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Ivanyi P, Fröhlich T, Grünwald V, Zschäbitz S, Bedke J, Doehn C. The Treatment of Metastatic Renal Cell Carcinoma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024:arztebl.m2024.0147. [PMID: 39158349 DOI: 10.3238/arztebl.m2024.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
BACKGROUND Approximately 15 000 people receive a diagnosis of renal cell carcinoma (RCC) in Germany each year; in 20-30% of cases, metastatic RCC (mRCC) is already present at the time of diagnosis. This disease in the metastatic stage is still mainly treated palliatively, yet the multimodal therapeutic landscape has changed markedly over the past 15 years, with the approval of many new treatments for patients with mRCC. METHODS This review is based on prospective studies retrieved by a selective search in PubMed and the ASCO and ESMO databases and on the German and European oncological and urological guidelines for RCC. RESULTS Drugs are the mainstay of treatment. mRCC can be treated with a combination of two immune checkpoint inhibitors (CPIs), a CPI and a tyrosine-kinase inhibitor (TKI) (evidence level IA), or a TKI as monotherapy (evidence level IIC-IC). With prognosis-based sequential drug treatment, a mean progression-free survival of 12 to 24 months and an overall survival of approximately 50 months can be achieved from the time of initiation of first-line therapy. Aside from pharmacotherapy, the multidisciplinary tumor board should evaluate the indications for local treatments such as cytoreductive nephrectomy, metastasectomy, and radiotherapy, depending on the individual prognostic constellation and the patient's present condition. CONCLUSION Optimal individualized decisions require a high level of expertise and the collaboration of a multidisciplinary tumor board. Older prognostic parameters currently play a leading role in decision-making, while predictive parameters and molecular markers are not yet adequately validated.
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Bencina G, Billeskov R, Bak R, Al‐Sabbagh A, Pedersen JH, Lunetcas M, Heeno E, Tolouee S, Ashraf T, Fristrup N, Azawi N. Recurrence patterns following nephrectomy for renal cell carcinoma in a Danish nationwide cohort. BJUI COMPASS 2024; 5:791-798. [PMID: 39157167 PMCID: PMC11327494 DOI: 10.1002/bco2.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/22/2024] [Accepted: 05/12/2024] [Indexed: 08/20/2024] Open
Abstract
Objectives This study aimed to characterize the demographic and clinical features of patients with renal cell carcinoma (RCC) post-surgery for localized or locally advanced disease in a national Danish cohort, with a specific focus on describing recurrence patterns in a subgroup aligned with the adjuvant KEYNOTE-564 trial classification. Methods This was a retrospective analysis of the Danish Renal Cancer (DaRenCa) database. Eligible subjects were individuals with an RCC diagnosis between January 2014 and December 2017 who subsequently underwent radical or partial nephrectomy. Variables of interest were demographic and clinical characteristics, rates and sites of recurrence. Recurrence rates were also assessed in a subpopulation stratified using the risk classifications of the KEYNOTE-564 trial. Results A total of 2164 RCC patients were identified. Most patients (84.8%) had non-metastatic RCC (stage M0). A recurrence was observed in 250 of the M0 patients (13.6%). Patients with a recurrence were older, male, had a higher tumour stage, had undergone radical nephrectomy and had a higher Leibovich score. The majority (74.8%) of M0 patients had recurrence at distant metastatic sites. A total of 392 patients were stratified by the KEYNOTE-564 risk classification: 335 intermediate-high risk, 17 high risk and 40 M1 NED (metastatic with no evidence of disease). Recurrence was observed in 37.0%, 88.2% and 27.5% of these risk groups, respectively. Conclusions This study elucidates the rates and determinants of post-surgical RCC recurrence in Denmark, underscoring the potential of adjuvant immunotherapy in refining therapeutic strategies, identifying suitable beneficiaries and minimizing overtreatment risks in RCC care.
