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Vazquez LC, Xi Y, Rasmussen RG, Venzor JER, Kapur P, Zhong H, Dai JC, Morgan TN, Cadeddu JA, Pedrosa I. Characterization of Demographical Histologic Diversity in Small Renal Masses With the Clear Cell Likelihood Score. J Comput Assist Tomogr 2024; 48:370-377. [PMID: 38213063 DOI: 10.1097/rct.0000000000001567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
OBJECTIVE This study aimed to develop a diagnostic model to estimate the distribution of small renal mass (SRM; ≤4 cm) histologic subtypes for patients with different demographic backgrounds and clear cell likelihood score (ccLS) designations. MATERIALS AND METHODS A bi-institution retrospective cohort study was conducted where 347 patients (366 SRMs) underwent magnetic resonance imaging and received a ccLS before pathologic confirmation between June 2016 and November 2021. Age, sex, race, ethnicity, socioeconomic status, body mass index (BMI), and the ccLS were tabulated. The socioeconomic status for each patient was determined using the Area Deprivation Index associated with their residential address. The magnetic resonance imaging-derived ccLS assists in the characterization of SRMs by providing a likelihood of clear cell renal cell carcinoma (ccRCC). Pathological subtypes were grouped into four categories (ccRCC, papillary renal cell carcinoma, other renal cell carcinomas, or benign). Generalized estimating equations were used to estimate probabilities of the pathological subtypes across different patient subgroups. RESULTS Race and ethnicity, BMI, and ccLS were significant predictors of histology (all P < 0.001). Obese (BMI, ≥30 kg/m 2 ) Hispanic patients with ccLS of ≥4 had the highest estimated rate of ccRCC (97.1%), and normal-weight (BMI, <25 kg/m 2 ) non-Hispanic Black patients with ccLS ≤2 had the lowest (0.2%). The highest estimated rates of papillary renal cell carcinoma were found in overweight (BMI, 25-30 kg/m 2 ) non-Hispanic Black patients with ccLS ≤2 (92.3%), and the lowest, in obese Hispanic patients with ccLS ≥4 (<0.1%). CONCLUSIONS Patient race, ethnicity, BMI, and ccLS offer synergistic information to estimate the probabilities of SRM histologic subtypes.
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Affiliation(s)
| | - Yin Xi
- From the Department of Radiology, University of Texas Southwestern School of Medicine
| | - Robert G Rasmussen
- From the Department of Radiology, University of Texas Southwestern School of Medicine
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Shim GY, Kim MS, Kim HJ, Park Y, Kim SW, Yoo MC. A 42-year-old patient with renal cell carcinoma presenting as low back pain: A case report. Medicine (Baltimore) 2024; 103:e37639. [PMID: 38552083 PMCID: PMC10977550 DOI: 10.1097/md.0000000000037639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
RATIONALE Renal cell carcinoma (RCC) is the most common renal neoplasm, accounting for 2.4% of all cancers in Korea. Although the usual clinical manifestations of RCC include flank pain, hematuria, and palpable mass, RCC is generally characterized by a lack of early warning signs and is mostly discovered incidentally in advanced stage. This case report describes a 42-year-old Korean man diagnosed with giant RCC who presented with simple back pain. PATIENT CONCERNS The clinical manifestation of a 42-year-old Korean man was chronic back pain. DIAGNOSES Contrast-enhanced computed tomography showed a 19.1-cm sized heterogeneous enhancing mass on the right kidney and tumor thrombosis extending into inferior vena cava. INTERVENTION Due to the large size of the tumor and extensive tumor thrombosis, the multidisciplinary team decided to administer neoadjuvant chemotherapy and an anticoagulant. Following 12 cycles of treatment with nivolumab and cabozantinib, he underwent a right radical nephrectomy with an adrenalectomy and tumor thrombectomy. OUTCOMES Treatment was successful and posttreatment he started a cancer rehabilitation program. He was followed-up as an outpatient and no longer complains of back pain. LESSONS RCC can manifest clinically as back pain, with diagnosis being difficult without appropriate imaging modalities. RCC should be included in the differential diagnosis of patients with low back pain, even at a young age.
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Affiliation(s)
- Ga Yang Shim
- Department of Physical and Rehabilitation Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Min-Su Kim
- Department of Physical and Rehabilitation Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hong Jun Kim
- Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yewan Park
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - So-Woon Kim
- Department of Pathology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Myung Chul Yoo
- Department of Physical and Rehabilitation Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
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3
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Zhang D, Ni Y, Wang Y, Feng J, Zhuang N, Li J, Liu L, Shen W, Zheng J, Zheng W, Qian C, Shan J, Zhou Z. Spatial heterogeneity of tumor microenvironment influences the prognosis of clear cell renal cell carcinoma. J Transl Med 2023; 21:489. [PMID: 37474942 PMCID: PMC10360235 DOI: 10.1186/s12967-023-04336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Clear cell renal cell carcinoma (ccRCC) is an immunologically and histologically diverse tumor. However, how the structural heterogeneity of tumor microenvironment (TME) affects cancer progression and treatment response remains unclear. Hence, we characterized the TME architectures of ccRCC tissues using imaging mass cytometry (IMC) and explored their associations with clinical outcome and therapeutic response. METHODS Using IMC, we profiled the TME landscape of ccRCC and paracancerous tissue by measuring 17 markers involved in tissue architecture, immune cell and immune activation. In the ccRCC tissue, we identified distinct immune architectures of ccRCC tissue based on the mix score and performed cellular neighborhood (CN) analysis to subdivide TME phenotypes. Moreover, we assessed the relationship between the different TME phenotypes and ccRCC patient survival, clinical features and treatment response. RESULTS We found that ccRCC tissues had higher levels of CD8+ T cells, CD163- macrophages, Treg cells, endothelial cells, and fibroblasts than paracancerous tissues. Immune infiltrates in ccRCC tissues distinctly showed clustered and scattered patterns. Within the clustered pattern, we identified two subtypes with different clinical outcomes based on CN analysis. The TLS-like phenotype had cell communities resembling tertiary lymphoid structures, characterized by cell-cell interactions of CD8+ T cells-B cells and GZMB+CD8+ T cells-B cells, which exhibited anti-tumor features and favorable outcomes, while the Macrophage/T-clustered phenotype with macrophage- or T cell-dominated cell communities had a poor prognosis. Patients with scattered immune architecture could be further divided into scattered-CN-hot and scattered-CN-cold phenotypes based on the presence or absence of immune CNs, but both had a better prognosis than the macrophage/T-clustered phenotype. We further analyzed the relationship between the TME phenotypes and treatment response in five metastatic ccRCC patients treated with sunitinib, and found that all three responders were scattered-CN-hot phenotype while both non-responders were macrophage/T-clustered phenotype. CONCLUSION Our study revealed the structural heterogeneity of TME in ccRCC and its impact on clinical outcome and personalized treatment. These findings highlight the potential of IMC and CN analysis for characterizing TME structural units in cancer research.
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Affiliation(s)
- Dawei Zhang
- Department of Urology, The Southwest Hospital, Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Yuanli Ni
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, China
| | - Yongquan Wang
- Department of Urology, The Southwest Hospital, Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Juan Feng
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, China
| | - Na Zhuang
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, China
| | - Jiatao Li
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, China
| | - Limei Liu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, China
| | - Wenhao Shen
- Department of Urology, The Southwest Hospital, Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Ji Zheng
- Department of Urology, The Southwest Hospital, Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Wei Zheng
- Anesthesiology Department, The 80th Army Hospital of Chinese PLA, Weifang, 261021, Shandong, China
| | - Cheng Qian
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, China.
| | - Juanjuan Shan
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, China.
| | - Zhansong Zhou
- Department of Urology, The Southwest Hospital, Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.
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Cetin T, Celik S, Sozen S, Akdogan B, Izol V, Aslan G, Suer E, Bayazit Y, Karakoyunlu N, Ozen H, Baltaci S, Gokalp F, Tinay I. Oncological outcomes of papillary versus clear cell renal cell carcinoma in pT1 and pT2 stage: Results from a contemporary Turkish patient cohort. Arch Ital Urol Androl 2023:11218. [PMID: 37254924 DOI: 10.4081/aiua.2023.11218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/17/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES To compare overall survival (OS), recurrence free survival (RFS), and cancer-specific survival (CSS) in the long-term follow-up of T1 and T2 clear-cell-Renal Cell Carcinoma (ccRCC) and papillary Renal Cell Carcinoma (pRCC) patients, as well as to determine the risk factors for recurrence and overall mortality. MATERIAL AND METHOD Data of patients with kidney tumors obtained from the Urologic Cancer Database - Kidney (UroCaD-K) of Turkish Urooncology Association (TUOA) were evaluated retrospectively. Out of them, patients who had pathological T1-T2 ccRCC and pRCC were included in the study. According to the two histological subtype, recurrence and mortality status, RFS, OS and CSS data were analyzed. RESULTS RFS, OS and CSS of pRCC and ccRCC were found to be similar. Radiological local invasion was shown to be a risk factor for recurrence in pRCC, and age was the only independent factor affecting overall mortality. CONCLUSIONS There were no differences in survivals (RFS, OS and CSS) of patients with localized papillary and clear cell RCC. While age was the only factor affecting overall mortality, radiological local invasion was a risk factor for recurrence in papillary RCC.
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Affiliation(s)
- Taha Cetin
- Izmir Bozyaka Research and Training Hospital Urology Department, Izmir; Member of Turkish Urooncology Association.
| | - Serdar Celik
- Izmir Bozyaka Research and Training Hospital Urology Department, Izmir; Member of Turkish Urooncology Association.
| | - Sinan Sozen
- Gazi University Faculty of Medicine Urology Department, Ankara; Member of Turkish Urooncology Association.
| | - Bulent Akdogan
- Hacettepe University Faculty of Medicine Urology Department, Ankara; Member of Turkish Urooncology Association.
| | - Volkan Izol
- Cukurova University Faculty of Medicine Urology Department, Adana; Member of Turkish Urooncology Association.
| | - Guven Aslan
- Dokuz Eylul University Faculty of Medicine Urology Department, Izmir; Member of Turkish Urooncology Association.
| | - Evren Suer
- Ankara University Faculty of Medicine Urology Department, Ankara; Member of Turkish Urooncology Association.
| | - Yildirim Bayazit
- Cukurova University Faculty of Medicine Urology Department, Adana; Member of Turkish Urooncology Association.
| | - Nihat Karakoyunlu
- University of Health Sciences Dıskapi Yildirim Beyazit Research and Training Hospital Urology Department, Ankara; Member of Turkish Urooncology Association.
| | - Haluk Ozen
- Hacettepe University Faculty of Medicine Urology Department, Ankara; Member of Turkish Urooncology Association.
| | - Sumer Baltaci
- Ankara University Faculty of Medicine Urology Department, Ankara; Member of Turkish Urooncology Association.
| | - Fatih Gokalp
- Mustafa Kemal University Tayfur Ata Sokmen Medicine Faculty Urology Department, Hatay; Member of Turkish Urooncology Association.
| | - Ilker Tinay
- Marmara University Faculty of Medicine Urology Department, Istanbul; Member of Turkish Urooncology Association.
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Schieda N, Davenport MS, Silverman SG, Bagga B, Barkmeier D, Blank Z, Curci NE, Doshi A, Downey R, Edney E, Granader E, Gujrathi I, Hibbert RM, Hindman N, Walsh C, Ramsay T, Shinagare AB, Pedrosa I. Multicenter Evaluation of Multiparametric MRI Clear Cell Likelihood Scores in Solid Indeterminate Small Renal Masses. Radiology 2022; 303:590-599. [PMID: 35289659 PMCID: PMC9794383 DOI: 10.1148/radiol.211680] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Solid small renal masses (SRMs) (≤4 cm) represent benign and malignant tumors. Among SRMs, clear cell renal cell carcinoma (ccRCC) is frequently aggressive. When compared with invasive percutaneous biopsies, the objective of the proposed clear cell likelihood score (ccLS) is to classify ccRCC noninvasively by using multiparametric MRI, but it lacks external validation. Purpose To evaluate the performance of and interobserver agreement for ccLS to diagnose ccRCC among solid SRMs. Materials and Methods This retrospective multicenter cross-sectional study included patients with consecutive solid (≥25% approximate volume enhancement) SRMs undergoing multiparametric MRI between December 2012 and December 2019 at five academic medical centers with histologic confirmation of diagnosis. Masses with macroscopic fat were excluded. After a 1.5-hour training session, two abdominal radiologists per center independently rendered a ccLS for 50 masses. The diagnostic performance for ccRCC was calculated using random-effects logistic regression modeling. The distribution of ccRCC by ccLS was tabulated. Interobserver agreement for ccLS was evaluated with the Fleiss κ statistic. Results A total of 241 patients (mean age, 60 years ± 13 [SD]; 174 men) with 250 solid SRMs were evaluated. The mean size was 25 mm ± 8 (range, 10-39 mm). Of the 250 SRMs, 119 (48%) were ccRCC. The sensitivity, specificity, and positive predictive value for the diagnosis of ccRCC when ccLS was 4 or higher were 75% (95% CI: 68, 81), 78% (72, 84), and 76% (69, 81), respectively. The negative predictive value of a ccLS of 2 or lower was 88% (95% CI: 81, 93). The percentages of ccRCC according to the ccLS were 6% (range, 0%-18%), 38% (range, 0%-100%), 32% (range, 60%-83%), 72% (range, 40%-88%), and 81% (range, 73%-100%) for ccLSs of 1-5, respectively. The mean interobserver agreement was moderate (κ = 0.58; 95% CI: 0.42, 0.75). Conclusion The clear cell likelihood score applied to multiparametric MRI had moderate interobserver agreement and differentiated clear cell renal cell carcinoma from other solid renal masses, with a negative predictive value of 88%. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Mileto and Potretzke in this issue.
