1
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Yang D. Prognostic Model and Immune Response of Clear Cell Renal Cell Carcinoma Based on Co-Expression Genes Signature. Clin Genitourin Cancer 2024:102167. [PMID: 39129082 DOI: 10.1016/j.clgc.2024.102167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND The identification of reliable prognostic markers is crucial for optimizing patient management and improving clinical outcomes in clear cell renal cell carcinoma (ccRCC). METHODS We used the GSE89563 dataset from the GEO database and the Kidney Clear Cell Carcinoma (KIRC) dataset from the TCGA database to develop a prognostic model based on weighted gene co-expression network analysis (WGCNA) and non-negative matrix factorization (NMF) to predict disease progression and prognosis in ccRCC. RESULT We utilized WGCNA to identify risk genes and applied NMF to stratify high-risk populations in ccRCC. We characterized the immune gene features of these high-risk groups and ultimately developed a risk prediction model for ccRCC patients using a Lasso regression approach. The risk score was calculated as follows: Risk score = SUM (-0.136394797 ANK3 + 0.004238138 BIVM_ERCC5 - 0.046248451 C4orf19 - 0.036013206 F2RL3 - 0.125531316 GNG7 - 0.012698109 METTL7A + 0.078462369 MSTO1 - 0.050450656 PINK1 - 0.059446590 SLC16A12 - 0.039883686 SLC2A9 + 0.083310722 TLCD1 - 0.059801739 WDR72 + 0.071430088 ZNF117). CONCLUSION We develop a prognostic model for clear cell renal cell carcinoma and analyzed immune response in subgroups and confirmed protein-level expression concordance.
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Affiliation(s)
- Dongsheng Yang
- Department of Nephrology, Houjie Hospital of Dongguan, No.21 Hetian Road, Houjie Town, Dongguan, 523000, China; Department of Nephrology, Dongguan Tungwah Hospital, Dongguan, China.
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2
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Zamora-Fuentes JM, Hernández-Lemus E, Espinal-Enríquez J. Methylation-related genes involved in renal carcinoma progression. Front Genet 2023; 14:1225158. [PMID: 37693315 PMCID: PMC10486271 DOI: 10.3389/fgene.2023.1225158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/25/2023] [Indexed: 09/12/2023] Open
Abstract
Renal carcinomas are a group of malignant tumors often originating in the cells lining the small tubes in the kidney responsible for filtering waste from the blood and urine production. Kidney tumors arise from the uncontrolled growth of cells in the kidneys and are responsible for a large share of global cancer-related morbidity and mortality. Understanding the molecular mechanisms driving renal carcinoma progression results crucial for the development of targeted therapies leading to an improvement of patient outcomes. Epigenetic mechanisms such as DNA methylation are known factors underlying the development of several cancer types. There is solid experimental evidence of relevant biological functions modulated by methylation-related genes, associated with the progression of different carcinomas. Those mechanisms can often be associated to different epigenetic marks, such as DNA methylation sites or chromatin conformation patterns. Currently, there is no definitive method to establish clear relations between genetic and epigenetic factors that influence the progression of cancer. Here, we developed a data-driven method to find methylation-related genes, so we could find relevant bonds between gene co-expression and methylation-wide-genome regulation patterns able to drive biological processes during the progression of clear cell renal carcinoma (ccRC). With this approach, we found out genes such as ITK oncogene that appear hypomethylated during all four stages of ccRC progression and are strongly involved in immune response functions. Also, we found out relevant tumor suppressor genes such as RAB25 hypermethylated, thus potentially avoiding repressed functions in the AKT signaling pathway during the evolution of ccRC. Our results have relevant implications to further understand some epigenetic-genetic-affected roles underlying the progression of renal cancer.
