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Ledezma RA, Negron E, Paner GP, Rjepaj C, Lascano D, Haseebuddin M, Dangle P, Shalhav AL, Crist H, Raman JD, Joel DeCastro G, Harik L, Paroder M, Uzzo RG, Kutikov A, Eggener SE. Clinically localized type 1 and 2 papillary renal cell carcinomas have similar survival outcomes following surgery. World J Urol 2015; 34:687-93. [PMID: 26407582 DOI: 10.1007/s00345-015-1692-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/14/2015] [Indexed: 01/20/2023] Open
Abstract
PURPOSE We aimed to determine incidence, pathologic findings, prognostic factors and clinical outcomes for patients with clinically localized papillary RCC. METHODS Demographic, clinical and pathologic findings were collected on all patients with PRCC undergoing surgery at four academic medical centers. The primary endpoint was cancer-specific survival (CSS). Relapse-free survival (RFS) and overall survival (OS) were secondary endpoints. Kaplan-Meier estimates were obtained, and Cox proportional hazard regression models were used to assess predictors of mortality and relapse. RESULTS We identified 626 PRCC, of which 373 (60 %) were type 1 and 253 (40 %) were type 2, with three-quarters of all tumors being pT1. Compared to patients with type 1, those with type 2 were older (mean age: 63 vs 61; p = 0.02), presented more commonly with symptoms (13 vs 7 %; p = 0.02) and had larger mean tumor size (5.2 vs 4.3 cm; p = 0.001). With a median follow-up of 41 months (IQR: 16-68), 92 patients had died of PRCC (15 %), 48 (8 %) experienced relapse, and 101 died from all causes (16 %). The estimated 5-year CSS, RFS and OS were 83, 91 and 82 %, respectively. In multivariable analysis, older age, T stage and nodal status were predictors of CSS and OS. However, PRCC subtype was not a predictor of CSS, RFS or OS. CONCLUSION While patients with type 2 PRCC appear to present with more advanced disease than patients with type 1, PRCC subtype does not appear to be an independent predictor of CSS, RFS or OS for treated localized disease.
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Affiliation(s)
- Rodrigo A Ledezma
- Section of Urology, Department of Surgery, University of Chicago Medical Center, 5841 South Maryland Avenue, MC6038, J-664, Chicago, IL, 60637, USA.
| | - Edris Negron
- Section of Urology, Department of Surgery, University of Chicago Medical Center, 5841 South Maryland Avenue, MC6038, J-664, Chicago, IL, 60637, USA
| | - Gladell P Paner
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, USA
| | - Chris Rjepaj
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Danny Lascano
- Department of Urology, Columbia University, New York, NY, USA
| | - Mohammed Haseebuddin
- Division of Urologic Oncology, Fox Chase Cancer Center Temple University Health System, Philadelphia, PA, USA
| | - Pankaj Dangle
- Section of Urology, Department of Surgery, University of Chicago Medical Center, 5841 South Maryland Avenue, MC6038, J-664, Chicago, IL, 60637, USA
| | - Arieh L Shalhav
- Section of Urology, Department of Surgery, University of Chicago Medical Center, 5841 South Maryland Avenue, MC6038, J-664, Chicago, IL, 60637, USA
| | - Henry Crist
- Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jay D Raman
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - G Joel DeCastro
- Department of Urology, Columbia University, New York, NY, USA
| | - Lara Harik
- Department of Pathology, Columbia University, New York, NY, USA
| | - Monika Paroder
- Department of Pathology, Columbia University, New York, NY, USA
| | - Robert G Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center Temple University Health System, Philadelphia, PA, USA
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center Temple University Health System, Philadelphia, PA, USA
| | - Scott E Eggener
- Section of Urology, Department of Surgery, University of Chicago Medical Center, 5841 South Maryland Avenue, MC6038, J-664, Chicago, IL, 60637, USA
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Fernandes DS, Lopes JM. Pathology, therapy and prognosis of papillary renal carcinoma. Future Oncol 2015; 11:121-32. [PMID: 25572787 DOI: 10.2217/fon.14.133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Papillary renal cell carcinoma (pRCC) accounts for approximately 10% of renal parenchymal tumors. There are two pRCC subtypes reported in several studies, but at present, there is limited molecular evidence to validate this pRCC subtyping in the daily routine. The utility of subtyping pRCC is based on reports describing that pRCC subtype is an independent predictor of outcome, with type 1 tumors showing significantly better survival than type 2 tumors. In this article, we summarize the relevant knowledge on pRCC regarding tumor features: clinical presentation, histopathology, electron microscopy, immunohistochemistry, cytogenetics, genetic/molecular and prognosis. We present an overview of the currently available pRCC treatment options and some of the new promising agents.
