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1. Corticosteroids in patients hospitalized for COVID-19 pneumonia who require oxygen: observational comparative study using routine care data

Author

Viet-Thi Tran, Matthieu Mahévas, Firouze Bani-Sadr, Olivier Robineau, Thomas Perpoint, Elodie Perrodeau, Laure Gallay, Philippe Ravaud, François Goehringer, François-Xavier Lescure, Sophie Ismaël, Cédric Laouénan, Jennifer Soulier, Oriane Puéchal, Eric D’Ortenzio, Yazdan Yazdanpanah, Laurence Maulin, Stéphanie Martinez, Diane Sanderink, Pascale Fialaire, Séverine Ansart, Lucas Perez, Anne - Laure Destrem, Chloé Moulin, Pascal Gicquel, Frédéric Rivière, Martin Martinot, Mahsa Mohseni Zadeh, Tomasz Chroboczek, Thibaut Challan Belval, Lionel Piroth, Thibault Sixt, Florian Moretto, André Cabié, Jérémie Pasquier, Ornella Cabras, Marine Morrier, Jean Reuter, Thomas Henin, Pierre Braquet, Helene Desmurs-Clavel, Arnaud Hot, Boris Bienvenu, Belkacem Asselate, Nicolas Vignier, Steve Nguala, Sylvain Diamantis, Guillemette Frémont, Pierre Louis Nivose, Mathilde Thiébaut, Benjamin Lefevre, Hélène Auge, Paul le Turnier, Naila Benkalfate, Olivier Grossi, Samuel Pineau, Elisa Demonchy, Julie Merindol, Claire Durand, Nathalie Tieulié, Viviane Queyrel, Didier Laureillard, Paul Loubet, Ségolène Greffe, Nathalie Dournon, Youssouf Mohamed Kassim, Cyrille Gourjault, Alexandre Lahens, Paul Legendre, Caroline Morbieu, Matthieu Mahevas, Giovanna Melica, Jean-Daniel Levièvre, Frédéric Schlemmer, Simone Tunesi, Claire Leblanc, Anne Bourgarit-Durand, Alexandre Bleibtreu, Gianpiero Tebano, Jérôme Pacanowski, Jean-Benoit Zabbe, Mathilde Devaux, Laurent Bellec, Marine Gosset-Woimant, Céleste Lambert, Maxime Hentzien, Amélie Servettaz, Kevin Alexandre, Manuel Etienne, Romain Leguillon, Marion Dollat, Rémi Lefrancois, Anne Pouvaret, Yvon Ruch, Yannick Dieudonné, Guillaume Martin-Blondel, Xavier Boumaza, Margaux Lafaurie, Macha Tetart, Adrien Lemaignen, Nicole Ferreira-Maldent, Amélie Duréault, Marie Gousseff, Claire Chantepie, Francesca Bisio, Fanny Pommeret, Emeline Colomba Blamble, and Claire Ara Somohano

Subjects
0301 basic medicine, Adult, Male, Microbiology (medical), medicine.medical_specialty, Adolescent, medicine.medical_treatment, Therapeutic evaluation, 030106 microbiology, Population, Severity of Illness Index, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Prednisone, Adrenal Cortex Hormones, Internal medicine, Observational study, Severity of illness, Medicine, Intubation, Corticosteroids, Humans, 030212 general & internal medicine, education, Aged, Mechanical ventilation, Aged, 80 and over, education.field_of_study, business.industry, Mortality rate, Hazard ratio, Oxygen Inhalation Therapy, COVID-19, General Medicine, Middle Aged, medicine.disease, Respiration, Artificial, COVID-19 Drug Treatment, Pneumonia, C-Reactive Protein, Infectious Diseases, Original Article, Female, business, medicine.drug
Abstract

OBJECTIVE: To assess the effectiveness of corticosteroids on outcomes of patients with COVID-19 pneumonia requiring oxygen without mechanical ventilation. METHODS: We used routine care data from 51 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids at 0.8 mg/kg/day eq. prednisone (CTC group) versus standard of care (no-CTC group) among adults 18 to 80 years old with confirmed COVID-19 pneumonia requiring oxygen without mechanical ventilation. The primary outcome was intubation or death by day 28. In our main analysis, characteristics of patients at baseline (i.e., time when patients met all inclusion criteria) were balanced by using propensity-score inverse probability of treatment weighting. RESULTS: Among the 891 patients included in the analysis, 203 were assigned to the CTC group. Use of corticosteroids was not significantly associated with risk of intubation or death by day 28 (weighted hazard ratio [wHR] 0.92, 95% CI 0.61 to 1.39) or cumulative death rate (wHR 1.03, 95% CI 0.54 to 1.98). However, use of corticosteroids was associated with reduced risk of intubation or death by day 28 in the prespecified subgroups of patients requiring oxygen ≥ 3 L/min (wHR 0.50, 95% CI 0.30 to 0.85) or C-reactive protein level ≥ 100 mg/L (wHR 0.44, 95%CI 0.23 to 0.85). Number of hyperglycaemia events was higher for patients with than without corticosteroids, but number of infections was similar. CONCLUSIONS: We found no association between the use of corticosteroids and intubation or death in the broad population of patients 18 to 80 years old with COVID-19 hospitalized in non-intensive care unit settings. However, the treatment was associated with reduced risk of intubation or death for patients with ≥ 3 L/min oxygen or C-reactive protein level ≥ 100 mg/L at baseline. Further research need to confirm the right timing of corticosteroids for patients with COVID-19 requiring oxygen only.

Published
2021
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2. Predominance of healthcare-associated cases among episodes of community-onset bacteraemia due to extended-spectrum β-lactamase-producing Enterobacteriaceae

