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Mei J, Yao Y, Wang X, Liu T, Sun L, Zhang G. Construction of a Model for Predicting the Risk of pT3 Based on Perioperative Characteristics in cT1 Renal Cell Carcinoma: A Retrospective Study at a Single Institution. Clin Genitourin Cancer 2024; 22:102122. [PMID: 38861916 DOI: 10.1016/j.clgc.2024.102122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/11/2024] [Accepted: 05/18/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION This study explored the predictors of upstaging and multiple sites of extension, and constructed a predictive model based on perioperative characteristics to calculate the risk of upstaging of cT1 renal cell carcinoma to pT3. METHODS We retrospectively reviewed 1012 patients diagnosed with cT1 renal cell carcinoma who underwent surgical treatment at the Affiliated Hospital of Qingdao University between June 2016 and August 2021. The continuous and categorical variables were analyzed using the Mann-Whitney U test and Chi-square test, respectively. After randomly dividing patients into a training set and an internal validation set with a ratio of 7:3, univariate and multivariate logistic regression analyses were used to explore the predictors of upstaging and multiple sites of extension. A nomogram model was established based on the predictors of upstaging and was validated. RESULTS Ninety-one cases (8.99%) of renal cell carcinoma were upstaged to pT3. In the training set, multivariate logistic regression identified the following predictors of upstaging: maximum tumor diameter, hilus involvement, tumor necrosis, tumor edge irregularity, symptoms, smoking, and platelet-lymphocyte ratio. A nomogram model was established based on the predictors. The area under the receiver operating characteristic curve was 0.810 in the training set, and 0.804 in the validation set. A 10-fold internal cross-validation conducted 200 times showed that the mean area under the curve was 0.797. The calibration curve and decision curve analysis suggested that the nomogram had robust clinical predictive power. Analyses showed higher neutrophil-lymphocyte ratio and tumor necrosis were associated with multiple sites of extrarenal extension in patients with pT3a renal cell carcinoma. CONCLUSIONS We identified 7 predictors of upstaging to pT3 and 2 predictors of multiple sites of extension. A nomogram model was constructed with satisfactory accuracy for predicting upstaging to pT3.
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Affiliation(s)
- Jingchang Mei
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu Yao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xin Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tian Liu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijiang Sun
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guiming Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Li KP, Chen SY, Wan S, Wang CY, Li XR, Yang L. Percutaneous ablation versus robotic‑assisted partial nephrectomy for cT1 renal cell carcinoma: an evidence-based analysis of comparative outcomes. J Robot Surg 2024; 18:301. [PMID: 39078530 DOI: 10.1007/s11701-024-02037-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/29/2024] [Indexed: 07/31/2024]
Abstract
This investigation sought to conduct a comprehensive meta-analysis to assess the comparative effectiveness and safety of percutaneous ablation (PCA) versus robotic-assisted partial nephrectomy (RAPN) among individuals diagnosed with cT1 renal tumors. This study rigorously followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to conduct a systematic review and meta-analysis. A systematic search was carried out in the PubMed, Embase, Web of Science, and Cochrane Library databases, focusing on studies published in English through February 2024. We focused on evaluating primary outcomes, specifically perioperative outcomes, functional outcomes, and oncological outcomes. In this analysis, data from 1534 patients across 13 studies were evaluated. PCA was found to have advantageous outcomes in comparison to RAPN regarding hospital stay durations, with a Weighted Mean Difference (WMD) of - 2.03 days (95% Confidence Interval [CI]: -3.78 to - 0.27; p = 0.02), operative times (WMD: -106.75 min; 95% CI: - 170.78 to - 42.72; p = 0.001), and overall complication rates (Odds Ratio [OR]: 0.61; 95% CI: 0.42 to 0.89; p = 0.01). Conversely, PCA showed a higher incidence of local recurrence compared to RAPN, with an OR of 3.20 (95% CI: 1.91 to 5.35; p < 0.00001). Moreover, there were no statistically significant differences between the two treatments in terms of major complications, declines in estimated glomerular filtration rates (eGFR), variations in creatinine levels, overall survival rates, and recurrence-free survival. While PCA exhibits higher local recurrence rates than RAPN, it also presents significant advantages, such as shorter hospital stays, decreased operative durations, and lower complication rates. This juxtaposition underscores the urgent need for further, more rigorous research to substantiate these findings.
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Affiliation(s)
- Kun-Peng Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China
| | - Si-Yu Chen
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China
| | - Shun Wan
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China
| | - Chen-Yang Wang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China
| | - Xiao-Ran Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China.
| | - Li Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China.
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Vamesu S, Ursica OA, Milea SE, Deacu M, Aschie M, Mitroi AF, Voinea F, Pundiche MB, Orasanu CI, Voda RI. Same Organ, Two Cancers: Complete Analysis of Renal Cell Carcinomas and Upper Tract Urothelial Carcinomas. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1126. [PMID: 39064555 PMCID: PMC11279004 DOI: 10.3390/medicina60071126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/06/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Renal cell carcinomas and upper tract urothelial carcinomas are types of malignancies that originate in the kidneys. Each of these examples shows an increasing trend in the frequency and the mortality rate. This study aims to comprehensively define carcinomas by analyzing clinical, paraclinical, and histological aspects to predict aggressiveness and mortality. Materials and Methods: We conducted a retrospective investigation on a group of patients suspected of kidney cancers. Results: We identified 188 cases. We observed a higher mortality rate and older age in individuals with urothelial carcinomas. Anemia, acute kidney injury, hematuria, and perineural invasion were the main risk factors that predicted their mortality. Tumor size in renal cell carcinomas correlates with the presence of necrosis and sarcomatoid areas. Factors that indicate a higher rate of death are older age, exceeding the renal capsule, a lesion that includes the entire kidney, lymphovascular invasion, acute kidney injury, and anemia. Conclusions: Even if they originate at the renal level, and the clinical-paraclinical picture is similar, the histopathological characteristics make the difference. In addition, to these are added the previously mentioned common parameters that can represent important prognostic factors. In conclusion, the characteristics commonly identified in one type of cancer may act as risk factors for the other tumor. The detected data include threshold values and risk factors, making a significant contribution to the existing literature.
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Affiliation(s)
- Sorin Vamesu
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
| | - Oana Andreea Ursica
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
| | - Serban Eduard Milea
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
| | - Mariana Deacu
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
| | - Mariana Aschie
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Department of Anatomy, Academy of Medical Sciences of Romania, 030171 Bucharest, Romania
- Department of Medical Sciences, The Romanian Academy of Scientists, 030167 Bucharest, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), “Ovidius” University of Constanta, 900591 Constanta, Romania
| | - Anca Florentina Mitroi
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), “Ovidius” University of Constanta, 900591 Constanta, Romania
- Clinical Service of Pathology, Departments of Genetics, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
| | - Felix Voinea
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Urology Clinical Department, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
| | - Mihaela Butcaru Pundiche
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Clinical Department of General Surgery, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
| | - Cristian Ionut Orasanu
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), “Ovidius” University of Constanta, 900591 Constanta, Romania
| | - Raluca Ioana Voda
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), “Ovidius” University of Constanta, 900591 Constanta, Romania
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Papanastasiou AD, Peroukidis S, Sirinian C, Arkoumani E, Chaniotis D, Zizi-Sermpetzoglou A. CD44 Expression in Clear Cell Renal Cell Carcinoma (ccRCC) Correlates with Tumor Grade and Patient Survival and Is Affected by Gene Methylation. Genes (Basel) 2024; 15:537. [PMID: 38790166 PMCID: PMC11121578 DOI: 10.3390/genes15050537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Clear cell RCC (ccRCC) represents the most common type of kidney cancer, with surgery being the only potential curative treatment. Almost one-third of ccRCC patients relapse either locally or as cases of distant metastases. Several biomarkers have been employed in order to separate ccRCC patients with better prognosis or to predict treatment outcomes, with limited results. CD44 is a membrane glycoprotein with multiple roles in normal development but also cancer. Recently, the CD44 standard isoform has been implicated in tumor progression and the metastasis cascade through microenvironment interactions. Here, through CD44 immunohistochemical staining of ccRCC patient samples and TCGA data analysis, we sought to elucidate the expression patterns (mRNA and protein) of CD44 in clear cell RCC and correlate its expression with clinicopathological parameters. We were able to show that CD44 expression presents a positive association with tumor grade and overall survival, predicting a worse patient outcome in ccRCC. In addition, our data indicate that the CD44 mRNA upregulation can be attributed to reduced gene methylation, implicating epigenetic gene regulation in ccRCC development and progression.
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Affiliation(s)
| | | | - Chaido Sirinian
- Molecular Oncology Laboratory, Division of Oncology, Department of Medicine, University of Patras, 26504 Patras, Greece
| | - Elisavet Arkoumani
- Pathology Department, Tzaneion General Hospital of Piraeus, 18536 Piraeus, Greece
| | - Dimitrios Chaniotis
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
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Nie P, Yang G, Wang Y, Xu Y, Yan L, Zhang M, Zhao L, Wang N, Zhao X, Li X, Cheng N, Wang Y, Chen C, Wang N, Duan S, Wang X, Wang Z. A CT-based deep learning radiomics nomogram outperforms the existing prognostic models for outcome prediction in clear cell renal cell carcinoma: a multicenter study. Eur Radiol 2023; 33:8858-8868. [PMID: 37389608 DOI: 10.1007/s00330-023-09869-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES To develop and validate a CT-based deep learning radiomics nomogram (DLRN) for outcome prediction in clear cell renal cell carcinoma (ccRCC), and its performance was compared with the Stage, Size, Grade, and Necrosis (SSIGN) score, the University of California, Los Angeles, Integrated Staging System (UISS), the Memorial Sloan-Kettering Cancer Center (MSKCC), and the International Metastatic Renal Cell Database Consortium (IMDC). METHODS A multicenter of 799 localized (training/ test cohort, 558/241) and 45 metastatic ccRCC patients were studied. A DLRN was developed for predicting recurrence-free survival (RFS) in localized ccRCC patients, and another DLRN was developed for predicting overall survival (OS) in metastatic ccRCC patients. The performance of the two DLRNs was compared with that of the SSIGN, UISS, MSKCC, and IMDC. Model performance was assessed with Kaplan-Meier curves, time-dependent area under the curve (time-AUC), Harrell's concordance index (C-index), and decision curve analysis (DCA). RESULTS In the test cohort, the DLRN achieved higher time-AUCs (0.921, 0.911, and 0.900 for 1, 3, and 5 years, respectively), C-index (0.883), and net benefit than SSIGN and UISS in predicting RFS for localized ccRCC patients. The DLRN provided higher time-AUCs (0.594, 0.649, and 0.754 for 1, 3, and 5 years, respectively) than MSKCC and IMDC in predicting OS for metastatic ccRCC patients. CONCLUSIONS The DLRN can accurately predict outcomes and outperformed the existing prognostic models in ccRCC patients. CLINICAL RELEVANCE STATEMENT This deep learning radiomics nomogram may facilitate individualized treatment, surveillance, and adjuvant trial design for patients with clear cell renal cell carcinoma. KEY POINTS • SSIGN, UISS, MSKCC, and IMDC may be insufficient for outcome prediction in ccRCC patients. • Radiomics and deep learning allow for the characterization of tumor heterogeneity. • The CT-based deep learning radiomics nomogram outperforms the existing prognostic models in ccRCC outcome prediction.
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Affiliation(s)
- Pei Nie
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guangjie Yang
- Department of Nuclear Medicine, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266061, Shandong, China
| | | | - Yuchao Xu
- School of Nuclear Science and Technology, University of South China, Hengyang, Hunan, China
| | - Lei Yan
- Department of Nuclear Medicine, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266061, Shandong, China
| | - Mingxin Zhang
- Department of Urology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lianzi Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ning Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250000, Shandong, China
| | - Xia Zhao
- Department of Radiology, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xianjun Li
- Department of Nuclear Medicine, Weifang People's Hospital, Weifang, Shandong, China
| | - Nan Cheng
- Department of Medical Imaging, the Affiliated Hospital of Jining Medical College, Jining, Shandong, China
| | - Yicong Wang
- Department of Nuclear Medicine, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Chengcheng Chen
- Department of Radiology, Rizhao People's Hospital, Rizhao, Shandong, China
| | - Nan Wang
- Department of Nuclear Medicine, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | | | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250000, Shandong, China.
| | - Zhenguang Wang
- Department of Nuclear Medicine, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266061, Shandong, China.
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Liu H, Wei Z, Xv Y, Tan H, Liao F, Lv F, Jiang Q, Chen T, Xiao M. Validity of a multiphase CT-based radiomics model in predicting the Leibovich risk groups for localized clear cell renal cell carcinoma: an exploratory study. Insights Imaging 2023; 14:167. [PMID: 37816901 PMCID: PMC10564697 DOI: 10.1186/s13244-023-01526-2] [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: 04/05/2023] [Accepted: 09/10/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE To develop and validate a multiphase CT-based radiomics model for preoperative risk stratification of patients with localized clear cell renal cell carcinoma (ccRCC). METHODS A total of 425 patients with localized ccRCC were enrolled and divided into training, validation, and external testing cohorts. Radiomics features were extracted from three-phase CT images (unenhanced, arterial, and venous), and radiomics signatures were constructed by the least absolute shrinkage and selection operator (LASSO) regression algorithm. The radiomics score (Rad-score) for each patient was calculated. The radiomics model was established and visualized as a nomogram by incorporating significant clinical factors and Rad-score. The predictive performance of the radiomics model was evaluated by the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA). RESULTS The AUC of the triphasic radiomics signature reached 0.862 (95% CI: 0.809-0.914), 0.853 (95% CI: 0.785-0.921), and 0.837 (95% CI: 0.714-0.959) in three cohorts, respectively, which were higher than arterial, venous, and unenhanced radiomics signatures. Multivariate logistic regression analysis showed that Rad-score (OR: 4.066, 95% CI: 3.495-8.790) and renal vein invasion (OR: 12.914, 95% CI: 1.118-149.112) were independent predictors and used to develop the radiomics model. The radiomics model showed good calibration and discrimination and yielded an AUC of 0.872 (95% CI: 0.821-0.923), 0.865 (95% CI: 0.800-0.930), and 0.848 (95% CI: 0.728-0.967) in three cohorts, respectively. DCA showed the clinical usefulness of the radiomics model in predicting the Leibovich risk groups. CONCLUSIONS The radiomics model can be used as a non-invasive and useful tool to predict the Leibovich risk groups for localized ccRCC patients. CRITICAL RELEVANCE STATEMENT The triphasic CT-based radiomics model achieved favorable performance in preoperatively predicting the Leibovich risk groups in patients with localized ccRCC. Therefore, it can be used as a non-invasive and effective tool for preoperative risk stratification of patients with localized ccRCC. KEY POINTS • The triphasic CT-based radiomics signature achieves better performance than the single-phase radiomics signature. • Radiomics holds prospects in preoperatively predicting the Leibovich risk groups for ccRCC. • This study provides a non-invasive method to stratify patients with localized ccRCC.