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Affiliation(s)
| | - Enrique Hernández-Lemus
- Computational Genomics Division, National Institute of Genomic Medicine, Mexico City, Mexico
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jesús Espinal-Enríquez
- Computational Genomics Division, National Institute of Genomic Medicine, Mexico City, Mexico
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Mexico City, Mexico
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3
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The role of cytoreductive nephrectomy and systemic therapy in the management of tumour thrombus in patients with metastatic renal cell carcinoma. Br J Cancer 2023; 128:1888-1896. [PMID: 36859686 PMCID: PMC10147707 DOI: 10.1038/s41416-023-02166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Outcomes for patients with metastatic renal cell carcinoma (mRCC) and tumour thrombus remain poor. Recent data suggest limited role for cytoreductive nephrectomy (CN) and data on thrombus response to systemic therapy (ST) is scarce. Here, we describe response and survival of patients with de novo mRCC and thrombi treated with ST with or without CN. METHODS Demographics, disease characteristics and survival of patients with de novo mRCC were collected. Progression-free survival (PFS) and overall survival (OS) in months (m) was calculated using the Kaplan-Meier method (log-rank). RESULTS Between 2002 and 2019, 226 patients with mRCC were identified, 64 (28.3%) had tumour thrombus out of which 18 (28.1%) received only ST. Among 12 evaluable patients, thrombus response, stability and progression were seen in 3 (25%), 6 (50%) and 3 (25%) patients, respectively. Median OS was similar for patients with and without tumour thrombus treated with systemic therapy alone [OS: 12.1 m (8.8-27.7) vs. 13.9 m (7.9-21.5), p = 0.87]. CN predicted for better OS in patients with tumour thrombus [OS: 29.4 m (17.4-48.9) vs. 12.1 m (8.8-27.7), p = 0.01]. CONCLUSION In this retrospective series of patients with mRCC and tumour thrombus, addition of CN to ST improved outcomes. Validation of these findings with contemporary regimens is needed.
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El-Badrawy A, Shebel H, El Atta HMA. MDCT diagnosis of synchronous primary gastrointestinal tract carcinoma and other solid malignancies: case series study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00707-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Abstract
Background
The presentation of synchronous multiple primary tumors is rare. The aim of this report was to report an uncommon series of cases diagnosed with synchronous gastrointestinal tract carcinoma and other solid malignancies by multidetector computed tomography.
Case presentation
Our report included 34 patients with synchronous gastrointestinal tract carcinoma and other solid malignancies from November 2009 to September 2019. They were 14 men and 20 women (mean age, 65.5 year; range, 52–82 years). The highest number of GIT cases were colonic carcinomas detected in 70% (24/34) of the patients. The most frequent extra-gastrointestinal primary malignancy sites were renal cell and breast carcinomas, 17.6% (6/34) of each.
Conclusions
Careful preoperative evaluation is recommended to detect this pattern of synchronous extra-gastrointestinal tumors. More reports of such cases should help to clarify the pathogenesis of this phenomenon and may lead to a new treatment strategy for synchronous gastrointestinal malignancy and other solid malignancies.
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El-Badrawy A. Multi-detector computed tomography (MDCT) evaluation of synchronous renal cell carcinoma and other solid malignancies. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00748-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Multiple primary malignant neoplasms (MPMNs) became more prevalent as the population aged and medical technology progressed. The purpose of this research was to review the findings of multidetector computed tomography (MDCT) in synchronous renal cell carcinoma and other solid tumors.
Results
31 individuals with synchronous renal cell carcinoma and additional solid cancers were included in this retrospective analysis. CT scanning was carried out using 64 MDCT scanners. All sixty-two malignancies were undergoing pathological assessment. Out of 685 patients with renal cell carcinoma, 31 individuals were identified with another primary solid cancer that occurred concurrently. All of our instances were pathologically verified. In all 31 individuals, clear renal cell carcinoma was found. The most frequent extra-renal malignancies were hepatocellular carcinoma (10/31), followed by breast carcinoma (4/31), non-Hodgkin lymphoma (4/31), bronchogenic carcinoma (3/31), colonic carcinoma (3/31), prostatic carcinoma (2/31), urinary bladder carcinoma (1/31), periampullary carcinoma (1/31), mucoepidermoid carcinoma (1/31) and skin squamous cell carcinoma (1/31) as well as malignant hemangioendothelioma (1/31).
Conclusion
MDCT scanning was an accurate imaging method for diagnosing synchronous renal cell carcinoma and other solid tumors. Even in the face of numerous cancers, the goal of therapy in cancer patients must always be curative. During the pretreatment examination, the potential of synchronous double malignancies with renal cell carcinoma should be explored.
