Radiofrequency ablation of small renal masses as an alternative to nephron-sparing surgery : preliminary results

INTRODUCTION: Radical endoscopic minimal-invasive treatment methods, such as thermal ablation, are sought as an alternative to standard radical surgical treatment of kidney neoplasms. We analysed patients who could be qualified for radical treatment due to T1a renal tumour. MATERIAL AND METHODS: Twenty-three patients out of 129 who underwent radiofrequency thermal ablation of kidney tumours in the years 2003-2010 were analysed. The inclusion criteria were age below 70 years, lack of major comorbidities (ASA score 1, 2), and competent contralateral kidney. In all cases tumour size was below 4 cm. All patients were followed up with computed tomography (CT) and ultrasonography (USG) every 6 months for 3 years. RESULTS: In 20 patients kidney tumour was biopsied before radiofrequency ablation (RFA) and 10 of these biopsies were positive and revealed cancer. Six patients required additional treatment due to recurrence visible in CT – 3 with a positive biopsy result, 1 with negative and 2 without biopsy. Three of them were treated with a second session of RFA, 1 with radical nephrectomy and 2 with partial nephrectomy. No disease dissemination was observed and all patients who received additional treatment remain disease free. CONCLUSIONS: The RFA can be safely used in selected patients with T1a tumour as an alternative to partial nephrectomy. Careful follow-up is required after thermal ablation and allows early detection and successful treatment of recurrences

Expression of OCT4A: The First Step to the Next Stage of Urothelial Bladder Cancer Progression

OCT4 (octamer-binding transcription factor) is a transcription factor responsible for maintaining the pluripotent properties of embryonic stem cells. In this paper, we present the results of studies to investigate the role of the OCT4 splicing variant in urothelial bladder cancer and the relationship between the OCT4 phenotype and the morphological parameters of tumor malignancy. Ninety patients who received a cystectomy for bladder cancer were enrolled. The expression of OCT4 protein was analyzed by immunohistochemistry. The ratio of OCT4-positive cells was the lowest in pT1 (pathological assessment (p)—tumor extent confined to mucosa (T1)) tumors and the highest in pTis (non-papillary tumor extent confined to urothelium) and pT2 (tumor extent including muscularis propria) tumors. Information about the percentage of OCT4A-positive tumor cells could facilitate choosing the treatment mode in borderline pTis–pT1 (crossing the border of the basement membrane; the first stage of progression) and pT1–pT2 (crossing the border of the muscularis propria; the second stage of progression) cases: a higher percentage of OCT4A-positive cells should support more radical therapy. A significantly higher percentage of cases with moderate OCT4 intensity was found in metastasizing (the third stage of progression) cases with >2 positive lymph nodes. The percentage of OCT4-positive cells was significantly higher for cancers with a high grade, higher non-classic differentiation number and greater aggressiveness of invasion. The differentiation, maturation and aggressiveness of tumor invasion appear to depend on the expression of the OCT4 phenotype in cancer cells, similar to the successive stages of malignancy progression in urothelial cancer

Changes in Immunogenicity during the Development of Urinary Bladder Cancer: A Preliminary Study

In the present study, we evaluated tumor-infiltrating lymphocytes (TILs) and blood regulatory T lymphocyte (Tregs, CD4+/CD25+/FoxP3+) expression in bladder cancer patients. The number of CD4+, CD8+, CD25+, FoxP3+ and CD20+ TILs was analyzed in association with clinico-pathomorphological features. In more advanced metastasizing tumors, showing non-classic differentiation (ND) and a more aggressive tissue invasion type (TIT), the number of TILs decreased. A low number of CD4+ TILs was associated with poor prognosis. Similarly, Treg frequency before surgery and after surgical treatment was significantly lower in more advanced tumors. The changes in TILs, as well as of local and systemic Tregs, were accompanied by changes in the histological phenotype of urothelial carcinoma regarding pT stage, NDs, TIT, and clinical outcomes. The number of TILs and the frequency of blood Tregs (indicators of antitumor response) may be essential for choosing an immunotherapy that is adjusted to the immune status according to the phase of tumor growth. Moreover, a significant reduction in the number of CD4+ and CD8+ TILs with the development of NDs in more advanced tumors may be associated with lower tumor immunogenicity, resulting in immune tolerance towards tumor tissue. These observations and the tendency of urothelial bladder carcinoma to undergo NDs in a heterogeneous manner during tumor progression suggest complex interactions between bladder cancer immunogenicity and stages of tumor progression

Expression of Vitamin D Receptor (VDR) Positively Correlates with Survival of Urothelial Bladder Cancer Patients

