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Hot Topics and New Frontiers in Kidney Cancer

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 21490

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Special Issue Editors

Dr. Riccardo Campi

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1. Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
2. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Interests: urologic oncology; renal cancer
Special Issues, Collections and Topics in MDPI journals

Dr. Umberto Capitanio

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Guest Editor

1. Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
2. Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
On behalf of the EAU Young Academic Urologists (YAU) Renal Cancer Working Group
Interests: biomarkers; imaging; kidney cancer; minimally-invasive surgery; nephron-sparing surgery; robotics; small renal masses; surveillance; urologic oncology

Special Issue Information

Dear colleagues,

Kidney cancer is the most lethal cancer of the urinary tract, with an annual incidence of >300,000 new cases and >140,000 deaths worldwide. Despite the progress of research in this field during the last several decades, there are still several unmet clinical needs in both the diagnosis and treatment of kidney cancer, making this a topic of increasing interest from both clinical and research perspectives.

Specific unmet clinical needs and hot topics in the field of kidney cancer include:

The diagnosis/screening of renal cell carcinoma by means of non-invasive liquid biomarkers and/or innovative imaging modality, including radiomics and machine-learning algorithms;
The use of artificial intelligence (AI) and Big Data to enhance the quality of clinical and basic research on kidney cancer, enabling robust analyses on the pan-omics landscape of RCC;
The pattern of care of kidney cancer across institutions and countries, focusing on the selection of candidates for non-surgical management, type of surgery (partial vs. radical nephrectomy), the use of minimally invasive surgery (especially for advanced kidney cancer), and quality indicators of kidney cancer care;
The impact of technological advancements such as 3D models and extended-reality applications on preoperative surgical strategy and intra/postoperative outcomes in kidney cancer surgery;
The refinement of the decision-making process in patients with small renal masses through the integration of biomarkers, imaging, and renal biopsy into structured algorithms aiming to select the best candidates for active surveillance, ablative therapies, and surgery (partial or radical nephrectomy);
The impact of telemedicine on kidney cancer services worldwide, in light of the recent effects of the COVID-19 pandemic on genito-urinary cancer care;
The effect of the centralization of kidney cancer management at high-volume referral centers on postoperative outcomes and quality indicators;
The definition of tailored treatment strategies in patients with newly diagnosed oligometastatic kidney cancer within a multidisciplinary kidney cancer service, including patient selection for cytoreductive nephrectomy;
The benefits and limitations of current prognostic models in the setting of metastatic kidney cancer in the immune-oncology (IO) era;
The definition of the best risk-adjusted treatment strategy in patients with newly diagnosed metastatic kidney cancer, including the selection of IO drugs and treatment sequences tailored to patients’ specific clinical characteristics, following the “precision medicine” paradigm.

In this increasingly dynamic scenario, JCM is proud to edit a Special Issue specifically aimed at providing an updated overview of the most compelling unmet needs, hot topics, and new frontiers in kidney cancer diagnosis and treatment.

We therefore invite investigators involved in kidney cancer to submit original research articles and systematic literature reviews on these topics. It is our hope to make this Special Issue a point of reference for researchers and clinicians worldwide. We extend our thanks to all of you in advance and look forward to receiving your contributions.

Dr. Riccardo Campi
On behalf of the EAU Young Academic Urologists (YAU) Renal Cancer working group
Dr. Umberto Capitanio
On behalf of the EAU Young Academic Urologists (YAU) Renal Cancer working group
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Artificial intelligence
Big Data
Biomarkers
Biopsy
Cytoreductive nephrectomy
Follow-up
Imaging
Genomics
Immuno-oncology
Kidney cancer
Metabolomics
Machine-learning
Minimally-invasive Surgery
3D Models
Nephrectomy
Omics
3D printing
Radiomics
Renal cell carcinoma
Renal Mass
Robotics
Surveillance
Telemedicine

Published Papers (7 papers)

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Research

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10 pages, 439 KiB

Open AccessArticle

Reliable Prediction of Post-Operative Complications’ Rate Using the G8 Screening Tool: A Prospective Study on Elderly Patients Undergoing Surgery for Kidney Cancer

by Fabio Traunero, Francesco Claps, Tommaso Silvestri, Maria Carmen Mir, Luca Ongaro, Michele Rizzo, Andrea Piasentin, Giovanni Liguori, Francesca Vedovo, Antonio Celia, Carlo Trombetta and Nicola Pavan