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Raman R, Vaena D. Immunotherapy in Metastatic Renal Cell Carcinoma: A Comprehensive Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:367354. [PMID: 26161397 PMCID: PMC4486756 DOI: 10.1155/2015/367354] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/04/2015] [Indexed: 11/17/2022]
Abstract
Localized renal cell carcinoma (RCC) is often curable by surgery alone. However, metastatic RCC is generally incurable. In the 1990s, immunotherapy in the form of cytokines was the mainstay of treatment for metastatic RCC. However, responses were seen in only a minority of highly selected patients with substantial treatment-related toxicities. The advent of targeted agents such as vascular endothelial growth factor tyrosine kinase inhibitors VEGF-TKIs and mammalian target of rapamycin (mTOR) inhibitors led to a change in this paradigm due to improved response rates and progression-free survival, a better safety profile, and the convenience of oral administration. However, most patients ultimately progress with about 12% being alive at 5 years. In contrast, durable responses lasting 10 years or more are noted in a minority of those treated with cytokines. More recently, an improved overall survival with newer forms of immunotherapy in other malignancies (such as melanoma and prostate cancer) has led to a resurgence of interest in immune therapies in metastatic RCC. In this review we discuss the rationale for immunotherapy and recent developments in immunotherapeutic strategies for treating metastatic RCC.
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Affiliation(s)
- Rachna Raman
- Division of Hematology Oncology and Bone Marrow Transplantation, Department of Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive C32GH, Iowa City, Iowa 52242, USA
| | - Daniel Vaena
- Division of Hematology Oncology and Bone Marrow Transplantation, Department of Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive C32GH, Iowa City, Iowa 52242, USA
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Abstract
INTRODUCTION Immune-based therapies (e.g., IL-2, IFN) have been used for some time in advanced clear cell renal cell carcinoma (RCC) with overall modest success. Recent advances have demonstrated that tumor cells evade immune-mediated destruction by inducing inhibitory signals that result in effector T-cell exhaustion. One mechanism involves interaction between the T-cell programmed death-1 (PD-1) receptor and its ligand, PD ligand-1, expressed on tumor and inflammatory cells. Nivolumab , an anti-PD-1 antibody, blocks this pathway, thereby reversing T-cell suppression and activating antitumor responses. AREAS COVERED In this review, the authors summarize selected aspects of PD-1 signaling, the development of immune checkpoint therapeutic agents, and clinical data regarding the safety and efficacy of nivolumab in RCC from Phase I and II clinical trials. EXPERT OPINION Objective responses and safety profiles of single-agent nivolumab are favorable in patients with previously treated and treatment-naive metastatic RCC. Combination therapies involving nivolumab are ongoing and have generated encouraging results. The use of nivolumab will have substantial impact on the management of patients with RCC.