Author

Jean-Ralph Zahar, Philippe Lesprit, Stephane Ruckly, Aurelia Eden, Hitoto Hikombo, Louis Bernard, Stephan Harbarth, Jean-François Timsit, Christian Brun-Buisson, Nejla Aissa, Alain Losniewski, Sandrine Henard, Christian Rabaud, Cécile Janssen, Léonardo Pagani, Stéphane Bland, Jacques Gaillat, Jean Pierre Bru, Pierre Bonnin, Gaelle Clavère, Virginie Vitrat, Laurence Maulin, Luc Quarsaet, Helene Roger, Jean-Baptiste Euzen, Eric Denes, Elodie Couve-Daecon, Catherine Lechiche, Jean-Philippe Lavigne, Véronique Mondain, Celine Pulcini, Veronique Garnier, Dorothée Lambert, Maxime Hentzien, Yohan Nguyen, Jean Paul Talarmin, Pascaline Rameau, Françoise Geffroy, Arnaud Salmon-Rousseau, Vincent Cattoir, Antoine Froissart, Said Aberrane, Laurence Legout, France Roblot, Guillaume Beraud, Patricia Pavese, Olivier Belmonte, Nicolas Traversier, Laurent Bellec, Marie Lagrange-Xelot, Marie-Pierre Moiton, Barbara Kuli, Pascal Longuet, Agnes Scanvic, Lea Colombain, Milagros Ferreyra, Maxime Jean, Etienne Laurens, Matthieu Saada, Hugues Aumaitre, Martine Malet, Frederique Roustant, Vincent LeMoing, Jean-Pierre Helene, Jonathan Theodore, Caroline Garandeau, Jocelyne Caillon, Benjamin Olivero, David Boutoille, Didier Lepelletier, Lucia Grandière-Perez, Aurélie Beaudron, Céline Ramanantsoa, Catherine Varache, Nicolas Varache, Nicolas Crochette, Hikombo Hitoto, Sophie Blanchi, Pascale Penn, Bernard Louis, Dominique Vanjak, Marie-Christine Escande, René-Gilles Patrigeon, Stéphanie Honoré, Audrey Barrelet, Marlène Amara, Jean-Marc Galempoix, Jean-Claude Réveil, Patricia Bucchiotty, Carine Couzigou, Alban LeMonnier, Emilie Boidin, Stephane Sire, Nelly Luizy, Caroline Bronstain, Carolina Fankhauser, Caroline Brossier, Elodie von Dach, Colette Sauve, Marie-Noelle Adam, Laurent Hocqueloux, Laurent Bret, Marie-Hélène André, Régine Barruet, Marion Challier, Andre Cabié, Benoit Roze, Patrick Plesiat, Katy Jeanot, Isabelle Patry, Joséphine Moreau, Catherine Chirouze, Aaron Laurent, Marie-Nadège Bachelier, Guillaume Kac, Nicolas Farthouat, Nicolas Feuillebois, Thomas Guimard, Sandra Bourdon, Sophie Nguyen, Serge Alfandari, Houcine Bentayeb, Mari-Thérèse Albertini, Bruno Marchou, Noémie Gaudré, Damien Dubois, Christelle Guillet-Caruba, Florence Doucet Populaire, Nicolas Fortineau, Leila Escaut, Vincent Fihman, Rémy Gauzit, Josette Raymond, Solene Kerneis, Veronique Leflon-Guibout, Agnes Lefort, Aurelien Dinh, Anne-Laure Roux, Sophie Abgrall, Françoise Jauréguy, Jean-Christophe Lucet, Nathalie Soismier, Amanda Lopes, Emmanuelle Cambau, Veronique Manceron, Guilène Barnaud, Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Hôpital Foch [Suresnes], Outcomerea, Centre Hospitalier Saint Jean de Perpignan, Centre Hospitalier Le Mans (CH Le Mans), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Faculté de médecine [Genève], Prévention et contrôle des infections (PCI ), Hôpitaux Universitaires de Genève (HUG), Services de Maladies Infectieuses et Tropicales [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)

Subjects
Male, 0301 basic medicine, Pediatrics, Bacteremia, Community-Acquired Infections/epidemiology/microbiology, Antibiotic appropriateness, Klebsiella spp, 0302 clinical medicine, Healthcare associated, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Prevalence, Risk of mortality, Medicine, Pharmacology (medical), Prospective Studies, 030212 general & internal medicine, beta-Lactamases/secretion, Community onset, ddc:616, Aged, 80 and over, Cross Infection, education.field_of_study, biology, Enterobacteriaceae Infections, General Medicine, Middle Aged, Enterobacteriaceae, 3. Good health, Community-Acquired Infections, Treatment Outcome, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Cross Infection/microbiology, Female, Bacteremia/epidemiology/microbiology, Microbiology (medical), medicine.medical_specialty, 030106 microbiology, Population, beta-Lactamases, 03 medical and health sciences, Extended-spectrum β-lactamase, Antibiotic therapy, Enterobacteriaceae/classification/enzymology/isolation & purification, Humans, Risk factor, education, Aged, Enterobacteriaceae Infections/epidemiology/microbiology, business.industry, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, bacterial infections and mycoses, Survival Analysis, Risk factors, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Bacteraemia, business
Abstract

International audience; Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are endemic pathogens worldwide. Infection with ESBL-PE may be associated with inadequate antibiotic therapy and a poor outcome. However, risk factors for ESBL-PE community-acquired infections are ill-defined. An observational multicentre study was performed in 50 hospitals to identify the prevalence of and risk factors for community-acquired ESBL-PE bacteraemia. All patients presenting with community-onset Enterobacteriaceae bacteraemia were recorded over a 2-month period (between June and November 2013). Risk factors and 14-day outcomes of patients were investigated. Among 682 Enterobacteriaceae bacteraemia episodes recorded, 58 (8.5%) were caused by ESBL-PE. The most frequent species isolated were Escherichia coli (537; 76.7%) and Klebsiella spp. (68; 9.7%), of which 49 (9.1%) and 8 (11.8%), respectively, were ESBL-producers. Most ESBL-PE episodes were healthcare-associated, and only 22 (38%) were apparently community-acquired. The main risk factor for community-acquired ESBL-PE bacteraemia was a prior hospital stay of ≥5 days within the past year. The overall 14-day survival was 90%; only 4 (6.9%) of 58 patients with ESBL-PE bacteraemia died. Inadequate initial antibiotic therapy was administered to 55% of patients with ESBL-PE bacteraemia but was not associated with increased 14-day mortality. Although many patients had community-onset ESBL-PE bacteraemia, almost two-thirds of the episodes were actually healthcare-associated, and true community-acquired ESBL-PE bacteraemia remains rare. In our essentially non-severely ill population, inappropriate initial therapy was not associated with a higher risk of mortality.

Published
2017

3. Nephron-sparing surgery is superior to radical nephrectomy in preserving renal function benefit even when expanding indications beyond the traditional 4-cm cutoff

Author

Michel Soulié, Julien Drai, Jérôme Rigaud, Nicolas Mottet, Christian Pfister, Jean Marie Ferriere, Roberto Bertini, Fabien Bouliere, Olivier Bouchot, Jean-Christophe Bernhard, Thomas Bessede, Laurent Bellec, Allan J. Pantuck, Géraldine Pignot, Arie S. Belldegrun, Marc Colombel, Karim Bensalah, Laurent Salomon, Jean Jacques Patard, Pierre Bigot, Arnauld Villers, Francesco Montorsi, Pignot, G, Bigot, P, Bernhard, Jc, Bouliere, F, Bessede, T, Bensalah, K, Salomon, L, Mottet, N, Bellec, L, Soulié, M, Ferrière, Jm, Pfister, C, Drai, J, Colombel, M, Villers, A, Rigaud, J, Bouchot, O, Montorsi, Francesco, Bertini, R, Belldegrun, A, Pantuck, Aj, and Patard, Jj

