident kidney cancer. RESULTS: During the 25 years of follow-up, 245 cases of kidney cancer occurred among 36,975 post-menopausal women. In an age-adjusted model, there was a significant association between time-dependent diabetes and the risk of kidney cancer [HR (95% CI) = 1.76 (1.26, 1.45)]; the association was attenuated after multivariable adjustment for age, body mass index (BMI), waist-to-hip ratio (WHR), hypertension, physical activity, diuretic use, pack-years of smoking, alcohol intake, and total caloric intake [HR = 1.35 (0.94, 1.94)]. However, among non-obese women or women with a waist circumference less than 34.6 in., diabetes was significantly associated with kidney cancer risk: for time-dependent diabetes, HRs (95% CIs) were 1.82 (1.10, 3.00) among those with BMI < 30 kg/m2 and 2.18 (1.08, 4.38) among those with a waist circumference <34.6 in.. CONCLUSIONS: Our results suggest that diabetes is associated with kidney cancer risk among non-obese post-menopausal women.


Assuntos
Diabetes Mellitus/epidemiologia , Neoplasias Renais/epidemiologia , Pós-Menopausa , Idoso , Feminino , Humanos , Hipertensão/epidemiologia , Iowa/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estudos Prospectivos , Fatores de Risco , Fumar/epidemiologia , Circunferência da Cintura , Saúde da Mulher
4.
Rev. cuba. inform. méd ; 12(2): e386, tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144463

RESUMO

Una de las campañas más reconocidas en el mundo es la lucha contra el cáncer, siendo el sistema renal uno de los más afectados por esta patología. El carcinoma de células renales (CCR), el más común de cáncer renal en los adultos, representa la sexta causa de muerte por cáncer. Debido al aumento en el uso de las técnicas de diagnóstico por imagen, las lesiones renales pueden ser diagnosticadas en forma incidental aproximadamente en 50% de los casos. Cuba apuesta por el uso de la tecnología en la salud y en la Universidad de las Ciencias Informáticas (UCI) se ha desarrollado un sistema para el almacenamiento, transmisión y visualización de imágenes médicas (XAVIA PACS), el cual se encuentra implantado en varios hospitales del país, pero no cuenta con alternativas para realizar la detección del CCR en imágenes tomográficas, haciendo más lento el diagnóstico, lo que se traduce en menos posibilidades para el paciente. La presente investigación tiene como objetivo realizar un análisis sobre las principales técnicas de segmentación y procesamiento para la detección de carcinomas renales en imágenes de tomografías abdominal, que propicie a los equipos de desarrollo contar con la base teórica necesaria para enfrentar el problema en cuestión. Para ello se realizó un análisis documental sobre trabajos relacionados con la temática y que propician soluciones al problema. Se estudiaron algoritmos y técnicas computacionales efectivas para la segmentación y procesamiento de imágenes abdominales. Como resultado de la investigación se obtuvieron los algoritmos más acordes para el sistema XAVIA PACS y el contexto médico cubano(AU)


One of the most recognized campaigns in the world is the fight against cancer, the kidney system being one of the most affected by this pathology. Renal cell carcinoma (RCC), the most common form of kidney cancer in adults, represents the sixth leading cause of cancer death. Due to the increased use of diagnostic imaging techniques, kidney injuries can be diagnosed incidentally in approximately 50% of cases. Cuba is committed to the use of technology in health and a system for the storage, transmission and display of medical images (XAVIA PACS) has been developed at the University of Computer Sciences (UCI), which is implanted in several hospitals of the country, but it does not have alternatives to detect RCC in tomographic images, slowing down the diagnosis, which translates into fewer possibilities for the patient. The objective of this research is to carry out an analysis on the main segmentation and processing techniques for the detection of renal carcinomas in abdominal tomography images, which provides development teams with the theoretical basis necessary to face the problem in question. For this, a documentary analysis was carried out on works related to the subject and that provide solutions to the problem. Algorithms and effective computational techniques for the segmentation and processing of abdominal images were studied. As a result of the research, the most suitable algorithms for the XAVIA PACS system and the Cuban medical context were obtained(AU)


Assuntos
Algoritmos , Linguagens de Programação , Software , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Neoplasias Renais/epidemiologia , Neoplasias Renais/diagnóstico por imagem
5.
Zhonghua Zhong Liu Za Zhi ; 42(12): 1001-1006, 2020 Dec 23.
Artigo em Chinês | MEDLINE | ID: mdl-33342155

