Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 15

2 7 T H CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
1 mRNA and protein expression in relation to RCC type and
clinicopathological variables.
Methods: Quantitative analysis of HIF-la mRNA expression in
202 patients including 168 clear cell (cRCC), 23 papillary (pRCC)
and 11 chromophobe RCCs. Also, 49 samples from corresponding
kidney cortex were analysed. Comparative analysis of HIF-1
protein expression was performed by immunohistochemistry
using a tissue micro array.
Results and discussion: HIF-la mRNA levels were significantly
lower in cRCC than in pRCC (p=0.001) and kidney cortex
(p=<0.000). In cRCC, HIF-1 mRNA correlated to gender and
age. For pRCC there was no correlation between HIF-la mRNA
and stage, grade, age, tumour size or gender. HIF-la mRNA
expression was inversely related to HIF-la protein levels in
pRCC (p=0.041) and nonsignificantly in cRCC (p=0.075).
Conclusion: HIF-la mRNA levels were significantly lower in
cRCC than in kidney cortex and other RCC types. High HIF-
la protein expression appeared to suppress HIF-la mRNA
expression, distressing the HIF-1 pathway in RCC. Further
studies of the function of HIF-1 in the different RCC types are
encouraged.
19 Is laparoscopic-assisted cryablation for renal cancer
safe and nefronsparing?
L Lund*, M Jonler, LJ Petersen, J Abrahamsen
Viborg, Denmark
dr.ll@dadlnet.dk
Aim: We present the results after laparoscopic assisted
cryoablation for renal carcinoma.
Material and methods: Renal cryoablation was performed
in 27 cases in 24 patients with renal carcinoma. Pre-operative
work-up included blood samples, GFR, scintigram, ultrasound
guided core biopsy from tumor, and CT/MR scanning of chest
and abdomen. Follow-up involved blood samples, evaluation of
renal function by GFR, and CT or MRI imaging at 3 months, 6
months, 12 months, 18 months postoperative and then annually.
A cryo-lesion biopsy was performed if there was an enhancement
in the treated area. All data were prospectively accrued.
Results: We included 19 men and 5 women. Mean age was 71
years (range 49-86 years). Three patients had only one kidney.
The mean follow-up time was 18 months (3-36 months). Mean
tumor size was 3.5 cm (1.6-6.5 cm). Median ASA score was
III. Mean operating time 187 min (155-210 min) with a mean
hospital stay of 2 days (1-3 days). There was no change in
creatinin or cystatine-C after cryo-ablation. The GFR was within
normal range after treatment in all but patients with one kidney
or one functional kidney where the function declined on average
with 10%. The treatment of larger tumors was found to affect the
split renogram. Overall, 1 patient developed local recurrence
and 1 patient developed a new tumor in the previously treated
kidney. One patient developed metastatic disease. There were 4
cancer deaths.
Conclusions: Laparoscopic assisted renal cryoablation is an
effective oncologic treatment for renal carcinoma in selected
patients. Renal function is well preserved in large majority of
the patients:
20 Early pulmonary metastases in renal cell carcinoma.
- Prevalence and operability
SJ Oddsson1'4' S Hardarson2' V Petursdottir2' E Jonsson34' H Vidarsdottirl,
GV Einarsson3' T Gudbjartsson1'4
Departments of'Cardiothoracic surgery, 2Pathology and 3Urology, Landspitali
University, 4Faculty ofMedicine, University oflceland, Reykjavik lceland
saemiodds@hotmail.com
Objective: Metastases are present in 20-30% of patients
diagnosed with RCC. Pulmonary metastases are most common
and survival of these patients is usually dismal. Recently,
pulmonary metastasectomy has been shown to significantly
improve survival in a subgroup of RCC patients, especially those
with a solitary metastasis. We studied synchronous pulmonary
metastases in patients diagnosed with RCC and evaluated how
many of them could theoretically benefit from metastasectomy.
Material and methods: This is a retrospective study including
all patients diagnosed alive with RCC in Iceland between 1971
and 2000. Clinical information was obtained from patient charts,
histology was reviewed and tumors staged according to the
TNM staging system. Synchronous metastases were defined as
metastases diagnosed within 3 months after the diagnosis of
RCC.
Results: Out of 701 patients, 130 had pulmonary metastases
(18.5%). Fifty four of these patients had metastases confined to
the lungs, 38 (79%) of them with multiple metastases, including
27 (56%) with bilateral lesions. A solitary pulmonary metastasis
was detected in 10 patients (6 males, mean age 63 years). All of
these 10 patients had a resectable kidney tumor and were in good
health; however, only one of them underwent metastasectomy.
Conclusion: One out of five patients has synchronous pulmonary
metastasis at the diagnosis of RCC. In every other case these
metastases are confined to the lungs and many of them are
solitary. If solitary metastases are used as criteria for resection,
between 7-8 % of RCC patients with synchronous pulmary
metastasis could potentially be candidates for metastasectomy.
21 Incidental detection of renal cell carcinoma is an
independent prognostic marker - Results of a long term
whole population study
HB Palsdottir1'4, S Hardarson2, V Petursdottir2, A Jonsson14, E Jonsson1'4,
GV Einarsson1, T Gudbjartsson13
’Departments of Urology, 2Pathology and 3Surgery, Landspitali University
Hospital, 4Faculty of Medicine, University oflceland, Reykjavik, Iceland
hbpl@hi.is
Introduction: Increased incidence of renal cell carcinoma (RCC)
in Iceland has mainly been attributed to increase in incidental
detection due to abdominal imaging of unrelated disease.
However, the impact of incidental detection on survival has been
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