Vitamin D3 shows tumoristatic and anticancer effects by acting through the vitamin D receptor (VDR), while hydroxylation of 25-hydroxyvitamin D3 at position 1α by CYP27B1 is an essential step in its activation. The expression of both the VDR and CYP27B1 has been found in many normal and cancer tissues, but there is a lack of information about its expression in human bladder cancers. The aim of the present research was to examine whether the expression of the VDR and CYP27B1 in bladder cancer was related to the prognostic markers and disease outcome. We analyzed VDR and CYP27B1 in samples of tumor and normal tissues obtained from 71 urinary bladder cancer patients. The highest VDR immunostaining was found in normal epithelium and was significantly lower in bladder cancer cells (p < 0.001 with Mann–Whitney U test). VDR expression was lowest in more advanced (pT2b–pT4) (p = 0.005 with Mann–Whitney U test) and metastasizing cancers (p < 0.05 and p = 0.004 with Mann–Whitney U test for nuclear and cytoplasmic VDR immunostaining, respectively). The lack of cytoplasmic and nuclear VDR was also related to shorter overall survival (for cytoplasmic VDR immunolocalization 13.3 vs. 55.3 months of survival, HR = 1.92, p = 0.04 and for nuclear VDR immunostaining 13.5 vs. 55.3 months of survival, HR = 2.47, p = 0.002 with Mantel-Cox test). In cases with the lack of high cytoplasmic VDR staining the non-classic differentiations (NDs) was observed in higher percentage of tumor area. CYP27B1 expression was lower in cancer cells than in normal epithelial cells (p = 0.03 with Mann–Whitney U test), but its expression did not correlate with tumor stage (pT), metastasizing, grade, mitotic activity or overall survival. In conclusion, expression of the VDR and CYP27B1 are deregulated in urothelial bladder cancers. Although our results showing a relationship between the decreased VDR expression and prognostic markers and survival time indicate potential usefulness of VDR as a new indicator of a poorer prognosis, further studies are needed in different patient cohorts by independent groups to validate this hypothesis. We also suggest that vitamin D-based therapies may represent an adjuvant strategy in treatment for bladder cancers expressing VDR

Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers—In Search for the Ideal Tumour

Over the recent years, the progress in imaging techniques has led to an increased detection of kidney tumours, including small renal masses. While surgery is still the standard of care, there is a growing interest in minimally invasive methods. Ultrasound (US)-guided percutaneous ablation is particularly attractive because it is a safe and relatively simple procedure. In this study, we investigated the success of percutaneous radiofrequency ablation (RFA) in relation to kidney tumour diameter and location. Between August 2016 and September 2021, 253 patients with 259 renal tumours underwent US-guided RFA as a primary treatment in our institution. A total of 67 patients were excluded from this study. Abdominal computed tomography (CT) and tumour biopsy were performed before the procedure. Patients were followed with contrast-enhanced CT, the average follow-up time was 28 months. The studied group was composed of 186 patients with 191 renal tumours—only biopsy-confirmed renal cancers were included. During the follow-up, 46 cases of residual disease and 4 cases of local progression were found. There was a significant correlation between tumour size and the ablation success rate. The success rate was 73.5% and 87.6% for lesions ≤25 mm, 94.6% for lesions ≤25 mm and exophytic, 79.1% for lesions 26–30 mm and 84.4% for lesions 26–30 mm and exophytic, respectively. Four Clavien-Dindo grade ≥2 complications were observed. US-guided percutaneous RFA of T1a renal cancers is safe and well-tolerated. Its effectiveness depends on tumour size, with best results for exophytic lesions smaller than 3 cm. Most of the recurrent or residual tumours can be successfully re-treated with US-guided percutaneous RFA

Expression of RCAS1 Correlates with Urothelial Bladder Cancer Malignancy

RCAS1 is a protein that participates in regulation of the tumor microenvironment and its immune responses, all in order to evade the immune system. The aim of this study was to analyze RCAS1 expression in urothelial bladder cancer cells (and in fibroblasts and macrophages of the tumor stroma) and its relationship with the histological pattern of malignancy. Eighty-three postcystectomy patients were enrolled. We analyzed the histological maturity (grade), progress (pT stage), tissue invasion type (TIT), nonclassic differentiation number (NDN), and the ability to metastasize (pN). The expression of RCAS1 protein was analyzed by immunohistochemistry. Indicators of histological malignancy were observed solely in association with the RCAS1 expression in cells in the border parts (BPs) of the tumor. Histological malignancy of the tumor, indicated by the pT and pN, and metastasis-free survival time, correlated significantly with RCAS1 expression in tumor neoplastic cells, whereas malignancy determined by grade, TIT, and NDN correlated with RCAS1 expression in fibroblasts and macrophages in the tumor microenvironment. These findings suggest that the increased RCAS1 expression depends on its cellular source and that RCAS1 expression itself is a component of various signaling pathways. The immune escape occurs within the tumor BPs, where the increase in the RCAS1 expression occurs within tumor cells and stromal cells in its microenvironment. We conclude that the histological pattern of tumor malignancy, indicated by grade, TIT, NDN, pT, and pN is a morphological indicator of immune escape

