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Objective A prospective, observational, post-marketing surveillance was conducted to assess the safety and effectiveness of temsirolimus in patients with renal cell carcinoma in Japan. Methods Patients prescribed temsirolimus for advanced renal cell carcinoma were registered and received temsirolimus (25 mg weekly, intravenous infusion for 30–60 minutes) in routine clinical settings (observation period: 96 weeks). Results Among 1001 patients included in the safety analysis data set (median age, 65.0 years; men, 74.8%; Eastern Cooperative Oncology Group performance status 0 or 1, 69.6%), 778 (77.7%) reported adverse drug reactions. The most common (≥10%) all-grade adverse drug reactions were stomatitis (26.7%), interstitial lung disease (17.3%) and platelet count decreased (11.1%). The incidence rate of grade ≥3 interstitial lung disease was 4.5%. The onset of interstitial lung disease was more frequent after 4–8 weeks of treatment or in patients with lower Eastern Cooperative Oncology Group performance status (21.6% for score 0 vs 8.3% for score 4, P, In this Japanese post-marketing surveillance study, the safety and effectiveness profile of temsirolimus was similar to that in the multinational phase 3 study. No new safety signals were identified.

Purpose To evaluate the significance of preoperative and follow-up neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors for recurrence in patients with non-metastatic clear cell renal cell carcinoma (NMCCRCC). Materials and methods We retrospectively reviewed the medical records of 309 patients with NMCCRCC who underwent radical or partial nephrectomy. The prognostic significance of various clinicopathological variables, preoperative NLR (pNLR) and PLR (pPLR), and NLR and PLR at recurrence or quasi-recurrence (rNLR and rPLR) for recurrence-free survival (RFS) was analyzed. Results At mean follow-up of 93 months, 44 patients (14.2%) developed recurrence. In the univariate analysis, clinical presentation, tumor size, pathologic tumor stage, Fuhrman grade, pNLR, pPLR and rNLR were significant prognostic factors for RFS. In the multivariate analysis using pNLR and pPLR as continuous variables, tumor size, pathologic tumor stage and pPLR were independent prognostic factors for RFS. In the multivariate analysis using pNLR and pPLR as dichotomous variables, tumor size, pathologic tumor stage, Fuhrman grade and pNLR ≥1.7 were independent prognostic factors for RFS. In multivariate analyses using rNLR and rPLR, only tumor size and pathologic tumor stage were independent prognostic factors for RFS. In a subset of patients with recurrence or at least 42 months follow-up without recurrence, rNLR ≥1.9 was significantly associated with worse RFS, albeit without independent significance. Conclusions pNLR and pPLR are independent prognostic factors for RFS in patients with NMCCRCC. We propose that postoperative follow-up NLR of 1.9 and higher with one or more adverse clinicopathological factors should prompt radiologic evaluation for possible metastasis.

Cilj istraživanja: Cilj ovog istraživanja bio je odrediti histološke tipove karcinoma bubrega te demografske podatke bolesnika kojima su isti dijagnosticirani. Materijali i metode: Ovo retrospektivno istraživanje obuhvatilo je 375 nalaza s patohistološkom potvrdom karcinoma bubrega u Kliničkom zavodu za patologiju, sudsku medicinu i citologiju pri KBC-u Split u vremenskom periodu od 1. 1. 2014. – 31. 12. 2018. godine. Podciljevi ove studije bili su analizirati broj oboljelih, godišnju raspodjelu oboljelih prema histološkom tipu karcinoma bubrega te demografska i patohistološka obilježja istih. Rezultati: Od ukupnog broja karcinoma (n=375), bilo je 271 svjetlostaničnih, 61 papilarnih, 18 kromofobnih te 25 ostalih karcinoma koji nisu predmet ovoga rada. Analiza godišnje raspodjele pokazuje pad broja oboljelih od svjetlostaničnog i kromofobnog karcinoma te održavanje broja oboljelih od papilarnog karcinoma bubrega. Muškarci su češće obolijevali od žena u svim histološkim tipovima karcinoma bubrega. Središnja vrijednost dobi oboljelih od svjetlostaničnog, papilarnog i kromofobnog karcinoma bubrega su redom 65, 66 i 58 godina. Sarkomatoidna komponenta bila je prisutna u većem postotku u svjetlostaničnom i papilarnom karcinomu, 7% i 4,9%, dok je u kromofobnom karcinomu bubrega iznosila 5,5%. Postotak tumorske nekroze veći je jedino u svjetlostaničnom karcinomu bubrega i iznosi 25,8%. 