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Affiliation(s)
- Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa. Ottawa, Ontario, Canada
| | | | - Stuart G. Silverman
- Department of Radiology, Brigham and Women’s Hospital. Harvard Medical School Boston, MA
| | - Barun Bagga
- Department of Radiology, NYU Langone Medical Center. New York, NY, USA
| | - Daniel Barkmeier
- Department of Radiology, University of Michigan. Ann Arbor, MI, USA
| | - Zane Blank
- Department of Radiology. University of Nebraska Medical Center. Omaha, Nebraska
| | - Nicole E Curci
- Department of Radiology, University of Michigan. Ann Arbor, MI, USA
| | - Ankur Doshi
- Department of Radiology. NYU Langone Medical Center. New York, NY, USA
| | - Ryan Downey
- Department of Radiology. University of Nebraska Medical Center. Omaha, Nebraska
| | - Elizabeth Edney
- Department of Radiology. University of Nebraska Medical Center. Omaha, Nebraska
| | - Elon Granader
- Department of Radiology. University of Nebraska Medical Center. Omaha, Nebraska
| | - Isha Gujrathi
- Department of Radiology, Brigham and Women’s Hospital. Harvard Medical School Boston, MA
| | - Rebecca M. Hibbert
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa. Ottawa, Ontario, Canada
| | - Nicole Hindman
- Department of Radiology. NYU Langone Medical Center, New York, NY, USA
| | - Cynthia Walsh
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa. Ottawa, Ontario, Canada
| | - Tim Ramsay
- Ottawa Hospital Research Institute. Ottawa, Ontario, Canada
| | - Atul B. Shinagare
- Department of Radiology, Brigham and Women’s Hospital. Harvard Medical School Boston, MA
| | - Ivan Pedrosa
- University of Texas Southwestern Medical Center. Dallas, TX
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Papillary renal cell carcinoma: a single institutional study of 199 cases addressing classification, clinicopathologic and molecular features, and treatment outcome. Mod Pathol 2022; 35:825-835. [PMID: 34949764 PMCID: PMC9177523 DOI: 10.1038/s41379-021-00990-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 01/20/2023]
Abstract
The morphologic spectrum of type 1 papillary renal cell carcinoma (PRCC) is not well-defined, since a significant proportion of cases have mixed type 1 and 2 histology. We analyzed 199 cases of PRCC with any (even if focal) type 1 features, with a median follow-up of 12 years, to identify clinicopathological features associated with outcome. Ninety-five tumors (48%) of the cohort contained some type 2 component (median amount: 25%; IQR: 10%, 70%). As a group they showed high rates of progression-free (PFS) and cancer-specific survival (CSS). Tumor size, mitotic rate, lymphovascular invasion, sarcomatoid differentiation, sheet-like architecture, and lack of tumor circumscription were significantly associated with CSS (p ≤ 0.015) on univariate analysis. While predominant WHO/ISUP nucleolar grade was associated with PFS (p = 0.013) and CSS (p = 0.030), the presence of non-predominant (<50%) nucleolar grade did not show association with outcome (p = 0.7). PFS and CSS showed no significant association with the presence or the amount of type 2 morphology. We compared the molecular alterations in paired type 1 and type 2 areas in a subset of 22 cases with mixed type 1 and 2 features and identified 12 recurrently mutated genes including TERT, ARID1A, KDM6A, KMT2D, NFE2L2, MET, APC, and TP53. Among 78 detected somatic mutations, 61 (78%) were shared between the paired type 1 and type 2 areas. Copy number alterations, including chromosome 7 and 17 gains, were similar between type 1 and 2 areas. These findings support that type 2 features in a PRCC with mixed histology represent either morphologic variance or clonal evolution. Our study underscores the notion that PRCC with any classic type 1 regions is best considered as type 1 PRCC and assigned the appropriate WHO/ISUP nucleolar grade. It provides additional evidence that type 2 PRCC as a separate category should be re-assessed and likely needs to be abandoned.
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7
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Trevisani F, Floris M, Vago R, Minnei R, Cinque A. Long Non-Coding RNAs as Novel Biomarkers in the Clinical Management of Papillary Renal Cell Carcinoma Patients: A Promise or a Pledge? Cells 2022; 11:cells11101658. [PMID: 35626699 PMCID: PMC9139553 DOI: 10.3390/cells11101658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 12/22/2022] Open
Abstract
Papillary renal cell carcinoma (pRCC) represents the second most common subtype of renal cell carcinoma, following clear cell carcinoma and accounting for 10–15% of cases. For around 20 years, pRCCs have been classified according to their mere histopathologic appearance, unsupported by genetic and molecular evidence, with an unmet need for clinically relevant classification. Moreover, patients with non-clear cell renal cell carcinomas have been seldom included in large clinical trials; therefore, the therapeutic landscape is less defined than in the clear cell subtype. However, in the last decades, the evolving comprehension of pRCC molecular features has led to a growing use of target therapy and to better oncological outcomes. Nonetheless, a reliable molecular biomarker able to detect the aggressiveness of pRCC is not yet available in clinical practice. As a result, the pRCC correct prognosis remains cumbersome, and new biomarkers able to stratify patients upon risk of recurrence are strongly needed. Non-coding RNAs (ncRNAs) are functional elements which play critical roles in gene expression, at the epigenetic, transcriptional, and post-transcriptional levels. In the last decade, ncRNAs have gained importance as possible biomarkers for several types of diseases, especially in the cancer universe. In this review, we analyzed the role of long non-coding RNAs (lncRNAs) in the prognosis of pRCC, with a particular focus on their networking. In fact, in the competing endogenous RNA hypothesis, lncRNAs can bind miRNAs, resulting in the modulation of the mRNA levels targeted by the sponged miRNA, leading to additional regulation of the target gene expression and increasing complexity in the biological processes.
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Affiliation(s)
- Francesco Trevisani
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milano, Italy;
- Unit of Urology, San Raffaele Scientific Institute, 20132 Milano, Italy
- Biorek s.r.l., San Raffaele Scientific Institute, 20132 Milano, Italy;
- Correspondence:
| | - Matteo Floris
- Nephrology, Dialysis, and Transplantation Division, G. Brotzu Hospital, University of Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Riccardo Vago
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milano, Italy;
| | - Roberto Minnei
- Nephrology, Dialysis, and Transplantation Division, G. Brotzu Hospital, University of Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Alessandra Cinque
- Biorek s.r.l., San Raffaele Scientific Institute, 20132 Milano, Italy;
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8
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Paner GP, Chumbalkar V, Montironi R, Moch H, Amin MB. Updates in Grading of Renal Cell Carcinomas Beyond Clear Cell Renal Cell Carcinoma and Papillary Renal Cell Carcinoma. Adv Anat Pathol 2022; 29:117-130. [PMID: 35275846 DOI: 10.1097/pap.0000000000000341] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The World Health Organization (WHO) recommends grading of clear cell renal cell carcinoma (RCC) and papillary RCC using the WHO/International Society of Urological Pathology (ISUP) grade, which is primarily based on nuclear features. As the spectrum of RCC continues to evolve, with more recently described subtypes in the past decade, literature evidence on grading these subtypes is limited or not available for some tumor types. Herein, we outline a pragmatic approach to the topic of grading RCC, dividing the contemporarily described RCC subtypes into 7 categories based on the potential clinical applicability of grading as a useful prognostic parameter: (1) RCC subtypes that are reasonably validated and recommended for WHO/ISUP grading; (2) RCC subtypes where WHO/ISUP is not applicable; (3) RCC subtypes where WHO/ISUP grading is potentially clinically useful; (4) inherently aggressive RCC subtypes where histologic classification itself confers an aggressive biologic potential; (5) renal epithelial tumors where WHO/ISUP grading provides potentially misleading prognostic implication; (6) renal epithelial neoplasms where low WHO/ISUP grade features are a prerequisite for accurate histologic classification; and (7) renal epithelial neoplasms with no or limited data on grading or incomplete understanding of the biologic potential. Our aim in outlining this approach is 2-fold: (a) identify the gaps in understanding and application of grading in RCC subtypes so that researchers in the field may perform additional studies on the basis of which the important pathologic function of assignment of grade may be recommended to be performed as a meaningful exercise across a wider spectrum of RCC; and (b) to provide guidance in the interim to surgical pathologists in terms of providing clinically useful grading information in RCC based on currently available clinicopathologic information.
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Affiliation(s)
- Gladell P Paner
- Department of Pathology, University of Chicago
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL
| | | | - Rodolfo Montironi
- Molecular Medicine and Cell Therapy Foundation, Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN
- Department of Urology, USC Keck School of Medicine, Los Angeles, CA
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Zhang Z, Guan B, Li Y, He Q, Li X, Zhou L. Increased phosphorylated CREB1 protein correlates with poor prognosis in clear cell renal cell carcinoma. Transl Androl Urol 2021; 10:3348-3357. [PMID: 34532259 PMCID: PMC8421817 DOI: 10.21037/tau-21-371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background This study aims to investigate the level of cAMP response element-binding protein 1 (phospho S133) (p-CREB1) protein in clear cell renal cell carcinoma (ccRCC) and evaluates its prognosis significance. Methods Immunohistochemistry (IHC) method was performed to detect p-CREB1 staining in 233 ccRCC patients. Three or more high-power fields per tissue section were equally captured by a Leica DMRXA microphotographic system, and average staining intensity (optical density, OD) was analyzed by Leica Qwin Standard V2.6 system. Univariate and multivariate Cox proportional regression model was performed to assess the correlation of p-CREB1 staining and clinical outcomes. Results IHC proved that the level of p-CREB1 protein was significantly higher in tumor tissues than in adjacent normal tissues, and gradually increased from normal to tumor sections. On the basis of the receiver operating characteristic curve, patients were divided into low p-CREB1 staining (OD ≤0.28) and high p-CREB1 staining subgroup (OD >0.28) according to p-CREB1 protein staining intensity of tumor cells. Multivariate analyses showed that high p-CREB1staining was an independent risk factor for cancer-specific free survival, overall survival and progression-free survival. Conclusions p-CREB1 protein is an independent prognostic biomarker for ccRCC patients.
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Affiliation(s)
- Zhongyuan Zhang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Bao Guan
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Yifan Li
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Qun He
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.,Pathology Lab, Department of Urology, Peking University First Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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10
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Papillary renal cell carcinoma: Review. Urol Oncol 2021; 39:327-337. [PMID: 34034966 DOI: 10.1016/j.urolonc.2021.04.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 01/20/2023]
Abstract
Kidney cancer is the 13th most common malignancy globally, and the incidence is rising. Papillary renal cell carcinoma is the second most common subtype, comprising 10-15% of renal cell carcinomas. Though the histologic features of this subtype were initially described in the 1990's, our understanding of the genetic and molecular characteristics of this disease have rapidly evolved over the past decade. In this review, we summarize the contemporary understanding of the clinical, morphologic, radiographic, and genetic characteristics of papillary renal cell carcinoma, as well as clinical considerations, current options for management, and prognosis.
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Zhang GL, Chen S, Li JD, Wang CG. Endobronchial Metastasis of Renal Carcinoma: A Case Report and Review of Previous Literature. Front Surg 2021; 8:658749. [PMID: 34095203 PMCID: PMC8175964 DOI: 10.3389/fsurg.2021.658749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/06/2021] [Indexed: 11/27/2022] Open
Abstract
The definition of endobronchial metastasis (EBM) lacks clarity because it is currently based on the judgments of surgeons; it is rare in patients with nonpulmonary malignancies. Although EBM represents an advanced stage of malignancy, it does not necessarily indicate a poorer prognosis than that for its primary tumors. The present study defines EBM as bronchoscopy-visible lesions with histologically confirmed primary extrapulmonary tumors, excluding those primary lung tumors with involvement of the bronchial lumen. A bronchoscopy and biopsy provide strong proof for diagnosis. Complete surgical resection is the best choice for patients with EBM. This study analyzed the case of a 69-year-old male patient who had undergone a radical left nephrectomy several years previously after the identification of a bronchoscopy-visible lesion in the left main bronchus. The lesion was initially diagnosed as an angiogenic tumor but was eventually confirmed by surgical biopsy as EBM from the left kidney. After diagnosis, the patient underwent a left pneumonectomy. The analysis of this case focused on diagnosis, symptoms, radiographic findings, treatment, and prognosis. A review of the previous literature relating to EBM was also conducted.