J. Clin. Med. 2022, 11(13), 3785; https://doi.org/10.3390/jcm11133785 - 30 Jun 2022

Cited by 4 | Viewed by 2441

Abstract

In the last years the incidence of renal neoplasms has been steadily increasing, along with the average age of patients at the time of diagnosis. Surgical management for localized disease is becoming more challenging because of patients’ frailty. We conducted a multi-center prospective study to evaluate the role of the G8 as a screening tool in the assessment of intra and post-operative complications of elderly patients (≥70 y.o.) undergoing surgery for kidney cancer. A total of 162 patients were prospectively enrolled between January 2015 to January 2019 and divided into two study groups (frail vs. not-frail) according to their geriatric risk profile based on G8 score. Several factors (i.e., age, CCI, ASA score, preoperative anemia, RENAL score, surgical procedures, and techniques) were analyzed to identify whether any of them would configure as a statistically significant predictor of surgical complications. According to the G8 Score, 90 patients were included in the frail group. A total of 52 frail patients vs. 4 non-frail patients developed a postoperative complication of any kind (p < 0.001). Of these, 11 were major complications and all occurred in the frail group. Our results suggest that the G8 screening tool is an effective and useful instrument to predict the risk of overall complications in elderly patients prior to renal surgery. Full article

(This article belongs to the Special Issue Hot Topics and New Frontiers in Kidney Cancer)

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10 pages, 248 KiB

Open AccessArticle

Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: Insights from a Large Multicenter International Prospective Observational Project (The Surface-Intermediate-Base Margin Score Consortium)

by Fabrizio Di Maida, Riccardo Campi, Brian R. Lane, Ottavio De Cobelli, Francesco Sanguedolce, Georgios Hatzichristodoulou, Alessandro Antonelli, Antonio Andrea Grosso, Sabrina Noyes, Oscar Rodriguez-Faba, Frank X. Keeley, Johan Langenhuijsen, Gennaro Musi, Tobias Klatte, Marco Roscigno, Bulent Akdogan, Maria Furlan, Claudio Simeone, Nihat Karakoyunlu, Martin Marszalek, Umberto Capitanio, Alessandro Volpe, Sabine Brookman-May, Jürgen E. Gschwend, Marc C. Smaldone, Robert G. Uzzo, Alexander Kutikov, Andrea Minervini and SIB International Consortium Show full author list Hide full author list

J. Clin. Med. 2022, 11(7), 1765; https://doi.org/10.3390/jcm11071765 - 23 Mar 2022

Cited by 2 | Viewed by 2105

Abstract

Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni- and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3–4.2) cm and median (IQR) PADUA score was 8 (7–9). SIB scores of 0–2 (enucleation), 3–4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3–4) versus enucleation (SIB score 0–2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25–7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon’s experience on margin status after robotic PN. Full article

(This article belongs to the Special Issue Hot Topics and New Frontiers in Kidney Cancer)

9 pages, 403 KiB

Open AccessArticle

Preoperative versus Postoperative Compensation of the Contralateral Normal Kidney in Patients Treated with Radical Nephrectomy for Renal Cell Carcinoma

by Chung-Un Lee, Hyunsoo Ryoo, Jae-Hoon Chung, Wan Song, Minyong Kang, Hyun-Hwan Sung, Byong-Chang Jeong, Seong-Il Seo, Seong-Soo Jeon, Hyun-Moo Lee and Hwang-Gyun Jeon