50,9% svjetlostaničnih karcinoma i 42% papilarnih karcinoma bubrega tip 1 bili su gradusa 2, a 45% papilarnih karcinoma bubrega tip 2 bilo je gradusa 3. Zaključci: U promatranom periodu od 2014. – 2018. godine uočava se pad oboljelih od svjetlostaničnog i kromofobnog karcinoma. Demografska i patohistološka obilježja u bolesnika oboljelih od karcinoma bubrega u skladu su sa studijama provedenim diljem svijeta., Objectives: The aim of this study was to determine the histological types of renal cell carcinoma (RCC) and the demographic data of patients diagnosed with it. Material and Methods: This retrospective study included 375 medical reports with pathohistological confirmation of renal cell carcinoma at the Clinical Department of pathology, forensic medicine and cytology at the University Hospital Center Split in the period from 1 January 2014 to 31 December 2018. Results: Of the total number of cancers (n = 375), there were 271 clear cell RCC , 61 papillary RCC, 18 chromophobe RCC and 25 other cancers that are not the subject of this study. The analysis of the annual distribution shows a decrease in the number of patients with clear cell RCC and chromophobe RCC and the maintenance of the number of patients with papillary RCC. All histological types of renal cell carcinoma have higher incidence in men than in women. The median age of patients with clear cell RCC, papillary RCC and chromophobe RCC are 65, 66 and 58 years, respectively. The sarcomatoid component was present in a higher percentage in clear cell and papillary RCC, 7% and 4.9%, while in chromophobe RCC it was 5.5%. The percentage of tumor necrosis is higher but only in clear cell RCC and is 25.8%. 50.9% of clear cell RCC and 42% of type 1 papillary RCC were nucleolar grade 2, and 45% of type 2 papillary RCC were nucleolar grade 3. Conclusion: In the observed period from 2014 to 2018, there was a decline in patients with clear cell and chromophobe RCC. Demographic and pathohistological characteristics in patients with RCC are consistent with studies conducted worldwide.

Ciljevi istraživanja: usporediti imunohistokemijski izražaj GLUT1 prijenosnika između skupina svijetlostaničnog, papilarnog i kromofobnog karcinoma bubrega. Također, usporediti ćemo izražaj GLUT1 prijenosnika između skupina karcinoma bubrega različitog nuklearnog gradusa. Materijal i metode: U studiju je uključeno osam uzoraka svijetlostaničnog, sedam uzoraka papilarnog i četiri uzorka kromofobnog karcinoma bubrega. Svi uzorci su imunohistokemijski obojeni s protutijelom na GLUT1 prijenosnik. Koristili smo semikvantitativnu HSCORE metodu za procjenu imunohistokemijskog bojanja na GLUT1 prijenosnik u svakoj grupi uzoraka. Rezultati: imunohistokemijski izražaj GLUT1 prijenosnika je bio statistički značajno veći (P=0,044) u skupini svijetlostaničnih karcinoma bubrega (HSCORE=2,44; IQR 2,06 – 2,61) u usporedbi s nesvijetlostaničnim karcinomima (HSCORE=2,01; IQR 2,00 – 2,03). Nije bilo statistički značajne razlike u GLUT1 izražaju između skupina karcinoma različitih gradusa (P=0,390). Zaključci: povišen izražaj GLUT1 prijenosnika u skupini svijetlostaničnih karcinoma bubrega, u usporedbi s ostalim tipovima karcinoma bubrega, mogao bi doprinjeti kliničkim karakteristikama te skupine karcinoma. Izražaj GLUT1 ne može se koristiti kao prognostički čimbenik za karcinome bubrega. Potrebna su daljnja istraživanja s većim brojem uzoraka karcinoma bubrega kako bi se rezultati ovog istraživanja potvrdili., Objectives: to compare immunohistochemical expression of GLUT1 transporter in clear cell, papillary and chromophobe renal cell carcinomas. In addition, we will compare GLUT1 transporter expression between groups of renal cell carcinoma with differing nuclear grade. Material and methods: We have enrolled eight samples of clear cell, seven samples of papillary and four samples of chromophobe renal cell carcinoma in the study. All samples were immunohistochemically stained with antibody to GLUT1 transporter. We used the semiquantitative Hscore method to asses immunohistochemical staining of GLUT1 transporter in each sample group. Results: We were able to show a statistically significant increase (P=0.044) in GLUT1 transporter immunohistochemical expression in the clear cell renal carcinoma group (HSCORE=2.44; IQR 2.06 – 2.61) compared to the non-clear cell group (HSCORE=2.01; IQR 2.00 – 2.03). No statistically significant difference in the immunohistochemical expression of GLUT1 could be found in renal cell carcinoma groups with differing grade (P=0.390). Conclusions: immunohistochemical overexpression of GLUT1 transporter in clear cell renal carcinomas, compared to other histological types, could be a contributing factor to clinical characteristics and behaviour of that group of carcinomas. Expression of GLUT1 cannot be used as a prognostic factor for renal cell carcinoma. Further studies with a larger sample are required to confirm the results of the presented study.