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Affiliation(s)
- Huayun Liu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zongjie Wei
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yingjie Xv
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Hao Tan
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Fangtong Liao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Jiang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Chen
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Klein C, Cazalas G, Margue G, Piana G, DE Kerviler E, Gangi A, Puech P, Nedelcu C, Grange R, Buy X, Michiels C, Jegonday MA, Rouviere O, Grenier N, Marcelin C, Bernhard JC. Percutaneous tumor ablation versus image guided robotic-assisted partial nephrectomy for cT1b renal cell carcinoma: a comparative matched-pair analysis (UroCCR 80). Minerva Urol Nephrol 2023; 75:559-568. [PMID: 37728492 DOI: 10.23736/s2724-6051.23.05274-6] [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: 09/21/2023]
Abstract
BACKGROUND Partial nephrectomy (PN) is the gold standard treatment for cT1b renal tumors. Percutaneous guided thermal ablation (TA) has proven oncologic efficacy with low morbidity for the treatment of small renal masses (<3 cm). Recently, 3D image-guided robot-assisted PN (3D-IGRAPN) has been described, and decreased perioperative morbidity compared to standard RAPN has been reported. Our objective was to compare two minimally invasive image-guided nephron-sparing procedures (TA vs. 3D-IGRAPN) for the treatment of cT1b renal cell carcinomas (4.1-7 cm). METHODS Patients treated with TA and 3D-IGRAPN for cT1b renal cell carcinoma, prospectively included in the UroCCR database (NCT03293563), were pair-matched for tumor size, pathology, and RENAL score. The primary endpoint was the local recurrence rate between the two groups. Secondary endpoints included metastatic evolution, perioperative complications, decrease in renal function, and length of hospitalization. RESULTS A total of 198 patients were included and matched into two groups of 72 patients. The local recurrence rate was significantly higher in the TA group than that in the 3D-IGRAPN group (4.2% vs. 15.2%, P=0.04). Metastatic evolution and perioperative outcomes such as major complications, eGFR decrease, and length of hospitalization did not differ significantly between the two groups. CONCLUSIONS 3D-IGRAPN resulted in a significantly lower local recurrence rate and comparable rates of complications and metastatic evolution compared with thermal ablation.
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Affiliation(s)
- Clément Klein
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France -
| | - Grégoire Cazalas
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Gaëlle Margue
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Gilles Piana
- Department of Radiology, Paoli-Calmettes Institute, Marseille, France
| | | | - Afshin Gangi
- Department of Interventional Radiology, Strasbourg University Hospital, Strasbourg, France
| | - Phillipe Puech
- Department of Radiology, Lille University Hospital, Lille, France
| | - Cosmina Nedelcu
- Department of Radiology, Angers University Hospital, Angers, France
| | - Remi Grange
- Department of Radiology, Saint-Etienne University Hospital, Saint Etienne, France
| | - Xavier Buy
- Department of Interventional Radiology, Bergonié Institute, Bordeaux, France
| | - Clément Michiels
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | | | | | - Nicolas Grenier
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Clément Marcelin
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
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Azawi N, Ebbestad FE, Nadler N, Mosholt KSS, Axelsen SS, Geertsen L, Christensen J, Jensen NV, Fristrup N, Lund L, Donskov F, Dalton SO. Lifestyle and Clinical Factors in a Nationwide Stage III and IV Renal Cell Carcinoma Study. Cancers (Basel) 2023; 15:4488. [PMID: 37760459 PMCID: PMC10526437 DOI: 10.3390/cancers15184488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The aim was to investigate whether patient-related or clinical risk factors present at the diagnosis of advanced stage renal cell carcinoma (RCC) had an impact on the overall mortality, cancer-specific mortality, and recurrence risk in a national cohort. METHODS Patients registered with stage III and IV RCC in the Danish Renal Cancer Database (DaRenCa) in 2014-2016 were included in the study and followed up until recurrence or death. We conducted a Cox Proportional Hazard Model to examine the association between several variables and the development of RCC. These variables included BMI, hypertension, smoking status, symptoms at diagnosis, performance status, multidisciplinary team (MDT) discussion, surgical margin, and primary metastasis. Separate analyses were performed for cc-RCC and non-ccRCC patients. RESULTS In our cohort of 929 patients, 424 individuals died from RCC during the follow-up period, with a median follow-up time of 4.1 (95% CI: 0.8-5.0) years for ccRCC and 2.0 (95% CI: 0.1-5.0) years for non-ccRCC. A multivariate analysis demonstrated that a positive surgical margin (HR 1.53 and 1.43), synchronous metastasis (HR 2.06 and 3.23), and poor performance status (HR 4.73 and 5.27) were significantly associated with a decreased 5-year overall and cancer-specific survival, respectively. Furthermore, a positive surgical margin was associated with a higher risk of recurrence in ccRCC. MDT discussion was found to reduce mortality risk in non-ccRCC. CONCLUSION Clinical- and disease-related variables have a greater impact on RCC mortality and recurrence than the selected lifestyle-related factors. The inclusion of MDT discussion in the diagnosis and management of advanced RCC should be further evaluated for its potential to improve patient outcomes.
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Affiliation(s)
- Nessn Azawi
- Department of Urology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark;
- Institute for Clinical Medicine, University of Copenhagen, Noerregade 10, 1165 Copenhagen, Denmark;
| | | | - Naomi Nadler
- Department of Urology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark;
| | | | - Sofie Staal Axelsen
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark; (S.S.A.); (N.F.)
| | - Louise Geertsen
- Department of Urology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; (L.G.); (L.L.)
| | - Jane Christensen
- Danish Cancer Institute, Strandboulevarden 49, 2100 Copenhagen, Denmark; (F.E.E.); (J.C.)
| | - Niels Viggo Jensen
- Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark;
| | - Niels Fristrup
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark; (S.S.A.); (N.F.)
| | - Lars Lund
- Department of Urology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; (L.G.); (L.L.)
| | - Frede Donskov
- Department of Oncology, Southern Denmark University Hospital, Esbjerg, Finsensgade 35, 6700 Esbjerg, Denmark;
| | - Susanne Oksbjerg Dalton
- Institute for Clinical Medicine, University of Copenhagen, Noerregade 10, 1165 Copenhagen, Denmark;
- Danish Cancer Institute, Strandboulevarden 49, 2100 Copenhagen, Denmark; (F.E.E.); (J.C.)
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Rådmandsengen 5, 4400 Næstved, Denmark
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9
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Ali RM, Muhealdeen DN, Fakhralddin SS, Bapir R, Tahir SH, Rashid RJ, Omer CS, Abdullah HO, Abdalla BA, Mohammed SH, Kakamad FH, Abdullah F, Karim M, Rahim HM. Prognostic factors in renal cell carcinoma: A single‑center study. Mol Clin Oncol 2023; 19:66. [PMID: 37614366 PMCID: PMC10442722 DOI: 10.3892/mco.2023.2662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/30/2023] [Indexed: 08/25/2023] Open
Abstract
Renal cell carcinoma (RCC) is a heterogeneous and complex disease with numerous pathophysiologic variants. ~40% of patients succumb due to the progression of the disease, making RCC the most fatal of the common urologic malignancies. Prognostic factors are indicators of the progression of the disease, and the precise determination of these factors is important for evaluating and managing RCC. In the present study, it was aimed to determine and find associations among the histopathological features of RCCs and their impact on survival and metastasis. This is a cross-sectional study of RCC cases who have undergone partial or radical nephrectomy from March 2008 to October 2021 and have been pathologically reviewed at Shorsh General Teaching Hospital in Sulaimani, Iraq. The data in the pathology studies were supplemented by follow-up of the patients to obtain information about survival, recurrence and metastasis. In total, 228 cases of RCC were identified, among whom 60.5% were men and 39.5% were women, with a median age of 51 years. The main tumor types were clear cell RCC (71.1%), papillary RCC (13.6%), and chromophobe RCC (11%). Various measures of aggressiveness, including tumor necrosis, sarcomatoid change, microvascular invasion, and parameters of invasiveness (invasion of the renal sinus and other structures), were significantly correlated with each other, and they were also associated with reduced overall survival and an increased risk of metastasis on univariate analysis. However, on multivariate analysis, only tumor size and grade, and microvascular invasion retained statistical significance and were associated with a lower survival rate. In conclusion, pathological parameters have an impact on prognosis in RCC. The most consistent prognostic factors can be tumor size and grade, and microvascular invasion.
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Affiliation(s)
- Rawa M. Ali
- Scientific Affairs Department, Smart Health Tower, Sulaymaniyah, Kurdistan 46001, Iraq
- Pathology Department, Shorsh General Teaching Hospital, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Dana N. Muhealdeen
- Department of Oncology, Hiwa Hospital, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Saman S. Fakhralddin
- Scientific Affairs Department, Smart Health Tower, Sulaymaniyah, Kurdistan 46001, Iraq
- College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Rawa Bapir
- Scientific Affairs Department, Smart Health Tower, Sulaymaniyah, Kurdistan 46001, Iraq
- Urology Department, Sulaymaniyah General Teaching Hospital, Sulaymaniyah, Kurdistan 46001, Iraq
- Kscien Organization for Scientific Research, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Soran H. Tahir
- Scientific Affairs Department, Smart Health Tower, Sulaymaniyah, Kurdistan 46001, Iraq
- College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Rezheen J. Rashid
- Scientific Affairs Department, Smart Health Tower, Sulaymaniyah, Kurdistan 46001, Iraq
- Department of Oncology, Hiwa Hospital, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Choman Sabah Omer
- Scientific Affairs Department, Smart Health Tower, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Hiwa O. Abdullah
- Scientific Affairs Department, Smart Health Tower, Sulaymaniyah, Kurdistan 46001, Iraq
- Kscien Organization for Scientific Research, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Berun A. Abdalla
- Scientific Affairs Department, Smart Health Tower, Sulaymaniyah, Kurdistan 46001, Iraq
- Kscien Organization for Scientific Research, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Shvan H. Mohammed
- Kscien Organization for Scientific Research, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Fahmi H. Kakamad
- Scientific Affairs Department, Smart Health Tower, Sulaymaniyah, Kurdistan 46001, Iraq
- College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan 46001, Iraq
- Kscien Organization for Scientific Research, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Fakher Abdullah
- Kscien Organization for Scientific Research, 3082 JJ Rotterdam, The Netherlands
| | - Muhammad Karim
- Kscien Organization for Scientific Research, Tampa, FL 33637, USA
| | - Hawbash M. Rahim
- Scientific Affairs Department, Smart Health Tower, Sulaymaniyah, Kurdistan 46001, Iraq
- Kscien Organization for Scientific Research, Sulaymaniyah, Kurdistan 46001, Iraq
- Medical Laboratory Science Department, University of Human Development, Sulaymaniyah, Kurdistan 46001, Iraq
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10
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Piening A, Al-Hammadi N, Dombrowski J, Hamilton Z, Teague RM, Swaminath A, Shahi J. Survival in Metastatic Renal Cell Carcinoma Treated With Immunotherapy and Stereotactic Radiation Therapy or Immunotherapy Alone: A National Cancer Database Analysis. Adv Radiat Oncol 2023; 8:101238. [PMID: 37408680 PMCID: PMC10318269 DOI: 10.1016/j.adro.2023.101238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/29/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose Immunotherapy (IO) has significantly improved outcomes in metastatic renal cell carcinoma (mRCC). Preclinical evidence suggests that responses to IO may be potentiated via immunomodulatory effects of stereotactic radiation therapy (SRT). We hypothesized that clinical outcomes from the National Cancer Database (NCDB) would demonstrate improved overall survival (OS) in patients with mRCC receiving IO + SRT versus IO alone. Methods and Materials Patients with mRCC receiving first-line IO ± SRT were identified from the NCDB. Conventional radiation therapy was allowed in the IO alone cohort. The primary endpoint was OS stratified by the receipt of SRT (IO + SRT vs IO alone). Secondary endpoints included OS stratified by the presence of brain metastases (BM) and timing of SRT (before or after IO). Survival was estimated using Kaplan-Meier methodology and compared via the log-rank test. Results Of 644 eligible patients, 63 (9.8%) received IO + SRT, and 581 (90.2%) received IO alone. Median follow-up time was 17.7 months (range, 2-24 months). Sites treated with SRT included the brain (71.4%), lung/chest (7.9%), bones (7.9%), spine (6.3%), and other (6.3%). OS was 74.4% versus 65.0% at 1 year and 71.0% versus 59.4% at 2 years for the IO + SRT and IO alone groups, respectively, although this difference did not reach statistical significance (log-rank P = .1077). In patients with BM, however, 1-year OS (73.0% vs 54.7%) and 2-year OS (70.8% vs 51.4%) was significantly higher in those receiving IO + SRT versus IO alone, respectively (pairwise P = .0261). Timing of SRT (before or after IO) did not influence OS (log-rank P = .3185). Conclusions Patients with BM secondary to mRCC had prolonged OS with the addition of SRT to IO. Factors such as International mRCC Database Consortium risk stratification, oligometastatic tumor burden, SRT dose/fractionation, and utilization of doublet therapy should be considered in future analyses to better identify patients who may benefit from combined IO + SRT. Further prospective studies are warranted.
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Affiliation(s)
- Alexander Piening
- Department of Molecular Microbiology and Immunology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Noor Al-Hammadi
- Department of Health and Clinical Outcomes Research, AHEAD Institute, Saint Louis University School of Medicine, St. Louis, Missouri
| | - John Dombrowski
- Department of Radiation Oncology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Zachary Hamilton
- Department of Surgery, Division of Urology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Ryan M. Teague
- Department of Molecular Microbiology and Immunology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Anand Swaminath
- Department of Radiation Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jeevin Shahi
- Department of Radiation Oncology, Saint Louis University School of Medicine, St. Louis, Missouri
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11
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Akıncı Ö, Türkoglu F, Nalbant MO, Öner Ö, İnci E. The Effectiveness of Volumetric MRI Histogram Analysis in Renal Cell Carcinoma. Acad Radiol 2023; 30 Suppl 1:S278-S285. [PMID: 37105802 DOI: 10.1016/j.acra.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023]
Abstract
RATIONALE AND OBJECTIVES This study investigated the utility of histogram parameters derived from diffusion-weighted imaging (DWI) for evaluating renal cell carcinoma (RCC) grading prior to surgery. MATERIALS AND METHODS This retrospective study included 88 patients who were histopathologically diagnosed with RCC and underwent magnetic resonance imaging (MRI) examinations. The patients were divided into two groups as well-differentiated (Group 1) and poorly differentiated (Group 2). Demographic data, preoperative MRI findings, MRI apparent diffusion coefficient (ADC) histogram analyzes, operation types, postoperative histopathological data and cancer stages of the patients were recorded. The histogram parameters of ADC values, comprising the mean, minimum, maximum, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, as well as skewness, kurtosis, and variance, were calculated. RESULTS The study included 59 males and 29 women with an average age of 56.21 ± 1.33 years. There were 52 patients in Group 1 and 36 patients in Group 2. The ADCmin, ADCmean, ADCmax, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of ADC values of the poorly differentiated group were all lower than those of the well-differentiated group. ADCmin and the 5th percentile of ADC values, as well as ADCmean and the 10th, 25th, 50th, and 75th percentiles of ADC values, showed a statistically significant difference (p < 0.05). The AUC, sensitivity, and specificity of the ADCmin value were 0.703, 56.3%, and 75.7%, respectively. CONCLUSION The present study indicated that histogram parameters generated from DWI were capable of differentiating between high-grade and low-grade RCC.
