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Abstract Background With increasing detection of small renal masses and accumulating evidence that nephron sparing surgery (NSS) could achieve oncological equivalence and functional superiority compared with radical nephrectomy (RN), NSS has become first‐line therapy for some patients with localized renal masses. Objective This study aims to review the publications in the kidney neoplasm and NSS field, exploring the research hotspots. Method Kidney neoplasm and NSS related publications before July 3th 2023 were obtained from the Web of Science Core Collection database. We then used bibliometric analysis to conduct performance analysis, citation analysis and co‐citation network of publications, together with keyword co‐occurrence analysis. Results Seven thousand five hundred and sixty‐four documents were finally retrieved, and the annual publications increased exponentially. The most productive authors were “KAOUK JH” and “GILL IS”, while USA, and 12 American affiliations such as CLEVELAND CLINIC FOUNDATION and MAYO CLINIC were far leading in this field. Journal of Urology and European Urology were journals with the highest citations and h‐index. Discussion Through literature reviewing plus co‐occurrence and clustering analysis, the therapeutic effects of partial nephrectomy (PN) versus RN on patients with localized renal cell carcinoma, different operative approaches of PN, and conservative NSS methods were deemed as the most focused topics. Conclusion Three aspects were the most important hotspots in this field. Firstly, how to provide the optimal management choices for different patients. Secondly, therapeutic effects of different management options and surgical techniques needed more prospective and randomized studies. Finally, more novel technologies and surgical techniques were required.

Background: With increasing detection of small renal masses and accumulating evidence that nephron sparing surgery (NSS) could achieve oncological equivalence and functional superiority compared with radical nephrectomy (RN), NSS has become first‐line therapy for some patients with localized renal masses. Objective: This study aims to review the publications in the kidney neoplasm and NSS field, exploring the research hotspots. Method: Kidney neoplasm and NSS related publications before July 3th 2023 were obtained from the Web of Science Core Collection database. We then used bibliometric analysis to conduct performance analysis, citation analysis and co‐citation network of publications, together with keyword co‐occurrence analysis. Results: Seven thousand five hundred and sixty‐four documents were finally retrieved, and the annual publications increased exponentially. The most productive authors were "KAOUK JH" and "GILL IS", while USA, and 12 American affiliations such as CLEVELAND CLINIC FOUNDATION and MAYO CLINIC were far leading in this field. Journal of Urology and European Urology were journals with the highest citations and h‐index. Discussion: Through literature reviewing plus co‐occurrence and clustering analysis, the therapeutic effects of partial nephrectomy (PN) versus RN on patients with localized renal cell carcinoma, different operative approaches of PN, and conservative NSS methods were deemed as the most focused topics. Conclusion: Three aspects were the most important hotspots in this field. Firstly, how to provide the optimal management choices for different patients. Secondly, therapeutic effects of different management options and surgical techniques needed more prospective and randomized studies. Finally, more novel technologies and surgical techniques were required. [ABSTRACT FROM AUTHOR]

PurposeObservational studies have revealed that serum minerals and vitamins are associated with cancer. However, the causal relationships between serum minerals and vitamins and renal malignancies remain unclear.MethodsMendelian randomization (MR) was used for causal estimation. Single nucleotide polymorphisms (SNPs) for serum minerals and vitamins were obtained from published genome-wide association studies (GWAS). GWAS for malignant kidney neoplasm was obtained from the FinnGen consortium. Methods of inverse variance weighted (IVW), MR-Egger, and weighted median were carried out for causal inference. F-statistic was calculated to ensure a robust instrumental variable. Cochran’s Q statistics was applied to calculate heterogeneity. MR-Egger regression, MR-pleiotropy residual sum and outlier methods (MR-PRESSO) methods were used to perform pleiotropy analysis. Meanwhile, confounding factors were considered to determine whether causal inference would be biased.ResultsEight different micronutrients were included (zinc, iron, magnesium, calcium, copper, selenium, phosphate, and vitamin B12). After MR analysis, we found a protective effect of serum zinc against malignant kidney neoplasm (IVW: odds ratios (ORs), 0.86; 95% confidence interval (95% CI), 0.78–0.94; p, 0.0016; MR-Egger: OR, 0.80; 95% CI, 0.64–0.97; p, 0.052; weighted median: OR, 0.85; 95% CI, 0.75–0.96; p, 0.011). Causal relationships between other micronutrients and malignant kidney neoplasm were not obtained. No heterogeneity and pleiotropy were detected, while causality was not biased by confounding factors.ConclusionWe considered that serum zinc exerted a protective effect against malignant kidney neoplasm. In clinical practice, for people with high malignant kidney neoplasm risk, an oral zinc supplementation might play a role in a potential therapeutic target.