Cilj istraživanja: Cilj ovog istraživanja bio je odrediti histološke tipove karcinoma bubrega te demografske podatke bolesnika kojima su isti dijagnosticirani. Materijali i metode: Ovo retrospektivno istraživanje obuhvatilo je 375 nalaza s patohistološkom potvrdom karcinoma bubrega u Kliničkom zavodu za patologiju, sudsku medicinu i citologiju pri KBC-u Split u vremenskom periodu od 1. 1. 2014. – 31. 12. 2018. godine. Podciljevi ove studije bili su analizirati broj oboljelih, godišnju raspodjelu oboljelih prema histološkom tipu karcinoma bubrega te demografska i patohistološka obilježja istih. Rezultati: Od ukupnog broja karcinoma (n=375), bilo je 271 svjetlostaničnih, 61 papilarnih, 18 kromofobnih te 25 ostalih karcinoma koji nisu predmet ovoga rada. Analiza godišnje raspodjele pokazuje pad broja oboljelih od svjetlostaničnog i kromofobnog karcinoma te održavanje broja oboljelih od papilarnog karcinoma bubrega. Muškarci su češće obolijevali od žena u svim histološkim tipovima karcinoma bubrega. Središnja vrijednost dobi oboljelih od svjetlostaničnog, papilarnog i kromofobnog karcinoma bubrega su redom 65, 66 i 58 godina. Sarkomatoidna komponenta bila je prisutna u većem postotku u svjetlostaničnom i papilarnom karcinomu, 7% i 4,9%, dok je u kromofobnom karcinomu bubrega iznosila 5,5%. Postotak tumorske nekroze veći je jedino u svjetlostaničnom karcinomu bubrega i iznosi 25,8%. 50,9% svjetlostaničnih karcinoma i 42% papilarnih karcinoma bubrega tip 1 bili su gradusa 2, a 45% papilarnih karcinoma bubrega tip 2 bilo je gradusa 3. Zaključci: U promatranom periodu od 2014. – 2018. godine uočava se pad oboljelih od svjetlostaničnog i kromofobnog karcinoma. Demografska i patohistološka obilježja u bolesnika oboljelih od karcinoma bubrega u skladu su sa studijama provedenim diljem svijeta. Objectives: The aim of this study was to determine the histological types of renal cell carcinoma (RCC) and the demographic data of patients diagnosed with it. Material and Methods: This retrospective study included 375 medical reports with pathohistological confirmation of renal cell carcinoma at the Clinical Department of pathology, forensic medicine and cytology at the University Hospital Center Split in the period from 1 January 2014 to 31 December 2018. Results: Of the total number of cancers (n = 375), there were 271 clear cell RCC , 61 papillary RCC, 18 chromophobe RCC and 25 other cancers that are not the subject of this study. The analysis of the annual distribution shows a decrease in the number of patients with clear cell RCC and chromophobe RCC and the maintenance of the number of patients with papillary RCC. All histological types of renal cell carcinoma have higher incidence in men than in women. The median age of patients with clear cell RCC, papillary RCC and chromophobe RCC are 65, 66 and 58 years, respectively. The sarcomatoid component was present in a higher percentage in clear cell and papillary RCC, 7% and 4.9%, while in chromophobe RCC it was 5.5%. The percentage of tumor necrosis is higher but only in clear cell RCC and is 25.8%. 50.9% of clear cell RCC and 42% of type 1 papillary RCC were nucleolar grade 2, and 45% of type 2 papillary RCC were nucleolar grade 3. Conclusion: In the observed period from 2014 to 2018, there was a decline in patients with clear cell and chromophobe RCC. Demographic and pathohistological characteristics in patients with RCC are consistent with studies conducted worldwide.