Subjects
Adult, Male, medicine.medical_specialty, Multivariate analysis, Urology, medicine.medical_treatment, Renal function, Kaplan-Meier Estimate, Nephrectomy, Young Adult, Renal cell carcinoma, medicine, Humans, Cutoff, Carcinoma, Renal Cell, Aged, Proportional Hazards Models, Retrospective Studies, Aged, 80 and over, Univariate analysis, Tumor size, business.industry, Nephrons, Middle Aged, medicine.disease, Kidney Neoplasms, Surgery, Oncology, Multivariate Analysis, Female, Nephron sparing surgery, business, Glomerular Filtration Rate
Abstract

Objectives To analyze to what extent partial nephrectomy (PN) is superior to radical nephrectomy (RN) in preserving renal function outcome in relation to tumor size indication. Methods and materials Clinical data from 973 patients operated at 9 academic institutions were retrospectively analyzed. Glomerular filtration rate (GFR) before and after surgery was calculated with the abbreviated Modification of the Diet in Renal Disease equation. For a fair comparison between the 2 techniques, all imperative indications for PN were excluded. A shift to a less favorable GFR group following surgery was considered clinically significant. Results Median age at diagnosis was 60 years (19–91). Tumor size was smaller than 4 cm in 665 (68.3%) cases and larger than 4 cm in 308 (31.7%) cases. PN and RN were performed in 663 (68.1%) and 310 (31.9%) patients, respectively. In univariate analysis, patients undergoing PN had a smaller risk for developing significant GFR change following surgery than those undergoing RN did. This was true for tumors≤4 cm ( P = 0.0001) and for tumors>4 cm ( P = 0.0001). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN ( P = 0.0001), preoperative GFR P = 0.0001), tumor size≥4 cm ( P = 0.0001), and older age at diagnosis ( P = 0.0001). Conclusions The renal function benefit carried out by elective PN over RN persists even when expanding nephron-sparing surgery indications beyond the traditional 4-cm cutoff.

Published
2014

4. Are warm ischemia and ischemia time still predictive factors of poor renal function after partial nephrectomy in the setting of elective indication?

Author

Michel Soulié, Jean-Marie Ferriere, Laurent Salomon, Pierre Bigot, B. Albouy, Frédéric Pouliot, Nicolas Mottet, Géraldine Pignot, Fabien Bouliere, Thomas Bessede, Karim Bensalah, Maxime Crepel, Thierry Dujardin, Laurent Bellec, Christian Pfister, Gregory Verhoest, Jean-Jacques Patard, and Jean-Christophe Bernhard

Subjects
Adult, Male, Nephrology, medicine.medical_specialty, Urology, medicine.medical_treatment, Operative Time, Renal function, urologic and male genital diseases, Nephrectomy, Constriction, Risk Factors, Renal cell carcinoma, Internal medicine, medicine, Carcinoma, Humans, Warm Ischemia, Renal Insufficiency, Chronic, Carcinoma, Renal Cell, Aged, Retrospective Studies, Aged, 80 and over, integumentary system, business.industry, Incidence, Patient Selection, Retrospective cohort study, Nephrons, Middle Aged, medicine.disease, Warm ischemia, Kidney Neoplasms, Surgery, Elective Surgical Procedures, Cardiology, Female, business, Glomerular Filtration Rate
Abstract

To evaluate renal function and to identify factors associated with renal dysfunction in the elective indications setting of nephron-sparing surgery (NSS).We retrospectively reviewed operative data and glomerular filtration rate (GFR) of 519 patients treated by NSS in an elective indications setting between 1984 and 2006 in eight academic institutions. A GFR decrease under the thresholds of 60 or 45 ml/min at last follow-up was considered a significant renal dysfunction. Univariate and multivariate regression models were used to assess multiple factors of renal function.Median age, tumor size, preoperative, and final GFR were 59.5 years (27-84), 2.7 cm (0.9-11), 79 (45-137), and 69 ml/min (p0.0001), respectively, with a median follow-up of 23 months (1-416). Hilar clamping was performed in 375 procedures (72.3 %). Significant GFR decrease was observed in 89 patients (17.1 %). Median operating time, hilar clamping duration, and blood loss were 137 min (55-350), 22 min (0-90), and 150 ml (0-4150), respectively. At univariate analysis, age (p = 0.002), preoperative GFR (p = 0.001), pedicular clamping (p = 0.01), and ischemia time (p = 0.0001) were associated with renal dysfunction. Age (p = 0.004; HR 1.2), pedicular clamping (p = 0.04; HR 1.3), and ischemia time (p = 0.0001; HR 1.8) remained independent risk factors for renal function deterioration in multivariate analysis.Non- or time-limited clamping techniques are associated with preservation of renal function in the elective indications setting of NSS.

Published
2014

5. The use of partial nephrectomy: results from a contemporary national prospective multicenter study

Author

P. Gimel, Hervé Baumert, Michel Soulié, Pascal Mouracade, J.-P. Couapel, Karim Bensalah, Christophe Vaessen, Laurent Salomon, Morgan Rouprêt, Marc-Olivier Timsit, Jean-Christophe Bernhard, Jean-Jacques Patard, Laurent Bellec, Pierre Bigot, Jean-Marie Ferriere, Herve Lang, Marc Zerbib, Arnauld Villers, Jérôme Rigaud, Géraldine Pignot, and Arnaud Mejean

Subjects
Adult, Male, Nephrology, medicine.medical_specialty, Urology, medicine.medical_treatment, Operative Time, Population, Nephrectomy, Young Adult, Robotic Surgical Procedures, Renal cell carcinoma, Internal medicine, medicine, Humans, Prospective Studies, Warm Ischemia, Prospective cohort study, Laparoscopy, education, Carcinoma, Renal Cell, Aged, Aged, 80 and over, education.field_of_study, medicine.diagnostic_test, business.industry, General surgery, Middle Aged, medicine.disease, Kidney Neoplasms, Surgery, Treatment Outcome, Cohort, Female, Observational study, France, business
Abstract

Despite benefits in functional renal outcome and favorable oncological efficacy, previous studies show marked underuse of partial nephrectomy (PN). We investigated national utilization of partial and radical nephrectomy (RN) using a contemporary, prospective population-based cohort.Between June and December 2010, 1,237 patients were treated by PN or RN for renal cell carcinoma in 56 French centers. Data were prospectively collected, and statistical analyses were performed.Overall, 667 (53.9 %) and 570 patients (46.1 %) underwent RN and PN, respectively. In case of PN, surgical approach was an open PN in 63.3 % of cases, a laparoscopic PN in 21.0 % of cases and a robot-assisted PN in 15.7 % of cases. PN was used in T1a, T1b, T2 and T3 tumors in 395 (76.7 %), 131 (38.2 %), 29 (14.7 %) and 7 (4.6 %), respectively. Median ischemia time was 16 min [0-60], and mean blood loss was 280.4 ml (±339.9). Tumor characteristics and operative features were significantly different according to the surgical approach. Warm ischemia time was significantly higher in case of laparoscopic or robot-assisted procedure (p0.001). There was no statistical significant difference in blood loss and transfusion rate according to surgical approach. Postoperative medical and surgical complications occurred in 8.2 and 10.0 % of PN, respectively, with no significant difference according to surgical approach.Partial nephrectomy for renal cell carcinoma is commonly used in this French centers sample. Mini-invasive approaches represent also a significant part of all partial nephrectomies with no difference in terms of complication rates.

