Kidney Cancer

Renal cell carcinoma (RCC) thrombus invasion in the inferior vena cava (IVC) wall needs adequate resection to improve survival. Surgical planning to avoid positive vascular surgical margins and recurrent disease can be facilitated by imaging capable of diagnosing this invasion and the extent of the thrombus.

To evaluate the diagnostic performance of multiparametric MR imaging (mpMRI) for detecting inferior vena cava (IVC) wall invasion and extent of renal cell carcinoma (RCC) thrombus.

In this prospective study, twenty consecutive patients underwent mpMRI before open radical nephrectomy with IVC thrombectomy was performed in a single high-volume institution by one urologist (PM) blinded for mpMRI findings. Primary endpoint was mpMRI negative- and positive predictive value (NPV/PPV) for IVC wall invasion as encountered during surgery. IVC wall invasion was assessed on mpMRI by a radiologist prior to the surgery based on qualitative imaging parameters. Also, NPV and PPV were calculated with incremental use of quantitative parameters. Therefore, the association between IVC wall invasion and the maximum IVC and renal vein orifice diameter, and the cranial extent of the thrombus was evaluated by logistic regression. After ROC analysis an optimal cut-off point was selected for significantly associated quantitative parameters. NPV and PPV were calculated using this optimal cut-off point.

mpMRI NPV and PPV for IVC wall invasion based on qualitative parameters was 82% and 100%, respectively. An increase in IVC diameter was significantly associated with IVC wall invasion (p < 0.05). With incremental use of an IVC diameter cut-off value of 27 mm NPV and PPV for IVC wall invasion were 100% and 89%, respectively.

mpMRI is able to reliably diagnose IVC wall invasion of RCC thrombus and can optimize radical surgical resection.

Tivozanib was approved in Europe in November 2017. We report on our initial experience of the use of Tivozanib in metastatic Renal Cell Carcinoma (RCC).

N = 23 patients undergoing Tivozanib therapy were included in this retrospective analysis from a prospective database at the Multidisciplinary Center on Renal Tumors, Department of Urology, University of Munich between Nov. 2017 and Oct. 2018.

Median age was 69.1 years (range 42.7–83.8) n = 8 patients were started on tivozanib in first line (34.8%) and n = 15 (75.2% in later line therapy (2nd– 6th line). Tumor response according to RECIST criteria was PR in 39.1%, SD in 52.2% and PD in 8.7% of the patients. Median progression free survival (PFS) was 14.9 months (95% CI 5.1–24.8). Median overall survival (OS) has not been reached. Although not statistically significant the difference in median PFS for first line patients was 30.3 months versus later line patients of 8.6 months (CI 5.1–12.2) (p = 0.291). The most commonly reported side-effects were diarrhea, hypertension, fatigue and hoarseness. 34.8% of the patients had grade 2 side effects and 21.7% had grade 3 adverse events, leading to treatment discontinuation in 3 patients (13%).

Tivozanib is a highly active tyrosine kinase inhibitor even in later lines of therapy. The side effects are well tolerated, and no new safety signals were detected.

Compare FDG-PET/CT, CT, and bone scan for detecting and monitoring bone metastases’ response in metastatic renal cell cancer (mRCC).

Patients with mRCC prospectively underwent FDG-PET/CT, CT, and bone scans at baseline and after 8 weeks of therapy. Tumor visibility and metabolic activity were retrospectively recorded. Response was evaluated by PERCIST, RECIST, and MD Anderson bone criteria. Kaplan-Meier methodology estimated event-time distributions for PFS, OS, and time to symptomatic skeletal event (SSE). Log-rank test tested differences in event-time distributions between response at 8 weeks by response criteria.

Sixteen patients (n = 30; 53%) were evaluable. Baseline FDG-PET/CT detected more osseous metastases (n = 55) than CT (n = 45) or bone scan (n = 34). From baseline to 8 weeks, metabolic activity of lesions decreased >20%, while qualitative and quantitative CT and bone scan parameters were unchanged for most patients. Partial metabolic responders by PERCIST had longer PFS and OS (n = 5, 20+ months) versus those with stable (n = 9; PFS = 9.2 mos, OS = 8.7 mos) and progressive (n = 2; PFS = 5.4 mos, OS = 12.1 mos) metabolic disease, p = 0.09 and 0.42, respectively. By RECIST, longer PFS and OS was seen for stable (n = 12, PFS = 8.3 mos, OS = 17.7 mos) versus progressive (n = 4; PFS = 3.7 mos, OS = 7.5 mos) disease, p = 0.16, 0.02, respectively. OS was not reached, but estimated ≥20 mos, for 4 patients with RECIST SD and PERCIST PMR, compared to OS of 17.7 mos for other patients with RECIST SD.

FDG-PET/CT identified more bone metastases and greater numbers of quantitative and qualitative treatment responses in mRCC compared to CT and bone scan. FDG-PET/CT also may identify a sub-group of patients with better outcomes than predicted by standard imaging modalities.

Renal cell carcinoma (RCC) is a lethal neoplasia. Data from Latin America are scarce, and the distinct ethnic origins of this population could affect predictive or prognostic factors.

We aim to describe a large cohort of non-metastatic renal cell carcinoma, identifying the demographic, clinical, and pathological prognostic factors for survival.

We used a multi-institutional retrospective cohort involving 5,670 patients who underwent radical or partial nephrectomy across seven Latin American countries and Spain from 1980 to 2016. The variables were compared, and Kaplan–Meier curves were used to estimate the overall survival (OS) and cancer-specific survival (CSS).

The clear cell subtype represented 66.7% of RCC, followed by chromophobe (13.7%), papillary (5.2%), and others (14.4%). Furthermore, 72.3% of renal masses were <7.0 cm. The 5-year OS and 10-year OS rates were 86.1% and 69.5%, respectively. The 5-year and 10-year CSS rates were 89.9% and 81.8%, respectively. The demographic and clinical predicting factors for OS in the multivariate analysis were age (HR: 2.978), anemia (HR: 1.44), presence of symptoms at presentation (HR: 1.26), Karnofsky score ≤80 (HR: 2.12), and ASA score ≥ 3 (HR: 1.49). The pathological factors were nodal metastasis (HR: 2.14), peri-renal fat invasion (HR: 2.12), inferior vena cava invasion (HR: 1.61), histologic tumoral necrosis (HR: 1.69), and tumor size >7 cm (HR: 1.64).

Our findings agreed with those reported for some developed countries. We emphasize that ASA and peri-renal fat invasion as prognostic factors deserve further study. Information regarding microvascular invasion should be regularly incorporated in pathological reports.