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Affiliation(s)
- Guang-Lei Zhang
- Department of Thorax, Second Hospital of Jilin University, Changchun, China
| | - Shu Chen
- Department of Thorax, Second Hospital of Jilin University, Changchun, China
| | - Jin-Dong Li
- Department of Thorax, Second Hospital of Jilin University, Changchun, China
| | - Chun-Guang Wang
- Department of Thorax, Second Hospital of Jilin University, Changchun, China
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12
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Are gastric metastases of renal cell carcinoma really rare? A case report and systematic review of the literature. Int J Surg Case Rep 2021; 82:105867. [PMID: 33839629 PMCID: PMC8055614 DOI: 10.1016/j.ijscr.2021.105867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/23/2022] Open
Abstract
Solitary gastric metastasis of RCC are scarce. When feasible, surgical or endoscopic treatment of gastric metastasis should be performed. Risk of metastatic recurrence is significant and must be taken into consideration in the therapeutic strategy.
Introduction Renal cell carcinoma (RCC) represents above 3 % of all cancers. At diagnosis, above 25 % of patients with RCC present an advanced disease. Gastric metastasis of RCC is associated with poor outcome. We report the case of a patient treated for a gastric metastasis of RCC and we conducted a systematic review of the literature to report all published cases of RCC patients with gastric metastasis. Case presentation In December 2010, a 61-year-old man was treated by open partial nephrectomy for a localized right clear cell RCC. In September 2018, a metachronous gastric metastasis was found on CT scan. The lesion was located on the lesser curvature of the stomach, measuring 4.5 cm long axis. No other secondary lesions were identified. A laparoscopic wedge resection, converted to laparotomy was performed. Two years later, in September 2020, a CT scan was performed, revealing a 17 mm adenopathy behind the hepatic hilum and a surgical management was performed, including a lymph node dissection of the hepatic hilum and the hepatic artery. Actually, he remains healthy. Clinical discussion and conclusion Our systematic review suggests that solitary gastric metastasis of RCC are scarce. In comparison of patients with multiple metastatic sites, the median survival of patients with solitary gastric metastasis is longer.
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Hou G, Zhao D, Jiang Y, Zhu Z, Huo L, Li F, Cheng W. Clinical utility of FDG PET/CT for primary and recurrent papillary renal cell carcinoma. Cancer Imaging 2021; 21:25. [PMID: 33632314 PMCID: PMC7908760 DOI: 10.1186/s40644-021-00393-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/15/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Papillary renal cell carcinoma (RCC) is the second most common subtype of RCC, after clear cell RCC. This study aimed to investigate the usefulness of FDG PET/CT in primary and recurrent papillary RCC, and the role of staging FDG PET/CT in predicting survival. Methods A total of 66 patients with histopathologically confirmed papillary RCC who underwent either staging or restaging FDG PET/CT scans (30 had staging scans only, 28 had restaging scans only, 8 had both) were retrospectively included in this study. The sensitivity and specificity of restaging FDG PET/CT for detecting recurrence were assessed by histopathology and/or clinical follow-up as standard reference. Results Staging FDG PET/CT scans were performed in 38 patients, of which 31 (81.5%) showed FDG-positive primary renal lesions. The SUVmax of high-grade (WHO grade 3 and 4) papillary RCCs were significantly higher than that of low-grade (WHO grade 1 and 2) tumors (9.44 ± 6.18 vs 4.83 ± 3.19, P = 0.008). The SUVmax was not significantly different between type 1 and type 2 papillary RCCs (5.71 ± 2.88 vs. 6.99 ± 5.57, P = 0.563). Of the 38 patients, 12 developed disease progression during the follow-up period. Patients with primary tumor SUVmax> 5.85 were associated with significantly shorter progression-free survival (PFS) than those with tumor SUVmax≤5.85 (P = 0.005). Restaging FDG PET/CT scans were performed in 36 patients with suspected recurrent papillary RCCs. FDG PET/CT showed a sensitivity and specificity of 100 and 72.7% for detecting recurrent disease. Comparison of PET/CT scans with CT/MRI imaging was available in 23 patients. FDG PET/CT revealed additional findings in 11 patients, mainly including lymph node and bone metastases. FDG PET/CT findings led to change in management in 5.3% (2/38) of patients in the staging setting and 16.7 (6/36) of patients in the restaging setting. Conclusions FDG PET/CT had a sensitivity of 81.5% for detecting primary papillary RCC, and tumor SUVmax derived from staging FDG PET/CT was a predictor of PFS. In the restaging process of papillary RCC, FDG PET/CT was very effective for detecting recurrent disease. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-021-00393-8.
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Affiliation(s)
- Guozhu Hou
- Department of Nuclear Medicine, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, 100730, China
| | - Dachun Zhao
- Department of Pathology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yuanyuan Jiang
- Department of Nuclear Medicine, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, 100730, China
| | - Zhaohui Zhu
- Department of Nuclear Medicine, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, 100730, China
| | - Li Huo
- Department of Nuclear Medicine, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, 100730, China
| | - Fang Li
- Department of Nuclear Medicine, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China. .,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, 100730, China.
| | - Wuying Cheng
- Department of Nuclear Medicine, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China. .,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, 100730, China.
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Dudani S, de Velasco G, Wells JC, Gan CL, Donskov F, Porta C, Fraccon A, Pasini F, Lee JL, Hansen A, Bjarnason GA, Beuselinck B, Pal SK, Yuasa T, Kroeger N, Kanesvaran R, Reaume MN, Canil C, Choueiri TK, Heng DYC. Evaluation of Clear Cell, Papillary, and Chromophobe Renal Cell Carcinoma Metastasis Sites and Association With Survival. JAMA Netw Open 2021; 4:e2021869. [PMID: 33475752 PMCID: PMC7821027 DOI: 10.1001/jamanetworkopen.2020.21869] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE There exists considerable biological and clinical variability between histologic variants of metastatic renal cell carcinoma (mRCC). Data reporting on patterns of metastasis in histologic variants of mRCC are sparse. OBJECTIVE To characterize sites of metastasis and their association with survival across the 3 most common histologic variants of mRCC: clear cell (ccRCC), papillary (pRCC), and chromophobe (chrRCC). DESIGN, SETTING, AND PARTICIPANTS In this multicenter, international cohort study, the International mRCC Database Consortium (IMDC) database was used to identify consecutive patients starting systemic therapy for mRCC between 2002 and 2019. Patients with mixed histologic subtype were excluded. Statistical analysis was performed from February to June 2020. EXPOSURES Data regarding histologic subtype and sites of metastatic involvement at the time of first systemic therapy initiation were collected. MAIN OUTCOMES AND MEASURES The primary outcomes were prevalence of metastatic site involvement and overall survival (OS) from time of systemic therapy initiation. Patients with multiple sites of metastatic involvement were included in analyses of all groups to which they had metastases. RESULTS A total of 10 105 patients were eligible for analysis. Median (interquartile range) age at diagnosis was 60 (53-67) years, 7310 (72.4%) were men and 8526 (84.5%) underwent nephrectomy. Of these, 9252 (92%) had ccRCC, 667 (7%) had pRCC, and 186 (2%) had chrRCC. The median number of sites of metastasis was 2 (range, 0-7). In ccRCC, the most common sites of metastasis were lung (70%; 6189 of 8804 patients [448 missing]), lymph nodes (45%; 3874 of 8655 patients [597 missing]), bone (32%; 2847 of 8817 patients [435 missing]), liver (18%; 1560 of 8804 [448 missing]), and adrenal gland (10%; 678 of 6673 patients [2579 missing]). Sites of metastasis varied between subtypes. Lung, adrenal, brain, and pancreatic metastases were more frequent in ccRCC, lymph node involvement was more common in pRCC, and liver metastases were more frequent in chrRCC. Median OS for ccRCC varied by site of metastatic involvement, ranging between 16 months (95% CI, 13.7-18.8 months) for the pleura and 50 months (95% CI, 41.1-55.5 months) for the pancreas. Compared with ccRCC, patients with pRCC tended to have lower OS, regardless of metastatic site. CONCLUSIONS AND RELEVANCE Sites of metastatic involvement differ according to histologic subtype in mRCC and are associated with OS. These data highlight the clinical and biological variability between histologic subtypes of mRCC. Patterns of metastatic spread may reflect differences in underlying disease biology. Further work to investigate differences in immune, molecular, and genetic profiles between metastatic sites and histologic subtypes is encouraged.
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Affiliation(s)
- Shaan Dudani
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Guillermo de Velasco
- Department of Medical Oncology, University Hospital 12 de Octubre, Madrid, Spain
| | - J Connor Wells
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Chun Loo Gan
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Frede Donskov
- Department of Oncology,Aarhus University Hospital, Aarhus, Denmark
| | - Camillo Porta
- Department of Internal Medicine, University of Pavia, Pavia, Italy
- Now with Department of Oncology, University of Bari Aldo Moro, Bari, Italy
| | | | - Felice Pasini
- Oncologia Medica Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | - Jae Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Aaron Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Georg A Bjarnason
- Division of Medical Oncology, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Benoit Beuselinck
- Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Takeshi Yuasa
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Nils Kroeger
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | | | - M Neil Reaume
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada
| | - Christina Canil
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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Comprehensive Review of Numerical Chromosomal Aberrations in Chromophobe Renal Cell Carcinoma Including Its Variant Morphologies. Adv Anat Pathol 2021; 28:8-20. [PMID: 33021507 DOI: 10.1097/pap.0000000000000286] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chromophobe renal cell carcinoma (ChRCC) accounts for 5% to 7% of all renal cell carcinomas. It was thought for many years that ChRCC exhibits a hypodiploid genome. Recent studies using advanced molecular genetics techniques have shown more complex and heterogenous pattern with frequent chromosomal gains. Historically, multiple losses of chromosomes 1, 2, 6, 10, 13, 17, and 21 have been considered a genetic hallmark of ChRCC, both for classic and eosinophilic ChRCC variants. In the last 2 decades, multiple chromosomal gains in ChRCCs have also been documented, depicting a considerably broader genetic spectrum than previously thought. Studies of rare morphologic variants including ChRCC with pigmented microcystic adenomatoid/multicystic growth, ChRCC with neuroendocrine differentiation, ChRCC with papillary architecture, and renal oncocytoma-like variants also showed variable chromosomal numerical aberrations, including multiple losses (common), gains (less common), or chromosomal changes overlapping with renal oncocytoma. Although not the focus of the review, The Cancer Genome Atlas (TCGA) data in ChRCC show TP53, PTEN, and CDKN2A to be the most mutated genes. Given the complexity of molecular genetic alterations in ChRCC, this review analyzed the existing published data, aiming to present a comprehensive up-to-date survey of the chromosomal abnormalities in classic ChRCC and its variants. The potential role of chromosomal numerical aberrations in the differential diagnostic evaluation may be limited, potentially owing to its high variability.
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Duan C, Li N, Niu L, Wang G, Zhao J, Liu F, Liu X, Ren Y, Zhou X. CT texture analysis for the differentiation of papillary renal cell carcinoma subtypes. Abdom Radiol (NY) 2020; 45:3860-3868. [PMID: 32444891 DOI: 10.1007/s00261-020-02588-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The objective of this study was to investigate whether computed tomography texture analysis can be used to differentiate papillary renal cell carcinoma (PRCC) subtypes. METHOD Sixty-two PRCC tumors were retrospectively evaluated, with 30 type 1 tumors and 32 type 2 tumors. Texture parameters quantified from three-phase contrast-enhanced CT images were compared with least absolute shrinkage and selection operator (LASSO) regression. Receiver operating characteristic (ROC) analysis was performed, and the area under the ROC curve (AUC) was calculated for each parameter. The selected texture parameters of each phase were used to generate support vector machine (SVM) classifiers. Decision curve analysis (DCA) of the classification was performed. RESULTS The two texture parameters with the top two AUC values were - 333-7 Correlation (AUC = 0.772) and 45-7 Entropy (AUC = 0.753) in the corticomedullary phase, 333-4 Correlation (AUC = 0.832) and 45-7 Entropy (AUC = 0.841) in the nephrographic phase, and 135-7 Entropy (AUC = 0.858) and - 333-1 InformationMeasureCorr2 (AUC = 0.849) in the excretory phase. Entropy and Correlation have a high correlation with the two types of PRCC and are increased in type 2 PRCC. A model incorporating the texture parameters with the top two AUC values in each phase produced an AUC of 0.922 with an accuracy of 84% (sensitivity = 89% and specificity = 80%). The nephrographic-phase model and the model combining the texture parameters of the three phases can differentiate the two types with the largest net benefit. CONCLUSIONS Computed tomography texture analysis can be used to distinguish type 2 PRCC from type 1 with high accuracy, which may be clinically important.
