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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Epidemiological and Histopathological Study of Renal Cell Carcinoma: A Retrospective Study
Correspondence Address :
Dr. Amit Kumar,
Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
E-mail: amitkumaratpmch@gmail.com
Introduction: The incidence of Renal Cell Carcinomas (RCCs) has increased steadily and they have become the seventh most common histological type of cancer across the globe.
Aim: To assess the profile of the patients of RCC with respect to age distribution, sex distribution, clinical presentation, site of tumour, risk factors, staging, histopathological examination, and operative complications.
Materials and Methods: A retrospective descriptive study was conducted in Department of Urology, Indira Gandhi Institute of Sciences, Patna, Bihar, India, from January 2019 to June 2020, that included patients with RCC. The pathology specimens and reports of patients with RCC who underwent laparoscopic, open, cytoreductive, and partial nephrectomy were reviewed. Data related to demographic characteristics, site of tumour, risk factors, co-morbidities, clinical features, histopathology, tumour grade and stage, type of surgery, intra-and postoperative complications, and Fuhrman nuclear grading system were recorded.
Results: Total 60 patients diagnosed with RCC were included in this study. Of these, majority of patients were men (n=44). Majority of patients belonged to the age group of ≤60 years (n=39). Smoking (n=30), hypertension (n=30), obesity (n=20), and occupational exposure (n=8) were major risk factors associated with RCC. Haematuria (n=36), flank pain (n=24), hematuria and lump, with flank pain (n=18), and weight loss (n=18) were the most common clinical features in patients with RCC. According to the histopathologic type, 30 (50.0%) patients had clear cell RCC, 18 (30.0%) had papillary RCC, 8 (13.3%) had chromophobe RCC and the other four (6.7%) had cystic neoplasm, urothelial, angiomyolipoma, or sarcomatoid. Twenty-four patients underwent laparoscopic nephrectomy while 31 patients underwent open nephrectomy. Cytoreductive and partial nephrectomy was performed in three and two patients, respectively.
Conclusion: The present study findings suggest that age has an impact on development of RCC. Also, intraoperative and postoperative complications were more common among patients who underwent open nephrectomy.
Clear cell carcinoma, Haematuria, Laparoscopic nephrectomy, Smoking
Renal Cell Carcinoma is a malignancy originating from the proximal renal tubular epithelium. The RCCs are the seventh most common histological type of cancer across the globe (1). In India RCC is a serious public health problem and the prevalence is about 2/100,000 in men population and among women it’s about 1/100,000 population (2).
There are several risk factors linked to RCC. Smoking is an independent risk factor for developing RCC (3). Globally, obesity has been estimated to account for over 18% of RCC cases (4). There is evidence that both obesity and hypertension (HTN) are frequently present in the same patient population. Further HTN is also an independent risk factor for the development of RCC.
The most frequent histological types of RCCs include clear cell RCC, papillary RCC, and chromophobe RCC (1). Clear cell carcinoma is observed at a frequency of 75% of all RCCs. It mainly arises from the epithelium of the proximal tubule. Papillary RCC accounts for approximately 15% of all RCCs and it mainly arises from the epithelium of the proximal tubule. While chromophobe RCCs have been observed at a frequency of ~5% of kidney tumours. It is thought to arise from the distal nephron and epithelium of the collecting tubule (5),(6).
Most of the epidemiological studies of RCC were done in western countries (3),(7),(8). Only a few studies from India reported the study on incidence, survival, risk factors, complications, and stages of RCC (9),(10),(11). Such evidence-based studies among the Indian populations were found to be scarce. The present study was conducted to assess the profile of the patients of RCC with respect to age distribution, sex distribution, clinical presentation, site of tumour, risk factors, staging, histopathological examination, and operative complications.
A retrospective descriptive study was conducted among patients with RCC recruited at Department of Urology, Indira Gandhi Institute of Sciences, Patna, Bihar, India from January 2019 to June 2020. The pathology specimens and reports of patients with RCC who underwent laparoscopic, open, cytoreductive, and partial nephrectomy were reviewed. The study protocol was approved by the Institutional Ethics Committee (EC approval number: 840/IEC/IGIMS/2019). Each study participant provided written informed consent before participating in the study.