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Tatar G, Gündoğan C, Şahin ÖF, Arslan E, Ergül N, Çermik TF. Prognostic Significance of 18F-FDG PET/CT Imaging in Survival Outcomes in Patients with Renal Cell Carcinoma. Mol Imaging Radionucl Ther 2022; 31:200-206. [PMID: 36268871 PMCID: PMC9585999 DOI: 10.4274/mirt.galenos.2022.42744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: Renal cell carcinoma (RCC) comprises 85%-90% of primary renal malignant tumors originating from the renal tubular epithelium and has different genetic characteristics. This study aimed to investigate the potential predictive role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and metabolic parameters in overall survival (OS) analysis in patients with RCC. Methods: 18F-FDG PET/CT images of 100 patients performed for initial staging before surgical or oncological treatments were analyzed retrospectively. Maximum standard uptake value (SUVmax-T) of the primary tumor was calculated and its relationship to patient survival was analyzed. The median follow-up time was 5.61 years (0.01-8.7 years). Results: SUVmax-T levels in the patients ranged from 2.1 to 48.9 (median 5.9, mean 9.0±7.9). SUVmax-T was significantly higher in RCC-related death more positive than in the negative cases (p<0.001). However, there was not any statistical significance for gender and pathological subtypes on the survival outcomes of patients (p=0.264 and p=0.784). The patients’ 1-year, 3-year, and 5-year OS rates were 71%, 61%, and 57%, respectively. The highest action of SUVmax-T for estimating OS was a cut-off level of 5.4, which maintained sensitivity and specificity of 81% and 75%, respectively. However, cancer staging remained independent significance for OS (p<0.001). Conclusion: SUVmax of primary tumor and cancer stage were demonstrated as significant prognostic factors for OS in patients with RCC. Evaluation of 18F-FDG accumulation with PET/CT may help plan treatment strategies and predict survival outcomes of these patients at diagnosis.
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Affiliation(s)
- Gamze Tatar
- University of Health Sciences Turkey, İstanbul Bağcılar Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Cihan Gündoğan
- University of Health Sciences Turkey, Diyarbakır Gazi Yaşargil Training and Research Hospital, Clinic of Nuclear Medicine, Diyarbakır, Turkey
| | - Ömer Faruk Şahin
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Esra Arslan
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Nurhan Ergül
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Tevfik Fikret Çermik
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
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Lu Z, He W, Zhou J, Yang C, Xiang R. Construction and validation of a novel prognostic nomogram for patients with metastatic renal cell carcinoma: a SEER-based study. J Int Med Res 2022; 50:3000605221105367. [PMID: 35726570 PMCID: PMC9218494 DOI: 10.1177/03000605221105367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective We aimed to establish and validate nomograms to evaluate overall survival (OS) and cancer-specific survival (CSS) in patients with metastatic renal cell carcinoma (MRCC). Methods Between 2010 and 2015, the clinical information of patients with MRCC was selected using the Surveillance, Epidemiology, and End Results database. Two nomograms were constructed based on Cox regression analysis, and their prediction accuracy was evaluated by concordance index (C-index), receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Results After propensity score matching, there were 568 patients with MRCC in the training group and 568 in the validation group. Multivariate analyses revealed that age, residence, pathology, T stage, N stage, surgery, and metastatic sites were independent prognostic factors for the OS and CSS of MRCC. The C-index and ROC curves indicated that the two nomograms of OS and CSS showed satisfactory discriminative power. Furthermore, DCA displayed that the nomograms achieved more clinical net benefit than the American Joint Committee on Cancer staging system. Conclusion We constructed and validated two effective prognostic nomograms for patients with MRCC that accurately predicted the probabilities of 1-, 2-, and 3-year OS and CSS.