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Affiliation(s)
- Özlem Akıncı
- Bakırköy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey.
| | - Furkan Türkoglu
- Bakırköy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Mustafa Orhan Nalbant
- Bakırköy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Özkan Öner
- Bakırköy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Ercan İnci
- Bakırköy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
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12
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Cazalas G, Klein C, Piana G, De Kerviler E, Gangi A, Puech P, Nedelcu C, Grange R, Buy X, Jegonday MA, Bigot P, Bensalah CK, Gaillard V, Pignot G, Paparel P, Badet L, Michiels C, Bernhard JC, Rouviere O, Grenier N, Marcelin C. A multicenter comparative matched-pair analysis of percutaneous tumor ablation and robotic-assisted partial nephrectomy of T1b renal cell carcinoma (AblatT1b study-UroCCR 80). Eur Radiol 2023; 33:6513-6521. [PMID: 37004570 DOI: 10.1007/s00330-023-09564-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE Renal cell carcinomas represent the sixth- and tenth-most frequently diagnosed cancer in men and women. Recently, percutaneous-guided thermal ablations have proved to be as effective as partial nephrectomy and safer for treating small renal masses (i.e., < 3 cm). This study compared the perioperative and recurrence outcomes of percutaneous thermal ablation (TA) and robotic-assisted partial nephrectomy (RAPN) for the treatment of T1b renal cell carcinomas (4.1-7 cm). METHODS Retrospective data from 11 centers on the national database, between 2010 and 2020, included 81 patients treated with thermal ablation (TA) and 308 patients treated with RAPN for T1b renal cell carcinoma, collected retrospectively and matched for tumor size, histology results, and the RENAL score. TA included cryoablation and microwave ablation. Endpoints compared the rate between the two groups: local recurrence, metastases, complications, renal function decrease, and length of hospitalization. RESULTS After matching, 75 patients were included in each group; mean age was 76.6 (± 9) in the TA group and 61.1 (± 12) in the RAPN group, including 69.3% and 76% men respectively. The local recurrence (LR) rate was significantly higher in the TA group than in the PN group (14.6% vs 4%; p = 0.02). The LR rate was 20% (1/5) after microwave ablation, 11.1% (1/9) after radiofrequency ablation, and 14.7% (9/61) after cryoablation. The major complication rate (Clavien-Dindo ≥ 3) was higher following PN than after TA (5.3% vs 0%; p < 0.001). Metastases, eGFR decrease, and length of hospitalization did not differ significantly between the two groups. CONCLUSIONS The local recurrence rate was significantly higher after thermal ablation; however, thermal ablation resulted in significantly lower rates of complications. Thermal ablation and robotic-assisted partial nephrectomy are effective treatments for T1b renal cancer; however, the local recurrence rate was higher after thermal ablation. KEY POINTS • The local recurrence rate was significantly higher in the thermal ablation group than in the partial nephrectomy group. • The major complication rate (Clavien-Dindo ≥ 3) was higher following PN than after TA (5.3% vs. 0%; p < 0.001).
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Affiliation(s)
- Grégoire Cazalas
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Clément Klein
- Service d'urologie, andrologie et transplantation rénale, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Gilles Piana
- Department of Radiology, Institut Paoli-Calmettes, Marseille, France
| | - Eric De Kerviler
- Department of Radiology, Hôpital Saint-Louis 1, avenue Claude Vellefaux, 75010, Paris, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Philippe Puech
- Department of Radiology CHU Lille, Radiology Department, Lille, France
| | - Cosmina Nedelcu
- Department of Radiology, University Hospital, CHU Angers, 4 rue Larrey, 49933, Angers, France
| | - Remi Grange
- Department of Radiology, CHU Nord Saint-Etienne Avenue Albert Raimond, Saint Etienne, France
| | - Xavier Buy
- Department of Interventional Radiology, Institut Bergonié, Bordeaux, France
| | | | - Pierre Bigot
- Department of Urology, University Hospital of Angers, Angers, France
| | | | - Victor Gaillard
- Department of Urology, University Hospital of Strasbourg, Strasbourg, France
| | - Géraldine Pignot
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - Philippe Paparel
- Service d'Urologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Lionel Badet
- Service d'Urologie, Hôpital Edouard Herriot, Lyon, France
| | - Clément Michiels
- Service d'urologie, andrologie et transplantation rénale, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Jean Christophe Bernhard
- Service d'urologie, andrologie et transplantation rénale, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Olivier Rouviere
- Department of Radiology - Pavillon B, Hôpital E. Herriot, 69003, Lyon, France
| | - Nicolas Grenier
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Clément Marcelin
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France.
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13
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Distante A, Marandino L, Bertolo R, Ingels A, Pavan N, Pecoraro A, Marchioni M, Carbonara U, Erdem S, Amparore D, Campi R, Roussel E, Caliò A, Wu Z, Palumbo C, Borregales LD, Mulders P, Muselaers CHJ. Artificial Intelligence in Renal Cell Carcinoma Histopathology: Current Applications and Future Perspectives. Diagnostics (Basel) 2023; 13:2294. [PMID: 37443687 DOI: 10.3390/diagnostics13132294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Renal cell carcinoma (RCC) is characterized by its diverse histopathological features, which pose possible challenges to accurate diagnosis and prognosis. A comprehensive literature review was conducted to explore recent advancements in the field of artificial intelligence (AI) in RCC pathology. The aim of this paper is to assess whether these advancements hold promise in improving the precision, efficiency, and objectivity of histopathological analysis for RCC, while also reducing costs and interobserver variability and potentially alleviating the labor and time burden experienced by pathologists. The reviewed AI-powered approaches demonstrate effective identification and classification abilities regarding several histopathological features associated with RCC, facilitating accurate diagnosis, grading, and prognosis prediction and enabling precise and reliable assessments. Nevertheless, implementing AI in renal cell carcinoma generates challenges concerning standardization, generalizability, benchmarking performance, and integration of data into clinical workflows. Developing methodologies that enable pathologists to interpret AI decisions accurately is imperative. Moreover, establishing more robust and standardized validation workflows is crucial to instill confidence in AI-powered systems' outcomes. These efforts are vital for advancing current state-of-the-art practices and enhancing patient care in the future.
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Affiliation(s)
- Alfredo Distante
- Department of Urology, Catholic University of the Sacred Heart, 00168 Roma, Italy
- Department of Urology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Laura Marandino
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Riccardo Bertolo
- Department of Urology, San Carlo Di Nancy Hospital, 00165 Rome, Italy
| | - Alexandre Ingels
- Department of Urology, University Hospital Henri Mondor, APHP (Assistance Publique-Hôpitaux de Paris), 94000 Créteil, France
| | - Nicola Pavan
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, 90133 Palermo, Italy
| | - Angela Pecoraro
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, 66100 Chieti, Italy
| | - Umberto Carbonara
- Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation-Urology, University of Bari, 70121 Bari, Italy
| | - Selcuk Erdem
- Division of Urologic Oncology, Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul 34093, Turkey
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy
| | - Riccardo Campi
- Urological Robotic Surgery and Renal Transplantation Unit, Careggi Hospital, University of Florence, 50121 Firenze, Italy
| | - Eduard Roussel
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Anna Caliò
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona, 37134 Verona, Italy
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Carlotta Palumbo
- Division of Urology, Maggiore della Carità Hospital of Novara, Department of Translational Medicine, University of Eastern Piedmont, 13100 Novara, Italy
| | - Leonardo D Borregales
- Department of Urology, Well Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Peter Mulders
- Department of Urology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Constantijn H J Muselaers
- Department of Urology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
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14
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Maurits JSF, Sedelaar JPM, Aben KKH, Kampman E, Kiemeney LALM, Vrieling A. Cohort profile - the Renal cell cancer: Lifestyle, prognosis and quality of life (ReLife) study in the Netherlands. BMJ Open 2023; 13:e066909. [PMID: 36972960 PMCID: PMC10069500 DOI: 10.1136/bmjopen-2022-066909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
PURPOSE The Renal cell cancer: Lifestyle, prognosis and quality of life (ReLife) study is set up to obtain insight into the association of patient and tumour characteristics, lifestyle habits and circulating biomarkers with body composition features in patients with localised renal cell cancer (RCC). Further, it aims to assess the association of body composition features, lifestyle habits and circulating biomarkers with clinical outcomes, including health-related quality of life. PARTICIPANTS The ReLife study is a multicentre prospective cohort study involving 368 patients with newly diagnosed stages I-III RCC recruited from January 2018 to June 2021 from 18 hospitals in the Netherlands. At 3 months, 1 year and 2 years after treatment, participants fill out a general questionnaire and questionnaires about their lifestyle habits (eg, diet, physical activity, smoking and alcohol consumption), medical history and health-related quality of life. At all three time points, patients wear an accelerometer and have blood samples taken. CT scans for body composition analysis are being collected. Permission is asked for collection of tumour samples. Information about disease characteristics, treatment of the primary tumour and clinical outcomes is being collected from medical records by the Netherlands Cancer Registry. FINDINGS TO DATE A total of 836 invited patients were eligible and 368 patients were willing to participate and were included (response rate 44%). The mean age of patients was 62.5±9.0 years and 70% was male. The majority had stage I (65%) disease and were treated with radical nephrectomy (57%). Data collection at 3 months and 1 years after treatment have been finalised. FUTURE PLANS Data collection at 2 years after treatment is expected to be finalised in June 2023 and longitudinal clinical data will continue to be collected. Results of studies based on this cohort are important to develop personalised evidence-based lifestyle advice for patients with localised RCC to enable them to get more control over their disease course.
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Affiliation(s)
- Jake S F Maurits
- Department for Health Evidence, Radboud Univerity Medical Center, Nijmegen, The Netherlands
| | - J P Michiel Sedelaar
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katja K H Aben
- Department for Health Evidence, Radboud Univerity Medical Center, Nijmegen, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Ellen Kampman
- Department for Health Evidence, Radboud Univerity Medical Center, Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | | | - Alina Vrieling
- Department for Health Evidence, Radboud Univerity Medical Center, Nijmegen, The Netherlands
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15
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Posada Calderon L, Eismann L, Reese SW, Reznik E, Hakimi AA. Advances in Imaging-Based Biomarkers in Renal Cell Carcinoma: A Critical Analysis of the Current Literature. Cancers (Basel) 2023; 15:cancers15020354. [PMID: 36672304 PMCID: PMC9856305 DOI: 10.3390/cancers15020354] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Cross-sectional imaging is the standard diagnostic tool to determine underlying biology in renal masses, which is crucial for subsequent treatment. Currently, standard CT imaging is limited in its ability to differentiate benign from malignant disease. Therefore, various modalities have been investigated to identify imaging-based parameters to improve the noninvasive diagnosis of renal masses and renal cell carcinoma (RCC) subtypes. MRI was reported to predict grading of RCC and to identify RCC subtypes, and has been shown in a small cohort to predict the response to targeted therapy. Dynamic imaging is promising for the staging and diagnosis of RCC. PET/CT radiotracers, such as 18F-fluorodeoxyglucose (FDG), 124I-cG250, radiolabeled prostate-specific membrane antigen (PSMA), and 11C-acetate, have been reported to improve the identification of histology, grading, detection of metastasis, and assessment of response to systemic therapy, and to predict oncological outcomes. Moreover, 99Tc-sestamibi and SPECT scans have shown promising results in distinguishing low-grade RCC from benign lesions. Radiomics has been used to further characterize renal masses based on semantic and textural analyses. In preliminary studies, integrated machine learning algorithms using radiomics proved to be more accurate in distinguishing benign from malignant renal masses compared to radiologists' interpretations. Radiomics and radiogenomics are used to complement risk classification models to predict oncological outcomes. Imaging-based biomarkers hold strong potential in RCC, but require standardization and external validation before integration into clinical routines.
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Affiliation(s)
- Lina Posada Calderon
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Lennert Eismann
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Stephen W. Reese
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ed Reznik
- Computational Oncology, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Abraham Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Correspondence:
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16
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Cimadamore A, Caliò A, Marandino L, Marletta S, Franzese C, Schips L, Amparore D, Bertolo R, Muselaers S, Erdem S, Ingels A, Pavan N, Pecoraro A, Kara Ö, Roussel E, Carbonara U, Campi R, Marchioni M. Hot topics in renal cancer pathology: implications for clinical management. Expert Rev Anticancer Ther 2022; 22:1275-1287. [PMID: 36377655 DOI: 10.1080/14737140.2022.2145952] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The updated European Association of Urology (EAU) Guidelines issued a weak recommendation for adjuvant pembrolizumab for patients with high-risk operable clear cell Renal Cell Carcinoma (ccRCC). High risk of recurrence was defined, as per protocol-criteria, as T2 with nuclear grade 4 or sarcomatoid differentiation, T3 or higher, regional lymph node metastasis, or stage M1 with no evidence of disease. Considering the heterogeneous population included in the recommendation, it has been questioned if adjuvant pembrolizumab may lead to overtreatment of some patients as well as undertreatment of patients with worse prognosis. AREAS COVERED In this review, we discuss the issues related to the assessment of pathological features required to identify those patients harboring a high-risk tumor, highlighting the issue related to interobserver variability and discuss the currently available prognostic scoring systems in ccRCC. EXPERT OPINION PPathologist assessment of prognostic features suffers from interobserver variability which may depend on gross sampling and the pathologist's expertise. The presence of clear cell feature is not sufficient criteria by itself to define ccRCC since clear cell can be also found in other histotypes. Application of molecular biomarkers may be useful tools in the near future to help clinicians identify patients harboring tumors with worse prognosis.
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Affiliation(s)
- Alessia Cimadamore
- Institute of Pathological Anatomy, Department of Medical Area, University of UdineUdineItaly
| | - Anna Caliò
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Laura Marandino
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Stefano Marletta
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Carmine Franzese
- Department of Urology, Polytechnic University of Marche, Ancona, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Science, "Ss. Annunziata" Hospital Urology Unit, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Stijn Muselaers
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Selcuk Erdem
- Division of Urologic Oncology, Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alexandre Ingels
- Department of Urology, University Hospital Henri Mondor, Créteil, France
| | - Nicola Pavan
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Angela Pecoraro
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Önder Kara
- Department of Urology, Kocaeli University School of Medicine, Izmit, Turkey
| | - Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Umberto Carbonara
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Science, "Ss. Annunziata" Hospital Urology Unit, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
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Han JH, Jeong SH, Han S, Yuk HD, Ku JH, Kwak C, Kim HH, Jeong CW. Association between decreased ipsilateral renal function and aggressive behavior in renal cell carcinoma. BMC Cancer 2022; 22:1143. [PMID: 36344958 PMCID: PMC9639309 DOI: 10.1186/s12885-022-10268-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
To assess prognostic value of pre-operative ipsilateral split renal function (SRF) on disease-free survival (DFS) and its association with aggressive pathological features in renal cell carcinoma (RCC) patients.
