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Elouarith I, Bouhtouri Y, Elmajoudi S, Bekarsabein S, Ech-charif S, Khmou M, Messaoudi H, Mahdi Y, Hachi H, El khannoussi B. Breast metastasis 18 years after nephrectomy for renal cell carcinoma: a case report. J Surg Case Rep 2022; 2022:rjac116. [PMID: 35530427 PMCID: PMC9071336 DOI: 10.1093/jscr/rjac116] [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: 02/19/2022] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
Metastasis of renal clear cell carcinoma (RCC) to the breast is exceptional. Breast metastases of extra-mammary tumors are rare and usually involve melanoma, lymphoma or leukemia. We report the case of a patient with breast metastasis of renal clear cell carcinoma occurring 18 years after nephrectomy. A history of RCC should always raise suspicion about breast metastasis, a situation that remains exceptional and whose diagnosis relies on anatomopathology.
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Affiliation(s)
- Ihssan Elouarith
- Pathology Department, Oncology National Institute, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Yassine Bouhtouri
- Department of Surgical Oncology, Oncology National Institute, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Salma Elmajoudi
- Pathology Department, Oncology National Institute, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Salma Bekarsabein
- Pathology Department, Oncology National Institute, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Soumaya Ech-charif
- Pathology Department, Oncology National Institute, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mouna Khmou
- Pathology Department, Oncology National Institute, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Hamza Messaoudi
- Department of Surgical Oncology, Oncology National Institute, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Youssef Mahdi
- Pathology Department, Oncology National Institute, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Hafid Hachi
- Department of Surgical Oncology, Oncology National Institute, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Basma El khannoussi
- Pathology Department, Oncology National Institute, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Thirunavu VM, Roumeliotis A, Shlobin NA, Kandula V, Shah P, Larkin C, Chan K, Hopkins BS, Cloney M, Karras CL, Dahdaleh NS. The role of preoperative embolization in the treatment of spinal metastases from renal cell carcinoma. Clin Neurol Neurosurg 2022; 215:107181. [DOI: 10.1016/j.clineuro.2022.107181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/03/2022]
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Motzer RJ, Jonasch E, Agarwal N, Alva A, Baine M, Beckermann K, Carlo MI, Choueiri TK, Costello BA, Derweesh IH, Desai A, Ged Y, George S, Gore JL, Haas N, Hancock SL, Kapur P, Kyriakopoulos C, Lam ET, Lara PN, Lau C, Lewis B, Madoff DC, Manley B, Michaelson MD, Mortazavi A, Nandagopal L, Plimack ER, Ponsky L, Ramalingam S, Shuch B, Smith ZL, Sosman J, Dwyer MA, Gurski LA, Motter A. Kidney Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:71-90. [PMID: 34991070 DOI: 10.6004/jnccn.2022.0001] [Citation(s) in RCA: 265] [Impact Index Per Article: 132.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The NCCN Guidelines for Kidney Cancer focus on the screening, diagnosis, staging, treatment, and management of renal cell carcinoma (RCC). Patients with relapsed or stage IV RCC typically undergo surgery and/or receive systemic therapy. Tumor histology and risk stratification of patients is important in therapy selection. The NCCN Guidelines for Kidney Cancer stratify treatment recommendations by histology; recommendations for first-line treatment of ccRCC are also stratified by risk group. To further guide management of advanced RCC, the NCCN Kidney Cancer Panel has categorized all systemic kidney cancer therapy regimens as "Preferred," "Other Recommended Regimens," or "Useful in Certain Circumstances." This categorization provides guidance on treatment selection by considering the efficacy, safety, evidence, and other factors that play a role in treatment selection. These factors include pre-existing comorbidities, nature of the disease, and in some cases consideration of access to agents. This article summarizes surgical and systemic therapy recommendations for patients with relapsed or stage IV RCC.
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Affiliation(s)
| | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center
| | | | - Ajjai Alva
- University of Michigan Rogel Cancer Center
| | | | | | | | | | | | | | - Arpita Desai
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Yasser Ged
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - John L Gore
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Naomi Haas
- Abramson Cancer Center at the University of Pennsylvania
| | | | - Payal Kapur
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | | | | | | | | | | | - Amir Mortazavi
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Lee Ponsky
- Case Comprehensive Cancer Center/ University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Zachary L Smith
- Siteman Cancer Center at Barnes- Jewish Hospital and Washington University School of Medicine
| | - Jeffrey Sosman
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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Zhang Z, Liang C, Hou B, Zhou L. Population-based evaluation of the risk factors and prognosis among renal cell carcinoma patients with initially diagnosed lung metastases. Actas Urol Esp 2021; 45:498-506. [PMID: 34332926 DOI: 10.1016/j.acuroe.2021.06.004] [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: 03/26/2020] [Accepted: 06/07/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate risk factors and prognosis of lung metastases in patients with renal cell carcinoma (RCC) based on the Surveillance, Epidemiology, and End Results (SEER) database. METHODS 56,617 patients with RCC were selected from the SEER database. Based on univariate and multivariate logistic regression, the risk factors for developing lung metastases were derived. 2906 patients were initially diagnosed with lung metastases, and then were used to research the prognostic factors. Multivariable Cox regression analyses were performed for the prediction of cancer-specific mortality. RESULTS In total, 2906 RCC patients were initially diagnosed with lung metastases. The prevalence of lung metastases in RCC was approximately 5% with poor survival. Aging, male, other race (American Indian/AK native, Asian Pacific islander) uninsured status, bilateral tumor, collecting duct, higher T stage, local lymph node metastases, higher tumor grade, and evidence of other distant metastases were significantly associated with developing lung metastases at diagnosis. Age >70 years-old, black, female, bilateral tumor, T4 stage, higher tumor grade, local lymph node metastases, collecting duct, and evidence of bone, liver, or brain metastases were related to higher risk of mortality. Blacks and female have lower odds of developing lung metastases at the time of diagnosis both in crude and adjusted logistic regression. Meanwhile, blacks and female showed higher risk of mortality compared with whites and male in Cox regression analyses. CONCLUSION Several factors related to the development and prognosis of lung metastases were revealed, especially black people and female gender have lower risk of developing lung metastatic RCC at initial diagnosis but have higher risk of mortality. These may provide preventive guidelines for the screening and treatment of lung metastases in patients with renal cell carcinoma.
