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Arnaud Méjean

Publications and source records attributed to Arnaud Méjean.

12 recordsLinked to original sources
PubMed2006

Prospective study of safety margins in partial nephrectomy: intraoperative assessment and contribution of frozen section analysis.

OBJECTIVES: To evaluate prospectively a healthy parenchymal safety margin during conservative surgery for renal cell carcinoma. METHODS: From 1997 to 2001, elective nephron-sparing surgery was performed through a flank incision in 61 consecutive patients (mean age 59.4 years, range 34.2 to 78.5). The mean tumor size was 32 mm (range 12 to 50). The tumor localization was juxtahilar in 10 and distant in 51. Prospective margin assessment used the following protocol. Margins were evaluated macroscopically by the surgeon, controlled by frozen section analysis, and subsequently measured during histologic examination. All patients were monitored with computed tomography scans, with a mean follow-up of 72.5 months (range 46 to 95). RESULTS: The histologic type was clear cell in 42 patients, papillary in 17, and chromophobic cell in 2. Of the 61 patients, 57 had 1997 TNM Stage pT1 and 4 had Stage pT2. The Furhman grade was grade 1 in 16, grade 2 in 35, and grade 3 in 10. No tumor margin was positive. Frozen section analysis and routine histologic examination yielded 53 complete and 8 incomplete margins compared with 51 and 10, respectively, as assessed by the surgeons. The mean peritumoral margin was 7 mm (range 4 to 10) for the cortex and 2 mm (range 0 to 5) for the deep part. No patient developed locoregional or metastatic relapse. CONCLUSIONS: No apparent relationship was observed between peritumoral margin width and the risk of disease progression, even for tumors abutting the hilum, rendering illusory a safety margin greater than 1 cm. Although the surgeons' macroscopic margin evaluations were accurate, frozen section analysis is mandatory when the margin status is in doubt. In all cases, margin negativity remains an oncologic imperative.

Adult↗
PubMed2006

[Should frozen section examination be performed systematically as part of conservative surgery for renal cell carcinoma?].

OBJECTIVE: To prospectively assess the value of frozen section examination during conservative surgery for renal cell carcinoma (RCC) in exclusively elective indications and to evaluate the reality of safety margins. MATERIAL AND METHODS: From 1997 to 2001, 220 conservative procedures for RCC were performed in our department, including 104 elective lumpectomies, 61 of which were studied prospectively. The mean age of these 61 patients was 59.4 years (range: 34.2 to 78.5). The mean tumour diameter was 32 mm (range: 12 to 50). Tumours were peripheral in 51 cases and in a juxtahilar position in 10 cases. Resection margins were evaluated macroscopically by the surgeon, and the specimen was systematically sent for frozen section examination. Incomplete margins, i.e. negative but with no safety margin, were distinguished from positive margins on the final histological examination. The thickness of the safety margins was measured on the cortical and deep extremities of the operative specimen. The mean follow-up was 78.5 months (range: 52 to 101). RESULTS: Histological types of RCC comprised conventional clear cell (n = 42), tubulopapillary (n = 17) and chromophobe (n = 2), stage pT1 (n = 57) and pT2 (n = 4), and grade 1 (n = 16), 2 (n = 35) and 3 (n = 10). No positive margins were detected. The mean thickness of the safety margin was 7 mm peripherally and 2 mm in depth with no correlation between these two values. Surgeons concluded on the presence of 51 complete margins and 10 incomplete margins versus 53 and 8 on histological examination, respectively. Frozen section examination never modified the course of the operation. All patients were alive and recurrence free at last follow-up. CONCLUSION: Macroscopic evaluation of resection margins by the surgeon is precise and usually avoids the need for frozen section. However when the margins are considered to be incomplete by the surgeon, frozen section examination is mandatory to avoid positive margins, which must remain the main objective of conservative surgery.

Adult↗
PubMed2005

[Kidney tumours: single-centre study of 810 patients. Changing features over a period of 15 years].