Purpose: Observational studies have revealed that serum minerals and vitamins are associated with cancer. However, the causal relationships between serum minerals and vitamins and renal malignancies remain unclear., Methods: Mendelian randomization (MR) was used for causal estimation. Single nucleotide polymorphisms (SNPs) for serum minerals and vitamins were obtained from published genome-wide association studies (GWAS). GWAS for malignant kidney neoplasm was obtained from the FinnGen consortium. Methods of inverse variance weighted (IVW), MR-Egger, and weighted median were carried out for causal inference. F-statistic was calculated to ensure a robust instrumental variable. Cochran's Q statistics was applied to calculate heterogeneity. MR-Egger regression, MR-pleiotropy residual sum and outlier methods (MR-PRESSO) methods were used to perform pleiotropy analysis. Meanwhile, confounding factors were considered to determine whether causal inference would be biased., Results: Eight different micronutrients were included (zinc, iron, magnesium, calcium, copper, selenium, phosphate, and vitamin B12). After MR analysis, we found a protective effect of serum zinc against malignant kidney neoplasm (IVW: odds ratios (ORs), 0.86; 95% confidence interval (95% CI), 0.78-0.94; p , 0.0016; MR-Egger: OR, 0.80; 95% CI, 0.64-0.97; p , 0.052; weighted median: OR, 0.85; 95% CI, 0.75-0.96; p , 0.011). Causal relationships between other micronutrients and malignant kidney neoplasm were not obtained. No heterogeneity and pleiotropy were detected, while causality was not biased by confounding factors., Conclusion: We considered that serum zinc exerted a protective effect against malignant kidney neoplasm. In clinical practice, for people with high malignant kidney neoplasm risk, an oral zinc supplementation might play a role in a potential therapeutic target., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Qiao and Tian.)

Abstract Background TSPAN7 is an important factor in tumor progression. However, the precise function of TSPAN7 and its role in pan-cancer are not clear. Methods Based on Xinhua cohort incorporating 370 patients with kidney neoplasm, we conducted differential expression analysis by immunohistochemistry between tumor and normal tissues, and explored correlations of TSPAN7 with patients’ survival. Subsequently, we conducted a pan-cancer study, and successively employed differential expression analysis, competing endogenous RNA (ceRNA) analysis, protein-protein interaction (PPI) analysis, correlation analysis of TSPAN7 with clinical characteristics, tumor purity, tumor genomics, tumor immunity, and drug sensitivity. Last but not least, gene set enrichment analysis was applied to identify enriched pathways of TSPAN7. Results In Xinhua cohort, TSPAN7 expression was significantly up-regulated (P-value = 0.0019) in tumor tissues of kidney neoplasm patients. High TSPAN7 expression was associated with decreases in overall survival (OS) (P-value = 0.009) and progression-free survival (P-value = 0.009), and it was further revealed as an independent risk factor for OS (P-value = 0.0326, HR = 5.66, 95%CI = 1.155–27.8). In pan-cancer analysis, TSPAN7 expression was down-regulated in most tumors, and it was associated with patients’ survival, tumor purity, tumor genomics, tumor immunity, and drug sensitivity. The ceRNA network and PPI network of TSPAN7 were also constructed. Last but not least, the top five enriched pathways of TSPAN7 in various tumors were identified. Conclusion TSPAN7 served as a promising biomarker of various tumors, especially kidney neoplasms, and it was closely associated with tumor purity, tumor genomics, tumor immunology, and drug sensitivity in pan-cancer level.