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Affiliation(s)
- Z Zhang
- Department of Urology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - C Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - B Hou
- Department of Urology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - L Zhou
- Department of Urology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
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Zhang Z, Liang C, Hou B, Zhou L. Population-based evaluation of the risk factors and prognosis among renal cell carcinoma patients with initially diagnosed lung metastases. Actas Urol Esp 2021. [PMID: 33958221 DOI: 10.1016/j.acuro.2020.06.014] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate risk factors and prognosis of lung metastases in patients with renal cell carcinoma (RCC) based on the Surveillance, Epidemiology, and End Results (SEER) database. METHODS 56, 617 patients with RCC were selected from the SEER database. Based on univariate and multivariate logistic regression, the risk factors for developing lung metastases were derived. 2, 906 patients were initially diagnosed with lung metastases, and then were used to research the prognostic factors. Multivariable Cox regression analyses were performed for the prediction of cancer-specific mortality. RESULTS In total, 2,906 RCC patients were initially diagnosed with lung metastases. The prevalence of lung metastases in RCC was approximately 5% with poor survival. Aging, male, other race (American Indian /AK native, Asian Pacific islander) uninsured status, bilateral tumor, collecting duct, higher T stage, local lymph node metastases, higher tumor grade, and evidence of other distant metastases were significantly associated with developing lung metastases at diagnosis. Age > 70 years-old, black, female, bilateral tumor, T4 stage, higher tumor grade, local lymph node metastases, collecting duct, and evidence of bone, liver, or brain metastases were related to higher risk of mortality. Blacks and female have lower odds of developing lung metastases at the time of diagnosis both in crude and adjusted logistic regression. Meanwhile, blacks and female showed higher risk of mortality compared with whites and male in Cox regression analyses. CONCLUSION Several factors related to the development and prognosis of lung metastases were revealed, especially black people and female gender have lower risk of developing lung metastatic RCC at initial diagnosis but have higher risk of mortality. These may provide preventive guidelines for the screening and treatment of lung metastases in patients with renal cell carcinoma.
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Verma V, Israrahmed A, Rao RN. Metastatic clear cell renal cell carcinoma presenting as breast lump: A rare case report. Diagn Cytopathol 2021; 49:E281-E285. [PMID: 33609330 DOI: 10.1002/dc.24710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 11/11/2022]
Abstract
Renal cell carcinoma is as an aggressive tumor associated with metastasis in about one-third of the cases, but it rarely metastasizes to breast, which further is a rare site of metastasis from extramammary solid tumors. Here, we report the case of a 60-year-old female who presented with breast metastasis from renal cell carcinoma. The mammogram showed a well-defined hyperdense mass of 2.5 × 2.7 cm with microlobulated margins. The mass was hypervascular on ultrasound. Further, contrast enhanced computed tomography (CECT) abdomen revealed a 6.3 × 6.0 × 6.2 cm mass arising from the middle and the lower pole of right kidney. Fine-needle aspiration cytology (FNAC) of the right breast lump, along with cellblock preparation from the aspirated material and immunohistochemistry (IHC) on the cellblock was performed. The tumor was positive for pan-cytokeratin, vimentin, and CD10, while the markers for primary breast carcinoma were negative. On the basis of morphology and IHC, the final diagnosis of the breast mass was metastatic clear cell renal cell carcinoma. This case highlights the importance of ruling out possibility of metastasis in cases of breast mass. The correct diagnosis of these cases is crucial since the mastectomy is not required. Here, we discuss the radiological and morphological features on cytology and cellblock of this rare case of breast metastasis from renal cell carcinoma.
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Affiliation(s)
- Vikrant Verma
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Amrin Israrahmed
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Ram N Rao
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
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Redig J, Dalén J, Harmenberg U, Lindskog M, Ljungberg B, Lundstam S, Sandin R, Wahlgren T, Åkerborg Ö, Jakobsson M. Real-world cost-effectiveness of targeted therapy in metastatic renal cell carcinoma in Sweden: a population-based retrospective analysis. Cancer Manag Res 2019; 11:1289-1297. [PMID: 30799955 PMCID: PMC6371932 DOI: 10.2147/cmar.s188849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To explore cost-effectiveness of targeted therapies (TTs) in the treatment of metastatic renal cell carcinoma (mRCC) in a real-world context using a nationwide population-based approach. METHODS Data on patients diagnosed with mRCC between 2002 and 2012 were extracted from Swedish national health data registers. To facilitate comparisons of patients diagnosed before and after TT introduction to the market, three cohorts were derived: pre-TT introduction (preTT), patients diagnosed 2002-2005; early TT introduction (TTi), patients diagnosed 2006-2008; and late TT introduction (TTii), which was limited to patients diagnosed 2009-2010 to ensure availability of total health care resource utilization (HCRU) data. Patients were followed until end of 2012. The value of TTs across cohorts was estimated using mean HCRU costs per life-year (LY) gained. Data on HCRU were obtained through national health registers for dispensed medication and inpatient and outpatient care, and the associated costs were estimated using the Lin method to account for censoring. LYs gained were defined as the difference in mean survival over the study period. RESULTS The preTT, TTi, and TTii cohorts consisted of 1,366, 1,158, and 806 patients, respectively. Mean survival in years from mRCC diagnosis was 1.45 in the preTT cohort, 1.62 in the TTi cohort, and 1.83 in the TTii cohort. The respective mean total HCRU cost per patient over the study period was US$16,894, US$29,922, and US$30,037. The cost per LY gained per cohort was US$78,656 for TTi vs preTT, US$34,132 for TTii vs preTT, and US$523 for TTii vs TTi. CONCLUSION Given common willingness-to-pay per LY gained thresholds, this study in a real-world population suggests the use of TTs in the Swedish mRCC population is increasingly cost-effective over time.
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Affiliation(s)
| | | | - Ulrika Harmenberg
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Magnus Lindskog
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Sven Lundstam
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Chen YL, Ge GJ, Qi C, Wang H, Wang HL, Li LY, Li GH, Xia LQ. A five-gene signature may predict sunitinib sensitivity and serve as prognostic biomarkers for renal cell carcinoma. J Cell Physiol 2018; 233:6649-6660. [PMID: 29327492 DOI: 10.1002/jcp.26441] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/05/2018] [Indexed: 02/06/2023]
Abstract
Sunitinib resistance is, nowadays, the major challenge for advanced renal cell carcinoma patients. Illuminating the potential mechanisms and exploring effective strategies to overcome sunitinib resistance are highly desired. We constructed a reliable gene signature which may function as biomarkers for prediction of sunitinib sensitivity and clinical prognosis. The gene expression profiles were obtained from The Cancer Genome Atlas database. By performing GEO2R analysis, numerous differentially expressed genes (DEGs) were found to be associated with sunitinib resistance. To acquire more precise DEGs, we integrated three different microarray datasets. Functional analysis revealed that these DEGs were mainly involved in Rap1 signaling pathway, p53 signaling pathway and Ras signaling pathway. Then, top five hub genes, BIRC5, CD44, MUC1, TF, CCL5, were identified from protein-protein interaction (PPI) network. Sub-network analysis carried out by MCODE plugin revealed that key DEGs were related with PI3K-Akt signaling pathway, Rap1 signaling pathway and VEGF signaling pathway. Next, we established sunitinib-resistant OS-RC-2 and 786-O cell lines and validated the expression of five hub genes in cell lines. To further evaluate the potentials of five-gene signature for predicting clinical prognosis, we analyzed RCC patients with gene expressions and overall survival information from two independent patient datasets. The Kaplan-Meier estimated the OS of RCC patients in the low- and high-risk groups according to gene expression signature. Multivariate Cox regression analysis indicated that the prognostic power of five-gene signature was independent of clinical features. In conclusion, we developed a five-gene signature which can predict sunitinib sensitivity and OS for advanced RCC patients, providing novel insights into understanding of sunitinib-resistant mechanisms and identification of RCC patients with poor prognosis.