WOS: 000513496500002 PubMed: 31823081 We aim to investigate the prognostic significance of the hemoglobin X lymphocyte / neutrophil ratio (HLNR) and hemoglobin x lymphocyte / platelet ratio (HLPR) with tumor aggressivity in patients with renal cell carcinoma. We retrospectively analyzed 127 patients' data who had diagnosed as renal cell carcinoma between 2008 and 2019 in Suleyman Demirel University Hospital. Tumor and patient characteristics, hemoglobin, neutrophil, lymphocyte, platelet values HLNR and HLPR were calculated in preoperative hemogram parameters. The relationship between tumor pathological stage, Fuhrman nuclear grade and tumor necrosis with HLPR and HLNR analyzed with statistically. There was a negative correlation between pathologic stage, Fuhrman nuclear grade and tumor necrosis with HLNR. P values are 0.003, 0.012 and 0.015 respectively. HLNR was lower in patients with high pathologic stage, high Fuhrman nuclear grade and accompanying tumor necrosis positiveness. There was a negative correlation between pathologic stage, Fuhrman nuclear grade and tumor necrosis with HLPR. P values are 0.001, 0.014 and 0.047 respectively. HLPR was lower in patients with high pathologic stage, high Fuhrman nuclear grade and accompanying tumor necrosis positiveness. High pathological stage, high Fuhrman nuclear grade and existence of tumor necrosis are associates with preoperative low HLNR and low HLPR in renal cell carcinoma patients. They can be used as prognostic markers in patients with renal mass preoperatively.

ResumenObjetivoDiferenciar el angiomiolipoma atípico del carcinoma de células renales del mismo tamaño mediante hallazgos tomográficos.Materiales y métodosSe realizó un estudio retrospectivo con 68 pacientes (17 con angiomiolipomas atípicos y 51 con carcinoma de células renales) nefrectomizados por diagnóstico presuntivo preoperatorio, mediante tomografía computada trifásica (fases sin contraste, corticomedular y excretora temprana), de carcinoma de células renales menor de 45mm. Dos radiólogos que desconocían el diagnóstico definitivo evaluaron retrospectivamente las características generales del tumor, su atenuación en fase sin contraste y las características de su realce. Se realizó un análisis estadístico con software R, aplicándose el modelo logit para diferenciar el angiomiolipoma atípico del carcinoma de células renales a partir de los hallazgos tomográficos de masa renal, incluidos en el modelo final el contorno, la atenuación en fase sin contraste y el patrón de realce con el tiempo.ResultadosLos hallazgos de angiomiolipoma atípico que resultaron significativos fueron atenuación tumoral en fase sin contraste hiperdensa y patrón de realce con tiempo prolongado con chance de ocurrencia de 10,49 (p=0,0381) y 36,71 (p=0,0009), respectivamente. En los pacientes, según el valor de cada hallazgo incluido en el modelo, se calculó probabilidad, sensibilidad (0,2941) y especificidad (0,9804). La curva característica operativa del receptor (ROC) determinó un punto de corte óptimo (0,9694) para discriminar el angiomiolipoma atípico, por lo que se confirmó su presencia.ConclusiónLa tomografía computada helicoidal trifásica es útil para diferenciar el angiomiolipoma atípico del carcinoma de células renales, siendo la atenuación hiperdensa sin contraste del tumor y su patrón de realce prolongado los hallazgos tomográficos más valiosos.SummaryObjectiveTo compare various computed tomographic features of atypical angiomyolipoma with those of size-matched renal cell carcinoma.Materials and methodsSixty-eight patients (17 with atypical angiomyolipomas and 51 with carcinoma renal cells) who had undergone nephrectomy by presumptive diagnosis of carcinoma renal cell

CILJ ISTRAŽIVANJA. Cilj doktorskog rada bio je prikazati izražaj koštanih morfogenetskih proteina (BMP), njihovih receptora (BMPR) i proteina njihovog signalnog puta (pSmad1/5/8) u zdravom tkivu bubrega, tkivu karcinoma bubrega (RCC) te tkivu na granici između karcinoma i normalnog bubrega. Nadalje,žţeljeli smo prikazati promjenu u njihovoj ekspresiji između zdravog tkiva i RCC u usporedbi s kliniĉkim i patološkim znaĉajkama ispitanika. ISPITANICI I METODE. Istraživanje je bilo prospektivno, a istražili smo tkivo bubrega u 64 ispitanika u kojih je, na Klinici za urologiju Kliniĉkog bolniĉkog centra Rijeka, uĉinjena nefrektomija zbog nemetastatskog karcinoma bubrega. Analizirali smo zdravo tkivo bubrega, tkivo karcinoma bubrega te graniĉno tkivo, a analiza tkiva je provedena na Zavodu za anatomiju, Medicinskog fakulteta u Rijeci. Zabilježđili smo ekspresiju proteina BMP-6, BMP-7, BMPR-IA, BMPR-IB, BMPR-II