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Paul Russo

Publications and source records attributed to Paul Russo.

At least 19 recordsLinked to original sources
PubMed2025

Long-term oncologic outcomes of metastatic clear-cell renal cell carcinoma after local therapy alone.

PURPOSE: Oligometastatic clear-cell renal cell carcinoma (ccRCC) represents a heterogeneous entity that can, in select cases, be managed with primary tumor resection and complete local treatment at all metastatic sites, rendering a patient metastatic with no evidence of disease (M1 NED). M1 NED patients have improved overall survival, although previous cohorts are relatively small and heterogeneous. We sought to identify the natural history of M1 NED ccRCC to clinical trial findings and to optimize management strategies. MATERIALS AND METHODS: Patients with synchronous metastatic ccRCC treated with local therapy alone and considered radiographically M1 NED at our institution between 1989 and 2023 were retrospectively evaluated. Survival probabilities used a combination of Kaplan-Meier estimator, log-rank test, and multivariable Cox proportional hazards regression. When available, limited genomic data obtained using the MSK-IMPACT targeted panel was correlated with outcomes. RESULTS: 85 patients met inclusion criteria. One-year disease free survival (DFS) was 53% (95% CI: 42 to 63%). Sarcomatoid features predicted shorter DFS (HR 2.62, CI: 1.08, 6.34, P = 0.03). Time from first disease recurrence to second recurrence was longer among patients with initial DFS ≥2 years (median 42 vs. 15 months, log-rank P = 0.005). A total of 18 patients (21%) underwent targeted genomic sequencing; higher fraction of genome altered and CDKN2A copy number loss were associated with shorter DFS. Findings were limited by cohort size. CONCLUSIONS: Most M1 NED ccRCC patients will experience disease recurrence, although certain baseline risk factors appear to predict earlier recurrence. Prognostic biomarkers are needed to predict outcomes and facilitate patient management.

Humans↗
PubMed2007

Leydig cell tumor after treatment for Ewing's sarcoma.

Leydig cell tumors account for 3% of testicular tumors and have never been reported after treatment for Ewing's sarcoma. We report the unusual occurrence of a patient who developed a Leydig cell tumor of the testis 18 years after successful treatment for Ewing's sarcoma. Additional monitoring for second malignancies may become appropriate as long-term survival continues to improve for patients with Ewing's sarcoma.

Adult↗
PubMed2007

Predicting the histology of renal masses using preoperative Doppler ultrasonography.

PURPOSE: Traditional imaging techniques cannot differentiate among benign, indolent and malignant renal neoplasms. Since conventional clear cell carcinomas are highly vascular, we used preoperative color and/or power Doppler ultrasonography to evaluate the association between vascular flow in a renal mass and surgical pathology. MATERIALS AND METHODS: Nephrectomies performed at our institution between January 2001 and December 2004 were retrospectively evaluated. Any detection of flow in the renal mass on color Doppler ultrasonography was defined as vascular flow. A prospective validation study was then performed from January 2005 to October 2005 and a nomogram was constructed to predict clear cell histology. RESULTS: Of 299 renal lesions in the retrospective cohort 210 (70%) had evidence of vascular flow, including 156 of 169 conventional clear cell carcinomas (92%) (p <0.0001). On logistic regression analysis vascular flow was associated with conventional clear cell histology (OR 16.9, 95% CI 8.7-32.8; p <0.0001). This finding was validated prospectively in 97 patients. Vascular flow was detected in 54 of 65 renal masses (83%) with conventional clear cell histology (p <0.0001), which was associated with an OR of 10.8 (95% CI 4.0-29.0; p <0.0001). A nomogram incorporating vascular flow along with clinical variables (clinical size, patient sex and age) to predict conventional clear cell histology was constructed on the retrospective cohort and validated on the prospective data set (concordance index 0.82 and 0.76, respectively). CONCLUSIONS: Vascular flow detected by color Doppler ultrasonography is strongly associated with conventional clear cell histology. A nomogram incorporating vascular flow on color Doppler ultrasonography and clinical parameters may aid in the preoperative characterization of renal lesions.

