Kidney Ca: Robotic partial, radical nephrectomy on the rise

Active surveillance in selected patients with localized renal masses 4 cm to 7 cm and a patient-derived xenograft system for predicting response to targeted and immune therapies in patients with metastatic RCC were among other noteworthy kidney cancer studies presented at AUA 2018. The take-home messages were presented by Brian Keith McNeil, MD, of SUNY Downstate Medical Center, Brooklyn, NY.

• Utilization and regional dissemination of minimally invasive (robotic) surgery for partial and radical nephrectomy are increasing.
• A downtrend in preoperative kidney function predicts development of stage 4 chronic kidney disease after radical or partial nephrectomy for kidney cancer.
• Researchers from Memorial Sloan Kettering Cancer Center, New York validated their preoperative nomogram for predicting 12-year probability of metastatic recurrence in patients undergoing surgery for localized renal cell carcinoma and introduced genomics into the nomogram after showing KDM5C mutation was independently associated with metastatis-free survival.
• Isolated involvement of renal sinus fat, perinephric fat, and renal venous invasion in patients with pathologic T3aN0/NxM0 clear cell RCC carry similar prognostic weight, but the presence of two or more of these features is associated with increased risk for worse outcomes.
• Active surveillance may be reasonable for selected patients with localized renal masses 4 cm to 7 cm.
• Findings of a study evaluating perioperative outcomes for patients with 4- to 7-cm renal masses undergoing microwave ablation, partial nephrectomy, or radical nephrectomy suggests that microwave ablation may be a good option for patients refusing surgery.
• Findings from two independent studies showed that cytoreductive nephrectomy may improve survival in patients with RCC and isolated brain metastasis.
• A patient-derived xenograft system predicted response to targeted and immune therapies in patients with metastatic RCC.
• Findings from the safety lead-in of a phase II trial showed neoadjuvant stereotactic ablative radiation for inferior vena cava thrombus in patients with RCC was safe and may improve metastasis-free survival.