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Affiliation(s)
- Zhaoxiang Lu
- Department of Urology, The Chao Hu Hospital of Anhui Medical University, Hefei, China
| | - Wei He
- Department of Urology, The Chao Hu Hospital of Anhui Medical University, Hefei, China
| | - Jun Zhou
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cheng Yang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Rong Xiang
- School of Electronic Engineering, Chao Hu University, Chaohu, China
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Wang Y, Yin L, Cui Y, Wang L, Wu J, Wang J, Zhao H, Liu C, Cui Y, Zhang Y, Li X, Zhu Z, Yang L. Prognostic Significance of Membranous Carbonic Anhydrase IX Expression in Patients with Nonmetastatic Clear Cell Renal Cell Carcinoma of Different Tumor Stages. Cancer Biother Radiopharm 2021; 37:494-502. [PMID: 34714117 DOI: 10.1089/cbr.2020.3948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: There are paradoxical results regarding whether carbonic anhydrase IX (CAIX) is a prognostic biomarker for patients with clear cell renal cell carcinoma (ccRCC). The objective of this study was to evaluate prognostic significance of CAIX in nonmetastatic ccRCC patients of different stages. Materials and Methods: This is a retrospective study on 1263 patients with nonmetastatic ccRCC from January 2005 to June 2018. Patients were stratified into eight subgroups (pT1a, pT1b, pT2a, pT2b, pT3a, pT3b, pT3c, and pT4) according to the 2016 TNM classification system. Immunohistochemical staining of membranous CAIX was quantified. Cancer-specific survival (CSS) rates in patients with high (>85%) and low (<85%) CAIX expressions were compared by Kaplan-Meier curves with log-rank test. Results: There were 220 tumors (17.42%) with low CAIX expression and 1043 tumors (82.58%) with high CAIX expression. The cumulative CSS rates were statistically significant between all patients with low and high CAIX expression (p-value <0.001). In pT2a, pT2b, and pT3a subgroups, the patients with low CAIX expression exhibited markedly decreased cumulative CSS rates compared to patients with high CAIX expression (p-value <0.05). Univariable and multivariable Cox regression analysis showed that CAIX expression was an independent predictor of prognosis in patients with pT2a, pT2b, and pT3a ccRCC (p-value <0.05), rather than in all nonmetastatic patients. Conclusion: CAIX expression is of independent prognostic value for ccRCC patients in pT2a, pT2b, and pT3a stages. CAIX expression combined with tumor stage would further improve risk stratification of nonmetastatic ccRCC patients and provide directions for therapies.
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Affiliation(s)
- Yongqiang Wang
- Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
| | - Likui Yin
- Clinical Laboratory, Dongying People's Hospital, Dongying, P.R. China
| | - Yupeng Cui
- Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
| | - Lin Wang
- Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
| | - Jitao Wu
- Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
| | - Jipeng Wang
- Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
| | - Hongwei Zhao
- Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
| | - Chu Liu
- Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
| | - Yuanshan Cui
- Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
| | - Yongfu Zhang
- Department of Urology, Affiliated Yantai Hospital of Binzhou Medical University, Yantai, P.R. China
| | - Xiaofei Li
- Department of Urology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Zhe Zhu
- Department of Medicine, Division of Regenerative Medicine, University of California, San Diego, School of Medicine, La Jolla, California, USA
| | - Liqing Yang
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
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A 25 year perspective on the evolution and advances in an understanding of the biology, evaluation and treatment of kidney cancer. Urol Oncol 2021; 39:548-560. [PMID: 34092483 DOI: 10.1016/j.urolonc.2021.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 01/20/2023]
Abstract
The diagnosis, evaluation and management of patients with renal cell carcinoma has transformed in the 21st century. Utilizing biological discoveries and technological advances, the field has moved from blunt surgical and largely ineffective medical treatments, to nuanced and fine-tuned approaches based on biology, extent of disease and patient preferences. In this review we will summarize the last 25 years of progress in kidney cancer.
