Best Papers on Kidney Cancer Vincenzo Ficarra Direttore Clinica di Urologia Azienda Ospedaliera Universitaria di Udine

Uro-oncological topics Renal Tumor biopsyRenal Tumor biopsy Positive Surgical Margins after PNPositive Surgical Margins after PN Expanding indications for PNExpanding indications for PN Relapses after nephrectomyRelapses after nephrectomy Cytoreductive nephrectomyCytoreductive nephrectomy

Tsivian M. et al. BJU Inter 2014; doi: /bju.12470

Topics and discussed items

Tsivian M. et al. BJU Inter 2014; doi: /bju RTB: indications

Tsivian M. et al. BJU Inter 2014; doi: /bju RTB: technical aspects

Tsivian M. et al. BJU Inter 2014; doi: /bju RTB: pathological interpretation

Uro-oncological topics Renal Tumor biopsy Positive Surgical Margins after PN Expanding indications for PN Relapses after nephrectomy Cytoreductive nephrectomy

Presence of cancer cells at the level of inked parenchymal excision surface

Ani I. et al. BJU Inter 2014; doi: /j X x Ontario Cancer Registry Pathology reports on 664 were reviewed Partial nephrectomy for RCC between 1995 and 2004 Seventy-one patients with PSMs (10.7%)

Ani I. et al. BJU Inter 2014; doi: /j X x PSMs after PN: overall survival NSM: 91.9% PSM: 90.9%

Ani I. et al. BJU Inter 2014; doi: /j X x PSMs after PN: cancer-specific survival NSM: 88.6% PSM: 84.4%

Khalifeh A. et al. J Urol 2013; 190: Prospective, multicenter study (5 US institutions) 943 RAPN 21 (2.2%) cases with positive surgical margins

Khalifeh A. et al. J Urol 2013; 190: Recurrence-free survivalMetastasis-free survival HR %CI – p <0.01)HR 78 95%CI ,967 – p <0.0001)

PSMs after PN: management Management Radical Nephrectomy1. Residual tumor present in 7-15% of the cases 2. Increased risk of CKD Repeat Partial Nephrectomy1. Technically demanding procedure 2. Intraoperative bleeding 3. Complications Ablative therapies1. No tissue is retrieved for histologic evaluation 2. Follow-up is hampered by artificial tissue alterations Observation (watchful waiting)1. Intensive follow-up is needed 2. No validated follow-up scheme exists

Uro-oncological topics Renal Tumor biopsyRenal Tumor biopsy Positive Surgical Margins after PNPositive Surgical Margins after PN Expanding indications for PNExpanding indications for PN Relapses after nephrectomyRelapses after nephrectomy Cytoreductive nephrectomyCytoreductive nephrectomy

Expanding indications for PN

Radical and Partial Nephrectomy for Clinical T2 Renal Tumors Kopp R. et al. BJU Inter 2014; (available online)

Radical and Partial Nephrectomy for Clinical T2 Renal Tumors Kopp R. et al. BJU Inter 2014; (available online)

Radical and Partial Nephrectomy for Clinical T2 Renal Tumors Kopp R. et al. BJU Inter 2014; (available online)

Babaian K et al. J Urol 2014; 192: 1-7 Retrospective analysis consecutive cohort of 33 patients with metastatic renal cell carcinoma partial nephrectomy at a single institution 1996 and 2011

Babaian K et al. J Urol 2014; 192: 1-7 Partial Nephrectomy for metastatic Renal Cell Carcinoma

Babaian K et al. J Urol 2014; 192: 1-7 Partial Nephrectomy for metastatic Renal Cell Carcinoma

Uro-oncological topics Renal Tumor biopsy Positive Surgical Margins after PN Expanding indications for PN Relapses after nephrectomy Cytoreductive nephrectomy

Brookman S. et al. BJU Inter 2013; 112:

Time to recurrence and CSS

Brookman S. et al. BJU Inter 2013; 112: Time to recurrence and CSS

Brookman S. et al. Eur Urol 2013; 64:

Late relapses after Nephrectomy Evaluated period:

Brookman S. et al. Eur Urol 2013; 64: Late relapses after Nephrectomy

Brookman S. et al. Eur Urol 2013; 64: Late relapses after Nephrectomy

Kroeger N. et al. Eur Urol 2014; 65:

Treatment outcomes after late relapses

Kroeger N. et al. Eur Urol 2014; 65: Treatment outcomes after late relapses

Kroeger N. et al. Eur Urol 2014; 65: Treatment outcomes after late relapses

Uro-oncological topics Renal Tumor biopsyRenal Tumor biopsy Positive Surgical Margins after PNPositive Surgical Margins after PN Expanding indications for PNExpanding indications for PN Relapses after nephrectomyRelapses after nephrectomy Cytoreductive nephrectomyCytoreductive nephrectomy

Aizer AA et al. BJU Inter 2014; BJU Int 2014; 113: 67–74 SEER programme to identify a population-based sample of 4914 patients diagnosed with metastatic RCC between 2000 and had non-clear-cell histology. Median follow-up was 20 months. Primary outcome measure was RCC-specific mortality

Aizer AA et al. BJU Inter 2014; BJU Int 2014; 113: 67–74 CN in non-clear-cell RCC

Aizer AA et al. BJU Inter 2014; BJU Int 2014; 113: 67–74 CN in non-clear-cell RCC

Aizer AA et al. BJU Inter 2014; BJU Int 2014; 113: 67–74 CN in non-clear-cell RCC Patients from the SEER programme with metastatic non-clear-cell RCC, including those treated in the targeted therapy era, appear to derive a survival benefit from CN, an association which remained significant regardless of histological subtype This observation suggests that CN should remain standard in patients with advanced RCC who are deemed to be surgical candidates