Adult↗
PubMed2006

Treatment outcome for metastatic papillary renal cell carcinoma patients.

BACKGROUND: Most clinical trial reports in metastatic renal cell carcinoma (RCC) do not distinguish between histologic subtypes, making it difficult to assess specific treatment efficacy. The current retrospective study sought to define clinical features and outcome data for metastatic papillary RCC. METHODS: Clinical features, treatment outcome, and survival were evaluated in 38 patients with metastatic papillary RCC who underwent clinical evaluation at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1985 and 2005. Twenty-three of 513 individuals were identified from a clinical trial database, 14 of 1895 from a surgery database, and 1 of 357 from a pathology database. A literature review of systemic therapy in metastatic papillary RCC was performed. RESULTS: Among the 38 patients, 30 had been treated at MSKCC with various systemic therapies, including cytokines. Twelve therapies resulted in stable disease, 30 in initial progression of disease, and 1 in an unknown response. One patient had a partial response to sunitinib, a novel multitargeted tyrosine kinase inhibitor. The median overall survival time for the entire study group was 8 months (95% confidence interval, 5-12). A literature review on treatment of metastatic papillary RCC produced 4 reports, confirming a lack of efficacy for systemic therapy. CONCLUSIONS: A resistance to systemic therapy characterizes patients with metastatic papillary RCC. Further understanding of the genetics and molecular biology and subtypes involved may provide the basis for more effective agents. Treatment with targeted therapies or other experimental agents is warranted.

Adult↗
PubMed2006

Impact of positive surgical margins in patients undergoing partial nephrectomy for renal cortical tumours.

OBJECTIVE: To evaluate the clinical outcome of patients undergoing partial nephrectomy (PN) for renal cortical tumours who had a positive surgical margin (SM), as recent studies have shown that a minimal SM is required to achieve equivalent disease-free survival (DFS). PATIENTS AND METHODS: Between 1989 and 2005, 777 PNs were performed at the authors' institution. Clinical and pathology data were obtained from our prospective surgical database after obtaining institutional review board approval. Variables were analysed in a logistic regression model to determine predictors of positive SMs. The clinical outcome was reported for local recurrence and distant metastasis and analysed using the log-rank test. RESULTS: Of the 777 PNs, the SM status was documented in 770; the SMs were positive in 57 of 770 (7%). Positive SMs occurred in 33 of 423 (8%) patients with tumours of high malignant potential, and in 24 of 347 (7%) patients with tumours of low malignant potential. On multivariate analysis, an imperative indication for a PN was a significant predictor for a positive SM (P = 0.003). With a median follow-up for survivors of 22 months, there was a local recurrence in two of 57 (4%) patients with a positive SM and four of 713 (0.5%) with a negative SM. No patients with a tumour of low malignant potential had a recurrence, despite having a positive SM. CONCLUSIONS: Although local recurrence after PN for renal cortical tumours is rare, our data suggest that patients with a tumour of high malignant potential and a positive SM might have a higher incidence of local recurrence.

Disease-Free Survival↗
PubMed2006

Long-term response with sunitinib for metastatic renal cell carcinoma.

A 65-year-old man with metastatic renal cell carcinoma developed progressive disease after treatment with interferon-alpha. He began treatment with sunitinib, a multitargeted tyrosine kinase inhibitor, on clinical trial. The patient achieved a partial response after two cycles of therapy, with a durable response continuing after 2 years of treatment. This case report illustrates the long-term response to sunitinib for patients with metastatic renal cell carcinoma.

Aged↗
PubMed2006

Renal cell carcinoma recurrence after nephrectomy for localized disease: predicting survival from time of recurrence.

