Biomedical subjects

Arnaud Mejean

Publications and source records attributed to Arnaud Mejean.

17 recordsLinked to original sources

PubMed2006

Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease: prognostic indicators of disease-specific survival.

OBJECTIVES: Outcome of patients with exclusive renal cell carcinoma (RCC) nodal metastases without distant metastases is not extensively described. We explored the ability of standard risk factors such as tumour size, Fuhrman grade, histologic subtype and symptom classification to predict renal cell carcinoma-specific survival (RCC-SS). METHODS: Analyses targeted 171 patients with RCC nodal metastases and absence of distant metastases. Univariable, multivariable, and predictive accuracy analyses addressed RCC-SS with the intent of identifying independent and most informative predictors of RCC-SS in this cohort of patients. RESULTS: Median RCC-SS was 2.3 yr. Symptom classification (61.3%, p<0.001) demonstrated the highest univariable accuracy. In multivariable analyses, symptom classification contributed the most to the combined predictive accuracy of all variables (+4.2%, p<0.001), followed by Fuhrman grade (+2.3%) and histologic subtype (+1.0%). CONCLUSIONS: Renal cell carcinoma-specific survival of patients with exclusive nodal metastases may show important variability. In presence of systemic symptoms, survival is extremely poor. Substantially better survival may be expected in patients with local or no symptoms. This observation has important implications when adjuvant therapies are considered.

Adolescent↗

PubMed2006

Relationship between age at diagnosis and clinicopathologic features of renal cell carcinoma.

OBJECTIVES: To analyse the influence of age at diagnosis on tumour characteristics and cancer-specific survival in renal cell carcinoma (RCC). METHODS: Data on age, tumour characteristics, and survival for 4774 patients from 12 European RCC databases were recorded. Patients were divided into four groups according to age at diagnosis: < or =40, >40 and <60, > or =60 and <80, and > or =80 yr. The following variables were analysed: TNM stage, Fuhrman grade, tumour size, symptoms at diagnosis, ECOG performance status (PS), and cancer-specific survival. The groups were compared for usual clinical and pathologic variables, and cancer-specific survival. RESULTS: The four groups accounted for 288 (6%), 1839 (38.5%), 2499 (52.3%), and 148 cases (3.2%), respectively. Differences were found among groups for tumour stage, symptoms at diagnosis, ECOG PS, Fuhrman grade (p<0.001), tumour size, M stage, and histologic subtype (p: 0.02). Patients < or =40 yr were more likely to have papillary or chromophobe RCCs and less likely to have clear-cell RCCs. No significant difference was found among groups for N stage (p: 0.15). The 5-yr cancer-specific survival rates for the four age categories were 85%, 74%, 70%, and 69%, respectively. In multivariate analysis age category remained an independent prognostic parameter (p<0.001). CONCLUSIONS: Renal tumours diagnosed in younger age are characterized by lower tumour stages and grades as well as favourable histologic patterns compared with tumours in older patients. Basic research is required for explaining such a relationship between age, tumour aggressiveness, and therefore tumour biology.

Adult↗

PubMed2006

Low predictive accuracy of the Kattan postoperative nomogram for renal cell carcinoma recurrence in a population of French patients.

BACKGROUND: The aim of the current study was to establish the predictive accuracy of the Kattan postoperative nomogram for nonmetastatic renal cell carcinoma (RCC) by comparing predictions with actual disease recurrence in patients who underwent surgery in a single center in France. METHODS: Between 1985 and 2000, 844 patients were treated for RCC. The following data were collated: age, symptoms, histology, tumor size, grade, TNM 1997 stage, recurrence, and progression. For each patient a prognostic score (predicted probability) for recurrence-free survival (RFS) at 5 years was calculated using the Kattan nomogram. The discriminating ability of the model was assessed by Harrell's concordance index (c-index). Bootstrapping was used to assess confidence intervals. Furthermore, survival was then estimated by the Kaplan-Meier method and Cox proportional hazards regression analysis. RESULTS: In all, 565 patients (median age, 62 years) were included. At the time of the last follow-up, 81 patients had died and 101 had experienced RCC recurrence. The c-index for RFS (Kattan nomogram) was only 0.607 (95% confidence interval [CI]: 0.576-0.635). The 5-year RFS rate and cancer-specific survival rate were 81.5% and 84.7%, respectively. Of the 4 variables included in the nomogram, only TNM stage was associated with recurrence in a multivariate analysis (Cox analysis) (P = .022). CONCLUSIONS: There was a discrepancy between predicted RFS as estimated by the Kattan nomogram and the likelihood of being recurrence-free at 5 years according to the Cox analysis in the current population of patients. However, until new dynamic models become available clinicians may still improve their predictive ability by using the current nomogram.