RESUMO

Objective: To estimate cancer incidence and mortality of kidney and unspecified urinary organs in China using cancer registry data in 2015. Methods: The cancer registry data from 501 local cancer registries in China were collected, checked and assessed based on the criteria of data quality control of the National Central Cancer Registry of China (NCCRC), and data from 368 registries were qualified for the analysis. Cancer incidence and mortality rates of kidney and unspecified urinary organs stratified by geographical location (eastern, middle, western areas), gender, age groups were calculated. Population data of 2015 was used to estimate the cancer cases and deaths of kidney and unspecified urinary organs in China. Chinese standard population in 2000 and Segi's world population were used for the calculation of age-standardized incidence and mortality rates. Results: A total of 74.2 thousand new cancer cases of kidney and unspecified urinary organs were diagnosed in 2015, 46.9 thousand of them were male, while 27.3 thousand were female, with a crude incidence rate of 5.40/10(5). The age-standardized incidence rates by Chinese (ASIRC) and world standard population (ASIRW) were 3.57/10(5) and 3.56/10(5), respectively. A total of 53.4 thousand and 20.8 thousand new cases were diagnosed in urban and rural area, with incidence rates of 6.93/10(5) and 3.45/10(5), respectively. The ASIRC of urban area was higher than that of rural area. There were 39.2 thousand, 20.6 thousand, and 14.4 thousand new cases diagnosed in eastern, middle, and western areas of China, respectively. The crude incidence rates were 7.60/10(5), 4.47/10(5), and 3.63/10(5), respectively, with a descend ASIRC of each area. A total of 27.1 thousand death cases reported, of them 16.9 thousand were male, while 10.2 thousand were female, with a crude mortality rate of 1.97/10(5), both of the ASIRC and ASMRW were 1.21/10(5). The deaths of urban and rural area were 19.5 thousand and 7.6 thousand cases, with the crude mortality rates of 2.53/10(5) and 1.26/10(5), respectively. The ASIRC of urban area was higher than that of rural area. There were 13.4 thousand, 8.4 thousand, and 5.1 thousand death cases reported in eastern, middle, and western areas, respectively, the crude mortality rates were 2.61/10(5), 1.83/10(5) and 1.30/10(5), respectively, with a descend ASIRC of each area. Conclusion: The disease burden of kidney cancer differs between urban area and rural area, and differs among eastern, middle, and western areas of China, therefore, different prevent and treatment strategies should be taken in different areas of China.


Assuntos
Neoplasias Renais , Neoplasias Urológicas , China/epidemiologia , Feminino , Humanos , Incidência , Neoplasias Renais/epidemiologia , Neoplasias Renais/mortalidade , Masculino , Sistema de Registros , Neoplasias Urológicas/epidemiologia , Neoplasias Urológicas/mortalidade
6.
Actas urol. esp ; 44(8): 554-560, oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197147

RESUMO

INTRODUCCIÓN: No están claramente definidos los patrones de recurrencia tras nefrectomía por cáncer renal. OBJETIVO: Evaluar patrones de recidiva en función del grupo de riesgo de recurrencia (GRR). MATERIAL Y MÉTODO: Análisis retrospectivo de 696 pacientes con carcinoma de células renales tratados con nefrectomía entre 1990-2010. Se definieron tres GRR según la presencia de variables anatomopatológicas (estadio pTpN, grado nuclear, necrosis tumoral [NT], diferenciación sarcomatoide [DS], margen de resección positivo [MR]): -GR bajo (GRB): pT1pNx-0 G1-4, pT2pNx-0 G1-2; no NT, DS y/o MR (+). -GR intermedio (GRI): pT2pNx-0 G3-4;pT3-4pNx-0 G1-2; GRB con NT. -GR alto (GRA): pT3-4pNx-0 G3-4; pT1-4pN+; GRI con NT y/o DS; GRB con DS y/o MR (+). Para el contraste de variables cualitativas se utilizó el test de la Chi cuadrado. El método de Kaplan-Meier se ha utilizado para evaluar la supervivencia libre de recidiva en función de los GRR. Para evaluar diferencias entre las curvas de supervivencia se ha utilizado el test de log-rank. RESULTADOS: La mediana de seguimiento fue de 105 (IQR 63-148) meses. Del total de la serie recidivaron 177 (25,4%) pacientes: 15,9% a distancia, 4,9% local y 4,6% a distancia y local. La tasa de recurrencia varió según el grupo de riesgo con tasas del 72,9% en GRA, 16,9% en GRI y 10,2% en GRB (p = 0,0001). La recurrencia en órgano único fue mayoritaria en el GRB (72,2%) (p = 0,006). El GRB presentó recidiva en forma de metástasis única en el 50% de los casos, frente al 30% y 18,6% en GRI y GRA, respectivamente (p = 0,009). Las localizaciones de recurrencia más habituales fueron pulmón y abdomen. La localización pulmonar predominó en el GRA (72,9%) (p = 0,0001) y la abdominal en el GRB (83,3%) con una tendencia a la significación (p = 0,15). CONCLUSIONES: A medida que aumenta el grupo de riesgo aumentan las recurrencias, sobre todo óseas y pulmonares. En el GRB son más frecuentes las metástasis únicas y en órgano único


