			Home About us Contact

Cortical Tumours (cortical + tumour)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Obesity is associated with a higher risk of clear-cell renal cell carcinoma than with other histologies

BJU INTERNATIONAL, Issue 1 2010
William T. Lowrance
Study Type , Prognosis (cohort) Level of Evidence 2a OBJECTIVE To investigate the association between body mass index (BMI) and histology of renal cell carcinoma (RCC) in a contemporary cohort, as obesity is increasingly prevalent in the USA and might be contributing to the increasing incidence of RCC, but little is known about the relationship of obesity with the different histological subtypes of RCC. PATIENTS AND METHODS From January 2000 to December 2007 we identified 1640 patients with renal cortical tumours undergoing surgical extirpation at our institution, and who had their BMI recorded. Multivariable logistic regression models were used to test the association of BMI with RCC histology. RESULTS The median (interquartile range) BMI was 28 (25,32) kg/m2 and 38% of patients were classified as obese (BMI >30 kg/m2). After adjusting for tumour size, age, gender, American Society of Anesthesiologists score, estimated glomerular filtration rate, hypertension, diabetes mellitus and smoking, the BMI was significantly associated with clear-cell histology; the odds ratios were 1.04 for each unit of BMI (95% confidence interval, CI, 1.02,1.06; P < 0.001) and 1.48 when comparing obese vs non-obese patients (95% CI 1.19,1.84; P < 0.001). In the subgroup of patients with RCC (excluding benign renal cortical tumours), BMI was still an independent predictor of clear-cell histology (odds ratio 1.04, 95% CI 1.02,1.06, P = 0.001). CONCLUSIONS These results suggest that BMI is an independent predictor of clear-cell histology in patients with a renal cortical tumour. While the aetiology of this phenomenon requires further study, these findings might have implications in determining a patient's risk of harbouring a clear-cell RCC and in subsequent treatment recommendations. [source]

The prognostic value of two different histopathological scoring systems for adrenocortical carcinomas

HISTOPATHOLOGY, Issue 2 2007
H P Van't Sant
Aims:, To compare two different multiparameter histopathological scoring indices and determine their prognostic value in patients presenting with adrenocortical carcinoma (ACC). Methods and results:, Seventy-nine adrenal cortical tumours were divided into adenomas (n = 17), non-metastatic carcinomas (n = 24) and carcinomas with metastatic disease and/or local recurrence during follow-up (n = 19) or at time of presentation (n = 19). All cases were scored according to the Weiss revisited index (WRI) and the Van Slooten index (VSI). Both scoring indices yielded a significantly different score (P < 0.005) between adenomas and carcinomas. Non-metastasized carcinomas had a lower score with both indices compared with carcinomas with metastases at the time of presentation (VSI, P = 0.017; WRI, P = 0.019). The VSI also distinguished ACC that had metastasized at any time from those that had not (P = 0.015). Cancer-specific survival in patients with metastasized ACC correlated with the scores for both indices (VSI, P = 0.0078; WRI, P = 0.0025). Time from diagnosis of ACC to development of metastatic disease was correlated with the WRI (P = 0.036, r = ,0.350). Conclusions:, The VSI and the WRI have equal validity in the correct categorization of ACC and adenomas. Furthermore, both indices show a correlation with survival for metastasizing ACC. [source]

Update on the management of T1 renal cortical tumours

BJU INTERNATIONAL, Issue 8 2010
Mark L. Cutress
There are a range of treatment strategies for the management of patients with small incidental renal cortical tumours including active surveillance, radiofrequency ablation, cryotherapy, radical nephrectomy and partial nephrectomy. A large number of such tumours are benign and might therefore be over-treated with radical nephrectomy. There are emergent short-term oncological and clinical outcomes for cryotherapy and radiofrequency ablation, and recent studies have illustrated the benefits of partial nephrectomy for minimizing the risk of progression to chronic kidney disease. The outcomes of these different treatment methods are discussed. [source]

Obesity is associated with a higher risk of clear-cell renal cell carcinoma than with other histologies

Invasion of renal sinus fat is not an independent predictor of survival in pT3a renal cell carcinoma