J. Clin. Med. 2021, 10(21), 4918; https://doi.org/10.3390/jcm10214918 - 24 Oct 2021

Cited by 2 | Viewed by 1832

Abstract

Background: We sought to identify the factors affecting renal compensatory processes that occur preoperatively as well as postoperatively in patients treated with radical nephrectomy (RNx) for renal cell carcinoma (RCC). Methods: We retrospectively reviewed the records of 906 patients treated with RNx for RCC. We defined the early compensatory process (process 1) as compensatory adaptation of the contralateral normal kidney (CNK) before RNx. We defined the late compensatory process (process 2) as compensatory adaptation of the CNK after RNx. Total compensation was defined as the combination of these two processes. Multivariable logistic regression analyses were used to identify significant factors associated with processes 1, 2 and total compensation. Results: Mean preoperative, 1-week, and 5-year postoperative estimated glomerular filtration rates (eGFR) were 84.5, 57.6 and 63.7 mL/min/1.73 m², respectively. Female sex (p < 0.001), lower body mass index (BMI) (p < 0.001), absence of hypertension (p = 0.019), lower preoperative eGFR (p < 0.001), larger tumor volume (p < 0.001), and larger CNK volume (p < 0.001) were significantly associated with process 1. Younger age (p = 0.019), higher BMI (p < 0.001), and absence of diabetes mellitus (DM) (p = 0.033) were significantly associated with process 2. Female sex (p < 0.001), younger age (p < 0.001), absence of DM (p = 0.002), lower preoperative eGFR (p < 0.001), and larger tumor (p = 0.001) and CNK volumes (p < 0.001) were significantly associated with total compensation. Conclusions: Different factors affected each compensatory process. Process 1 made a greater contribution to the entire renal compensatory process than process 2. Full article

(This article belongs to the Special Issue Hot Topics and New Frontiers in Kidney Cancer)

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14 pages, 1118 KiB

Open AccessArticle

The Effect of Remote Ischemic Preconditioning on Serum Creatinine in Patients Undergoing Partial Nephrectomy: A Randomized Controlled Trial

by Jaeyeon Chung, Min Hur, Hyeyeon Cho, Jinyoung Bae, Hyun-Kyu Yoon, Ho-Jin Lee, Young Hyun Jeong, Youn Joung Cho, Ja Hyeon Ku and Won Ho Kim

J. Clin. Med. 2021, 10(8), 1636; https://doi.org/10.3390/jcm10081636 - 12 Apr 2021

Cited by 8 | Viewed by 1906

Abstract

Renal function declines after partial nephrectomy due to ischemic reperfusion injury induced by surgical insult or renal artery clamping. The effect of remote ischemic preconditioning (RIPC) on reducing renal injury after partial nephrectomy has not been studied regarding urinary biomarkers. Eighty-one patients undergoing partial nephrectomy were randomly assigned to either RIPC or the control group. RIPC protocol consisted of four cycles of five-min inflation and deflation of a blood pressure cuff to 250 mmHg. Serum creatinine levels were compared at the following time points: preoperative baseline, immediate postoperative, on the first and third days after surgery, and two weeks after surgery. The incidence of acute kidney injury, other surgical complication rates, and urinary biomarkers, including urine creatinine, β-2 microglobulin, microalbumin, and N-acetyl-beta-D-glucosaminidase were compared. Split renal functions measured by renal scan were compared up to 18 months after surgery. There was no significant difference in the serum creatinine level on the first postoperative day (median (interquartile range) 0.87 mg/dL (0.72–1.03) in the RIPC group vs. 0.92 mg/dL (0.71–1.12) in the control group, p = 0.728), nor at any other time point. There was no significant difference in the incidence of acute kidney injury. Secondary outcomes, including urinary biomarkers, were not significantly different between the groups. RIPC showed no significant effect on the postoperative serum creatinine level of the first postoperative day. We could not reveal any significant difference in the urinary biomarkers and clinical outcomes. However, further larger randomized trials are required, because our study was not sufficiently powered for the secondary outcomes. Full article

(This article belongs to the Special Issue Hot Topics and New Frontiers in Kidney Cancer)

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Review

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11 pages, 245 KiB

Open AccessReview

PSMA PET/CT in Renal Cell Carcinoma: An Overview of Current Literature

by Stijn Muselaers, Selcuk Erdem, Riccardo Bertolo, Alexandre Ingels, Önder Kara, Nicola Pavan, Eduard Roussel, Angela Pecoraro, Michele Marchioni, Umberto Carbonara, Laura Marandino, Daniele Amparore, Riccardo Campi and on behalf of the European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group

J. Clin. Med. 2022, 11(7), 1829; https://doi.org/10.3390/jcm11071829 - 25 Mar 2022

Cited by 14 | Viewed by 3508

Abstract

Although the vast majority of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging occurs in the field of prostate cancer, PSMA is also highly expressed on the cell surface of the microvasculature of several other solid tumors, including renal cell carcinoma (RCC). This makes it a potentially interesting imaging target for the staging and monitoring of RCC. The objective of this review is to provide an overview of the current evidence regarding the use of PSMA PET/Computed Tomography in RCC patients. Full article

(This article belongs to the Special Issue Hot Topics and New Frontiers in Kidney Cancer)