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Affiliation(s)
- Chongfeng Duan
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Nan Li
- Department of Information Management, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lei Niu
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Gang Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Jiping Zhao
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Fang Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Xuejun Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Yande Ren
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China
| | - Xiaoming Zhou
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 1677, Wu Tai Shan Road, Huangdao District, Qingdao, Shandong, China.
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17
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Russo P. Historical Perspective on Partial Nephrectomy and Renal Functional Preservation. Urology 2020; 145:314-315. [DOI: 10.1016/j.urology.2020.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zhuang W, Liu N, Guo H, Zhang C, Gan W. Gender difference analysis of Xp11.2 translocation renal cell carcinomas's attack rate: a meta-analysis and systematic review. BMC Urol 2020; 20:130. [PMID: 32843027 PMCID: PMC7449070 DOI: 10.1186/s12894-020-00696-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
Background Xp11.2 translocation renal cell carcinoma (tRCC) is recently recognized. As Xp11.2 tRCC involved gene translocation and fusion in X chromosome and the number of X chromosomes in female is twice of male, we wondered whether the gender difference of attack rate is consistent with the proportion of the X chromosome. Methods: In the present paper, meta-analysis was performed to find out the difference of morbidity between male and female. Results Nine studies with 209 cases calculated. Odds ratios (ORs) and ORs with 95% confidence intervals (CIs) were calculated for attack rate of Xp11.2 RCC with different gender. The result showed that the attack rate of female was higher than that of male with pooled OR of 2.84 (95% CI = 1.48–5.45), while the rate rises even further in adult (OR = 3.37, 95% CI =2.19–5.18). In other types of common kidney cancer, the OR value is less than 1, which means that the incidence of female is lower than that of male. Conclusions The result showed that the incidence rate of female patients is much higher than that of male patients with Xp11.2 tRCC, it was reasonable to indicate that this particular incidence rate is related to the X chromosome.
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Affiliation(s)
- Wenyuan Zhuang
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, China
| | - Ning Liu
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, China
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, China
| | - Chunni Zhang
- Department of Clinical Laboratory, Jinling Hospital, State Key Laboratory of Analytical Chemistry for Life Science, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, Nanjing University School of Medicine, Nanjing University, Nanjing, China.
| | - Weidong Gan
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, China.
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Prospective performance of clear cell likelihood scores (ccLS) in renal masses evaluated with multiparametric magnetic resonance imaging. Eur Radiol 2020; 31:314-324. [PMID: 32770377 DOI: 10.1007/s00330-020-07093-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/02/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Solid renal masses have unknown malignant potential with commonly utilized imaging. Biopsy can offer a diagnosis of cancer but has a high non-diagnostic rate and complications. Reported use of multiparametric magnetic resonance imaging (mpMRI) to diagnose aggressive histology (i.e., clear cell renal cell carcinoma (ccRCC)) via a clear cell likelihood score (ccLS) was based on retrospective review of cT1a tumors. We aim to retrospectively assess the diagnostic performance of ccLS prospectively assigned to renal masses of all stages evaluated with mpMRI prior to histopathologic evaluation. METHODS In this retrospective cohort study from June 2016 to November 2019, 434 patients with 454 renal masses from 2 institutions with heterogenous patient populations underwent mpMRI with prospective ccLS assignment and had pathologic diagnosis. ccLS performance was assessed by contingency table analysis. The association between ccLS and ccRCC was assessed with logistic regression. RESULTS Mean age and tumor size were 60 ± 13 years and 5.4 ± 3.8 cm. Characteristics were similar between institutions except for patient age and race (both p < 0.001) and lesion laterality and histology (both p = 0.04). The PPV of ccLS increased with each increment in ccLS (ccLS1 5% [3/55], ccLS2 6% [3/47], ccLS3 35% [20/57], ccLS4 78% [85/109], ccLS5 93% [173/186]). Pooled analysis for ccRCC diagnosis revealed sensitivity 91% (258/284), PPV 87% (258/295) for ccLS ≥ 4, and specificity 56% (96/170), NPV 94% (96/102) for ccLS ≤ 2. Diagnostic performance was similar between institutions. CONCLUSIONS We confirm the optimal diagnostic performance of mpMRI to identify ccRCC in all clinical stages. High PPV and NPV of ccLS can help inform clinical management decision-making. KEY POINTS • The positive predictive value of the clear cell likelihood score (ccLS) for detecting clear cell renal cell carcinoma was 5% (ccLS1), 6% (ccLS2), 35% (ccLS3), 78% (ccLS4), and 93% (ccLS5). Sensitivity of ccLS ≥ 4 and specificity of ccLS ≤ 2 were 91% and 56%, respectively. • When controlling for confounding variables, ccLS is an independent risk factor for identifying clear cell renal cell carcinoma. • Utilization of the ccLS can help guide clinical care, including the decision for renal mass biopsy, reducing the morbidity and risk to patients.
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Yan H, Wei X, Wu A, Sha Y, Li X, Qi F. Nomograms for predicting overall and cancer-specific survival in patients with papillary renal cell carcinoma: a population-based study using SEER database. Transl Androl Urol 2020; 9:1146-1158. [PMID: 32676398 PMCID: PMC7354311 DOI: 10.21037/tau-19-807] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/08/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To establish and validate nomograms for predicting the overall survival (OS) and cancer-specific survival (CSS) in patients with papillary renal cell carcinoma (pRCC). METHODS Patients diagnosed with pRCC between 2010 and 2014 in the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively included in this study and divided into training and validation groups randomly. Uni- and multivariate Cox regression analyses were used to identify significant variables related to OS and CSS in the training group. Based on results of multivariate Cox regression analysis, nomograms for 3- and 5-year CSS and OS were established, respectively. Additionally, Kaplan-Meier (KM) survival curves were produced to learn the actual effects of different variables. Finally, the nomograms were evaluated both in the training group and the validation group using the area under the receiver operating characteristic (ROC) curve, the concordance index (C-index) and calibration curves. RESULTS A total of 4,859 eligible patients were enrolled, with 3,403 categorized into the training group and 1,456 into the validation group. Seven factors [age, T stage, N stage, M stage, use of surgery/lymph node removal (LNR) and insurance status] were significantly related to OS and seven factors (age, T stage, N stage, M stage and use of surgery/chemotherapy/LNR) were significantly associated with CSS. These factors were eventually included in the predictive nomograms. The C-indexes for OS in the training and validation groups were 0.764 and 0.723 respectively, and 0.859 and 0.824 for CSS. The 3- and 5-year AUCs for OS were 0.779 and 0.752 in the training cohort, and 0.749 and 0.722 in the validation cohort. Similarly, 3- and 5-year AUCs for OS were 0.871 and 0.844 in the training cohort, and 0.853 and 0.822 in the validation group. Finally, the calibration curves suggested that the predictive nomograms had a good consistency between the observed and the predicted survival. CONCLUSIONS It was the first time to develop nomograms to predict the survival outcomes of pRCC patients. The prognostic nomograms were reliable with high accuracy, which might have guiding significance for clinical practice.
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Affiliation(s)
- Haicui Yan
- Department of Oncology, The Second People’s Hospital of Lianyungang, Lianyungang 222000, China
| | - Xiyi Wei
- First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
| | - Aimin Wu
- Department of Orthopaedic, Zhejiang Provincial Key Laboratory of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Yeqin Sha
- First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
| | - Xiao Li
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Feng Qi
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
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Predictive Value of In Vivo MR Spectroscopy With Semilocalization by Adiabatic Selective Refocusing in Differentiating Clear Cell Renal Cell Carcinoma From Other Subtypes. AJR Am J Roentgenol 2020; 214:817-824. [PMID: 32045306 DOI: 10.2214/ajr.19.22023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study is to evaluate the diagnostic value of in vivo MR spectroscopy (MRS) with semilocalization by adiabatic selective refocusing (semi-LASER MRS) in differentiating clear cell renal cell carcinoma (RCC) from the non-clear cell subtype. SUBJECTS AND METHODS. Sixteen patients with biopsy-proven RCC or masses highly suspicious for RCC were prospectively recruited to participate in the study. Single-voxel 1H spectra were acquired using a 3-T MRI system, with a semi-LASER sequence acquired for renal tumors in 14 patients and for healthy renal tissue (control tissue) in 12 patients. Offline processing of the MR spectra was performed. MRI and spectra analysis were performed independently by radiologists who were blinded to the reference histopathologic findings. RESULTS. Semi-LASER MRS was diagnostic for nine of 11 patients (82%) with histopathologically proven clear cell RCC, showing a strong lipid peak in seven patients and a weaker lipid resonance in two others, whereas control spectra showed weakly positive findings in only one patient. MRS findings were negative for lipid resonance in two of three patients (67%) with non-clear cell tumors and were weakly positive in another patient. Semi-LASER MRS had a high sensitivity and positive predictive value of 82% and 90%, respectively, in addition to a specificity of 67%, a negative predictive value of 50%, and overall accuracy of 79% for the detection of clear cell RCC. Lipid resonance was detected by MRS for four of six clear cell RCCs with no intravoxel fat on chemical-shift MRI. CONCLUSION. The preliminary results of the present study show that semi-LASER MRS is promising for the noninvasive discrimination of clear cell RCC from non-clear cell RCC on the basis of detection of lipid resonance and that it provides an incremental yield compared with chemical-shift MRI.
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Electrophysiological differences between typical and dense benign prostatic hyperplasia tissues retrieved after holmium laser enucleation of the prostate. J INCL PHENOM MACRO 2019. [DOI: 10.1007/s10847-019-00895-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Deng J, Li L, Xia H, Guo J, Wu X, Yang X, Hong Y, Chen Q, Hu J. A comparison of the prognosis of papillary and clear cell renal cell carcinoma: Evidence from a meta-analysis. Medicine (Baltimore) 2019; 98:e16309. [PMID: 31277173 PMCID: PMC6635153 DOI: 10.1097/md.0000000000016309] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To compare the prognosis of papillary and clear cell renal cell carcinoma (RCC) in order to determine the optimal follow-up and therapy for patients with RCC. METHODS A systematic search of Web of Science, EMBASE, Cochrane Library, and PubMed databases was conducted for articles published through July 30, 2018, reporting on a comparison of the prognosis of papillary RCC and clear cell RCC using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS Of 1896 studies, 11 were considered for the evidence synthesis. A total of 35,832 patients were included. Of these patients, 6907 patients were diagnosed with papillary renal cell carcinoma, and 28,925 patients were diagnosed with clear cell renal cell carcinoma. The prognosis of papillary RCC was better than that of clear cell RCC (hazard ratio (HR) = 0.50; 95% confidence interval (CI) 0.45 to 0.56; P < .001; I = 91.9%). A subgroup analysis indicated that papillary RCC was associated with better outcomes (HR = 0.76, 95% CI 0.50-1.16), and a trend toward a higher risk of mortality was observed in patients with metastatic RCC presenting with papillary histology, but the difference was not statistically significant (HR = 1.12, 95% CI 0.71-1.76, P = .085). Pooled data suggested a lack of a significant difference between papillary RCC (p-RCC) type 1 and clear cell RCC (cc-RCC) (HR = 0.30, 95% CI 0.12-0.73, P = .085). The pooled HR for the prognosis of p-RCC type 2 compared to cc-RCC was 1.69 (95% CI 0.93-3.08; P = .032). CONCLUSION Papillary RCC is associated with better outcomes than clear cell RCC in patients without metastases, but not in patients with metastases. Optimal follow-up or therapy for patients with RCC should be assigned according to the tumor stage and subtype.