Published
2014

6. Morbidity and Clinical Outcome of Nephron-Sparing Surgery in Relation to Tumour Size and Indication

Author

Jean-Jacques Patard, Allan J. Pantuck, Maxime Crepel, John S. Lam, Laurent Bellec, Baptiste Albouy, David Lopes, Jean-Christophe Bernhard, François Guillé, Bertrand Lacroix, Alexandre De La Taille, Laurent Salomon, Christian Pfister, Michel Soulié, Jacques Tostain, Jean-Marie Ferriere, Claude C. Abbou, Marc Colombel, and Arie S. Belldegrun

Subjects
Male, Time Factors, Urology, Nephrons, Length of Stay, Middle Aged, Prognosis, Nephrectomy, California, Kidney Neoplasms, Survival Rate, Humans, Female, France, Morbidity, Carcinoma, Renal Cell, Follow-Up Studies, Neoplasm Staging, Retrospective Studies
Abstract

To analyse through a large multicentre series, morbidity of nephron-sparing surgery (NSS) in relation to tumour size and surgical indication.The study included patients from eight international academic centres. Age, sex, TNM stage, tumour size, Fuhrman grade, Eastern Cooperative Oncology Group performance status (ECOG-PS), surgical margins, local and distant recurrences, and overall and cancer-specific survival rates were collected and analysed. Indication for elective or mandatory NSS, medical and surgical complication rates, mean blood loss, blood transfusion, and length of hospital stay were specifically recorded for the purpose of this study. Groups were compared for qualitative and quantitative variables by using chi(2) (Fischer exact test) and Student t tests, respectively.A total of 1048 NSS procedures were included in this study. Mean tumour size was 3.4+/-2.1cm. In 730 elective procedures mean operative time (p=0.002), mean blood loss (p=0.01), the need for blood transfusion (p=0.001), and urinary fistula rate (p=0.01) were significantly increased for tumours4 cm. However, these differences did not result in significantly increased medical (p=0.4), surgical complication rates (p=0.6), or length of hospital stay (p=0.9). Finally, in elective procedures for malignant tumours, positive surgical margins, local or distant recurrence rates, and cancer-specific survival were not significantly different in tumoursor =4 cm and4 cm.Excellent cancer control and outcomes can be achieved with NSS in carefully selected patients with tumours4 cm. Expanding the size indication of elective NSS results in an increased but acceptable morbidity.

Published
2007

7. The accuracy of renal tumor biopsy: analysis from a national prospective study

Author

L. Salomon, M. Schneider, Jean-Christophe Bernhard, Maxime Crepel, R. Mallet, Laurent Zini, E. Rolland, F. Salome, Marc-Olivier Timsit, M. Rouprêt, E. Xylinas, J. L. Auberget, J.P. Ansieau, Pierre Bigot, Laurent Bellec, J. M. Legraverend, A. Mejean, Christian Pfister, P. Gimel, Géraldine Pignot, L. Le Pellec, Herve Lang, J. Berger, J.J. Patard, C. Castagnola, P. Monod, Philippe Paparel, F. Bruyère, and Hervé Baumert

Subjects
Nephrology, Adult, Male, medicine.medical_specialty, Urology, Concordance, medicine.medical_treatment, Malignancy, Nephrectomy, Young Adult, McNemar's test, Renal cell carcinoma, Internal medicine, Biopsy, medicine, Adenoma, Oxyphilic, Humans, Prospective Studies, Prospective cohort study, Carcinoma, Renal Cell, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, Nephrons, Middle Aged, medicine.disease, Carcinoma, Papillary, Kidney Neoplasms, Female, Radiology, Biopsy, Large-Core Needle, France, business, Organ Sparing Treatments
Abstract

To assess preoperative renal tumor biopsy (RTB) accuracy. As part of the prospective NEPHRON study, data from 1,237 renal tumors were collected, including the use and results of RTB and final histology following nephrectomy. During the 6 months period of inclusion, 130 preoperative biopsies were performed. We used the kappa coefficient of the McNemar test to determine the concordance between the biopsy and the nephrectomy specimen (NS) regarding four parameters: malignant/benign status, histological subtype, Fuhrman grade and microscopic necrosis. Preoperative biopsies were performed in 9.7 and 11.4 % of the 667 radical and 570 partial nephrectomies, respectively. Tumor biopsy was inconclusive in 7.7 % of the cases. In 117 cases, a comparison between RTB and NS was available. Benign tumors accounted for three (2.6 %) and five (4.3 %) of the RTB and NS, respectively (κ = 0.769, good). With seven (6 %) discordant results in terms of histological subtype characterization between RTB and final pathology, RTB accuracy was considered excellent (κ = 0.882). In 33 cases (31.7 %), Fuhrman grade was underestimated at biopsy resulting in an intermediate concordance level (κ = 0.498). Tumor microscopic necrosis was identified in 12 RTB (10.4 %) versus 33 NS (28.4 %) (κ = 0.357, poor). RTB provides good to excellent diagnostic performance for discriminating malignancy and tumor histological subtype. However, its performance is intermediate or even poor when considering prognostic criteria like Fuhrman grade or microscopic necrosis. Thus, this possible inaccuracy should be taken into consideration when using RTB for accurate guidance of treatment strategy.