PURPOSE: Prognostic factors for patients with metastatic renal cell carcinoma (RCC) are well established. However, the risk profile is unknown for patients with recurrent RCC after a nephrectomy for localized disease. PATIENTS AND METHODS: From January 1989 to July 2005, we identified patients with localized RCC treated by nephrectomy who subsequently developed recurrent disease. We applied a validated prognostic scoring system previously developed for patients with metastatic RCC. Each patient was given a total risk score of 0 to 5, with one point for each of five prognostic variables (recurrence < 12 months after nephrectomy, serum calcium > 10 mg/dL, hemoglobin < lower limit of normal, lactate dehydrogenase > 1.5x upper limit of normal, and Karnofsky performance status < 80%). Patients were categorized into low- (score = 0), intermediate- (score = 1 to 2), and high-risk subgroups (score = 3 to 5). RESULTS: Our final cohort included 118 patients, with a median survival time of 21 months from the time of recurrence. Median follow-up time for survivors was 27 months. Overall survival was strongly associated with risk group category (P < .0001). Low-risk, intermediate-risk, and high-risk criteria were fulfilled in 34%, 50%, and 16% of patients, respectively. Median survival time for low-risk, intermediate-risk, and high-risk patients was 76, 25, and 6 months, respectively. Two-year overall survival rates for low-risk, intermediate-risk, and high-risk patients were 88% (95% CI, 77% to 99%), 51% (95% CI, 37% to 65%), and 11% (95% CI, 0% to 24%), respectively. CONCLUSION: At disease recurrence after nephrectomy for localized disease, a scoring system based on objective clinical and laboratory data provides meaningful risk stratification for both patient counseling and clinical trial entry.

Aged↗
PubMed2006

Phase II trial of intravesical gemcitabine in bacille Calmette-Guérin-refractory transitional cell carcinoma of the bladder.

PURPOSE: The aim of this phase II study was to determine the efficacy of gemcitabine administered as an intravesical agent in patients with bacille Calmette-Guérin (BCG) -refractory transitional cell carcinoma of the bladder. PATIENTS AND METHODS: Patients with superficial bladder cancer refractory or intolerant to intravesical BCG therapy and refusing a cystectomy were considered eligible for the trial. Eligible patients received two courses of intravesical gemcitabine twice weekly at a dose of 2,000 mg/100 mL for 3 consecutive weeks, with each course separated by 1 week of rest. Patients were evaluated for response at 8 weeks, then every 3 months to 1 year. RESULTS: Thirty eligible patients were included on study. The median follow-up for all the patients was 19 months (range, 0 to 35 months). Of the 30 patients, 15 (50%; 95% CI, 32% to 68%) achieved a complete response (CR). Twelve patients had tumor recurrence with a median recurrence-free survival time of 3.6 months (95% CI, 2.9 to 11.0 months). Two patients maintained a CR at 23 and 29 months, respectively. The 1-year recurrence-free survival rate for patients with a CR was 21% (95% CI, 0% to 43%). Two patients progressed to a higher stage while receiving gemcitabine treatment. The median follow-up for patients who did not have a progression or a cystectomy was 19 months (range, 2 to 35 months). Eleven patients (37%) underwent a cystectomy subsequent to gemcitabine therapy. CONCLUSION: Gemcitabine has activity in a high-risk patient population and remains a viable option for some patients who refuse cystectomy.

Administration, Intravesical↗
PubMed2006

Individualized therapy of disseminated cancer using malignant melanoma as a model.

Approximately 20 to 25% of patients with malignant melanoma will die of metastatic disease. The current standards of care for advanced metastatic melanoma (stage IV, AJCC classification) are poor. To date, randomized trials have failed to demonstrate that one regimen is better than another. It is therefore crucial that patients with disseminated malignant melanoma be recruited into clinical trials. In recent years, there have been impressive advances in our knowledge of the biology and nature of cancer development and the growth and progression to metastasis. The approach "from bench to bedside" is current reality in the treatment of several solid tumors and hematologic malignancies. The identification of new targets to facilitate individualized melanoma treatment is now an important issue. This article will give an overview of recent developments in clinical trials of targeted therapies in metastatic melanoma patients.

Angiogenesis Inhibitors↗
PubMed2006

Prognostic nomogram for renal insufficiency after radical or partial nephrectomy.