Methods
We examined patients registered in SNUG-RCC-Nx who underwent partial or radical nephrectomy at Seoul National University Hospital between January 1, 2010 and December 31, 2020. Patients with the following criteria were excluded from the study. 1) non-kidney origin cancer or benign renal tumor, 2) no pre-operative Tc 99 m-DTPA renal scan, 3) single kidney status or previous partial or radical nephrectomy, and 4) bilateral renal mass. Finally, 1,078 patients were included.
Results
Among 1,078 patients, 899 (83.4%) showed maintained ipsilateral SRF on DTPA renal scan; 179 patients (16.6%) showed decreased SRF. The decreased SRF group showed significantly large tumor size (maintained vs. decreased SRF; 3.31 ± 2.15 vs. 6.85 ± 3.25, p < 0.001), high Fuhrman grade (grade 3–4) (41.7% vs. 55.6%, p < 0.001), and high T stage (T stage 3–4) (9.0% vs. 20.1%, p < 0.001). Pathological invasive features, including invasion of the renal capsule, perirenal fat, renal sinus fat, vein, and collecting duct system, were associated with low SRF of the ipsilateral kidney. Univariate Cox regression analysis identified higher SSIGN (The stage, size, grade, and necrosis) score and decreased ipsilateral SRF as significant risk factors, while multivariate analysis showed SSIGN (5–7) (hazard ratio [HR] 11.9, p < 0.001) and SSIGN (8–10) (HR 69.2, p < 0.001) were significantly associated with shortened DFS, while decreased ipsilateral SRF (HR 1.75, p = 0.065) showed borderline significance. Kaplan–Meier analysis showed that decreased ipsilateral SRF (< 45%) group had shorter DFS than the other group (median DFS: 90.3 months vs. not reached, p < 0.001).
Conclusions
Among unilateral RCC patients, those with low ipsilateral SRF showed poor prognosis with pathologically invasive features. Our novel approach may facilitate risk stratification in RCC patients, helping formulate a treatment strategy.
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Wang T, Liu Y, Li Q, Luo Y, Liu D, Li B. Cuproptosis-related gene FDX1 expression correlates with the prognosis and tumor immune microenvironment in clear cell renal cell carcinoma. Front Immunol 2022; 13:999823. [PMID: 36225932 PMCID: PMC9549781 DOI: 10.3389/fimmu.2022.999823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cuproptosis, a newly discovered form of cell death, is regulated by protein lipoylation and is related to mitochondrial metabolism. However, further research is needed to determine how the cuproptosis-related gene ferredoxin 1 (FDX1) affects the tumor immune response and its prognostic significance in clear cell renal cell carcinoma (ccRCC). Methods The Cancer Genome Atlas was used to screen for FDX1 gene expression in ccRCC and healthy tissue samples. The results were validated using the Gene Expression Omnibus and the Human Protein Atlas. Multivariable analysis and Kaplan-Meier survival curves were used to examine the relationship between FDX1 gene expression, clinicopathological parameters, and overall survival (OS). The protein network containing FDX1 gene interaction was constructed using the online Search Tool for the Retrieval of Interacting Genes/Proteins. The relationship between FDX1 gene expression and immune cell infiltration in ccRCC was examined using Gene Ontology, gene set enrichment analysis (GSEA), and a single-sample GSEA. Using the Gene Expression Profiling Interactive Analysis and Tumor Immune Estimation Resource databases, we investigated the relationship between FDX1 gene expression, the degree of immune cell infiltration, and the corresponding gene marker sets. Results ccRCC samples had significantly (p < 0.05) lower FDX1 gene expression levels than normal tissue samples. Lower FDX1 gene expression levels were strongly associated with higher cancer grades and more advanced tumor-node-metastasis stages. The findings of multivariate and univariate analyses illustrated that the OS in ccRCC patients with low FDX1 expression is shorter than in patients with high FDX1 expression (p < 0.05). Ferredoxin reductase and CYP11A1 are key proteins interacting with the FDX1 gene, and ccRCC with an FDX1 enzyme defect was associated with a low number of invading immune cells and their corresponding marker. Conclusion In ccRCC, decreased FDX1 expression was linked to disease progression, an unfavorable prognosis, and dysregulated immune cell infiltration.
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Sendur MAN. Adjuvant immunotherapy for renal cell carcinoma. Lancet Oncol 2022; 23:1110-1111. [DOI: 10.1016/s1470-2045(22)00509-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 01/04/2023]
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FECH Expression Correlates with the Prognosis and Tumor Immune Microenvironment in Clear Cell Renal Cell Carcinoma. JOURNAL OF ONCOLOGY 2022; 2022:8943643. [PMID: 36059798 PMCID: PMC9436586 DOI: 10.1155/2022/8943643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 11/21/2022]
Abstract
Background Clear cell renal cell carcinoma (ccRCC) is, by far, the most prevalent and fatal kind of kidney cancer. Ferrochelatase (FECH) is an enzyme that performs a significant function in the onset and progression of many distinct kinds of malignant tumors. Nevertheless, its predictive usefulness in renal clear cell carcinoma (RCC) has not yet been fully investigated. Methods FECH expression in ccRCC and healthy adjoining tissues was primarily screened utilizing data sourced from The Cancer Genome Atlas (TCGA) and subsequently validated using data from an independent cohort derived from the Gene Expression Omnibus (GEO) and the Human Protein Atlas HPA databases. The relationship among FECH expression, clinicopathological parameters, and overall survival (OS) was assessed utilizing multivariate analysis and Kaplan–Meier survival curves. Additionally, the protein networks with FECH interaction were constructed with the aid of the online Search Tool for the Retrieval of Interacting Genes/Proteins (STRING). Gene ontology (GO) analysis, and gene set enrichment analysis (GSEA) were conducted based on TCGA data, and a single-sample GSEA was utilized to explore the link between FECH expression and the infiltration status of immune cells in the tumor. The Gene Expression Profiling Interactive Analysis (GEPIA) and TIMER databases were utilized to investigate the relationships of FECH expression with the infiltrating immune cells and the matching gene marker sets. Results FECH expression was shown to be substantially lowered in ccRCC tumors as opposed to that observed in normal tissues (p < 0.05). Lower levels of FECH expression were shown to have a strong association with higher grades of cancer and more advanced TNM stages. The findings of multivariate and univariate analyses illustrated that the OS in patients with ccRCC with low FECH expression is shorter in contrast with that in the high FECH expression group (p < 0.05). It was discovered that CPOX and frataxin are key proteins that interact with FECH. ccRCC with FECH deficiency was linked to the lack of infiltrating immune cells and their respective marker sets, which included CD4+ T cells. Conclusion In ccRCC, decreased FECH expression was linked to disease progression, unfavorable prognosis, and impaired immune cell infiltration.
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Wang Y, Shen Z, Mo S, Dai L, Song B, Gu W, Ding X, Zhang X. Construction and validation of a novel ten miRNA-pair based signature for the prognosis of clear cell renal cell carcinoma. Transl Oncol 2022; 25:101519. [PMID: 35998436 PMCID: PMC9421317 DOI: 10.1016/j.tranon.2022.101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/12/2022] [Accepted: 08/10/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Clear cell renal cell carcinoma (ccRCC) is the most predominate pathological subtype of renal cell carcinoma, causing a recurrence or metastasis rate as high as 20% to 40% after operation, for which effective prognostic signature is urgently needed. METHODS The mRNA and miRNA profiles of ccRCC specimens were collected from the Cancer Genome Atlas. MiRNA-pair risk score (miPRS) for each miRNA pair was generated as a signature and validated by univariate and multivariate Cox proportional hazards regression analysis. Functional enrichment was performed, and immune cells infiltration, as well as tumor mutation burden (TMB), and immunophenoscore (IPS) were evaluated between high and low miPRS groups. Target gene-prediction and differentially expressed gene-analysis were performed based on databases of miRDB, miRTarBase, and TargetScan. Multivariate Cox proportional hazards regression analysis was adopted to establish the prognostic model and Kaplan-Meier survival analysis was performed. FINDINGS A novel 10 miRNA-pair based signature was established. Area under the time-dependent receiver operating curve proved the performance of the signature in the training, validation, and testing cohorts. Higher TMB, as well as the higher CTLA4-negative PD1-negative IPS, were discovered in high miPRS patients. A prognostic model was built based on miPRS (1 year-, 5 year-, 10 year- ROC-AUC=0.92, 0.84, 0.82, respectively). INTERPRETATION The model based on miPRS is a novel and valid tool for predicting the prognosis of ccRCC. FUNDING This study was supported by research grants from the China National Natural Scientific Foundation (81903972, 82002018, and 82170752) and Shanghai Sailing Program (19YF1406700 and 20YF1406000).
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Affiliation(s)
- Yulin Wang
- Department of Nephrology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China; Shanghai Medical Center of Kidney Disease, Shanghai 200032, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China
| | - Ziyan Shen
- Department of Nephrology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China; Shanghai Medical Center of Kidney Disease, Shanghai 200032, China; Shanghai Institute of Kidney and Dialysis, No. 136 Medical College Road, Shanghai 200032, China
| | - Shaocong Mo
- Department of Digestive Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Leijie Dai
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Biao Song
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, 100005, China
| | - Wenchao Gu
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511, Japan
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China; Shanghai Medical Center of Kidney Disease, Shanghai 200032, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China; Shanghai Institute of Kidney and Dialysis, No. 136 Medical College Road, Shanghai 200032, China.
| | - Xiaoyan Zhang
- Department of Nephrology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China; Shanghai Medical Center of Kidney Disease, Shanghai 200032, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China; Shanghai Institute of Kidney and Dialysis, No. 136 Medical College Road, Shanghai 200032, China.
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22
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Risk of recurrence after nephrectomy: Comparison of predictive ability of validated risk models. Urol Oncol 2022; 40:167.e1-167.e7. [DOI: 10.1016/j.urolonc.2021.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
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Yang G, Nie P, Yan L, Zhang M, Wang Y, Zhao L, Li M, Xie F, Xie H, Li X, Xiang F, Wang N, Cheng N, Zhao X, Wang N, Wang Y, Chen C, Yun C, Cui J, Duan S, Zhang R, Hao D, Wang X, Wang Z, Niu H. The radiomics-based tumor heterogeneity adds incremental value to the existing prognostic models for predicting outcome in localized clear cell renal cell carcinoma: a multicenter study. Eur J Nucl Med Mol Imaging 2022; 49:2949-2959. [PMID: 35344062 DOI: 10.1007/s00259-022-05773-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/19/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Tumor heterogeneity, which is associated with poor outcomes, has not been exhibited in the University of California, Los Angeles, Integrated Staging System (UISS), and the Stage, Size, Grade and Necrosis (SSIGN) scores. Radiomics allows an in-depth characterization of heterogeneity across the tumor, but its incremental value to the existing prognostic models for clear cell renal cell carcinoma (ccRCC) outcome is unknown. The purpose of this study was to evaluate the association between the radiomics-based tumor heterogeneity and postoperative risk of recurrence in localized ccRCC, and to assess its incremental value to UISS and SSIGN. METHODS A multicenter 866 ccRCC patients derived from 12 Chinese hospitals were studied. The endpoint was recurrence-free survival (RFS). A CT-based radiomics signature (RS) was developed and assessed in the whole cohort and in the subgroups stratified by UISS and SSIGN. Two combined nomograms, the R-UISS (combining RS and UISS) and R-SSIGN (combining RS and SSIGN), were developed. The incremental value of RS to UISS and SSIGN in RFS prediction was evaluated. R statistical software was used for statistics. RESULTS Patients with low radiomics scores were 4.44 times more likely to experience recurrence than those with high radiomics scores (P<0.001). Stratified analysis suggested the association is significant among low- and intermediate-risk patients identified by UISS and SSIGN. The R-UISS and R-SSIGN showed better predictive capability than UISS and SSIGN did with higher C-indices (R-UISS vs. UISS, 0.74 vs. 0.64; R-SSIGN vs. SSIGN, 0.78 vs. 0.76) and higher clinical net benefit. CONCLUSIONS The radiomics-based tumor heterogeneity can predict outcome and add incremental value to the existing prognostic models in localized ccRCC patients. Incorporating radiomics-based tumor heterogeneity in ccRCC prognostic models may provide the opportunity to better surveillance and adjuvant clinical trial design.
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Affiliation(s)
- Guangjie Yang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Pei Nie
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lei Yan
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mingxin Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yangyang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lianzi Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Mingyao Li
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Fei Xie
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, Yantai, Shandong, China
| | - Xianjun Li
- Department of Radiology, Weifang People's Hospital, Weifang, Shandong, China
| | - Fawei Xiang
- Department of Radiology, Weifang People's Hospital, Weifang, Shandong, China
| | - Nan Wang
- Department of Nuclear Medicine, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Nan Cheng
- Department of Medical Imaging, The Affiliated Hospital of Jining Medical College, Jining, Shandong, China
| | - Xia Zhao
- Department of Radiology, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ning Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yicong Wang
- Department of Nuclear Medicine, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Chengcheng Chen
- Department of Radiology, Rizhao People's Hospital, Rizhao, Shandong, China
| | - Canhua Yun
- Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jingjing Cui
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai, China
| | - Shaofeng Duan
- GE Healthcare, Precision Health Institution, Shanghai, China
| | - Ran Zhang
- Huiying Medical Technology Co. Ltd, Beijing, China
| | - Dapeng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
| | - Zhenguang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Haitao Niu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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The distribution of metastatic renal cell carcinoma by presenting tumor stage in the modern era. Clin Genitourin Cancer 2022; 20:e296-e302. [DOI: 10.1016/j.clgc.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/26/2022] [Accepted: 03/01/2022] [Indexed: 11/18/2022]
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Inamoto T, Azuma H, Adachi M, Okayama Y, Sunaya T, Oya M. Outcomes of sorafenib treatment of advanced renal cell carcinoma according to International Metastatic Renal Cell Carcinoma Data Consortium risk criteria: analysis of Japanese real-world data from postmarketing all-patient surveillance of sorafenib. Future Oncol 2022; 18:1371-1380. [PMID: 35023360 DOI: 10.2217/fon-2021-1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess sorafenib survival outcomes in renal cell carcinoma patients using standard International Metastatic Renal Cell Carcinoma Data Consortium (IMDC) risk criteria. Patients & methods: The authors restratified a real-world cohort of 3255 advanced renal cell carcinoma patients, obtained from Japanese sorafenib postmarketing surveillance, to assess survival outcomes using IMDC criteria; intermediate risk was subdivided into Int-1 and Int-2 (one and two risk factors, respectively). Results: Overall, 2225 (68%) IMDC-evaluable patients were reclassified as favorable (17%), intermediate (62%) and poor (21%) risk, with median progression-free survival of 10.4, 8.1 and 3.4 months, respectively. Int-1 (36%) and Int-2 (26%) subgroups had median progression-free survival of 10.1 and 6.0 months, respectively. Sorafenib had acceptable safety/tolerability. Conclusion: Sorafenib effectiveness was promising for IMDC intermediate risk, particularly Int-1, warranting further investigation.