Published
2014

8. Nephron-sparing surgery for renal tumors measuring more than 7 cm: morbidity, and functional and oncological outcomes

Author

Idir Ouzaid, Yann Neuzillet, Michel Soulié, Vincent Ravery, Guillaume Ploussard, Hervé Baumert, Evanguelos Xylinas, Morgan Rouprêt, Tarek Fardoun, Nicolas Grenier, Olivier Merigot de Treigny, Karim Bensalah, Laurent Bellec, Denis Chautard, Gregory Verhoest, Edouard Robine, Laurent Brureau, Pierre Bigot, Jean-Jacques Patard, Bernard Escudier, C. Maurin, Jean-François Hetet, Jean-Christophe Bernhard, Abdel-Rahmène Azzouzi, Marc Zerbib, Thomas Bessede, Souhil Lebdai, Jean-Alexandre Long, Nathalie Rioux-Leclercq, Jean Rouffilange, Philippe Paparel, François Audenet, Jérôme Rigaud, N. Hoarau, Laurence Bastien, Pierre Mongiat-Artus, Géraldine Pignot, Service d'urologie, Université d'Angers ( UA ) -CHU Angers, Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Institut Mondor de Recherche Biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), INSERM U955, équipe 7, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Institut Mondor de Recherche Biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10, Service d'urologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications [Grenoble] ( TIMC-IMAG ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut polytechnique de Grenoble - Grenoble Institute of Technology ( Grenoble INP ) -IMAG-Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ), CHU Grenoble-Hôpital Michallon, CHU Angers, Service d'urologie et transplantation rénales [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Institut Mondor de recherche biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), FLIRT, Fédération pour L'étude de l'Ischémie Reperfusion en Transplantation, Service d'Urologie [CHU Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut de Génétique et Développement de Rennes ( IGDR ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Centre National de la Recherche Scientifique ( CNRS ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), urology, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Hôtel-Dieu, Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Hôpital Saint-Joseph, Oncologie génito-urinaire, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy ( IGR ) -Institut Gustave Roussy ( IGR ), Service d'urologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Imagerie moléculaire et fonctionnelle: de la physiologie à la thérapie, Université Bordeaux Segalen - Bordeaux 2-IFR8-Centre National de la Recherche Scientifique ( CNRS ), Service d'Imagerie Diagnostique et Interventionnelle de l'Adulte, CHU Bordeaux [Bordeaux], Service de Génétique Moléculaire, Jonchère, Laurent, Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire d'Angers (CHU Angers), Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Université Bordeaux Segalen - Bordeaux 2-IFR8-Centre National de la Recherche Scientifique (CNRS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)

Subjects
Adult, Male, medicine.medical_specialty, Survival, Urology, medicine.medical_treatment, Population, 030232 urology & nephrology, Renal function, [SDV.GEN] Life Sciences [q-bio]/Genetics, Malignancy, Nephrectomy, Disease-Free Survival, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Renal cell carcinoma, Risk Factors, medicine, Humans, Risk factor, education, Carcinoma, Renal Cell, Aged, Retrospective Studies, Aged, 80 and over, education.field_of_study, [SDV.GEN]Life Sciences [q-bio]/Genetics, business.industry, Hazard ratio, Perioperative, Nephrons, Robotics, Middle Aged, medicine.disease, Kidney Neoplasms, 3. Good health, Survival Rate, Treatment Outcome, Oncology, 030220 oncology & carcinogenesis, Female, Laparoscopy, Neoplasm Recurrence, Local, business, [ SDV.GEN ] Life Sciences [q-bio]/Genetics
Abstract

International audience; BACKGROUND: The purpose of this study was to evaluate morbidity, functional, and oncological outcomes after NSS in renal tumors \textgreater 7 cm. MATERIALS AND METHODS: We retrospectively analyzed data from 168 patients with tumors \textgreater 7 cm who were treated using NSS between 1998 and 2012. RESULTS: Imperative and elective indications accounted for 76 (45.2%) and 92 (54.8%) patients, respectively. Major perioperative complications and renal function deterioration occurred in 33 (19.6%) and 51 patients (30.4%), respectively. In multivariate analysis, age older than 60 years (P = .001; hazard ratio [HR], 5) and tumor malignancy (P = .014; HR, 6.7) were prognostic factors for renal function deterioration whereas imperative indication was a risk factor for major postoperative complications (P = .0019; HR, 2.7). In 126 (75%) patients with malignant tumors, after a median follow-up of 30 months (range, 1-254 months), 25 patients (20.2%) died. In multivariate analysis, imperative indication (P = .023; HR, 4.2), positive surgical margin (P = .021; HR, 3.3), and Fuhrman grade \textgreater II (P = .013; HR, 3.7) were prognostic indicators for cancer-free survival (CFS). Imperative indication (P = .04; HR, 8.5) and Fuhrman grade \textgreater II (P = .04; HR, 3.9) were predictive factors of cancer-specific survival (CSS). In case of elective indication, positive surgical margin, local recurrence, and cancer-related death occurred in 4 (7.6%), 1 (1.1%), and 1 (1.1%) cases, respectively. For elective indication, 5-year estimates of CFS, CSS, and overall survival rates were: 85.7%, 98%, and 93.9%, respectively. CONCLUSION: In this selected population, imperative vs. elective indication status seems to play a critical role in oncologic outcomes. Oncologic results for elective indications are close to those reported with radical nephrectomy.

Published
2014

9. Is there a volume-outcome relationship for partial nephrectomy?

Author

F. Salome, Laurent Zini, Laurent Bellec, P. Gimel, Michel Soulié, Karim Bensalah, F. Bruyère, J.P. Ansieau, Hervé Baumert, A. Mejean, Christian Pfister, J.J. Patard, Pierre Bigot, Christophe Vaessen, Jean-Christophe Bernhard, Géraldine Pignot, L. Salomon, Jacques Hubert, E. Mourey, J.L. Jung, Jean-Baptiste Rigaud, Herve Lang, Marc-Olivier Timsit, M. Rouprêt, J.-P. Couapel, J. Berger, Service d'Urology [Rennes], CHU Pontchaillou [Rennes], service d'urologie [CHU Bordeaux], CHU Bordeaux [Bordeaux], Service d'urologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'Urologie, andrologie et transplantation rénale [CHRU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'Urologie [Strasbourg], CHU Strasbourg, Service d'Urologie [Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'Urologie [Colmar], CH Colmar, Service d'Urologie [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service d'Urologie [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service d'urologie [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau, Service de Chirurgie urologique et andrologie [CHU Limoges], CHU Limoges, Service d'Urologie [Mulhouse], Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA)-Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Centre de Médecine Générale Avicenne [Cabestany], Polyclinique de Limoges - site François Chénieux [Limoges], Service d'Urologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'urologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Groupe Hospitalier Paris Saint Joseph, Service de Microbiologie [CHU GeorgesPompidou], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service d'Urologie [CHU Georges Pompidou], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service d'Urologie [CHU de Bicêtre], AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)

Subjects
Nephrology, Adult, medicine.medical_specialty, Hospitals, Low-Volume, genetic structures, Urology, medicine.medical_treatment, 030232 urology & nephrology, Nephrectomy, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Hospital volume, Renal cell carcinoma, Internal medicine, medicine, Humans, Prospective Studies, Aged, Aged, 80 and over, Volume outcome, business.industry, Middle Aged, medicine.disease, Kidney Neoplasms, 3. Good health, Surgery, Treatment Outcome, 030220 oncology & carcinogenesis, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Hospitals, High-Volume
Abstract

International audience; OBJECTIVE:To investigate the impact of hospital volume on partial nephrectomy indications and outcomes.MATERIALS AND METHODS:Data were extracted from the National Observational Registry on the Practice and Hemostasis in Partial Nephrectomy registry. Four groups were created according to the number of partial nephrectomy (PN) performed: very high (VH, ≥ 19 PN), high (H, 10-18 PN), moderate (M, 4-9 PN) and low (L