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Affiliation(s)
- Yuan-Lei Chen
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guang-Ju Ge
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chao Qi
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huan Wang
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huai-Lan Wang
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Yang Li
- Department of Mathematics and Statistics Science, University College of London, London, England
| | - Gong-Hui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Qun Xia
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Guo Q, Zhang C, Guo X, Tao F, Xu Y, Feng G, Han X, Ren Z, Zhang H, Zhang P, Wang X, Wang G. Incidence of bone metastasis and factors contributing to its development and prognosis in newly diagnosed renal cell carcinoma: a population-based study. Cancer Manag Res 2018; 10:2935-2944. [PMID: 30214288 PMCID: PMC6118275 DOI: 10.2147/cmar.s170083] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to assess the incidence of and the risk factors and prognostic factors for bone metastasis (BM) in initial metastatic renal cell carcinoma (RCC) based on a large population analysis. Patients and methods Data were obtained for a total of 45,824 RCC patients recorded in the database of the Surveillance, Epidemiology, and End Results program of the National Cancer Institute between 2010 and 2014. Multivariate logistic and Cox regression analyses were used to identify the risk factors and prognostic factors associated with BM in RCC patients. Kaplan-Meier analysis was used to estimate the overall survival of RCC patients, and the difference between the survival curves was tested by log-rank tests. Results A total of 1,509 (3.29%) patients were diagnosed with bone metastases at initial diagnosis. Male gender, higher T stage, lymph node involvement, poor tumor grade, presence of lung, liver, and brain metastases, and the collecting duct type of RCC were positively associated with BM occurrence. The median survival time for RCC patients with bone metastases was 12.0 (95% confidence interval [CI]: 10.69-13.31) months, and the survival time for those with collecting duct, clear-cell, papillary, and chromophobe subtypes of RCC were 3 (95% CI: 0.23-5.77), 13 (95% CI: 11.60-14.40), 8 (95% CI: 5.09-10.91), and 11 (95% CI: 5.02-16.98) months; these differences were significantly different (P<0.01). Older age, higher T stage, lymph node involvement, poor tumor grade, the presence of lung, liver, and brain metastases, collecting duct RCC, and the absence of surgical treatments were the factors associated with worse prognoses. Conclusion BM was highly prevalent and significantly decreased the survival rate of RCC patients. A number of factors associated with the development and prognosis of BM were identified, and these insights provide preventive guidelines for screening and treatment of BM in RCC patients.
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Affiliation(s)
- Qi Guo
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China, .,Department of Orthopedics, General Hospital of North China Petroleum Administration, Renqiu, China
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Xu Guo
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China, .,Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, China
| | - Fang Tao
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Yao Xu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Guowei Feng
- Department of Urology, Tianjin Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiuxin Han
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Zhiwu Ren
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Hui Zhang
- Department of Orthopedics, General Hospital of North China Petroleum Administration, Renqiu, China
| | - Pingfang Zhang
- Department of Orthopedics, General Hospital of North China Petroleum Administration, Renqiu, China
| | - Xin Wang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing 400038, China,
| | - Guowen Wang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
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Rodrigues P, Patel SA, Harewood L, Olan I, Vojtasova E, Syafruddin SE, Zaini MN, Richardson EK, Burge J, Warren AY, Stewart GD, Saeb-Parsy K, Samarajiwa SA, Vanharanta S. NF-κB-Dependent Lymphoid Enhancer Co-option Promotes Renal Carcinoma Metastasis. Cancer Discov 2018; 8:850-865. [PMID: 29875134 PMCID: PMC6031301 DOI: 10.1158/2159-8290.cd-17-1211] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/26/2018] [Accepted: 05/01/2018] [Indexed: 01/10/2023]
Abstract
Metastases, the spread of cancer cells to distant organs, cause the majority of cancer-related deaths. Few metastasis-specific driver mutations have been identified, suggesting aberrant gene regulation as a source of metastatic traits. However, how metastatic gene expression programs arise is poorly understood. Here, using human-derived metastasis models of renal cancer, we identify transcriptional enhancers that promote metastatic carcinoma progression. Specific enhancers and enhancer clusters are activated in metastatic cancer cell populations, and the associated gene expression patterns are predictive of poor patient outcome in clinical samples. We find that the renal cancer metastasis-associated enhancer complement consists of multiple coactivated tissue-specific enhancer modules. Specifically, we identify and functionally characterize a coregulatory enhancer cluster, activated by the renal cancer driver HIF2A and an NF-κB-driven lymphoid element, as a mediator of metastasis in vivo We conclude that oncogenic pathways can acquire metastatic phenotypes through cross-lineage co-option of physiologic epigenetic enhancer states.Significance: Renal cancer is associated with significant mortality due to metastasis. We show that in metastatic renal cancer, functionally important metastasis genes are activated via co-option of gene regulatory enhancer modules from distant developmental lineages, thus providing clues to the origins of metastatic cancer. Cancer Discov; 8(7); 850-65. ©2018 AACR.This article is highlighted in the In This Issue feature, p. 781.
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Affiliation(s)
- Paulo Rodrigues
- MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, United Kingdom
| | - Saroor A Patel
- MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, United Kingdom
| | - Louise Harewood
- Cancer Research UK/Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Ioana Olan
- MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, United Kingdom
| | - Erika Vojtasova
- MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, United Kingdom
| | - Saiful E Syafruddin
- MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, United Kingdom
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Jalan Yaa'cob Latiff, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - M Nazhif Zaini
- MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, United Kingdom
| | - Emma K Richardson
- MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, United Kingdom
| | - Johanna Burge
- Academic Urology Group, Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Anne Y Warren
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Grant D Stewart
- Academic Urology Group, Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Kourosh Saeb-Parsy
- Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Shamith A Samarajiwa
- MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, United Kingdom
| | - Sakari Vanharanta
- MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, United Kingdom.
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Chen P, Quan J, Jin L, Lin C, Xu W, Xu J, Guan X, Chen Z, Ni L, Yang S, Chen Y, Lai Y. miR-216a-5p acts as an oncogene in renal cell carcinoma. Exp Ther Med 2018; 15:4039-4046. [PMID: 29556270 PMCID: PMC5844176 DOI: 10.3892/etm.2018.5881] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 01/19/2018] [Indexed: 02/05/2023] Open
Abstract
MiR-216a-5p has been acknowledged as an oncogene and is known to be involved in the progression and metastasis of numerous cancer subtypes. However, the potential role of miR-216a-5p in renal cell carcinoma (RCC) remains to be elucidated. In the present study, reverse transcription-quantitative polymerase chain reaction was performed to detect the expression levels of miR-216a-5p in RCC tissues. Cell counting kit-8, MTT, wound scratch, Transwell and flow cytometric assays were performed to establish the biological functions of miR-216a-5p in RCC. Functional experiments demonstrated that the expression of miR-216a-5p was upregulated in RCC (P<0.05) and miR-216a-5p mimics promoted cellular proliferation, viability and motility, and suppressed apoptosis. Conversely, miR-216a-5p inhibitor suppressed cellular proliferation, viability, motility and induced apoptosis. Based on these findings, it was concluded that miR-216a-5p may function as an oncogene in RCC. MiR-216a-5p target genes need to be explored and the potential of miR-216a-5p to be used as a diagnostic or a prognostic biomarker for RCC needs to be validated by future research.
