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[PMID]:29505538
[Au] Autor:Zhu J; Li H; Ding L; Cheng H
[Ad] Endereço:Department of Radiology.
[Ti] Título:Imaging appearance of renal epithelioid angiomyolipoma: A case report and literature review.
[So] Source:Medicine (Baltimore);97(1):e9563, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Epithelioid angiomyolipoma (EAML) is an extremely rare disease. It commonly occurs in middle-aged females and mainly involves the kidney. Histological and immunohistochemical examination play important roles in differentiating EAML from renal cell carcinoma (RCC) and poor-fat angiomyolipoma (AML). PATIENT CONCERNS: Here, We report the imaging phenotype, as well as the pathological findings of a case of EAML in a 39-year-old female. DIAGNOSES: Preoperative noncontrast computed tomography (CT) scan revealed a 6.0 × 5.2 × 7.0 cm soft tissue mass with necrosis, located in the left kidney. On contrast-enhanced CT images, aprogressive enhancement pattern was observed. CT angiography did not show any enlarged vessels or vascular malformation. Abdominal MRI showed a well-circumscribed solid mass with a heterogeneous signal on T1-weighted and T2-weighted images. Ultrasonography of the abdomen demonstrated a hypoechoic mass with abundant blood flow. This patient underwent radical nephrectomy. The pathologic diagnosis was EAML. INTERVENTIONS: This patient underwent operative resection of the tumor. The resection margins were negative for the neoplastic proliferation and no distant metastases were found. The patient did not receive advanced radiotherapy or chemotherapy. OUTCOMES: Four months after surgery, the follow-up CT scan did not reveal any local recurrence or distant metastases. LESSONS: This case adds to the experience with EAML by summarizing its imaging characteristics as well as reviewing the literature. Additionally, we described the state-of-the-art management of the management of this rare tumor.
[Mh] Termos MeSH primário: Angiomiolipoma/diagnóstico por imagem
Neoplasias Renais/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Angiomiolipoma/patologia
Feminino
Seres Humanos
Rim/patologia
Neoplasias Renais/patologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180306
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009563


  2 / 59479 MEDLINE  
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[PMID]:29376614
[Au] Autor:Popkov VM; Tarasenko AI; Maslyakova GN; Rossolovskii AN; Berezinets OL
[Ad] Endereço:Saratov State Medical University n. a. V. I. Razumovsky, Saratov, Russia.
[Ti] Título:[A look at the problem of surgical treatment of renal cel carcinoma in the aspect of biomolecular diagnosis and assessment of renal function].
[So] Source:Urologiia;(6):153-159, 2017 Dec.
[Is] ISSN:1728-2985
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:The article reviews the domestic and international literature on the issues of biomolecular diagnosis of acute renal injury in the perioperative period in patients with renal cell carcinoma (RCC). Emerging opportunities for early detection of tumors make even more relevant the use of minimally invasive interventions. Of equal importance is the assessment of renal function in patients with diagnosed RCC and the prediction of acute renal injury and progression of chronic kidney disease in the postoperative period. The authors performed a systematic search for preclinical and clinical studies to identify the main trends and achievements in the field of biomolecular diagnosis of RCC and renal injury allowing the individual approach to choosing surgical treatment, improve the survival and quality of life of the patient and improve the functional state of the renal parenchyma.
[Mh] Termos MeSH primário: Carcinoma de Células Renais
Neoplasias Renais
Laparoscopia/métodos
Nefrectomia/métodos
[Mh] Termos MeSH secundário: Carcinoma de Células Renais/diagnóstico
Carcinoma de Células Renais/metabolismo
Carcinoma de Células Renais/cirurgia
Seres Humanos
Neoplasias Renais/diagnóstico
Neoplasias Renais/metabolismo
Neoplasias Renais/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180130
[St] Status:MEDLINE


  3 / 59479 MEDLINE  
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[PMID]:29376604
[Au] Autor:Guliev BG; Yagubov KK
[Ad] Endereço:Department of Urology, I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russia.
[Ti] Título:[Laparoscopic transperitoneal partial nephrectomy for a tumor of the upper segment].
[So] Source:Urologiia;(6):96-100, 2017 Dec.