INTRODUCTION: Recurrence trends after renal cell cancer nephrectomy are not clearly defined. OBJECTIVE: To evaluate recurrence trends according to recurrence risk groups (RRG). MATERIAL AND METHOD: Retrospective analysis of 696 patients with renal cell cancer treated with nephrectomy between 1990-2010. Three RRG were defined according to the presence of anatomopathological variables (pTpN stage, nuclear grade, tumor necrosis [TN], sarcomatoid differentiation [SD], positive resection margin [RM]): -Low RG (LRG): pT1pNx-0 G1-4, pT2pNx-0 G1-2; no TN, SD and/or RM (+). -Intermediate RG (IRG): pT2pNx-0 G3-4; pT3-4pNx-0 G1-2; LRG with TN. -High RG (HRG): pT3-4pNx-0 G3-4; pT1-4pN+; IRG with TN and/or SD; LRG with SD and/or RM (+). The Kaplan-Meier method has been used to evaluate recurrence-free survival as a function of RRG. The log-rank test was used to evaluate differences between survival curves. RESULTS: The median follow-up was 105 (IQR 63-148) months. Of the total series, 177 (25.4%) patients presented recurrence: distant 15.9%, local 4.9% and 4.6% distant and local. The recurrence rate varied according to the RRG with values of 72.9% for HRG, 16.9% for IRG and 10.2% for LRG (p=.0001). Most cases in LRG presented single organ recurrence (72.2%) (p=.006). The LRG experienced recurrence as single metastasis in 50% of cases, compared to 30% and 18.6% in IRG and HRG, respectively (p=.009). The most common sites of recurrence were lung and abdomen. Lung recurrence predominated in the HRG (72.9%) (p=.0001) and abdominal, in the LRG (83.3%) with a tendency to significance (p=.15). CONCLUSIONS: Recurrence rates (especially bone and lung) increase with higher RG. Single organ recurrences and single metastases are more frequent in LRG


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Carcinoma/cirurgia , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Recidiva Local de Neoplasia/epidemiologia , Estudos Retrospectivos , Carcinoma/patologia , Neoplasias Renais/patologia , Carcinoma/epidemiologia , Neoplasias Renais/epidemiologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Espanha/epidemiologia
7.
Actas urol. esp ; 44(7): 512-518, sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-199430

RESUMO

INTRODUCCIÓN Y OBJETIVOS: El objetivo primario del presente estudio es conocer la incidencia real de los tumores transicionales del tracto urinario superior (TTUS) en nuestro medio. MATERIAL Y MÉTODOS: Estudio epidemiológico prospectivo y multicéntrico desarrollado en 31 centros hospitalarios españoles a través de la Plataforma de Investigación de Estudios Multicéntricos (PIEM) de la Asociación Española de Urología (AEU). El reclutamiento se inició el 01 de mayo de 2017, finalizando el 30 de abril de 2018. La base de datos final incluyó 402 casos válidos. El manejo estadístico de los datos se realizó mediante el software SPSS V 23 y EPIDAT V 3.4. RESULTADOS: Incidencia ajustada por edad a la población española de 3,27 casos/100.000 habitantes/año (2,93-3,61, IC 95%); para la población europea fue de 3,3 (2,96-3,66, IC 95%). La edad media al diagnóstico fue de 70 años, siendo el 77% de los pacientes varones. El diagnóstico fue incidental en el 34% de los casos. La localización más frecuente fue la pielocalicial (54%), seguida por el uréter distal (22%). La ureterorrenoscopia previa al tratamiento definitivo se realizó en 114 pacientes, modificando la indicación inicial del tratamiento en el 58% de los casos. La nefrectomía radical fue el tratamiento empleado en 311 pacientes; en 76 casos (20% del total) el tratamiento fue conservador. Se registraron complicaciones en el 69% de los casos tratados, la mayoría Clavien 1 y 2 (86% de todas las complicaciones). La mortalidad postoperatoria global fue de 1,76%, asociada únicamente a la realización de nefroureterectomía. CONCLUSIONES: La incidencia ajustada por edad de los TTUS es de 3,27 en España y de 3,3 en Europa. La ureterorrenoscopia como elemento de diagnóstico permite modificar la indicación inicial del tratamiento en el 58% de los pacientes


