Benefit and Harm of Active Surveillance for Biopsy-proven Renal Oncocytoma : A Systematic Review and Pooled Analysis

Context: Active surveillance (AS) of biopsy-proven renal oncocytomas may reduce overtreatment. However, on biopsy, the risk of misdiagnosis owing principally to entities with peculiar hybrids and overlap morphology, and phenotypes argues for early intervention. Objective: To assess the benefit and harm of AS in biopsy-proven renal oncocytoma. Evidence acquisition: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We systematically searched PubMed, Scopus, and Web of Science databases from September 26 up to October 2021, for studies that analyzed the outcomes of AS in patients with biopsy-proven renal oncocytoma. Evidence synthesis: A total of ten studies with 633 patients met our inclusion criteria and were included for analysis. After a median follow-up of 34.5 mo (95% confidence interval [CI] 30.6-38.4), the overall definitive treatment rate from AS to definitive treatment was 17.3% (n = 75/433, six studies). The pooled pathological agreement between the initial renal mass biopsy and the surgical pathology report was 91.1%. The main indications for surgery during follow-up were rapid tumor growth and patient request. The pooled median growth rate was 1.55 mm/yr (95% CI 0.9-2.2). No metastasis or death related to renal oncocytoma was reported. Conclusions: Annual tumor growth of biopsy-proven renal oncocytoma is low. AS is oncologically safe, with favorable compliance of patients. Crossover to definitive treatment revealed a strong concordance between biopsy and final pathology. Further studies on the long-term outcomes of AS are needed. Patient summary: In this study, we examined the benefit and harm of active surveillance (AS) in biopsy-proven oncocytoma. Based on the available data, AS appears oncologically safe and may represent a promising alternative to immediate treatment. Patients should be included in AS decision discussions

Résultats oncologiques de la surveillance des oncocytomes biopsiés

Contexte : la surveillance active (SA) des oncocytomes rénaux prouvés par biopsie peut réduire le surtraitement, mais le risque de méconnaître une tumeur hybride à la biopsie plaide en faveur d'une intervention précoce.Objectif : l’objectif était de conduire une revue systématique de la littérature et une méta-analyse pour évaluer les avantages et les inconvénients de la SA dans l'oncocytome rénal prouvé par biopsie.Méthodes : Une revue de la littérature a été menée selon les critères Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Nous avons questionné les bases de données PubMed, Scopus et Web of Science du 26 au 28 septembre 2021 pour sélectionner les études rapportant les résultats de la SA chez les patients avec un oncocytome rénal prouvé par biopsie. La fonction « metamedian » de R version 4.0.2 (The R Foundation for Statistical Computing, Vienne, Autriche) a été utilisée pour calculer les médianes des médianes.Résultats : un total de 10 études incluant 633 patients répondait à nos critères d'inclusion et ont été inclus dans l'analyse finale. Après un suivi médian de 34,5 mois (IC 95% 30,6-38,4), le taux de conversion global pour un traitement définitif était de 17,3 % (n=75/433, 6 études). Chez les patients finalement opérés, la concordance pathologique entre la biopsie de la masse rénale initiale et la pièce opératoire était de 91,1% (deux tumeurs hybrides, un CCR). Les principales indications rapportées pour indiquer un traitement définitif étaient une croissance tumorale rapide et le souhait du patient. Le taux de croissance médian était de 1,55 mm/an (IC 95% 0,9-2,2). Aucune métastase ou décès lié à un oncocytome n'a été signalé.Conclusions : la croissance tumorale annuelle de l'oncocytome rénal prouvé par biopsie est faible. La SA est sûre sur le plan oncologique avec une observance favorable des patients. La conversion de la SA pour un traitement définitif a révélé une bonne concordance entre la biopsie et l'anatomopathologie finale. La SA devrait être proposée comme le traitement de première intention dans les oncocytomes rénaux prouvés par biopsie. Pour améliorer la prise de décision, les préférences et les attentes des patients doivent être prises en compte

Best nonsurgical managements of acute urinary retention: what's new?

