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Prevalence of renal cell carcinoma in patients with ESRD pre-transplantation: a pathologic analysis. Kidney Int

Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Kidney International (Impact Factor: 8.52). 07/2002; 61(6):2201-9. DOI: 10.1046/j.1523-1755.2002.00374.x
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ABSTRACT Acquired renal cystic disease (ARCD), renal adenoma (AD), and renal cell carcinoma (RCC) are more common in patients with end-stage renal disease (ESRD). However, the prevalence of these conditions in patients undergoing transplantation, and the clinical characteristics associated with their occurrence are unclear.
At our institution, the majority of patients undergo an ipsilateral native nephrectomy at the time of transplantation, providing a unique opportunity to study the prevalence and pathology of ARCD, AD and RCC in ESRD. We retrospectively reviewed all consecutive nephrectomy pathology reports over a six year period. Demographic and clinical characteristics associated with these lesions were identified.
Two hundred and sixty nephrectomy reports were reviewed: ARCD, AD, RCC and oncocytoma were found in 33%, 14%, 4.2% and 0.6% of cases, respectively. On multivariable analysis, ARCD was positively associated with male sex and longer dialysis duration and negatively associated with peritoneal dialysis. Similarly, AD was positively associated with male sex, longer dialysis duration and greater age. There was a trend for RCC cases to share similar associations although the small total number of cases precluded findings of statistical significance.
By pathologic analysis, renal tumors are more common in the pre-transplant ESRD population than previously reported (using radiologic methods). Our study also identifies risk factors for their occurrence. This may prove useful in designing screening studies for renal tumors in this patient population.

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    • "Several factors could contribute to this higher prevalence, including depressed host immunity [6], impaired antioxidant defense mechanisms, increased synthesis of reactive oxygen [7] [8], and acquired renal cystic formation [9]. On the contrary, the biological behavior of RCC related to ESRD (ESRD-RCC) is generally reported to be less aggressive than that of RCC in the general population [3] [10]. However, the natural history and the prognosis of ESRD-RCC still remain unclear, with limited data from only a few small and noncomparative RCC series on dialysis patients or renal transplant patients or both [10]. "
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    ABSTRACT: Previous studies have reported that elevated pretreatment C-reactive protein (CRP) levels are associated with poor outcome in various malignancies, including renal cell carcinoma (RCC), in the general population. However, there is no evidence of such an association in dialysis patients. Therefore, the aim of this study is to evaluate the prognostic significance of preoperative serum CRP levels in patients with RCC related to end-stage renal disease (ESRD) requiring hemodialysis (HD).
    Urologic Oncology 08/2014; 33(2). DOI:10.1016/j.urolonc.2014.07.004 · 3.36 Impact Factor
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    • "Acquired cystic kidney disease (ACKD), which is commonly associated with end-stage renal disease (ESRD), also has been reported as a condition predisposing patients to an increased risk of RCC [2]. However, data from the literature are limited to a few small and noncomparative RCC series in dialysed patients [3] [4] [5] [6] [7] [8] and in renal transplant patients [9] [10] [11] [12] [13] [14] [15] [16]. These studies have individually suggested specific clinical, pathologic, or outcome features for ESRD native renal tumours. "
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    ABSTRACT: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Positive surgical margin (PSM) frequency after radical cystectomy has been estimated to be 4-15%. Studies that have not distinguished between the different sites of PSM have failed to show that they are an independent prognostic factor for disease-free survival. Only perivesical soft tissue PSMs have been associated with an increased risk of cancer recurrence and cancer-specific death. This is the first comprehensive published analysis of PSMs occurring during radical cystectomy for pTx pN0 M0 bladder cancer according to their location, comparing their cancer-specific survival (CSS) and other outcomes with those of a control group paired according to TNM status, age, sex and urinary diversion method. Local recurrence-free survival rates were found to be lower in patients with both soft tissue and urethral PSMs. Moreover, soft-tissue PSMs were associated with lower metastatic recurrence-free and CSS rates. OBJECTIVE: To compare the prognoses associated with positive surgical margins (PSMs) according to their urethral, ureteric and/or soft tissue locations in patients with pN0 M0 bladder cancer who have not undergone neoadjuvant chemotherapy. PATIENTS AND METHODS: A retrospective, case-control study was conducted between 1991 and 2011 using data from 17 academic centres in France. A total of 154 patients (cases) with PSMs met the eligibility criteria and were matched according to centre, pT stage, gender, age and urinary diversion method with a population-based sample of 154 patients (controls) from 3651 patients who had undergone cystectomies. The median follow-up period was 23.9 months. Multivariable Cox regression analysis was used to test the effects of PSMs on local recurrence (LR)-free survival, metastatic recurrence (MR)-free survival and cancer-specific survival (CSS). RESULTS: The 5-year LR-free survival and CSS rates of patients with urethral and soft tissue PSMs were lower than those in the control group. A significant decrease in CSS was associated with soft tissue PSMs (P = 0.003, odds ratio = 0.425, 95% confidence interval 0.283-0.647). The prognosis was not affected in cases of ureteric PSMs. CONCLUSIONS: Soft tissue PSMs were associated with poor CSS rates in patients with pN0 M0 bladder cancer. A correlation between urethrectomy and a reduction of the risk of LR in a urethral PSM setting was observed.
    BJU International 01/2013; DOI:10.1111/j.1464-410X.2012.11664.x · 3.13 Impact Factor
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    • "Acquired cystic kidney disease (ACKD), which is commonly associated with end-stage renal disease (ESRD), also has been reported as a condition predisposing patients to an increased risk of RCC [2]. However, data from the literature are limited to a few small and noncomparative RCC series in dialysed patients [3] [4] [5] [6] [7] [8] and in renal transplant patients [9] [10] [11] [12] [13] [14] [15] [16]. These studies have individually suggested specific clinical, pathologic, or outcome features for ESRD native renal tumours. "
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    ABSTRACT: Study Type – Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Patients with end-stage renal disease (ESRD) have an increased risk of developing RCC in their native kidneys. The prevalence of RCC is 3–4% in cases of ESRD in dialyzed and/or transplanted patients, which corresponds to a rate 100-times higher than that in the general population. This is the first study, to our knowledge, comparing the characteristics of kidney cancer in the ESRD population according to their dialysis or transplantation status at the time of diagnosis. The differences in stage and survival we observed may be due to differences in surveillance strategies between transplanted and not transplanted patients, nevertheless, the differences in pathological subtypes suggest they could also be due to differences in the tumorigenesis process.
    BJU International 06/2012; 110(11B). DOI:10.1111/j.1464-410X.2012.11273.x · 3.13 Impact Factor
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