Inclusion and exclusion criteria: Patients of either sex, aged 20 years or older, and homogenous renal masses measuring >15 HU were included. Patients with lipid-rich angiomyolipoma, aged <20 years, enhancement <15 HU, life threatening co-morbid conditions, and non-enhancing renal mass were excluded.
Data collection
Clinical diagnosis was made by Contrast-Enhanced CT (CECT) scans after diagnosis of a renal space occupying lesion. Data related to demographic characteristics (sex, age, and religion), site of tumour, risk factors, co-morbidities, clinical features, histopathology, tumour grade and stage, type of surgery, intra-and postoperative complications were collected during routine care. Fuhrman grade, histopathological subtypes, and lymph node involvement were analysed. Fuhrman nuclear grade is the most widely used grading system for RCC. Fuhrman nuclear grading system is a 4-tiered grading system determined by the nucleus shape, size, and nucleolar prominence (Table/Fig 1) (12). Staging of RCC was done using the American Joint Committee on Cancer (AJCC) Tumour, Node and Metastases (TNM) system (13). The TNM staging system are shown in (Table/Fig 2).
The primary endpoint was to determine the profile of the patients of RCC in respect to age distribution, sex distribution, clinical presentation, site of tumour, risk factors, staging, histopathological examination, and intra-and postoperative complications. In the present study, the post-operative complications were compared between the groups with the Clavien-Dindo classification. The Clavien-Dindo classification is a standardised system for assessing postoperative complications. It was developed by Clavien in 1992 based on the severity of a complication. Grade 1included minor risk events requiring minimal or no intervention. Grade 2 complications consists of potentially life-threatening complications requiring therapeutic intervention or a hospital stay. Grade 2a included complications requiring therapeutic intervention and grade 2b included complications requiring an invasive procedure. Grade 3 consists of complications leading to lasting disability or organ resection. Grade 4 complication indicated death of a patient due to a complication (14).
Statistical Analysis
Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0 (SPSS Inc., Chicago, Illinois, USA). Continuous variables were summarized with descriptive statistics, including mean and Standard Deviation (SD) and categorical variables were presented as frequency and percentages. A comparison of quantitative variables between the groups was done using the chi-square test. A p<0.05 was considered statistically significant.
A total of 60 patients vising the institute were diagnosed with RCC of which 44 patients were men and 16 patients were women. The major attributable risk factors include smoking (n=30), obesity (n=20), and occupational exposure (n=8). The most prevalent comorbidities in these patients were HTN (50.0%) and benign prostatic hyperplasia (41.7%).
The most common histopathologic type of RCC was clear cell carcinoma (50.0%), followed by papillary (30.0%), chromophobe carcinoma (13.3%), and the other four (6.7%) had cystic neoplasm, urothelial, angiomyolipoma, and sarcomatoid. Twenty four patients (40.0%) underwent laparoscopic nephrectomy while 31 patients (51.7%) underwent open nephrectomy. Cytoreductive and partial nephrectomy was performed in three (5.0%) and two (3.3%) patients, respectively (Table/Fig 3).
Intraoperative haemorrhage (n=5), Gerota’s fascia (n=3), pulmonary metastasis (n=2), hepatic metastasis (n=1), unresectable tumour (n=1) was observed in patients who underwent open nephrectomy. Postoperative flank haematoma (n=1), wound infection (n=1), ileus (n=1), pneumonia (n=1), and anaemia (n=1) was observed in patients who underwent laparoscopic nephrectomy (Table/Fig 4). The association of RCC with age and sex is depicted in (Table/Fig 5).
The present study evaluated the epidemiological and histopathological pattern of RCC and risk factors associated with RCC. The key findings were; a) majority of the population were men presenting age group of ≤60 years; b) Smoking, obesity, and occupational exposure were common risk factors associated with RCC; c) The most prevalent comorbidities in these patients were HTN and benign prostatic hyperplasia; d) haematuria, flank pain, lump, and weight loss were the most common clinical features of patients with RCC; e) clear cell carcinoma was the most common histopathologic type of RCC followed by papillary and chromophobe carcinoma; f) intra- and postoperative complications were common among patients who underwent open nephrectomy than laparoscopic nephrectomy.