INTRODUCTION AND OBJECTIVES: The incidence of upper urinary tract tumors is currently unknown. The aim of this study is to determine the real incidence of upper tract urothelial carcinoma (UTUC) in Spain. MATERIAL AND METHODS: A descriptive, prospective and multicenter epidemiological study was conducted in 31 Spanish facilities by means of the Platform for Multicenter Studies of the Spanish Association of Urology. Recruitment was opened from May 1st, 2017 to April 30th, 2018. The original database was exported directly from the electronic Data Collection Logbook on December 15th, 2018, with a total of 404 cases registered (402 valid cases after depuration). Statistical analysis was performed using IBM SPSS software V 23 and EPIDAT V 3.4. RESULTS: The incidence adjusted to Spanish population from raw data was 3.27 cases per 100.000 inhabitants per year (2.93 - 3.61 95% CI) and 3,3 cases per 100.000 inhabitants per year (2.96-3.66 95%CI) when adjusted to European population by age. The mean age at diagnosis was 70 years, and 77% of patients were male. Thirty-four percent of patients had an incidental diagnosis. Tumors were most commonly located in the pyelocalyceal system (54%), followed by the distal ureter (22%). Prior ureteroscopy was performed in 114 patients: this technique modified the subsequent treatment indication in 58% of cases. Radical nephroureterectomy was performed in 311 patients. Kidney-sparing surgery was the elected treatment in 76 patients (20%). Complications were found in 69% of cases, most of them classified as Clavien 1 and 2 (86% of all complications). Postoperative mortality rate was 1.7%. CONCLUSIONS: UTUC adjusted incidence rate in Spain is 3.27 and 3.3 in Europe. Prior URS modified the treatment indication in 18% of patients. We found a 69% complication rate and a 1.7% mortality rate


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/epidemiologia , Neoplasias Renais/epidemiologia , Neoplasias Ureterais/epidemiologia , Estudos Epidemiológicos , Incidência , Estudos Prospectivos , Espanha/epidemiologia
8.
Pediatr Infect Dis J ; 39(11): 1040-1042, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32773656

RESUMO

Since December 2019, severe acute respiratory syndrome coronavirus 2 infection has spread worldwide. We all are concerned about immunocompromised children, especially hematologic and oncologic pediatric patients. We want to share our experience with 2 pediatric cancer patients with severe acute respiratory syndrome coronavirus 2 infection. Both presented mild disease and good outcome. No respiratory symptoms were identified, but both developed diarrhea, one probably secondary to lopinavir/ritonavir. Pediatric cancer patients may have milder disease than adults, but larger studies are needed to make conclusions.


Assuntos
Infecções por Coronavirus/diagnóstico , Neoplasias Renais/virologia , Pneumonia Viral/diagnóstico , Sarcoma de Ewing/virologia , Tumor de Wilms/virologia , Adolescente , Betacoronavirus/isolamento & purificação , Criança , Pré-Escolar , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Diarreia/etiologia , Diarreia/virologia , Feminino , Humanos , Neoplasias Renais/epidemiologia , Lopinavir/uso terapêutico , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Ritonavir/uso terapêutico , Sarcoma de Ewing/epidemiologia , Espanha/epidemiologia , Tumor de Wilms/epidemiologia
9.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(6): 638-643, 2020 Jun 06.
Artigo em Chinês | MEDLINE | ID: mdl-32842279

RESUMO

Objective: To investigate the association between metabolic syndrome (MS) components and renal cell cancer in Chinese males. Methods: All male employees and retirees of the Kailuan Group were recruited in the Chinese Kailuan Male Cohort Study. They had been experienced routine physical examinations ever two years since May 2006. A total of 104 274 males were prospectively observed by 31 December 2015. Information on demographics, height, weight, blood glucose, blood lipid, blood pressure, as well as the information of incident renal cell cancer cases were collected at the baseline investigation by questionnaire, physical measurement and laboratory test. Cox proportional hazards regression models were used to evaluate the association between baseline MS and MS components (body mass index, blood glucose, blood lipid, blood pressure) and the risk of renal cell cancer in males. Results: A total of 104 274 males were recruited in our study with a age of (51.21±13.46) years, with 823 892.96 person-years follow-up and the median follow-up time was 8.88 years. A total of 131 new renal cell cancer cases were identified in the Kailuan male cohort study, and the crude incidence density was 15.90 per 100,000 person-years. Compared with no MS, the hazard ratios (HR) (95% CI) of MS was 1.97 (1.32-2.94).When compared with normal level, the HR (95%CI) of obesity or overweight, hypertension, and dyslipidemia was 1.49 (1.04-2.14), 1.56 (1.06-2.29), and 1.77(1.23-2.54), after adjusting for potential confounding factors (i.e., age, education, income, smoke, and alcohol drink), respectively. In addition, a statistically significant trend (P for trend<0.001) of increased renal cell cancer risk with an increasing number of abnormal MS components was observed. Conclusion: Obesity or overweight, hypertension, dyslipidemia and MS may increase the risk of renal cell cancer for Chinese males.


