SAN FRANCISCO, CA USA (UroToday.com) - In this session, Dr. Daniel Canter chose articles in epidemiology/screening, localized renal cancer, and metastatic renal cancer.
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Risk factors for renal cell carcinoma from the VITAL study (Macleod LC, et al., Journal of Urology, 190 (5): 2013) were presented. The VITAL study is composed of approximately 75 000 patients from the state of Washington. Overall, 0.32% of study participants developed renal cell carcinoma (RCC). Male gender, obesity, smoking, hypertension, and history of kidney disease/viral hepatitis were associated with developing RCC. While the study was limited by a small number of RCC cases and a homogeneous study population, it nicely identified a number of modifiable risk factors in patients who develop RCC.
For localized RCC, Dr, Canter presented “the association between statin medication and progression after surgery for localized RCC” (Hamilton RJ, et al., Journal of Urology, 2013). Ten percent of patients with localized (N0M0) RCC will progress following surgery, but no approved therapies exist to reduce the risk of progression. Early data for statins is promising in a variety of neoplasms. The authors evaluated 2 608 patients with localized RCC treated with PN or RN, 9.5% of which progressed after surgery. Twenty-seven percent of patients were on a statin at the time of surgery, and statin use was significantly associated with reduced risk of progression (HR 0.67 [95 CI 0.47-0.96]). Statin type, dose, duration, and initiation of statin therapy following surgery had no effect on rates of progression. Although this was a retrospective study subject to significant selection bias, statin use may confer protective effect on the risk of progression after surgery for localized RCC and deserves further study.
Finally, Dr. Canter closed by presenting “In-hospital mortality and failure to rescue after cytoreductive nephrectomy” (Trinh et al., European Urology, 63(6): 2013). The authors used the claims-based Nationwide Inpatient Sample (NIS) to evaluate 16 285 patients treated with cytoreductive nephrectomy. Thirty-one percent of the cohort experienced a peri-operative complication, and patients ≥ 75 years of age with a Charlson comorbidity score of ≥ 3 were more likely to experience a complication. Five percent of patients died during their hospitalization. Older, more co-morbid, non-white patients with two or more metastatic sites undergoing CN at a small-sized hospital were less likely to be rescued after a peri-operative complication. This study highlights the importance of patient selection and disease biology in influencing perioperative outcomes.
Highlights of a presentation by Daniel Canter, MD at the 2014 Genitourinary Cancers Symposium - January 30 - February 1, 2014 - San Francisco Marriott Marquis - San Francisco, California USA
Einstein Healthcare Network, Philadelphia, PA USA