Carcinoma, Renal Cell↗

PubMed2006

Renal cell carcinoma in adults 40 years old or less: young age is an independent prognostic factor for cancer-specific survival.

OBJECTIVES: Renal cell carcinoma (RCC) is uncommon in young adults. Based on the few studies published to date, it is difficult to determine whether this tumour has a particular progression pattern. This retrospective, multicentre study analysed RCC in young patients, defined as </=40 yr old, compared to RCC in older patients. METHODS: Between 1988 and 2000, 1233 patients, 93 under 40 yr old and 1140 older (mean ages, 34.2 and 61.9 years, respectively) underwent surgery for RCC in four teaching hospitals. Clinical and biologic parameters at diagnosis were compared and subjected to univariate and multivariate analyses to study survival. Mean follow-up was 4.5 yr for young and 4.1 yr for older patients. RESULTS: When comparing younger to older patients, respectively, they had a lower male-to-female ratio (1.2 vs. 2.5), lower stage (84.9% vs. 67.4% pT1-pT2N0M0; p=0.001), and fewer clear-cell carcinomas (73.1% vs. 82%), but more papillary carcinomas (20.4% vs. 11.4%; p=0.01) and better 5-yr cancer-specific survival rates (90.8% vs. 78.3%; p=0.005). Independent prognostic factors for survival, in the order of decreasing impact, were tumor stage (p<0.0001), Fuhrman nuclear grade (p<0.0001), and age </=40 yr at diagnosis (risk ratio 0.4, p<0.047). Young patients tended to have a better 5-yr progression-free survival (80.5% vs. 70.7%; p=0.05). CONCLUSIONS: RCC in young adults was more often localised at diagnosis and had a better prognosis than the disease in older subjects. Age under 40 yr old was an independent prognostic factor for survival.

Adult↗

PubMed2006

[Conservative treatment of kidney cancer by cryoablation and radiofrequency].

Cryoablation and radiofrequency are minimally invasive techniques allowing resection of the tumour by application of physical means (cold or heat) to the centre of the lesion, rather than strictly surgical resection. The incision is usually percutaneous but can be laparoscopic in certain indications. Indications are currently limited to exophytic renal tumours < 40 mm, situated away from structures of the hilum (vessels and renal pelvis) and gastrointestinal structures in patients > 70 years or in the context of previously operated hereditary renal carcinoma (von Hippel Lindau disease). The results of the first series are encouraging, although more contradictory for radiofrequency probably due to the heterogeneous equipment (electrodes, generator, frequency, etc.). The complication rate is low. A PHRC national multicentre randomized study is currently underway to compare the functional and oncological results of radiofrequency and conservative surgery.

Catheter Ablation↗

PubMed2006

[Sporadic bilateral kidney tumour: practical approach and place of conservative surgery].

