Thread by @ChangUCanSpare

About to give SIU IM Grand Rd on my favorite talk on #onconephrology, a topic that launched my academic career and contains message that more urologists, pathologists, and nephrologists need to hear. Will tweet more slides later

There has been a large increase in the incidence of kidney cancer in the last 10 yrs, probably from increased imaging and definitely more detection of T1 tumors

In the 1980s, ~40% of kidney cancers were T1 tumors, but now it is >60%. At most academic centers this number can approach 90%.

Note the 5 yr survival rate. Essentially, most T1 tumors are cured after surgery

These independent risk factors for kidney cancer also happen to be major causes of chronic kidney disease / ESKD, so you shouldn't be surprised when I tell you later about all the #renalpath that is present

Nice review on the relationship between CKD and RCC
nature.com/articles/nrnep…

Remember that the end-stage kidney has a 100 fold increase risk of developing kidney cancer. Similar to how hepatocellular carcinoma develops in cirrhosis

Urologists were the first to note that partial nephrectomy had better clinical outcomes than radical nephrectomy due to renal function preservation, even though oncologic outcomes were similar. Thus, the current movement towards nephron-sparing surgery, whenever possible

Remember: most T1 tumors are indolent

This fascinating review of deceased donor kidneys emphasizes this point -where an incidental RCC was resected during procurement and the kidney was still transplanted & had excellent outcomes (only 1 recurrence)
doi.org/10.1111/ctr.12…

In contrast, CKD/ESKD kills >100,000 Americans every yr, which is more than the #1 female malignancy (breast cancer) and the #1 male malignancy (prostate ca).

So renal function preservation and the identification of non-neoplastic renal dzs matter a great deal in kidney cancer patients, b/c they are very common. This is the 1st comprehensive study on the topic from @VBijol

doi.org/10.1097/01.pas…

Our study on this topic focused on how frequently these dzs were missed almost 90% of the time. And mostly due to the fact that most pathology residents receive no exposure to #renalpath

doi.org/10.1097/PAS.0b…

And if you don't believe the data from Boston and Chicago. Here is an abstract from LA and the largest study from NYC

doi.org/10.5858/arpa.2…

For pathologists, most use @Pathologists cancer protocol templates for synoptic reporting with these 14 required parameters

Of the 14 required parameters, I used to think that margin status would be the most important one, but several studies argue against its importance, including this nice one from my colleague, Tatjana Antic

doi.org/10.1309/AJCP7L…

If margin status is not important for T1 tumors, then diagnosing non-neoplastic renal dzs is the most important. This requires better coordinated care between urologists, pathologists, and nephrologists, and clearly there remains a lot of room for improvement. /End