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10
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Liu T, Zhao Z, Feng B, Wang X, Li T, Xie S, Zhu W, Li X, Guo H, Yang R. Robotic-assisted laparoscopic tumor enucleation is a feasible technique for renal hilar tumors: A retrospective study. J Surg Oncol 2021; 124:135-142. [PMID: 33836093 DOI: 10.1002/jso.26479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/26/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE: This study aimed to evaluate the safety and efficacy of robot-assisted laparoscopic tumor enucleation (RAE) for the treatment of renal hilar tumors and to describe our experience with renorrhaphy-related surgical techniques. METHODS Retrospective data were collected from 173 consecutive patients who underwent RAE for localized renal tumors (cT1-cT2N0M0) at our hospital between September 2014 and November 2019. RESULTS Seventy-five patients had renal hilar tumors and 98 patients had nonhilar tumors. There were no statistical differences between the hilar and nonhilar groups in operation time (190 [115-390] vs. 190 [110-390] min, p = 0.889), warm ischemia time (26 [12-60] vs. 27 [17-41] min, p = 0.257), hospital stay duration (8 [3-16] vs. 7.5 [4-18] days, p = 0.386), renal function (estimated glomerular filtration rate, 102.5 [29.4-144] vs. 101.3 [64.2-134.7] ml/min/1.73 m2 , p = 0.631); creatinine level, (76 [43-169] vs. 78.5 [50-281.3] µmol/L, p = 0.673), perioperative complications rate, or surgical margin status. However, patients with hilar tumors lost significantly more blood than did those with nonhilar tumors (250 [50-1500] vs. 200 [20-1200] ml, p = 0.007). During the follow-up period (median, 30 months), three patients in each group experienced recurrence. The 5-year recurrence-free rates were 93.0% and 95.4% in the hilar and nonhilar tumor groups, respectively (p = 0.640). CONCLUSIONS For experienced robot laparoscopists, RAE is a safe, effective, and feasible procedure for renal hilar tumors, without increased risk of positive surgical margins or worse midterm oncologic outcomes compared with nonhilar tumors.
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Affiliation(s)
- Tianyao Liu
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zihan Zhao
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Baofu Feng
- Department of Urology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Xin Wang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tianhang Li
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shangxun Xie
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenjie Zhu
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaogong Li
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rong Yang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Update on the Role of Imaging in Clinical Staging and Restaging of Renal Cell Carcinoma Based on the AJCC 8th Edition, From the AJR Special Series on Cancer Staging. AJR Am J Roentgenol 2021; 217:541-555. [PMID: 33759558 DOI: 10.2214/ajr.21.25493] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This article reviews the essential role of imaging in clinical staging and restaging of renal cell carcinoma (RCC). To completely characterize and stage an indeterminate renal mass, renal CT or MRI without and with IV contrast administration is recommended. The critical items for initial clinical staging of an indeterminate renal mass or of a known RCC according to the TNM staging system are tumor size, renal sinus fat invasion, urinary collecting system invasion, perinephric fat invasion, venous invasion, adrenal gland invasion, invasion of the perirenal (Gerota) fascia, invasion into other adjacent organs, the presence of enlarged or pathologic regional (retroperitoneal) lymph nodes, and the presence of distant metastatic disease. Larger tumor size is associated with higher stage disease and invasiveness, lymph node spread, and distant metastatic disease. Imaging practice guidelines for clinical staging of RCC, as well as the role of renal mass biopsy, are highlighted. Specific findings associated with response of advanced cancer to antiangiogenic therapy and immunotherapy are discussed, as well as limitations of changes in tumor size after targeted therapy. The accurate clinical staging and restaging of RCC using renal CT or MRI provides important prognostic information and helps guide the optimal management of patients with RCC.
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Kaldany A, Leopold ZR, Kim JE, Patel HV, Srivastava A, Tabakin AL, Singer EA. Dissecting the role of lymphadenectomy in the management of renal cell carcinoma: past, present, and future. KIDNEY CANCER JOURNAL : OFFICIAL JOURNAL OF THE KIDNEY CANCER ASSOCIATION 2020; 18:103-108. [PMID: 35069965 PMCID: PMC8772661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Lymph node involvement in renal cell carcinoma (RCC) portends a poor prognosis. However, the role of lymph node dissection (LND) at the time of tumor resection is not fully understood. Conflicting data have been published regarding the survival implications of LND during RCC surgery, and the optimal patient population for which LND might be beneficial has yet to be identified. Based on recent data characterizing the outcomes of node-positive RCC, some have advocated for revising the current staging guidelines to better reflect these findings. Given the paucity of high-quality evidence supporting or refuting the routine use of LND in RCC, further research is needed to shed light on this important topic. There are a number of ongoing clinical trials evaluating the role of perioperative (neoadjuvant and adjuvant) systemic therapy, which include patients with node-positive RCC, and will serve to guide changes in treatment practices for this patient population moving forward.