OBJECTIVE: To study the specific features of the sporadic form of bilateral renal cell carcinoma (RCC). MATERIAL AND METHOD: Twenty-six patients presented bilateral RCC among a total of 759 patients operated for RCC in our institution between 1985 and 1998. The mean follow-up for 23 patients (3 were lost to follow-up) was 56.5 months. Actuarial survival was estimated by the Kaplan-Meier method and comparisons between the various groups were performed with a Mann-Whitney test. RESULTS: This series comprised 10 asynchronous tumours and 16 synchronous tumours. The mean diameter of synchronous tumours was significantly greater than that of asynchronous tumours (61 vs 33.5 mm). Histology revealed 16 clear cell carcinomas (CCC), 7 tubulopapillary carcinomas (TPC), 2 cases with CCC and TPC, and one bilateral oncocytoma. Malignant tumours were classified as stage T1-T2 (n=23) or T3 (n=2). TPC was more frequently bilateral than CCC (7.9% vs. 2.8%). Forty-four surgical operations (19 radical nephrectomies and 24 partial nephrectomies) were performed. The mean interval between two operations for asynchronous tumours was 85.2 months. Follow-up demonstrated 15 remissions and 6 deaths, including 5 deaths due to RCC, one local recurrence and one local recurrence with metastases. One-year specific survival was 96% and 5-year survival was 74%. Age, gender, histological type and the asynchronous or synchronous mode did not induce any significant difference on survival. CONCLUSION: The surgical approach must therefore be resolutely conservative in view of the good 5-year survival rate and the low local recurrence and metastasis rates.

Adult↗

PubMed2005

[Follow-up of renal cancer. Guidelines of the Comité de Cancérologie de l'Association Française d'Urologie].

The follow-up of renal cancer is essentially based on thoracoabdominal computed tomography (CT). The duration of this follow-up and the frequency of examinations depend on the patient's level of risk. Early detection of metastases has a limited therapeutic value at the present time, apart from tumours with a good prognosis or for the management of complications. Recent publications on targeted treatments raise new hopes and may lead to a modification of follow-up guidelines.

Algorithms↗

PubMed2004

[Bellini renal cell carcinoma. Diagnosis and treatment].

The Bellini collecting duct carcinoma is a very rare form of renal cell carcinoma (1%). It presents at the stage of metastases in the very great majority of cases. The diagnosis should be considered in patients presenting with marked deterioration of the general status and/or the presence of a very large invasive renal tumour on abdominal CT scan. The overall 2-year survival rate of Bellini carcinoma is about 20%. As the prognosis is very poor, even despite radical nephrectomy, biopsy may be performed as the first-line procedure when the diagnosis is suspected. In the case of primary metastatic Bellini carcinoma, radical nephrectomy alone appears to be useless and dangerous except for analgesic purposes or in the context of new multicentre chemotherapy protocols, combining gemcitabine and cisplatin, currently under evaluation.

Carcinoma, Renal Cell↗

PubMed2003

DNA adducts in normal bladder tissue and bladder cancer risk.

Cigarette smoking is an established cause of bladder cancer. The direct relationship between smoking-induced DNA adducts in bladder cells and cancer risk at that site has, however, been poorly assessed. We therefore investigated the relationship between bladder cancer risk and levels of DNA adducts measured in normal bladder biopsies by 32P-post-labeling in a hospital-based case-control study of 59 bladder cancer patients and 45 controls submitted to surgery for prostatic hyperplasia or urinary incontinence. An approximately 2-fold risk for bladder cancer was found in individuals with an adduct level >14.8 (median among controls) compared with those with an adduct level < or =14.8 (OR = 1.9, 95% CI 0.8-4.3, P = 0.13). A dose-response relationship was also suggested (trend test, P = 0.13): compared with adduct levels below 13.5, the OR for bladder cancer was 1.7 (95% CI 0.6-4.6) for adduct levels between 13.5 and 18.5 and 2.2 (95% CI 0.8-6.1) for adduct levels >18.5. These findings provide some evidence that DNA adducts in bladder tissue might predict smoking-induced bladder cancer. Larger studies are still warranted to confirm these results.

Aged↗

PubMed2003

Prognostic factors for the survival of patients with papillary renal cell carcinoma: meaning of histological typing and multifocality.