A recent noteworthy study by Qu Y et al., noted that RCC incidence was majorly driven by men than women (69.9 vs. 37.1%) (15). This finding was in general agreement with previous worldwide and Indian reports showing that the incidence of RCC was more often in men than women (16),(17). The previous study by Abraham G et al conducted in Northern India reported the prevalence of RCC and it was found to be higher in men than women (2). Another evidence-based retrospective study reported the higher prevalence of RCC in men than women with a men to women ratio of 2.7:1 (10). These results were in line with the present study which showed higher incidence of RCC in men, with a men-to-women ratio of 2.8:1. These observations suggest that sex was an independent predictor of the incidence of RCC.
A previous histopathological study from Northern India, revealed that the majority of RCC cases at presentation were between 39 and 59 years of age (~60%) and nearly 40% of patients presented at <60 years of age (11). Another noteworthy study in Indian literature that had a relatively small sample size (n=142) also showed RCC was predominant in young patients aged <60 years (10). Similarly, the present study noted the remarkable prevalence of RCC in young individuals aged ≤60 years (65.0%) as compared to older individuals aged >60 years (35.0%). Evidence from a study that included the adult Indian population demonstrated corroborating observations thereby suggesting RCC is relatively frequent among young individuals aged <60 years (18). Moreover, a decreasing trend in the prevalence of RCC was observed with increasing age groups suggesting an inverse relationship between age and incidence of RCC. In contrast to above-aforementioned studies, a recently published population based analysis involving a larger population (n=114,539) noted the higher prevalence of RCC in older patients (58-90 years; 64.9%) as compared to the young adult population (18-57 years; 35.1%) (15).
Several risk factors have been studied. Cigarette smoking, obesity, and Chronic Kidney Disease (CKD) were the major risk factor responsible for increased risk of renal cell carcinoma (19). Smoking was the most common lifestyle related risk factor seen among this study population. The majority of patients had HTN followed by obesity and occupational exposure. These findings are in concordance with Ray RP et al. wherein smoking, HTN, obesity, and occupational exposure were the factors shown to be strongly associated with RCC (20). A previous retrospective study by Tsivian M et al., depicted that smoking was consistently associated with advanced RCC. Interestingly, current and former smokers had increased odds of advanced RCC by 1.5- and 1.6-fold, respectively (21). The association between obesity and RCC has been documented in many studies (22),(23),(24) however the exact mechanism between obesity and RCC is still not understood. Hypertension or its treatment has been linked to the occurrence of RCC (25). Overall evidence reveals that passive smoking, HTN, obesity, and occupational exposure leads to increased risk for the development of RCC.
In the present study haematuria (60.0%), flank pain (40.0%), and flank pain (30.0%), and weight loss (30.0%) were the most clinical features of RCC. The previous study conducted at Eastern India reported haematuria (53.3%) and flank pain (50.7%) as the most common presenting symptoms in patients with RCC (20). Another evidence based retrospective study reported haematuria as the most common presenting symptom in 53.1% of patients. While, other less common symptoms reported were pain with haematuria, mass per abdomen, pain with mass, and isolated heamaturia (26). Similar findings were observed in a study done by Datta B et al, which reported flank pain and hematuria in around 73.0% and 61.0% of patients, respectively (27). Therefore, all these evidences along with the present study conclude haematuria and flank pain are the common findings among the patients with RCC.
A recent study by Singh A and Urry RJ, studied the intra-and postoperative complications of laparoscopic and open nephrectomy. Results concluded that blood loss and transfusion rates were significantly lower in the laparoscopy group than in open nephrectomy (28). A study by Reifsnyder et al. reported that patients who underwent laparoscopy had more major complications (grades 3 through 5) compared to the patients who underwent open nephrectomy (29). Similar trends were seen in the present study wherein intra- and postoperative complications were more common among patients who underwent open nephrectomy than laparoscopic nephrectomy.
Limitation(s)
The major limitations of this study were its single center, single arm study, and small sample size. This considerably limited the result interpretation and indicates a need for well designed prospective studies to validate these results. Further, this study did not record the fatality status of the patients therefore the study could not carry out survival statistics among patients.
The present study findings suggest that apart from smoking history, demographic characteristics including age, and sex appear to have an impact on RCC development. In addition, intra- and postoperative complications were more common among patients who underwent open nephrectomy than laparoscopic nephrectomy.
DOI: 10.7860/JCDR/2022/51677.16637
Date of Submission: Jul 31, 2021
Date of Peer Review: Dec 06, 2021
Date of Acceptance: Feb 11, 2022
Date of Publishing: Jul 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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