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Affiliation(s)
- Rosa M Michel Ortega
- Medical University of South Carolina, Division of Hematology and Oncology and Hollings Cancer Center , Charleston, SC 29425 , USA
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Trends of Systemic Therapy Use for Renal Cell Carcinoma in the United States. Urology 2015; 85:1399-403. [DOI: 10.1016/j.urology.2015.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/20/2015] [Accepted: 03/09/2015] [Indexed: 01/12/2023]
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Wang W, Qi L, Tan M, Zhang Z, Du J, Wei X, Yao X. Effect of platelet-derived growth factor-B on renal cell carcinoma growth and progression. Urol Oncol 2015; 33:168.e17-27. [DOI: 10.1016/j.urolonc.2014.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/22/2014] [Accepted: 12/22/2014] [Indexed: 10/23/2022]
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The Impact of Targeted Therapy on Management of Metastatic Renal Cell Carcinoma: Trends in Systemic Therapy and Cytoreductive Nephrectomy Utilization. Urology 2015; 85:442-50. [DOI: 10.1016/j.urology.2014.10.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 09/30/2014] [Accepted: 10/11/2014] [Indexed: 11/20/2022]
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Hwang SM, Kuyava JM, Grande JP, Swetz KM. Metastatic renal cell carcinoma mimicking diverticulitis in a patient with chronic lymphocytic leukaemia. BMJ Case Rep 2015; 2015:bcr-2014-206101. [PMID: 25568267 DOI: 10.1136/bcr-2014-206101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We present an unusual case of metastatic renal cell carcinoma (RCC) mimicking diverticulitis in a 76-year-old man with a 16-year history of chronic lymphocytic leukaemia (CLL) and a 2 cm left renal mass. The patient presented with severe abdominal pain and lower gastrointestinal bleeding with anticoagulation from recent pulmonary embolism. His clinical course was troubled by recurrent hospitalisations and complications that delayed investigations and potential treatments. Radiographic findings revealed stable CLL, mild sigmoid diverticulitis and a small renal mass. Small renal masses (less than 4 cm) are considered low risk for metastasising and are, thus, often observed or ablated, rather than resected. Furthermore, gastrointestinal metastases from RCC are rare. This case adds new perspective to the unpredictable nature of RCC and how synchronous malignancies may be masked in patients with long-standing CLL.
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Affiliation(s)
- S M Hwang
- Mayo Medical School, Rochester, Minnesota, USA
| | - J M Kuyava
- Section of Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - J P Grande
- Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - K M Swetz
- Section of Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Shuch B, Amin A, Armstrong AJ, Eble JN, Ficarra V, Lopez-Beltran A, Martignoni G, Rini BI, Kutikov A. Understanding pathologic variants of renal cell carcinoma: distilling therapeutic opportunities from biologic complexity. Eur Urol 2014; 67:85-97. [PMID: 24857407 DOI: 10.1016/j.eururo.2014.04.029] [Citation(s) in RCA: 363] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/29/2014] [Indexed: 12/17/2022]
Abstract
CONTEXT Once believed to represent a uniform malignant phenotype, renal cell carcinoma (RCC) is now viewed as a diverse group of cancers that arise from the nephron. OBJECTIVE To review the pathologic characteristics, clinical behavior, molecular biology, and systemic therapy options of recognized RCC histologic subtypes. EVIDENCE ACQUISITION A systematic review of English-language articles was performed using the Medline and Web of Science databases. Manuscripts were selected with consensus of the coauthors and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. EVIDENCE SYNTHESIS The major findings of the evaluated manuscripts are discussed with an emphasis on the description of the pathologic features, clinical behavior, prognosis, and therapeutic strategies. CONCLUSIONS Classification schemes for kidney cancer have undergone dramatic changes over the past two decades. Improvements in these classification schemes are important, as pathologic variants differ not only in disease biology, but also in clinical behavior, prognosis, and response to systemic therapy. In the era of genomic medicine, further refinements in characterization of RCC subtypes will be critical to the progress of this burgeoning clinical space. PATIENT SUMMARY Kidney cancer can be subdivided into related but different cancers that arise from the kidney's tubules. In this article we review current classifications for kidney cancer, discuss their characteristics, and provide an overview of each subtype's clinical behavior and treatment. We stress that each subtype harbors unique biology and thus responds differently to available treatment strategies.
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MESH Headings
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/therapy
- Basic Helix-Loop-Helix Leucine Zipper Transcription Factors/genetics
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/therapy
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/therapy
- Carcinoma, Renal Cell/classification
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/therapy
- Humans
- Kidney Neoplasms/pathology
- Kidney Neoplasms/therapy
- Prognosis
- Translocation, Genetic
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Affiliation(s)
- Brian Shuch
- Department of Urology, Yale School of Medicine, New Haven, CT, USA.