Abstract Cancers of the kidney and renal pelvis are among the most prevalent types of urinary cancers. We aimed to outline the incidence trends of kidney and renal pelvis cancers by age, sex, race/ethnicity, and histology in the United States (US) from 2000 to 2020. The data was obtained from the Surveillance, Epidemiology, and End Results (SEER) 22 database. The identification of patients with kidney and renal pelvis cancers with morphologies of renal cell carcinoma, nephroblastoma, sarcoma, and neuroendocrine tumor was conducted utilizing the International Classification of Diseases for Oncology version 3. The average annual percent change (AAPC) were presented. All estimates were given in the form of counts and delayed age-standardized incidence rates (ASIRs) per 100,000 people. From 2000 to 2019, a total of 490,481 cases of kidney and renal pelvic cancer were recorded across all age groups in the US. The majority of them were among Non-Hispanic Whites (NHWs) (69.75%) and those aged 55–69 years (39.96%). The ASIRs per 100,000 for kidney and pelvis cancers were 22.03 for men and 11.14 for women. Non-Hispanic Black men had the highest ASIR (24.53 [24.24, 24.81]), and increase in ASIR over the 2000–2019 period (AAPC: 2.19% [1.84, 2.84]). There was a noticeable increase in incidence of kidney and renal pelvis cancers. Individuals aged 70–84 years had the highest ASIR for kidney and renal pelvis cancers. The COVID-19 era has resulted in a significant reduction in incidence rates across all demographics.

Purpose - Recent improvements in the treatment of renal cell carcinoma (RCC), with the introduction of targeted agents, have increased the need of accurate data on its epidemiology. This descriptive study was designed to collate comprehensive information on RCC epidemiology from North Africa and the Middle East, which could provide the basis for further research. Methods - A network of reference oncologists in North Africa and the Middle East were invited to share all available national and regional information on RCC epidemiology, captured in a comprehensive questionnaire. No statistical analysis was planned as the intention was to conduct a purely descriptive study. Results - The results reported that the incidence of RCC within the region is in the range of 0.9–2.35/100,000 for men (with Lebanon as an exception at 4.3/100,000 for men) and 0.5– 1.7/100,000 for women, which is considerably lower than in Europe and the USA. No mortality or survival data are available. The age at diagnosis (mean < 60 years) is lower than in Western countries and a high proportion of patients in North Africa and the Middle East (21‒45%) have metastatic disease at diagnosis. Conclusions - The information presented here provides a more complete and current picture of RCC in North Africa and the Middle East; however, there are still gaps in the data. Further research is needed to allow planning of treatment strategies and resource allocation.

Cystic nephroma is a rare kidney neoplasm belonging to the entity of cystic tumours. It is a slow-growing tumour, which develops insidiously, sometimes reaching a considerable size. The diagnosis is more often accidental (except for mass syndrome in children). It is a benign tumour that may be treated by partial sparing nephrectomy. Malignant degeneration is few and far between. However, no medical examination can confirm the diagnosis before surgery. On medical imaging, the tumour enhances after contrast injection and there will always be a doubt about the benignity. Furthermore, percutaneous biopsy of the mass is not contributory to the diagnosis. This means that it is not easy to propose a conservative surgical treatment, even though this remains the best way to deal with such a tumour.

Mixed epithelial and stromal tumor (MEST) of the kidney is not a common diagnosis. This tumor usually mimics solid-cystic malignant renal tumors and most cases are treated surgically. Here, we presented a 35-year-old female with simultaneous two separate large solid-cystic masses with contrast enhancement in lower and upper pole of left kidney which were managed surgically via partial nephrectomy. Microscopic evaluation showed solid-cystic tumor with variably sized cysts lined by flattened to cuboidal epithelium that was compatible with MEST. Follow up evaluation revealed normal parenchymal renal tissue and proper function without any evidence of local recurrence.

To present a patient with horseshoe kidney and bilateral squamous cell carcinoma (SCC) which has not been reported so far. A 61-year-old woman presented with abdominal mass and recent episodes of gross hematuria. Imaging revealed malignant lesion of lower calyces of the right kidney and isthmus of horse-shoe kidney with midline crossing to the left side. Finally, the patient underwent bilateral enbloc radical nephroureterectomy and pathology evaluation was compatible with bilateral squamous cell carcinoma. This is the first report of bilateral SCC in horseshoe kidney which was managed via open enbloc radical nephroureterectomy.