Assuntos
Carcinoma de Células Renais/epidemiologia , Neoplasias Renais/epidemiologia , Síndrome Metabólica/epidemiologia , Estudos de Coortes , Humanos , Incidência , Masculino , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
10.
Urol Clin North Am ; 47(3): 293-303, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32600532

RESUMO

In the preceding two decades, several milestones have been reached in the management of patients with metastatic renal cell carcinoma (mRCC), including the development of novel targeted agents paralleling an increased understanding of the molecular biology of this disease process. Recently, a renewed enthusiasm for immunotherapy in the form of immune checkpoint blockade has resulted in significant strides in the treatment of mRCC. Despite these advances, treatment remains challenging for clinicians, and only modest survival benefits are observed with current treatment paradigms. The risk-stratification tools and investigated predictive and prognostic biomarkers in patients with mRCC are detailed in this review.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Carcinoma de Células Renais/epidemiologia , Neoplasias Renais/epidemiologia , Biomarcadores/análise , Carcinoma de Células Renais/metabolismo , Humanos , Imunoterapia , Neoplasias Renais/metabolismo , Prognóstico , Medição de Risco
11.
Anticancer Res ; 40(7): 4087-4093, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620657

RESUMO

BACKGROUND/AIM: Hypertension is a risk factor for occurrence of renal cell carcinoma; however, it remains unclear whether hypertension affects development and prognosis of renal cell carcinoma. This study evaluated the impact of hypertension on the progression of renal cell carcinoma. PATIENTS AND METHODS: Renal cell carcinoma patients who were treated from October 2007 to December 2018 at our Institution were retrospectively analyzed. RESULTS: Of 462 patients, the number of patients with and without hypertension was 234 (including 227 treated with anti-hypertensive agents) and 228, respectively. The tumor size was significantly smaller in the hypertension group than in the non-hypertension group (median 32 and 45 mm, respectively, p=0.010). The 5-year cancer-specific and metastasis-free survival in the hypertension group were significantly better than those in the non-hypertension group (93.6% and 80.4%, and 84.6% and 73.0%, respectively, p=0.021 and p=0.017). Propensity score matching revealed significantly better metastatic-free survival in the hypertension group than the non-hypertension group (p=0.022). CONCLUSION: Renal cell carcinoma patients with hypertension show better prognosis with low metastasis possibility.


Assuntos
Carcinoma de Células Renais/epidemiologia , Hipertensão/epidemiologia , Neoplasias Renais/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Carcinoma de Células Renais/patologia , Progressão da Doença , Feminino , Humanos , Hipertensão/tratamento farmacológico , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Carga Tumoral , Adulto Jovem
12.
Eur Urol Focus ; 6(5): 1086-1096, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32540268

RESUMO

CONTEXT: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic that erupted in December 2019 has affected more than a million people from over 200 countries, claiming over 70 000 lives (by April 7, 2020). As the viral infection is driven by increased angiotensin-converting enzyme-2 (ACE2) expression, with the kidney exhibiting the highest expression, it is crucial to gain insights into the mechanisms underlying renal cell carcinoma (RCC) and coronavirus disease 2019 (COVID-19). OBJECTIVE: This study considers up-to-date information on the biological determinants shared by COVID-19 and renal disease, and aims to provide evidence-based recommendations for the clinical management of RCC patients with COVID-19. EVIDENCE ACQUISITION: A literature search was performed using all sources (MEDLINE, EMBASE, ScienceDirect, Cochrane Libraries, and Web of Science). As of March 31, 2020, the Center for Disease Control reported that of the adults hospitalized for COVID-19 with underlying conditions in the USA, 74.8% had chronic renal disease. EVIDENCE SYNTHESIS: Evidence is discussed from epidemiological studies on SARS-CoV-2 pandemic and molecular studies on the role of kidney in facilitating routes for SARS-CoV-2 entry, leading to increased virulence of SARS-CoV-2 and clinical manifestation of symptoms in RCC. CONCLUSIONS: This analysis will advance our understanding of (1) the molecular signatures shared by RCC and COVID-19 and (2) the clinical implications of overlapping signaling pathways in the therapeutic management of RCC and COVID-19 patients. PATIENT SUMMARY: Amid the coronavirus disease 2019 (COVID-19) pandemic, patients diagnosed with renal cell carcinoma and infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may receive complimentary treatment modalities to enhance therapeutic response.