OBJECTIVE: The Association Française d 'Urologie conducted a national epidemiological study in 1997. Using our database, we compared our results, up-dated the epidemiological data and evaluated the differences observed over a period of 15 years. PATIENTS AND METHODS: 844 patients operated for kidney tumour between 1985 and 2000 were analysed and 810 were included in this study. Survival analysis was performed according to the Kaplan-Meier method. Relative risks were determined by the Log-Rank test and multivariate analysis was performed with the Cox regression model. The limit of significance was 0.05. RESULTS: The mean age at the time of diagnosis was 59.6 years (range: 14.6-90.2). Most tumours were discovered incidentally by ultrasound. The mean tumour diameter was 61.7 mm (range: 20-230). The most frequent surgical operation was radical nephrectomy, but there was a tendency towards an increasing number of conservative operations. Histology revealed 94% of renal cell carcinomas, with 73% of conventional cell carcinomas. The mean follow-up was 49 months (range: 0-197) and 5-year and 10-year survival rates were 74.9 months and 62.6 months, respectively. Multivariate statistical analysis confirmed the prognostic significance of N and M stage, Fuhrman grade, histological type, as well as renal capsule invasion. CONCLUSION: Our data largely confirm those of the last national study conducted in 1997 as well as those of the international literature. Kidney tumours are increasingly discovered incidentally, but tumour size and the age of patients remain stable, while the number of conservative procedures continues to increase each year In addition to the usual prognostic factors, we found that renal capsule invasion was an independent prognostic factor.

Adolescent↗
PubMed2004

Renal cell carcinoma of the grafted kidney: how to improve screening and graft tracking.

Renal cell carcinoma of transplanted kidneys is rare. We report three such cases among 1,250 kidney grafts that were performed or followed from 1968 to 2002. A strategy to diagnose these lesions is needed because of their rarity, late detection, and therapeutic repercussions. At the least, the strategy should include annual ultrasonography of the graft throughout its lifespan. Because the risk of tumor development in another organ from the same donor is not negligible, a national registry should be established to rapidly alert graft recipients with the same donor and other transplantation centers about the risk of graft tumors.

Adolescent↗
PubMed2004

Genotype-phenotype correlation in von Hippel-Lindau families with renal lesions.

von Hippel-Lindau (VHL) disease arises from mutations in the VHL gene and predisposes patients to develop a variety of tumors in different organs. In the kidney, single or multiple cysts and renal cell carcinomas (RCC) may occur. Both inter- and intrafamilial heterogeneity in clinical expression are well recognized. To identify VHL-dependent genetic factors, we investigated the renal phenotype in 274 individuals from 126 unrelated VHL families in whom 92 different VHL mutations were characterized. The incidence of renal involvement was increased in families with mutations leading to truncated protein (MLTP) or large rearrangement, as compared to families with missense changes (81 vs. 63%, respectively; P=0.03). In the latter group, we identified two mutation cluster regions (MCRs) associated with a high risk of harboring renal lesions: MCR-1 (codons 74-90) and MCR-2 (codons 130-136). In addition, the incidence of RCC was higher in families with MLTP than in families with missense changes (75 vs. 57%; P=0.04). Furthermore, mutations within MCR-1 but not MCR-2 conferred genetic susceptibility to develop RCC. Overall, our data argued for a substantial contribution of the genetic change in the VHL gene to susceptibility to renal phenotype in VHL patients.

Adult↗
PubMed2004

[Kidney tumors].

Explore the source record for details and available documents.

Humans↗
PubMed2003

Is there a place for radical nephrectomy in the presence of metastatic collecting duct (Bellini) carcinoma?

PURPOSE: We describe diagnostic and therapeutic characteristics, and long-term followup of collecting (Bellini) duct carcinoma. MATERIALS AND METHODS: Ten patients underwent surgery, including radical nephrectomy in 9 and partial nephrectomy in 1, for collecting duct carcinoma diagnosed by histological and immunohistochemical criteria. RESULTS: Collecting duct carcinoma, which represented 1.3% of renal cell carcinomas diagnosed between 1986 and 1999, developed at a mean patient age of 66.2 years (range: 50.7 to 81). It was detected clinically but never because of macroscopic hematuria. Mean tumor size was 94 mm. (range 30 to 150). Stage was pT3, pT2 and pT1 in 7, 1 and 2 cases, respectively. Seven patients had lymph node or extranodal metastases, and 8 and 2 had Fuhrman grades 3 and 4 disease, respectively. Eight patients died, including 3 early during the perioperative or postoperative period, which was attributable to major surgical difficulties associated with these invasive tumors. Two of the 3 patients who did not have metastases were alive 99 and 100 months after surgery, respectively. Median overall survival +/- SD was 9 +/- 6 and 6 +/- 8 months for patients with metastases. The all survival rate was 20% at 2 years. CONCLUSIONS: Most collecting duct carcinomas are already metastatic at presentation. Because the prognosis is dismal despite radical nephrectomy, biopsy should be performed first when radiological findings are suggestive of collecting duct carcinoma. For metastatic collecting duct carcinoma radical nephrectomy alone does not seem to be useful except for palliative reasons or in the framework of new multicentric chemotherapy protocols in progress.