[Is] ISSN:1728-2985
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:INTRODUCTION: Laparoscopic resection of upper pole kidney tumors is a technically challenging procedure. When tumors are located on the dorsal side of the kidney, the renal-rotation technique may facilitate laparoscopic partial nephrectomy. AIM: To present the technique and results of laparoscopic partial nephrectomy (LPN) for tumors of the upper pole of the kidney with its rotation around the renal hilum. MATERIAL AND METHODS: The study presents a retrospective analysis of the results of 12 patients who underwent LPN for upper pole kidney tumors using the renal-rotation technique. The kidney with the renal hilar vessels and the upper third of the ureter were mobilized using a transperitoneal access. Then the kidney was rotated over its pedicular axis so that the upper pole was located inferiorly. As a result, the posterior upper pole tumor was located anteriorly, thereby facilitating its resection. After removing the tumor and confirming homeostasis, the kidney was returned to its original position. RESULTS: The results of LPN using this technique were successful in all 12 patients. The mean operative time was 120+/-35.0 (90-210) min, the warm ischemia time was 14.5+/-7.8 (10-26) min, and the blood loss was 120.0+/-65.5 (60-300) ml. The intraoperative complication occurred in 1 (8.3%) patients, postoperative complications were observed in 3 patients. Histopathology showed that 11 (91.7%) patients had renal cell carcinoma and one (8.3%) had angiomyolipoma. Analysis of early (18.6+/-5.0 months) oncological outcomes showed no local recurrence and distant metastases. CONCLUSION: With dorsally located upper pole kidney tumors, the renal-rotation technique facilitates the performance of LPN and minimizes the risk of intra- and postoperative complications. This method requires the maximum mobilization of the kidney along with the renal hilar vessels and the upper third of the ureter to rotate it for optimal resection conditions.
[Mh] Termos MeSH primário: Neoplasias Renais/cirurgia
Laparoscopia/métodos
Nefrectomia/métodos
Isquemia Quente/métodos
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Neoplasias Renais/diagnóstico por imagem
Masculino
Meia-Idade
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180130
[St] Status:MEDLINE


  4 / 59479 MEDLINE  
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[PMID]:29376603
[Au] Autor:Komyakov BK; Guliev BG; Novikov AI; Yagubov KK
[Ad] Endereço:Department of Urology, I.I. Mechnikov North-Western State Medical University, Saint-Petersburg, Russia.
[Ti] Título:[Results of open and laparoscopic partial nephrectomy for localized renal cancer].
[So] Source:Urologiia;(6):91-95, 2017 Dec.
[Is] ISSN:1728-2985
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:AIM: To compare the results of laparoscopic and open partial nephrectomy. MATERIALS AND METHODS: From February 2000 to June 2016, 178 patients (mean age 58.2 years) with stage T1 kidney tumors underwent partial nephrectomy. This cohort included 106 (59.5%) men and 72 (40.5%) women. Open partial nephrectomy was performed in 102 (57.3%) patients (group 1) and laparoscopic partial nephrectomy (LPL) - 76 (42.7%, 2nd group). The majority (92.2%) of patients underwent resection for elective and 14 (7.8%) for absolute indications. Preoperatively, 163 (91.6%) and 15 (8.4%) patients had stage T1a stage T1b, respectively. The tumor size ranged from 2.4 to 6.2 cm and from 2 cm to 5.4 cm in group 1 and 2, respectively. A comparative analysis included operative time, warm ischemia time, blood loss, duration of drainage and the length of hospital stay. RESULTS: Open partial nephrectomy was associated with shorter operative time (105 min versus 125 min) and warm ischemia time (14.5 vs. 20.8 min) compared with laparoscopic partial nephrectomy. Laparoscopic partial nephrectomy was characterized by a smaller blood loss (180 ml vs. 365 ml, p<0.05) and a shorter length of hospital stay (2.5 days vs. 5.6 days, p<0.05). One patient from each group was found to have positive surgical margins. CONCLUSION: Currently, laparoscopic partial nephrectomy is the method of choice for stage T1 kidney tumors. Despite the comparatively longer operative time and warm ischemia time, laparoscopic partial nephrectomy leads to faster patient recovery and fewer complications.