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Affiliation(s)
- Alain Kaldany
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Zev R. Leopold
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Juliana E. Kim
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Hiren V. Patel
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Arnav Srivastava
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Alexandra L. Tabakin
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric A. Singer
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Srivastava A, Rivera-Núñez Z, Kim S, Sterling J, Farber NJ, Radadia KD, Patel HV, Modi PK, Goyal S, Parikh R, Mayer TM, Saraiya B, Sadimin ET, Weiss RE, Kim IY, Elsamra SE, Jang TL, Singer EA. Impact of pathologic lymph node-positive renal cell carcinoma on survival in patients without metastasis: Evidence in support of expanding the definition of stage IV kidney cancer. Cancer 2020; 126:2991-3001. [PMID: 32329899 DOI: 10.1002/cncr.32912] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/01/2020] [Accepted: 02/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Stage III renal cell carcinoma (RCC) encompasses both lymph node-positive (pT1-3N1M0) and lymph node-negative (pT3N0M0) disease. However, prior institutional studies have indicated that among patients with stage III disease, those with lymph node disease have worse oncologic outcomes and experience survival that is similar to that of patients with American Joint Committee on Cancer (AJCC) stage IV disease. The objective of the current study was to validate these findings using a large, nationally representative sample of patients with kidney cancer. METHODS Patients with AJCC stage III or stage IV RCC were identified using the National Cancer Data Base (NCDB). Patients were categorized as having lymph node-positive stage III (pT1-3N1M0), lymph node-negative stage III (pT3N0M0), or stage IV metastatic (pT1-3 N0M1) disease. Cox proportional hazards models compared outcomes while adjusting for comorbidities. Kaplan-Meier estimates illustrated relative survival when comparing staging groups. RESULTS A total of 8988 patients met the inclusion criteria, with 6587 patients classified as having lymph node-negative stage III disease, 2218 as having lymph node-positive stage III disease, and 183 as having stage IV disease. Superior survival was noted among patients with lymph node-negative stage III disease, but similar survival was noted between patients with lymph node-positive stage III and stage IV RCC, with 5-year survival rates of 61.9% (95% confidence interval [95% CI], 60.3%-63.4%), 22.7% (95% CI, 20.6%-24.9%), and 15.6% (95% CI, 11.1%-23.8%), respectively. CONCLUSIONS Current RCC staging systems group pT1-3N1M0 and pT3N0M0 disease as stage III disease. However, the results of the current validation study suggest the need for further stratification and even placement of patients with pT1-3N1M0 disease into the stage IV category. Staging that accurately reflects oncologic prognosis may help clinicians better counsel and select patients who might derive the most benefit from lymphadenectomy, adjuvant systemic therapy, more rigorous imaging surveillance, and clinical trial participation.
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Affiliation(s)
- Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Zorimar Rivera-Núñez
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sinae Kim
- Division of Biometrics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Kushan D Radadia
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Parth K Modi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Rahul Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Tina M Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Biren Saraiya
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Evita T Sadimin
- Division of Genitourinary Pathology and Informatics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Robert E Weiss
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sammy E Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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14
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Patel HV, Srivastava A, Singer EA. To Be or "Node" to Be: Nodal Disease and the Role of Lymphadenectomy in the Treatment of Renal Cell Carcinoma. ACTA ACUST UNITED AC 2020; 8. [PMID: 32582841 DOI: 10.18103/mra.v8i5.2091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Lymph node involvement in renal cell carcinoma (RCC) correlates with poor oncologic outcomes. However, current RCC staging guidelines may not fully reflect the survival impact of lymph node positive disease. Recent data demonstrates that nodal disease has significant impact on survival and modifications to current staging guidelines have been proposed. Lymph node dissection (LND) at the time of surgical intervention for RCC remains controversial. While clinical trial data have demonstrated conflicting evidence for LND, some institutional studies suggests that carefully selected patients at high-risk for recurrence may benefit from LND. Prospectively, clinical trials are examining treating nodal disease and disease at high-risk of recurrence in the neoadjuvant and/or adjuvant setting at the time of nephrectomy. These promising trials are poised, if successful, to influence the treatment paradigm for localized RCC.