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Affiliation(s)
- Jun Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University
| | - Lei Li
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University
| | - Haimei Xia
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University
| | - Ju Guo
- Department of Urology, The First Affiliated Hospital of Nanchang University
| | - Xin Wu
- Department of Urology, The First Affiliated Hospital of Nanchang University
| | - Xiaorong Yang
- Department of Urology, The First Affiliated Hospital of Nanchang University
| | - Yanyan Hong
- Department of Nursing, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qingke Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University
| | - Jieping Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University
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Wong ECL, Di Lena R, Breau RH, Pouliot F, Finelli A, Lavallée LT, So A, Tanguay S, Fairey A, Rendon R, Richard PO, Lattouf JB, Kawakami J, Mallick R, Kapoor A. Morphologic subtyping as a prognostic predictor for survival in papillary renal cell carcinoma: Type 1 vs. type 2. Urol Oncol 2019; 37:721-726. [PMID: 31176614 DOI: 10.1016/j.urolonc.2019.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/17/2019] [Accepted: 05/13/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate outcomes of surgically treated patients with clinically localized papillary renal cell carcinoma (RCC) and determine if papillary RCC subtype is associated with recurrence and survival. METHODS This is a historical cohort study using the prospectively maintained Canadian Kidney Cancer Information System database between January 2011 and September 2018. All patients underwent partial or radical nephrectomy. Patient, tumor, treatment, and outcomes were compared between papillary RCC type 2 and type 1 cohorts. RESULTS During the study period, 509 patients had clinically localized papillary RCC type 2 (n = 172) or type 1 (n = 337) histology. Sex, race, and comorbidities were similar between groups. Pathologic stage (pT3 or pT4), nuclear grade (3 or 4), and tumor diameter were higher in the type 2 papillary RCC cohort (P < 0.0001). A greater proportion of type 2 papillary RCC patients received radical nephrectomy (42.4% vs. 24.6%, P< 0.0001). More type 2 papillary RCC patients underwent lymph node dissection (19.6% vs. 5.5%, P< 0.0001) and had lymph node metastases removed during surgery (6.4% vs. 0.6%, P= 0.103). Overall, adjusting for age, grade, pathologic stage, positive nodes, and tumor size, type 2 papillary RCC had worse outcomes compared to type 1, as demonstrated by elevated all-cause mortality (hazard ratio = 7.7 [95% confidence interval: 2.0-28.9]), P=0.0027) and worse recurrence-free survival (hazard ratio = 8.2 [95% confidence interval: 3.6-19.0], P< 0.0001). CONCLUSION Patients with clinically localized type 2 papillary RCC present with higher risk disease and have worse prognosis compared to patients with clinically localized type 1 papillary RCC. To the best of our knowledge, this is the largest cohort study comparing papillary RCC subtypes.
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Affiliation(s)
- Emily C L Wong
- Department of Surgery, Division of Urology, Hamilton, Ontario
| | - Richard Di Lena
- Department of Surgery, Division of Urology, Hamilton, Ontario
| | - Rodney H Breau
- Department of Surgery, Division of Urology, Ottawa, Ontario
| | | | - Antonio Finelli
- Department of Surgery, Division of Urology, Toronto, Ontario
| | | | - Alan So
- Department of Surgery, Division of Urology, Vancouver, British Columbia
| | - Simon Tanguay
- Department of Surgery, Division of Urology, Montreal, Quebec
| | - Adrian Fairey
- Department of Surgery, Division of Urology, Edmonton, Alberta
| | - Ricardo Rendon
- Department of Surgery, Division of Urology, Halifax, Nova Scotia
| | | | | | - Jun Kawakami
- Department of Surgery, Division of Urology, Calgary, Alberta
| | | | - Anil Kapoor
- Department of Surgery, Division of Urology, Hamilton, Ontario.
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Clinicopathological and survival analysis of clinically advanced papillary and chromophobe renal cell carcinoma. Urol Oncol 2019; 37:727-734. [PMID: 31174958 DOI: 10.1016/j.urolonc.2019.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/28/2019] [Accepted: 05/13/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Clinically, the papillary (pRCC) and chromophobe (chRCC) histologic subtypes of renal cell carcinoma (RCC) are viewed as more indolent compared to the more-common clear cell histology (ccRCC). However, there remain advanced cases of these purportedly less-aggressive histologies that lead to significant mortality. We therefore sought to evaluate outcomes of advanced pRCC and chRCC compared to ccRCC utilizing the National Cancer Database's registry of RCC patients. MATERIALS AND METHODS A total of 115,365 ccRCC patients, 28,344 pRCC patients, and 11,942 chRCC patients met eligibility criteria. Overall survival (OS) was estimated using the Kaplan-Meier method (median follow-up 3.6 years). OS was compared between stage III and IV ccRCC, pRCC, and chRCC using multivariable Cox proportional hazards model adjusted for clinical and treatment characteristics. RESULTS A total of 25.7% of ccRCC patients, 14.1% of pRCC patients, and 14.8% of chRCC patients had stage III to IV disease. The 5-year OS for stage III ccRCC, pRCC, and chRCC was 66.9%, 63.6%, and 80.5%, respectively. The 5-year OS for stage IV ccRCC, pRCC and chRCC was 19.7%, 13.3%, and 22.0%, respectively. The hazard of death was significantly higher for stage IV pRCC vs. ccRCC (hazard ratio = 1.29; 95% confidence interval = 1.19, 1.39; P < 0.01) and similar for stage IV chRCC vs. ccRCC (hazard ratio = 1.01; 95% confidence interval = 0.85, 1.21; P = 0.885). CONCLUSIONS pRCC and chRCC are rare but similarly fatal compared to ccRCC when advanced or metastatic. With most clinical trials devoted toward ccRCC, greater efforts to identify aggressive variants and treatment strategies for metastatic pRCC and chRCC are necessary.
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Naher S, Padinharakam S, Balakrishnar B, Chua W, Descallar J, Adams D, de Souza P, Harrison M, Lim S. Patterns of Presentation and Treatment Outcomes of Non-clear-cell Renal Cell Carcinoma and Sarcomatoid Renal Cell Carcinoma Patients in 2 Tertiary Referral Centers in Sydney, Australia. Clin Genitourin Cancer 2019; 17:e565-e569. [PMID: 30935815 DOI: 10.1016/j.clgc.2019.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-clear-cell renal cell carcinoma (nccRCC) and renal cell carcinoma with sarcomatoid features (scRCC) are rare, and represent subtypes with less defined treatment strategies. The aim of this study is to describe the patterns of care and outcomes of these patients in 2 tertiary referral centers in South Western Sydney Local Health District over a 10-year period. PATIENTS AND METHODS Patients with RCC seen at South Western Sydney Local Health District from January 1, 2005 to December 31, 2015 were identified from electronic medical records. For each patient, we extracted details regarding demographics, tumor characteristics, treatment, recurrences, and survival, which was analyzed using the Kaplan-Meier method. RESULTS Of 178 patients with RCC identified between 2005 and 2015, 23% (n = 41) had nccRCC and 8% (n = 15) had scRCC. Twenty-five patients in total had de novo metastatic disease or disease recurrence. The median follow-up was 46 and 16 months for nccRCC and scRCC, respectively. The median overall survival for nccRCC with metastatic disease was 34 months (range, 14 months to not reached). Seventy percent of these patients received systemic therapy. By contrast, the median overall survival for scRCC with metastatic disease was 10 months (range, 1.6-89 months). Less than one-half of the patients with scRCC received systemic therapy in our cohort, with only 34% receiving no more than 1 line of treatment. CONCLUSIONS Our data confirm the rapid and aggressive course of scRCC, highlighting the need for more effective therapeutic strategies in this rare patient population.
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Affiliation(s)
- Sayeda Naher
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia.
| | - Shamsudheen Padinharakam
- School of Medicine, University of New South Wales, Kensington, New South Wales, Australia; School of Health Sciences, University of Tasmania, Tasmania, Australia; Launceston General Hospital, Launceston, Tasmania, Australia
| | | | - Wei Chua
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Joseph Descallar
- School of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Diana Adams
- Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia
| | - Paul de Souza
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia
| | - Michelle Harrison
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
| | - Stephanie Lim
- School of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia
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Zhang H, Pan J, Shen Y, Bai X, Wang Y, Wang H, Ye H. High signal renal tumors on DWI: the diagnostic value of morphological characteristics. Abdom Radiol (NY) 2019; 44:239-246. [PMID: 30141057 DOI: 10.1007/s00261-018-1728-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess the usefulness of morphological characteristics of diffusion-weighted imaging (DWI) for differentiating malignant renal tumors from benign renal tumors, and clear cell renal cell carcinoma (RCC) from non-clear cell RCC at 3.0 T. METHODS The study included 249 patients with 251 histopathologically confirmed renal tumors that showed high signal on DWI. For each tumor, two radiologists independently evaluated apparent diffusion coefficient (ADC) values and morphological characteristics of DWI. The differences in the quantitative and qualitative magnetic resonance imaging (MRI) features determined by the readers were assessed. The ADC values between malignant and benign renal tumors and between clear cell and non-clear cell RCC were compared using Mann-Whitney tests. The proportional differences of morphological characteristics of DWI between malignant and benign renal tumors and between clear cell and non-clear cell RCC were compared using Chi-square tests. RESULTS There were no significant differences in the quantitative and qualitative MRI features determined by the readers. The ADC values for malignant renal tumors were statistically significantly higher than those for benign renal tumors (p < 0.05), and the ADC values for clear cell RCC were statistically significantly higher than those for non-clear cell RCC (p < 0.05). The proportion of morphological characteristics of DWI between malignant and benign renal tumors was statistically significantly different at ring, nodular, flaky high signal. The proportion of morphological characteristics of DWI between clear cell and non-clear cell RCC was statistically significantly different at uniform high signal. CONCLUSIONS The morphological characteristics of DWI are useful in differentiating renal tumors.
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Affiliation(s)
- Hongtao Zhang
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
- Department of Radiology, 307 Hospital, PLA, Beijing, China
| | - Jingjing Pan
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
- Department of Radiology, General Hospital of the PLA Rocket Force, Beijing, China
| | - Yanguang Shen
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Xu Bai
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Yingwei Wang
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Haiyi Wang
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
| | - Huiyi Ye
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
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Abstract
PURPOSE To investigate whether multiphasic MDCT enhancement profiles can help to identify PTEN expression in clear cell renal cell carcinomas (ccRCCs). Lack of PTEN expression is associated with worsened overall survival, a more advanced Fuhrman grade, and a greater likelihood of lymph mode metastasis. METHODS With IRB approval for this retrospective study, we derived a cohort of 103 histologically proven ccRCCs with preoperative 4-phase renal mass MDCT from 2001-2013. Following manual segmentation, a computer-assisted detection algorithm selected a 0.5-cm-diameter region of maximal attenuation within each lesion in each phase; a 0.5-cm-diameter region of interest was manually placed on uninvolved renal cortex in each phase. The relative attenuation of each lesion was calculated as [(Maximal lesion attenuation - cortex attenuation)/cortex attenuation] × 100. Absolute and relative attenuation in each phase were compared using t tests. The performance of multiphasic enhancement in identifying PTEN expression was assessed with logistic regression analysis. RESULTS PTEN-positive and PTEN-negative ccRCCs both exhibited peak enhancement in the corticomedullary phase. Relative corticomedullary phase attenuation was significantly greater for PTEN-negative ccRCCs in comparison to PTEN-positive ccRCCs (33.7 vs. 9.5, p = 0.03). After controlling for lesion stage and size, relative corticomedullary phase attenuation had an accuracy of 84% (86/103), specificity of 100% (84/84), sensitivity of 11% (2/19), positive predictive value of 100% (2/2), and negative predictive value of 83% (84/101) in identifying PTEN expression. CONCLUSION Relative corticomedullary phase attenuation may help to identify PTEN expression in ccRCCs, if validated prospectively.
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Wen L, Yu Y, Lv H, He Y, Yang B. FTO mRNA expression in the lower quartile is associated with bad prognosis in clear cell renal cell carcinoma based on TCGA data mining. Ann Diagn Pathol 2018; 38:1-5. [PMID: 30380400 DOI: 10.1016/j.anndiagpath.2018.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/04/2018] [Accepted: 10/23/2018] [Indexed: 01/31/2023]
Abstract
Fat mass and obesity associated (FTO) is a protein-coding gene, also known as the obesity gene. It has been reported previously to be associated with a variety of malignant cancers, such as breast, thyroid and acute myeloid leukemia. The aim of the present study was to investigate the FTO mRNA expression in human clear cell renal cell carcinoma and its clinical value. FTO mRNA expression and its prognostic value were investigated by bioinformatic analysis of the data from The Cancer Genome Atlas (TCGA, https://cancergenome.nih.gov/). The Kaplan-Meier analysis showed that FTO mRNA expression in the lower quartile is significantly associated with poor survival in clear cell renal cell carcinoma patients (P < 0.0001). This study indicated that higher FTO mRNA expression may have a protective role and it may be a vital molecular marker in the prognosis of clear cell renal cell carcinoma patients.
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Affiliation(s)
- Lijie Wen
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yang Yu
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Hang Lv
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yi He
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Bo Yang
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China.
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Association of the Gross Appearance of Intratumoral Vascularity at MDCT With the Carbonic Anhydrase IX Score in Clear Cell Renal Cell Carcinoma. AJR Am J Roentgenol 2018; 211:1254-1258. [PMID: 30300009 DOI: 10.2214/ajr.18.19725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether qualitative MDCT features are associated with the carbonic anhydrase IX (CAIX) score of clear cell renal cell carcinoma (RCC). The CAIX score has been previously found to have prognostic significance for disease-free survival, overall survival, and lymph node involvement. MATERIALS AND METHODS A cohort of 105 histologically proven clear cell RCCs in patients who underwent preoperative four-phase renal mass MDCT was derived from 2001 to 2013. Two genitourinary radiologists evaluated each lesion for the gross appearance of intratumoral vascularity, calcification, enhancement pattern, necrosis, margin, collecting system invasion, and renal vein invasion. Immunohistochemical analysis was used to determine the CAIX score (defined as the positive staining percentage multiplied by the staining intensity). Logistic and linear regression analyses were performed. RESULTS In a linear regression model controlled for lesion size and stage, the gross appearance of intratumoral vascularity had a significant positive association with CAIX score (β = 38.33, p = 0.010). In a logistic regression model controlled for lesion size and stage, the gross appearance of intratumoral vascularity had an odds ratio of 2.85 (p = 0.019) in differentiating clear cell RCCs with a CAIX score of 200-300 from clear cell RCCs with a CAIX score of 0-199. CONCLUSION In clear cell RCCs, the gross appearance of intratumoral vascularity at MDCT was significantly associated with CAIX score, a prognostically significant molecular marker. Current assessment of CAIX score requires pathologic tissue sampling and immunohistochemical analysis. A noninvasive imaging biomarker that may help predict CAIX score may be of great clinical value.
