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Laterality in Renal Cancer: Effect on Survival in Veteran Population
Background
Kidney and renal pelvis cancers (KC) represent 4% of new cancer cases in the US. Although it is a common cancer, there is no data to compare the effect of laterality on survival in veteran population. In this abstract, we attempt to bridge this gap and compare the effect of laterality on survival.
Methods
We obtained data from Albany VA (VAMC) for patients diagnosed with KC between 2010-2020. Data were analyzed for age, stage at diagnosis, histopathological type, laterality of tumor, and 6,12 and 60-months survival after the diagnosis and performed a comparison of overall survival of left versus rightsided cancer by calculating odds ratio using logistic regression, significance level was established at p< 0.05.
Results
We reviewed 130 patients diagnosed with KC at VAMC. 62 had right-sided, 62 had left-sided, and 6 had bilateral cancer. Clear cell (40.8%) was predominant type. Other less common histopathological types include Papillary RCC, mixed, papillary urothelial and transitional types. 58 patients had stage 1 (28 right versus 30 left), 8 had stage 2 (5 versus 3), 29 had stage 3 (13 versus 16), 16 with stage 4 (12 versus 4), and 14 had stage 0 (papillary-urothelial). 59.2% patients underwent surgical treatment after diagnosis (R=35, L=39). At 6-months, 60 patients (96.8%) with left-sided and 53 (85.5%) with right-sided cancer survived. The odds of surviving 6-months were 12% higher (95% CI: 1.014, 1.236; p=0.03) in left versus right-sided cancer. For 1-year survival, the results were similar. 111 patients completed a 5-year follow-up and there was no evidence to support a difference in survival between cohorts at 5-years: OR (95% CI: 0.88, 1.47; p=0.32).
Conclusions
In this study, we discovered that leftsided cancer showed better survival at 6-months and 1-year compared to right-sided cancer, but 5-year survival rates appeared similar irrespective of laterality of cancer. Both subgroups had similar distribution for baseline characteristics with majority of patients being males, older than 60 years, with stage 1 disease. Further studies in larger populations with wider distribution of baseline characteristics are needed to establish clear role of laterality as a prognostic factor.
Background
Kidney and renal pelvis cancers (KC) represent 4% of new cancer cases in the US. Although it is a common cancer, there is no data to compare the effect of laterality on survival in veteran population. In this abstract, we attempt to bridge this gap and compare the effect of laterality on survival.
Methods
We obtained data from Albany VA (VAMC) for patients diagnosed with KC between 2010-2020. Data were analyzed for age, stage at diagnosis, histopathological type, laterality of tumor, and 6,12 and 60-months survival after the diagnosis and performed a comparison of overall survival of left versus rightsided cancer by calculating odds ratio using logistic regression, significance level was established at p< 0.05.
Results
We reviewed 130 patients diagnosed with KC at VAMC. 62 had right-sided, 62 had left-sided, and 6 had bilateral cancer. Clear cell (40.8%) was predominant type. Other less common histopathological types include Papillary RCC, mixed, papillary urothelial and transitional types. 58 patients had stage 1 (28 right versus 30 left), 8 had stage 2 (5 versus 3), 29 had stage 3 (13 versus 16), 16 with stage 4 (12 versus 4), and 14 had stage 0 (papillary-urothelial). 59.2% patients underwent surgical treatment after diagnosis (R=35, L=39). At 6-months, 60 patients (96.8%) with left-sided and 53 (85.5%) with right-sided cancer survived. The odds of surviving 6-months were 12% higher (95% CI: 1.014, 1.236; p=0.03) in left versus right-sided cancer. For 1-year survival, the results were similar. 111 patients completed a 5-year follow-up and there was no evidence to support a difference in survival between cohorts at 5-years: OR (95% CI: 0.88, 1.47; p=0.32).
Conclusions
In this study, we discovered that leftsided cancer showed better survival at 6-months and 1-year compared to right-sided cancer, but 5-year survival rates appeared similar irrespective of laterality of cancer. Both subgroups had similar distribution for baseline characteristics with majority of patients being males, older than 60 years, with stage 1 disease. Further studies in larger populations with wider distribution of baseline characteristics are needed to establish clear role of laterality as a prognostic factor.