Published
2013

10. Predictive factors for ipsilateral recurrence after nephron-sparing surgery in renal cell carcinoma

Author

Karim Bensalah, Laurent Salomon, Clement Claude Abbou, Allan J. Pantuck, Maxime Crepel, Grégoire Robert, Laurent Bellec, Jacques Tostain, Jean-Marie Ferriere, B. Albouy, Michel Soulié, Arie S. Belldegrun, Jean-Christophe Bernhard, Bertrand Lacroix, D. Lopes, Sylvie Maurice-Tison, Christian Pfister, Jean-Jacques Patard, Alexandre de la Taille, Marc Colombel, Hervé Wallerand, Rodolphe Thuret, Gilles Pasticier, Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Department of Urology, University of California [Los Angeles] (UCLA), University of California-University of California, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Service d'information médicale, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Service d'urologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'urologie-andrologie, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Hôpital nord, Service Urologie [Lapeyronie], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Service d'urologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), University of California (UC)-University of California (UC), Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Saint-Etienne-Université Jean Monnet - Saint-Étienne (UJM)-Hôpital nord, De Villemeur, Hervé, Service d'urologie [Rennes], Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes]

Subjects
Male, MESH: Tumor Burden, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, 030232 urology & nephrology, Nephrectomy, Surgery, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Proportional Hazards Models, 0302 clinical medicine, Renal cell carcinoma, Risk Factors, MESH: Risk Factors, Local recurrence, Multicenter Studies as Topic, MESH: Aged, MESH: Middle Aged, MESH: Carcinoma, Renal Cell, MESH: Neoplasm Staging, Middle Aged, Prognosis, Kidney Neoplasms, Tumor Burden, 030220 oncology & carcinogenesis, Female, Nephron sparing surgery, MESH: Neoplasm Recurrence, Local, medicine.medical_specialty, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, MESH: Prognosis, 03 medical and health sciences, Text mining, [SDV.CAN] Life Sciences [q-bio]/Cancer, Carcinoma, medicine, Humans, In patient, Carcinoma, Renal Cell, Aged, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, MESH: Humans, business.industry, Proportional hazards model, fungi, Retrospective cohort study, MESH: Retrospective Studies, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Male, MESH: Nephrectomy, MESH: Multicenter Studies as Topic, Neoplasm Recurrence, Local, MESH: Kidney Neoplasms, business, MESH: Female
Abstract

Ipsilateral recurrence after nephron-sparing surgery (NSS) is rare, and little is known about its specific determinants.To determine clinical or pathologic features associated with ipsilateral recurrence after NSS performed for renal cell carcinoma (RCC).We analysed 809 NSS procedures performed at eight academic institutions for sporadic RCCs retrospectively.Age, gender, indication, tumour bilaterality, tumour size, tumour location, TNM stage, Fuhrman grade, histologic subtype, and presence of positive surgical margins (PSMs) were assessed as predictors for recurrence in univariate and multivariate analysis by using a Cox proportional hazards regression model.Among 809 NSS procedures with a median follow-up of 27 (1-252) mo, 26 ipsilateral recurrences (3.2%) occurred at a median time of 27 (14.5-38.2) mo. In univariate analysis, the following variables were significantly associated with recurrence: pT3a stage (p=0.0489), imperative indication (p0.01), tumour bilaterality (p0.01), tumour size4cm (p0.01), Fuhrman grade III or IV (p=0.0185), and PSM (p0.01). In multivariate analysis, tumour bilaterality, tumour size4cm, and presence of PSM remained independent predictive factors for RCC ipsilateral recurrence. Hazard ratios (HR) were 6.31, 4.57, and 11.5 for tumour bilaterality, tumour size4cm, and PSM status, respectively. The main limitations of this study included its retrospective nature and a short follow-up.RCC ipsilateral recurrence risk after NSS is significantly associated with tumour size4cm, tumour bilaterality (synchronous or asynchronous), and PSM. Careful follow-up should be advised in patients presenting with such characteristics.

Published
2010

11. Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery

Author

Romain Spie, Jérôme Rigaud, Jacques Tostain, Michel Soulié, Bastien Rambeaud, Hendrik Van Poppel, Alfredo Aguilera, Maxime Crepel, Laurent Zini, Ofer Nativ, Jean Marie Ferriere, Luis Martinez Pineiro, Steven Joniau, Patrick J. Bastian, Rodolphe Thuret, Jean Jacques Patard, Stefan C. Müller, Frédéric Pouliot, Jean-Christophe Bernhard, Amnon Zisman, Andreas H. Wille, Christian Pfister, Pascal Rischmann, Nicolas Mottet, Laurent Bellec, Alexandre de la Taille, Allan J. Pantuck, Laurent Guy, Thierry Dujardin, R. Avakian, Jan Roigas, François Richard, Nathalie Rioux-Leclercq, Christian Doehn, Pierre I. Karakiewicz, Arie S. Belldegrun, Roberto Bertini, Orit E. Raz, Karim Bensalah, Laurent Salomon, B. Albouy, T. Culty, Thierry Lebret, Morgan Rouprêt, A. Villers, Francesco Montorsi, Fabien Saint, Herve Lang, Roy Farfara, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Department of Urology, University of California [Los Angeles] (UCLA), University of California-University of California, Service Urologie [Lapeyronie], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Department of urology, Università Vita-Salute San Raffaele, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Cancer Prognostics and Health Outcome Unit, Service d'urologie-andrologie, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Hôpital nord, Université Jean Monnet [Saint-Étienne] (UJM), Service d'urologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), National and Kapodistrian University of Athens (NKUA), Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Université Fédérale Toulouse Midi-Pyrénées, Université de Nantes (UN), Service d'urologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Image Science for Interventional Techniques (ISIT), Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS)-Clermont Université, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Hôpital Foch [Suresnes], Université de Picardie Jules Verne (UPJV), Assaf Harofeh Medical Centre, Tel Aviv University [Tel Aviv]-Assaf Harofeh Medical Centre, CHU Strasbourg, Berlin Charity Hospital, La Paz University Hospital, Bnai Zion Hospital, Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Lubeck University Hospital, Bonn University Hospital, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS), University of California (UC)-University of California (UC), CHU Saint-Etienne-Université Jean Monnet - Saint-Étienne (UJM)-Hôpital nord, Université Jean Monnet - Saint-Étienne (UJM), Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université-Centre National de la Recherche Scientifique (CNRS), Tel Aviv University (TAU)-Assaf Harofeh Medical Centre, Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), De Villemeur, Hervé, Bensalah, Karim, Pantuck Allan, J., Rioux Leclercq, Nathalie, Thuret, Rodolphe, Montorsi, Francesco, Karakiewicz Pierre, I., Mottet, Nicola, Zini, Laurent, Bertini, Roberto, Salomon, Laurent, Villers, Arnaud, Soulie, Michel, Bellec, Laurent, Rischmann, Pascal, De La Taille, Alexandre, Avakian, Raffi, Crepel, Maxime, Ferriere Jean, Marie, Bernhard Jean, Christophe, Dujardin, Thierry, Pouliot, Frederic, Rigaud, Jerome, Pfister, Christian, Albouy, Baptiste, Guy, Laurent, Joniau, Steven, van Poppel, Hendrik, Lebret, Thierry, Culty, Thibault, Saint, Fabien, Zisman, Amnon, Raz, Orit, Lang, Herve, Spie, Romain, Wille, Andrea, Roigas, Jan, Aguilera, Alfredo, Rambeaud, Bastien, Martinez Pineiro, Lui, Nativ, Ofer, Farfara, Roy, Richard, Francoi, Roupret, Morgan, Doehn, Christian, Bastian Patrick, J., Muller Stefan, C., Tostain, Jacque, Belldegrun Arie, S., Patard Jean, Jacques, Service d'Urologie - Andrologie [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM), Université de Toulouse (UT), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and University Hospital Bonn

