Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) Classification of Renal Tumours in Patients who are Candidates for Nephron-Sparing Surgery

Ficarra, Vincenzo; Novara, Giacomo; Secco, Silvia; Macchi, Veronica; Porzionato, Andrea; De, Raffaele; Artibani, Walter

doi:10.1016/j.eururo.2009.07.040

Cited by 898 publications

(638 citation statements)

References 13 publications

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“…Therefore, the present data should be regarded as a proof of noninferiority in terms of local cancer control of SE versus standard PN but prospective randomized series are awaited to shed light on this oncological issue. Longitudinal location (polar vs. mesorenal), exophytic, hilar location, and clinical dimension of the tumor (parameters that belong to the preoperative aspects and dimensions used for an anatomical classification of renal tumors) 30 could be significant preoperative factors able to predict the complexity of the NSS and could be related to the risk of complications and of PSMs. It seems reasonable that, the higher is the surgical complexity, the more challenging it is to achieve local control and complete resection.…”

Section: Riccardo Schiavina Et Almentioning

confidence: 99%

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

Schiavina

Serni

Mari

et al. 2015

Clinical Genitourinary Cancer

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The early oncological goal of any partial nephrectomy (PN) is to achieve negative surgical margins (SMs). Several factors have been advocated as predictors of positive SMs (PSMs) after nephron-sparing surgery (NSS). In our study, age, upper pole tumor location, standard PN and Fuhrman 3/4 nuclear grade were found to be independent predictors of PSMs at multivariable analysis. Further evaluations are required to verify the oncological effect of the PSM on local and systemic recurrence. Background: The purpose of this study was to evaluate the predictors of positive margins in one of the largest available prospective multi-institutional studies. Patients and Methods: We evaluated all patients who underwent NSS for radiologically diagnosed kidney tumors between January 2009 and December 2012 at 19 urological Italian centers (Registry of Conservative Renal Surgery [RECORd] project). Preoperative and anthropometric data, comorbidities, intraoperative and postoperative outcomes, and histological findings were analyzed. The negative and PSMs were compared according to the clinical and surgical variables. Multivariable logistic regression models were applied to analyze predictors of PSMs. Results: Eight hundred consecutive patients were evaluated. Seven hundred sixty-one (95.1%) and 39 patients (4.9%) achieved negative and PSMs, respectively. Patients with PSMs were significantly older compared with those with negative margins (median age: 66.6 vs. 61.8 years, respectively; P ¼ .001). A higher incidence of PSMs was observed when NSS was performed for renal masses located in the upper pole (P ¼ .001). A lower rate of PSMs was found in patients treated with simple enucleation rather than standard PN (1.6% vs. 7.4%, respectively; P < .0001). A greater incidence of PSMs was found in Fuhrman 3/4 tumors (11.3%; P < .0001). At multivariable analysis, age (odds ratio [OR], 1.04; P ¼ .01), upper pole tumor location (OR, 2.85; P ¼ .005), standard PN (OR, 3.45; P ¼ .004), and Fuhrman 3-4 nuclear grade (OR, 4.81; P ¼ .001) were found to be independent predictors of PSMs. Conclusion: In our multi-institutional report, young age, simple enucleation, middle or lower tumor location, and low-grade tumor were demonstrated to be independent predictors of negative SMs.

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Section: Riccardo Schiavina Et Almentioning

confidence: 99%

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

Schiavina

Serni

Mari

et al. 2015

Clinical Genitourinary Cancer

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“…Anatomical factors are reflected in the TNM classification and provide the most reliable prognostic information. In addition, objective anatomical classification systems such as the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classification system, the RENAL nephrometry score, and the C-index have been proposed to standardise the description of renal tumours and aid in comparing nephron-sparing treatment strategies [39][40][41]. Histological factors include nuclear grade, RCC subtype, sarcomatoid features, microvascular A chest CT is recommended for staging assessment of the lungs and mediastinum C A bone scan is not routinely recommended C A renal tumour biopsy is recommended before ablative therapy and systemic therapy without previous pathology C A percutaneous biopsy is recommended in patients in whom active surveillance is pursued C A percutaneous renal tumour biopsy should be obtained with a coaxial technique C Use of the current TNM classification system is recommended.…”

Section: Prognostic Factorsmentioning

confidence: 99%

EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

Ljungberg¹,

Cowan²,

Hanbury³

et al. 2010

European Urology

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Context: The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management. Objectives: To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable. Evidence acquisition: For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. Evidence synthesis: All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10 862 articles. A total of 151 studies reporting on 78 792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence.

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“…Several methods of quantifying these tumours have been proposed as an objective means of pre-operative assessment and will play an increasing role in the future as urologists carefully weigh the risks and benefits of treatment decisions for SRMs. [73][74][75][76] …”

Section: Equivalent Complication Ratesmentioning

confidence: 99%

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

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The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). PN has been associated with better long-term renal function, and has also been linked to improved cardiac morbidity and overall survival. However, the relationship between treatment choice and definitive outcomes of chronic kidney disease (CKD) are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy.We performed a population-based, retrospective cohort study with data from linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed renal cell carcinoma (RCC) diagnosed between 1995 and 2010. Cox proportional hazards (PH) models, propensity score models, and competing risks models were used to assess the impact of treatment choice. PN compared to RN reduces the risk of ESRD requiring renal replacement therapy in a modern cohort of patients (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). PN is associated with a lower risk of new-onset CKD, lower risk of cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.iii ACKNOWLEDGEMENTS

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Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) Classification of Renal Tumours in Patients who are Candidates for Nephron-Sparing Surgery

Cited by 898 publications

References 13 publications

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

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