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    Best of AUA 2014: Kidney Cancer

     

    • In a more mature dataset, renal tumor biopsies could provide a diagnosis in up to 89% of patients and surgery could be avoided in 23% based on a negative preoperative biopsy. Final agreement between biopsy and histopathology could be achieved in 92% of patients, and from 2001 to 2013, the non-diagnostic rate dropped from 15% to 6%, signifying a learning curve in performing and interpreting biopsy correctly.

    • Active surveillance may be reasonable even for patients with T1b tumors. Tumors >4 cm in diameter grow at about 0.44 cm per year, about the same as smaller tumors. Fifteen percent showed no growth, and 34% progressed to intervention.

    • Partial nephrectomy decreased the incidence of cardiovascular events by 50% versus radical nephrectomy. But 10-year other-cause mortality rates were the same for partial and radical nephrectomy, and partial nephrectomy did not confer a survival advantage.

    • In partial nephrectomy, tumor enucleation is a reasonable technique to treat small renal masses that maximizes preservation of normal-functioning parenchyma. Ischemia time for enucleation was 4 minutes shorter and OR time 32 minutes shorter than that for sharp tumor excision.

    • A study showing a 5% positive surgical margin rate after partial nephrectomy showed no difference in progression-free survival between patients who had positive versus negative margins.

    • Contrary to a common belief, patients who have compromised kidneys prior to undergoing partial nephrectomy and those who have healthy kidneys have the same rate of kidney function recovery after ischemic insult.

    • Patients who have surgically induced chronic kidney disease have a slower rate of kidney function decline and superior other-cause mortality than patients who have medical or medical/surgical chronic kidney disease.

    • In patients with locally advanced T2 and T3 tumors, axitinib (Inlyta) was able to reduce tumor size by about 28%, with 46% of patients showing a response and 54% showing stable disease.

    • In patients with inferior vena cava (IVC) thrombus treated with targeted therapies, mean tumor size decreased in 74% of patients. Mean reduction was about 14 mm, and the level of the thrombus was changed in 16%, indicating that the benefit of targeted therapy is limited.

    • In patients with IVC thrombus and metastatic RCC, adding surgery to targeted therapy did not confer any benefit in progression-free or overall survival compared with targeted therapy alone.

    • Those patients with metastatic RCC who are on statins tend to have superior cancer-specific survival compared with those who are not on statins, and on multivariate analysis, statins independently predicted cancer-specific survival.UT


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