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Affiliation(s)
- Peijie Chen
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- Department of Urology, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Jing Quan
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Lu Jin
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Canbin Lin
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- Department of Urology, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Weijie Xu
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Jinling Xu
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Xin Guan
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Zebo Chen
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Liangchao Ni
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Shangqi Yang
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Yun Chen
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Yongqing Lai
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology of Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
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12
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Abstract
PURPOSE OF REVEIW Approximately one in three patients with nonmetastatic renal cell carcinoma (RCC) at the time of surgery will subsequently develop local or metastatic recurrence. The purpose of this review is to examine the current rationale for surveillance, describe sites of RCC metastasis, evaluate the existing guidelines for postsurgical follow-up studies, and analyze the risk stratification systems following RCC surgery. RECENT FINDINGS Although 75% of recurrences will be identified during the first 5 years following surgery, late recurrences are not uncommon. The risk of recurrence can be predicted from the tumor stage, grade, and other pathologic features. Advanced risk stratification will likely be possible in the future with increased use of molecular classification and serum biomarkers. Patient comorbidities, age, and individual recurrence risk should also be considered when designing individualized surveillance protocols. SUMMARY Follow-up after surgery for RCC should focus on imaging of the chest and abdomen to detect common sites of recurrence. Patients should be stratified for risk, and surveillance imaging should be more frequent and intensive in healthy patients with higher risk. Future research is needed to define an optimal individualized surveillance strategy that balances the potential benefits of early cancer detection with the risks and cost of surveillance.
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13
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Xu Y, Hou R, Lu Q, Deng Y, Hu B. Renal clear cell carcinoma metastasis to the breast ten years after nephrectomy: a case report and literature review. Diagn Pathol 2017; 12:76. [PMID: 29096639 PMCID: PMC5668985 DOI: 10.1186/s13000-017-0666-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 10/25/2017] [Indexed: 02/06/2023] Open
Abstract
Background Renal cell carcinoma most commonly metastasizes to the lungs, skeleton or liver. Metastatic renal cell carcinoma to the breast is very rare, especially for clear cell carcinoma, and few cases regarding this condition have been reported. Case Presentation The case we presented was a 68-year-old Chinese female with metastatic renal clear cell carcinoma of the left breast 10 years after a nephrectomy. Identification of the metastatic renal clear cell carcinoma in the breast required multiple breast imaging modalities. Imaging showed a single, ovary-shaped, well-defined hypo-echoic mass, with abundant blood flow on ultrasound images. The mass was enhanced early on MRI, and it was hypointense on a T1-weighted image and hyperintense on a fat-saturated T2-weighted image. Following surgical excision of the tumor, a routine immunohistochemistry antibody panel on the tumor cells revealed negative staining for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (Her-2). Strong positive staining for the cluster of differentiation 10 (CD10) and vimentin was present. Conclusion This case is unusual because of the site of metastatic progression. It is important for physicians to be aware of this progression so early diagnoses can be made, and appropriate therapeutic planning can be initiated.
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Affiliation(s)
- Yanjun Xu
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600th Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
| | - Rui Hou
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600th Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
| | - Qijie Lu
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600th Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
| | - Yifan Deng
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600th Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
| | - Bin Hu
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600th Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China.
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14
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Chandrasekar T, Klaassen Z, Goldberg H, Kulkarni GS, Hamilton RJ, Fleshner NE. Metastatic renal cell carcinoma: Patterns and predictors of metastases-A contemporary population-based series. Urol Oncol 2017; 35:661.e7-661.e14. [PMID: 28728748 DOI: 10.1016/j.urolonc.2017.06.060] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/25/2017] [Accepted: 06/27/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the patterns and predictors of metastatic disease in renal cell carcinoma (RCC) at the time of diagnosis in a contemporary series. METHODS The Surveillance, Epidemiology, and End Results database was queried for all patients with kidney RCC from 2010 to 2013 (N = 50,815). Distribution and predictors of distant metastases at diagnosis were assessed. Multivariate logistic regression hazard analyses were performed to determine covariates associated with the likelihood of having metastases at diagnosis, whereas competing risks regression analysis was used to assess predictors of cancer-specific mortality (CSM) in patients with metastatic disease. RESULTS Lung (7.73%) and bone (5.17%) metastases were the most common. The strongest predictors of metastatic disease were disease-specific factors, such as clinical T-stage (cT4 vs. cT1; odds ratio = 43.08; P<0.01) and higher Fuhrman grade (FG4 vs. FG1; odds ratio = 5.09; P<0.01). Papillary RCC and chromophobe RCC were associated with localized disease at the time of diagnosis. For CSM, the presence of brain and liver metastases were associated with worse CSM than lung or bone metastases. Although patient factors did not contribute to the presence of metastases at diagnosis, lower socioeconomic status and being widowed/divorced predicted worse CSM. CONCLUSION Understanding the distribution of distant metastases and associated CSM is important to counseling patients with newly diagnosed metastatic RCC. Although pathologic factors drive the presence of metastases at diagnosis, health care deficits in treatment remain.
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Affiliation(s)
- Thenappan Chandrasekar
- Department of Surgical Oncology, Division of Urologic Oncology, University Health Network and University of Toronto, Toronto, Ontario, Canada.
| | - Zachary Klaassen
- Department of Surgical Oncology, Division of Urologic Oncology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Hanan Goldberg
- Department of Surgical Oncology, Division of Urologic Oncology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Department of Surgical Oncology, Division of Urologic Oncology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Robert J Hamilton
- Department of Surgical Oncology, Division of Urologic Oncology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Neil E Fleshner
- Department of Surgical Oncology, Division of Urologic Oncology, University Health Network and University of Toronto, Toronto, Ontario, Canada
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15
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Dong B, Gao Y, Kang X, Gao H, Zhang J, Guo H, You MJ, Xue W, Cheng J, Huang Y. SENP1 promotes proliferation of clear cell renal cell carcinoma through activation of glycolysis. Oncotarget 2016; 7:80435-80449. [PMID: 27741516 PMCID: PMC5348332 DOI: 10.18632/oncotarget.12606] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 10/03/2016] [Indexed: 12/28/2022] Open
Abstract
Metabolic shift toward aerobic glycolysis is a fundamental element contributing to the development and progression of clear cell renal cell carcinoma (ccRCC). We and others previously observed enhanced glycolysis and diminished tricarboxylic acid (TCA) cycle activity in ccRCC tissue. Here, by integrated gene expression and metabolomic analyses of 36 matched pairs of tumor and adjacent normal tissues, we showed that expression of Sentrin/SUMO-specific protease 1 (SENP1) is positively associated with glycolysis levels in ccRCC. Moreover, SENP1 knockdown in RCC4/VHL cells downregulated expression of key glycolytic enzymes under normoxic and hypoxic conditions and inhibited cell proliferation under hypoxic conditions, possibly due to ineffective deSUMOylation and stablization of Hif-1α related to the SENP-1 deficiency. Finally, SENP1 expression correlated positively with tumor pathological grade and was an indicator of poor overall survival and advanced tumor progression in ccRCC. Altered VHL gene function is found in 60-90% ccRCC cases of ccRCC, but therapies targeting VHL-related signaling pathways have been ineffective, spurring exploration of alternative pathological signaling events. Our results provide a possible mechanistic explanation for the role of SENP1 in the initiation and development of ccRCC with normal VHL activity, and identifies SENP1 as a potential treatment target for the disease.
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Affiliation(s)
- Baijun Dong
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yujing Gao
- Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, Department of Biochemistry and Molecular Biology, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xunlei Kang
- Department of Biochemistry and Molecular Cell Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongchang Gao
- School of Pharmacy, Wenzhou Medical College, Wenzhou, China
| | - Jin Zhang
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Guo
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, USA
- Current address: North Shore LIJ Health System, New York, USA
| | - Mingjian J You
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, USA
- The Graduate School of Biomedical Science, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Wei Xue
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinke Cheng
- Department of Biochemistry and Molecular Cell Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiran Huang
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
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16
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Lukamowicz-Rajska M, Mittmann C, Prummer M, Zhong Q, Bedke J, Hennenlotter J, Stenzl A, Mischo A, Bihr S, Schmidinger M, Vogl U, Blume I, Karlo C, Schraml P, Moch H. MiR-99b-5p expression and response to tyrosine kinase inhibitor treatment in clear cell renal cell carcinoma patients. Oncotarget 2016; 7:78433-78447. [PMID: 27738339 PMCID: PMC5346651 DOI: 10.18632/oncotarget.12618] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/18/2016] [Indexed: 11/25/2022] Open
Abstract
A number of treatments targeting VEGF or mTOR pathways have been approved for metastatic clear cell Renal Cell Carcinoma (ccRCC), but the majority of patients show disease progression after first line therapy with a very low rate of complete or long-term responders. It has been shown that miRs may play a role in prediction of treatment response in various cancer types. The aim of our study was to identify a miR signature predictive for RCC patients' response to antiangiogenic tyrosine kinase inhibitor (TKI) treatment in the first line therapy. Sequencing of 40 paired normal/tumor formalin fixed and paraffin embedded ccRCC tissues revealed separate clustering via unsupervised dendrograms. With supervised analysis, the strongest differential expression was obtained with miR-99b-5p, which was significantly lower in patients with short progression free survival (<8 months) and TKI non-responders (progressive disease patients according to RECIST) (p<0.0001, each). Validation using RTqPCR and a second patient cohort compiled from three different hospitals (n=65) showed higher expression of miR-99b-5p in complete responders, but this trend did not reach statistical significance. It is concluded that low miR-99b-5p expression analyzed with sequencing methodology may correlate with tumor progression in TKI-treated ccRCC patients.
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Affiliation(s)
| | - Christiane Mittmann
- Institute of Surgical Pathology, University Hospital Zürich, Zurich, Switzerland
| | - Michael Prummer
- NEXUS Personalized Health Technologies, ETH Zürich, Zürich, Switzerland
| | - Qing Zhong
- Institute of Surgical Pathology, University Hospital Zürich, Zurich, Switzerland
| | - Jens Bedke
- Department of Urology, University Tübingen, Tübingen, Germany
| | | | - Arnulf Stenzl
- Department of Urology, University Tübingen, Tübingen, Germany
| | - Axel Mischo
- Oncology Department, University Hospital Zürich, Zürich, Switzerland
| | - Svenja Bihr
- Oncology Department, University Hospital Zürich, Zürich, Switzerland
| | - Manuela Schmidinger
- Department of Internal Medicine I, Division of Oncology & Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Ursula Vogl
- Department of Internal Medicine I, Division of Oncology & Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Iris Blume
- Institute for diagnostic and interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Christoph Karlo
- Institute for diagnostic and interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Peter Schraml
- Institute of Surgical Pathology, University Hospital Zürich, Zurich, Switzerland
| | - Holger Moch
- Institute of Surgical Pathology, University Hospital Zürich, Zurich, Switzerland
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17
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Ratasvuori M, Sillanpää N, Wedin R, Trovik C, Hansen BH, Laitinen M. Surgery of non-spinal skeletal metastases in renal cell carcinoma: No effect of preoperative embolization? Acta Orthop 2016; 87:183-8. [PMID: 26986551 PMCID: PMC4812082 DOI: 10.3109/17453674.2015.1127726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Surgery for metastases of renal cell carcinoma has increased in the last decade. It carries a risk of massive blood loss, as tumors are hypervascular and the surgery is often extensive. Preoperative embolization is believed to facilitate surgery. We evaluated the effect of preoperative embolization and resection margin on intraoperative blood loss, operation time, and survival in non-spinal skeletal metastases of renal cell carcinoma. PATIENTS AND METHODS This retrospective study involved 144 patients, 56 of which were treated preoperatively with embolization. The primary outcome was intraoperative blood loss. We also identified factors affecting operating time and survival. RESULTS We did not find statistically significant effects on intraoperative blood loss of preoperative embolization of skeletal non-spinal metastases. Pelvic localization and large tumor size increased intraoperative blood loss. Marginal resection compared to intralesional resection, nephrectomy, level of hemoglobin, and solitary metastases were associated with better survival. INTERPRETATION Tumor size, but not embolization, was an independent factor for intraoperative blood loss. Marginal resection rather than intralesional resection should be the gold standard treatment for skeletal metastases in non-spinal renal cell carcinoma, especially in the case of a solitary lesion, as this improved the overall survival.
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Affiliation(s)
| | - Niko Sillanpää
- Medical Imaging Center, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Rikard Wedin
- Department of Orthopedics, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Clement Trovik
- Department of Orthopedics, Haukeland University Hospital, Bergen, Norway
| | - Bjarne H Hansen
- Department of Orthopedics, University Hospital, Aarhus, Denmark
| | - Minna Laitinen
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere
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18
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Nowicka AM, Häuselmann I, Borsig L, Bolduan S, Schindler M, Schraml P, Heikenwalder M, Moch H. A novel pVHL-independent but NEMO-driven pathway in renal cancer promotes HIF stabilization. Oncogene 2015; 35:3125-38. [PMID: 26500060 DOI: 10.1038/onc.2015.400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 07/22/2015] [Accepted: 08/14/2015] [Indexed: 12/11/2022]
Abstract
Activation of hypoxia-inducible factor (HIF) is due to loss of von Hippel-Lindau protein (pVHL) function in most clear cell renal cell carcinomas (ccRCCs). Here we describe a novel pVHL-independent mechanism of HIF regulation and identify nuclear factor (NF)-κB essential modulator (NEMO) as a hitherto unknown oncogenic factor influencing human ccRCC progression. Over 60% of human ccRCCs (n=157) have negative or weak NEMO protein expression by immunohistochemistry. Moderate/strong NEMO protein expression is more frequent in VHL wild-type ccRCCs. We show that NEMO stabilizes HIFα via direct interaction and independently of NF-κB signaling in vitro. NEMO prolongs tumor cell survival via regulation of apoptosis and activation of epithelial-to-mesenchymal transition, facilitating tumor metastasis. Our findings suggest that NEMO-driven HIF activation is involved in progression of ccRCC. Therefore, NEMO may represent a clinically relevant link between NF-κB and the VHL/HIF pathways. Targeting NEMO with specific inhibitors in patients with metastatic ccRCC could be a novel treatment approach in patients with ccRCC expressing functional pVHL.
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Affiliation(s)
- A M Nowicka
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - I Häuselmann
- Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - L Borsig
- Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - S Bolduan
- Institute of Virology, Technische Universität München/Helmholtz Zentrum München, Munich, Germany
| | - M Schindler
- Institute of Virology, Technische Universität München/Helmholtz Zentrum München, Munich, Germany
| | - P Schraml
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - M Heikenwalder
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland.,Institute of Virology, Technische Universität München/Helmholtz Zentrum München, Munich, Germany.,Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - H Moch
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
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19
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Roza T, Hakim L, van Poppel H, Joniau S. Bone-targeted therapies for elderly patients with renal cell carcinoma: current and future directions. Drugs Aging 2014; 30:877-86. [PMID: 24072355 DOI: 10.1007/s40266-013-0117-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Bone metastases are very common in advanced renal cell carcinoma (RCC) and can have a huge impact on quality of life by leading to skeletal-related events (SREs), including pain, pathologic fractures and spinal cord compression with need for surgery or radiotherapy. Because of their osteolytic aspect and biologic behaviour, these SREs are more common in patients with bone metastases from RCC than from other malignancies. As overall survival is increased by new anti-angiogenic drugs like tyrosine kinase inhibitors and mammalian target of rapamycin inhibitors, the incidence of SREs is rising, making the clinical management of bone metastases in RCC ever more important, especially in the more vulnerable elderly patient. In this review we discuss the current advances and future directions in bone-targeted therapies in patients with RCC with a special focus on the elderly population. Recently, two bone-targeted agents have been approved in the prevention of SREs in advanced RCC: zoledronic acid and denosumab. To date, there is no specific data on the use of bisphosphonates or denosumab in the elderly and specific studies in this setting are warranted. We compare the available evidence for the use and implications of both agents in the elderly patient and give general information on safety concerns that could be more important in these patients.
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Affiliation(s)
- Thomas Roza
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium,
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20
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Renal carcinoma relapse presenting as a peripheral nerve sheath tumor: A case report and brief review of the literature. Neurochirurgie 2013; 59:128-32. [PMID: 23806763 DOI: 10.1016/j.neuchi.2013.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/02/2013] [Accepted: 04/11/2013] [Indexed: 11/20/2022]
Abstract
We report a rare case of renal carcinoma metastasis involving a lumbar nerve root. Metastases to nerve roots are rare occurrences, and to our knowledge, only six cases have been reported so far in the literature. The patient in this report presented with weakness in the right lower limb and intractable pain irradiating along the L5 dermatome. MRI findings revealed a right-sided L5 nerve root mass, suggestive of a schwannoma, involving the spinal ganglion and its extraforaminal region. Complete macroscopic resection of this mass was performed, and histopathologic analysis confirmed the lesion to be a metastasis of a renal clear cell carcinoma. Local radiotherapy was given and tyrosine kinase inhibitors administered. At 5 months, the patient was pain-free and his right limb weakness had completely resolved. A tumoral recurrence could be observed on the control MRI 5 months after surgery. This report presents the first case of a patient with a renal clear cell carcinoma metastasis to a L5 nerve root, as well as a brief review of previous cases of metastases to peripheral nerve roots.
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21
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Ratasvuori M, Wedin R, Keller J, Nottrott M, Zaikova O, Bergh P, Kalen A, Nilsson J, Jonsson H, Laitinen M. Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis. Surg Oncol 2013; 22:132-8. [PMID: 23562148 DOI: 10.1016/j.suronc.2013.02.008] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/21/2013] [Accepted: 02/16/2013] [Indexed: 01/10/2023]
Abstract
The number of cancer patients living with metastatic disease is growing. The increased survival has led to an increase in the number of cancer-induced complications, such as pathologic fractures due to bone metastases. Surgery is most commonly needed for mechanical complications, such as fractures and intractable pain. We determined survival, disease free interval and complications in surgically treated bone metastasis. Data were collected from the Scandinavian Skeletal Metastasis Registry for patients with extremity skeletal metastases surgically treated at eight major Scandinavian referral centres between 1999 and 2009 covering a total of 1195 skeletal metastases in 1107 patients. Primary breast, prostate, renal, lung, and myeloma tumors make up 78% of the tumors. Number of complications is tolerable and is affected by methods of surgery as well as preoperative radiation therapy. Overall 1-year patient survival was 36%; however, mean survival was influenced by the primary tumor type and the presence of additional visceral metastases. Patients with impending fracture had more systemic complications than those with complete fracture. Although surgery is usually only a palliative treatment, patients can survive for years after surgery. We developed a simple, useful and reliable scoring system to predict survival among these patients. This scoring system gives good aid in predicting the prognosis when selecting the surgical method. While it is important to avoid unnecessary operations, operating when necessary can provide benefit.
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Affiliation(s)
- Maire Ratasvuori
- Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland
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22
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The ineligible patient: how to treat patients not included in clinical studies. World J Urol 2013; 32:9-18. [DOI: 10.1007/s00345-013-1042-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/05/2013] [Indexed: 12/26/2022] Open
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23
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Epigenetic expansion of VHL-HIF signal output drives multiorgan metastasis in renal cancer. Nat Med 2012; 19:50-6. [PMID: 23223005 PMCID: PMC3540187 DOI: 10.1038/nm.3029] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 11/14/2012] [Indexed: 12/13/2022]
Abstract
Inactivation of the von Hippel-Lindau tumor suppressor gene, VHL, is an archetypical tumor-initiating event in clear cell renal carcinoma (ccRCC) that leads to the activation of hypoxia-inducible transcription factors (HIFs). However, VHL mutation status in ccRCC is not correlated with clinical outcome. Here we show that during ccRCC progression, cancer cells exploit diverse epigenetic alterations to empower a branch of the VHL-HIF pathway for metastasis, and the strength of this activation is associated with poor clinical outcome. By analyzing metastatic subpopulations of VHL-deficient ccRCC cells, we discovered an epigenetically altered VHL-HIF response that is specific to metastatic ccRCC. Focusing on the two most prominent pro-metastatic VHL-HIF target genes, we show that loss of Polycomb repressive complex 2 (PRC2)-dependent histone H3 Lys27 trimethylation (H3K27me3) activates HIF-driven chemokine (C-X-C motif) receptor 4 (CXCR4) expression in support of chemotactic cell invasion, whereas loss of DNA methylation enables HIF-driven cytohesin 1 interacting protein (CYTIP) expression to protect cancer cells from death cytokine signals. Thus, metastasis in ccRCC is based on an epigenetically expanded output of the tumor-initiating pathway.