Subjects
Surgical margin, medicine.medical_specialty, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, MESH: Survival Rate, Urology, medicine.medical_treatment, 030232 urology & nephrology, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Renal cell carcinoma, Predictive Value of Tests, medicine, Humans, Survival rate, Carcinoma, Renal Cell, MESH: Nephrons, Retrospective Studies, MESH: Humans, MESH: Middle Aged, Proportional hazards model, business.industry, Retrospective cohort study, MESH: Retrospective Studies, Nephrons, MESH: Carcinoma, Renal Cell, Middle Aged, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Kidney Neoplasms, MESH: Predictive Value of Tests, 3. Good health, Surgery, Survival Rate, MESH: Nephrectomy, 030220 oncology & carcinogenesis, Predictive value of tests, MESH: Kidney Neoplasms, business, Kidney cancer
Abstract

International audience; BACKGROUND: The occurrence of positive surgical margins (PSMs) after partial nephrectomy (PN) is rare, and little is known about their natural history. OBJECTIVE: To identify predictive factors of cancer recurrence and related death in patients having a PSM following PN. DESIGN, SETTING, AND PARTICIPANTS: Some 111 patients with a PSM were identified from a multicentre retrospective survey and were compared with 664 negative surgical margin (NSM) patients. A second cohort of NSM patients was created by matching NSM to PSM for indication, tumour size, and tumour grade. MEASUREMENTS: PSM and NSM patients were compared using student t tests and chi-square tests on independent samples. A Cox proportional hazards regression model was used to test the independent effects of clinical and pathologic variables on survival. RESULTS AND LIMITATIONS: Mean age at diagnosis was 61+/-12.5 yr. Mean tumour size was 3.5+/-2 cm. Imperative indications accounted for 39% (43 of 111) of the cases. Some 18 patients (16%) underwent a second surgery (partial or total nephrectomy). With a mean follow-up of 37 mo, 11 patients (10%) had recurrences and 12 patients (11%) died, including 6 patients (5.4%) who died of cancer progression. Some 91% (10 of 11) of the patients who had recurrences and 83% of the patients (10 of 12) who died belonged to the group with imperative surgical indications. Rates of recurrence-free survival, of cancer-specific survival, and of overall survival were the same among NSM patients and PSM patients. The multivariable Cox model showed that the two variables that could predict recurrence were the indication (p=0.017) and tumour location (p=0.02). No other variable, including PSM status, had any effect on recurrence. None of the studied parameters had any effect on the rate of cancer-specific survival. CONCLUSIONS: PSM status occurs more frequently in cases in which surgery is imperative and is associated with an increased risk of recurrence, but PSM status does not appear to influence cancer-specific survival. Additional follow-up is needed.

Published
2010

12. Clinicopathological features and prognosis of synchronous bilateral renal cell carcinoma: an international multicentre experience

Author

Luca Cindolo, Maxime Crepel, Jacques Tostain, Michel Soulié, John S. Lam, Jean-Marie Ferriere, Laurent Bellec, M. Böhm, Heiko Wunderlich, Ernst P. Allhoff, Arnaud Mejean, Tobias Klatte, Christian Pfister, Marc Colombel, Arie S. Belldegrun, Jean-Jacques Patard, Kerstin Junker, Alexandre de la Taille, Allan J. Pantuck, B. Albouy, Fairooz F. Kabbinavar, Mark D. Kleid, Jörg Schubert, Amnon Zisman, and Jean-Christophe Bernhard

Subjects
Nephrology, Male, medicine.medical_specialty, Urology, urologic and male genital diseases, Nephrectomy, Cohort Studies, Neoplasms, Multiple Primary, Renal cell carcinoma, Internal medicine, medicine, Carcinoma, Humans, neoplasms, Carcinoma, Renal Cell, Testicular cancer, Survival analysis, Retrospective Studies, business.industry, Retrospective cohort study, Middle Aged, medicine.disease, Prognosis, Survival Analysis, female genital diseases and pregnancy complications, Kidney Neoplasms, Surgery, Female, business, Kidney cancer, Kidney disease
Abstract

An interesting group of papers in this section is headed by two papers on synchronous bilateral renal tumours, one from an international group of authors and one from Germany. The large series of patients are examined carefully by both groups, and the findings should be useful for all who are interested in this area. Authors from the UK examine the role of lactate dehydrogenase as a prognostic factor for testicular cancer. They found that it had limited sensitivity, specificity and positive predictive value for detecting relapse, with false-positive elevations being common. OBJECTIVE To present a multicentre experience and the largest cohort to date of nonmetastatic (N0M0) synchronous bilateral renal cell carcinoma (RCC), as because it is rare the single-institutional experience is limited. PATIENTS AND METHODS We retrospectively studied 10 337 patients from 12 urological centres to identify patients with N0M0 synchronous bilateral RCC; the clinicopathological features and cancer-specific survival were compared to a cohort treated for N0M0 unilateral RCC. RESULTS In all, 153 patients had synchronous bilateral solid renal tumours, of whom 135 (88%) had synchronous bilateral RCC, 118 with nonmetastatic disease; 91% had nonfamilial bilateral RCC. Bilateral clear cell RCC was the major histological subtype (76%), and papillary RCC was the next most frequent (19%). Multifocality was found in 54% of bilateral RCCs. Compared with unilateral RCC, patients did not differ in Eastern Cooperative Oncology Group performance status (ECOG PS) and T classification, but bilateral RCCs were more frequently multifocal (54% vs 16%, P

Published
2007

13. [Comparison of open and laparoscopic partial nephrectomy: a French multicentre experience]