PURPOSE: We identified prognostic factors of papillary renal cell carcinoma (PRCC) types 1 (PRCC1) and 2 (PRCC2). MATERIALS AND METHODS: Between 1985 and 1998, 759 patients underwent surgery for renal cell carcinoma, of whom 88 (11.6%), including 69 males and 19 females with a mean age of 61.8 years (range 21.3 to 85.9) who had PRCC. Multifocality was defined as 2 or greater tumors separated by 10 mm or greater. Small basophilic cells defined PRCC1 and large eosinophilic cells defined PRCC2. Mean followup in 79 cases was 71.1 months (range 1 to 196.6). Survival rates were calculated and statistical analyses were done. RESULTS: The 88 patients underwent radical nephrectomy (65) or conservative surgery (28, that is elective in 17 and imperative in 11). Mean tumor size was 62 mm (range 10 to 190) and 41% of lesions were multifocal, independent of PRCC size, stage, grade or type. Comparing the 56 PRCC1s (63.6%) to the 32 PRCC2s (36.4%) showed that PRCC2 grade and stage were significantly higher (p = 0.024 and 0.025, respectively). A total of 51 patients (64.6%) remained relapse-free and progression-free. Local relapses occurred only after imperative conservative surgery in 2 cases (2.5%). Of the 26 deaths 15 (4 PRCC 1 and 11 PRCC 2) were tumor associated. Mean survival was 26.6 months (range 1 to 112.5). The overall 10-year survival rate was 73% with PRCC1 and PRCC2 10-year rates of 80% and 59%, respectively (p <0.003). Univariate analysis identified stage (p <0.0001), grade (p <0.0001) and histological type (p <0.003) as prognostic factors. Multivariate analysis retained stage (p = 0.006) and grade (p = 0.004). CONCLUSIONS: PRCC multifocality was not associated with stage, grade or histological type and it seems not to be an argument against conservative surgery. Univariate analysis of PRCC prognostic factors identified stage, grade and histological type but the latter was not retained on multivariate analysis.

Adult↗

PubMed2003

Nephron sparing surgery for renal cell carcinoma and von Hippel-Lindau's disease: a single center experience.

PURPOSE: We reviewed the efficacy and safety of nephron sparing surgery for renal cell carcinoma in patients with von Hippel-Lindau disease. MATERIALS AND METHODS: Data were collated for all 56 patients with a mean age of 37.2 +/- 11.3 years (range 14 to 62) with von Hippel-Lindau disease who underwent radical nephrectomy or nephron sparing surgery at our department for 1 or more 25 to 60 mm renal cell carcinomas between 1988 and 2001. RESULTS: Overall 30 nephrectomies (33%) and 62 enucleations (67%) were performed for 62 bilateral and 30 unilateral tumors. For nephron sparing surgery estimated intraoperative blood loss was 175 +/- 231.7 cc (range 50 to 1,300), 97% of surgeries had vascular pedicle clamping for 32 +/- 10.4 minutes (range 10 to 50) and there were 4 immediate complications (1 perinephric abscess, 2 urinary fistulas and 1 acute renal failure requiring temporary dialysis). Renal atrophy was noted in 7.3% of cases. Tumor diameter was 31.2 +/- 10.7 mm (range 15 to 60) and recurrence diameter was 22 +/- 7.8 mm (range 4 to 45). Hospital stay was 7.6 +/- 2.4 days (range 5 to 21). Preoperative and postoperative creatinine was 1.0 +/- 0.2 (range 0.6 to 1.7) and 1.2 +/- 0.9 mg/dl (range 0.7 to 6.5), respectively. Median followup was 55.9 months. There were 17 local recurrences (27.4%) and no metastases at recurrence. The overall survival rate was 100% at 5 years and 67% at 10 years. CONCLUSIONS: Nephron sparing surgery is effective and, when feasible, it need not be called into question. However, it may probably be superseded by less invasive techniques for tumors less than 20 mm diagnosed early after these techniques have been validated in long-term trials.

Adolescent↗

PubMed2003

[Prostate cancer screening].

