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Åkerla J, Helminen O, Väyrynen JP, Parkkinen A, Järvenpää H, Böhm J, Ahtiainen M, Seikkula H. CD3+ and CD8+ T cell-based immune cell score as a prognostic factor in clear-cell renal cell carcinoma. Acta Oncol 2024; 63:105-110. [PMID: 38578213 DOI: 10.2340/1651-226x.2024.19690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/06/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND PURPOSE Immunoscore® is a prognostic parameter based on densities of lymphocyte populations in the tumor center and invasive margin. Immunoscore® is validated in colorectal cancer as a high Immunoscore® is associated with longer survival. Previous studies have suggested that Immunoscore® may also predict oncological outcomes in clear-cell renal cell carcinoma (ccRCC). This study aims to assess the prognostic role of immune cell score in ccRCC. MATERIAL AND METHODS All patients with ccRCC undergoing surgery between 2007 and 2020 in Central Finland Central Hospital were retrospectively identified. CD3+ and CD8+ cell densities were calculated from tissue samples to determine the immune cell score using Immunoscore® principles. Receiver-operating characteristic analysis, Kaplan-Meier survival curve, and Cox regression were used to evaluate the association between immune cell score and survival. RESULTS A total of 203 patients (mean age 66.5 years) were identified. The median follow-up time was 6.2 years. Based on the immune cell score, the patients were divided into three groups: low, intermediate, and high. In Cox regression analysis, adjusted with age, sex, and Charlson Comorbidity Index, no significant differences in disease-specific mortality were observed among the three groups. The hazard ratios (HRs) for disease-specific mortality were 0.93 (95% confidence interval [CI] 0.48-1.79) and 1.12 (0.52-2.37) for intermediate- and high-immune cell score groups when compared to low-immune cell score group, respectively. INTERPRETATION This study found no association between immune cell score and survival. These results indicate that immune cell score may not serve as a prognostic tool in ccRCC.
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Affiliation(s)
- Jonne Åkerla
- Department of Urology, Tampere University Hospital, Tampere, Finland.
| | - Olli Helminen
- Cancer and Translational Medicine Research Unit, Medical Research Centre, University of Oulu and Oulu University Hospital, Oulu, Finland; Department of Gastrointestinal Surgery, Oulu University Hospital, Oulu, Finland
| | - Juha P Väyrynen
- Cancer and Translational Medicine Research Unit, Medical Research Centre, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Anne Parkkinen
- Department of Surgery, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Hilma Järvenpää
- Department of Surgery, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Jan Böhm
- Department of Pathology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Maarit Ahtiainen
- Department of Pathology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Heikki Seikkula
- Department of Surgery, Hospital Nova of Central Finland, Jyväskylä, Finland
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Naik P, Dudipala H, Chen YW, Rose B, Bagrodia A, McKay RR. The incidence, pathogenesis, and management of non-clear cell renal cell carcinoma. Ther Adv Urol 2024; 16:17562872241232578. [PMID: 38434237 PMCID: PMC10906063 DOI: 10.1177/17562872241232578] [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: 10/29/2023] [Accepted: 01/18/2024] [Indexed: 03/05/2024] Open
Abstract
Renal cell carcinoma (RCC) is the most common type of kidney cancer and is divided into two distinct subtypes, clear cell renal cell carcinoma (ccRCC) and non-clear cell renal cell carcinoma (nccRCC). Although many treatments exist for RCC, these are largely based on clinical trials performed in ccRCC and there are limited studies on the management of nccRCC. Non-clear cell RCC consists of multiple histological subtypes: papillary, chromophobe, translocation, medullary, collecting duct, unclassified, and other rare histologies. Due to variations in pathogenesis and therapeutic response, therapy should be tailored to specific variant histologies. For patients with localized nccRCC, surgical resection remains the gold standard. In the metastatic setting, the standard of care has yet to be clearly defined, and most guidelines recommend clinical trial participation. General therapeutic options include immunotherapy, either as monotherapy or in combination, targeted therapies such as vascular endothelial growth factor tyrosine kinase inhibitors and MET inhibitors, and chemotherapy in certain subtypes. Here we present a review of the incidence and pathogenesis of the various subtypes, as well as available clinical data to support therapeutic recommendations for these subtypes. We also highlight currently available clinical trials in nccRCC and future directions in investigating novel treatment modalities tailored to patients with variant histology.