i pSmad1/5/8 (imunohistokemija i Western Blot: WB) odnosno njihove mRNA: mRNA BMP-2, mRNA BMP-4, mRNA BMP-6, mRNA BMP-7, mRNA BMPR-IA, mRNA BMPR-IB, BMP-RII (lanĉana reakcija polimeraze nakon reverzne transkripcije: RT-PCR). Razliku u ekspresiji BMP između razliĉitih tkiva utvrdili smo korištenjem Student t testa (WB) i Mann-Whitney testa (RT-PCR). REZULTATI. U normalnom bubregu proteini BMP-7, BMPR-IA, BMPR-IB, BMPR-II i pSmad1/5/8 dominantno su bili prisutni u proksimalnim tubulima. U tkivu RCC pronašli smo ekspresiju proteina BMP-7, BMPR-IA, BMPR-IB, BMPR-II te pSmad 1/5/8. Ekspresiju BMP-6 u normalnom tkivu i u RCC nismo dokazali imunohistokemijskom metodom. Graniĉno tkivo je pokazivalo obrazac ekspresije normalnog tkiva bubrega odnosno karcinoma bubrega u ovisnosti o kojem dijelu graniĉnog tkiva se radilo. Western blot metodom dokazali smo ekspresiju proteina BMP-6 i BMP-7, BMPR-IB, BMPR-II i pSmad1/5/8 u tkivu zdravog bubrega i u RCC. Ekspresija BMPR-IB i pSmad1/5/8 je bila povećana, a ekspresija BMPR-II, BMP-6 i BMP-7 je bila sniţena u bolesnika s RCC. BMPR-IA se, ovom metodom, nije prikazao. mRNA svih BMP i njihovih receptora je pronaĊena u oba tkiva i bila je viša u RCC. Najsnaţniji izraţaj pokazao je mRNA BMP-2. Pronašli smo snažniju ekspresiju mRNA BMP2 u bolesnika s višim tumorskim stadijem i višu ekspresiju mRNA BMP-6 u bolesnika starijih od 60 godina. Također je izražaj mRNA BMP-7 veći u žena. U uznapredovalom tumorskom stadiju (T3 i T4) bolesnika s RCC došlo je do gubitka ekspresije mRNA BMP-6, BMP-7 i BMPR-IB. ZAKLJUĈAK. BMP i njihovi receptori su prisutni u zdravom tkivu bubrega te u tkivu karcinoma bubrega. BMP proteini, u ovoj studiji, su podjednakog izraţaja u normalnom tkivu i karcinomu bubrega ali je ekspresija njihove mRNA znatno veća u RCC. Spoznaja kako je mRNA BMP-2 snažno eksprimiran u RCC te kako njegova ekspresija ovisi o tumorskom stadiju govori u prilog njegove važnosti u tumorigenezi karcinoma bubrega koju bi trebalo daljnjim istraživanjima ispitati., OBJECTIVES. Aim of our study was to present expression of different bone morphogenetic proteins (BMPs), their receptors (BMPRs) and protein of their signaling pathway (pSmad1/5/8) in healthy kidney tissue, renal cell carcinoma (RCC) and borderline tissue. Also, we compared changes in expression between healthy kidney tissue and RCC and correlate their expression with clinicopathological parameters. PATIENTS AND METHODS. We prospectively examined kidney tissue samples of 64 patients who underwent nephrectomy for localized kidney cancer. All patients were operated in Department of Urology, University Hospital Rijeka. Analysis was performed on healthy kidney tissue, RCC and borderline tissue on Institute of Anatomy, School of Medicine Rijeka. Protein expression of BMP-6, BMP-7, BMPR-IA, BMPR-IB, BMPR-II and pSmad 1/5/8 was determinated with immunohistochemistry and Western blot:WB) and expression of mRNA BMP-2, mRNA BMP-4, mRNA BMP-6, mRNA BMP-7, mRNA BMPR-IA, mRNA BMPR-IB, BMP-RII with reverse transcriptase polymerase chain reaction (RT-PCR). Difference in expression between tissue was estimated by Student t test (WB) and Mann-Whitney test (RT-PCR). RESULTS. In healthy kidney proteins BMP-7, BMPR-IA, BMPR-IB, BMPR-II and pSmad1/5/8 were dominantly expressed in proximal tubule. In RCC expression of proteins BMP-7, BMPR-IA, BMPR-IB, BMPR-II and pSmad 1/5/8 was found. Expression of BMP-6 was not noticed in any tissue with immunohistochemistry. Borderline tissue showed expression like RCC or healthy tissue in dependence which part of borderline tissue was examined. Proteins BMP-6, BMP-7, BMPR-IB, BMPR-II and pSmad1/5/8 were detected with WB in RCC and normal kidney. Expression of BMPR-IB and pSmad1/5/8 was increased and expression of BMPR-II, BMP-6 and BMP-7 was decreased in RCC. BMPR-IA was not detected with WB. mRNA of all BMPs and BMPRs was detected in both tissue with higher expression in RCC, specially for BMP-2. Expression of mRNA BMP-2 was increased in patients with higher tumor stage, mRNA BMP-6 was increased in elderly (> 60 years) and mRNA BMP-7 in female. We also found loss of mRNA BMP-6, BMP-7 i BMPR-IB expression in tumor stage T3 and T4. CONCLUSION. BMPs and their receptors was expressed in healthy kidney tissue and RCC. BMP proteins, in our study, have similar level of expression in both tissue but expression of their mRNA was higher in RCC. High level of mRNA BMP-2 expression in RCC and their increased expression with higher tumor stage are arguments in favour of their role in RCC. Futher investigation is needed to elucidate role of BMP-2 in RCC.

