Does the embolization of the tumor, prior to radical nephrectomy, prologs the life of patients with renal cell carcinoma * Department of Urology Regional.

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

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lizacji

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nefr

ek

tom

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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