Prognostic and Predictive Factors for Renal Cell Carcinoma

Metastatic sites and clinical outcomes in renal cell carcinoma patients receiving immune-based combinations: the MOUSEION-08 study

Immune-based combinations have significantly improved the treatment of metastatic renal cell carcinoma (mRCC); however, immunotherapy has reported varying degrees of efficacy across different metastatic sites, with liver and bone metastases traditionally considered more challenging to treat. In MOUSEION-08 study, we aimed to investigate the association between lung, liver, and bone metastases and clinical outcomes such as Overall Survival (OS) and Progression- Free Survival (PFS) in mRCC patients receiving immune-based combinations. The present systematic review and study-level meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). PFS and OS were measured as Hazard Ratios (HRs) and 95% confidence intervals (CIs). The protocol was registered with PROSPERO, Registration number: CRD42024581488. Our search resulted in the identification of 2364 potentially relevant reports, which were subsequently restricted to three. The pooled HRs for OS and PFS in patients with lung metastases receiving immune-based combinations versus sunitinib were 0.61 (95% CI, 0.51-0.72) and 0.47 (95% CI, 0.38-0.59), respectively. In patients with liver metastases, the pooled HRs for OS and PFS were 0.56 (95% CI, 0.42-0.75) and 0.48 (95% CI, 0.34-0.67), while the pooled HRs for OS and PFS in patients with bone metastases were 0.64 (95% CI, 0.49-0.84) and 0.36 (95% CI, 0.27-0.49), respectively. According to our findings, the analyses reported similar HRs for OS and PFS, something that further underlines the role of immune-based combinations in this setting, regardless of metastatic sites, such as lung, liver, and bone metastases. Ongoing research and clinical trials are destined to refine and improve immunotherapeutic strategies for mRCC, aiming to enhance efficacy across all metastatic sites and to define predictive biomarkers.

The prognostic role of perirenal fat tissue in non-metastatic renal cell carcinoma

PURPOSE

The aim of this study was to evaluate the impact of perirenal fat volume and perirenal fat density on prognosis in surgically treated non-metastatic renal cell carcinomas (RCC).

METHODS AND MATERIALS

All consecutive patients who underwent partial or total nephrectomy surgery between March 2019 and December 2021 were assessed. Measurements of perirenal fat volume and perirenal fat density were performed on computed tomography (CT) images. The relationship between progression and perirenal fat parameters was evaluated using ROC analysis, Cox regression analysis, and Kaplan-Meier analysis.

RESULTS

In the study population comprising 118 patients diagnosed with RCC (74.6% male, mean age of 59.1 ± 11.8 years), the median follow-up duration was 43 months (interquartile range: 33-51 months). Perirenal fat volume (AUC: 0.669, 95% CI 0.538-0.799, p = 0.011) and perirenal fat density (AUC: 0.680, 95% CI 0.558-0.803, p = 0.007) demonstrated acceptable discrimination performance in predicting progression. There was a significant association between high perirenal fat volume and high perirenal fat density with poor progression-free survival (HR: 1.007, 95% CI 1.003-1.011, p = 0.001 vs. HR: 1.084, 95% CI 1.033-1.137, p = 0.001; respectively).

CONCLUSION

High perirenal fat volume and high perirenal fat density are independent predictors for poor progression-free survival. Perirenal fat parameters, easily obtainable from preoperative CT images, may serve as potential tools in predicting the prognosis of non-metastatic RCC.

A three miRNAs panel in paraffin tissue serves as tool for predicting prognosis of renal cell carcinoma

Background

Renal cell carcinoma (RCC) stands as the most prevalent form of urogenital cancer. However, there is currently no universally accepted method for predicting the prognosis of RCC. MiRNA holds great potential as a prognostic biomarker for RCC.

Methods

A total of 100 cases with complete paraffin specimens and over 5-year follow-up data meeting the requirements were collected. Utilizing the clinical information and follow-up data of the specimens, an information model was developed. The expression levels of eight microRNAs were identified using RT-qPCR. Finally, determine and analyze the clinical application value of these microRNAs as prognostic markers for RCC.

Results

Significant differences were observed in the expression of two types of miRNAs (miR-378a-5p, miR-23a-5p) in RCC tissue, and three types of miRNAs (miR-378a-5p, miR-642a-5p, miR-23a-5p) were found to be linked to the prognosis of RCC. Establish biomarker combinations of miR-378a-5p, miR-642a-5p, and miR-23a-5p to evaluate RCC prognosis.

Conclusion

The combination of three microRNA groups (miR-378a-5p, miR-642a-5p, and miR-23a-5p) identified in paraffin section specimens of RCC in this study holds significant potential as biomarkers for assessing RCC prognosis.

Prognostic factors in renal cell carcinoma: A single‑center study

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.