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24
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Pawłowski R, Mühl SM, Sulser T, Krek W, Moch H, Schraml P. Loss of PBRM1 expression is associated with renal cell carcinoma progression. Int J Cancer 2012; 132:E11-7. [DOI: 10.1002/ijc.27822] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/17/2012] [Indexed: 12/29/2022]
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25
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Abstract
Incidence of kidney cancer is on the rise, and a better understanding of molecular mechanisms involved in the cancer invasion and metastasis is required for the development of curative therapeutics. In this study, we report that the proinflammatory cytokine prostaglandin E2 (PGE2) induces the malignant SN12C, but not benign HK2 kidney cell invasion. The PGE2 increases SN12C cell invasion through a signal pathway that encompasses EP2 and EP4, Akt, small GTPase RalA and Ral·GTP inactivator RGC2. The results support the idea that targeted interference of EP2/EP4 signal to RalA·GTP may provide benefit to patients diagnosed with advanced kidney cancer.
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Affiliation(s)
- Z Li
- Department of Urology and Prostate Disease Center, University of Florida College of Medicine, Gainesville, FL, USA
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Bianchi M, Sun M, Jeldres C, Shariat SF, Trinh QD, Briganti A, Tian Z, Schmitges J, Graefen M, Perrotte P, Menon M, Montorsi F, Karakiewicz PI. Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann Oncol 2011; 23:973-80. [PMID: 21890909 DOI: 10.1093/annonc/mdr362] [Citation(s) in RCA: 438] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We assessed the distribution of site-specific metastases in patients with renal cell carcinoma (RCC) according to age. Moreover, we evaluated recommendations proposed by guidelines and focused specifically on bone and brain metastases. PATIENTS AND METHODS Patients with metastatic RCC (mRCC) were abstracted from the Nationwide Inpatient Sample (1998-2007). Age was stratified into four groups: <55, 55-64, 65-74 and ≥ 75 years. Cochran-Armitage trend test and multivariable logistic regression analysis tested the relationship between age and the rate of multiple metastatic sites. Finally, we examined the rates of brain or bone metastases according to the presence of other metastatic sites. RESULTS In 11,157 mRCC patients, the rate of multiple metastatic sites decreased with increasing age (P < 0.001). This phenomenon was confirmed in patients with lung, bone, liver and brain metastases (all P ≤ 0.01). The rate of bone metastases was 10% in patients with exclusive abdominal metastases and 49% in patients with abdominal, thoracic and brain metastases. The rate of brain metastases was 2% in patients with exclusive abdominal metastases and 16% in patients with thoracic and bone metastases. CONCLUSIONS The proportion of patients with multiple metastatic sites is higher in young patients. The rates of bone (10%-49%) and brain (2%-16%) metastases are nonnegligible in mRCC patients.
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Affiliation(s)
- M Bianchi
- Department of Urology, Vita-Salute University, Urological Research Institute, Milan, Italy.
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Wu J, Zhang Y, Frilot N, Kim JI, Kim WJ, Daaka Y. Prostaglandin E2 regulates renal cell carcinoma invasion through the EP4 receptor-Rap GTPase signal transduction pathway. J Biol Chem 2011; 286:33954-62. [PMID: 21832044 DOI: 10.1074/jbc.m110.187344] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Prognosis for patients with early stage kidney cancer has improved, but the treatment options for patients with locally advanced disease and metastasis remain few. Understanding the molecular mechanisms that regulate invasion and metastasis is critical for developing successful therapies to treat these patients. Proinflammatory prostaglandin E(2) plays an important role in cancer initiation and progression via activation of cognate EP receptors that belong to the superfamily of G protein-coupled receptors. Here we report that prostaglandin E(2) promotes renal cancer cell invasion through a signal transduction pathway that encompasses EP4 and small GTPase Rap. Inactivation of Rap signaling with Rap1GAP, like inhibition of EP4 signaling with ligand antagonist or knockdown with shRNA, reduces the kidney cancer cell invasion. Human kidney cells evidence increased EP4 and decreased Rap1GAP expression levels in the malignant compared with benign samples. These results support the idea that targeted inhibition of EP4 signaling and restoration of Rap1GAP expression constitute a new strategy to control kidney cancer progression.
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Affiliation(s)
- Juanjuan Wu
- Department of Pathology, Georgia Health Sciences University, Augusta, Georgia 30912, USA
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Aben KKH, Heskamp S, Janssen-Heijnen ML, Koldewijn EL, van Herpen CM, Kiemeney LA, Oosterwijk E, van Spronsen DJ. Better survival in patients with metastasised kidney cancer after nephrectomy: a population-based study in the Netherlands. Eur J Cancer 2011; 47:2023-32. [PMID: 21459570 DOI: 10.1016/j.ejca.2011.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/22/2011] [Accepted: 03/01/2011] [Indexed: 01/12/2023]
Abstract
AIM Cytoreductive nephrectomy is considered beneficial in patients with metastasised kidney cancer but only a minority of these patients undergo cytoreductive surgery. Factors associated with nephrectomy and the independent effect of nephrectomy on survival were evaluated in this study. METHODS Patients were selected from the population-based cancer registry and detailed data were retrieved from clinical files. Factors associated with nephrectomy were evaluated by logistic regression analyses. Cox proportional hazard regression analysis was performed to evaluate factors associated with survival; a propensity score reflecting the probability of being treated surgically was included in order to adjust for confounding by indication. RESULTS 37.5% of 328 patients diagnosed with metastatic kidney cancer between 1999 and 2005 underwent nephrectomy. Patients with a low performance score, high age, ≥2 comorbid conditions, ≥2 metastases, low or high BMI, weight loss, elevated lactate dehydrogenase, elevated alkaline phosphatase, female gender and liver or bone metastases were less likely to be treated surgically. Three year survival was 25% and 4% for patients with and without nephrectomy, respectively (p<0.001). After adjustment for other prognostic factors including the propensity score, nephrectomy remained significantly associated with better survival (Hazard ratio: 0.52, 95% Confidence interval: 0.37-0.73). CONCLUSIONS Even after accounting for prognostic profile, patients still benefit from a nephrectomy; an approximately 50% reduction in mortality was observed. It is, therefore, recommended that patients with metastasised disease receive cytoreductive surgery when there is no contraindication. Trial results on cytoreductive surgery combined with targeted molecular therapeutics are awaited for.
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Affiliation(s)
- K K H Aben
- Department of Cancer Registry and Research, Comprehensive Cancer Centre East, Nijmegen, The Netherlands.