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Dong F, Xu L, Peng X, Xu T, Shen Y, Gao F, Wang X, Zhang X, Chen S, Zhang M, Zhong S, Ding Q. Pathologically examining a minimum of three lymph nodes could better determine node negativity in patients with non-metastatic chromophobe renal cell carcinoma. Jpn J Clin Oncol 2018; 48:942-949. [PMID: 30137442 DOI: 10.1093/jjco/hyy121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/03/2018] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the prognostic value of lymph node (LN) involvement for patients with chromophobe renal cell carcinoma (chRCC) and ascertain the minimum number of LNs that need to be pathologically examined to reliably diagnose a patient with node negative chRCC. Methods From 2004 to 2014, non-metastatic chRCC patients receiving radical nephrectomy together with lymphadenectomy were identified from the Surveillance, Epidemiology and End Results (SEER) database. The primary outcome was overall survival (OS). Results Two hundred and forty-six patients received lymph node dissection during the surgery. Of the patients, 24 (10%) had pathologically confirmed positive LN. Multivariate Cox regression model showed that positive LN was an independent unfavorable predictor for OS (HR = 2.83, 95%CI = 1.14-6.98, P = 0.024). More importantly, LN(-) patients with at least three LNs dissected had significantly better OS compared with when 1-2 LNs were examined (P = 0.048). Multivariate analysis confirmed that in LN(-) patients, the examination of three or more LNs could independently predict better OS compared with patients with only 1-2 LNs dissected (HR≥3LNs = 0.362, 95% CI = 0.135-0.972, P = 0.044). Additionally, the likelihood of finding at least one positive LN was significantly higher on dissection of ≥3 LNs compared with examination of 1-2 LNs (15% vs 5%, P = 0.018). Decision curve analysis found a better clinical validity of the '3 LNs examined'-based classification compared with the traditional LN(-)/LN(+) classification. Conclusion The proportion of positive LNs in chRCC was far from neglectable and LN metastasis could independently predict unfavorable OS. We recommended a minimum of three LNs should be pathologically examined in order to reliably determine node negative.
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Affiliation(s)
- Fan Dong
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Liqi Xu
- Department of Urology, No.113 Hospital of PLA, Ningbo, Zhejiang
| | - Xiaoqiong Peng
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Tianyuan Xu
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai
| | - Yifan Shen
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Fengbin Gao
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xianjin Wang
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Xiaohua Zhang
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Shanwen Chen
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Minguang Zhang
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Shan Zhong
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
| | - Qiang Ding
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai
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Utility of multiphasic multidetector computed tomography in discriminating between clear cell renal cell carcinomas with high and low carbonic anhydrase-IX expression. Abdom Radiol (NY) 2018. [PMID: 29520426 DOI: 10.1007/s00261-018-1546-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate if multiphasic multidetector computed tomography (MDCT) enhancement profiles can distinguish clear cell renal cell carcinomas (ccRCCs) with high carbonic anhydrase-IX (CA-IX) expression from ccRCCs with low CA-IX expression. METHODS With IRB approval for this retrospective study, we derived a cohort of 105 histologically proven ccRCCs with preoperative 4-phase renal mass MDCT from 2001 to 2013. Following manual segmentation, the computer-assisted detection algorithm selected a 0.5-cm-diameter region of maximal attenuation within each lesion in each phase. CA-IX expression level was determined by immunohistochemical staining of tumor specimens. In the high and low CA-IX expression subgroups, the magnitude of enhancement and washout were compared using t tests; the performance of contrast washout in differentiating between subgroups was assessed with logistic regression analysis. RESULTS ccRCCs with high and low CA-IX expression both exhibited peak enhancement in the corticomedullary phase. ccRCCs with high CA-IX expression demonstrated significantly greater relative nephrographic washout than those with low CA-IX expression (18.4% vs. 7.8%, p = 0.03). ccRCCs with high CA-IX expression had greater relative excretory washout than ccRCCs with low CA-IX expression with a trend toward significance (33.4% vs. 25.2%, p = 0.05). After controlling for tumor size and stage, for distinguishing ccRCCs with high and low CA-IX expression, relative excretory washout had a sensitivity, negative predictive value, accuracy, and positive predictive value of 99% (65/66), 88% (7/8), 69% (72/105), and 67% (65/97), respectively. CONCLUSION Relative nephrographic and excretory washout may have the potential to help distinguish ccRCCs with high and low CA-IX expression, but this requires further validation.
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Chiarello MA, Mali RD, Kang SK. Diagnostic Accuracy of MRI for Detection of Papillary Renal Cell Carcinoma: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:812-821. [PMID: 30063398 PMCID: PMC6440798 DOI: 10.2214/ajr.17.19462] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of our study was to perform a systematic review and meta-analysis of the diagnostic performance of MRI in differentiation of papillary renal cell carcinoma (RCC) from other renal masses. MATERIALS AND METHODS We performed searches of three electronic databases for studies that used MRI techniques to differentiate papillary RCC from other renal lesions. Methodologic quality was assessed, and diagnostic test accuracy was summarized using bivariate random-effects modeling or with construction of a summary ROC (SROC) curve. RESULTS Thirteen studies involving 275 papillary RCC lesions and 758 other renal masses met the inclusion criteria. Resulting summary estimates for the performance of MRI to differentiate papillary RCC from other renal lesions were a sensitivity of 79.6% (95% CI, 62.3-90.2%) and specificity of 88.1% (95% CI, 80.1-93.1%). In subgroup analysis, quantitative pooling of seven studies using enhancement in the corticomedullary phase resulted in a sensitivity of 85.6% (95% CI, 67.8-94.4%), specificity of 91.7% (95% CI, 76.0-97.5%), and area under the SROC curve of 0.894. Four studies used tumor appearance on T2-weighted imaging to detect papillary RCC, and results showed a pooled sensitivity of 89.9% (95% CI, 73.0-96.7%) and specificity of 84.9% (95% CI, 69.0-93.4%). Three studies used signal loss on T1-weighted in-phase imaging to detect papillary RCC but marked heterogeneity precluded pooling. CONCLUSION Meta-analysis supports moderate sensitivity and excellent specificity of quantitative enhancement in the corticomedullary phase for differentiating papillary RCC from other tumors. The accuracy of combining enhancement and T2 signal-intensity characteristics merits further evaluation as a potential aid for management decisions.
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Affiliation(s)
- Matthew A Chiarello
- 1 Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016
| | - Rahul D Mali
- 1 Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016
| | - Stella K Kang
- 1 Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016
- 2 Department of Population Health, NYU School of Medicine, New York, NY
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Differentiation of Papillary Renal Cell Carcinoma Subtypes on MRI: Qualitative and Texture Analysis. AJR Am J Roentgenol 2018; 211:1234-1245. [PMID: 30240294 DOI: 10.2214/ajr.17.19213] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether quantitative texture analysis of MR images would improve the ability to distinguish papillary renal cell carcinoma (RCC) subtypes, compared with analysis of qualitative MRI features alone. MATERIALS AND METHODS A total of 47 pathologically proven papillary RCC tumors were retrospectively evaluated, with 31 (66%) classified as type 1 tumors and 16 (34%) classified as type 2 tumors. MR images were reviewed by two readers to determine tumor size, signal intensity, heterogeneity, enhancement pattern, margins, perilesional stranding, vein thrombosis, and metastasis. Quantitative texture analysis of gray-scale images was performed. A logistic regression was derived from qualitative and quantitative features. Model performance was compared with and without texture features. RESULTS The significant qualitative MR features noted were necrosis, enhancement appearance, perilesional stranding, and metastasis. A multivariable model based on qualitative features did not identify any factor as an independent predictor of a type 2 tumor. The logistic regression model for predicting papillary RCCs on the basis of qualitative and quantitative analysis identified probability of the 2D volumetric interpolated breath-hold examination (VIBE) sequence (AUC value, 0.87; 95% CI, 0.77-0.98) as an independent predictor of a type 2 tumor. No difference in the model AUC value was noted when texture features were included in the analysis; however, the model had increased sensitivity and an improved predictive value without loss of specificity. CONCLUSION The addition of texture analysis to analysis of conventional qualitative MRI features increased the probability of predicting a type 2 papillary RCC tumor, which may be clinically important.
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Nouhaud FX, Bernhard JC, Bigot P, Khene ZE, Audenet F, Lang H, Bergerat S, Fraisse G, Grenier N, Cornelis F, Nedelcu C, Béjar S, Fromont-Hankard G, Allory Y, Lindner V, Verkarre V, Daniel L, Yacoub M, Correas JM, Méjean A, Rioux-Leclercq N, Bensalah K. Contemporary assessment of the correlation between Bosniak classification and histological characteristics of surgically removed atypical renal cysts (UroCCR-12 study). World J Urol 2018; 36:1643-1649. [PMID: 29730837 DOI: 10.1007/s00345-018-2307-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/24/2018] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate and compare pathological characteristics of renal cysts Bosniak IIF, III and IV in light of recent histological classification. PATIENTS AND METHODS The French research network for kidney cancer UroCCR conducted a multicentre study on patients treated surgically for a renal cyst between 2007 and 2016. Independent radiological and centralized pathological reviews were performed for every patient. Pathological characteristics were compared to the Bosniak classification. RESULTS Of a total 216 patients included, 175 (81.0%) tumours (90.9% of Bosniak IV, 69.8% of Bosniak III) were malignant or had a low malignant potential, with 60% of clear cell renal cell carcinoma (CCRCC), 24% of papillary RCC (PRCC) and 6.9% of multilocular cystic renal tumour of low malignant potential (MCRTLMP). Malignancies were mostly of low pT stage (86.4% of pT1-2), and low ISUP grade (68.0% of 1-2). Bosniak III cysts had a lower rate of CCRCC (46.7 vs. 67.3%), higher rate of PRCC (30 vs. 20.9%) and MCRTLMP (18.3 vs. 0.9%) compared to Bosniak IV (p < 0.001). Low-malignant potential lesions were less likely Bosniak IV and pT3-4 stage was more frequent in Bosniak IV vs. III (15.7 vs. 3.5%; p = 0.04). There were two recurrences (1.1%) and no cancer-related death occurred during follow-up. CONCLUSION These results confirmed that cystic renal malignancies have excellent prognosis. Bosniak III cysts had a low malignant potential, which suggests surveillance could be an option for these lesions.
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Affiliation(s)
| | | | - Pierre Bigot
- Department of Urology, Angers University Hospital, Angers, France
| | | | - François Audenet
- Department of Urology, European Georges Pompidou Hospital, APHP, Paris, France
| | - Herve Lang
- Department of Urology, Strasbourg University Hospital, Strasbourg, France
| | - Sebastien Bergerat
- Department of Urology, Strasbourg University Hospital, Strasbourg, France
| | - Guillaume Fraisse
- Department of Urology, European Georges Pompidou Hospital, APHP, Paris, France
| | - Nicolas Grenier
- Department of Radiology, Bordeaux University Hospital, Bordeaux, France
| | - François Cornelis
- Department of Radiology, Bordeaux University Hospital, Bordeaux, France
| | - Cosmina Nedelcu
- Department of Radiology, Angers Urology Hospital, Angers, France
| | - Sofiane Béjar
- Department of Radiology, Rouen University Hospital, Rouen, France
| | | | - Yves Allory
- Department of Pathology, Henry Mondor University Hospital, APHP, Créteil, France
| | - Véronique Lindner
- Department of Pathology, Strasbourg University Hospital, Strasbourg, France
| | - Virginie Verkarre
- Department of Pathology, European Georges Pompidou Hospital, APHP, Paris, France
| | - Laurent Daniel
- Department of Pathology, Timone University Hospital, APHM, Marseille, France
| | - Mokrane Yacoub
- Department of Pathology, Bordeaux University Hospital, Bordeaux, France
| | - Jean-Michel Correas
- Department of Radiology, European Georges Pompidou Hospital, APHP, Paris, France
| | - Arnaud Méjean
- Department of Urology, European Georges Pompidou Hospital, APHP, Paris, France
| | | | - Karim Bensalah
- Department of Urology, Rennes University Hospital, Rennes, France
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Abstract
OBJECTIVE Renal cell carcinoma (RCC) has a propensity to metastasize to the chest, with the lungs being the most common distant metastatic site. The histologic subtype of RCC has implications for prognosis. CONCLUSION Significant advances have been made in the management of metastatic RCC, both in systemic and locoregional therapies. The aim of this article is to review appearances of intrathoracic metastases from RCC and to discuss treatment considerations.
