Araştırma Çıktıları

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    An Independent Validation of 2010 Tumor-Node-Metastasis Classification for Renal Cell Carcinoma: A Multi-center Study by the Urooncology Association of Turkey Renal Cancer-Study Group
    (GALENOS YAYINCILIK, 2017-01-01) Ozkan, Tayyar Alp; Eskicorapci, Saadettin; Yaycioglu, Ozgur; Akdogan, Bulent; Gogus, Cagatay; Dirim, Ayhan; Can, Cavit; Yildirim, Asif; Ozen, Haluk; Turkeri, Levent; Renal, Urooncology Assoc Turkey
    Objective: The American Joint Committee on Cancer tumor-node-metastasis (TNM) classification has been updated by the 7th edition in 2010. The objective of the study was to evaluate cancer-specific survival (CSS) in patients with renal cell carcinoma (RCC) and assess the concordance of 2002 and novel 2010 TNM primary tumor classifications. Materials and Methods: A retrospective analysis of RCC registries from 25 institutions of the Urooncology Association of Turkey Renal CancerStudy Group was performed. Patients with RCC had a radical or partial nephrectomy. The database consisted of 1889 patients. Results: Median follow-up time was 25 months (interquartile range: 11.2-47.8). The 5-year CSS rate for pT1a, pT1b, pT2a, pT2b, pT3a and pT4 tumors were 97\% {[}95\% confidence interval (CI): 0.93-0.99], 94\% (95\% CI: 0.91-0.97), 88\% (95\% CI: 0.81-0.93), 77\% (95\% CI: 0.64-0.86) 74\% (95\% CI: 0.65-0.81) and 66\% (95\% CI: 0.51-0.77), respectively according to the 2010 TNM classification (p<0.001). CSS comparisons between pT1a-pT1b (p=0.022), pT1b-pT2a (p=0.030), pT3a-pT3b (p<0.001) and pT3b-pT4 (p=0.020) were statistically significant. Conversely, pT2a-pT2b (p=0.070) and pT2b-pT3a (p=0.314) were not statistically significant. Multivariable analyses revealed the pT stage in the 2010 TNM classification as an independent prognostic factor for CSS (p for trend=0.002). C-indexes for 2002 and 2010 TNM classifications were 0.8683 and 0.8706, respectively. Conclusion: Subdividing pT2 does not have a CSS advantage. Moving adrenal involvement to pT4 yielded a more accurate prognosis prediction. T stage and LNI are independent prognostic factors for CSS in RCC. Overall, the novel 2010 TNM classification is slightly improved over the former one. However, shown by C-index values, this improvement is not sufficient to state that 2010 TNM outperforms the 2002 TNM.
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    Isolated omental metastasis of renal cell carcinoma after extraperitoneal open partial nephrectomy: A case report
    (ELSEVIER SCI LTD, 2016-01-01) Acar, Omer; Mut, Tuna; Saglican, Yesim; Sag, Alan Alper; Falay, Okan; Selcukbiricik, Fatih; Tabak, Levent; Esen, Tarik
    INTRODUCTION: Metachronous metastatic spread of clinically localized renal cell carcinoma (RCC) affects almost 1/3 of the patients. They occur most frequently in lung, liver, bone and brain. Isolated omental metastasis of RCC has not been reported so far. CASE PRESENTATION: A 62-year-old patient previously diagnosed and treated due to pulmonary sarcoidosis has developed an omental metastatic lesion 13 years after having undergone open extraperitoneal partial nephrectomy for T1 clear-cell RCC. Constitutional symptoms and imaging findings that were attributed to the presence of a sarcomatoid paraneoplastic syndrome triggered by the development this metastatic focus complicated the diagnostic work-up. Biopsy of the {[}18F]-fluorodeoxyglucose (+) lesions confirmed the diagnosis of metastatic RCC and the patient was managed by the resection of the omental mass via near-total omentectomy followed by targeted therapy with a tyrosine kinase inhibitor. DISCUSSION: Late recurrence of RCC has been reported to occur in 10-20\% of the patients within 20 years. Therefore lifelong follow up of RCC has been advocated by some authors. Diffuse peritoneal metastases have been reported in certain RCC subtypes with adverse histopathological features. However, isolated omental metastasis without any sign of peritoneal involvement is an extremely rare condition. CONCLUSION: To our knowledge, this is the first reported case of metachronously developed, isolated omental metastasis of an initially T1 clear-cell RCC. Constitutional symptoms, despite a long interval since nephrectomy, should raise the possibility of a paraneoplastic syndrome being associated with metastatic RCC. Morphological and molecular imaging studies together with histopathological documentation will be diagnostic. (C) 2016 The Authors. Published by Elsevier Ltd. on behalf of IJS Publishing Group Ltd.