[Mh] Termos MeSH primário: Perda Sanguínea Cirúrgica/prevenção & controle
Neoplasias Renais/cirurgia
Rim/cirurgia
Laparoscopia/métodos
Nefrectomia/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seguimentos
Seres Humanos
Rim/patologia
Neoplasias Renais/patologia
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180130
[St] Status:MEDLINE


  5 / 59479 MEDLINE  
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[PMID]:29376602
[Au] Autor:Alekseeva GN; Stegnii KV; Pisareva LF; Gurina LI; Volkov MV
[Ad] Endereço:Pacific State Medical University of Minzdrav of Russia, Vladivostok, Russia.
[Ti] Título:[Improving renal cancer care].
[So] Source:Urologiia;(6):87-90, 2017 Dec.
[Is] ISSN:1728-2985
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:The article reviews the rates of incidence, late diagnosis and mortality from kidney cancer in Primorsky Krai. The authors address the issues of improving primary and specialized medical care by introducing a three-level health care system and restructuring of hospital beds. They propose a new medical technology for assessing the individual risk of kidney cancer and present a program of measures and organizational modules for prevention, early diagnosis and reduction of mortality from kidney cancer.
[Mh] Termos MeSH primário: Neoplasias Renais/diagnóstico
Neoplasias Renais/epidemiologia
Neoplasias Renais/terapia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
Fatores de Risco
Sibéria/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180130
[St] Status:MEDLINE


  6 / 59479 MEDLINE  
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[PMID]:29376589
[Au] Autor:Alyaev YG; Sirota ES; Bezrukov EA; Fiev DN; Bukatov MD; Letunovskii AV; Byadretdinov IS
[Ad] Endereço:I.M. Sechenov First MSMU of Minzdrav of Russia, Research Institute of Uronephrology and Human Reproductive Health, Moscow, Russia.
[Ti] Título:[Application of 3D soft print models of the kidney for treatment of patients with localized cancer of the kidney (a pilot study)].
[So] Source:Urologiia;(6):12-19, 2017 Dec.
[Is] ISSN:1728-2985
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:AIM: To evaluate the possibility of using 3D-printing in the management of patients with localized kidney cancer. MATERIALS AND METHODS: The study comprised five patients with localized kidney cancer who were treated at the Urology Clinic of the I.M. Sechenov First Moscow State Medical University from January 2016 to April 2017. Along with the standard examination, the patients underwent multispiral computed tomography (MSCT) to produce patient-specific 3D-printed models of the kidney tumors using 3D modeling and 3D printing. To evaluate the effectiveness of using 3D-printed models, two-stage preoperative planning was conducted, and five surgeons were surveyed using a four-question multiple choice questionnaire. At the first stage, the planning of operations was carried out based on MSCT findings. At the second stage, the surgeons were given patient-specific soft 3D models of the kidney with a tumor for preoperative training. After preoperative training, patients underwent laparoscopic resection of the kidney with a tumor. RESULTS: According to the survey results, each of the participating surgeons at least once changed surgical plan based on data obtained with 3D printed models of the kidney with the tumor. The implementation of preoperative training using 3D printed models of the kidney turned out to be effective. All patients underwent laparoscopic surgery performed by a single surgeon with extensive experience in this type of surgery. The mean operative time was 187 minutes. All operations were performed with main renal artery occlusion. The men warm ischemia time was 19.5 minutes and the mean blood loss was 170 ml. There were no conversions to open surgery and organ-removing operations. There were no postoperative complications or deaths. All surgical margins were negative. Morphological examination showed that four patients had renal cell carcinoma one patient had the oncocytoma. CONCLUSION: The study demonstrated the promise of using 3D printing for preoperative planning and surgical performance due to a high-precision three-dimensional soft patient-specific model of the localized kidney.
[Mh] Termos MeSH primário: Imagem Tridimensional
Neoplasias Renais/patologia
Rim/patologia
Modelos Anatômicos
Impressão Tridimensional
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Rim/cirurgia
Neoplasias Renais/cirurgia
Masculino
Pilotos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180130
[St] Status:MEDLINE


  7 / 59479 MEDLINE  
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[PMID]:29429165
[Au] Autor:Zhou JX; He XR; Song GX; Zou ZG; Wang LH; Hu R; Li HX
[Ad] Endereço:Department of Pathology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
[Ti] Título:[Clinicopathologic features with collecting duct carcinoma of kidney: report of 10 cases].
[So] Source:Zhonghua Bing Li Xue Za Zhi;47(2):123-127, 2018 Feb 08.