Although renal collecting system invasion is not considered in the current TNM staging system, this finding may be relevant in terms of treatment planning and prognosis. The objective of this study was to investigate the frequency of collecting system invasion in renal cell carcinoma (RCC) and to assess the diagnostic performance of excretory phase CT for the assessment of collecting system invasion.We conducted a retrospective study of 261 patients (171 men and 90 women; average age, 61 years; age range, 32-86 years) who underwent CT before nephrectomy for RCC between November 2008 and July 2011 at a single institution. On excretory phase contrast-enhanced CT images, two radiologists independently determined whether RCC components caused a filling defect within the collecting system and whether the RCC was in contact to the collecting system wall or separated from it. Histopathology served as the standard of reference. Interreader agreement and diagnostic performance tests for the detection of collecting system invasion were calculated.Histopathology identified collecting system invasion exclusively in clear cell RCC that showed a filling defect within the collecting system on excretory phase CT images (5.4%, 14/261). Tumors separated from or in contact with the collecting system on imaging (both readers; 94.6%, 247/261) did not show collecting system invasion on histopathology (sensitivity, 100%; specificity, 100%). Interreader agreement was excellent (κ, 0.965; 95% CI, 0.93-0.99).CT provides reliable assessment of collecting system invasion in patients with RCC, with excellent sensitivity and specificity.

OBJETIVOS: Pacientes com carcinoma de células renais (CCR) quando diagnosticados precocemente têm maior possibilidade de cura com o tratamento cirúrgico. Este estudo tem como objetivo analisar as características anatomopatológicas dos espécimes cirúrgicos que justificam a diferença da história natural dos pacientes com CCR incidental e sintomático. MÉTODOS: Foram estudados retrospectivamente 115 pacientes submetidos a nefrectomia por CCR esporádico, divididos em Grupo 1: 59 pacientes assintomáticos com diagnóstico incidental e Grupo 2: 56 pacientes sintomáticos. A média de idade dos pacientes foi de 59 anos, com 86 homens e 29 mulheres. Cirurgia radical foi realizada em 96 pacientes e cirurgia conservadora em 19 casos. Foram analisadas as características anatomopatológicas, incluindo grau nuclear, estadio patológico, tamanho do tumor e presença de invasão microvascular intratumoral, sendo estes parâmetros comparados com a sobrevida dos pacientes. RESULTADOS: Ao compararmos os dois grupos, confirmou-se que os tumores incidentais têm menor grau nuclear (p=0,003), menor tamanho (p=0,001), menor incidência de invasão microvascular (pBACKGROUND: Patients with early diagnosis of renal cell carcinoma (CCR) have higher chance of cure following surgical treatment. This study was set to compare the pathological characteristics between the surgical specimens and the survival of the patients with incidental and symptomatic CCR. METHODS: One hundred and fifteen patients with sporadic CCR were studied retrospectively following nephrectomy and divided into two groups. Group 1; 59 patients with incidental diagnosis and Group 2; 56 symptomatic patients. The mean age of the patients was 59 years, with 86 men and 29 women. Radical nephrectomy was performed in 96 patients and the conservative surgery was performed in the remaining 19. Comparison parameters included pathological outcome, specifically nuclear grade, pathological stage, size of the tumor and presence of microvascular invasion intratumoral and patients survival. RESULTS: Comparison between the two groups confirmed that the incidental tumors have smaller nuclear grade (p=0,003), smaller size (p=0,001) smaller incidence of micro vascular invasion (p< 0,001) and lower stage (p