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Diagnostic Accuracy of Unenhanced CT Analysis to Differentiate Low-Grade From High-Grade Chromophobe Renal Cell Carcinoma. AJR Am J Roentgenol 2018; 210:1079-1087. [PMID: 29547054 DOI: 10.2214/ajr.17.18874] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The objective of our study was to evaluate tumor attenuation and texture on unenhanced CT for potential differentiation of low-grade from high-grade chromophobe renal cell carcinoma (RCC). MATERIALS AND METHODS A retrospective study of 37 consecutive patients with chromophobe RCC (high-grade, n = 13; low-grade, n = 24) who underwent preoperative unenhanced CT between 2011 and 2016 was performed. Two radiologists (readers 1 and 2) blinded to the histologic grade of the tumor and outcome of the patients subjectively evaluated tumor homogeneity (3-point scale: completely homogeneous, mildly heterogeneous, or mostly heterogeneous). A third radiologist, also blinded to tumor grade and patient outcome, measured attenuation and contoured tumors for quantitative texture analysis. Comparisons were performed between high-grade and low-grade tumors using the chi-square test for subjective variables and sex, independent t tests for patient age and tumor attenuation, and Mann-Whitney U tests for texture analysis. Logistic regression models and ROC curves were computed. RESULTS There were no differences in age or sex between the groups (p = 0.652 and 0.076). High-grade tumors were larger (mean ± SD, 62.6 ± 34.9 mm [range, 17.0-141.0 mm] vs 39.0 ± 17.9 mm [16.0-72.3 mm]; p = 0.009) and had higher attenuation (mean ± SD, 45.5 ± 8.2 HU [range, 29.0-55.0 HU] vs 35.3 ± 8.5 HU [14.0-51.0 HU]; p = 0.001) than low-grade tumors. CT size and attenuation achieved good accuracy to diagnose high-grade chromophobe RCC: The AUC ± standard error was 0.85 ± 0.08 (p < 0.0001) with a sensitivity of 69.0% and a specificity of 100%. Subjectively, high-grade tumors were more heterogeneous (mildly or markedly heterogeneous: 69.2% [9/13] for reader 1 and 76.9% [10/13] for reader 2; reader 1, p = 0.024; reader 2, p = 0.001) with moderate agreement (κ = 0.57). Combined texture features diagnosed high-grade tumors with a maximal AUC of 0.84 ± 0.06 (p < 0.0001). CONCLUSION Tumor attenuation and heterogeneity assessed on unenhanced CT are associated with high-grade chromophobe RCC and correlate well with the histopathologic chromophobe tumor grading system.
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Mostafa ME, Abdelkader A, Kuroda N, Pérez-Montiel D, Banerjee A, Hes O, Iczkowski KA. Variation in nuclear size and PD-L2 positivity correlate with aggressive chromophobe renal cell carcinoma. Ann Diagn Pathol 2018; 34:31-35. [PMID: 29661724 DOI: 10.1016/j.anndiagpath.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/08/2018] [Indexed: 01/12/2023]
Abstract
Chromophobe renal cell carcinoma (CRCC) is not amenable to International Society for Urologic Pathology-endorsed nucleolar grading. Novel grading approaches were proposed, but the rarity of adverse pathology hampers their discriminatory value. We investigate simple linear micrometer measurements and a proposed immunostain in CRCCs. 32 patients' CRCCs were studied: 12 adverse cases (stage pT3, recurrence, or metastasis), 15 controls (stage ≤pT2, no recurrence or metastasis after >3 years), and 8 metastases (3 were paired with primary adverse cases). The ratio of greatest dimensions of largest and smallest nuclei, in each of 5 "worst" high-power fields, excluding those with degenerative features, was designated variation in nuclear size (VNS). Percent multinucleate cells (PMC) were also counted. Mouse anti PD-L2 monoclonal antibody immunostaining was performed. Mean VNS measured in adverse primary and control primary tumors were 3.7 ± 0.5 and 2.4 ± 0.4 respectively (P < .001), and 3.4 ± 0.4 for metastases (P < .001). Optimal VNS cut-off was 2.5, with sensitivity and specificity 0.85 and 0.81, respectively. PMCs were 6.0 ± 3.0 for adverse group, 5.7 ± 2.7 for controls, and 4.1 ± 1.6 for metastases (P = NS). PD-L2 could not discriminate adverse versus good primary tumors (χ21.6, P = .2), but was higher in metastases (χ2 6.9, P < .01), or metastases plus adverse primary tumors (χ2 4.8, P = .03), compared to good-pathology primary tumors. In conclusion, VNS is an easily obtained measurement that can predict adverse behavior of chromophobe RCC, and may impart value for needle biopsy reporting and the choice of active surveillance. PD-L2 was elevated in metastases but was less useful for primary tumors.
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Affiliation(s)
- Mohamed E Mostafa
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Amrou Abdelkader
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Naoto Kuroda
- Department of Diagnostic Pathology, Kochi Red Cross Hospital, Japan
| | - Delia Pérez-Montiel
- Department of Pathology, Instituto Nacional de Cancerologia, Mexico, D.F., Mexico
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ondrej Hes
- Department of Pathology, Charles University, Faculty of Medicine in Plzeň, Czechia
| | - Kenneth A Iczkowski
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States.
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Hickman LA, Sawinski D, Guzzo T, Locke JE. Urologic malignancies in kidney transplantation. Am J Transplant 2018; 18:13-22. [PMID: 28985026 DOI: 10.1111/ajt.14533] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023]
Abstract
With advances in immunosuppression, graft and patient outcomes after kidney transplantation have improved considerably. As a result, long-term complications of transplantation, such as urologic malignancies, have become increasingly important. Kidney transplant recipients, for example, have a 7-fold risk of renal cell carcinoma (RCC) and 3-fold risk of urothelial carcinoma (UC) compared with the general population. While extrapolation of data from the general population suggest that routine cancer screening in transplant recipients would allow for earlier diagnosis and management of these potentially lethal malignancies, currently there is no consensus for posttransplantation RCC or UC screening as supporting data are limited. Further understanding of risk factors, presentation, optimal management of, and screening for urologic malignancies in kidney transplant patients is warranted, and as such, this review will focus on the incidence, surveillance, and treatment of urologic malignancies in kidney transplant recipients.
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Affiliation(s)
- Laura A Hickman
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Deirdre Sawinski
- Department of Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas Guzzo
- Department of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jayme E Locke
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Hassanen O, Ghieda U, Eltomey MA. Contrast enhanced MRI and Diffusion Weighted Imaging (DWI) in the evaluation of renal cell carcinoma and differentiation of its subtypes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Ross K, Jones RJ. Immune checkpoint inhibitors in renal cell carcinoma. Clin Sci (Lond) 2017; 131:2627-2642. [PMID: 29079639 PMCID: PMC5869245 DOI: 10.1042/cs20160894] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 01/05/2023]
Abstract
The immune system has long been known to play a critical role in the body's defence against cancer, and there have been multiple attempts to harness it for therapeutic gain. Renal cancer was, historically, one of a small number of tumour types where immune manipulation had been shown to be effective. The current generation of immune checkpoint inhibitors are rapidly entering into routine clinical practice in the management of a number of tumour types, including renal cancer, where one drug, nivolumab, an anti-programmed death-1 (PD-1) monoclonal antibody (mAb), is licensed for patients who have progressed on prior systemic treatment. Ongoing trials aim to maximize the benefits that can be gained from this new class of drug by exploring optimal timing in the natural course of the disease as well as combinations with other checkpoint inhibitors and drugs from different classes.
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Affiliation(s)
- Kirsty Ross
- Department of Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, U.K
| | - Rob J Jones
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow G12 0YN, U.K.
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Young JR, Young JA, Margolis DJA, Sauk S, Sayre J, Pantuck AJ, Raman SS. Sarcomatoid Renal Cell Carcinoma and Collecting Duct Carcinoma: Discrimination From Common Renal Cell Carcinoma Subtypes and Benign RCC Mimics on Multiphasic MDCT. Acad Radiol 2017; 24:1226-1232. [PMID: 28528853 DOI: 10.1016/j.acra.2017.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/16/2017] [Accepted: 03/21/2017] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate whether imaging features on multiphasic multidetector computed tomography (MDCT) can help discriminate sarcomatoid renal cell carcinoma (RCC) and collecting duct carcinoma (CDC) from other solid renal masses. MATERIALS AND METHODS With institutional review board approval for this HIPAA-compliant study, we derived a cohort of 7 sarcomatoid RCCs, 4 CDCs, 165 clear cell RCCs, 56 papillary RCCs, 22 chromophobe RCCs, 49 oncocytomas, and 16 lipid-poor angiomyolipomas with preoperative multiphasic MDCT with up to four phases (unenhanced, corticomedullary, nephrographic, and excretory). Each lesion was reviewed for contour, spread pattern, pattern of enhancement, neovascularity, and calcification. RESULTS Sarcomatoid RCCs and CDCs were more likely than other solid renal masses to have an irregular contour (64% vs 2%, P < 0.001) and an infiltrative spread pattern, defined as infiltration into adjacent renal parenchyma, collecting system, or neighboring structures (82% vs 7%, P < 0.001). When used to discriminate sarcomatoid RCC and CDC from other solid renal masses, an infiltrative spread pattern had a specificity of 93% (287/308) and sensitivity of 82% (9/11), and an irregular contour had a specificity of 98% (303/308) and sensitivity of 64% (7/11). CONCLUSIONS Solid renal lesions with an irregular contour or an infiltrative spread pattern are suspicious for sarcomatoid RCC or CDC.
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MESH Headings
- Adenoma, Oxyphilic/diagnostic imaging
- Adenoma, Oxyphilic/pathology
- Adult
- Aged
- Aged, 80 and over
- Angiomyolipoma/diagnostic imaging
- Angiomyolipoma/pathology
- Carcinoma, Ductal/diagnostic imaging
- Carcinoma, Ductal/pathology
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/pathology
- Carcinoma, Renal Cell/diagnostic imaging
- Carcinoma, Renal Cell/pathology
- Diagnosis, Differential
- Female
- Humans
- Kidney Neoplasms/diagnostic imaging
- Kidney Neoplasms/pathology
- Male
- Middle Aged
- Multidetector Computed Tomography
- Retrospective Studies
- Sensitivity and Specificity
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Affiliation(s)
- Jonathan R Young
- Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7437.
| | - Jocelyn A Young
- Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7437
| | - Daniel J A Margolis
- Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7437
| | - Steven Sauk
- Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7437
| | - James Sayre
- Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7437
| | - Allan J Pantuck
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Steven S Raman
- Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7437
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Wagener N, Edelmann D, Benner A, Zigeuner R, Borgmann H, Wolff I, Krabbe LM, Musquera M, Dell’Oglio P, Capitanio U, Klatte T, Cindolo L, May M, Brookman-May SD. Outcome of papillary versus clear cell renal cell carcinoma varies significantly in non-metastatic disease. PLoS One 2017; 12:e0184173. [PMID: 28934212 PMCID: PMC5608215 DOI: 10.1371/journal.pone.0184173] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/18/2017] [Indexed: 11/30/2022] Open
Abstract
Renal cell carcinoma (RCC) comprises a heterogenous group of tumors. Traditionally, papillary RCC (pRCC) is associated with a favorable outcome compared to clear cell RCC (ccRCC), while other series report equivalent or worse prognosis. In this paper we comparatively evaluate outcome of pRCC versus ccRCC in two large multi-institutional databases (cohort study), including distribution of pRCC subtypes 1 and 2. Retrospective data of 1,943 surgically treated pRCC patients from 17 European/ North American centers between 1984–2015 were compared to 5,600 ccRCC patients from a database comprising 11 European/ North American centers (1984–2011). Median follow-up was 64.6 months. Differences between pRCC, subtypes, and ccRCC were compared with t-tests, Chi^2-tests, and exact Fisher tests. Cancer-specific mortality was analyzed with cumulative incidence curves and Cox cause-specific hazard models. The robustness of our results was examined with sensitivity analyses. We present that cancer-specific mortality rates and variables as stage, lymph node, and distant metastasis differ significantly between groups. Furthermore, we demonstrate that patients with non-metastatic pRCC had a significantly better cancer-specific mortality (HR 0.76, p = 0.007), when compared to ccRCC. Additionally, pRCC type 2 versus ccRCC exhibited no difference in cancer-specific mortality (HR 0.9, p = 0.722), whereas pRCC type 1 versus ccRCC displayed a risk of death reduced by 69% (p = 0.044). Taken together, outcome of pRCC versus ccRCC varies significantly in non-metastatic disease. Furthermore, pRCC type 2 exhibited no difference in cancer-specific mortality, whereas pRCC type 1 displayed a significantly reduced risk of death. Consequently, there is urgent need to respect histopathological entities and their subtypes, when assigning follow-up or targeted therapy to RCC patients.