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Affiliation(s)
| | | | - Rasmine Bak
- Department of UrologyAarhus University HospitalAarhusDenmark
| | | | | | - Marina Lunetcas
- Department of UrologyHerlev and Gentofte University HospitalHerlevDenmark
| | - Emma Heeno
- Department of UrologyOdense University HospitalOdenseDenmark
| | - Sara Tolouee
- Department of UrologyRigshospitaletCopenhagenDenmark
| | - Tuba Ashraf
- Department of UrologyZealand University HospitalRoskildeDenmark
| | - Niels Fristrup
- Department of OncologyAarhus University HospitalAarhusDenmark
| | - Nessn Azawi
- Department of UrologyZealand University HospitalRoskildeDenmark
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Wang K, Guo B, Niu Y, Li G. Development and validation of a nomogram to predict recurrence for clinical T1/2 clear cell renal cell carcinoma patients after nephrectomy. BMC Surg 2024; 24:196. [PMID: 38926690 PMCID: PMC11201317 DOI: 10.1186/s12893-024-02487-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE To develop and validate a nomogram for predicting recurrence-free survival (RFS) for clinical T1/2 (cT1/2) clear cell renal cell carcinoma (ccRCC) patients after nephrectomy. METHODS Clinicopathological and survival data from 1289 cT1/2 ccRCC patients treated at the Second Hospital of Tianjin Medical University between 2017 and 2020 were included. Cox regression analysis was used to identify independent risk factors in 902 and 387 ccRCC patients in the training and validation cohorts, respectively, and construct the nomogram. The performance of the nomogram was assessed through calibration plots, time-dependent receiver operating characteristic (ROC) curves, C-index (concordance-index), and decision curve analysis (DCA). Kaplan-Meier curves were used to evaluate the probability of RFS in patients with different recurrence risks. RESULTS Age, tumor size, surgical approach, Fuhrman grade, and pT3a upstage were identified as independent predictors of RFS. The area under the curve (AUC) for the 3-year and 5-year RFS ROC curves were 0.791 and 0.835 in the training cohort, and 0.860 and 0.880 in the validation cohort. The DCA and calibration plots demonstrated the optimal application and excellent accuracy of the nomogram for predicting 3-year and 5-year RFS. Kaplan-Meier curves revealed significant differences in RFS among the three risk groups in both the training and validation cohorts. Clinically, the developed nomogram provides a more precise tool for risk stratification, enabling tailored postoperative management and surveillance strategies, ultimately aiming to improve patient outcomes. CONCLUSIONS We developed a nomogram for predicting RFS in cT1/2 ccRCC patients after nephrectomy with high accuracy. The clinical implementation of this nomogram can significantly enhance clinical decision-making, leading to improved patient outcomes and optimized resource utilization in the management of ccRCC.
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Affiliation(s)
- Keruo Wang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University Tianjin, Tianjin, 300211, China
| | - Baoyin Guo
- Department of Urology, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, 301800, China
| | - Yuanjie Niu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University Tianjin, Tianjin, 300211, China
| | - Gang Li
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University Tianjin, Tianjin, 300211, China.
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Thia I, Tan A, Botha E, Picardo A, Brown M, Thyer I, Abdul-Hamid A, Tan A, Teichmann D, Hayne D, McCombie SP. Nurse-led renal cell carcinoma clinic: a single center review. ANZ J Surg 2024; 94:1071-1075. [PMID: 38426382 DOI: 10.1111/ans.18920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND In 2015 our centre introduced a nurse-led renal cell cancer follow-up protocol and clinic for patients who have undergone partial or radical nephrectomy for organ-confined kidney tumours. The main aims of this clinic were to improve healthcare efficiency and standardize follow-up processes. OBJECTIVES The primary objective was to assess the effectiveness of a nurse-led renal cell cancer follow up clinic in regard to surveillance protocol compliance and the timely identification and appropriate management of recurrences. A secondary objective was to evaluate this locally developed follow up protocol against the current European Association of Urology (EAU) guidelines surveillance protocol. PATIENT AND METHODS All patients who underwent a partial or radical nephrectomy between 2015 and 2021 at a single Western Australia institution for a primary renal malignancy were included. Data was collected from local clinical information systems and protocol adherence, recurrence characteristics and management were assessed. The current EAU guidelines were applied to the cohort to assess differences in risk-stratification and theoretical outcomes between the protocols. RESULTS After a mean follow up period of 31.2 months (range 0-77 months), 75.5% (185/245) of patients had all follow up imaging and reviews within 1 month of the timeframe scheduled on the protocol. 17.1% (42/245) had a delay in their follow up of more than a month at some stage, 5.7% (14/245) did not attend for follow up but had documented attempts to facilitate their compliance, and 0.4% (1/245) were lost to follow up with no evidence of attempted contact. 15.5% (38/245) of patients had recurrence of malignancy detected during follow up and these were all discussed in a multi-disciplinary team (MDT) meeting. The recurrence rate was 2.5% (3/119) for low risk, 17.7% (14/79) for intermediate risk, and 44.7% (21/47) for high risk patients when they were re-stratified according to EAU risk categories. No recurrences were detected through ultrasound (USS) or chest x-ray (CXR) in this cohort and our protocol tended to place patients in higher risk-stratification groups as compared to current EAU guidelines. CONCLUSION Nurse-led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and Computerized tomography (CT) should be considered the imaging modality of choice for this purpose. The EAU surveillance protocol appears superior to our protocol, and we have therefore transitioned to the EAU guideline protocol going forward.