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Affiliation(s)
- Teruo Inamoto
- Department of Urology, Osaka Medical & Pharmaceutical University, Osaka, 569-8686, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical & Pharmaceutical University, Osaka, 569-8686, Japan
| | - Masatoshi Adachi
- Medical Affairs GU Oncology, Bayer Yakuhin Ltd, Osaka, 530-0001, Japan
| | - Yutaka Okayama
- PMS, Pharmacovigilance Monitoring & Governance, Bayer Yakuhin Ltd, Osaka, 530-0001, Japan
| | - Toshiyuki Sunaya
- Statistics & Data Insights, Research & Development Japan, Bayer Yakuhin Ltd, Osaka, 530-0001, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, 160-8582, Japan
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Genomics of Clear-cell Renal Cell Carcinoma: A Systematic Review and Meta-analysis. Eur Urol 2022; 81:349-361. [PMID: 34991918 DOI: 10.1016/j.eururo.2021.12.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 11/21/2022]
Abstract
CONTEXT Although antiangiogenic treatments and immunotherapies have significantly improved the prognosis of metastatic renal cell carcinoma (RCC), many patients will develop resistance, leading to treatment failure. Genetic tumor heterogeneity is a major cause of this resistance. OBJECTIVE To perform a meta-analysis of genomic data for clear-cell RCC obtained from primary tumors and metastases to assess the prevalence of gene mutations and copy number alterations (CNAs). EVIDENCE ACQUISITION Articles were selected from Medline and Embase libraries using the search algorithm ("Kidney Neoplasms"[Mesh] OR "Renal Cell Carcinoma") AND ("Genomics"[Mesh] OR "Mutation") from January 1999 to February 2021. A critical review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Ninety-three publications were selected for inclusion in this meta-analysis. EVIDENCE SYNTHESIS Our meta-analysis included a total 14 696 patients, 14 299 primary tumor samples, and 969 metastatic samples. We evaluated the overall and subgroup prevalence of gene mutations and CNAs, including comparisons between primary tumors and metastases. In particular, for metastases we observed that the mutation prevalence was significantly more marked for ten genes compared to primary tumors, with no or little heterogeneity across studies. The VHL mutation prevalence increased significantly from 64% in primary tumors to 75% in metastases (p < 0.001). There was a significant increase in CNA prevalence from primary tumors to metastases for chromosomes 1p36.11, 9p21.3, and 18 in terms of losses, and for chromosomes 1q21.3, 7q36.3, 8q, and 20q11.21 in terms of gains. CDKN2A, also called p16 and involved in cell-cycle progression, is located at the 9p21.3 locus and was lost in 76% of metastatic samples. ASXL1, located on 20p11.21 and amplified in 50% of metastatic RCCs compared to 21% of primary tumors (p < 0.001), is closely linked to BAP1 function. CONCLUSIONS Our results underline the added value of preferential biopsies on RCC metastases to fully explore the biology of metastatic disease for therapeutic purposes. PATIENT SUMMARY We reviewed the literature on genetic mutations in primary tumors and metastatic lesions in kidney cancer. Our pooled results for all the relevant studies show a higher level of mutations in metastases than in primary tumors. This highlights the importance of taking biopsies of metastases to analyze genetic mutations and potentially guide selection of the most suitable treatment strategy.
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Wang T, Xie F, Li YH, Liang B. Downregulation of ACE2 is associated with advanced pathological features and poor prognosis in clear cell renal cell carcinoma. Future Oncol 2021; 17:5033-5044. [PMID: 34704468 DOI: 10.2217/fon-2020-1164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aims: The aim of this study was to explore the alteration in ACE2 expression and correlation between ACE2 expression and immune infiltration in clear cell renal cell carcinoma (ccRCC). Methods: The authors first analyzed the expression profiles and prognostic value of ACE2 in ccRCC patients using The Cancer Genome Atlas public database. The authors used ESTIMATE and CIBERSORT algorithms to analyze the correlation between ACE2 expression and tumor microenvironment in ccRCC samples. Results: ACE2 was correlated with sex, distant metastasis, clinical stage, tumor T stage and histological grade. Moreover, downregulation of ACE2 was correlated with unfavorable prognosis. In addition, ACE2 expression was associated with different immune cell subtypes. Conclusion: The authors' analyses suggest that ACE2 plays an important role in the development and progression of ccRCC and may serve as a potential prognostic biomarker in ccRCC patients.
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Affiliation(s)
- Tianjiao Wang
- Bioinformatics Department, Key Laboratory of Cell Biology, Ministry of Public Health & Key Laboratory of Medical Cell Biology, Ministry of Education, School of Life Sciences, China Medical University, Shenyang 110122, China
| | - Fang Xie
- Medical Basic Experimental Teaching Center, China Medical University, Shenyang 110122, China
| | - Yun-Hui Li
- Department of Clinical Laboratory, General Hospital of PLA Northern Theater Command, Shenyang 110016, China
| | - Bin Liang
- Bioinformatics Department, Key Laboratory of Cell Biology, Ministry of Public Health & Key Laboratory of Medical Cell Biology, Ministry of Education, School of Life Sciences, China Medical University, Shenyang 110122, China
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Teixeira AL, Patrão AS, Dias F, Silva C, Vieira I, Silva JF, Ferreira M, Morais A, Maurício J, Medeiros R. AGO2 expression levels and related genetic polymorphisms: influence in renal cell progression and aggressive phenotypes. Pharmacogenomics 2021; 22:1069-1079. [PMID: 34672687 DOI: 10.2217/pgs-2021-0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Renal cell carcinoma (RCC) is the most lethal urological cancer and up to 40% of patients submitted to surgery will relapse. Thus, the study aim was to analyze the associations of AGO2 SNPs with RCC patients' prognosis, and evaluate their effect on AGO2 mRNA levels. Materials & methods: The AGO2 rs4961280, rs3928672 and rs11996715 polymorphisms and the relative quantification of AGO2 mRNA levels were analyzed by real-time PCR. Results: We observed that AGO2 rs4961280 AC + AA genotypes carriers presented a higher cancer progression risk (odds ratio= 3.13, p < 0.001), a reduced progression-free survival (log rank test, p = 0.003) and an increased risk of an early relapse (hazard ratio= 2.26, p = 0.008). In fact, these patients also presented higher circulating levels of AGO2 mRNA (p = 0.043), with the high levels being associated with more aggressive tumors. Conclusion: The AGO2 rs4961280 AA/AC genotypes are unfavorable RCC prognostic biomarkers, with the AGO2 levels being a useful RCC aggressive phenotype biomarker.
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Affiliation(s)
- Ana Luísa Teixeira
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto CCC)
| | - Ana Sofia Patrão
- Medical Oncology Department of The Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Francisca Dias
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/RISECI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto CCC)
| | - Carlos Silva
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/RISECI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto CCC)
| | - Isabel Vieira
- Urology Department of The Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - José Fernando Silva
- Urology Department of The Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Marta Ferreira
- Medical Oncology Department of The Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - António Morais
- Urology Department of The Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Joaquina Maurício
- Medical Oncology Department of The Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/RISECI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto CCC).,ICBAS, Abel Salazar Institute for The Biomedical Sciences, University of Porto, Portugal.,FMUP, Faculty of Medicine, University of Porto, Portugal.,Research Department, LPCC- Portuguese League Against Cancer (NR Norte), Porto, Portugal.,Faculty of Health Sciences, Fernando Pessoa University, Porto, Portugal
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Lee J, Suh J, Song C, You D, Jeong IG, Hong B, Hong JH, Kim CS, Ahn H. Association Between Sarcopenia and Survival of Patients with Organ-Confined Renal Cell Carcinoma after Radical Nephrectomy. Ann Surg Oncol 2021; 29:2473-2479. [PMID: 34625877 DOI: 10.1245/s10434-021-10881-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/13/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND We aimed to describe the effect of preoperative sarcopenia on oncologic outcomes of organ-confined renal cell carcinoma (RCC) after radical nephrectomy. PATIENTS AND METHODS A total of 632 patients with pT1-2 RCC who underwent radical nephrectomy between 2004 and 2014 were retrospectively analyzed. From preoperative computerized tomography (CT) scans, skeletal muscle index (SMI) was measured and gender-specific cutoff values at third lumbar vertebra of 52.4 cm2/m2 for men and 38.5 cm2/m2 for women were used to define sarcopenia. Survivals were compared and associations with sarcopenia were analyzed using Kaplan-Meier log rank tests and Cox proportional hazard regression models. Median follow-up was 83 months. RESULTS Of 632 patients, 268 (42.4%) were classified as sarcopenic. The sarcopenic group was more advanced in age (57 versus 53 years) and more predominantly male (71.3% versus 59.9%). Sarcopenic patients had lower body mass index (BMI, 23.0 versus 25.9 kg/m2), but there was no difference in tumor size, stage, or nuclear grade. Sarcopenia was associated with poorer overall survival (OS) and cancer-specific survival (CSS; OS 94.0% versus 82.1%; p < 0.001 and CSS 97.5% versus 91.8%; p < 0.001). On multivariate analysis, sarcopenia was an independent risk factor for all-cause mortality [hazard ratio (HR) 2.58; 95% CI 1.02-6.54] and cancer-specific mortality (HR 3.07; 95% CI 1.38-6.83). CONCLUSIONS Sarcopenia at diagnosis was an independent risk factor for all-cause and cancer-specific mortality after radical nephrectomy for pT1-2 RCC. These findings underscore the importance of assessing presence of sarcopenia for risk stratification even among surgical candidates.
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Affiliation(s)
- Jongpil Lee
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jungyo Suh
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Dalsan You
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - In Gab Jeong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Bumsik Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jun Hyuk Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Choung Soo Kim
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Joosten SC, Odeh SNO, Koch A, Buekers N, Aarts MJB, Baldewijns MMLL, Van Neste L, van Kuijk S, Schouten LJ, van den Brandt PA, Tjan-Heijnen VC, van Engeland M, Smits KM. Development of a prognostic risk model for clear cell renal cell carcinoma by systematic evaluation of DNA methylation markers. Clin Epigenetics 2021; 13:103. [PMID: 33947447 PMCID: PMC8094610 DOI: 10.1186/s13148-021-01084-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/19/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Current risk models for renal cell carcinoma (RCC) based on clinicopathological factors are sub-optimal in accurately identifying high-risk patients. Here, we perform a head-to-head comparison of previously published DNA methylation markers and propose a potential prognostic model for clear cell RCC (ccRCC). PATIENTS AND METHODS Promoter methylation of PCDH8, BNC1, SCUBE3, GREM1, LAD1, NEFH, RASSF1A, GATA5, SFRP1, CDO1, and NEURL was determined by nested methylation-specific PCR. To identify clinically relevant methylated regions, The Cancer Genome Atlas (TCGA) was used to guide primer design. Formalin-fixed paraffin-embedded (FFPE) tissue samples from 336 non-metastatic ccRCC patients from the prospective Netherlands Cohort Study (NLCS) were used to develop a Cox proportional hazards model using stepwise backward elimination and bootstrapping to correct for optimism. For validation purposes, FFPE ccRCC tissue of 64 patients from the University Hospitals Leuven and a series of 232 cases from The Cancer Genome Atlas (TCGA) were used. RESULTS Methylation of GREM1, GATA5, LAD1, NEFH, NEURL, and SFRP1 was associated with poor ccRCC-specific survival, independent of age, sex, tumor size, TNM stage or tumor grade. Moreover, the association between GREM1, NEFH, and NEURL methylation and outcome was shown to be dependent on the genomic region. A prognostic biomarker model containing GREM1, GATA5, LAD1, NEFH and NEURL methylation in combination with clinicopathological characteristics, performed better compared to the model with clinicopathological characteristics only (clinical model), in both the NLCS and the validation population with a c-statistic of 0.71 versus 0.65 and a c-statistic of 0.95 versus 0.86 consecutively. However, the biomarker model had limited added prognostic value in the TCGA series with a c-statistic of 0.76 versus 0.75 for the clinical model. CONCLUSION In this study we performed a head-to-head comparison of potential prognostic methylation markers for ccRCC using a novel approach to guide primers design which utilizes the optimal location for measuring DNA methylation. Using this approach, we identified five methylation markers that potentially show prognostic value in addition to currently known clinicopathological factors.
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Affiliation(s)
- S C Joosten
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S N O Odeh
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - A Koch
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - N Buekers
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - M J B Aarts
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - L Van Neste
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - S van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L J Schouten
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - P A van den Brandt
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - V C Tjan-Heijnen
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M van Engeland
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - K M Smits
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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Sun Y, Li J, Qu Z, Yang Z, Jia X, Lin Y, He Q, Zhang L, Luo Y. Causal Associations between Serum Urea and Cancer: A Mendelian Randomization Study. Genes (Basel) 2021; 12:genes12040498. [PMID: 33805346 PMCID: PMC8066321 DOI: 10.3390/genes12040498] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/08/2021] [Accepted: 03/24/2021] [Indexed: 01/20/2023] Open
Abstract
Urea is largely derived from the urea cycle reactions through hepatic detoxification of free ammonia and cleared by urination, and the serum urea level is a crucial medical indicator for measuring the kidney function in patients with nephropathy; however, investigative revelations pointing to the serum urea level as a risk factor for cancer are very scarce, and relevant studies are restricted by potential biases. We aimed to explore the causal relationships of the serum urea level with cancer development by focusing on renal cell carcinoma (RCC) using the Mendelian randomization (MR) analyses. Summary estimates were collected from the inverse-variance weighted (IVW) method based on six single nucleotide polymorphisms (SNPs). The selected SNPs related to the serum urea were obtained from a large genome-wide association study (GWAS) of 13,312 European participants. The summary statistics of RCC were also available from public databases (IARC, n = 5219 cases, n = 8011 controls). Sensitivity analyses included the weighted median and MR-Egger methods. Serum urea was inversely associated with RCC in females (effect = 1.93; 95% CI: 1.24 to 3.01; p = 0.004) but exhibited null association with RCC in males, breast cancer (BRCA) in both genders and prostate cancer (PCa) in males. Similar conclusions were also drawn from the weighted median and MR-Egger. These findings reveal an intriguing link between serum urea and cancer risks for the very first time. Without ambiguity, the serum urea is causatively related to RCC specifically in females, although the mechanism(s) by which urea is involved in RCC development remains to be experimentally/clinically investigated. Our studies may well provide novel insights for RCC diagnosis, intervention and/or therapy.
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Affiliation(s)
- Yandi Sun
- Department of Biochemistry and Cancer Institute of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; (Y.S.); (J.L.); (Z.Y.); (X.J.); (Y.L.); (Q.H.); (L.Z.)
- Key Laboratory of Cancer Prevention and Intervention of China National Ministry of Education, Hangzhou 310058, China
| | - Jingjia Li
- Department of Biochemistry and Cancer Institute of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; (Y.S.); (J.L.); (Z.Y.); (X.J.); (Y.L.); (Q.H.); (L.Z.)
- Key Laboratory of Cancer Prevention and Intervention of China National Ministry of Education, Hangzhou 310058, China
| | - Zihao Qu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China;
- Orthopedic Research Institute of Zhejiang University, Hangzhou 310058, China
| | - Ze Yang
- Department of Biochemistry and Cancer Institute of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; (Y.S.); (J.L.); (Z.Y.); (X.J.); (Y.L.); (Q.H.); (L.Z.)