PURPOSE: We analyzed prognostic factors to predict renal insufficiency after partial or radical nephrectomy. We developed and performed internal validations of a postoperative nomogram for this purpose. We used a prospectively updated renal tumor database of more than 1,500 patients. MATERIALS AND METHODS: From July 1989 to October 2003, 161 partial nephrectomies and 857 radical nephrectomies performed at Memorial Sloan-Kettering Cancer Center for renal cortical tumors were analyzed. Computerized tomography images were reviewed by a single radiologist. Kidney volume was calculated using the ellipsoid formula, V = L1 x L2 x L3 x pi/6, where V represents volume and L represents length. Renal insufficiency was defined by 2 serum creatinine values greater than 2.0 mg/dl at least 1 month postoperatively. Tumor histology was not an exclusion criterion and yet we excluded cases of bilateral synchronous disease. Prognostic variables were preoperative serum creatinine, American Society of Anesthesiologists score, percent change in kidney volume after surgery, and patient age and sex. RESULTS: Renal insufficiency was noted in 105 of the 857 patients with radical nephrectomy (12.3%) and in 6 of the 161 with partial nephrectomy (3.7%) studied. Patients had a median followup of 21.2 months (maximum 157.9). The 7-year probability of freedom from renal insufficiency in the cohort was 79.1% (95% CI 74.6 to 83.6). The nomogram was designed based on a Cox proportional hazards regression model. Following internal statistical validation nomogram predictions appeared accurate and discriminating with a concordance index of 0.835. CONCLUSIONS: A nomogram was developed that can predict the 7-year probability of renal insufficiency in patients undergoing radical or partial nephrectomy.

Adolescent↗
PubMed2006

Temporary renal ischemia during nephron sparing surgery is associated with short-term but not long-term impairment in renal function.

PURPOSE: The emergence of laparoscopic nephron sparing surgery has rekindled interest in the impact of warm renal ischemia on renal function. To provide data with which warm renal ischemia can be compared we analyzed short-term and long-term changes in the glomerular filtration rate after temporary cold renal ischemia. MATERIALS AND METHODS: In patients undergoing open nephron sparing surgery the estimated glomerular filtration rate was assessed preoperatively, early in the postoperative hospital stay, and 1 and 12 months after surgery using the abbreviated Modification of Diet in Renal Disease Study equation. We separately analyzed 70 patients with a solitary kidney and 592 with 2 functioning kidneys. The end point was the percent change from the baseline glomerular filtration rate. A linear regression model was used to test the association between the glomerular filtration rate change, and ischemia time, patient age, tumor size, estimated blood loss and intraoperative fluid administration. RESULTS: Median cold ischemia time was 31 minutes in patients with a solitary kidney and 35 minutes in those with 2 kidneys. Compared to patients with 2 kidneys those with a solitary kidney had a significantly lower preoperative estimated glomerular filtration rate (p < 0.001), which decreased a median of 30% during the early postoperative period, and 15% and 32% 1 and 12 months after surgery, respectively. In patients with 2 kidneys the corresponding glomerular filtration rate decreases were 16%, 13% and 14%, respectively. On multivariate analyses in each group cold ischemia duration and intraoperative blood loss were significantly associated with early glomerular filtration rate changes. However, 12 months after surgery age was the only independent predictor of a glomerular filtration rate decrease in patients with 2 kidneys. CONCLUSIONS: Cold renal ischemia during nephron sparing surgery is a significant determinant of the short-term postoperative glomerular filtration rate. Longer clamping time is particularly detrimental in patients with a solitary kidney but it does not appear to influence long-term renal function. Patients of advanced age may be less likely to recover from acute ischemic renal injury.

Aged↗
PubMed2006

Adult genitourinary sarcoma: the 25-year Memorial Sloan-Kettering experience.