Introduction and Objective: Robot-assisted radical nephrectomy (RRN) is increasingly utilized as an alternative to laparoscopic radical nephrectomy (LRN), but there are concerns over costs and objective benefit. In the setting of very large renal masses (>10 cm), comparison between techniques is limited and it is unclear whether a robotic approach confers any perioperative benefit over LRN or open radical nephrectomy (ORN). In this study, perioperative outcomes of RRN, LRN, and ORN for very large renal masses are compared. Methods: Using the National Cancer Database, patients were identified who underwent radical nephrectomy for kidney tumors >10 cm diagnosed from 2010 to 2015. Patients were analyzed according to surgical approach. Perioperative outcomes, including conversion to open, length of stay, readmission rates, positive surgical margins, and 30- and 90-day mortality were compared among cohorts. Results: A total of 9288 patients met inclusion criteria (RRN = 842, LRN = 2326, ORN = 6120). Compared with ORN, recipients of RRN or LRN had similar rates of 30-day readmission and 30- and 90-day mortality. Length of hospital stay was significantly shorter in RRN (-1.73 days ±0.19; p

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Abstract Objectives Lymphocyte activation gene 3 (LAG3), an inhibitory receptor in T‐cell activation, is a negative prognostic factor. However, its impact on tumours has yet to be comprehensively elucidated on a pan‐cancer scale. Thus, we aim to reveal its role at the pan‐cancer level. Methods We performed IHC staining on a retrospective cohort of 370 patients. Then we assessed the prognostic effect of LAG3 using Kaplan–Meier survival analysis and multivariate Cox regression analysis. In pan‐cancer analysis, we constructed competing endogenous RNA and protein–protein interaction networks, conducted gene set enrichment analysis and identified correlations between LAG3 gene expression and various factors, including clinical characteristics, tumour purity, mutations, tumour immunity and drug sensitivity across 33 cancer types. Results LAG3 was expressed higher in normal kidney tissues than in tumours. A high level of LAG3 gene expression was an independent prognostic factor for OS (HR = 6.60, 95% CI = 2.43–17.90, P

Malignant priapism (MP) is defined as a condition of persistent erection of the penile without sexual stimulation due to malignant cell invasion to the cavernous sinus and the efferent veins. We present a case of a man, 63 years old, with previous history of high-grade renal carcinoma pT3N0M0 had been through radical nephrectomy, diagnosed with MP secondary from metastatic renal carcinoma. The management of this case was aspiration of corpora cavernosa and distal shunting with the Al-Ghorab procedure, then continued to total penectomy and perineostomy.

Objectives: Nephron-sparing surgery (NSS) exposes the kidney to ischemia–reperfusion injury. Blood loss and hypotension are also associated with kidney injury. We aimed to test the hypothesis that, during NSS, both ischemia duration and blood loss significantly affect postoperative renal function and that their effects interact. Methods: Consecutive patients undergoing NSS were enrolled. The primary endpoint was renal function expressed as the absolute delta between preoperative and postoperative peak creatinine. We developed a generalized linear model with the ischemia duration and absolute hemoglobin difference as independent variables, their interaction term, and the RENAL score. The model was than expanded to include a history of hypertension (as a proxy for hypotension susceptibility) and related interaction terms. Further, we described the perioperative and mid-term oncological outcomes. Results: A total of 478 patients underwent NSS, and 209 (43.7%) required ischemia for a mean of 10.9 min (SD 8). Both the ischemia duration (partial eta 0.842, p = 0.006) and hemoglobin difference (partial eta 0.933, p = 0.029) significantly affected postoperative renal function, albeit without evidence of a significant interaction (p = 0.525). The RENAL score also significantly influenced postoperative renal function (p = 0.023). After the addition of a previous history of hypertension, the effects persisted, with a significant interaction between blood loss and a history of hypertension (p = 0.02). Conclusions: Ischemia duration and blood loss had a similar impact on postoperative renal function, albeit without potentiating each other. While the surgical technique and ischemia minimization remain crucial to postoperative kidney function, increased awareness of conscious hemodynamic management appears warranted.

ObjectivesMany people are turning to alternatives to the conventional doctor-patient relationship, such as web-based search engines and video forums for their health care information. We undertook this study to investigate the quality of videos and information on renal cancer available on the streaming platform YouTube.MethodsWe completed a search of YouTube (w w w.YouTube.com) in September 2021 with the term “kidney cancer.” The first 120 videos found which met the inclusion criteria (English speaking, duration greater than one minute, greater than 500 views, renal cancer addressed) were selected. We recorded information including duration, view count, likes, dislikes, comments, publisher, and author. The modified DISCERN tool and Global Quality Score (GQS) questionnaire were used to assess the quality of the included videos. The level of misinformation was assessed using a Likert 5-point scale. Descriptive statistics were used to analyse the collected data. A 2-sample t test was used to further analyse the quality assessment tool results before, during, and after 2016.ResultsMost videos were published during or after 2016 (63.3%), were predominantly created in North America (77.5%), and were presented by health care professionals (60%). The median length of the videos was 4.23 (1.01 to 65.55) minutes, and the median number of views was 3087 (514 to 228 152). The median number of likes and dislikes was 24 and 5, respectively. The median modified DISCERN score was 3, the median GQS score was 3, and the grading for overall level of misinformation was moderate.ConclusionThe quality of information accessed from YouTube on kidney cancer is of a low to moderate overall standard with significant levels of misinformation. YouTube should not be used alone for educational purposes on renal cancer by patients or the public. It is best used in conjunction with information and advice from a medical practitioner and the health care system.

Primary renal synovial sarcoma is a rare malignancy that may present similarly to other renal neoplasms. The diagnosis of synovial sarcoma is performed through the identification of a SYT-SSX gene fusion. Here, we present a case of a primary renal synovial sarcoma in a patient who presented with renal mass initially thought to be renal cell carcinoma until further pathological characterization. After undergoing radical open nephrectomy, the patient developed pulmonary and psoas metastases and was treated with systemic therapy.

Abstract Objective The experience of performing robot-assisted partial nephrectomy (RAPN) is associated with better surgical outcomes. However, surgeon’s generation may impact surgical outcomes. We evaluated the perioperative outcomes of RAPN between first- and second-generation surgeons according to the surgeon’s experience. Methods This study included 529 patients who underwent RAPN for renal cell carcinoma from January 2013 to November 2018. Four specific surgeons performed the surgery. According to the surgeon’s generation, the patients were divided into two groups: first-generation and second-generation. To reflect the learning curve of RAPN, the surgical outcomes of each case (1–50, 51–100, 101–150) were evaluated between these groups. Results Between 1 to 50 cases and 101–150 cases, no significant differences in patient characteristics were observed between the two generations. Between 51–100 cases, age at surgery was significantly younger in the first-generation than in the second-generation group (58 years vs. 64 years, p = 0.04). The second-generation group had a shorter operation time in cases 1–50 (169 min vs. 188 min, p = 0.0001), 51–100 (145 min vs. 169 min, p = 0.008), and 101–150 (142 min vs. 165 min, p = 0.009), than the first-generation group. Although shorter WIT and higher trifecta achievement were observed in the second-generation group than in the first-generation group between 1–50 cases, the difference was not noted between 51–100 cases and 101–150 cases. Conclusion Patients operated by second-generation surgeons had better surgical outcomes than first-generation surgeons, especially during the early experience period, which might result from their assistance experience, sophisticated surgical procedures refined by the first-generation, and the first-generation surgeon’s introduction.