Assuntos
Betacoronavirus/metabolismo , Carcinoma de Células Renais/metabolismo , Infecções por Coronavirus/metabolismo , Neoplasias Renais/metabolismo , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/metabolismo , Insuficiência Renal Crônica/metabolismo , Glicoproteína da Espícula de Coronavírus/metabolismo , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/metabolismo , Lesão Renal Aguda/terapia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anticorpos Neutralizantes/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Antivirais/uso terapêutico , Carcinoma de Células Renais/epidemiologia , Comorbidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Antagonistas dos Receptores de Endotelina/uso terapêutico , Hospitalização , Humanos , Ipilimumab/uso terapêutico , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/epidemiologia , Biópsia Líquida , Nivolumabe/uso terapêutico , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Inibidores de Proteínas Quinases/uso terapêutico , Diálise Renal , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Serina Endopeptidases/metabolismo , Índice de Gravidade de Doença , Sunitinibe/uso terapêutico
14.
Gene ; 754: 144839, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32504654

RESUMO

Wilms tumor is the most frequently occurring pediatric renal malignancy. Wilms tumor suppressor-1-associated protein (WTAP) is a vital component of N6-methyltransferase complex involved in tumorigenesis. However, the roles of WTAP gene single nucleotide polymorphisms (SNPs) in Wilms tumor risk have not been clarified to date. We successfully genotyped three WTAP gene SNPs using TaqMan assay in 405 Wilms tumor patients and 1197 cancer-free controls of Chinese children. Odds ratios (ORs) and 95% confidence intervals (CIs) were applied to determine the effects of WTAP gene SNPs on Wilms tumor risk. Carriers of the rs1853259 G variant are less susceptible to developing Wilms tumor, with an adjusted OR of 0.78 (AG vs. AA: 95% CI = 0.61-0.995, P = 0.046). Single locus analysis of rs9457712 G > A and rs7766006 G > T, as well as the combined analysis of risk genotypes, failed to unveil an association with Wilms tumor risk, respectively. Stratified analysis of the three SNPs and their combined risk effects showed more significant relationships with Wilms tumor risk under certain subgroups. In all, we found weak evidence of the association between WTAP gene SNPs and the risk of Wilms tumor. Further replication studies with greater sample size and different ethnicities are necessary to verify our findings.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Proteínas de Ciclo Celular/genética , Transformação Celular Neoplásica/genética , Neoplasias Renais/genética , Polimorfismo de Nucleotídeo Único , Fatores de Processamento de RNA/genética , Tumor de Wilms/genética , Estudos de Casos e Controles , Transformação Celular Neoplásica/patologia , China/epidemiologia , Feminino , Seguimentos , Predisposição Genética para Doença , Genótipo , Humanos , Lactente , Neoplasias Renais/epidemiologia , Neoplasias Renais/patologia , Masculino , Prognóstico , Tumor de Wilms/epidemiologia , Tumor de Wilms/patologia
15.
Eur Urol ; 78(2): 276-280, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32534910

RESUMO

Preliminary data suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with higher mortality among cancer patients, particularly in those on systemic therapy. It is unclear whether this applies to patients receiving immune checkpoint inhibitors (ICIs). In this case series, 74 patients from a single institution with genitourinary (GU) cancer on ICI were followed up during a 12-wk period. During this period, 11 patients (15%) developed symptoms consistent with coronavirus disease 2019 (COVID-19) and four (5%) tested positive. Two patients had metastatic urothelial cancer (treated with atezolizumab) and two had metastatic renal cancer (treated with ipilimumab and nivolumab). All had additional risk factors associated with COVID-19 mortality and two received steroids within 1 mo of infection. Two patients developed symptoms requiring hospitalisation. All four are alive 32-45 d after their first symptoms and 28-38 d after testing positive. These patients all had multiple risk factors associated with severe COVID-19. These data suggest that the higher risk of COVID-19 death associated with systemic therapy in cancer may not apply to patients on ICIs. Assessment of COVID-19 severity in these patients can be complicated by the underlying cancer and its treatment.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Fatores Imunológicos/uso terapêutico , Neoplasias Renais/tratamento farmacológico , Pneumonia Viral/complicações , Idoso , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Feminino , Seguimentos , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
16.
Isr Med Assoc J ; 22(5): 285-288, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32378819

RESUMO

BACKGROUND: Heart transplantation (HT) success rate is limited by a high incidence of cancer post-HT. Data on kidney cancer following solid organ transplantation, especially HT, are limited, and only a few cases have been reported. OBJECTIVES: To report a unique case series of detected kidney cancer following HT. METHODS: Between 1997 and 2018, 265 patients who underwent HT were enrolled and prospectively followed in the HT registry of the Sheba Medical Center. RESULTS: The series included 5 patients, 4 men and a woman (age range 35-50 years at HT). The patients were diagnosed with kidney tumors 6-11 years after HT (age range at diagnosis 40-72 years). Two of the men were identical twin brothers. At HT four patients received induction therapy with anti-thymocyte globulin and all received an initial immunosuppressive regimen based on cyclosporine. All male HT recipients had a history of heavy smoking. Two male patients developed allograft vasculopathy, but all had preserved heart function. The 72-year-old woman developed a kidney tumor of the native kidney 5 years after re-HT and kidney transplantation. Two patients had features of multifocal papillary renal cell carcinoma (RCC) and eventually underwent bilateral nephrectomy, while another patient underwent left partial nephrectomy with preserved renal function. CONCLUSIONS: To the best of our knowledge, this is the first case series study describing kidney tumors following HT. With the improving outcomes and life expectancy of HT patients, a better understanding of the factors that determine cancer risk is of the utmost importance and may have a major impact on the non-cardiac surveillance.