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Affiliation(s)
- I Thia
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - A Tan
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - E Botha
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - A Picardo
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - M Brown
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - I Thyer
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - A Abdul-Hamid
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - A Tan
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - D Teichmann
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - D Hayne
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - S P McCombie
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Shapiro DD, Lozar T, Cheng L, Xie E, Laklouk I, Lee MH, Huang W, Jarrard DF, Allen GO, Hu R, Kinoshita T, Esbona K, Lambert PF, Capitini CM, Kendziorski C, Abel EJ. Non-Metastatic Clear Cell Renal Cell Carcinoma Immune Cell Infiltration Heterogeneity and Prognostic Ability in Patients Following Surgery. Cancers (Basel) 2024; 16:478. [PMID: 38339231 PMCID: PMC10854750 DOI: 10.3390/cancers16030478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024] Open
Abstract
Predicting which patients will progress to metastatic disease after surgery for non-metastatic clear cell renal cell carcinoma (ccRCC) is difficult; however, recent data suggest that tumor immune cell infiltration could be used as a biomarker. We evaluated the quantity and type of immune cells infiltrating ccRCC tumors for associations with metastatic progression following attempted curative surgery. We quantified immune cell densities in the tumor microenvironment and validated our findings in two independent patient cohorts with multi-region sampling to investigate the impact of heterogeneity on prognostic accuracy. For non-metastatic ccRCC, increased CD8+ T cell infiltration was associated with a reduced likelihood of progression to metastatic disease. Interestingly, patients who progressed to metastatic disease also had increased percentages of exhausted CD8+ T cells. Finally, we evaluated the spatial heterogeneity of the immune infiltration and demonstrated that patients without metastatic progression had CD8+ T cells in closer proximity to ccRCC cells. These data strengthen the evidence for CD8+ T cell infiltration as a prognostic biomarker in non-metastatic ccRCC and demonstrate that multi-region sampling may be necessary to fully characterize immune infiltration within heterogeneous tumors. Tumor CD8+ T cell infiltration should be investigated as a biomarker in adjuvant systemic therapy clinical trials for high-risk non-metastatic RCC.
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Affiliation(s)
- Daniel D. Shapiro
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI 53705, USA
| | - Taja Lozar
- McArdle Laboratory for Cancer Research, University of Wisconsin, Madison, WI 53706, USA
| | - Lingxin Cheng
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (L.C.)
| | - Elliot Xie
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (L.C.)
| | - Israa Laklouk
- Department of Pathology, University of California, Los Angeles, Los Angeles, CA 90024, USA;
| | - Moon Hee Lee
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Wei Huang
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA (R.H.); (K.E.)
| | - David F. Jarrard
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Glenn O. Allen
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Rong Hu
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA (R.H.); (K.E.)
| | - Toshi Kinoshita
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA (R.H.); (K.E.)
| | - Karla Esbona
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA (R.H.); (K.E.)
| | - Paul F. Lambert
- McArdle Laboratory for Cancer Research, University of Wisconsin, Madison, WI 53706, USA
| | - Christian M. Capitini
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA;
| | - Christina Kendziorski
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (L.C.)
| | - Edwin Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
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Gupta S, Kanwar SS. Biomarkers in renal cell carcinoma and their targeted therapies: a review. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2023; 4:941-961. [PMID: 37970211 PMCID: PMC10645469 DOI: 10.37349/etat.2023.00175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/21/2023] [Indexed: 11/17/2023] Open
Abstract
Renal cell carcinoma (RCC) is one of the most life-threatening urinary malignancies displaying poor response to radiotherapy and chemotherapy. Although in the recent past there have been tremendous advancements in using targeted therapies for RCC, despite that it remains the most lethal urogenital cancer with a 5-year survival rate of roughly 76%. Timely diagnosis is still the key to prevent the progression of RCC into metastatic stages as well as to treat it. But due to the lack of definitive and specific diagnostic biomarkers for RCC and its asymptomatic nature in its early stages, it becomes very difficult to diagnose it. Reliable and distinct molecular markers can not only refine the diagnosis but also classifies the tumors into thier sub-types which can escort subsequent management and possible treatment for patients. Potential biomarkers can permit a greater degree of stratification of patients affected by RCC and help tailor novel targeted therapies. The review summarizes the most promising epigenetic [DNA methylation, microRNA (miRNA; miR), and long noncoding RNA (lncRNA)] and protein biomarkers that have been known to be specifically involved in diagnosis, cancer progression, and metastasis of RCC, thereby highlighting their utilization as non-invasive molecular markers in RCC. Also, the rationale and development of novel molecular targeted drugs and immunotherapy drugs [such as tyrosine kinase inhibitors and immune checkpoint inhibitors (ICIs)] as potential RCC therapeutics along with the proposed implication of these biomarkers in predicting response to targeted therapies will be discussed.
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Affiliation(s)
- Shruti Gupta
- Department of Biotechnology, Himachal Pradesh University, Summer Hill, Shimla 171 005, India
| | - Shamsher Singh Kanwar
- Department of Biotechnology, Himachal Pradesh University, Summer Hill, Shimla 171 005, India
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7
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Azawi N, Mosholt KSS, Fryd ND, Lund L, Brignone JI, Hvid N, Wulf-Johansson H, Pedersen OBV, Saekmose SG, Dabestani S. suPARnostic: an advanced predictive tool for detecting recurrence in renal cell carcinoma. BMC Urol 2023; 23:168. [PMID: 37875832 PMCID: PMC10594785 DOI: 10.1186/s12894-023-01337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Plasma soluble urokinase-type Plasminogen Activator Receptor (suPAR) predicts disease aggressiveness in renal cell carcinoma (ccRCC), but its prognostic accuracy has not been investigated. To investigate the prognostic accuracy of preoperative plasma suPAR in patients who received curative treatment for initially localized ccRCC. METHODS We retrospectively analyzed plasma samples stored in the Danish National Biobank between 2010 and 2015 from 235 patients with ccRCC at any stage. Relationships with outcome analyzed using univariate and multiple logistic Cox regression analysis. RESULTS There were 235 patients with ccRCC. The median follow-up period was 7.7 years. In univariate analysis suPAR ≥ 6 ng/mL was significantly associated with overall survival (OS) and recurrence-free survival (RFS). Patients with elevated suPAR were more likely to recur, with a Hazard Ratio (HR) of 2.3 for RFS. In multiple logistic regression, suPAR ≥ 6 ng/mL remained a negative predictor of OS and RFS. Limitations include retrospective study design, wide confidence intervals, and tumor subtype heterogeneity bias. CONCLUSIONS ccRCC patients with high plasma suPAR concentrations are at an elevated risk of disease recurrence and see lower OS. suPAR is a promising surveillance tool to more precisely follow up with ccRCC patients and detect future recurrences. In this study, we showed that new type of liquid marker in blood plasma, called suPAR, is associated to a higher risk of kidney cancer recurrence when elevated above 6ng/mL. We also showed suPAR to independently be able to predict patients overall and recurrence free survival in patient with any stage of kidney cancer.
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Affiliation(s)
- Nessn Azawi
- Department of Urology, Zealand University Hospital, Sygehusvej 6, Roskilde, 4000, Denmark.
- Institute of Clinical Medicine, University of Copenhagen, Norregade 10, copenhagen, Copenhagen, 1165, Denmark.
| | | | - Nathalie Demuth Fryd
- Deparment of Urology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark
| | - Lars Lund
- Deparment of Urology, Odense University Hospital, J. B. Winslows Vej 4, Odense, 5000, Denmark
| | - Juan Ignacio Brignone
- Department of Urology, Aalborg University hospital, Hobrovej 18-22, Aalborg, Aalborg, 9100, Denmark
| | - Nanna Hvid
- Deparment of Urology, Odense University Hospital, J. B. Winslows Vej 4, Odense, 5000, Denmark
| | - Helle Wulf-Johansson
- Department of Clinical Immunology, Naestved Hospital, Ringstedgade 61, Naestved, Naestved, 4700, Denmark
| | | | - Susanne Gjørup Saekmose
- Department of Clinical Immunology, Naestved Hospital, Ringstedgade 61, Naestved, Naestved, 4700, Denmark
| | - Saeed Dabestani
- Department of Urology, Kristianstad Central Hospital, Region Skane, Kristianstad, Sweden
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Lund, