Navegando por Palavras-chave "renal cell"
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- ItemAcesso aberto (Open Access)Assessment of stage T1 (TNM 1997) for renal cell carcinoma: is recommended the subdivision in T1a and T1b?(Sociedade Brasileira de Urologia, 2003-04-01) Dall Oglio, Marcos Francisco [UNIFESP]; Srougi, Miguel [UNIFESP]; Mangini, Marcelo; Ribeiro, Eduardo [UNIFESP]; Ferraz, Márcio [UNIFESP]; Sañudo, Adriana [UNIFESP]; Leite, Kátia Ramos Moreira [UNIFESP]; Nesrallah, Luciano [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Classification TNM 1997 defines renal cell carcinoma smaller than 7 cm and confined to the kidney as stage T1. Our goal is to discuss if tumors smaller than 4 cm have the same behavior characteristics then tumors between 4 and 7 cm, to compose the same stage of the disease. MATERIALS AND METHODS: Retrospective assessment of 138 patients in stage T1 (TNM - 97), divided into 2 groups; group-1: composed of 65 patients (47%) with tumors < 4 cm, and group-2: composed of 73 patients (53%) with tumors between 4 and 7 cm. The following prognostic factors were assessed in the recurrence of the disease and survival of patients: nuclear degree, microvascular invasion, sarcomatous degeneration, and involved lymph nodes. Statistical evaluation has been accomplished through the log rank test, chi-square test, and Fishers exact text. RESULTS: Average tumor size was 2.5 cm for group-1, and 5.3 cm for group-2. In group-2, there was the predominance of worse prognostic factors, with high-grade tumors (p = 0.01) and presence of microvascular invasion (p = 0.001). Sarcomatous tumors and involvement of lymph nodes did only happen in group-2. Disease-free survival for group-1, analyzed in the median period of 36 months, was 100%, and for group 2, in the median period of 31 months, was 81% (p = 0.008). CONCLUSION: The results obtained allow the conclusion that the present stage T1 for renal cell carcinoma gathers tumors of different evolution, being therefore recommendable the stratification in T1a for tumors smaller than 4 cm, and T1b for tumors between 4 and 7 cm.
- ItemSomente MetadadadosLow clinical stage renal cell carcinoma: Relevance of microvascular tumor invasion as a prognostic parameter(Lippincott Williams & Wilkins, 2004-08-01) Goncalves, P. D.; Srougi, M.; Dall'Oglio, M. F.; Leite, KRM; Ortiz, V; Hering, F.; Universidade Federal de São Paulo (UNIFESP); Hosp Sirio LibanesPurpose: Renal cell carcinoma is a tumor with unpredictable behavior and defining reliable prognostic factors would be extremely valuable in the clinical setting. Tumor stage, nuclear grade and tumor cell type are the main prognostic clinical parameters available. in this study we evaluated the role of microvascular involvement in the primary lesion for predicting tumor behavior in patients with low stage clinical disease.Materials and Methods: A total of 95 patients with clinically localized renal cell carcinoma (stages T-1-T-2 N-x M-0) underwent radical nephrectomy and/or nephron sparing surgery, and were followed for a median of 45 months. the impact of microvascular tumor invasion on disease progression and its correlation with known pathological outcomes (tumor size, nuclear grade and cell type) were studied.Results: Microvascular tumor invasion was observed in 24 patients (25%), of whom 50% had disease recurrence. of the 71 patients without microvascular invasion only 4 (6%) showed tumor recurrence. When microvascular invasion was correlated with other histological parameters, a significant statistical association was noted with tumor diameter, perirenal fat invasion, macroscopic extension to the renal vein, nuclear grade, lymph node metastasis and sarcomatous elements in the tumor. Multivariate analysis showed that microvascular invasion and the involvement of regional lymph nodes were independent predictors of disease recurrence. Concerning cancer specific survival, microvascular invasion and perirenal fat infiltration were the only factors related to death.Conclusions: Microvascular invasion is an independent and relevant clinical prognostic parameter for low clinical stage renal cell carcinoma.
- ItemAcesso aberto (Open Access)Sarcomatoid differentiation in renal cell carcinoma: prognostic implications(Sociedade Brasileira de Urologia, 2005-02-01) Dall'Oglio, Marcos Francisco [UNIFESP]; Lieberknecht, Marco [UNIFESP]; Gouveia, Valter [UNIFESP]; Sant'anna, Alexandre C. [UNIFESP]; Leite, Kátia Ramos Moreira [UNIFESP]; Srougi, Miguel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Renal cell carcinoma with sarcomatoid differentiation is a tumor with aggressive behavior that is poorly responsive to immunotherapy. The objective of this study is to report our experience in the treatment of 15 patients with this tumor. MATERIALS AND METHODS: We retrospectively analyzed 15 consecutive cases of renal cell carcinoma with sarcomatoid differentiation diagnosed between 1991 and 2003. The clinical presentation and the pathological stage were assessed, as were the tumor's pathological features, use of adjuvant immunotherapy and survival. The study's primary end-point was to assess survival of these individuals. RESULTS: The sample included 8 women and 7 men with mean age of 63 years (44 - 80); follow-up ranged from 1 to 100 months (mean 34). Upon presentation, 87% were symptomatic and 4 individuals had metastatic disease. Mean tumor size was 9.5 cm (4 - 24) with the following pathological stages: 7% pT1, 7% pT2, 33% pT3, and 53% pT4. The pathological features showed high-grade tumors with tumoral necrosis in 87% of the lesions and 80% of intratumoral microvascular invasion. Disease-free and cancer-specific survival rates were 40 and 46% respectively, with 2 cases responding to adjuvant immunotherapy. CONCLUSIONS: Patients with sarcomatoid tumors of the kidney have a low life expectancy, and sometimes surgical resection associated with immunotherapy can lead to a long-lasting therapeutic response.