[Is] ISSN:0529-5807
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To study the pathological features, immunophenotypes, differential diagnoses and prognostic parameters of collecting duct carcinoma of the kidney (CDC). Clinical imaging, histopathology, immunohistochemistry, and survival data of 10 patients at First Affiliated Hospital of Nanjing Medical University from January 2009 to August 2017 were retrospectively analyzed along with a review of literatures. The clinical symptoms of CDC were not specific, and image examinations showed space-occupying mass lesions. Tumors were mainly located in renal medulla with grey and firm cut face and the presence of focal hemorrhage and necrosis. Microscopically, there were predominant tubular or tubular-papillary structures with associated focal sarcomatoid areas, desmoplastic stromal reaction and lymphoplasmacytic cells infiltration. Tumor cells had marked cytological atypia with high grade nuclei, conspicuous nucleolus and numerous mitoses. Immunohistochemically, tumor cells were strongly positive for CK19, E-cadherin, vimentin, HCK, CK7 and PAX8. The main treatment was radical nephrectomy in the patients. Seven cases died of CDC with median survival of 10 months. CDC is a rare, highly aggressive malignancy of kidney with poor prognosis. Definitive diagnosis should be made by histology and immunohistochemistry. Differential diagnoses include papillary renal cell carcinoma(type â…¡), renal medullary carcinoma, infiltrating high grade urothelial carcinoma, renal pelvis adenocarcinoma and metastatic adenocarcinomas.
[Mh] Termos MeSH primário: Carcinoma de Células Renais/patologia
Neoplasias Renais/patologia
Túbulos Renais Coletores/patologia
[Mh] Termos MeSH secundário: Caderinas/análise
Carcinoma de Células Renais/química
Carcinoma de Células de Transição/patologia
Nucléolo Celular
Núcleo Celular
Diagnóstico Diferencial
Seres Humanos
Imuno-Histoquímica
Neoplasias Renais/química
Túbulos Renais Coletores/química
Necrose/patologia
Vimentina/análise
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (CDH1 protein, human); 0 (Cadherins); 0 (Vimentin)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180213
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0529-5807.2018.02.009


  8 / 59479 MEDLINE  
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[PMID]:28464554
[Au] Autor:Khene ZE; Peyronnet B; Bosquet E; Pradère B; Robert C; Fardoun T; Kammerer-Jacquet SF; Verhoest G; Rioux-Leclercq N; Mathieu R; Bensalah K
[Ad] Endereço:Department of Urology, Rennes University Hospital, Rennes, France.
[Ti] Título:Does training of fellows affect peri-operative outcomes of robot-assisted partial nephrectomy?
[So] Source:BJU Int;120(4):591-599, 2017 10.
[Is] ISSN:1464-410X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the impact of fellows' involvement on the peri-operative outcomes of robot-assisted partial nephrectomy (RAPN). MATERIALS AND METHODS: We analysed 216 patients who underwent RAPN for a small renal tumour. We stratified our cohort into two groups according to the involvement of a fellow surgeon during the procedure: expert surgeon operating alone (expert group) and fellow operating under the supervision of the expert surgeon (fellow group). Peri-operative data were compared between the two groups. Linear and logistic regression analyses were performed to assess the impact of fellows' involvement on peri-operative and postoperative outcomes. Trifecta and margins ischaemia complications (MIC) score achievement rates were used to assess the quality of surgery in both the expert and fellow groups. Trifecta was defined as a combination of warm ischaemia time <25 min, negative surgical margins and no peri-operative complications. MIC score was defined as negative surgical margins, ischaemia time <20 min, and absence of complications grade ≥3. RESULTS: Fellows were involved in a total of 89 procedures (41%). Patients' characteristics were similar in the two groups. Operating time and warm ischaemia time (WIT) were longer in the fellow group (180 vs 120 min, P < 0.001, and 18 vs 14 min, P = 0.002, respectively). Length of hospital stay (LOS) was longer in the fellow group (5 vs 4.3 days; P = 0.05) and patients in this group had higher estimated blood loss (EBL; 400 vs 300 mL; P = 0.01), but this had no impact on transfusion rate (14% vs 11%; P = 0.43). Positive surgical margin rates were similar in the fellow and expert groups (2.2% vs 3.1%; P = 0.70). Major complications were more frequent in the fellow group (12.3% vs 6.3%), but the difference was not significant (P = 0.10). In multivariable analysis, fellow involvement was predictive of longer WIT (ß = 0.22; P = 0.003) and operating time (ß = 0.49; P < 0.001), but was not associated with EBL (ß = 0.12, P = 0.09) or LOS (ß = 0.12, P = 0.11). Finally, fellow involvement was associated with a lower rate of trifecta and MIC score accomplishment (odds ratio [OR] 0.53, P = 0.05 and OR 0.46, P = 0.01, respectively). CONCLUSION: Training fellows to perform RAPN is associated with longer operating time and WIT but does not appear to compromise other peri-operative outcomes.