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Affiliation(s)
- Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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15
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Kheir P, Abdessater M, El Khoury J, Akiel R, El Hachem C, Tawil N, El Khoury R. Renal angiomyolipoma with IVC thrombus: A case report. Int J Surg Case Rep 2020; 70:149-153. [PMID: 32416484 PMCID: PMC7229267 DOI: 10.1016/j.ijscr.2020.04.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/20/2020] [Indexed: 11/08/2022] Open
Abstract
The occurrence of venous invasion in patients with renal angiomyolipoma is a rare and unique phenomenon. CT scan is the imaging of choice in case of invasion of vena cava. Collaboration of the urologist and the vascular surgeon is sometimes mandatory for optimal surgical treatment.
Introduction Renal angiomyolipomas (AML) are often regarded as benign tumors. This article reports the case of a 47 year old patient with AML associated with a venous invasion of the inferior vena cava. Presentation of case Our 47 year old male patient presented for flank pain and hematuria. CT Scan revealed a 3 cm lobulated low-density lesion in the renal sinus, middle and upper lobes of the right kidney, with evidence of IVC thrombus on angioscan. Right radical nephrectomy and thrombectomy were successfully done with use of cardiopulmonary bypass. On pathology, AML was confirmed. Discussion Renal AML are unilateral and sporadic in most cases, with a female predominance. The occurrence of venous invasion in patients with AML is a rare and unique phenomenon. CT scan is the imaging of choice in such cases and surgery remains the optimal treatment. Conclusion More focus should be put on the ability of AML to invade venous structures. Early imaging and therapeutic planning are necessary for the best outcome in case of vena cava invasion. Collaboration of the urologist with the vascular surgeon can lead to better surgical results.
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Affiliation(s)
- Pietro Kheir
- Department of Cardiovascular Surgery, Notre Dame des Secours University Hospital Center, Byblos City, Lebanon; Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Maher Abdessater
- Departent of Urology, Notre Dame des Secours University Hospital Center, Byblos City, Lebanon; Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
| | - Joey El Khoury
- Departent of Urology, Notre Dame des Secours University Hospital Center, Byblos City, Lebanon; Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Rody Akiel
- Department of Cardiovascular Surgery, Notre Dame des Secours University Hospital Center, Byblos City, Lebanon; Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Charbel El Hachem
- Departent of Urology, Notre Dame des Secours University Hospital Center, Byblos City, Lebanon; Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Nabil Tawil
- Department of Cardiovascular Surgery, Notre Dame des Secours University Hospital Center, Byblos City, Lebanon; Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Rahgid El Khoury
- Departent of Urology, Notre Dame des Secours University Hospital Center, Byblos City, Lebanon; Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
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16
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Shapiro DD, Abel EJ. Renal cell carcinoma with isolated lymph node metastases should be reclassified as stage IV. Cancer 2020; 126:2965-2967. [PMID: 32329898 DOI: 10.1002/cncr.32913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel D Shapiro
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - E Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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17
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Han J, Li Q, Li P, Wang S, Zhang R, Qiao Y, Song Q, Fu Z. Reassessment of American Joint Committee on Cancer Staging for Stage III Renal Cell Carcinoma With Nodal Involvement: Propensity Score Matched Analyses of a Large Population-Based Study. Front Oncol 2020; 10:365. [PMID: 32266145 PMCID: PMC7096477 DOI: 10.3389/fonc.2020.00365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 03/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background: To assess the role of nodal involvement in stage III renal cell carcinoma (RCC) according to the American Joint Committee on Cancer (AJCC) 8th staging system. We compared the survival outcomes of RCC patients with pT1-3N1M0 disease and those with pT3N0M0 or stage IV (stratified as pT4NanyM0 and pTanyNanyM1) disease in a large population-based cohort. Methods: A cohort of 3,112 eligible patients with RCC was identified from the Surveillance, Epidemiology, and End Results (SEER) database, registered between January 2004 and December 2015. Kaplan-Meier and