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Affiliation(s)
- Nina Wagener
- Department of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany
- * E-mail: (NW); (SBM)
| | - Dominic Edelmann
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Hendrik Borgmann
- Department of Urology, University Medical Center, University of Mainz, Mainz, Germany
| | - Ingmar Wolff
- Department of Urology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - Laura M. Krabbe
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Mireia Musquera
- Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Paolo Dell’Oglio
- Unit of Urology and Division of Experimental Oncology, Urological Research Institute (URI), San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Umberto Capitanio
- Unit of Urology and Division of Experimental Oncology, Urological Research Institute (URI), San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Luca Cindolo
- Department of Urology, San Pio da Pietrelcina Hospital, Vasto, Italy
| | - Matthias May
- Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany
| | - Sabine D. Brookman-May
- Department of Urology, Ludwig-Maximilians-University (LMU), Munich, Germany
- * E-mail: (NW); (SBM)
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Young JR, Coy H, Douek M, Lo P, Sayre J, Pantuck AJ, Raman SS. Type 1 papillary renal cell carcinoma: differentiation from Type 2 papillary RCC on multiphasic MDCT. Abdom Radiol (NY) 2017; 42:1911-1918. [PMID: 28265706 DOI: 10.1007/s00261-017-1091-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate whether multiphasic MDCT enhancement can help differentiate type 1 papillary renal cell carcinoma (RCC) from type 2 papillary RCC. METHODS With IRB approval for this HIPAA-compliant retrospective study, we derived a cohort of 36 type 1 papillary RCCs and 33 type 2 papillary RCCs with preoperative multiphasic MDCT with up to four phases (unenhanced, corticomedullary, nephrographic, and excretory) from 2000 to 2013. Following segmentation, a computer-assisted detection (CAD) algorithm selected a 0.5 cm-diameter region of maximal attenuation within each lesion in each phase; a 0.5 cm-diameter region of interest was manually placed on uninvolved renal cortex in each phase. The relative attenuation of each lesion was calculated as [(Lesion attenuation-cortex attenuation)/cortex attenuation] × 100. Absolute and relative attenuation values were compared using Mann-Whitney tests with Bonferroni correction for multiple comparisons. RESULTS Relative excretory phase attenuation of type 2 papillary RCCs was significantly greater than that of type 1 papillary RCCs (2.0 vs. -18.3, p = 0.005). Relative excretory phase attenuation differentiated type 1 papillary RCCs from type 2 papillary RCCs with an accuracy of 73% (36/49), sensitivity of 87% (26/30), positive predictive value of 74% (26/35), and negative predictive value of 71% (10/14). CONCLUSION Multiphasic MDCT enhancement may assist in differentiating type 1 papillary RCCs from type 2 papillary RCCs, if prospectively validated.
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Affiliation(s)
- Jonathan R Young
- Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, USA.
| | - Heidi Coy
- Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, USA
| | - Michael Douek
- Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, USA
| | - Pechin Lo
- Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, USA
| | - James Sayre
- Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, USA
| | - Allan J Pantuck
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steven S Raman
- Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, USA
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45
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Connor Wells J, Donskov F, Fraccon AP, Pasini F, Bjarnason GA, Beuselinck B, Knox JJ, Rha SY, Agarwal N, Bowman IA, Lee J, Pal SK, Srinivas S, Scott Ernst D, Vaishampayan UN, Wood LA, Simpson R, De Velasco G, Choueiri TK, Heng DYC. Characterizing the outcomes of metastatic papillary renal cell carcinoma. Cancer Med 2017; 6:902-909. [PMID: 28414866 PMCID: PMC5430092 DOI: 10.1002/cam4.1048] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/21/2017] [Accepted: 02/02/2017] [Indexed: 12/19/2022] Open
Abstract
Outcomes of metastatic papillary renal cell carcinoma (pRCC) patients are poorly characterized in the era of targeted therapy. A total of 5474 patients with metastatic renal cell carcinoma (mRCC) in the International mRCC Database Consortium (IMDC) were retrospectively analyzed. Outcomes were compared between clear cell (ccRCC; n = 5008) and papillary patients (n = 466), and recorded type I and type II papillary patients (n = 30 and n = 165, respectively). Overall survival (OS), progression-free survival (PFS), and overall response rate (ORR) favored ccRCC over pRCC. OS was 8 months longer in ccRCC patients and the hazard ratio of death was 0.71 for ccRCC patients. No differences in PFS or ORR were detected between type I and II PRCC in this limited dataset. The median OS for type I pRCC was 20.0 months while the median OS for type II was 12.6 months (P = 0.096). The IMDC prognostic model was able to stratify pRCC patients into favorable risk (OS = 34.1 months), intermediate risk (OS = 17.0 months), and poor-risk groups (OS = 6.0 months). pRCC patient outcomes were inferior to ccRCC, even after controlling for IMDC prognostic factors. The IMDC prognostic model was able to effectively stratify pRCC patients.
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Affiliation(s)
- John Connor Wells
- Tom Baker Cancer CentreUniversity of CalgaryCalgaryAlbertaCanada
- Queen's UniversityKingstonOntarioCanada
| | | | | | - Felice Pasini
- Medical Oncology DepartmentOspedale Santa Maria della MisericordiaRovigoItaly
| | | | | | | | - Sun Young Rha
- Yonsei University College of MedicineSeoulSouth Korea
| | - Neeraj Agarwal
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtah
| | | | - Jae‐Lyun Lee
- Asan Medical CentreUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Sumanta K. Pal
- City of Hope Comprehensive Cancer CenterDuarteCalifornia
| | | | | | | | - Lori A. Wood
- Queen Elizabeth II Health Sciences CentreHalifaxNova ScotiaCanada
| | - Robin Simpson
- Queen Elizabeth II Health Sciences CentreHalifaxNova ScotiaCanada
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46
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Bieniasz M, Chmura A, Kwapisz M, Czerwińska M, Kieszek R, Domagała P, Wszoła M, Serwańska-Świętek M, Górnicka B, Durlik M, Pączek L, Kwiatkowski A. Renal Tumor in Allogeneic Kidney Transplant Recipient. Transplant Proc 2017; 48:1849-54. [PMID: 27496506 DOI: 10.1016/j.transproceed.2016.01.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/21/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Malignancies will be a leading cause of mortality in renal transplant recipients in the next 20 years. Renal cell cancer (RCC) is the most common urologic cancer in kidney transplant recipients. The risk of RCC development in kidney transplant recipients is 15-100 times higher than in the general population. The purpose of the current retrospective study was to assess the frequency of nephrectomies performed because of renal tumors in the native kidneys in kidney transplant recipients in the Department of General and Transplantation Surgery at the Medical University of Warsaw between 2010 and 2014 year; the identification of kidney recipients diagnosed with RCC; and epidemiologic, clinical, and histopathological aspects associated with RCC. PATIENTS AND METHODS A total of 319 nephrectomies were performed in the Department of General and Transplantation Surgery at the Medical University of Warsaw between 2010 and 2014 year. Renal tumors were diagnosed in 25 renal transplant recipients. RESULTS Among malignant tumors, 13 cases of RCC and 1 case of post-transplant lymphoproliferative disorder (PTLD) were observed. There was no significant difference between age and duration of pretransplantation dialysis in patients with RCC and patients with benign tumors (P = .14 and P = .91, respectively). Body mass index was significantly higher in patients with RCC than in patients with benign tumors (P = .04). CONCLUSIONS Renal cell cancer is more common among male kidney recipients. There is a good Polish screening system allowing detection of kidney cancer in native kidney. We recommend performing periodic screening for kidney cancers to obtain an early diagnosis.
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Affiliation(s)
- M Bieniasz
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - A Chmura
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Kwapisz
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Czerwińska
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - R Kieszek
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - P Domagała
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Wszoła
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Serwańska-Świętek
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - B Górnicka
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - M Durlik
- Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - L Pączek
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - A Kwiatkowski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
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47
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Performance of Relative Enhancement on Multiphasic MRI for the Differentiation of Clear Cell Renal Cell Carcinoma (RCC) From Papillary and Chromophobe RCC Subtypes and Oncocytoma. AJR Am J Roentgenol 2017; 208:812-819. [DOI: 10.2214/ajr.16.17152] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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48
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Xue LY, Lu Q, Huang BJ, Li CX, Yan LX, Wang WP. Differentiation of subtypes of renal cell carcinoma with contrast-enhanced ultrasonography. Clin Hemorheol Microcirc 2017; 63:361-371. [PMID: 26598999 DOI: 10.3233/ch-152024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We aimed to assess the difference of enhancement patterns among the three RCC subtypes with contrast-enhanced ultrasound (CEUS). Two hundreds cases of pathologically proved clear cell renal cell carcinomas (ccRCC), 58 papillary renal cell carcinomas (pRCC) and 51 chromophobe renal cell carcinomas (chRCC) underwent preoperative conventional ultrasound and CEUS. The wash-in and wash-out pattern, peak enhancement degree and homogeneity, and the presence of pseudocapsule were evaluated by two blinded observers respectively. The interreader agreement in the characterization of CEUS features between two observers was good (κ = 0.649-0.775). Compared with pRCCs and chRCCs, ccRCCs demonstrated higher frequency of simultaneous wash-in pattern, hyperenhancement and heterogeneity with necrotic areas. Most pRCCs and chRCCs manifested hypoenhancement, homogeneity, fast wash-out and presence of pseudocapsule. The only difference we obtained between pRCC and chRCC was the wash-in pattern, with slow wash-in in pRCC and simultaneous wash-in in chRCC. In small lesions with long diameter≤3 cm, the majority of the three subtypes of RCC showed homogeneous enhancement and there was no difference among them. CEUS was a useful method to preoperatively differentiate the ccRCC from non-ccRCC subtypes. There were no distinguishing features identifid on CEUS that allowed reliable differentiation of pRCC from chRCC.
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Affiliation(s)
- Li-Yun Xue
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qing Lu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Bei-Jian Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Cui-Xian Li
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Li-Xia Yan
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
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49
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Motoshima T, Komohara Y, Ma C, Dewi AK, Noguchi H, Yamada S, Nakayama T, Kitada S, Kawano Y, Takahashi W, Sugimoto M, Takeya M, Fujimoto N, Oda Y, Eto M. PD-L1 expression in papillary renal cell carcinoma. BMC Urol 2017; 17:8. [PMID: 28086852 PMCID: PMC5237189 DOI: 10.1186/s12894-016-0195-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 12/22/2016] [Indexed: 12/28/2022] Open
Abstract
Background The immune escape or tolerance of cancer cells is considered to be closely involved in cancer progression. Programmed death-1 (PD-1) is an inhibitory receptor expressed on activating T cells, and several types of cancer cells were found to express PD-1 ligand 1 (PD-L1) and ligand 2 (PD-L2). Methods In the present study, we investigated PD-L1/2 expression in papillary renal cell carcinoma (pRCC). Result We found PD-L1 expression in 29 of 102 cases, but no PD-L2 expression was seen. PD-L1 expression was not significantly correlated with any clinicopathological factor, including progression-free survival and overall survival. The frequency of PD-L1-positive cases was higher in type 2 (36%) than in type 1 (22%) pRCC; however, there was no significant difference in the percentages of score 0 cases (p value = 0.084 in Chi-square test). The frequency of high PD-L1 expression cases was higher in type 2 (23%) than in type 1 (11%), and the frequency of high PD-L1 expression cases was higher in grade 3/4 (21%) than in grade 1/2 (13%). However, no significant association was found between PD-L1 expression and all clinicopathological factors in pRCC. Conclusion High expression of PD-L1 in cancer cells was potentially associated to highly histological grade of malignancy in pRCC. The evaluation of the PD-L1 protein might still be useful for predicting the efficacy of anti-cancer immunotherapy using immuno-checkpoint inhibitors, however, not be useful for predicting the clinical prognosis. Electronic supplementary material The online version of this article (doi:10.1186/s12894-016-0195-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Takanobu Motoshima
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, 860-8556, Japan.,Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshihiro Komohara
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, 860-8556, Japan.
| | - Chaoya Ma
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
| | - Arni Kusuma Dewi
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, 860-8556, Japan.,Department of Anatomy Histology, Faculty of Medicine Airlangga University, Surabaya, Indonesia
| | - Hirotsugu Noguchi
- Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Sohsuke Yamada
- Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshiyuki Nakayama
- Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shohei Kitada
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiaki Kawano
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Wataru Takahashi
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masaaki Sugimoto
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motohiro Takeya
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Naohiro Fujimoto
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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50
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Localized chromophobe carcinomas treated by nephron-sparing surgery have excellent oncologic outcomes. Urol Oncol 2017; 35:35.e15-35.e19. [DOI: 10.1016/j.urolonc.2016.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/03/2016] [Accepted: 08/22/2016] [Indexed: 01/11/2023]
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