Date of Award

January 2019

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Toby Chai

Second Advisor

Brian Shuch

Abstract

The primary aim of this study was to review the renal cell carcinoma (RCC) histology, imaging characteristics, method of diagnosis, and treatment choice in the end stage renal disease (ESRD) population at our institution. We identified patients with a diagnosis of RCC between the years of 2012 to 2018 with a prior history ESRD. Clinical documentation was reviewed for demographics, receipt of dialysis and transplantation, tumor pathology, imaging characteristics, treatment, and clinical outcome. Time between dialysis or transplant initiation and RCC diagnosis was plotted on a Kaplan-Meier curve. Differences between the dialysis and transplant groups were assessed with the chi-square method and student’s t-tests. 24 patients developed RCC after being diagnosed with ESRD (11 dialysis only, 5 transplants only, 8 dialysis followed by transplant). The average age at diagnosis of RCC was 56.2 ± 10.0. The predominant histological findings were clear cell (31%), papillary (27%), and clear cell papillary (19%). The tumors had an average size of 3.7 ± 3.3 cm, with a majority pT1a or pT1b (71.4%) disease. All cases of pT2 and pT3 disease were clear cell or unclassified (p < 0.001). Both transplant groups (with and without dialysis exposure) took longer from ESRD diagnosis to develop tumors than dialysis only patients (11 ± 5.7 for dialysis and transplant, 13.3 ± 9.7 for transplant only, and 4.5 ± 3.3 for dialysis only). In conclusion, the majority of cases presented as pT1 disease, with papillary histology highly represented. Radical nephrectomy is the most common management, but active surveillance can be selected for some patients. For those with metastatic disease systemic therapy may be initiated, although data on the safety and efficacy in this population is lacking.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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