Assuntos
Transplante de Coração , Neoplasias Renais/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
17.
Cancer Epidemiol ; 66: 101706, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32247207

RESUMO

INTRODUCTION: Wilms' tumor is the most frequently diagnosed renal tumor in children. Little is known about its etiology. The aim of this study was to investigate the potential role of specific exposures related to parental habits such as parental smoking, maternal alcohol consumption and the use of household pesticides during pregnancy. METHODS: The ESTELLE study was a nationwide case-control study that included 117 Wilms' tumor cases and 1100 control children from the general French population, frequency-matched by age and gender. Unconditional logistic regression was used to estimate odds ratios and 95 % confidence intervals. RESULTS: After controlling for matching variables and potential confounders, the maternal use of any type of pesticide during pregnancy was associated with the risk of Wilms' tumor in children (OR 1.6 [95 % CI 1.1-2.3]). Insecticides were the most commonly reported type of pesticide and there was a positive association with their use (OR 1.7 [95 % CI 1.1-2.6]. The association was stronger when they were used more often than once a month (OR 1.9 [95 % CI 1.2-3.0]. Neither maternal smoking during pregnancy nor paternal smoking during preconception/pregnancy was associated with a risk of Wilms' tumor (ORs 1.1[95 % CI 0.7-1.8] and 1.1 [95 % CI 0.7-1.7], respectively). No association was observed with maternal alcohol intake during pregnancy (OR 1.2 [95 % CI 0.8-2.0]). CONCLUSION: Our findings suggest an association between the maternal use of household pesticides during pregnancy and the risk of Wilms' tumor.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Exposição Ambiental/efeitos adversos , Hábitos , Neoplasias Renais/epidemiologia , Pais/psicologia , Assistência Perinatal/métodos , Praguicidas/efeitos adversos , Fumar/efeitos adversos , Tumor de Wilms/epidemiologia , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Gravidez , Fatores de Risco
18.
J Vasc Interv Radiol ; 31(4): 564-571, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32127324

RESUMO

PURPOSE: To assess use of stereotactic body radiotherapy (SBRT) for stage I renal cell carcinoma (RCC) and compare outcomes with thermal ablation and partial nephrectomy (PN). MATERIALS AND METHODS: The 2004-2015 National Cancer Database was investigated for histopathologically proven stage I RCC treated with PN, cryoablation, radiofrequency (RF) or microwave (MW) ablation, or SBRT. Patients were propensity score-matched to account for potential confounders, including patient age, sex, race, comorbidities, tumor size, histology, grade, tumor sequence, administration of systemic therapy, treatment in academic vs nonacademic centers, treatment location, and year of diagnosis. Overall survival (OS) was evaluated with Kaplan-Meier plots, log-rank tests, and Cox proportional hazards models. RESULTS: A total of 91,965 patients were identified (SBRT, n = 174; PN, n = 82,913; cryoablation, n = 5,446; RF/MW ablation, n = 3,432). Stage I patients who received SBRT tended to be older women with few comorbidities treated at nonacademic centers in New England states. After propensity score matching, a cohort of 636 patients was obtained with well-balanced confounders between treatment groups. In the matched cohort, OS after SBRT was inferior to OS after PN and thermal ablation (PN vs SBRT, hazard ratio [HR] = 0.29, 95% confidence interval [CI] 0.19-0.46, P < .001; cryoablation vs SBRT, HR = 0.40, 95% CI 0.26-0.60, P < .001; RF/MW ablation vs SBRT, HR = 0.46, 95% CI 0.31-0.67, P < .001). Compared with PN, neither cryoablation nor RF/MW ablation showed significant difference in OS (cryoablation vs PN, HR = 1.35, 95% CI 0.80-2.28, P = .258; RF/MW ablation vs PN, HR = 0.64, 95% CI 0.95-2.55, P = .079). CONCLUSIONS: Current SBRT protocols show lower OS compared with thermal ablation and PN, whereas thermal ablation and PN demonstrate comparable outcomes.


