Does the embolization of the tumor, prior to radical nephrectomy, prologs the life of patients with renal cell carcinoma

1
Does the embolization of the tumor, prior to
radical nephrectomy, prologs the life of patients
with renal cell carcinoma
L. Swiebocki, J. Lorenz,

• Department of Urology Regional Specialistic
  Hospital , Wroclaw
• Clinic of Urology Medical Academy, Wroclaw

2
Patients

• Cohort of 441 patients with RCC
• 178 women and 263 men
• embolizing patients - group E 180 (W- 68, M-112)
• 82/180 - embolization was the treatment of
  last resort
• 98/180 - radical nephrectomy done
  after embolization

3
Patients
Group E

• 98 - nephrectomised after embolization
  compared
• 261 - control group 110 - women and 151 -
  men nephrectomised during last 10 years

Group K
4
Comparison of groups E and K according to sex
Group E
38
68
112
62
Women Men


Group K
chi-square test - group E and K
42
110
151

• Both groups were statistically equal according to
  sex

58
5
Comparison of groups E and K according to age

• Both groups were statistically equal according to
  age

U Mann-Whitneys test
6
Distant metastases
7
Comparison of groups E and K according to tumor
grade

• Both groups were statistically equal according to
  tumor stage

chi-square test - group E and K
8
Tumor stage - TNM classification
9
Tumor stage - TNM classification

• Both groups were not equal statistically
  according do tumor stage

chi-square test - group E and K
10
Groups of patients chosen for statistic analysis

• Group E - from 97 embolized and nephrectomised
  patients , 91 with complete follow-up were
  separate
• Group K - from 261 nephrectomised patients, 91
  patients with the same tumor stage, lymph node
  status, metastases and tumor grade were chosen

11
Comparison of new groups E and K according to age

• Both groups were statistically equal

12
Embolizing agents

• Ethanol - 134 cases
• Ethanol Gelfoam - 32 cases
• Ethanol Gianturco coil - 4 cases
• Gianturco coil gel foam - 2 cases
• Gelfoam - 8 cases

13
Mechanism of alcohol ablation

• perivascular necrosis
• sluding of erythrocytes in small arteries
• small artery spasms
• endothelial damage and sloughing leading to
  occlusion
• denaturation of blood proteins and injuries of
  the vascular endothelium inciting an intense
  thrombosis

14
Delay nephrectomy

• Varied from 3 to 273 days
• 75 of patients were nephrectomised before 47 day

15
Influence of delaying surgical treatment for
better survival rate
Group 1 time of delay until 30 days Group 2 time
of delay 30-60 days Group 3 time of delay over 60
days
16
Comparison of general survival rateKaplan-Meiers
curves

• Survival rate for E group patients was better,
  statistically significant p lt 0,01

17
Comparison of 5-year survival rate - I5
18
Comparison of 10-year survival rate - I10
19
Influence of delaying surgical treatment for
better survival rate
Kaplan-Meiers curves and F Cox - test, apparent
difference in the median survival time
20
Impact of embolization on the general condition
of the patients in stage IV RCC

• Most of the patients within the study group had
  advanced cancer. Their general conditions at the
  time of diagnosis were very poor.
• Together with general weakness, symptoms of
  circulatory insufficiency were also often
  present. These were easily fatigability,
  peripheral edema.
• The effect of embolization on half of all
  patients with unfavorable clinical symptoms
  resulting from the presence of advanced cancer,
  made it possible to undertake further surgical
  treatment.

21
Haematuria
Percentage of patients with haematuria after
embolization was significantly lower p lt 0,0001
22
Loss of weight
Percentage of patients with loss of weight after
embolization was significantly lower, p lt 0,0001
23
Loss of apetite
Percentage of patients with loss of appetite
after embolization was significantly lower
24
Anemia
Percentage of patients with anemia after
embolization was significantly lower p lt 0,0001
25
Conclusions

• Embolization prior to nephrectomy performed in
  not infiltrating tumors prolongs the life of
  patients
• Delaying of nephrectomy for 30-60 days after
  embolization provides to improve survival rate
• Embolization performed in infiltrating kidney
  tumors didnt prolong the life but was of value
  in improving the clinical status of patients