- Key Laboratory of Cancer Prevention and Intervention of China National Ministry of Education, Hangzhou 310058, China
| | - Xueyao Jia
- Department of Biochemistry and Cancer Institute of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; (Y.S.); (J.L.); (Z.Y.); (X.J.); (Y.L.); (Q.H.); (L.Z.)
- Key Laboratory of Cancer Prevention and Intervention of China National Ministry of Education, Hangzhou 310058, China
| | - Yindan Lin
- Department of Biochemistry and Cancer Institute of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; (Y.S.); (J.L.); (Z.Y.); (X.J.); (Y.L.); (Q.H.); (L.Z.)
- Key Laboratory of Cancer Prevention and Intervention of China National Ministry of Education, Hangzhou 310058, China
| | - Qian He
- Department of Biochemistry and Cancer Institute of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; (Y.S.); (J.L.); (Z.Y.); (X.J.); (Y.L.); (Q.H.); (L.Z.)
- Key Laboratory of Cancer Prevention and Intervention of China National Ministry of Education, Hangzhou 310058, China
| | - Lihong Zhang
- Department of Biochemistry and Cancer Institute of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; (Y.S.); (J.L.); (Z.Y.); (X.J.); (Y.L.); (Q.H.); (L.Z.)
- Key Laboratory of Cancer Prevention and Intervention of China National Ministry of Education, Hangzhou 310058, China
| | - Yan Luo
- Department of Biochemistry and Cancer Institute of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; (Y.S.); (J.L.); (Z.Y.); (X.J.); (Y.L.); (Q.H.); (L.Z.)
- Key Laboratory of Cancer Prevention and Intervention of China National Ministry of Education, Hangzhou 310058, China
- Correspondence: ; Tel.: +86-1875-713-6369
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Giulietti M, Cecati M, Sabanovic B, Scirè A, Cimadamore A, Santoni M, Montironi R, Piva F. The Role of Artificial Intelligence in the Diagnosis and Prognosis of Renal Cell Tumors. Diagnostics (Basel) 2021; 11:206. [PMID: 33573278 PMCID: PMC7912267 DOI: 10.3390/diagnostics11020206] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 02/07/2023] Open
Abstract
The increasing availability of molecular data provided by next-generation sequencing (NGS) techniques is allowing improvement in the possibilities of diagnosis and prognosis in renal cancer. Reliable and accurate predictors based on selected gene panels are urgently needed for better stratification of renal cell carcinoma (RCC) patients in order to define a personalized treatment plan. Artificial intelligence (AI) algorithms are currently in development for this purpose. Here, we reviewed studies that developed predictors based on AI algorithms for diagnosis and prognosis in renal cancer and we compared them with non-AI-based predictors. Comparing study results, it emerges that the AI prediction performance is good and slightly better than non-AI-based ones. However, there have been only minor improvements in AI predictors in terms of accuracy and the area under the receiver operating curve (AUC) over the last decade and the number of genes used had little influence on these indices. Furthermore, we highlight that different studies having the same goal obtain similar performance despite the fact they use different discriminating genes. This is surprising because genes related to the diagnosis or prognosis are expected to be tumor-specific and independent of selection methods and algorithms. The performance of these predictors will be better with the improvement in the learning methods, as the number of cases increases and by using different types of input data (e.g., non-coding RNAs, proteomic and metabolic). This will allow for more precise identification, classification and staging of cancerous lesions which will be less affected by interpathologist variability.
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Affiliation(s)
- Matteo Giulietti
- Department of Specialistic Clinical & Odontostomatological Sciences, Polytechnic University of Marche, 60126 Ancona, Italy; (M.G.); (M.C.); (B.S.)
| | - Monia Cecati
- Department of Specialistic Clinical & Odontostomatological Sciences, Polytechnic University of Marche, 60126 Ancona, Italy; (M.G.); (M.C.); (B.S.)
| | - Berina Sabanovic
- Department of Specialistic Clinical & Odontostomatological Sciences, Polytechnic University of Marche, 60126 Ancona, Italy; (M.G.); (M.C.); (B.S.)
| | - Andrea Scirè
- Department of Life and Environmental Sciences, Polytechnic University of Marche, 60126 Ancona, Italy;
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of Marche, United Hospitals, 60126 Ancona, Italy; (A.C.); (R.M.)
| | - Matteo Santoni
- Oncology Unit, Macerata Hospital, 62012 Macerata, Italy;
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of Marche, United Hospitals, 60126 Ancona, Italy; (A.C.); (R.M.)
| | - Francesco Piva
- Department of Specialistic Clinical & Odontostomatological Sciences, Polytechnic University of Marche, 60126 Ancona, Italy; (M.G.); (M.C.); (B.S.)
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Kundu A, Sen A, Choudhury S, Mandal TK, Guha D, Lahiry S. Immunohistochemical analysis of beta-catenin expression: a probable prognostic marker and potential therapeutic target in renal cell carcinoma. Med Pharm Rep 2021; 94:65-72. [PMID: 33629051 PMCID: PMC7880061 DOI: 10.15386/mpr-1767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/31/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background and aims Renal cell carcinoma (RCC) seems to be the most aggressive type of genitourinary neoplasm. Down regulation of normal beta-catenin expression contributes to development of RCC, reflecting the role of beta-catenin/Wnt signaling pathway in pathogenesis. This study aims to evaluate the significance of beta-catenin expression and its correlation with the prognostic parameters. Methods A cross-sectional observational study was carried out in a tertiary care center on 58 RCC cases using variables like histological grade and type, tumor stage, necrosis. Formalin fixed, paraffin-embedded blocks were evaluated for beta-catenin expression by immunohistochemistry using scoring system. Data were analyzed by mean ± SD, χ2 test, Pearson’s correlation test. Results Membranous score (MS) had a strong negative correlation with tumor stage (r=−0.407, p=0.044) and grade (r=−0.787, p=<0.001). Mean membranous score difference between low (Stage 1 and 2) vs. high stage (Stage 3 and 4) and low (Grade 1 and 2) vs. high grade (Grade 3 and 4) was statistically significant (p<0.001). Cytoplasmic score (CS) had positive correlation with tumor stage (r=0.586; p=0.002). No significant correlation was evident between cytoplasmic scores and tumor grade, however the mean cytoplasmic score difference between low grade vs. high grade was statistically significant (p < 0.001). Conclusion Beta-catenin may play a crucial role in the pathogenesis of RCC and has a positive correlation with the biological behavior of this tumor. The important role of beta-catenin as a prognostic parameter and probably a critical evaluator of targeted chemotherapy cannot be overemphasized.
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Affiliation(s)
- Ayan Kundu
- Department of Pathology, NRS Medical College & Hospital, Kolkata, India
| | - Anway Sen
- Department of Pathology, NRS Medical College & Hospital, Kolkata, India
| | | | | | - Debasish Guha
- Department of Pathology, NRS Medical College & Hospital, Kolkata, India
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Chen SH, Xu LY, Wu YP, Ke ZB, Huang P, Lin F, Li XD, Xue XY, Wei Y, Zheng QS, Xu N. Tumor volume: a new prognostic factor of oncological outcome of localized clear cell renal cell carcinoma. BMC Cancer 2021; 21:79. [PMID: 33468079 PMCID: PMC7816334 DOI: 10.1186/s12885-021-07795-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/05/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Clear cell renal cell carcinoma (ccRCC) is one of the most frequent malignancies; however, the present prognostic factors was deficient. This study aims to explore whether there is a relationship between tumor volume (TV) and oncological outcomes for localized ccRCC. METHODS Seven hundred forty-nine localized ccRCC patients underwent surgery in our hospital. TV was outlined and calculated using a three-dimensional conformal radiotherapy planning system. We used receiver operating characteristic (ROC) curves to identified optimal cut-off value. Univariable and multivariable Cox regression models were performed to explore the association between TV and oncological outcomes. Kaplan-Meier method and log-rank test were used to estimate survival probabilities and determine the significance, respectively. Time-dependent ROC curve was utilized to assess the prognostic effect. RESULTS Log rank test showed that higher Fuhrman grade, advanced pT classification and higher TV were associated with shortened OS, cancer-specific survival (CSS), freedom from metastasis (FFM) and freedom from local recurrence (FFLR). multivariable analysis showed higher Fuhrman grade and higher TV were predictors of adverse OS and CSS. The AUC of TV for FFLR was 0.822. The AUC of TV (0.864) for FFM was higher than that of pT classification (0.818) and Fuhrman grade (0.803). For OS and CSS, the AUC of TV was higher than that of Fuhrman grade (0.832 vs. 0.799; 0.829 vs 0.790). CONCLUSIONS High TV was an independent predictor of poor CSS, OS, FFLR and FFM of localized ccRCC. Compared with pT classification and Fuhrman grade, TV could be a new and better prognostic factor of oncological outcome of localized ccRCC, which might contribute to tailored follow-up or management strategies.
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Affiliation(s)
- Shao-Hao Chen
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Long-Yao Xu
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Yu-Peng Wu
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Zhi-Bin Ke
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Peng Huang
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Fei Lin
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Xiao-Dong Li
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Xue-Yi Xue
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Yong Wei
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Qing-Shui Zheng
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
| | - Ning Xu
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
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Novel Blood Indicators of Progression and Prognosis in Renal Cell Carcinoma: Red Cell Distribution Width-to-Lymphocyte Ratio and Albumin-to-Fibrinogen Ratio. JOURNAL OF ONCOLOGY 2020; 2020:2895150. [PMID: 33299415 PMCID: PMC7710420 DOI: 10.1155/2020/2895150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/18/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
Objective To evaluate the value of preoperative red cell distribution width-to-lymphocyte ratio (RLR) and albumin-to-fibrinogen ratio (AFR) to the prognosis of patients after renal cell carcinoma (RCC). Methods From 2012 to 2016, a total of 273 RCC patients underwent radical nephrectomy or partial nephrectomy. This study retrospectively analyzed this group of patients. X-tile software was used to determine the optimal values of RLR and AFR in the peripheral blood. The nomogram constructed with independent factors was used to predict the survival outcome of the patients after RCC. Results The RLR of the RCC group was higher than that of the normal control group (P=0.002), whereas the AFR of the RCC group was lower than that of the normal control group (P < 0.001). RLR and AFR are related to tumour type and tumour-node-metastasis (TNM) stage (P < 0.05 for all). Cox regression analysis showed that the independent prognostic factors affecting overall survival and disease-free survival in the RCC group were symptom, tumour type, TNM stage, Fuhrman grade, RLR, and AFR (P < 0.05 for all). The nomogram constructed by multiple factors has better predictive power for patients after RCC. Conclusion Preoperative RLR and AFR can serve as potential biomarkers to predict the prognosis of postoperative RCC patients and improve the predictability of patient recurrence and survival.
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Development and validation of an individualized DNA repair-related gene signature in localized clear cell renal cell carcinoma. World J Urol 2020; 39:1203-1210. [PMID: 32458095 DOI: 10.1007/s00345-020-03270-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/17/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND To establish a robust, individualized DNA repair-related gene signature to estimate prognosis for patients with localized clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS We retrospectively analyzed gene expression profiles of 541 localized ccRCC patients from two public ccRCC cohorts. The DNA repair-related gene pair index (DRPI) was constructed with the least absolute shrinkage and selection operator (LASSO) regression model. The associations between DRPI, overall survival (OS), and disease-specific survival (DSS) were evaluated by Kaplan-Meier analysis, univariate analysis, and multivariate Cox regression survival analysis. We compared the predictive accuracy of different risk models with Harrel's C-index. RESULTS In the primary univariate analysis, patients in DRPI-high-risk group had significantly shorter OS [P < 0.001, HR (95% CI) 2.093 (1.431-3.061)] and DSS [P < 0.001, HR (95% CI) 3.567 (2.017-6.339)]. After adjusted for stage and grade, DRPI-high-risk group remained an independent adverse risk factor for both OS [P = 0.026, HR (95% CI) 1.629 (1.094-2.452)] and DSS [P = 0.010, HR (95% CI) 2.209 (1.217-4.010)]. DPRI showed comparable predictive accuracy with cell cycle proliferation (CCP) score and ccA/ccB signature. Copy number alterations and tumor mutation burden were enriched in DRPI-high tumors. There were elevated number of Treg cells and higher T cell exhaustion marker expression in DRPI-high-risk tumors. The combined DNA repair-clinical score outperformed other risk models in terms of C-index. CONCLUSION We validated the proposed DRPI as a predictor of clinical outcome in localized ccRCC patients. It provides an individualized and more accurate risk assessment beyond clinicopathological characteristics.
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Seon DY, Kwak C, Kim HH, Ku JH, Kim HS. Impact of perioperative blood transfusion on oncologic outcomes in patients with nonmetastatic renal cell carcinoma treated with curative nephrectomy: A retrospective analysis of a large, single-institutional cohort. Investig Clin Urol 2020; 61:136-145. [PMID: 32158964 PMCID: PMC7052423 DOI: 10.4111/icu.2020.61.2.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/13/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To evaluate the impact of perioperative blood transfusion (PBT) on oncologic outcomes after surgery in patients with nonmetastatic renal cell carcinoma (RCC). Materials and Methods This retrospective review included 2,329 patients who underwent partial or radical nephrectomy for localized RCC in a single institution from 2000 to 2014. PBT was defined as transfusion of allogeneic packed red blood cells (pRBCs) during nephrectomy or within the preoperative or postoperative hospitalization period. Oncologic outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS). Results PBT was performed in 275 patients (11.8%). In the multivariable logistic regression analysis, symptomatic presentation, advanced age at surgery, higher preoperative serum creatinine, and lower preoperative hemoglobin were independent preoperative risk factors for PBT (all p<0.05). Kaplan–Meier plots revealed that transfused patients showed poorer 5-year RFS (65.1% vs. 91.2%, p<0.001), OS (71.4% vs. 92.8%, p<0.001), and CSS (74.0% vs. 95.5%, p<0.001) than nontransfused patients. However, in the multivariable Cox regression analyses, PBT was not significantly associated with RFS, OS, or CSS. In multivariable analyses involving transfused patients only (n=275), an higher number of pRBC units was an independent predictor of worse OS (hazard ratio [HR], 1.043; 95% confidence interval [CI], 1.008–1.078; p=0.016) and CSS (HR, 1.066; 95% CI, 1.033–1.100; p<0.001). Conclusions The results of this study are inconclusive in that the influence of PBT on survival outcomes could not be determined in the multivariate analysis. However, increasing pRBC units in transfused patients might be a concern in light of worse OS and CSS. Therefore, efforts to limit PBT overuse seem necessary to improve postoperative survival in patients with RCC.