Assuntos
Técnicas de Ablação/tendências , Carcinoma de Células Renais/radioterapia , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/radioterapia , Neoplasias Renais/cirurgia , Nefrectomia/tendências , Padrões de Prática Médica/tendências , Radiocirurgia/tendências , Técnicas de Ablação/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/patologia , Ablação por Cateter/tendências , Criocirurgia/tendências , Bases de Dados Factuais , Feminino , Humanos , Neoplasias Renais/epidemiologia , Neoplasias Renais/patologia , Masculino , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Lesões por Radiação/epidemiologia , Radiocirurgia/efeitos adversos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
19.
Cancer Epidemiol ; 65: 101692, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32151978

RESUMO

BACKGROUND: Cancers comprise a significant proportion of urologic workload. The epidemiology of prostate and renal cancers is well described. We report the incidence, survival and predictors of survival for non-prostate, non-renal urologic cancers between 1977 and 2013. METHODS: All patients in the South Australian Cancer Registry diagnosed with bladder, testis, penis, renal pelvis, ureteric and other male genital organ cancers between 1977 and 2013 were included. Demographic data included age, sex, year of diagnosis, grade, and metropolitan/rural status. Changes in incidence, survival and predictors of survival are reported for each cancer type. RESULTS: Between 1977 and 2013, bladder cancer was the most common of the studied urologic cancers (6465/9317). Age standardized incidence rate for bladder cancer decreased from 15.6-9.0 per 100,000 in 2013 (Annual Percentage Change (APC) -0.97 %, p < 0.05 %). Between 1977 and 2013 mortality has increased in patients with bladder cancer (HR 1.01 per year, p = 0.004). Testicular cancer diagnoses increased from 1.7 to 4.7 per 100,000 through 1977-2012 (APC 2.41 %, p < 0.05 %). Survival has increased (HR 0.95 per year, p < 0.001). Incidence of penile cancers has increased from 0.23 to 0.46 per 100,000 (APC 2.8 %); Penile cancer survival has remained static (HR 1.02 p = 0.23).Five and ten year survival estimates were highest for testicular cancer - 93.4 % and 91.1 % respectively; and lowest for renal pelvis - 36.3 % and 24.6 %. CONCLUSION: The incidence of non-prostate, non-renal urologic cancers remains low and stable. The age-standardized incidence of testicular cancer has increased whilst there has been a decline in the age-standardized incidence of bladder cancer. Bladder cancer survival has decreased since the 1970s.


Assuntos
Neoplasias Penianas/epidemiologia , Neoplasias Testiculares/epidemiologia , Neoplasias Urológicas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Feminino , Humanos , Incidência , Neoplasias Renais/epidemiologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Adulto Jovem
20.
BMC Cancer ; 20(1): 219, 2020 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-32171288

RESUMO

BACKGROUND: We performed a pooled analysis of the COMPARZ study assessing efficacy and safety of pazopanib versus sunitinib in treatment-naïve Chinese patients with locally advanced and/or metastatic renal cell carcinoma (a/mRCC). METHODS: In the COMPARZ study, patients were randomized (1:1) to receive pazopanib 800 mg once daily (QD) continuously or sunitinib 50 mg QD in 6-week cycles (4 weeks on, 2 weeks off). The primary endpoint was progression-free survival (PFS); secondary endpoints included overall response rate (ORR), overall survival (OS), and safety. PFS and ORR were assessed by independent review committee (IRC) and local investigators. RESULTS: Of the 209 Chinese patients (pazopanib, [n = 109] and sunitinib, [n = 100]), 155 (74%) were males and median age was 57 years (range, 18-79). Median PFS was 13.9 months for pazopanib versus 14.3 months for sunitinib per investigator assessment and 8.3 months in both arms per IRC assessment; PFS hazard ratio was 1.17 (investigator) and 0.99 (IRC). Median OS was not reached in pazopanib arm and was 29.5 months in sunitinib arm. ORR was significantly higher in pazopanib arm versus sunitinib arm (investigator: 41% versus 23% [P = 0.0052]; IRC: 35% versus 20% [P = 0.0203]). Pazopanib was generally well tolerated in Chinese patients with a/mRCC. Most frequent AEs in the pazopanib arm were diarrhea and hair color changes whereas the most frequent AEs in the sunitinib arm were decreased platelets, decreased neutrophil count, and thrombocytopenia. CONCLUSION: The results of the pooled analysis were consistent with the overall population in the COMPARZ study, and confirmed similar PFS and OS of pazopanib and sunitinib in the Chinese patients. TRIAL REGISTRATION: clinical trials.gov, NCT00720941 (August 14, 2008) and NCT01147822 (May 19, 2010).


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Neoplasias Renais/tratamento farmacológico , Pirimidinas/uso terapêutico , Sulfonamidas/uso terapêutico , Sunitinibe/uso terapêutico , Adolescente , Adulto , Idoso , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Carcinoma de Células Renais/epidemiologia , China/epidemiologia , Feminino , Humanos , Neoplasias Renais/epidemiologia , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Pirimidinas/administração & dosagem , Pirimidinas/efeitos adversos , Sulfonamidas/administração & dosagem , Sulfonamidas/efeitos adversos , Sunitinibe/administração & dosagem , Sunitinibe/efeitos adversos , Adulto Jovem
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