HAPLN3 inhibits apoptosis and promotes EMT of clear cell renal cell carcinoma via ERK and Bcl-2 signal pathways

Hyaluronan and proteoglycan link protein 3 (HAPLN3) is a member of the hyaluronan and proteoglycan link protein family expressed in the extracellular matrix closely associated with the development and occurrence of various malignant tumors; yet, its function in clear cell renal cell cancer (ccRCC) is still poorly understood. The following study investigated the progress and mechanism of HAPLN3 on ccRCC using bioinformatics analysis and in vitro experiments. In order to determine whether HAPLN3 is differentially expressed in ccRCC, we analyzed data from the Cancer Genome Atlas (TCGA) and GSE40435 and further validated them in the Human Protein Atlas (HPA) database. Simultaneously, the TCGA dataset was utilized to study the relationship between HAPLN3 expression and the progression of ccRCC and its prognostic value in ccRCC. Gene enrichment analysis (GSEA) was used to explore HAPLN3-related signaling pathways in ccRCC. The TIMER database investigates the link for both HAPLN3 and immune cell infiltration. Different ccRCC cell lines the role of HAPLN3 on cell biological behavior in vitro. HAPLN3 was increased in ccRCC, and its high expression was related to the patients' survival rates and clinical characteristics. GSEA showed that HAPLN3 is mainly enriched in proliferative and metastatic pathways. In addition, HAPLN3 was an independently associated significant predictor in patients with ccRCC. Functional experiments demonstrated that HAPLN3 could promote the proliferation, migration, and invasion of ccRCC cells through the ERK1/2 signaling pathway. To sum up, our data suggest that HAPLN3 may serve as a new prognostic biomarker and potential therapeutic target for ccRCC.

Clinical Factors Associated With Long-Term Benefit in Patients With Metastatic Renal Cell Carcinoma Treated With Axitinib: Real-World AXILONG Study

BACKGROUND

Axitinib monotherapy obtained approval in pre-treated mRCC patients and recently in combination with pembrolizumab or avelumab in the first-line setting. However, patient profiles that may obtain increased benefit from this drug and its combinations still need to be identified.

PATIENTS AND METHODS

Retrospective multicentre analysis describing clinical characteristics associated with axitinib long-responder (LR) population by comparing two extreme-response sub-groups (progression-free survival [PFS] ≥9 months vs. disease progression/refractory patients [RP]). A multivariate logistic-regression model was used to analyse clinical factors. Efficacy and safety were also analysed.

RESULTS

In total, 157 patients who received axitinib in second or subsequent line were evaluated (91 LR and 66 RP). Older age at start of axitinib and haemoglobin levels > LLN were independent predictive factors for LR in multivariate analyses. In LR patients, median (m) PFS was 18.1 months, median overall survival was 36.0 months and objective response rate (ORR) was 45.5%. In 59 LR patients receiving axitinib in second-line, mPFS was 18.7 months, mOS was 44.8 months and ORR was 43.9%. mOS was significantly longer in second line compared to subsequent lines (44.8 vs. 26.5 months; P = .009). In LR vs. RP, mPFS with sunitinib in first-line was correlated with mPFS with axitinib in second-line (27.2 vs. 10.9 months P < .001). The safety profile was manageable and consistent with known data.

CONCLUSIONS

This study confirms the long-term benefits of axitinib in a selected population, helping clinicians to select the best sequential approach and patients who could obtain a greater benefit from axitinib.

Prognostic value of preoperative prognostic nutritional index in patients with renal cell carcinoma after nephrectomy

PURPOSE

The present study was performed to explore the prognostic value of prognostic nutritional index (PNI) in renal cell carcinoma (RCC) patients following nephrectomy.

METHODS

A total of 660 patients were included. PNI was calculated based on the following formula: serum albumin level (g/L) + 0.005 × total lymphocyte count (per mm³). Kaplan-Meier survival curve and the log-rank test were conducted. Univariate analysis and multivariate Cox regression analysis were performed to explore the prognostic factors.

RESULTS

The patients in low PNI group were more likely to be older (P < 0.001), have a larger tumor (P < 0.001), higher pathological T stage (P < 0.001), positive lymph node (P = 0.038), distant metastasis (P = 0.005), higher tumor grade (P < 0.001) and tumor necrosis (P < 0.001). Multivariable analysis revealed low preoperative PNI was an independent predictor of overall survival (OS) (P = 0.034) and progression-free survival (PFS) (P = 0.004) for all patients. Besides, low preoperative PNI was also significantly associated with poor OS (P = 0.008), cancer-specific survival (CSS) (P = 0.032) and PFS (P = 0.003) for non-metastatic RCC patients.

CONCLUSION

The patients with lower preoperative PNI were associated with adverse factors. Furthermore, the low preoperative PNI was also associated with inferior oncological outcomes in RCC patients who underwent nephrectomy.