[Mh] Termos MeSH primário: Competência Clínica
Educação de Pós-Graduação em Medicina/métodos
Neoplasias Renais/cirurgia
Nefrectomia/métodos
Procedimentos Cirúrgicos Robóticos/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Estudos de Coortes
Bases de Dados Factuais
Feminino
Seguimentos
França
Hospitais Universitários
Seres Humanos
Neoplasias Renais/patologia
Masculino
Meia-Idade
Nefrectomia/efeitos adversos
Duração da Cirurgia
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/fisiopatologia
Estudos Retrospectivos
Medição de Risco
Procedimentos Cirúrgicos Robóticos/métodos
Resultado do Tratamento
Isquemia Quente
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1111/bju.13901


  9 / 59479 MEDLINE  
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[PMID]:28452170
[Au] Autor:White V; Marco DJT; Bolton D; Davis ID; Jefford M; Hill D; Prince HM; Millar JL; Winship IM; Coory M; Giles GG
[Ad] Endereço:Cancer Council Victoria, Melbourne, Vic., Australia.
[Ti] Título:Trends in the surgical management of stage 1 renal cell carcinoma: findings from a population-based study.
[So] Source:BJU Int;120 Suppl 3:6-14, 2017 11.
[Is] ISSN:1464-410X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To determine whether the use of nephron-sparing surgery (NSS) for treatment of stage 1 renal cell carcinoma (RCC) changed between 2009 and the end of 2013 in Australia. PATIENTS AND METHODS: All adult cases of RCC diagnosed in 2009, 2012 and 2013 were identified through the population-based Victorian Cancer Registry. For each identified patient, trained data-abstractors attended treating hospitals or clinician rooms to extract tumour and treatment data through medical record review. Multivariable logistic regression analyses were carried out to examine the significance of change in use of NSS over time, after adjusting for potential confounders. RESULTS: A total of 1 836 patients with RCC were identified. Of these, the proportion of cases with stage 1 tumours was 64% in 2009, 66% in 2012 and 69% in 2013. For T1a tumours, the proportion of patients residing in metropolitan areas receiving NSS increased from 43% in 2009 to 58% in 2012 (P < 0.05), and 69% in 2013 (P < 0.05). For patients residing in non-metropolitan areas, the proportion receiving NSS increased from 27% in 2009 to 49% in 2012, and 61% in 2013 (P < 0.01). Univariable logistic regression showed patients with moderate (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.35-0.94) or severe comorbidities (OR 0.58, 95% CI 0.33-0.99), residing in non-metropolitan areas (OR 0.65, 95% CI 0.47-0.90), were less likely to be treated by NSS, while those attending high-volume hospitals (≥30 cases/year: OR 1.79, 95% CI 1.21-2.65) and those with higher socio-economic status (OR 1.45, 95% CI 1.02-2.07) were more likely to be treated by NSS. In multivariable analyses, patients with T1a tumours in 2012 (OR 2.00, 95% CI 1.34-2.97) and 2013 (OR 3.15, 95% CI 2.13-4.68) were more likely to be treated by NSS than those in 2009. For T1b tumours, use of NSS increased from 8% in 2009 to 20% in 2013 (P < 0.05). CONCLUSION: This population-based study of the management of T1 renal tumours in Australia found that the use of NSS increased over the period 2009 to 2013. Between 2009 and 2013 clinical practice for the treatment of small renal tumours in Australia has increasingly conformed to international guidelines.