BJU INTERNATIONAL, Issue 12 2009
Stephen A. Poon
OBJECTIVE To clarify the significance of the location of extrarenal tumour extension of renal cell carcinoma (RCC) as in the 2002 Tumour-Nodes-Metastasis classification. Renal cortical tumours with perirenal fat invasion (PFI) or sinus fat invasion (SFI) are consolidated within the pT3a grouping; tumours with SFI are close to the renal veins, lymphatics and the collecting system. This might carry a worse prognosis for disease-specific survival (DSS), but reports are limited and contradictory. PATIENTS AND METHODS We retrospectively reviewed 1244 patients treated with nephrectomy from 1988 to 2007, to identify patients with pT3a renal tumours. They were classified as having PFI or SFI. Kaplan-Meier analysis and Cox proportional hazards regression models were used to assess predictors of survival. RESULTS The 230 patients who met the inclusion criteria had a median follow-up of 24 months. SFI was found in 63 (27.4%) patients and was associated with a worse 5-year DSS than the 167 (72.6%) with PFI (62.5% vs 75.0%; log rank P = 0.022). On univariate analysis, diameter (hazard ratio, HR 1.1), nuclear grade (HR 4.5), margin status (HR 5.8), lymph node metastases (HR 6.4), and systemic metastases (HR 15.4) were significant for DSS. In a multivariate model, only nuclear grade (HR 3.1), margin status (HR 8.9) and systemic metastases (HR 9.8) were independent predictors. CONCLUSION Patients with renal tumours with SFI are more likely to die from RCC than those with PFI. However, in the present patients the presence of SFI was not an independent predictor of DSS. [source]

Pathological tumour diameter predicts risk of conventional subtype in small renal cortical tumours

BJU INTERNATIONAL, Issue 10 2008
Melissa A. Laudano
OBJECTIVE To examine whether pathological tumour diameter assists in predicting conventional vs other histological subtypes in renal cortical tumours (RCTs) of ,4 cm diameter. PATIENTS AND METHODS In all, 393 patients from Columbia University's Comprehensive Urologic Oncology Database who underwent radical or partial nephrectomy between 1988 and 2005 and had RCTs of ,4 cm were analysed. Logistic regression analysis using tumour diameter as a continuous variable was used to determine whether size predicted histological subtype. Odds ratios (ORs) were calculated to estimate the likelihood of having conventional histology based on diameter. RESULTS The median patient age at surgery was 64.3 years and median tumour diameter was 3 cm, In all, 256 (65.1%) of the RCTs were conventional subtype and 137 (34.9%) were nonconventional. Logistic regression analysis showed that for every 1 cm increase in diameter up to 4 cm, the RCT was 1.27 times more likely to be conventional (P = 0.020). The ORs showed that a 4-cm RCT was 2.06 times more likely to be conventional than tumours of 0.6,1.5 cm. CONCLUSION There was a positive association between RCT diameter and the risk of having conventional renal cell carcinoma (RCC). Given that RCC histological subtype is a prognostic indicator for outcome, these findings may be applied in the selection of treatment options. Further studies investigating tumour size and other variables predictive of tumour histology will help clinicians better predict the RCC subtype. [source]

Age-related penetrance of endocrine tumours in multiple endocrine neoplasia type 1 (MEN1): a multicentre study of 258 gene carriers

CLINICAL ENDOCRINOLOGY, Issue 4 2007
Andreas Machens
Summary Objective, In multiple endocrine neoplasia type 1 (MEN1), age-related tumour penetrance according to the type of MEN1 germline mutation has not been investigated in-depth. This study was conducted to examine whether carriers of out-of-frame/truncating and in-frame MEN1 mutations differ in age-related tumour penetrance. Design, A multicentre study with biochemical, hormonal and radiological screening for MEN1-associated tumours. Patients, A total of 258 MEN1 carriers from six major German tertiary referral centres averaging 43 years of age at last follow-up. Measurements, Main outcome measure was time to first diagnosis of MEN1-associated tumours. Results, Independent of the year of birth and observation period, time to first tumour diagnosis did not vary much by the type of MEN1 germline mutation or endocrine organ system, and perhaps not even by the type of endocrine tumour when the amount of time was considered by which the diagnosis probably has been advanced through the manifestation of hormonal symptoms. Parathyroid hyperplasia and adenomas developed almost twice as often as enteropancreatic and pituitary tumours (77%vs. 49,32%), and more than five to sevenfold as often as adrenal cortical tumours and carcinoids (77%vs. 15,10%), reaching penetrance rates of up to 90%, 60%, 40%, 26% and 17%, respectively. The heterogeneity of tumour penetrance was marked, ranging from 9 years to 25 years for the earliest, and from 68 years to 77 years for the latest tumour manifestation. Conclusions, Because of our inability of predicting tumour penetrance and malignant transformation individually, life-long follow-up of MEN1 carriers is warranted to prevent tumour morbidity. [source]