PURPOSE: Urological sarcomas are rare. We describe a continued single institutional experience during 25 years. MATERIALS AND METHODS: The records from July 1977 to July 2003 were reviewed of all patients at our institution with sarcoma arising in the urinary tract or male genital system who were 16 years or older at diagnosis. RESULTS: The primary tumor site in 131 patients was the bladder in 20, the kidney in 26, paratesticular in 57, the prostate in 21 and other in 7. Median followup was 4.0 years. The most common histological subtypes were leiomyosarcoma in 29% of cases and liposarcoma in 26%. Median tumor size was 7 cm and 78% of lesions were high grade. Of the patients 28 (21%) presented with metastatic disease and their median survival was 1.4 years compared to 10.7 years in patients without metastatic disease (p < 0.0001). Disease specific survival was 56% and 42% at 5 and 10 years, respectively and median survival was 7.6 years. On univariate analysis unfavorable prognostic variables for disease specific survival were metastasis at presentation, high tumor grade, a lack of leiomyosarcoma and liposarcoma histological subtypes, prostate sarcoma and large tumor size, incomplete surgical resection and positive surgical margin. Patient sex, age and surgical margin status were not significant predictors. On multivariate analysis 2 variables remained significant predictors of disease specific survival, including tumor size (HR 1.1, 95% CI 1.02 to 1.17) and absent metastasis at diagnosis (HR 4.9, 95% CI 1.4 to 17.2). CONCLUSIONS: Predictors of disease specific survival include local disease at presentation, complete tumor resection and tumor grade, size, location and histological subtype. With adequate surgical treatment most patients who presented with primary disease and underwent complete surgical resection achieved prolonged disease specific survival.

Adolescent↗
PubMed2006

Incidence of benign lesions for clinically localized renal masses smaller than 7 cm in radiological diameter: influence of sex.

PURPOSE: We determined the incidence of benign renal lesions in patients undergoing definitive surgery for localized renal masses 7 cm or less in maximum radiological diameter, and assessed preoperative and clinical parameters associated with benign histology. MATERIALS AND METHODS: The records of 1,184 patients who underwent consecutive partial or radical nephrectomies between January 2000 and January 2005 were retrospectively reviewed. We excluded 208 patients with lesions more than 7 cm in maximum radiological diameter, 17 with evidence of renal vein or vena caval invasion, 75 with suspected or documented metastatic disease, 28 with a history of renal cell carcinoma and 41 with no available imaging. Logistic regression was done to determine clinical factors associated with benign renal masses, including radiological tumor size, cystic vs solid appearance, patient sex, age, presenting symptoms and race. RESULTS: Of 815 nephrectomies in our data set 134 (16.4%) were associated with benign lesions, including oncocytoma in 87 (10.7%), angiomyolipoma in 17 (2%), simple cysts in 10 (1.2%), metanephric adenoma in 8 (1%), cystic nephroma in 5 (0.6%) and other in 7. On multivariate logistic regression analysis only sex was significantly associated with benign histology with females having an OR of 1.8 (95% CI 1.2 to 2.6, p = 0.002). Tumor size was not independently associated with benign histology (p = 0.13). CONCLUSIONS: A significant number (16.4%) of benign lesions less than 7 cm in radiological diameter were operated on based on suspicious preoperative imaging. Women had almost twice the likelihood of having a benign lesion.

Adenoma, Oxyphilic↗
PubMed2006

Perioperative clinical thromboembolic events after radical or partial nephrectomy.

OBJECTIVES: To evaluate the incidence of, and identify the risk factors for, clinical thromboembolic events after radical/partial nephrectomy. Cancer is an established risk factor for deep vein thrombosis (DVT) and pulmonary embolism (PE); however, their incidence after nephrectomy for renal tumors has been poorly studied. METHODS: We reviewed our prospective institutional renal database and identified 2208 patients who underwent renal tumor surgery from January 1989 to July 2005. The clinical parameters evaluated were age, sex, race, body mass index, smoking history, medical comorbidities, American Society of Anesthesia grade, procedure type, estimated blood loss, and length of hospitalization. Hospital records, discharge "International Classification of Diseases, Ninth Revision" codes, and 30-day postoperative morbidity and mortality data were reviewed to identify patients diagnosed with perioperative DVT or PE. RESULTS: A total of 34 (1.5%, 95% confidence interval 1.1% to 2.1%) thromboembolic events (20 PEs and 14 DVTs) were identified in 33 patients. Patients with a preoperative history of arrhythmia (P = 0.02) or prior DVT (P = 0.053) were more likely to experience PE. The estimated blood loss was directly associated with an increased risk of PE (P = 0.001). Patients with coronary artery disease (P = 0.050) or of advanced age (P = 0.02) were more likely to experience DVT (P = 0.02). CONCLUSIONS: To our knowledge, this is the first study on the incidence of thromboembolic events after nephrectomy. Thromboembolic events are rare but are more likely to occur in patients with coronary artery disease, cardiac arrhythmia, prior DVT, Stage 3 or 4 tumors, or a large estimated blood loss.

