Evaluation of Perirenal Fat as a Predictor of cT(1a) Renal Cortical Neoplasm Histopathology and Surgical Outcomes
ABSTRACT With the increasing detection of small renal cortical neoplasms (RCNs), the preoperative prediction of histopathology has become increasingly important. Because perirenal fat (PF) is known to be metabolically active, we evaluated PF as a predictor of renal tumor histopathology.
We retrospectively evaluated patients who underwent laparoscopic nephron-sparing procedures for cT(1a) RCN at two institutions. PF was measured using the digital measuring tool function on standard imaging software, at the level of the renal hilum as the perpendicular distance between the posterior surface of the kidney and the external margin of the psoas muscle. The Mann-Whitney test and logistic regression were used to examine PF, selected demographic, clinical, and operative parameters, and their association with tumor histopathology.
Data from 250 patients were included in this study. There were 157 (63%) men and 93 (37%) women with a median body mass index (BMI) of 28 kg/m(2). Median tumor size was 2.4 cm, and the median PF distance was 12 mm. Significant correlations were noted between PF and sex and BMI. No significant correlations were found between PF and the operative parameters. Results of a multivariate logistic regression analysis revealed that PF (P<0.01), age (P<0.04), and tumor location (P<0.04) were significant predictors of clear-cell renal-cell carcinoma (RCC) histopathology.
In this study, PF, location of tumor, and age were significant predictors of clear-cell RCC histopathology. The correlation of PF and histopathology may be useful in preoperative decision-making and surgical planning in the management of small RCN.
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ABSTRACT: Visceral adiposity has been inconsistently associated with clinicopathologic features and outcomes of clear cell renal cell carcinoma (ccRCC); however, most studies were conducted in non-Western populations. We evaluated the associations between visceral and subcutaneous adiposity and clinicopathological characteristics of non-metastatic ccRCC patients in a Western population. The medical records of 220 surgically treated ccRCC patients with documented preoperative body mass index (BMI) and computed tomography (CT) scans were retrospectively reviewed. Nineteen patients with stage IV disease were excluded. Visceral (VFA) and subcutaneous fat area (SFA) were computed from pre-operative CT scans. Correlations between obesity measures were assessed with Pearson correlation. Associations between obesity measures and pathologic features were evaluated using logistic regression models adjusted for sex. Overall survival (OS) probabilities were estimated using Cox regression analysis. The log-rank test was used for group comparisons. The study cohort comprised 150 men and 51 women. Women had higher SFA (p = 0.01) but lower VFA (p < 0.001) than men. BMI was highly correlated with SFA (r = 0.804) and moderately correlated with VFA (r = 0.542). SFA and VFA were weakly correlated (r = 0.367). An increased BMI was associated with a better OS (p = 0.028). When adjusting for sex, neither SFA nor VFA was significantly associated with tumour grade, stage, or OS. Consistent with prior reports, our study suggests that increased BMI is associated with a better OS for patient with nonmetastatic ccRCC. Despite the high correlation between SFA and BMI, neither SFA nor VFA were significantly associated with tumour stage, grade, or OS in the current study; however, further studies in larger cohorts are required to validate this finding.10/2014; 8(9-10):E675-E680. DOI:10.5489/cuaj.1979
Article: Biomarkers of renal cell carcinoma.[Show abstract] [Hide abstract]
ABSTRACT: The incidence of renal cell carcinoma (RCC) has increased steadily in past few decades and is partially attributable to the increased utilization of cross-sectional imaging. Many of these carcinomas are small incidental discoveries, although a subset leads to locally advanced or distant disease. Although its molecular pathophysiology is not completely understood, knowledge of hereditary RCCs has shed light on some of the pathways involved. More recently, the rapid advances in genomics, proteomics, and metabolomics have allowed for a deeper and more nuanced understanding of the genetic aberrations that lead up to and result from the transformation of a renal tubular epithelial cell into a carcinoma. These discoveries have allowed for the development of novel therapeutics that target these pathways. They have also led to the development of diagnostic, prognostic, and predictive biomarkers that could radically change the way RCC is diagnosed and treated. Although some of the current investigations are nascent and it remains to be seen which biomarkers will become clinically available, many candidate biomarkers show promise and require external validation. Ultimately, biomarkers may allow for cost-effective screening of high-risk patients, the identification of aggressive cancers among small renal masses, the identification of high-risk patients, the detection of recurrences postoperatively with minimal imaging, and the ability to choose appropriate targeted therapies for patients with metastatic disease.Urologic Oncology 11/2013; DOI:10.1016/j.urolonc.2013.07.011 · 3.36 Impact Factor