Does the embolization of the tumor, Does the embolization of the tumor, prior to radical nephrectomy, prologs prior to radical nephrectomy, prologs
the life of patients with renal cell the life of patients with renal cell carcinomacarcinoma
* Department of Urology Regional Specialistic * Department of Urology Regional Specialistic Hospital , WroclawHospital , Wroclaw
** Clinic of Urology Medical Academy, Wroclaw** Clinic of Urology Medical Academy, Wroclaw
L. Świebocki*, J. Lorenz**,
PatientsPatients
Cohort of 441 patients with RCCCohort of 441 patients with RCC 178 women and 263 men178 women and 263 men embolizing patients - group E: embolizing patients - group E: 180180 (W- (W- 6868, M-, M-112112)) 82/180 -82/180 - embolization was the treatment of lastembolization was the treatment of last
resortresort 98/180 -98/180 - radical nephrectomy done afterradical nephrectomy done after
embolizationembolization
Patients Patients
98 - nephrectomised after embolization 98 - nephrectomised after embolization
comparedcompared
261 - control group261 - control group 110 - women and 151 - men 110 - women and 151 - men
nephrectomised during last 10 yearsnephrectomised during last 10 years
Group KGroup K
Group EGroup E
38%38%
62%62%WomenWomen
MenMen
Group EGroup E
68112
Both groups were statistically Both groups were statistically equal according to sexequal according to sex
42%42%
58%58%
Group KGroup K
110151
chi-square test - group E and Kchi-square test - group E and K
Comparison of groups E and K according Comparison of groups E and K according to to sexsex
U Mann-Whitney’s test U Mann-Whitney’s test
Both groups were Both groups were statistically equal statistically equal according to ageaccording to age
Comparison of groups E and K according Comparison of groups E and K according to to ageage
Distant metastases Distant metastases
Comparison of groups E and K according Comparison of groups E and K according to tumor gradeto tumor grade
Both groups were statistically Both groups were statistically equal according to tumor stage equal according to tumor stage
chi-square test - group E and Kchi-square test - group E and K
Tumor stage Tumor stage -- TNM classification TNM classification
Group T2 T3a T3b T3c T4 Total
E 4 57 45 8 66 180
K 19 156 34 4 48 261
Total 23 213 79 12 114 441
Tumor stage Tumor stage -- TNM classification TNM classification
Both groups were not Both groups were not equal statistically equal statistically according do tumor stage according do tumor stage
chi-square test - group E and Kchi-square test - group E and K
Groups of patients chosen for statistic analysis Groups of patients chosen for statistic analysis
Group E - from 97 embolized and nephrectomised Group E - from 97 embolized and nephrectomised patients , 91 with complete follow-up were patients , 91 with complete follow-up were separate separate
Group K - from 261 nephrectomised patients, 91 Group K - from 261 nephrectomised patients, 91 patients with the same: tumor stage, lymph node patients with the same: tumor stage, lymph node status, metastases and tumor grade were chosenstatus, metastases and tumor grade were chosen
Comparison of new groups E and K Comparison of new groups E and K according to ageaccording to age
Both groups were statistically equalBoth groups were statistically equal
Embolizing agents:Embolizing agents:
EthanolEthanol - 134 cases- 134 cases Ethanol + GelfoamEthanol + Gelfoam - 32 cases- 32 cases Ethanol + Gianturco coil Ethanol + Gianturco coil - 4 cases- 4 cases Gianturco coil + gel foamGianturco coil + gel foam - 2 cases- 2 cases GelfoamGelfoam - 8 cases- 8 cases
Mechanism of alcohol ablationMechanism of alcohol ablation
perivascular necrosisperivascular necrosis sluding of erythrocytes in small arteriessluding of erythrocytes in small arteries small artery spasmssmall artery spasms endothelial damage and sloughing leading to endothelial damage and sloughing leading to
occlusionocclusion denaturation of blood proteins and injuries of the denaturation of blood proteins and injuries of the
vascular endothelium inciting an intense thrombosisvascular endothelium inciting an intense thrombosis
Delay nephrectomy:Delay nephrectomy:
Varied from 3 to 273 daysVaried from 3 to 273 days 75% of patients were nephrectomised before 47 day75% of patients were nephrectomised before 47 day
Maks. = 276,0000Min = 0,000000
75% = 46,0000025% = 0,000000
Mediana:Med = 6,500000
Czas
od
