Русский
The morphologic results of organ-sparing interventions in patients with renal tumor aged up to 40 years and older
DOI: https://dx.doi.org/10.18565/urology.2018.6.80-84
Yu.G. Alyaev, E.S. Syrota, E.A. Bezrukov, Y.V. Lerner
1 Department of Urology, 2 Urologic Clinic,3 Scientific Research Institute of Uronephrology and Reproductive Health, 4 Department of Pathology of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia (Sechenov University), Moscow, Russia
Aim: to evaluate the features pathologic results of organ-sparing interventions in patients aged up to 40 years and older and assess an influence of patient age on the recurrence-free survival in case of pathologically proven renal cell cancer.
Materials and methods. A retrospective analysis of laparoscopic organ-sparing removal of kidney tumors in 314 patients performed from January 2012 to May 2017 was conducted. The mean patient age was 54.4±10.9 (25–78) years. There were 178 males (56.7%) and 136 females (43.3%). All patients were divided into two groups. In Group 1 a total of 37 patients aged ≤ 40 years (11.8%) were included and Group 2 consisted of 277 patients (88.2%) over 40 years. In Group 1 there was no family cases of renal cell cancer.
Results. In Group 1 malignant tumors were more common (n=33 cases (89.2%)), and benign tumors were diagnosed in 4 (9.8%) cases. Among patients older than 40 years the malignant and benign tumors were determined in 242 cases (87.4%) and 35 cases (12.6%), respectively. It was estimated that there were no differences in neither malignant tumors rate (p=0.75), nor in proportion of different pathologic forms of benign (p=0.68) and malignant neoplasms (p=0.25), nor in proportion of various degrees of anaplasia (р=0.33). A mortality rate was 0.6% (2 patients in Group 2), and there was 3 relapse (1.1%). A proportion of censored cases was 99.4% for overall survival and 98.9% for recurrence-free survival. A point estimate of overall survival after 36-months follow-up was 35.77±0.16 months. The mean disease-free survival was 35.47±0.24 months. The survival differences between two groups were not significant due to absence of relapse and mortality in patients aged ≤40 years.
Conclusion. During the planning of surgical treatment of patients with kidney tumors aged ≤ 40 years a preference to organ-sparing interventions should be given. The postoperative genetic counselling is recommended to exclude hereditary renal cell cancer. Considering a high risk of local recurrence in all patients aged ≤ 40 years meticulous and regular follow-up is needed.
Materials and methods. A retrospective analysis of laparoscopic organ-sparing removal of kidney tumors in 314 patients performed from January 2012 to May 2017 was conducted. The mean patient age was 54.4±10.9 (25–78) years. There were 178 males (56.7%) and 136 females (43.3%). All patients were divided into two groups. In Group 1 a total of 37 patients aged ≤ 40 years (11.8%) were included and Group 2 consisted of 277 patients (88.2%) over 40 years. In Group 1 there was no family cases of renal cell cancer.
Results. In Group 1 malignant tumors were more common (n=33 cases (89.2%)), and benign tumors were diagnosed in 4 (9.8%) cases. Among patients older than 40 years the malignant and benign tumors were determined in 242 cases (87.4%) and 35 cases (12.6%), respectively. It was estimated that there were no differences in neither malignant tumors rate (p=0.75), nor in proportion of different pathologic forms of benign (p=0.68) and malignant neoplasms (p=0.25), nor in proportion of various degrees of anaplasia (р=0.33). A mortality rate was 0.6% (2 patients in Group 2), and there was 3 relapse (1.1%). A proportion of censored cases was 99.4% for overall survival and 98.9% for recurrence-free survival. A point estimate of overall survival after 36-months follow-up was 35.77±0.16 months. The mean disease-free survival was 35.47±0.24 months. The survival differences between two groups were not significant due to absence of relapse and mortality in patients aged ≤40 years.
Conclusion. During the planning of surgical treatment of patients with kidney tumors aged ≤ 40 years a preference to organ-sparing interventions should be given. The postoperative genetic counselling is recommended to exclude hereditary renal cell cancer. Considering a high risk of local recurrence in all patients aged ≤ 40 years meticulous and regular follow-up is needed.
About the Autors
Corresponding author: E.S. Syrota – Cand.Med.Sci., senior researcher at the Scientific Research Institute of Uronephrology and Reproductive Health, Urologic Department and Clinic of I.M. Sechenov First Moscow State Medical University, Head of Surgical Unit of Urologic clinic of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia (Sechenov University), Moscow, Russia; e-mail: essirota@mail.ru
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