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Objectives To determine short-term differences in renal function evolution between patients with renal cell carcinoma ( RCC) submitted to radical nephrectomy ( RN) and living kidney donors matched for age and gender., To assess the role of co-morbidity as a risk factor for developing an estimated glomerular filtration rate ( eGFR) of <60 mL/min/1.73 m2., Patients and Methods In this retrospective study patients undergoing Radical Nefrectomy ( RN) between January 2000 and February 2011 for suspicion of localised RCC were matched by age and gender to living kidney donors., Renal function was compared between the groups using the Modification in Diet and Renal Disease ( MDRD) equation at 1 year after RN., Charlson co-morbidity score, incidence of hypertension, diabetes and cardiovascular disease were compared and assessed as predictors for developing an eGFR of <60 mL/min/1.73 m2., Results In all, 196 patients were included, 98 in each group., The mean age was respectively 60.6 ( RCC group) and 59.1 years (donors)., The 1-year postoperative mean eGFR (available in 89 patients with RCC and 87 donors) was similar, at a mean ( sd) of 56.7 (16.4) mL/min/1.73 m2 in patients with RCC and 56.2 (9.8) mL/min/1.73 m2 in donors ( P = 0.83)., In patients with RCC the incidence and severity of co-morbidities was significantly higher., A preoperative eGFR of 60-89 mL/min/1.73 m2 was the only independent risk factor for developing a postoperative eGFR of <60 mL/min/1.73 m2 (odds ratio 4.4, confidence interval 2.1-9.5, P < 0.001, 95% confidence interval)., Conclusions In our cohorts with advanced age the 1-year follow-up eGFR was similar in both groups., Despite increased co-morbidity in the RCC group there was no increased decline in renal function., Only reduced preoperative eGFR could be identified as risk factor for developing a postoperative eGFR of <60 mL/min/1.73 m2. [ABSTRACT FROM AUTHOR]

Purpose: To assess the use of prognostic factors and models in renal-cell carcinoma (RCC) and to gain insight in the motivations precluding prognosis estimation and the use of prognosticators. Materials and Methods: A questionnaire was sent to 110 urologists involved in the Clinical Research Office of the Endourological Society (CROES) Global Renal Mass Study. Frequencies were gathered using descriptive statistics. Results: The majority of the 86 responders worked in a university hospital in Europe. Most of the urologists (97.7%) used the tumor-node-metastasis (TNM) classification, and 44% performed prognosis estimations in all patients. The main reason not to estimate prognosis was lack of accuracy (20.9%) and of additional benefit (11.6%). In addition, clinical, laboratory, or pathologic factors were used by 89.5% of the urologists and biomarkers by 16.3%. Preoperative models were used by 20.9%, postoperative models by 38.4%, and metastatic models by 38.4%. The Raj and Motzer models were the most used in preoperative and metastatic settings, while no predominance among the different postoperative models was seen. The most important reasons to skip the use of models were 'lack of additional value' and 'lack of familiarity' reported by 30.2% and 27.9% of the responders, respectively. Conclusions: The TNM is the mainstay for assessing prognosis in RCC. Our data indicate that penetration of prognostic systems is, at most, moderate, suggesting limited use outside original developmental settings. On the contrary, clinical, laboratory, and pathologic factors are used by almost all urologists for prognosis estimations. The most important reason not to use models is the lack of additional value. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Optical Coherence Tomography (OCT) was developed in the early 1990s for ophthalmological application and is currently widely accepted in ophthalmology for retinal imaging purposes. In kidneys, the first experiments were performed on transplant kidneys to investigate the ability of OCT to assess ischaemic damage of kidneys. An ex vivo pilot study on the ability of OCT to differentiate normal renal tissue from malignant renal tissue, showed positive results and here we present the results of the first in vivo experiment. The study shows for the first time that in vivo OCT is feasible and safe to perform in humans and that a significant different attenuation coefficient (as a quantitative measurement of the OCT images) is