Background
Kidney and renal pelvis cancers (KC) represent 4% of new cancer cases in the US. Although it is a common cancer, there is no data to compare the effect of laterality on survival in veteran population. In this abstract, we attempt to bridge this gap and compare the effect of laterality on survival.
Methods
We obtained data from Albany VA (VAMC) for patients diagnosed with KC between 2010-2020. Data were analyzed for age, stage at diagnosis, histopathological type, laterality of tumor, and 6,12 and 60-months survival after the diagnosis and performed a comparison of overall survival of left versus rightsided cancer by calculating odds ratio using logistic regression, significance level was established at p< 0.05.
Results
We reviewed 130 patients diagnosed with KC at VAMC. 62 had right-sided, 62 had left-sided, and 6 had bilateral cancer. Clear cell (40.8%) was predominant type. Other less common histopathological types include Papillary RCC, mixed, papillary urothelial and transitional types. 58 patients had stage 1 (28 right versus 30 left), 8 had stage 2 (5 versus 3), 29 had stage 3 (13 versus 16), 16 with stage 4 (12 versus 4), and 14 had stage 0 (papillary-urothelial). 59.2% patients underwent surgical treatment after diagnosis (R=35, L=39). At 6-months, 60 patients (96.8%) with left-sided and 53 (85.5%) with right-sided cancer survived. The odds of surviving 6-months were 12% higher (95% CI: 1.014, 1.236; p=0.03) in left versus right-sided cancer. For 1-year survival, the results were similar. 111 patients completed a 5-year follow-up and there was no evidence to support a difference in survival between cohorts at 5-years: OR (95% CI: 0.88, 1.47; p=0.32).
Conclusions
In this study, we discovered that leftsided cancer showed better survival at 6-months and 1-year compared to right-sided cancer, but 5-year survival rates appeared similar irrespective of laterality of cancer. Both subgroups had similar distribution for baseline characteristics with majority of patients being males, older than 60 years, with stage 1 disease. Further studies in larger populations with wider distribution of baseline characteristics are needed to establish clear role of laterality as a prognostic factor.
Double Hit: Epstein-Barr Virus Causing Infectious Mononucleosis Followed by Hemolytic Uremic Syndrome
Introduction
Epstein-Barr virus (EBV) is a herpes virus that commonly causes infectious mononucleosis (IM) and linked to different hematological conditions. Here we present a case of EBV-triggered Hemolytic Uremic Syndrome (HUS) with pulmonary involvement.
Case Presentation
A 20-year-old male presented with fever, thrombocytopenia, and splenomegaly. Acute EBV serology was positive. Creatinine and hemoglobin were normal. He was diagnosed with IM. platelet count improved within 3 weeks. 4 weeks later, he returned with severe hemoptysis. Hgb 6.8g/dL, platelet 133,000/uL, lactate dehydrogenase 969u/L, creatinine 21mg/dL, and schistocytes on peripheral smear. Chest computed tomography showed bilateral opacities consistent with diffuse alveolar hemorrhage (DAH). Emergent hemodialysis and plasmapheresis were started. Infectious work up was negative. Autoimmune work up was also negative (anti-neutrophil cytoplasmic, anti-basement membrane antibodies, ANA). Aadamts13 activity was 62% (normal ~66%) ruling out thrombotic thrombocytopenic purpura (TTP). Kidney biopsy revealed thrombotic microangiopathic process. The patient was eventually diagnosed with HUS and treated with Eculizumab. 4 months later his renal function has partially recovered and no longer needs hemodialysis.
Discussion
HUS is a rare entity that is known to be triggered by different underlying pathologies. However, its link to EBV remains unclear. Literature review has revealed only two cases of EBV-triggered HUS, even though almost 90-95% of adults are EBV-seropositive. What unique about our case is the patient initially presented with documented IM, and HUS happened a month later. This raises the theory that HUS could be a sequela of the infection, rather than an effect of acute viral phase and this is the first case to report such correlation. The other unique thing is pulmonary involvement in HUS. With consultation with pulmonary service, we believe our patient had DAH based on clinical and radiographic findings. To our knowledge this is the first case to show this association.
Conclusion
EBV is a common virus with high seropositivity among world’s population. Its link to HUS remains unclear and needs more investigation. Providers should recognize HUS as a complication of EBV infection, either in the acute phase or as a sequela. Adolescents are at higher risk for such complication since IM is common in this population.
Introduction
Epstein-Barr virus (EBV) is a herpes virus that commonly causes infectious mononucleosis (IM) and linked to different hematological conditions. Here we present a case of EBV-triggered Hemolytic Uremic Syndrome (HUS) with pulmonary involvement.
Case Presentation
A 20-year-old male presented with fever, thrombocytopenia, and splenomegaly. Acute EBV serology was positive. Creatinine and hemoglobin were normal. He was diagnosed with IM. platelet count improved within 3 weeks. 4 weeks later, he returned with severe hemoptysis. Hgb 6.8g/dL, platelet 133,000/uL, lactate dehydrogenase 969u/L, creatinine 21mg/dL, and schistocytes on peripheral smear. Chest computed tomography showed bilateral opacities consistent with diffuse alveolar hemorrhage (DAH). Emergent hemodialysis and plasmapheresis were started. Infectious work up was negative. Autoimmune work up was also negative (anti-neutrophil cytoplasmic, anti-basement membrane antibodies, ANA). Aadamts13 activity was 62% (normal ~66%) ruling out thrombotic thrombocytopenic purpura (TTP). Kidney biopsy revealed thrombotic microangiopathic process. The patient was eventually diagnosed with HUS and treated with Eculizumab. 4 months later his renal function has partially recovered and no longer needs hemodialysis.
Discussion
HUS is a rare entity that is known to be triggered by different underlying pathologies. However, its link to EBV remains unclear. Literature review has revealed only two cases of EBV-triggered HUS, even though almost 90-95% of adults are EBV-seropositive. What unique about our case is the patient initially presented with documented IM, and HUS happened a month later. This raises the theory that HUS could be a sequela of the infection, rather than an effect of acute viral phase and this is the first case to report such correlation. The other unique thing is pulmonary involvement in HUS. With consultation with pulmonary service, we believe our patient had DAH based on clinical and radiographic findings. To our knowledge this is the first case to show this association.
Conclusion
EBV is a common virus with high seropositivity among world’s population. Its link to HUS remains unclear and needs more investigation. Providers should recognize HUS as a complication of EBV infection, either in the acute phase or as a sequela. Adolescents are at higher risk for such complication since IM is common in this population.
Introduction
Epstein-Barr virus (EBV) is a herpes virus that commonly causes infectious mononucleosis (IM) and linked to different hematological conditions. Here we present a case of EBV-triggered Hemolytic Uremic Syndrome (HUS) with pulmonary involvement.
Case Presentation
A 20-year-old male presented with fever, thrombocytopenia, and splenomegaly. Acute EBV serology was positive. Creatinine and hemoglobin were normal. He was diagnosed with IM. platelet count improved within 3 weeks. 4 weeks later, he returned with severe hemoptysis. Hgb 6.8g/dL, platelet 133,000/uL, lactate dehydrogenase 969u/L, creatinine 21mg/dL, and schistocytes on peripheral smear. Chest computed tomography showed bilateral opacities consistent with diffuse alveolar hemorrhage (DAH). Emergent hemodialysis and plasmapheresis were started. Infectious work up was negative. Autoimmune work up was also negative (anti-neutrophil cytoplasmic, anti-basement membrane antibodies, ANA). Aadamts13 activity was 62% (normal ~66%) ruling out thrombotic thrombocytopenic purpura (TTP). Kidney biopsy revealed thrombotic microangiopathic process. The patient was eventually diagnosed with HUS and treated with Eculizumab. 4 months later his renal function has partially recovered and no longer needs hemodialysis.
Discussion
HUS is a rare entity that is known to be triggered by different underlying pathologies. However, its link to EBV remains unclear. Literature review has revealed only two cases of EBV-triggered HUS, even though almost 90-95% of adults are EBV-seropositive. What unique about our case is the patient initially presented with documented IM, and HUS happened a month later. This raises the theory that HUS could be a sequela of the infection, rather than an effect of acute viral phase and this is the first case to report such correlation. The other unique thing is pulmonary involvement in HUS. With consultation with pulmonary service, we believe our patient had DAH based on clinical and radiographic findings. To our knowledge this is the first case to show this association.
Conclusion
EBV is a common virus with high seropositivity among world’s population. Its link to HUS remains unclear and needs more investigation. Providers should recognize HUS as a complication of EBV infection, either in the acute phase or as a sequela. Adolescents are at higher risk for such complication since IM is common in this population.