Publications by authors named "Sara V Tornberg"

5 Publications

  • Page 1 of 1

A three-feature prediction model for metastasis-free survival after surgery of localized clear cell renal cell carcinoma.

Sci Rep 2021 Apr 21;11(1):8650. Epub 2021 Apr 21.

Department of Oncology and Radiotherapy, Fican West Cancer Centre, University of Turku and Turku University Hospital, Hämeentie 11, Post Box 52, 20521, Turku, Finland.

After surgery of localized renal cell carcinoma, over 20% of the patients will develop distant metastases. Our aim was to develop an easy-to-use prognostic model for predicting metastasis-free survival after radical or partial nephrectomy of localized clear cell RCC. Model training was performed on 196 patients. Right-censored metastasis-free survival was analysed using LASSO-regularized Cox regression, which identified three key prediction features. The model was validated in an external cohort of 714 patients. 55 (28%) and 134 (19%) patients developed distant metastases during the median postoperative follow-up of 6.3 years (interquartile range 3.4-8.6) and 5.4 years (4.0-7.6) in the training and validation cohort, respectively. Patients were stratified into clinically meaningful risk categories using only three features: tumor size, tumor grade and microvascular invasion, and a representative nomogram and a visual prediction surface were constructed using these features in Cox proportional hazards model. Concordance indices in the training and validation cohorts were 0.755 ± 0.029 and 0.836 ± 0.015 for our novel model, which were comparable to the C-indices of the original Leibovich prediction model (0.734 ± 0.035 and 0.848 ± 0.017, respectively). Thus, the presented model retains high accuracy while requiring only three features that are routinely collected and widely available.
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http://dx.doi.org/10.1038/s41598-021-88177-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8060273PMC
April 2021

Serum tumour associated trypsin inhibitor, as a biomarker for survival in renal cell carcinoma.

Scand J Urol 2020 Oct 4;54(5):413-419. Epub 2020 Aug 4.

Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Objective: Tumour associated trypsin inhibitor (TATI) is a peptide that is a marker for several tumours. TATI may also behave as an acute phase reactant in severe inflammatory disease. Overexpression of TATI predicts an unfavourable outcome for many cancers. This study aimed to evaluate the prognostic value of pre- and postoperative concentration of TATI in serum (S-TATI) of patients with renal cell carcinoma (RCC).

Materials And Methods: S-TATI was determined by time resolved immunofluorometric assay in preoperative and postoperative samples that were collected from 132 RCC patients, who underwent partial or complete nephrectomy in Helsinki University Hospital from May 2005 to July 2010.

Results: Preoperative S-TATI was significantly associated with tumour stage, lymph-node involvement, metastatic stage, Chronic Kidney Disease Stage (CKD grade), and preoperative C-reactive protein level ( < 0.05). Postoperative S-TATI was significantly associated only with CKD grade ( < 0.001). Multivariate Cox regression analysis of postoperative S-TATI, as a continuous variable, was an independent prognostic factor for overall survival (HR = 1.01, 95% CI = 1.00-1.01,  = 0.03) and cancer-specific survival (CSS) (HR = 1.01, 95% CI = 1.00-1.02,  = 0.004).

Conclusions: Our data suggest that elevated postoperative S-TATI may be associated with adverse prognosis in RCC patients.
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http://dx.doi.org/10.1080/21681805.2020.1798501DOI Listing
October 2020

Surgery for metastases of renal cell carcinoma: outcome of treatments and preliminary assessment of Leuven-Udine prognostic groups in the targeted therapy era.

Scand J Urol 2018 Oct - Dec;52(5-6):419-426. Epub 2019 Jan 20.

a Department of Urology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.

Aim: This study was conducted to evaluate the efficacy of surgical treatment for metastases accompanied by modern targeted therapies and to evaluate the performance of the Leuven-Udine (L.U.) prognostic groups model.

Methods: This retrospective analysis included 97 consecutive patients with metastatic renal cell carcinoma (mR.C.C.) who underwent surgery for metastases at Helsinki University Hospital between 2006 and 2017. The endpoints were overall survival (O.S.), cancer-specific survival (C.S.S.), recurrence-free survival (R.F.S.) and interval from diagnosis to oncological treatment.