Author

Maxime, Crepel, Jean-Christophe, Bernhard, Laurent, Bellec, Baptiste, Albouy, David, Lopes, Bertrand, Lacroix, Alexandre, De la Taille, Laurent, Salomon, Christian, Pfister, Michel, Soulie, Jacques, Tostain, Jean-Marie, Ferriere, Claude-C, Abbou, François, Guille, Karim, Bensalah, Sébastien, Vincendeau, Andrea, Manunta, Marc, Colombel, and Jean-Jacques, Patard

Subjects
Adult, Aged, 80 and over, Male, Humans, Female, Laparoscopy, France, Middle Aged, Nephrectomy, Kidney Neoplasms, Aged, Retrospective Studies
Abstract

To compare open (OPN) and laparoscopic (LPN) partial nephrectomy (PN) techniques in the light of a French multicentre series.Data corresponding to 741 PN (91 laparoscopic and 650 open procedures) were compared in terms of the indications, tumour diameter, operative data, complication rates and length of hospital stay.Tumours were smaller in the LPN group (2.7 vs 3.4 cm, p = 0.001). There were fewer malignant tumours (71.1% vs 80% p = 0.05) and fewer NP by necessity (20.9% vs 31.4%. p = 0.04) in the LPN group than in the OPN group. There were fewer hilar tumours in the LPN group than in the OPN group (LPN: 4% vs OPN: 14.8%, p = 0.03). Pedicle clamping was performed less frequently in the LPN group (33% vs 50.2%, p = 0.002) but for a significantly longer mean duration (35 minutes vs 19 minutes, p = 0.0001). The mean operating time was longer in the LPN group (163 vs 150 minutes, p = 0.02). The surgical complication rate (17.6% vs 14.3%), transfusion rate (6.6% vs 10.5%) and mean blood loss (363 vs 434 ml) were not significantly different between the 2 groups. There were significantly more urinary fistulas (12.1% vs 2.5%, p0.001) and medical complications (24.2% vs 14%, p = 0.01) in the laparoscopy group, but, in the longer-term, urinarvfistula rates were comparable in the 2 groups. The length of hospital stay was shorter for LPN (9.1 vs 11.2 days, p = 0.009).This comparative series, reflecting initial experience, shows that laparoscopic partial nephrectomy achieves similar operative and perioperative results to those of open partial nephrectomy. However, the indications for laparoscopic partial nephrectomy remain selective, as the pedicle clamping time and medical complication rates are higher with laparoscopic surgery. Experience and technical progress in laparoscopic partial nephrectomy should make the operative technique comparable to that of open surgery.

Published
2007

14. [Partial nephrectomy by selective renal parenchymal clamping using a new clamp]

Author

Mehdi, Khedis, Laurent, Bellec, Bertrand, Leobon, Matthieu, Thoulouzan, Pierre, Labarthe, Joe, Nohra, Michel, Soulie, Eric, Huyghe, and Pierre, Plante

Subjects
Adult, Aged, 80 and over, Humans, Equipment Design, Middle Aged, Constriction, Nephrectomy, Kidney Neoplasms, Aged
Abstract

To study the results of open partial nephrectomy by selective renal parenchymal clamping using a new renal parenchyma clamp, the Réniclamp.Partial nephrectomy was performed in 37 patients using the Réniclamp for an imperative indication in 7 patients (solitary kidneys) and an elective indication in 30 patients. The tumour was situated in a pole in 22 cases and on the lateral border of the kidney in 15 cases. The mean tumour diameter was 29 mm (range: 10 - 60 mm).The mean operating time was 147 minutes and the mean clamping time was 25 minutes. Mean blood loss was 191 cc (range : 50-450 cc) and no patient required blood transfusion. No cases of slipping of the clamp or renal parenchymal lesion due to the clamp were observed.A urinary fistula treated by endoscopy and obstructive clot of the upper urinary tract, which required endoscopic treatment and selective embolisation. The surgical margins were negative in every case.Partial nephrectomy by selective renal parenchymal clamping is an alternative to the pedicle clamping technique in almost every case of renal tumour except for central renal lesions. Réniclamp distributes the pressure homogeneously, avoiding damage to the parenchyma due to excess pressure on the proximal part of the clamp and bleeding due to insufficient pressure on the distal part of the clamp.

Published
2007

15. The effect of gender and age on kidney cancer survival: Younger age is an independent prognostic factor in women with renal cell carcinoma

Author

Christian Pfister, Luca Cindolo, Jean-Christophe Bernhard, Jean-Jacques Patard, Arnaud Mejean, Edward N. Rampersaud, Geoffrey D. Bass, Allan J. Pantuck, Laurent Bellec, Karim Bensaleh, Marc Colombel, Tobias Klatte, M. Böhm, Arie S. Belldegrun, Ernst P. Allhoff, Daniel J. George, Alexandre de la Taille, and Michel Soulié

Subjects
Adult, Male, Oncology, medicine.medical_specialty, Urology, medicine.medical_treatment, Kaplan-Meier Estimate, Cohort Studies, Age and gender, Sex Factors, Renal cell carcinoma, Internal medicine, Epidemiology, medicine, Humans, Carcinoma, Renal Cell, Aged, Proportional Hazards Models, Gynecology, Proportional hazards model, business.industry, Incidence (epidemiology), Age Factors, Middle Aged, Prognosis, medicine.disease, Kidney Neoplasms, Nephrectomy, Treatment Outcome, Cohort, Female, business, Kidney cancer
Abstract

Gender-specific differences in incidence of renal cell carcinoma (RCC) and its outcome have previously been reported. We used age as a surrogate to test whether this might be hormone-related in a large international RCC cohort.This study included patients treated by nephrectomy at 10 international academic centers. Clinicopathologic features were assessed using chi-square and the Student t-tests. Kaplan-Meier survival estimates and Cox proportional hazards models addressed the effect of gender and age on disease-specific survival.Of the 5,654 patients, 3,777 (67%) were men and 1,877 (33%) were women. Generally, women presented at lower T stages (P0.001), had fewer metastases (P0.001), and had lower-grade tumors (P0.001). Women more frequently had clear-cell (87% vs. 82%) and less frequently had papillary RCC (7% vs. 12%) than men (P0.001). Women had a 19% reduced risk of death from RCC than men (hazard ratio 0.81, 95% confidence interval 0.73-0.90, P0.001). The survival advantage for women was present to the greatest degree in the age group42 years (P = 0.0136) and in women aged 42 to 58 years (P0.001), but was not apparent in patients aged 59 years and older (P = 0.248). Age was an independent predictor of disease-specific survival in women (hazard ratio 1.011, 95% confidence interval 1.004-1.019, P = 0.004), but not in men.As a group, women present with less advanced tumors, leading to a 19% reduced risk of RCC-specific death compared with men. This survival difference is present only in patients aged59 years. Because this gender-based survival difference is not related to pathologic features, the role of hormonal effects on the development and progression of RCC needs to be investigated.

Published
2014

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