Objectives: Lymphocyte activation gene 3 (LAG3), an inhibitory receptor in T‐cell activation, is a negative prognostic factor. However, its impact on tumours has yet to be comprehensively elucidated on a pan‐cancer scale. Thus, we aim to reveal its role at the pan‐cancer level. Methods: We performed IHC staining on a retrospective cohort of 370 patients. Then we assessed the prognostic effect of LAG3 using Kaplan–Meier survival analysis and multivariate Cox regression analysis. In pan‐cancer analysis, we constructed competing endogenous RNA and protein–protein interaction networks, conducted gene set enrichment analysis and identified correlations between LAG3 gene expression and various factors, including clinical characteristics, tumour purity, mutations, tumour immunity and drug sensitivity across 33 cancer types. Results: LAG3 was expressed higher in normal kidney tissues than in tumours. A high level of LAG3 gene expression was an independent prognostic factor for OS (HR = 6.60, 95% CI = 2.43–17.90, P < 0.001) and PFS (HR = 3.44, 95% CI = 1.68–7.10, P < 0.001). In pan‐cancer analysis, LAG3 exhibited robust correlations with survival and tumour stages in various cancers. Moreover, LAG3 was strongly associated with immune‐related genes, proteins and signalling pathways. LAG3 gene expression was positively associated with increased infiltration of activated immune cells and decreased infiltration of several resting cells. LAG3 gene expression was associated with tumour mutation burden and microsatellite instability in multiple cancers. Conclusion: High LAG3 gene expression was an independent risk factor in kidney neoplasms. It also functioned as a biomarker for prognosis, TIME and immunotherapy efficacy in the pan‐cancer dimension. [ABSTRACT FROM AUTHOR]

Cystic renal cell carcinoma (RCC) is a malignant epithelial tumor arising in a pre-existing renal cyst. The renal cyst maybe multilocular or unilocular with the latter being an even rarer occurrence. Cystic renal malignancy arising in a unilocular cyst is quite rare with only a few cases reported till date, most of which are clear cell RCCs. Literature available with regard to staging tumor nodule in a benign unilocular cyst is limited. We report a case of a 52-year-old male presenting with a single large unilocular cyst which had a small solid nodule of papillary RCC in its posterior wall which was detected on microsopy. On pathologic examination, all cases of clinically/ radiologically benign renal cysts should be examined with a high index of suspicion as a small tumor focus may be present in the form of a nodule or in the free wall of the cyst which was initially missed.

Solitary fibrous tumor (SFT) is a rare spindle cell neoplasm, usually occurring in the pleura. Pararenal SFT, mimicking an adrenal gland or renal tumor, as here described, is extremely rare. We report a case of a right suprarenal SFT, incidentally discovered by abdominal ultrasound in a 54-year-old woman carrying a point neurofibromatosis 1 (NF1) gene mutation. Preoperative diagnostic work-up was ineffective in evaluating its origin, and an open radical right nephrectomy was therefore undertaken. Immunohistochemical assay showed a positivity for CD34, CD99 and Bcl-2, so suggesting a diagnosis of SFT. According to our knowledge, the association between this type of tumor and NF1 gene mutation has never been described. In cases of pararenal tumors, a more detailed preoperative diagnosis could be useful to better plan the extension of resection, allowing, in selected cases, nephron-sparing surgery. More studies are needed to better analyze the relationship between NF1 gene mutation and SFT.

Aim: To demonstrate the utility of the renal artery embolization (RAE) in the dissection of gross neoplasms and the reduction in blood loss and operative time., Case Report: We report a case of a gross left renal neoplasm (with the diameter of about 12 cm) in a 45 years old Caucasian female who underwent to renal artery embolization 24 hours before left nephroureterectomy. This procedure has determined a reduction in operative times (about 90 minutes) because of the ligature of the renal vein was facilitated. Intraoperative blood loss was of about 100 ml and the patient didn't need of blood transfusions; the abdominal drain was removed in third postoperative day (daily drained serous fluid was about 20 ml). The patient was discharged 7 days later., Conclusion: RAE facilitates the dissection of gross neoplasms (diameter> than 10 cm), so causing a reduction in intraoperative blood loss and in blood transfusion. The operative times are lower because the ligature of the renal vein is less difficult and the dissection is facilitated for the presence of tissue oedema. The disadvantages are the incomplete hembolyzation, coil migration, hematomes, post-infarction syndrome (nausea, vomit, abdominal pain, leucocytosis, hyperpyrexia, hematoma); other risks include the possibility of pulmonary embolism, intestinal infarction and infections. Its reduced utilization could be due to the lack of randomized prospective studies showing its potential benefits.