International audienc

Association of 5α-Reductase Inhibitors with Depression and Suicide: A Mini Systematic Review and Meta-analysis

International audienc

Enhanced level of VCAM in transplant preservation fluid is an independent predictor of Early Kidney Allograft Dysfunction

International audienceBackground: We aimed to evaluate whether donor-related inflammatory markers found in kidney transplant preservation fluid can associate with early development of kidney allograft dysfunction.Methods: Our prospective study enrolled 74 consecutive donated organs who underwent kidney transplantation in our center between September 2020 and June 2021. Kidneys from 27 standard criteria donors were allocated to static cold storage and kidneys from 47 extended criteria donors to hypothermic machine perfusion. ELISA assessment of inflammatory biomarkers (IL-6, IL6-R, ICAM, VCAM, TNFα, IFN-g, CXCL1 and Fractalkine) was analyzed in view of a primary endpoint defined as the occurrence of delayed graft function or slow graft function during the first week following transplantation.Results: Soluble VCAM levels measured in transplant conservation fluid were significantly associated with recipient serum creatinine on day 7. Multivariate stepwise logistic regression analysis identified VCAM as an independent non-invasive predictor of early graft dysfunction, both at 1 week (OR: 3.57, p = .04, 95% CI: 1.06-12.03) and 3 Months (OR: 4.039, p = .034, 95% CI: 1.11-14.73) after transplant surgery.Conclusions: This prospective pilot study suggests that pre-transplant evaluation of VCAM levels could constitute a valuable indicator of transplant health and identify the VCAM-CD49d pathway as a target to limit donor-related vascular injury of marginal transplants

Implementing a Checklist for Transurethral Resection of Bladder Tumor to Standardize Outcome Reporting : When High-quality Resection Could Influence Oncological Outcomes

Several randomized controlled trials (RCTs) comparing en bloc resection of bladder tumor (ERBT) to conventional transurethral resection of bladder tumor (cTURBT) have reported controversial results. In particular, the 1-yr recurrence rate ranged from 5% to 40% for ERBT and from 11% to 31% for cTURBT. We provide an updated analysis of an RCT comparing the 1-yr recurrence rate for ERBT versus cTURBT for a cohort of 219 patients comprising 123 (56.2%) in the ERBT group and 96 (43.8%) in the cTURBT group. At 1 yr, 11 patients in the ERBT group and 12 in the cTURBT group experienced recurrence. The heterogeneity in recurrence observed in other RCTs could be explained by the scarce and heterogeneous adoption of tools and techniques that have been proved to lower the recurrence rate, supporting the need for implementation of a TURBT checklist. This prompted us to create a checklist of items for RCTs to standardize how TURBT is performed in trials, facilitate comparison between studies, assess the applicability of results in real-life practice, and provide a push towards high-quality resections to improve oncological outcomes. The checklist could have utility as a user-friendly guide for reporting TURBT procedures to improve our understanding of trials involving this procedure. We compared the recurrence rate at 1 year for bladder cancer treated with two different approaches to remove bladder tumors in our center. The rates were comparable for the two groups. Other studies have found widely differing recurrence rates, so we propose use of a checklist to standardize these procedures and provide more consistent outcomes for patients

Nonsuspicious prebiopsy multiparametric MRI: is prostate biopsy still necessary?

International audiencePurpose To evaluate the negative predictive value (NPV) of multiparametric magnetic resonance imaging (mpMRI), alone or combined with Prostate-Specific Antigen density (PSAd) to exclude clinically significant prostate cancer (csPCa). Patients and Methods We performed a retrospective chart review of all the patients who had transrectal ultrasound-guided biopsy (TRUSGB) in our center between January 2014 and March 2019. We included patients who had nonsuspicious prebiopsy mpMRI defined as Prostate Imaging-Reporting and Data System (PI-RADS) <= 2. MRI was performed using a 1.5 or 3-Tesla Magnetic Resonance scanners with external phased-array coil. The primary outcome was the detection of csPCa, defined as a Gleason score 3 + 4 (ISUP 2) or higher on at least one biopsy core. Results One hundred and ninety-one consecutive men (median age: 65 years, median PSA level: 9.3 ng/mL) underwent TRUSGB following negative prebiopsy mpMRI corresponding to 126 (66%) biopsy-naive patients, 36 (18.8%) patients with prior negative biopsy, and 29 (15.2%) patients under active surveillance with confirmatory biopsies. The overall PCa and csPCA detection rates were 26.7% and 5.2%, conferring a NPV of 73.3% and 94.8%, respectively. The NPV of negative mpMRI improved to 95.8% in patients with PSAd < 0.15 ng/mL/cm(3)and to 100% in patients with PSAd < 0.10 ng/mL/cm(3). Conclusions A negative prebiopsy mpMRI had an overall NPV of 94.8% for csPCa when mpMRI was used alone to 95.8% when combined with PSAd < 0.15 ng/mL/cm(3). Future studies are needed to balance the low benefit of a biopsy in this indication with the morbidity of the procedure