Results: The median follow-up time was 46 months (interquartile range, I.Q.R. = 24-74). The estimated median O.S. was 67 months (I.Q.R. = 30-130). A radical surgical result at metastasectomy was achieved in 46 of 97 patients (47%). Of those 46 patients, 28 (61%) experienced recurrence after complete metastasectomy. Median R.F.S. after complete metastasectomy was 10 months (I.Q.R. = 3-37). Five-year O.S. was 59% for patients with complete metastasectomy and 44% for patients with non-complete metastasectomy (p = .035). The median interval from diagnosis to the initiation of targeted oncological treatment was 19 months for patients with non-complete metastasectomy and has hitherto not been reached for patients with complete metastasectomy (p = .006). A statistically significant validation of the prognostic value of the L.U. prognostic groups for predicting C.S.S. was not obtained (p = .420).

Conclusions: Metastasectomy is an option for selected patients with mR.C.C. Complete resection should be attempted when feasible. The data failed to support the prognostic significance of the L.U. model in patients with mR.C.C.
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http://dx.doi.org/10.1080/21681805.2018.1553893DOI Listing
August 2019

Evolving Clinical Picture of Renal Cell Carcinoma: A Population-Based Study from Helsinki.

Urol Int 2019 11;102(4):390-398. Epub 2019 Jan 11.

Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: There is a lack of detailed population-based data for renal cell carcinoma (RCC).

Objectives: The study aimed to examine the contemporary changes in the clinical picture and treatment of RCC.

Methods: A total of 1,719 consecutive patients living in the Helsinki metropolitan area with a solid or cystic renal mass (Bosniak 3-4) ≥10 mm were identified. Data from medical records was evaluated for clinical characteristics and treatments in the periods I (2006-2008), II (2009-2011), III (2012-2014), and IV (2015-2016).

Results: The proportions of patients with comorbidities (Charlson index ≥2) and frailty (Eastern Co-operative Oncology Group classification ≥2) increased significantly during the study period. The percentage of clinical stage I patients, cystic tumors and use of needle biopsies increased significantly. Use of observation increased from 9% (I) to 32% (IV; p < 0.001). First-line oncological treatments within 6 months were given to 47% of 262 patients with metastases and -cytoreductive nephrectomy (CN) was delivered to 54% of those patients.

Conclusions: The size of renal tumors continued to decrease, while the percentage of patients with significant comorbidity or frailty increased. Active surveillance emerged as the initial strategy. Tyrosine kinase inhibitors with CN remained the primary option in patients with metastatic RCC.
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http://dx.doi.org/10.1159/000494363DOI Listing
January 2020

Outcome of surgery for patients with renal cell carcinoma and tumour thrombus in the era of modern targeted therapy.

Scand J Urol 2016 Oct;50(5):380-6

a Department of Urology , Helsinki University Hospital , Helsinki , Finland ;

Objective: This study evaluated the clinical outcome of patients with renal cell carcinoma (RCC) with tumour thrombus (TT) after surgical management.

Materials And Methods: In total, 142 consecutive RCC patients with TT who were operated on in Helsinki University Hospital between 2006 and 2014 were analysed. Eighty-eight (62%) of these patients had been operated on with radical intention and 54 (38%) with cytoreductive intention. A total of 73 patients (51%) received postoperative targeted therapy. The primary endpoint was cancer-specific survival (CSS).

Results: The 5 year CSS for level of involvement of TT in the renal vein, subdiaphragmatic vena cava and supradiaphragmatic vena cava was 60% (81 patients), 43% (52 patients) and 51% (nine patients), respectively (p = .42). The median CSS for lymph-node involvement was 63 months for patients with no lymph-node involvement but 10 months for patients with lymph-node involvement (p < .01). The median CSS for metastasis status was 63 months for patients with no metastases compared with 18 months for patients with metastases (p < .01). Among several factors examined, WHO performance status (p = .04), tumour necrosis (p = .05), presence of distant metastases (p = .04) and tumour histology (p = .05) were associated with CSS in the multivariate analysis.

Conclusions: Operative treatment for RCC with TT is associated with good prognosis when there is no lymph-node involvement or distant metastases.
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http://dx.doi.org/10.1080/21681805.2016.1217558DOI Listing
October 2016
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