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lizacji
do
nefr
ek
tom
ii [
dn
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0
40
80
120
160
200
240
280
Influence of delaying surgical treatment Influence of delaying surgical treatment for better survival ratefor better survival rate
Group 1 time of delay until 30 daysGroup 1 time of delay until 30 daysGroup 2 time of delay 30-60 daysGroup 2 time of delay 30-60 daysGroup 3 time of delay over 60 daysGroup 3 time of delay over 60 days
Comparison of general survival rateComparison of general survival rateKaplan-Meier’s curvesKaplan-Meier’s curves
Survival rate for E group patients was better, Survival rate for E group patients was better, statistically significant statistically significant pp << 0,010,01
Comparison of 5-year survival rate -Comparison of 5-year survival rate - I I55
5-year survival rate - I5 and No patients Tomor
stage group E group K p
T3a l5 = 68,7% n = 33 l5 = 48,3% n = 33 0,0487
T3b l5 = 44,5% n = 23 l5 = 16,7% n = 23 0,0234
T3c l5 = 12,5% n = 3 l5 = 6,2% n = 3 -
T4 l5 = 23,4% n = 32 l5 = 15,3% n = 32 0,2076
Total l5 = 47,8% n = 91 l5 = 29,6% n = 91 0,0069
Comparison of 10-year survival rate - IComparison of 10-year survival rate - I1010
10-year survival rate and No patients Tomor
stage group E group K p
T3a l10 = 52,1% n = 33 l10 = 25,6% n = 33 0,0154
T3b l10 = 15,2% n = 23 l10 = 0,0% n = 23 0,0291
T3c l10 = 0,0% n = 3 l10 = 0,0% n = 3 -
T4 l10 = 10,6% n = 32 l10 = 0,0% n = 32 0,0315
Total l10 = 40,4% n = 91 l10 = 16,4% n = 91 0,0002
Influence of delaying surgical treatment Influence of delaying surgical treatment for better survival ratefor better survival rate
Kaplan-Meier’s curves and F Cox - test, Kaplan-Meier’s curves and F Cox - test, apparent difference in the median survival time apparent difference in the median survival time
Impact of Impact of embolization on the general condition of embolization on the general condition of the patients in stage IV RCCthe patients in stage IV RCC
Most of the patients within the study group had advanced Most of the patients within the study group had advanced cancer. Their general conditions at the time of diagnosis cancer. Their general conditions at the time of diagnosis were very poor.were very poor.
Together with general weakness, symptoms of circulatory Together with general weakness, symptoms of circulatory insufficiency were also often present. These were: easily insufficiency were also often present. These were: easily fatigability, peripheral edema.fatigability, peripheral edema.
The effect of embolization on half of all patients with The effect of embolization on half of all patients with unfavorable clinical symptoms resulting from the unfavorable clinical symptoms resulting from the presence of advanced cancer, made it possible to presence of advanced cancer, made it possible to undertake further surgical treatmentundertake further surgical treatment..
HaematuriaHaematuria
Percentage of patients with haematuria after embolization was Percentage of patients with haematuria after embolization was significantly lower p < 0,0001significantly lower p < 0,0001
Loss of weight Loss of weight
Percentage of patients with loss of weight after embolization was Percentage of patients with loss of weight after embolization was significantly lower,significantly lower, p < 0,0001 p < 0,0001
Loss of apetiteLoss of apetite
Percentage of patients with loss of appetite after embolization was Percentage of patients with loss of appetite after embolization was significantly lowersignificantly lower
AnemiaAnemia
Percentage of patients with anemia after embolization was Percentage of patients with anemia after embolization was significantly lower p < 0,0001significantly lower p < 0,0001
Conclusions: Conclusions:
Embolization prior to nephrectomy performed in not Embolization prior to nephrectomy performed in not infiltrating tumors prolongs the life of patientsinfiltrating tumors prolongs the life of patients
Delaying of nephrectomy for 30-60 days after embolization Delaying of nephrectomy for 30-60 days after embolization provides to improve survival rateprovides to improve survival rate
Embolization performed in infiltrating kidney tumors didn’t Embolization performed in infiltrating kidney tumors didn’t prolong the life but was of value in improving the clinical prolong the life but was of value in improving the clinical status of patientsstatus of patients