found between normal renal tissue and malignant renal tumours with a clear trend towards significance in the difference between benign and malignant renal tumours in a small pilot study. This suggests potential use of OCT in different clinical settings for diagnostic purposes in the course of renal tumours, and justifies further research. OBJECTIVE To determine the ability of optical coherence tomography (OCT) in differentiating human renal tumours in an in-vivo setting by assessing differences in attenuation coefficient (µOCT; mm-1) as a quantitative measurement., METHODS Consecutive patients undergoing nephrectomy (partial/radical) or cryoablation for an enhancing solid renal tumour were included in our centre between October 2010 and May 2011., In vivo OCT images were obtained from renal tumour and normal parenchyma during surgery. Ex vivo OCT images of internal (subcapsular) tissue were obtained after longitudinal dissection of the extirpated specimen., Attenuation coefficients of the OCT images were determined off-line and compared between normal renal parenchyma and renal tumours (grouped per tissue type and per individual patient); and between OCT images recorded from tissue surface vs internal (subcapsular) tissue., RESULTS In vivo OCT was performed in 16 cases (11 renal cell carcinoma, three benign tumours, one non-diagnostic biopsy and one not-accessible tumour)., Median attenuation coefficient of normal renal parenchyma was 5.0 mm−1 vs 8.2 mm−1 for tumour tissue ( P < 0.001) with normal parenchyma differing significantly from malignant tumour (9.2 mm−1, P < 0.001) and non-significantly from benign tumour (7.0 mm−1, P= 0.050). The attenuation coefficient of benign tumours did not differ significantly from that of malignant tumours (7.0 vs 9.2 mm−1, P= 0.139)., Using patients as their own control, attenuation coefficients of normal renal parenchyma differed significantly from malignant tumour ( P < 0.001) and non-significantly from benign tumour ( P= 0.109)., Assessed in 10 patients, there was no significant difference between attenuation coefficients of tumour surface and internal tumour (8.5 vs 9.7 mm−1 respectively, P= 0.260)., CONCLUSIONS In this first in vivo study on OCT for differentiation of renal tumours in humans the attenuation coefficients (as a quantitative assessment) differed significantly between normal renal parenchyma and malignant tumour., Tumour surface and internal tumour did not differ significantly, suggesting that a superficial OCT attenuation coefficient reliably assesses tissue composition inside the tumour., These results justify further research on OCT for various clinical applications in the diagnosis of renal tumours. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated the influence of age on gender related differences in the renal cell carcinoma presentation of patients operated on between 1995 and 2005 in a European country. We also assessed the trend of missing pathological data. Materials and Methods: Data on all patients who underwent radical or partial nephrectomy for renal cell carcinoma during 1995 to 2005 in The Netherlands were retrospectively collected from the prospective PALGA (Pathological Anatomical National Automated Archive) database. Patients were divided into 5 cohorts based on age at surgery, including 40 or less, 41 to 50, 51 to 60, 61 to 70 and greater than 70 years. Variables evaluated were gender differences by age, and tumor size, subtype, stage and Fuhrman grade. Results: A higher mean age in women was only observed in those older than 70 years (p <0.001). The male-to-female ratio was 2:1 at ages 41 to 60 years and 1.2:1 at greater than 70 years. Compared to men women had smaller tumors at ages 51 to 60 years (p = 0.03), stage pT3 was less common at age 41 years or greater (p = 0.02), and grade 2 was less common at age 61 years or greater (p <0.001). The incidence of tumors with missing data on stage (14.9%), subtype (52.2%) and grade (47.1%) decreased substantially during the study period (p <0.001). Conclusions: Older age in women than in men who present to surgery for RCC was only prevalent in those older than 70 years. The male-to-female ratio was almost equal in patients older than 70 years compared to a 2:1 ratio at ages 41 to 60 years. Women presented with fewer pT3 tumors than men at age 41 years or greater. Missing pathological data decreased significantly between 1995 and 2005. [ABSTRACT FROM AUTHOR]