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Affiliation(s)
- Priyanka Naik
- Undergraduate Studies, University of California, San Diego, La Jolla, CA, USA
| | - Harshitha Dudipala
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Yu-Wei Chen
- Department of Hematology and Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Brent Rose
- Department of Radiation Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Aditya Bagrodia
- Department of Urology, University of California, San Diego, La Jolla, CA, USA
| | - Rana R. McKay
- Department of Hematology and Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
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Qian X, Wan J, Qian C, Zhang J. Clinicopathological Features and Prognostic Outcomes of Papillary Renal Cell Carcinoma. Int J Gen Med 2021; 14:7523-7531. [PMID: 34754225 PMCID: PMC8572091 DOI: 10.2147/ijgm.s340569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Although papillary renal cell carcinoma (pRCC) is the second common renal malignant tumor, the current understanding of pRCC is poor. This study aims to explore the clinicopathological features and prognostic factors of pRCC. Methods From August 2007 and August 2017, 87 patients diagnosed with pRCC by postoperative pathology were enrolled. The clinicopathological features between type1 pRCC and type2 pRCC were compared by Chi-square test, Fisher’s exact test, or t-test. The Kaplan–Meier method was performed to estimate progression-free survival (PFS). Univariate and multivariate cox regression models were used to verify the prognostic factors. Results Of the 87 cases, the median tumor diameter was 5.3cm. Twenty-nine patients were diagnosed with type1 pRCC and 58 patients with type2 pRCC. According pathological stage, 59 (67.8%) cases were in pT1 stage, 19 (21.8%) in pT2 stage, and 9 (10.4%) in pT3 stage. WHO/ISUP pathological grade revealed that 56 (64.4%) patients were in grade I, 17 (19.5%) in grade II, 7 (8.05%) in grade III, and 7 (8.05%) in grade IV. The median follow-up time was 57.0months, and the 1-, 3-year PFS was 95.4%, and 80.8%, respectively. For type1 and type2 pRCC, 3-years PFS was 93.0% and 74.9%, respectively. Survival of type1 pRCC was better than that of type2 (P= 0.027). Patients with late pT stage, lymph node metastasis, distant metastasis, high pathological grade, and large size exhibited worse survival. pTNM stage, pathological grade, and tumor types were potentially related to prognosis for PFS. However, an independent prognostic factor affecting PFS was not found in multivariate regression models. For patients with the pT1 stage, nephron-sparing surgery (NSS) and radical nephrectomy (RN) did not affect the PFS, ignoring tumor types (P=0.45). Conclusion Type2 pRCC is more than type1 pRCC and has an advanced TNM stage and a higher pathological grade. For patients with pRCC with the pT1 stage, the outcome of NSS is not inferior to that of RN.
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Affiliation(s)
- Xiaoyuan Qian
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Junlai Wan
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Can Qian
- Department of Traditional Chinese Medicine and Rheumatology, Southwest Hospital, Army Military Medical University, Chongqing, People's Republic of China
| | - Jiaqiao Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Xi W, Tan Q, Hou Y, Hu X, Wang H, Liu L, Xia Y, Bai Q, Wang J, Zhou J, Guo J. No Detection of Pseudocapsule of Tumor-Parenchyma Interface on Multidetector Computed Tomography (MDCT) Images: Clinical Significance and Histological Reflections in Renal Cell Carcinoma. Cancer Manag Res 2021; 13:5403-5411. [PMID: 34262348 PMCID: PMC8275039 DOI: 10.2147/cmar.s315379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022] Open
Abstract
Objective Pseudocapsule (PS) of tumor-parenchyma interface (TPI) can be detected by MDCT (ctPS) in renal cell carcinoma (RCC) with exceptions. We aim to study the prognostic implications and histological reflections of no detection of ctPS in RCC. Patients and Methods A total of 210 RCC patients who had MDCT examination and received nephrectomy in our institution were included in the analysis. Absence or presence of ctPS was recognized, and its associations with overall survival (OS) and progression-free survival (PFS), pathological PS (pPS) and vasculature were studied. Results A total of 172 (81.9%) patients were recognized to have a ctPS and 38 (18.1%) had no detection of it. They had comparable histology, stage, grade, and necrosis. Patients without a ctPS had significantly shortened overall survival (OS, p = 0.001) and progression-free survival (PFS, p <0.001), the significance of which persisted in multivariable analysis (OS, HR 3.104, p = 0.003; PFS, HR 3.313, p = 0.001). Nearly all tumors (34/38, 89.4%) without a ctPS actually had a pPS being detected and incompleteness of pPS was also irrelevant (p = 0.739). Compared with ctPS presence, those without a ctPS had significantly thinned pPS (0.36 vs 0.43 mm, p = 0.005). In clear-cell histology, those without a ctPS also contained increased vascular density and cross-sectional area of vessels with long diameter ≥200 um in the pPS layer (p = 0.005 and 0.011) and increased vascular density in the 500 um layer outside pPS (p = 0.017). Conclusion Absence of ctPS on MDCT significantly increases the risk of adverse clinical outcome in RCC. It is the reflection of a thinner pPS and enriched vasculature of TPI rather than absence of pPS itself.
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Affiliation(s)
- Wei Xi
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Qinxuan Tan
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Xiaoyi Hu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Hang Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Li Liu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yu Xia
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Qi Bai
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jiajun Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jianming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
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Selvi I. Comment on "Prognostic value of immunological profile based on CD8+ and FoxP3+ T lymphocytes in the peritumoral and intratumoral subsites for renal cell carcinoma". Int Urol Nephrol 2021; 53:1361-1362. [PMID: 33710532 DOI: 10.1007/s11255-021-02833-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/06/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Ismail Selvi
- Department of Urology, Başakşehir Çam and Sakura City Hospital, 34480, Istanbul, Turkey.
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