| | - Ali Amin
- Department of Pathology and Laboratory Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Andrew J Armstrong
- Divisions of Urology and Medical Oncology, Departments of Medicine and Surgery, Duke School of Medicine, Durham, NC, USA
| | - John N Eble
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Vincenzo Ficarra
- Department of Oncologic, Surgical and Gastrointestinal Sciences, Urologic Unit, University of Padova, Padova, Italy
| | - Antonio Lopez-Beltran
- Unit of Anatomical Pathology, Department of Surgery and Pathology, University of Cordoba, Faculty of Medicine, Cordoba, Spain
| | - Guido Martignoni
- Department of Pathology and Diagnostic, University of Verona and Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Brian I Rini
- Department of Solid Tumor Oncology and Urology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
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Conti SL, Thomas IC, Hagedorn JC, Chung BI, Chertow GM, Wagner TH, Brooks JD, Srinivas S, Leppert JT. Utilization of cytoreductive nephrectomy and patient survival in the targeted therapy era. Int J Cancer 2014; 134:2245-52. [PMID: 24135850 DOI: 10.1002/ijc.28553] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 09/27/2013] [Accepted: 09/30/2013] [Indexed: 11/06/2022]
Abstract
We sought to analyze utilization and survival outcomes of cytoreductive nephrectomy (CN) in patients with metastatic renal cell carcinoma (RCC) before and after introduction of targeted therapy. We identified patients with metastatic RCC between 1993 and 2010 in the SEER registry and examined temporal trends in utilization. We performed a joinpoint regression to determine when changes in utilization of CN occurred. We fitted multivariable proportional hazard models in full and propensity score-matched cohorts. We performed a difference-in-difference analysis to compare survival outcomes before and after introduction of targeted therapy. The proportion of patients undergoing CN increased from 1993 to 2004, from 29% to 39%. We identified a primary joinpoint of 2004, just prior to the introduction of targeted therapy. Beginning in 2005, there was a modest decrease in utilization of CN. CN was associated with a lower adjusted relative hazard (0.41, 95% confidence interval 0.34–0.43). Median survival among patients receiving CN increased in the targeted therapy era (19 vs. 13 months), while median survival among patients not receiving CN increased only slightly (4 vs. 3 months). Difference-in-difference analysis showed a significant decrease in hazard of death among patients who received CN in the targeted therapy era. Despite decreased utilization in the targeted therapy era, CN remains associated with improved survival. Prospective randomized trials are needed to confirm the benefit of CN among patients with metastatic RCC treated with novel targeted therapies.
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Song J, Kim E, Mobley J, Vemana G, Tanagho Y, Vetter J, Bhayani S, Russo P, Fugita O, Yang SSD, Iwamura M, Figenshau RS. Port site metastasis after surgery for renal cell carcinoma: harbinger of future metastasis. J Urol 2014; 192:364-8. [PMID: 24582771 DOI: 10.1016/j.juro.2014.02.089] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE Port site metastasis is a rare occurrence after minimally invasive treatment for renal cell carcinoma. However, its prognostic implications are unclear because reports in the literature are heterogeneous in detail and followup. We clarify the significance of port site metastasis in cancer specific survival and broaden our understanding of this phenomenon. MATERIALS AND METHODS A MEDLINE® search for published studies of renal cell carcinoma port site metastasis was performed. Contributing factors to port site metastasis, stage, Fuhrman grade, pathology, port site metastasis treatment method, followup protocol and long-term outcomes were collected. The corresponding authors of each publication were contacted to fill in details and provide long-term outcomes. We added 1 case from our recent experience. RESULTS A total of 16 cases from 12 authors (including ourselves) were found. Of the 12 authors 8 were available for correspondence and 9 cases were updated. Eventual outcomes were available for 11 of the 16 cases and survival curves showed poor prognosis with a 31.8% overall 1-year survival rate. Of the 16 cases 12 were radical nephrectomy and 4 were partial nephrectomy, and 13 involved multiple metastases in addition to the port site metastasis. Nine of the cases had no identifiable technical reason for port site metastasis formation such as specimen morcellation, absence of entrapment or tumor rupture. These tumors were uniformly aggressive, Fuhrman grade 3 or higher. CONCLUSIONS Port site metastasis after minimally invasive surgery for renal cell carcinoma is a rare occurrence with a poor prognosis. In most cases port site metastasis is not an isolated metastasis but instead is a harbinger of progressive disease. While technical factors can have a role in port site metastasis formation, it appears that biological factors like high tumor grade also contribute.
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Affiliation(s)
- Joseph Song
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Eric Kim
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jonathan Mobley
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Goutham Vemana
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Youssef Tanagho
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Joel Vetter
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sam Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Paul Russo
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | | | | | - Robert S Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri.
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