[Mh] Termos MeSH primário: Carcinoma de Células Renais/epidemiologia
Carcinoma de Células Renais/cirurgia
Neoplasias Renais/epidemiologia
Neoplasias Renais/cirurgia
Nefrectomia/estatística & dados numéricos
Tratamentos com Preservação do Órgão/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Austrália/epidemiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Nefrectomia/tendências
Tratamentos com Preservação do Órgão/tendências
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1111/bju.13889


  10 / 59479 MEDLINE  
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[PMID]:27771126
[Au] Autor:Davis ID; Xie W; Pezaro C; Donskov F; Wells JC; Agarwal N; Srinivas S; Yuasa T; Beuselinck B; Wood LA; Ernst DS; Kanesvaran R; Knox JJ; Pantuck A; Saleem S; Alva A; Rini BI; Lee JL; Choueiri TK; Heng DYC
[Ad] Endereço:Monash University and Eastern Health, Box Hill. Victoria, Australia. Electronic address: ian.davis@monash.edu.
[Ti] Título:Efficacy of Second-line Targeted Therapy for Renal Cell Carcinoma According to Change from Baseline in International Metastatic Renal Cell Carcinoma Database Consortium Prognostic Category.
[So] Source:Eur Urol;71(6):970-978, 2017 Jun.
[Is] ISSN:1873-7560
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: We hypothesized that changes in International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic category at start of second-line therapy (2L) for metastatic renal cell carcinoma (mRCC) might predict response. OBJECTIVE: To assess outcomes of 2L according to type of therapy and change in IMDC prognostic category. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective review of the IMDC database for mRCC patients who received first-line (1L) VEGF inhibitors (VEGFi) and then 2L with VEGFi or mTOR inhibitors (mTORi). IMDC prognostic categories were defined before each line of therapy (favorable, F; intermediate, I; poor, P). Data were analyzed for 1516 patients, of whom 89% had clear cell histology. INTERVENTION: All included patients received targeted therapy for mRCC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Overall survival (OS), time to treatment failure, and response to 2L were analyzed using Cox or logistic regression. RESULTS AND LIMITATIONS: At start of 2L, 60% of patients remained in the same prognostic category; 9.0% improved (3% I → F; 6% P → I); 31% deteriorated (15% F → I or P; 16% I → P). Patients with the same or better IMDC prognostic category had a longer time to treatment failure if they remained on VEGFi compared to those who switched to mTORi (adjusted hazard ratio [AHR] ranging from 0.33 to 0.78, adjusted p<0.05). Patients who deteriorated from F to I appeared more likely to benefit from switching to mTORi (median OS 16.5 mo, 95% confidence interval [CI] 12.0-19.0 for VEGFi; 20.2 mo, 95% CI 14.3-26.1 for mTORi; AHR 1.53, 95% CI 1.04-2.24; adjusted p=0.03). CONCLUSIONS: Changes in IMDC prognostic category predict the subsequent clinical course for patients with mRCC and provide a rational basis for selection of subsequent therapy. PATIENT SUMMARY: The pattern of treatment failure might help to predict what the next treatment should be for patients with metastatic renal cell carcinoma.
[Mh] Termos MeSH primário: Inibidores da Angiogênese/uso terapêutico
Carcinoma de Células Renais/tratamento farmacológico
Neoplasias Renais/tratamento farmacológico
Terapia de Alvo Molecular
Inibidores de Proteínas Quinases/uso terapêutico
[Mh] Termos MeSH secundário: Inibidores da Angiogênese/efeitos adversos
Carcinoma de Células Renais/enzimologia
Carcinoma de Células Renais/secundário
Bases de Dados Factuais
Progressão da Doença
Intervalo Livre de Doença
Substituição de Medicamentos
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Neoplasias Renais/enzimologia
Neoplasias Renais/patologia
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Modelos de Riscos Proporcionais
Inibidores de Proteínas Quinases/efeitos adversos
Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores
Receptores de Fatores de Crescimento do Endotélio Vascular/metabolismo
Estudos Retrospectivos
Transdução de Sinais/efeitos dos fármacos
Serina-Treonina Quinases TOR/antagonistas & inibidores
Serina-Treonina Quinases TOR/metabolismo
Fatores de Tempo
Resultado do Tratamento
Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
Fator A de Crescimento do Endotélio Vascular/metabolismo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Angiogenesis Inhibitors); 0 (Protein Kinase Inhibitors); 0 (VEGFA protein, human); 0 (Vascular Endothelial Growth Factor A); EC 2.7.1.1 (MTOR protein, human); EC 2.7.1.1 (TOR Serine-Threonine Kinases); EC 2.7.10.1 (Receptors, Vascular Endothelial Growth Factor)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE



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