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Affiliation(s)
- Dong Young Seon
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung Suk Kim
- Department of Urology, Dongguk University Ilsan Medical Center, Goyang, Korea
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Pavlović I, Pejić S, Radojević-Škodrić S, Todorović A, Stojiljković V, Gavrilović L, Popović N, Basta-Jovanović G, Džamić Z, Pajović SB. The effect of antioxidant status on overall survival in renal cell carcinoma. Arch Med Sci 2020; 16:94-101. [PMID: 32051711 PMCID: PMC6963148 DOI: 10.5114/aoms.2019.86818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/26/2017] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The oxidative stress contributes to all three phases of carcinogenesis and represents a concomitant condition in renal cell carcinoma (RCC). RCC is the most common type of neoplasm of the kidney, and despite numerous studies the set of predictive and prognostic markers of survival are still unknown. The aim of our study was to examine the relation between antioxidant (AO) status and overall survival (OS) in RCC patients. MATERIAL AND METHODS Our study included 95 patients with RCC, who underwent radical nephrectomy. We analysed the prognostic role of antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase, glutathione S-transferase, glutathione reductase, glutathione, and malondialdehyde) and other clinicopathological factors (size, grade, stage, and histological subtype) on the OS of RCC patients. RESULTS The 5-year OS was 54.6%. The survival analysis related to AO parameters showed no significant difference in survival of RCC patients. The concentration of malondialdehyde, an indicator of lipid peroxidation, also had no significant effect on the survival rate of RCC patients. Univariate and multivariate analysis confirmed the significance of clinicopathological parameters (size, p < 0.001; Fuhrman grade, p = 0.001, and stage, p < 0.001) for patients' survival. CONCLUSIONS In our cohort of patients, different antioxidant parameters were not found to be predictors for OS of patients with RCC, who underwent radical nephrectomy.
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Affiliation(s)
- Ivan Pavlović
- Laboratory of Molecular Biology and Endocrinology, “Vinča” Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - Snežana Pejić
- Laboratory of Molecular Biology and Endocrinology, “Vinča” Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | | | - Ana Todorović
- Laboratory of Molecular Biology and Endocrinology, “Vinča” Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - Vesna Stojiljković
- Laboratory of Molecular Biology and Endocrinology, “Vinča” Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - Ljubica Gavrilović
- Laboratory of Molecular Biology and Endocrinology, “Vinča” Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - Nataša Popović
- Laboratory of Molecular Biology and Endocrinology, “Vinča” Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | | | - Zoran Džamić
- Clinic of Urology, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Snežana B. Pajović
- Laboratory of Molecular Biology and Endocrinology, “Vinča” Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
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Brighi N, Farolfi A, Conteduca V, Gurioli G, Gargiulo S, Gallà V, Schepisi G, Lolli C, Casadei C, De Giorgi U. The Interplay between Inflammation, Anti-Angiogenic Agents, and Immune Checkpoint Inhibitors: Perspectives for Renal Cell Cancer Treatment. Cancers (Basel) 2019; 11:E1935. [PMID: 31817109 PMCID: PMC6966461 DOI: 10.3390/cancers11121935] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/30/2019] [Accepted: 12/01/2019] [Indexed: 12/12/2022] Open
Abstract
Treatment options for metastatic renal cell carcinoma (RCC) have been expanding in the last years, from the consolidation of several anti-angiogenic agents to the approval of immune checkpoint inhibitors (ICIs). The rationale for the use of immunomodulating agents derived from the observation that RCC usually shows a diffuse immune-cell infiltrate. ICIs target Cytotoxic T Lymphocytes Antigen 4 (CTLA-4), programmed death 1 (PD-1), or its ligand (PD-L1), showing promising therapeutic efficacy in RCC. PD-L1 expression is associated with poor prognosis; however, its predictive role remains debated. In fact, ICIs may be a valid option even for PD-L1 negative patients. The establishment of valid predictors of treatment response to available therapeutic options is advocated to identify those patients who could benefit from these agents. Both local and systemic inflammation contribute to tumorigenesis and development of cancer. The interplay of tumor-immune status and of cancer-related systemic inflammation is pivotal for ICI-treatment outcome, but there is an unmet need for a more precise characterization. To date, little is known on the role of inflammation markers on PD-1 blockade in RCC. In this paper, we review the current knowledge on the interplay between inflammation markers, PD-1 axis, and anti-angiogenic agents in RCC, focusing on biological rationale, implications for treatment, and possible future perspectives.
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Affiliation(s)
- Nicole Brighi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Alberto Farolfi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Vincenza Conteduca
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Giorgia Gurioli
- Bioscience Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (G.G.); (S.G.)
| | - Stefania Gargiulo
- Bioscience Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (G.G.); (S.G.)
| | - Valentina Gallà
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Giuseppe Schepisi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Cristian Lolli
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Chiara Casadei
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
| | - Ugo De Giorgi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (N.B.); (V.C.); (G.S.); (C.L.); (C.C.); (U.D.G.)
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Gonnet A, Salabert L, Roubaud G, Catena V, Brouste V, Buy X, Gross Goupil M, Ravaud A, Palussière J. Renal cell carcinoma lung metastases treated by radiofrequency ablation integrated with systemic treatments: over 10 years of experience. BMC Cancer 2019; 19:1182. [PMID: 31795959 PMCID: PMC6892199 DOI: 10.1186/s12885-019-6345-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 11/07/2019] [Indexed: 12/12/2022] Open
Abstract
Background To determine safety and efficacy of radiofrequency ablation (RFA) for local treatment of lung metastases of renal cell carcinoma (RCC), sequenced or combined with systemic treatments. Methods Retrospectively, we studied 53 patients treated by RFA for a maximum of six lung metastases of RCC. The endpoints were local efficacy, overall (OS), disease-free (DFS), pulmonary progression-free (PPFS) and systemic treatment-free (STFS) survivals, complications graded by the CTCAE classification and factors associated with survivals. Potential factors analysed were: clinical and pathological data, tumoral staging of TNM classification, primary tumor histology, Fuhrman’s grade, age, number and size of lung metastases and extra-pulmonary metastases pre-RFA. Results One hundred metastases were treated by RFA. Median follow-up time was 61 months (interquartile range 90–34). Five-year OS was 62% (95% confidence interval (CI): 44–75). Median DFS was 9.9 months (95% CI: 6–16). PPFS at 1 and 3 years was 58.9% (95%CI: 44.1–70.9) and 35.2% (95%CI: 21.6–49.1), respectively. We observed 3% major complications (grade 3 and 4 of CTCAE classification). Local efficacy was 91%. Median STFS was 28.3 months. Thirteen patients (25%) with lung recurrence could be treated by another RFA. T3/T4 tumors had significantly worse OS, PPFS and STFS. Having two or more lung metastases increased the risk of pulmonary progression more than threefold. Conclusion Integrated to systemic treatment strategy, RFA is safe and effective for the treatment strategy of lung metastasis from RCC with good OS and long systemic treatment-free survival. RFA offers the possibility of repeat procedures, with low morbidity.
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Affiliation(s)
- Alexis Gonnet
- Department of Radiology, Institut Bergonié, 229 cours de l'Argonne, 33000, Bordeaux, France.,Department of Radiology CH Pau, 4 Boulevard Hauterive, 64000, Pau, France
| | - Laura Salabert
- Department of Medical Oncology, Hospital Saint-Andre, Univ. Bordeaux, 33000, Bordeaux, France.,Department of Medical Oncology, Institut Bergonié, 33000, Bordeaux, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, 33000, Bordeaux, France
| | - Vittorio Catena
- Department of Radiology, Institut Bergonié, 229 cours de l'Argonne, 33000, Bordeaux, France
| | - Véronique Brouste
- Department of Statistics, Institut Bergonié, 33000, Bordeaux, France
| | - Xavier Buy
- Department of Radiology, Institut Bergonié, 229 cours de l'Argonne, 33000, Bordeaux, France
| | - Marine Gross Goupil
- Department of Medical Oncology, Hospital Saint-Andre, Univ. Bordeaux, 33000, Bordeaux, France
| | - Alain Ravaud
- Department of Medical Oncology, Hospital Saint-Andre, Univ. Bordeaux, 33000, Bordeaux, France
| | - Jean Palussière
- Department of Radiology, Institut Bergonié, 229 cours de l'Argonne, 33000, Bordeaux, France.
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Mohammad Ahmad MI, Sabr M, Roshy E. Assessment of apparent diffusion coefficient value as prognostic factor for renal cell carcinoma aggressiveness. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Assurance of prognostic elements is important for the management of renal cell carcinoma (RCC). Our goal was to check the relation between apparent diffusion coefficient (ADC) values and parameters predicting prognosis of RCC. Fifty pathologically confirmed RCC underwent diffusion-weighted (DW) MRI. ADC values were calculated using b factor (800 s/mm2). The correlation between ADC values and tumor size, cystic/necrotic feature, growth pattern, unenhanced T1, histological grade, clinical stage, and distant metastasis were analyzed.
Results
The optimal ADC threshold for prognosis of RCC appeared to be 1.4 × 10−3 mm2/s. There was a significant inverse correlation between ADC values and growth pattern (R = − 0, P = 0.05), unenhanced T1(R = − 0.41, P = 0.01), cystic/necrotic feature (R = − 0.4, P = 0.01), histological grade (R = − 0.37, P = 0.02), clinical stage (r = − 0.4, P = 0.01), and distant metastasis (R = − 0.33, P = 0.04), and significant linear correlation with tumor size (R = 0.39, P < 0.02).
Conclusion
The performance of ADC value as a newly proposed prognostic parameter follows with the degree of tumor differentiation and that may recognize extremely aggressive RCC. RCC with low ADC values should be inspected extensively for the risk of high pathological grade, high clinical stage, and distant metastasis.
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Xiong Y, Liu L, Bai Q, Xia Y, Qu Y, Wang J, Guo J. Individualized immune-related gene signature predicts immune status and oncologic outcomes in clear cell renal cell carcinoma patients. Urol Oncol 2019; 38:7.e1-7.e8. [PMID: 31653560 DOI: 10.1016/j.urolonc.2019.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/01/2019] [Accepted: 09/22/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To develop an individualized immune-related gene signature that predicts oncologic outcomes and immune status of clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS The immune-related gene pair (IGP) index was constructed and validated based on pairwise comparison in 634 ccRCC patients. Association with overall survival (OS), progression-free interval (PFI), and disease-specific survival (DSS) was evaluated by Kaplan-Meier analysis, univariate and multivariate cox regression survival analysis. Prognostic values of different risk models were compared using Harrell's C-index. RESULTS The IGP index of 17 gene pairs was an adverse independent risk factor in multivariate analyses for OS (hazard ratio [HR], 1.718; P = 0.001), PFI (HR, 1.550; P = 0.006), and DSS (HR, 2.201; P = 0.001) in ccRCC patients. It showed comparable prognostic accuracy with ccA/ccB signature (C-index for OS, 0.657 vs. 0.640; P = 0.686) and better intratumor homogeneity. Immunosuppressive immune cell, markers, and pathways were all enriched in high immune-risk tumors. The integrated immune-clinical prognostic score outperformed ccA/ccB signature and University of California Integrated Staging System risk model in terms of C-index for estimation of OS, PFI, and DSS (P < 0.001). CONCLUSIONS The proposed IGP index is a robust and promising biomarker for estimating oncologic outcomes in ccRCC. High immune-risk tumors are immunosuppressive.
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Affiliation(s)
- Ying Xiong
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Li Liu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Bai
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu Xia
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Qu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiajun Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
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Role of MR texture analysis in histological subtyping and grading of renal cell carcinoma: a preliminary study. Abdom Radiol (NY) 2019; 44:3336-3349. [PMID: 31300850 DOI: 10.1007/s00261-019-02122-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The study evaluated the usefulness of magnetic resonance imaging (MRI) texture parameters in differentiating clear cell renal carcinoma (CC-RCC) from non-clear cell carcinoma (NC-RCC) and in the histological grading of CC-RCC. MATERIALS AND METHODS After institutional ethical approval, this retrospective study analyzed 33 patients with 34 RCC masses (29 CC-RCC and five NC-RCC; 19 low-grade and 10 high-grade CC-RCC), who underwent MRI between January 2011 and December 2012 on a 1.5-T scanner (Avanto, Siemens, Erlangen, Germany). The MRI protocol included T2-weighted imaging (T2WI), diffusion-weighted imaging [DWI; at b 0, 500 and 1000 s/mm2 with apparent diffusion coefficient (ADC) maps] and T1-weighted pre and postcontrast [corticomedullary (CM) and nephrographic (NG) phase] acquisition. MR texture analysis (MRTA) was performed using the TexRAD research software (Feedback Medical Ltd., Cambridge, UK) by a single reader who placed free-hand polygonal region of interest (ROI) on the slice showing the maximum viable tumor. Filtration histogram-based texture analysis was used to generate six first-order statistical parameters [mean intensity, standard deviation (SD), mean of positive pixels (MPP), entropy, skewness and kurtosis] at five spatial scaling factors (SSF) as well as on the unfiltered image. Mann-Whitney test was used to compare the texture parameters of CC-RCC versus NC-RCC, and high-grade versus low-grade CC-RCC. P value < 0.05 was considered significant. A 3-step feature selection was used to obtain the best texture metrics for each MRI sequence and included the receiver-operating characteristic (ROC) curve analysis and Pearson's correlation test. RESULTS The best performing texture parameters in differentiating CC-RCC from NC-RCC for each sequence included (area under the curve in parentheses): entropy at SSF 4 (0.807) on T2WI, SD at SSF 4 (0.814) on DWI b500, SD at SSF 6 (0.879) on DWI b1000, mean at SSF 0 (0.848) on ADC, skewness at SSF 2 (0.854) on T1WI and skewness at SSF 3 (0.908) on CM phase. In differentiating high from low-grade CC-RCC, the best parameters were: entropy at SSF 6 (0.823) on DWI b1000, mean at SSF 3 (0.889) on CM phase and MPP at SSF 5 (0.870) on NG phase. CONCLUSION Several MR texture parameters showed excellent diagnostic performance (AUC > 0.8) in differentiating CC-RCC from NC-RCC, and high-grade from low-grade CC-RCC. MRTA could serve as a useful non-invasive tool for this purpose.
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Patel A, Cohen S, Moret R, Maresh G, Gobe GC, Li L. Patient-derived xenograft models to optimize kidney cancer therapies. Transl Androl Urol 2019; 8:S156-S165. [PMID: 31236333 DOI: 10.21037/tau.2018.11.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Renal cell carcinoma (RCC) is the most common solid neoplasm of the adult kidney and has a high potential for developing metastatic spread. Approximately 25-30% of RCC patients have metastatic disease at presentation, and 30-40% of patients develop metastases after the initial diagnosis. Advanced renal cancer is a deadly and difficult-to-treat cancer. The 5-year survival rate of patients with metastatic disease is less than 10%, partly because RCC metastases become resistant to current therapies. Pre-clinical models may help to identify the optimum therapeutic options for individual patients. Here we reviewed various mouse xenograft methods for RCC treatment screening especially patient-derived orthotopic xenograft models. Advantages and disadvantaged of some of the models are also discussed.