Aged↗
PubMed2003

Prognostic factors of renal cell carcinoma.

PURPOSE: Determination of prognostic factors is essential for the management of renal cell carcinoma. Stage, histological grade and type, and performance status are now well known and commonly used. During the last decade numerous predictors of patient outcome were tested. This review summarizes the most important studies, explores and compares the results, and tries to respond to the question, "Today, what do we expect of clinical, molecular and genetic factors concerning survival of patients with renal cell carcinoma?" MATERIALS AND METHODS: Based on MEDLINE literature searches we comprehensively reviewed the literature on the prognostic factors associated with the tumor, the patient and the treatment. RESULTS: During the last decades numerous factors have been studied but few of them maintained independent significance in terms of overall survival as assessed by multivariate analysis. Results are more often controversial from one series to another. No known molecular or cytogenetic tumor marker has been identified to help diagnose, manage or confirm renal cell carcinoma remission, progression or relapse. CONCLUSIONS: The classical prognostic factors remain histological grade, histological type, performance status, patient age, number and location(s) of metastatic sites, time to appearance of metastases and prior nephrectomy. The only striking advancement during the last few years has been the proven contribution of radical nephrectomy for metastatic disease in patients with good performance status.

Apoptosis↗
PubMed2003

[Value of bootstrapping for small series of patients: application to survival analysis for 26 patients followed for bilateral sporadic renal cell carcinoma].

OBJECTIVE: To use Bootstrapping to estimate the Kaplan-Meier survival of sporadic forms of bilateral renal cell carcinoma (RCC). PATIENTS AND METHODS: Over a period of 13 years, 759 patients were operated for RCC. 26 patients had bilateral sporadic RCC (3.4%) and 23 of them were reviewed with a median follow-up of 50 months (range: 7.8 to 143.4). The 95% confidence interval (95% CI) of Kaplan-Meier survival was estimated according to the Greenwood (Gw) normalized method and by Bootstrap percentile (B*) with B = 1000. RESULTS: The overall 1-year and 5-year survival rates were 95.8% (95% CI Gw: [87.6-100] and B*: [92.1-96.4]) and 73.6% (95% CI Gw: [54.9-92.15] and B*: [72.3-86.5%]), respectively. CONCLUSION: For diseases with a low incidence, Bootstrapping can improve the precision of the Kaplan-Meier survival estimate, by providing a narrower CI. This statistical technique provides the clinician with more precise results in a study limited by a small number of patients.

Adult↗
PubMedDate not supplied

Delineation of a 2.8 megabases region harboring a potential tumor suppressor gene involved in renal cell carcinoma, that is commonly deleted from chromosome 14.

MATERIALS AND METHODS: To investigate the genetic alterations that occur during the development of renal cell carcinomas (RCC), we used 20 microsatellite markers to examine 48 renal cell carcinomas for allelic losses of chromosome arm 14q. RESULTS: We identified 14q LOH in 31% of cases. Twelve tumors were entirely lacking the 14q arm and three were partially deleted. For the first time on fresh tumors, these findings led to the delineation of a 17.9 Mb region between markers D14S281 and D14S277 that is commonly deleted. Interestingly, this segment overlaps with the previously reported 37.8 Mb commonly deleted region. CONCLUSION: Taken together these results allowed us to define a new 2.8 Mb segment between markers D14S588 and D14S277 that potentially harbors a tumor suppressor gene involved in the development of RCC which can be reached by positional cloning.

Adult↗