OBJETIVOS: O comportamento do carcinoma de células renais estádio PT1 não está completamente esclarecido. Nós estudamos a presença de fatores prognósticos e tamanho tumoral na recorrência e sobrevida do carcinoma de rim esporádico após tratamento cirúrgico. MÉTODOS: Foram revisados retrospectivamente 120 pacientes, 93 PT1, nove PT2, 11 PT3, sete PT4, seguidos após nefrectomia. Foram analisadas sobrevida e recorrência da doença dentro de três grupos de tumores: grupo 1: < 4cm, grupo 2: 4-7 cm e grupo 3: >7 cm e os fatores prognósticos preditivos avaliados foram grau nuclear, invasão microvascular, presença de gânglios comprometidos e degeneração sarcomatosa RESULTADOS: A freqüência de fatores prognósticos adversos aumenta à medida que aumenta o tamanho do tumor. No grupo 1 tivemos apenas quatro tumores de alto grau e somente um apresentou invasão microvascular não havendo gânglios comprometidos ou degeneração sarcomatosa. No grupo 2 havia 16 tumores de alto grau, quatro sarcomatosos, dois com invasão microvascular positiva e dois com gânglios positivos. No grupo 3, encontraram-se 18 tumores de alto grau, 15 com invasão microvascular e sete com gânglios positivos e cinco sarcomatosos. Houve significância estatística na sobrevida câncer específica (p=0,002) e livre de doença (p=0,0002) entre os três grupos. CONCLUSÃO: A evolução dos tumores PT1 é distinta para tumores menores de 4 cm e de 4-7 cm cabendo a subdivisão destes dois grupos em T1a e T1b.OBJECTIVE: The behavior of the renal cells carcinoma stage PT1 is not completely clarified. We studied the presence of factors after prognostics and tumoral size in the recurrence of survival of the sporadic kidney carcinoma after surgical treatment. METHODS: 120 patients followed after nephrectomy had been revised retrospectively 93 PT1, 9 PT2, 11 PT3, 7 PT4, It was analyzed survival and recurrence of the disease inside of three groups of tumors: Group 1: < 4cm, group 2: 4-7cm and group 3: > 7cm, and the prognostics factors above-mentioned evaluated were nuclear degree, microvascular invasion, presence of committed ganglia and sarcomatous degeneration. RESULTS: The frequency of adverse prognostics factors increase as the tumor size increase. In the group 1, we had only four tumors of high degree and only one shown microvascular invasion that does not committed ganglia or sarcomatous degeneration. In group 2 there was 16 tumors of high degree, 4 sarcomatoses, two with positive microvascular invasion and two with positive ganglia. In group 3, was found 18 tumors of high degree, 15 with microvascular invasion and 7 with positive ganglia and 5 sarcomatoses. There was statistical significance in the specific cancer survival (p=0.002) and free of illness (p=0.0002) between the three groups. CONCLUSION: The evolution of tumors PT1 is distinct for lesser tumors of 4 cm and 4-7 cm fitting the subdivision of these two groups in T1a and T1b.

PURPOSE To assess diagnostic performance and interreader agreement of tumor to sinus distance measurements and visual assessment of renal sinus fat invasion at T2 weighted magnetic resonance (MR) imaging as predictors of muscular venous branch invasion (MVBI) in patients with renal cell carcinoma (RCC). MATERIALS AND METHODS The institutional review board approved this retrospective study and waived the informed consent requirement. The study was HIPAA compliant. A total of 186 consecutive patients underwent preoperative 1.5 T MR imaging; 188 RCCs were identified. Blinded to histopathologic information two readers independently measured the tumor to sinus distance and assessed renal sinus fat invasion on transverse and coronal T2 weighted MR images. Interreader agreement (intraclass correlation coefficient Cohen ?) and performance characteristics of imaging tests were calculated. Histopathologic findings served as the standard of reference. RESULTS Histopathologic findings indicated MVBI in 35 (66 of 188) of tumors. At imaging all tumors with MVBI had a tumor to sinus distance of 0 mm. All tumors with renal sinus fat invasion at imaging had MVBI. Sensitivity and specificity for the detection of renal sinus fat invasion were 100 (95 confidence interval [CI]: 92 100) and 94 (95 CI: 89 98). In the absence of renal sinus fat invasion at imaging a tumor to sinus distance of 0 mm was associated with MVBI in 21 (18 of 86) of cases. Interreader agreement for quantitative (intraclass correlation coefficient = 0.92; 95 CI: 0.89 0.94) and qualitative (? = 0.89; 95 CI: 0.81 0.96) assessments was excellent. CONCLUSION Tumor to sinus distance measurements and the assessment of renal sinus fat invasion at T2 weighted MR imaging can be used reliably to rule out MVBI in patients with RCC.