Prostate cancer has become the most frequent cancer and the second cause of cancer mortality in men. This public health problem is becoming increasingly important due to the increasing life expectancy. At the present time, prostate cancer will be discovered in one in every eight men during their lifetime. Prostate cancer represents 25% of all new cases of male cancers. Prostate cancer screening is designed to detect early stage, asymptomatic prostate cancer, as the patient's chances of cure are higher when the cancer is diagnosed at an early stage. The conclusions of the ANAES evaluation in 1998 did not recommend mass screening for prostate cancer. Several international prospective randomized studies based on serum PSA assay, sometimes associated with digital rectal examination, are currently underway. France is participating in the European ERSPC study (European Randomized Study of Screening for Cancer Prostate) and is organizing a national study on high-risk populations. While waiting for the final results of these studies, a recommendation needs to be proposed to inform general practitioners and specialists about optimal use of the currently available tests. Based on the conclusions of its oncology committee (composed of urologists, medical oncologists, radiotherapists, pathologists and radiologists), the Association Française d'Urologie proposes a recommendation concerning prostate cancer screening and defines its modalities, especially concerning the target population, screening tests and the information given to men before screening. The Association Française d'Urologie recommends prostate cancer screening by PSA assay (prostate specific antigen) and digital rectal examination annually between the ages of 50 and 75 years, and from the age of 45 years in men with a family or ethnic risk. If total PSA is above the normal value of the test or if digital rectal examination is abnormal, referral to a urologist is recommended. Information concerning the limits, benefits and risks of screening and the available treatment options must be given before performing these examinations.

Humans↗

PubMed2003

[Hereditary renal cell carcinoma: results and place of conventional conservative surgery].

OBJECTIVES: To report the results of conservative surgery for the treatment of hereditary renal cell carcinoma (RCC) and to define its place with respect to new less invasive treatment options. MATERIAL AND METHOD: Over a period of 14 years, 30 women and 26 men were operated for one or several hereditary RCC, either by radical nephrectomy or nephron-sparing excision, via a lumbar or subcostal incision, when the diameter of at least one RCC was greater than 2.5 cm. RESULTS: 92 operations were performed: 62 local excisions and 30 nephrectomies. The TNM stage was: 75 pT1, 14 pT2, 3 pT3b; 4 N+; 3 M+. 26 patients (46%) were operated at least twice. Two or more RCC were resected in 43 cases (47%). In the case of nephron-sparing surgery, mean blood loss was 175 +/- 231.7 cc (range: 50-1300 cc); mean pedicle clamping time (97% of cases) was 32 +/- 10.4 min (range: 10-50 min); mean preoperative serum creatinine was 85 +/- 18 micromol/L (range: 52-150 micromol/L) and mean postoperative serum creatinine was 105 +/- 80 micromol/L (range: 59-576 micromol/L); the calculated tumour recurrence rate was 24% at 5 years and 80% at 8 years; overall 5-year survival was 100% and overall 10-year survival was 67%. The median follow-up was 55.9 months. CONCLUSION: When hereditary RCCs are situated between 2.5 cm and 6 cm in diameter, nephron-sparing surgery is the reference treatment. Modern imaging and genetic screening should allow early detection of increasingly smaller RCCs. In the future, less invasive treatment options could replace surveillance for RCCs less than 2 cm and eventually reduce the indications for local excision.

Adolescent↗

PubMed2002

Adoptive immunotherapy for superficial bladder cancer with autologous macrophage activated killer cells.

PURPOSE: We assessed the efficacy and safety of adoptive immunotherapy administered to 17 patients with TaGIII or recurrent TaGII superficial bladder cancer following transurethral tumor resection. MATERIALS AND METHODS: Macrophage activated killer (MAK) cells were obtained from autologous mononuclear cells harvested by apheresis, after in vitro culture for 7 days and activation with interferon-gamma on the last day of culture. The patients received 6 weekly intravesical infusions of approximately 2 x 10(8) cells each. Additionally, 5 patients received 2 or 3 more infusions at 3-month intervals. Each patient was followed for 1 year or until tumor recurrence, whichever came first. RESULTS: A total of 112 intravesical infusions were performed. During the 12-month followup period 8 patients experienced 11 common toxicity criteria grade 1 or grade 2 adverse events considered possibly related to protocol. No clinically relevant grade 1 or 2 laboratory test results were reported while the patients received treatment. In 17 patients 8 tumors recurred compared to 34 recurrences during the year before the first MAK cell infusion. This difference was highly significant (p </=0.0005). CONCLUSIONS: The promising efficacy and safety results of this study and the fact that the MAK cell treatment regimen proved feasible should encourage initiation of further large scale studies to confirm these data.