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Unfavourable pattern of metastases in M0 breast cancer patients during 1978-2008: a population-based analysis of the Munich Cancer Registry. Breast Cancer Res Treat 2011; 128:795-805. [PMID: 21311969 DOI: 10.1007/s10549-011-1372-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 01/23/2011] [Indexed: 10/18/2022]
Abstract
Little is known about time trends in metastases in the patients treated in routine health care facilities without metastases at diagnosis (M0) and about survival after these metastases. Data on 33,771 M0 patients with primary breast cancer diagnosed between 1978 and 2003 were obtained from the Munich Cancer Registry. Survival analyses were restricted to the patients with metastases within 5 years of the initial diagnosis. The incident number of the patients approximately doubled each period and 5-year overall survival increased from 77% in the first to 82% percent in the last period. 5490 (16%) M0 patients developed metastases within 5 years after the initial diagnosis. The hazard of developing metastases was lowest in the most recent period compared to the first period (HR = 0.50, P < 0.001). The hazard of dying after metastases was equal for patients diagnosed between 1978-1984 and 1995-2003 (HR 1.08, P = 0.3). The percentage of the patients that developed bone metastases decreased each time period, but the percentage primary liver and CNS metastases increased. Exclusion of site of metastases in the multivariate analysis led to a 20% (P = 0.02) higher hazard of dying following metastases in the last versus the first period. In the period 1978-2008, unfavourable changes in the pattern of metastases were exhibited and no improvement was observed in survival of the patients after occurrence of metastases. An explanation might be the increased use of adjuvant systemic treatment, which has less effect on the highly lethal liver and CNS metastases than on bone metastases. The increased use also appeared to contribute to the overall prevention of metastases in breast cancer and therefore to improve overall survival.
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Woodward E, Jagdev S, McParland L, Clark K, Gregory W, Newsham A, Rogerson S, Hayward K, Selby P, Brown J. Skeletal complications and survival in renal cancer patients with bone metastases. Bone 2011; 48:160-6. [PMID: 20854942 DOI: 10.1016/j.bone.2010.09.008] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 09/02/2010] [Accepted: 09/08/2010] [Indexed: 10/19/2022]
Abstract
Skeletal metastases occur in around one third of patients with advanced or metastatic renal cell carcinoma (RCC). Skeletal involvement is commonly an aggressive, lytic process which causes substantial morbidity through skeletal complications and occurrence of skeletal related events (SREs). However, compared with bone metastases in breast and prostate cancer, there is a paucity of data relating to the demographics of bone metastases in RCC and their sequelae in terms of SREs and survival. The study population included all patients (N=803) with advanced or metastatic RCC treated in a tertiary centre serving a regional population of 2.6 million between 1998 and 2007. Demographic and survival data and information relating to metastatic disease were extracted from electronic records. Thirty-two percent (N=254) of the study population presented with (N=131) or later developed (N=123) bone metastases and 83% of these (N=210) also developed metastases elsewhere. The mean number of SREs experienced by the bone metastatic patients over the course of their disease was 2.4 and only 37 patients experienced no SRE. A high proportion of patients (80%) received radiotherapy for bone pain and there was a surprising and strikingly high incidence of spinal cord/nerve root compression, which was experienced by 28% patients. Although bisphosphonate use increased following the availability of zoledronic acid in 2004, approximately 50% patients with bone metastases did not receive bisphosphonate treatment. The skeletal morbidity rate (number of SREs per patient years at risk) was 1.0 and 1.4 for patients who received or did not receive bisphosphonates, respectively. The median survival following diagnosis of RCC was similar in patients who developed bone metastases (20.4 months) and those who did not (20.9 months). Median survival from diagnosis of metastases was 13.3 months for those who never developed bone metastases, 10.6 months for those who presented with them, 19.6 months for those who developed them later and 22.6 months for patients who had bone only metastases. This is the largest study to date focusing specifically on skeletal complications in RCC. A striking finding was the high incidence of spinal cord/nerve root compression and more research into this area is needed. Clearer, internationally accepted guidelines are recommended for the management of this patient group.
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Affiliation(s)
- Emma Woodward
- Section of Oncology and Clinical Research, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
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Melegari S, Albo G, Rocco B, Verweij F, Abbinante M, de Cobelli O. Metachronous bladder metastases from renal cell carcinoma: a case report and review of the literature. Ecancermedicalscience 2010; 4:175. [PMID: 22276029 PMCID: PMC3234030 DOI: 10.3332/ecancer.2010.175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Indexed: 11/07/2022] Open
Abstract
Introduction: adrenal gland, parotid gland, pharynx, eye and bladder are rare localizations of metastases of renal cell carcinoma (RCC). We report a case of metachronous RCC metastases to the bladder in a patient with a medical history of transitional cell carcinoma (TCC) of the bladder. Materials and methods: a case study and review of the relevant literature are presented. Results: during a follow-up cystoscopy examination following treatment of TCC, a single 5-mm lesion was detected and endoscopically resected. The histology of the resected sample was confirmed to be RCC, comparable to a primary kidney cancer and not recurrent TCC. Conclusion: the patient had a probability of metastases three years after nephrectomy of 62.9%. Survival rates following single metastasectomy are 60% and 38% at three and five years, respectively; metachronous diagnosis has a better prognosis than synchronous. During RCC follow-up, each lesion should be considered as a possible metastasis of RCC.
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Affiliation(s)
- S Melegari
- Department of Urology, European Institute of Oncology, Via Ripamonti 435, 20141 Milano, Italy
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Abstract
Renal cell carcinoma is the sixth leading cause of death for cancer in industrialized countries and one third of patients has metastases at the time of diagnosis. The three most common histological types of renal cell carcinoma are: clear cell carcinoma (70–80%), papillary carcinoma (10–15%) and chromophobe cell carcinoma (5%). The location of metastases vary according to histotype: lung metastases are found in 53.6% of cases in patients with clear cell carcinoma, whereas in patients with papillary carcinoma or chromophobe cell carcinoma in 33.3% and 28.2% of cases, respectively. In contrast, chromophobe cell carcinoma is more often associated with liver metastases (33.3%), compared with clear cell carcinoma (9.7%) or papillary carcinoma (18%). Patients with renal cell carcinoma metastatic to a single organ have a better prognosis than patients with metastases in multiple organs and the overall survival of patients with localized lung metastases is similar to that of patients with exclusive bone metastases. The overall survival, therefore, is related more to the number of organs involved by metastasis rather than by the location of metastases. The widespread use of abdominal non-invasive diagnostic procedures, with an incidental finding of renal cell carcinomas still in a low stage of development, and the refinement of surgical techniques for resection of metastatic disease (metastasectomy) have led to only a slight improvement in overall survival in the last 30 years for the resistance of the tumor to common chemo-radiotherapy Surgery remains the best therapeutic option and a rising in cutting-edge molecular therapies is strongly needed.
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Affiliation(s)
- L Roncati
- Dipartimento ad Attività Integrata di Laboratori, Anatomia Patologica e Medica Legale; Struttura Complessa di Anatomia - Istologia e Citologia Patologica, Università degli Studi di Modena e Reggio Emilia, Modena
| | - A. Majorana
- Dipartimento ad Attività Integrata di Laboratori, Anatomia Patologica e Medica Legale; Struttura Complessa di Anatomia - Istologia e Citologia Patologica, Università degli Studi di Modena e Reggio Emilia, Modena
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