13 pages, 1069 KiB

Open AccessReview

Expanding the Role of Ultrasound for the Characterization of Renal Masses

by Eduard Roussel, Riccardo Campi, Daniele Amparore, Riccardo Bertolo, Umberto Carbonara, Selcuk Erdem, Alexandre Ingels, Önder Kara, Laura Marandino, Michele Marchioni, Stijn Muselaers, Nicola Pavan, Angela Pecoraro, Benoit Beuselinck, Ivan Pedrosa, David Fetzer, Maarten Albersen and on behalf of the European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group

J. Clin. Med. 2022, 11(4), 1112; https://doi.org/10.3390/jcm11041112 - 19 Feb 2022

Cited by 5 | Viewed by 6232

Abstract

The incidental detection of renal masses has been steadily rising. As a significant proportion of renal masses that are surgically treated are benign or indolent in nature, there is a clear need for better presurgical characterization of renal masses to minimize unnecessary harm. Ultrasound is a widely available and relatively inexpensive real-time imaging technique, and novel ultrasound-based applications can potentially aid in the non-invasive characterization of renal masses. Evidence acquisition: We performed a narrative review on novel ultrasound-based techniques that can aid in the non-invasive characterization of renal masses. Evidence synthesis: Contrast-enhanced ultrasound (CEUS) adds significant diagnostic value, particularly for cystic renal masses, by improving the characterization of fine septations and small nodules, with a sensitivity and specificity comparable to magnetic resonance imaging (MRI). Additionally, the performance of CEUS for the classification of benign versus malignant renal masses is comparable to that of computed tomography (CT) and MRI, although the imaging features of different tumor subtypes overlap significantly. Ultrasound molecular imaging with targeted contrast agents is being investigated in preclinical research as an addition to CEUS. Elastography for the assessment of tissue stiffness and micro-Doppler imaging for the improved detection of intratumoral blood flow without the need for contrast are both being investigated for the characterization of renal masses, though few studies have been conducted and validation is lacking. Conclusions: Several novel ultrasound-based techniques have been investigated for the non-invasive characterization of renal masses. CEUS has several advantages over traditional grayscale ultrasound, including the improved characterization of cystic renal masses and the potential to differentiate benign from malignant renal masses to some extent. Ultrasound molecular imaging offers promise for serial disease monitoring and the longitudinal assessment of treatment response, though this remains in the preclinical stages of development. While elastography and emerging micro-Doppler techniques have shown some encouraging applications, they are currently not ready for widespread clinical use. Full article

(This article belongs to the Special Issue Hot Topics and New Frontiers in Kidney Cancer)

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Other

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5 pages, 193 KiB

Open AccessTechnical Note

Robotic Off-Clamp Simple Enucleation Single-Layer Renorrhaphy Partial Nephrectomy (ROSS): Surgical Insights after an Initial Experience

by Riccardo Bertolo, Chiara Cipriani, Matteo Vittori, Riccardo Campi, Juan Garisto, Michele Di Dio, Filippo Annino and Pierluigi Bove

J. Clin. Med. 2023, 12(1), 198; https://doi.org/10.3390/jcm12010198 - 27 Dec 2022

Cited by 7 | Viewed by 1913

Abstract

Robotic technology allows the beginner surgeon to approach minimally-invasive partial nephrectomy (PN) avoiding the otherwise long learning curve of pure laparoscopy. The present video-article reported the surgical technique and the outcomes of the first 11 cases performed by a young surgeon starting with the experience of robotic PN. Transperitoneal robotic PN, with an off-clamp approach, a simple enucleation technique, and a single-layer medullar renorrhaphy was performed uneventfully in all cases but one, with comparable outcomes to the available literature. With the present experience, we are trying to give the reader a different point of view of the current knowledge. In our series, off-clamp robotic PN was not chosen while looking for a better functional outcome, but rather as a “forced” choice within the specific “in training” setting the interventions were performed in. We underline how the off-clamp approach was the way to cut out the potential for vascular complications derived from the application/removal of the clamp itself on the renal artery. Indeed, when Scanlan bulldogs are not available, one of the limits of robotic PN is that the first surgeon is not autonomous in placing/removing the clamp. We found that tumour enucleation resection technique had the perfect synergistic effect in maximizing the perioperative vision, and thus the safety, notwithstanding the clampless approach. Full article

(This article belongs to the Special Issue Hot Topics and New Frontiers in Kidney Cancer)

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