Administration, Intravesical↗

PubMed2002

Coloepiploic mobilization during left radical nephrectomy for renal cell carcinoma is indicated to reduce the risk of iatrogenic splenectomy.

OBJECTIVES: To determine whether coloepiploic mobilization (CEM) is indicated to reduce the incidence of iatrogenic splenectomy during left radical nephrectomy for renal cell carcinoma. The incidence of iatrogenic splenectomy during a left nephrectomy is estimated to be between 1.4% and 24%. In a recent study, we reported that the incidence of iatrogenic splenectomy was 8% during a left nephrectomy performed for renal cell carcinoma through a transperitoneal anterior subcostal incision. METHODS: A left radical nephrectomy was performed in 233 consecutive patients for renal cell carcinoma through a transperitoneal anterior subcostal incision with a CEM procedure in which the left colonic flexure was completely detached from the epiploa. Perioperative and postoperative complications, including splenic injury, were noted in a database. The mean patient age was 51.3 years (range 21.3 to 90.2). The mean tumor size was 58 mm (range 15 to 230). RESULTS: An iatrogenic splenectomy was required in 3 patients, and in 1 patient, a splenic injury was treated conservatively. The incidence of iatrogenic splenectomy accompanying left radical nephrectomy was 1.3%. The mean operative time was 120 minutes (range 80 to 240). The mean time to normal gut motility was 3.4 days (range 2 to 11) and to discharge from the hospital it was 9.3 days (range 6 to 19). Regarding CEM, we did not observe any significant abdominal complications. CONCLUSIONS: The incidence of iatrogenic splenectomy during a left radical nephrectomy through a transperitoneal anterior subcostal incision may be reduced by performing the technique of CEM.

Adult↗

PubMed2002

Nephron sparing surgery for renal cell carcinoma using selective renal parenchymal clamping.

PURPOSE: We describe a technical artifice facilitating nephron sparing surgery for renal cell carcinoma without clamping the renal pedicle. MATERIALS AND METHODS: Selective renal parenchymal clamping was performed using a large curved DeBakey aortic clamp placed around and sufficiently far from the tumor. The lesion was resected with a surrounding margin of normal renal parenchyma. The intrarenal vessels were suture ligated and the collecting system was closed as necessary. Time was not limited since the artery was not clamped. RESULTS: Ten patients with renal cell carcinoma in whom nephron sparing surgery was indicated underwent selective renal parenchymal clamping. The indication was elective in 8 patients and urgent in 2. The tumor was at the renal pole in 3 cases and peripheral in 7. Mean tumor size was 32 mm. (range 19 to 52). Blood loss was insignificant. Operative time was 81 minutes (range 61 to 125) and there were no perioperative or postoperative complications. CONCLUSIONS: Selective renal parenchymal clamping is a simple and efficient technical maneuver for facilitating nephron sparing surgery without pedicle dissection and clamping for renal peripheral or pole tumors. Neoplasm location and size are the limiting factors of this technique.

Aged↗

PubMed2002

[Metastatic kidney cancer: new therapeutic approaches].

Several promising approaches to the treatment of renal cancer have been developed over recent years. Two independent North American and European studies have demonstrated the value of nephrectomy in patients with metastatic disease: the overall survival of patients treated with interferon was improved by nephrectomy, essentially in patients with a good general status. Several publications have also emphasized the value of surgery for metastases. New experimental approaches have also been developed. Dendritic cells fused with tumour cells induced 4 complete remissions and 2 partial remissions in a series of 17 patients. Allogeneic haematopoietic stem cell transplantation induced lasting remissions in 10 out of 17 patients. The National Cancer Institute team, in the United States, has developed this approach for patients with an HLA-compatible relative. Finally, various molecules with promising antiangiogenic properties are currently under development in renal cancer.

Angiogenesis Inhibitors↗