Cox proportional hazards models were used to evaluate the overall survival (OS), and cancer-specific survival (CSS). The prognostic value of the modified stage for pT1-3N1M0 disease was assessed by nomogram-based analyses. Propensity score matching (PSM) was used to adjust for potential baseline confounding. Results: Patients with pT1-3N1M0 disease showed similar survival outcomes (median OS 41.0 vs. 38.0 months, P = 0.77; CSS 45.0 vs. 39.0 months, P = 0.59) to pT4NanyM0 patients, whereas the significantly better survival outcome was found for pT3N0M0 patients. After PSM, comparable survival rates were observed between pT1-3N1M0 group and pT4NanyM0 group, which were still significantly worse than the survival of pT3N0M0 patients. The modified stage IIIA (pT3N0M0), IIIB (pT1-3N1M0, pT4NanyM0), and IV (pTanyNanyM1) showed higher predictive accuracy than AJCC stage system in the nomogram-based analyses (concordance index: 0.70 vs. 0.68, P < 0.001 for OS; 0.71 vs. 0.69, P < 0.001 for CSS). Conclusions: The pT1-3N1M0 RCC might be reclassified as stage IIIB together with pT4NanyM0 disease for better prediction of prognosis, further examination and validation are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | - Zhenming Fu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
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18
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Swami U, Nussenzveig RH, Haaland B, Agarwal N. Revisiting AJCC TNM staging for renal cell carcinoma: quest for improvement. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S18. [PMID: 31032299 DOI: 10.21037/atm.2019.01.50] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Umang Swami
- Department of Hematology, Oncology and Blood and Marrow Transplantation, The Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Roberto H Nussenzveig
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Benjamin Haaland
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Neeraj Agarwal
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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19
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Patel HV, Srivastava A, Shinder B, Sadimin E, Singer EA. Strengthening the foundation of kidney cancer treatment and research: revising the AJCC staging system. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S33. [PMID: 31032312 DOI: 10.21037/atm.2019.02.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Brian Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Evita Sadimin
- Section of Urologic Pathology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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20
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Shao N, Wang HK, Zhu Y, Ye DW. Modification of American Joint Committee on cancer prognostic groups for renal cell carcinoma. Cancer Med 2018; 7:5431-5438. [PMID: 30306741 PMCID: PMC6247054 DOI: 10.1002/cam4.1790] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022] Open
Abstract
Background To compare the predictive value of the current AJCC stage grouping for renal cell carcinoma (RCC) to our modifications. Patients and methods A total of 2120 patients with RCC from Fudan University Shanghai Cancer Center (FUSCC) database and 74 506 counterparts from SEER database were included. Cox regression was used to calculate the relative impacts between prognostic groups. The predictive accuracy of overall survival (OS) was assessed using the concordance index (C‐index), which was compared by likelihood ratio test. Results In FUSCC cohort, the 5‐year‐OS rate for T3N0M0 patients was higher than T1‐3N1M0 (72.7% vs 38.1%). The 5‐year‐OS rate for T4N0M0 was 36.2%, which was close to T1‐3N1M0 but not to T4N1M0 (0%) and TanyNanyM1 (12.6%). The elements of AJCC groups were regrouped according to the ranks of hazard ratios. The modified stages II (T3N0M0), III (T1‐3N1M0, T4N0M0), and IV (T4N1M0, TanyNanyM1) exhibited greater survival stratification than AJCC groups. The modifications were validated in SEER cohort and yielded similar survival outcomes. The predictive accuracy of OS in modified prognostic groups was significantly higher than AJCC groups in stages II‐IV subgroups in both FUSCC (C‐index: 0.801 vs 0.779, P < 0.001) and SEER cohort (C‐index: 0.770 vs 0.764, P < 0.001). Conclusions The modified AJCC prognostic groups for RCC provided significantly improved survival prediction compared with the 8th AJCC edition. A precise risk stratification of modified stages II‐IV disease provides an important basis for risk‐equivalent treatment recommendation.
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Affiliation(s)
- Ning Shao
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong-Kai Wang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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