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Affiliation(s)
- Avi Patel
- UQ-Ochsner Clinical School, Institute for Translational Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Sarah Cohen
- UQ-Ochsner Clinical School, Institute for Translational Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Ravan Moret
- UQ-Ochsner Clinical School, Institute for Translational Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Grace Maresh
- UQ-Ochsner Clinical School, Institute for Translational Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Glenda C Gobe
- UQ NHMRC CKD.QLD CRE, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,University of Queensland Princess Alexandra Hospital Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
| | - Li Li
- UQ-Ochsner Clinical School, Institute for Translational Research, Ochsner Clinic Foundation, New Orleans, LA, USA
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Yun EJ, Lin CJ, Dang A, Hernandez E, Guo J, Chen WM, Allison J, Kim N, Kapur P, Brugarolas J, Wu K, He D, Lai CH, Lin H, Saha D, Baek ST, Chen BPC, Hsieh JT. Downregulation of Human DAB2IP Gene Expression in Renal Cell Carcinoma Results in Resistance to Ionizing Radiation. Clin Cancer Res 2019; 25:4542-4551. [PMID: 31000589 DOI: 10.1158/1078-0432.ccr-18-3004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/21/2019] [Accepted: 04/15/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Renal cell carcinoma (RCC) is known to be highly radioresistant but the mechanisms associated with radioresistance have remained elusive. We found DOC-2/DAB2 interactive protein (DAB2IP) frequently downregulated in RCC, is associated with radioresistance. In this study, we investigated the underlying mechanism regulating radioresistance by DAB2IP and developed appropriate treatment. EXPERIMENTAL DESIGN Several RCC lines with or without DAB2IP expression were irradiated with ionizing radiation (IR) for determining their radiosensitivities based on colony formation assay. To investigate the underlying regulatory mechanism of DAB2IP, immunoprecipitation-mass spectrometry was performed to identify DAB2IP-interactive proteins. PARP-1 expression and enzymatic activity were determined using qRT-PCR, Western blot analysis, and ELISA. In vivo ubiquitination assay was used to test PARP-1 degradation. Furthermore, in vivo mice xenograft model and patient-derived xenograft (PDX) model were used to determine the effect of combination therapy to sensitizing tumors to IR. RESULTS We notice that DAB2IP-deficient RCC cells acquire IR-resistance. Mechanistically, DAB2IP can form a complex with PARP-1 and E3 ligases that is responsible for degrading PARP-1. Indeed, elevated PARP-1 levels are associated with the IR resistance in RCC cells. Furthermore, PARP-1 inhibitor can enhance the IR response of either RCC xenograft model or PDX model. CONCLUSIONS In this study, we unveil that loss of DAB2IP resulted in elevated PARP-1 protein is associated with IR-resistance in RCC. These results provide a new targeting strategy to improve the efficacy of radiotherapy of RCC.
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Affiliation(s)
- Eun-Jin Yun
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
- Division of Integrative Bioscience and Biotechnology, POSTECH, Pohang, Republic of Korea
| | - Chun-Jung Lin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew Dang
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth Hernandez
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jiaming Guo
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wei-Min Chen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joyce Allison
- Department of Internal Medicine and Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nathan Kim
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Payal Kapur
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James Brugarolas
- Department of Internal Medicine and Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kaijie Wu
- Department of Urology, The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, China
| | - Dalin He
- Department of Urology, The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, China
| | - Chih-Ho Lai
- Department of Microbiology and Immunology, Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ho Lin
- Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Debabrata Saha
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Seung Tae Baek
- Division of Integrative Bioscience and Biotechnology, POSTECH, Pohang, Republic of Korea
| | - Benjamin P C Chen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jer-Tsong Hsieh
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
- Graduate Institute of Cancer Biology, China Medical University Hospital, Taichung, Taiwan, Republic of China
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Impact of routine imaging in the diagnosis of recurrence for patients with localized and locally advanced renal tumor treated with nephrectomy. World J Urol 2019; 37:2727-2736. [PMID: 30895362 DOI: 10.1007/s00345-019-02724-8] [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: 10/30/2018] [Accepted: 03/07/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Modalities of surveillance to detect recurrence after nephrectomy for localized or locally advanced renal tumor are not standardized. The aim was to assess the impact of surveillance scheme on oncological outcomes. METHODS Patients treated for localized or locally advanced renal tumor with total or partial nephrectomy between 2006 and 2010 in an academic institution were included retrospectively. According to the University of California Los Angeles Integrated Staging System (UISS) protocol, follow-up was considered adequate or not. Symptoms, location and number of lesions at recurrence diagnosis were collected. Recurrence-free, cancer-specific and overall survivals were estimated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards regression models were calculated to identify prognostic factors. RESULTS A total of 267 patients were included. Median follow-up was 72 months. Recurrence rate was 23.2% (62/267 patients). Recurrences were local (16%), single metastatic (23%), oligo-metastatic (15%) or multi-metastatic (46%). 72.6% of the recurrences occurred within the 3 years after surgery. No recurrence was diagnosed by chest X-ray or abdominal ultrasound. One hundred and twenty-one patients had inadequate follow-up. They had similar recurrence-free survival, cancer-specific survival and overall survival as patients with adequate follow-up. In multivariable analysis, the presence of multi-metastatic lesions was an independent prognostic factor of worse cancer-specific mortality after recurrence diagnosis (HR = 10.15, 95% CI: 2.29-44.82, p = 0.002). CONCLUSION Role of chest X-ray and abdominal ultrasound for the detection of recurrences is limited. Rigorous follow-up according to the UISS protocol does not improve oncological outcomes. Follow-up schedules with less frequent imaging should be discussed.
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Lv Q, Wang G, Zhang Y, Han X, Li H, Le W, Zhang M, Ma C, Wang P, Ding Q. FABP5 regulates the proliferation of clear cell renal cell carcinoma cells via the PI3K/AKT signaling pathway. Int J Oncol 2019; 54:1221-1232. [PMID: 30968158 PMCID: PMC6411348 DOI: 10.3892/ijo.2019.4721] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/30/2019] [Indexed: 01/15/2023] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) has been associated with one of the highest mortality rates among all cancers. Fatty acid binding proteins (FABPs) are 14‑15 kDa proteins that are highly abundant in the cytosol of most tissues. FABP5, a member of the FABP family, has been observed to promote tumor cell growth in numerous cancer types. In order to investigate the function of FABP5 in ccRCC cells in the present study, RNA sequencing data from The Cancer Genome Atlas were analyzed to determine the expression levels of FABP5 in ccRCC patient samples. Survival and Cox regression analyses were performed to measure the association between FABP5 expression and clinicopathological features of patients with ccRCC. Subsequent in vitro experiments downregulated or overexpressed FABP5 in Caki‑1 and 786O ccRCC cells using lentiviral vectors to evaluate cell proliferation ability, and a xenograft transplantation model was established to examine the effect of FABP5 on tumorigenesis in vivo. The results demonstrated that FABP5 expression was significantly upregulated in samples from patients with ccRCC when compared with normal tissue samples. High FABP5 expression was also significantly correlated with tumor and metastasis classifications and predicted poor survival in patients with ccRCC. In ccRCC cells, silencing of FABP5 significantly inhibited cell proliferation, while overexpression of FABP5 promoted cell proliferation when compared to the respective controls. In addition, treatment with the phosphatidylinositol‑4,5‑bisphosphate 3‑kinase (PI3K)/AKT inhibitor, LY294002, attenuated the pro‑proliferative effects of exogenous FABP5 expression in Caki‑1 and 786O cells. This indicated that the PI3K/AKT signaling pathway may be partially involved in the FABP5‑mediated increase in ccRCC cell proliferation. Furthermore, FABP5 was observed to regulate tumor growth in nude mice in vivo. In conclusion, the results of the present study suggest that FABP5 may exert a pro‑proliferative role in ccRCC and may be associated with malignant progression and tumorigenesis.
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Affiliation(s)
- Qi Lv
- Imaging Department of Tongji Hospital, Medical School of Tongji University, Shanghai 200065, P.R. China
| | - Gangmin Wang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Yinan Zhang
- Department of Urology, Shandong Province affiliated Hospital, Shandong University, Jinan, Shandong 250021, P.R. China
| | - Xiao Han
- Department of Human Anatomy, Medical School of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Haoming Li
- Department of Human Anatomy, Medical School of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Wei Le
- Imaging Department of Tongji Hospital, Medical School of Tongji University, Shanghai 200065, P.R. China
| | - Minguang Zhang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Chunhui Ma
- Department of Orthopedic Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, P.R. China
| | - Peijun Wang
- Imaging Department of Tongji Hospital, Medical School of Tongji University, Shanghai 200065, P.R. China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
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Chen Z, Wang K, Lu H, Xue D, Fan M, Zhuang Q, Yin S, He X, Xu R. Systemic inflammation response index predicts prognosis in patients with clear cell renal cell carcinoma: a propensity score-matched analysis. Cancer Manag Res 2019; 11:909-919. [PMID: 30697081 PMCID: PMC6342149 DOI: 10.2147/cmar.s186976] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose In the present study, we aimed to evaluate the prognostic significance of the systemic inflammation response index (SIRI), which was defined based on peripheral blood counts of neutrophils, lymphocytes, and monocytes, in patients with localized or locally advanced clear cell renal cell carcinoma (CCRCC). Patients and methods The prognostic value of SIRI was evaluated in a primary cohort consisting of 414 patients with localized or locally advanced CCRCC and then further validated in an independent cohort composed of 168 patients. Results Kaplan-Meier survival analyses of both cohorts revealed that CCRCC patients with high SIRI levels exhibited poorer overall survival (OS) and cancer-specific survival (CSS) compared with those with low SIRI levels. Furthermore, univariate and multivariate analyses identified SIRI as a significant independent predictor for both OS (HR: 4.853; 95% CI: 2.362-9.972; P<0.001) and CSS (HR: 5.913; 95% CI: 2.681-13.040; P<0.001). Following propensity score matching analysis, SIRI remained an excellent predictor for both OS and CSS. The area under the curve for SIRI was larger than that of the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and Memorial Sloan Kettering Cancer Center (MSKCC) prognostic score in both cohorts. Conclusion SIRI might be a better prognostic predictor than PLR, NLR, MLR, and MSKCC score in patients with localized or locally advanced CCRCC. Institutional review board approval number (2010) Scientific Research Project No. 39.
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Affiliation(s)
- Zhen Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, People's Republic of China, ;
| | - Kai Wang
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, People's Republic of China, ;
| | - Hao Lu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, People's Republic of China, ;
| | - Dong Xue
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, People's Republic of China, ;
| | - Min Fan
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, People's Republic of China, ;
| | - Qianfeng Zhuang
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, People's Republic of China, ;
| | - Shuai Yin
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, People's Republic of China, ;
| | - Xiaozhou He
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, People's Republic of China, ;
| | - Renfang Xu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, People's Republic of China, ;
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He D, Yu Z, Liu S, Dai H, Xu Q, Li F. Methylenetetrahydrofolate Dehydrogenase 1 (MTHFD1) is Underexpressed in Clear Cell Renal Cell Carcinoma Tissue and Transfection and Overexpression in Caki-1 Cells Inhibits Cell Proliferation and Increases Apoptosis. Med Sci Monit 2018; 24:8391-8400. [PMID: 30459299 PMCID: PMC6259576 DOI: 10.12659/msm.911124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background The aims of this study were to investigate the expression of methylenetetrahydrofolate dehydrogenase 1 (MTHFD1) in human tissue containing clear cell renal cell carcinoma (CCRCC) compared with normal renal tissue, and the effects of upregulating the expression of MTHFD1 in the human CCRCC cell line, Caki-1. Material/Methods Tumor and adjacent normal renal tissue were obtained from 44 patients who underwent radical nephrectomy for CCRCC. Caki-1 human CCRCC cells were divided into the control group, the empty vector (EV) group, and the plasmid-treated group that overexpressed MTHFD1. MTHFD1 mRNA and protein levels were measured by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot, respectively. The cell counting kit-8 (CCK-8) assay measured cell viability. Flow cytometry evaluated apoptosis and the cell cycle. Western blot measured the protein levels of MTHFD1, Bax, Bcl-2, Akt, p53, and cyclin D1, and qRT-PCR determined the gene expression profiles. Results MTHFD1 mRNA and protein levels in CCRCC tumor tissues were significantly lower compared with adjacent normal renal tissue. MTHFD1 over-expression in Caki-1 cells inhibited cell proliferation, arrested cells in the G1 phase, increased cell apoptosis, and upregulated gene and protein expression of Bax/Bcl-2 and p53, and inhibited p-Akt, and cyclin D1. Conclusions MTHFD1 was underexpressed in CCRCC tissue when compared with normal renal tissue. MTHFD1 transfection of human CCRCC Caki-1 cells in vitro inhibited cell proliferation and promoted apoptosis, associated with reduced expression of cyclin D1, reduced Akt phosphorylation, and increased expression of Bax/Bcl-2 and p53.
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Affiliation(s)
- Donglin He
- Department of Urology, Chongqing Three Gorges Central Hospital, Chongqing, China (mainland)
| | - Zhihai Yu
- Department of Urology, Chongqing Three Gorges Central Hospital, Chongqing, China (mainland)
| | - Sheng Liu
- Department of Urology, Chongqing Three Gorges Central Hospital, Chongqing, China (mainland)
| | - Hong Dai
- Department of Urology, Chongqing Three Gorges Central Hospital, Chongqing, China (mainland)
| | - Qing Xu
- Department of Urology, Chongqing Three Gorges Central Hospital, Chongqing, China (mainland)
| | - Feng Li
- Department of Urology, Chongqing Three Gorges Central Hospital, Chongqing, China (mainland)
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Cheng Q, Qu D, Lu Z, Zhang L. Knockdown of CHCHD2 inhibits migration and angiogenesis of human renal cell carcinoma: A potential molecular marker for treatment of RCC. Oncol Lett 2018; 17:765-772. [PMID: 30655828 PMCID: PMC6313053 DOI: 10.3892/ol.2018.9686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/05/2018] [Indexed: 01/12/2023] Open
Abstract
Coiled-coil-helix-coiled-coil-helix domain-containing protein 2 (CHCHD2), a novel cell migration determinant, is able to co-express with other genes of the oxidative phosphorylation pathway by using a computational expression screening technique. However, little is known about the expression and biological function of CHCHD2 in human renal cell carcinoma (RCC). Western blotting was performed to detect CHCHD2 expression levels in normal renal cells and carcinoma cells. Immunohistochemistry was performed to detect an association between CHCHD2 expression and clinicopathological parameters in 75 RCC tissues using a tissue microarray. The function of CHCHD2 in the migration and angiogenesis of RCC cells was investigated using Transwell migration and tube formation assays. CHCHD2 expression was markedly increased in human RCC cells. The results of immunohistochemical analysis revealed that CHCHD2 expression was markedly associated with tumor grade (P<0.001). Notably, CHCHD2 knockdown inhibited RCC migration and tube formation of human umbilical vascular endothelial cells. CHCHD2 knockdown further suppressed matrix metalloproteinase-2 protein levels and enzyme activity. An ELISA identified that CHCHD2 knockdown decreased the secretion of vascular endothelial growth factor. The gathered data disclose information on the association of CHCHD2 with migration and angiogenesis of human RCC, and may strengthen the feasibility of targeting CHCHD2 as a potential therapeutic target.
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Affiliation(s)
- Qian Cheng
- Cancer Institute, Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Debao Qu
- Cancer Institute, Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China.,Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Zheng Lu
- Cancer Institute, Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Longzhen Zhang
- Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China.,Jiangsu Center for The Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
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