Surgical therapy and exenteration for advanced cervical cancer – literature review

While the surgical technique of exenteration has been around for 60 years now, recent progress in the development of reconstructive surgery has created new opportunities for gastrointestinal and urinary tract anastomosis. As pre- and postoperative care has improved and indications for the exenteration procedure have became more precise, the outcomes of the treatment for advanced malignant pelvic tumors have also improved. Consequently, the perioperative mortality rate has decreased from the 28% specified by Brunschwig to the present rate of 3%. Moreover, the number of complications resulting from such complex procedures has decreased. Today, postoperative complications are no longer a factor that impacts how eligibility for exenteration is decided. It has been demonstrated that the quality of life of patients subject to exenteration procedure compared to those having palliative chemotherapy is lower in the first months following surgery, but is higher in the long-term follow-up beginning 9 months after the procedure. At the same time, multiple studies have unambiguously demonstrated that the overall five-year survival rate in patients with cervical cancer recurrence after radiation therapy is the longest upon exenteration and, subject to strict following of the indications for the procedure, allows a survival rate of 50% to be exceeded in this group of patients. Since the exenteration procedure is the culmination of a combined treatment, eligibility for such a procedure should entail multiple factors related to the course of treatment and the biology of a given neoplasm and should be decided only by an interdisciplinary team composed of at least a radiation therapist, a gynecologist-oncologist, and a clinical oncologist. Also, surgery of this kind is of a disciplinary nature therefore the procedure should be performed only in a reference site employing gynecologists, oncologists, urologists, and oncological surgeons who have comprehensive surgical experience. Only sites that employ such health care professionals allow for the safe performance of the exenteration procedure.Technika zabiegu wytrzewienia znana jest od 60 lat. Jednak postęp, jaki dokonał się w rozwoju chirurgii rekonstrukcyjnej, stworzył nowe możliwości odtworzenia ciągłości przewodu pokarmowego i dróg moczowych. W efekcie ulepszania opieki przed- i pooperacyjnej oraz uściślenia wskazań do tego zabiegu poprawiły się wyniki leczenia zaawansowanych nowotworów złośliwych rozwijających się w miednicy. Śmiertelność okołooperacyjna zmniejszyła się obecnie z 28% opisywanych przez Brunschwiga do 3%. Liczba powikłań po tak rozległej operacji także znacznie się zmniejszyła. Dzisiaj powikłania nie są już czynnikiem wpływającym na podjęcie decyzji o kwalifikacji do wykonania tego zabiegu. Wykazano, że jakość życia chorych po wytrzewieniu w porównaniu z paliatywną chemioterapią jest gorsza tylko w pierwszych miesiącach po zabiegu, a z wieloletniej obserwacji wynika również, że od 9. miesiąca po operacji jakość życia jest nawet lepsza. Z wielu badań jednoznacznie wynika też, że całkowite przeżycie 5-letnie u pacjentek ze wznową raka szyjki macicy po radioterapii jest najdłuższe po leczeniu polegającym na wytrzewieniu, przy ściśle przestrzeganych wskazaniach do zabiegu, i pozwala w tej grupie chorych przekroczyć 50%. Ponieważ jest to operacja, która wieńczy niejako leczenie skojarzone, kwalifikacja do niego powinna uwzględniać wiele czynników związanych z dotychczasowym przebiegiem terapii oraz z biologią danego nowotworu i być podejmowana wyłącznie przez interdyscyplinarne zespoły, składające się co najmniej z radioterapeuty, ginekologa onkologa i onkologa klinicznego. Chirurgia w takim przypadku również ma charakter interdyscyplinarny, dlatego zabieg ten należy wykonywać jedynie w ośrodkach referencyjnych, w których doświadczenie chirurgiczne przenika pomiędzy ginekologami onkologami, urologami i chirurgami onkologami. Tylko ośrodki zatrudniające lekarzy o dużym doświadczeniu chirurgicznym mogą zapewnić bezpieczny przebieg zabiegu wytrzewienia