Aged↗
PubMed2006

Impact of body mass index on survival of patients with surgically treated renal cell carcinoma.

PURPOSE: Population studies link increased BMI with an increased risk of cancer and cancer mortality and in particular a greater risk of RCC. We evaluated the impact of BMI and other clinical/pathological characteristics on survival in patients with RCC treated with radical or partial nephrectomy. MATERIALS AND METHODS: Between 1995 and 2003 patients undergoing radical (760) or partial (399) nephrectomy for RCC were entered into a database. BMI data were available on 1,137 of 1,159 (98%). Demographic and clinical/pathological parameters were analyzed. World Health Organization BMI definitions (normal-less than 25 kg/m(2), overweight-25 to 29.9 kg/m(2), obese-30 kg/m(2) or more) were used. RESULTS: A total of 75% of patients had greater than normal BMI with 472 (41.5%) overweight and 387 (34.0%) obese. Median followup was 33 months with a median overall survival of 110 months and a 5-year overall survival probability of 0.79. BMI categories were similar in age, gender, smoking status, presenting symptoms, tumor size, stage, and type of surgery. Significant increases in blood loss and operative time (p <0.05) were seen with increasing BMI. Although BMI 30 kg/m(2) or greater was associated with a higher proportion of clear cell histology (p = 0.002), it did not translate into an increased pathological stage, or incidence of metastasis. Multivariate analysis revealed age older than 65 years, systemic symptoms, surgery type, and pathological stage impacted overall survival (p <0.05). CONCLUSIONS: Although an increased BMI was associated with a greater proportion of clear cell histology, comorbidity, and surgical morbidity, BMI did not adversely impact overall or progression-free survival.

Aged↗
PubMed2006

Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study.

BACKGROUND: Chronic kidney disease is a graded and independent risk factor for substantial comorbidity and death. We aimed to examine new onset of chronic kidney disease in patients with small, renal cortical tumours undergoing radical or partial nephrectomy. METHODS: We did a retrospective cohort study of 662 patients with a normal concentration of serum creatinine and two healthy kidneys undergoing elective partial or radical nephrectomy for a solitary, renal cortical tumour (</=4 cm) between 1989 and 2005 at a referral cancer centre. Glomerular filtration rate (GFR) was estimated with the abbreviated Modification in Diet and Renal Disease Study equation. Separate analysis was undertaken, with chronic kidney disease defined as GFR lower than 60 mL/min per 1.73 m(2) and GFR lower than 45 mL/min per 1.73 m(2). FINDINGS: 171 (26%) patients had pre-existing chronic kidney disease before surgery. After surgery, the 3-year probability of freedom from new onset of GFR lower than 60 mL/min per 1.73 m(2) was 80% (95% CI 73-85) after partial nephrectomy and 35% (28-43; p<0.0001) after radical nephrectomy; corresponding values for GFRs lower than 45 mL/min per 1.73 m(2) were 95% (91-98) and 64% (56-70; p<0.0001), respectively. Multivariable analysis showed that radical nephrectomy remained an independent risk factor for patients developing new onset of GFR lower than 60 mL/min per 1.73 m(2) (hazard ratio 3.82 [95% CI 2.75-5.32]) and 45 mL/min per 1.73 m(2) (11.8 [6.24-22.4]; both p<0.0001). INTERPRETATION: Because the baseline kidney function of patients with renal cortical tumours is lower than previously thought, accurate assessment of kidney function is essential before surgery. Radical nephrectomy is a significant risk factor for the development of chronic kidney disease and might no longer be regarded as the gold standard treatment for small, renal cortical tumours.

Adult↗