OBJETIVOS: Pacientes com carcinoma de células renais (CCR) quando diagnosticados precocemente têm maior possibilidade de cura com o tratamento cirúrgico. Este estudo tem como objetivo analisar as características anatomopatológicas dos espécimes cirúrgicos que justificam a diferença da história natural dos pacientes com CCR incidental e sintomático. MÉTODOS: Foram estudados retrospectivamente 115 pacientes submetidos a nefrectomia por CCR esporádico, divididos em Grupo 1: 59 pacientes assintomáticos com diagnóstico incidental e Grupo 2: 56 pacientes sintomáticos. A média de idade dos pacientes foi de 59 anos, com 86 homens e 29 mulheres. Cirurgia radical foi realizada em 96 pacientes e cirurgia conservadora em 19 casos. Foram analisadas as características anatomopatológicas, incluindo grau nuclear, estadio patológico, tamanho do tumor e presença de invasão microvascular intratumoral, sendo estes parâmetros comparados com a sobrevida dos pacientes. RESULTADOS: Ao compararmos os dois grupos, confirmou-se que os tumores incidentais têm menor grau nuclear (p=0,003), menor tamanho (p=0,001), menor incidência de invasão microvascular (p

OBJETIVOS: O comportamento do carcinoma de células renais estádio PT1 não está completamente esclarecido. Nós estudamos a presença de fatores prognósticos e tamanho tumoral na recorrência e sobrevida do carcinoma de rim esporádico após tratamento cirúrgico. MÉTODOS: Foram revisados retrospectivamente 120 pacientes, 93 PT1, nove PT2, 11 PT3, sete PT4, seguidos após nefrectomia. Foram analisadas sobrevida e recorrência da doença dentro de três grupos de tumores: grupo 1: < 4cm, grupo 2: 4-7 cm e grupo 3: >7 cm e os fatores prognósticos preditivos avaliados foram grau nuclear, invasão microvascular, presença de gânglios comprometidos e degeneração sarcomatosa RESULTADOS: A freqüência de fatores prognósticos adversos aumenta à medida que aumenta o tamanho do tumor. No grupo 1 tivemos apenas quatro tumores de alto grau e somente um apresentou invasão microvascular não havendo gânglios comprometidos ou degeneração sarcomatosa. No grupo 2 havia 16 tumores de alto grau, quatro sarcomatosos, dois com invasão microvascular positiva e dois com gânglios positivos. No grupo 3, encontraram-se 18 tumores de alto grau, 15 com invasão microvascular e sete com gânglios positivos e cinco sarcomatosos. Houve significância estatística na sobrevida câncer específica (p=0,002) e livre de doença (p=0,0002) entre os três grupos. CONCLUSÃO: A evolução dos tumores PT1 é distinta para tumores menores de 4 cm e de 4-7 cm cabendo a subdivisão destes dois grupos em T1a e T1b. OBJECTIVE: The behavior of the renal cells carcinoma stage PT1 is not completely clarified. We studied the presence of factors after prognostics and tumoral size in the recurrence of survival of the sporadic kidney carcinoma after surgical treatment. METHODS: 120 patients followed after nephrectomy had been revised retrospectively 93 PT1, 9 PT2, 11 PT3, 7 PT4, It was analyzed survival and recurrence of the disease inside of three groups of tumors: Group 1: < 4cm, group 2: 4-7cm and group 3: > 7cm, and the prognostics factors above-mentioned evaluated were nuclear degree, microvascular invasion, presence of committed ganglia and sarcomatous degeneration. RESULTS: The frequency of adverse prognostics factors increase as the tumor size increase. In the group 1, we had only four tumors of high degree and only one shown microvascular invasion that does not committed ganglia or sarcomatous degeneration. In group 2 there was 16 tumors of high degree, 4 sarcomatoses, two with positive microvascular invasion and two with positive ganglia. In group 3, was found 18 tumors of high degree, 15 with microvascular invasion and 7 with positive ganglia and 5 sarcomatoses. There was statistical significance in the specific cancer survival (p=0.002) and free of illness (p=0.0002) between the three groups. CONCLUSION: The evolution of tumors PT1 is distinct for lesser tumors of 4 cm and 4-7 cm fitting the subdivision of these two groups in T1a and T1b. Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Urologia UNIFESP, EPM, Depto. de Urologia SciELO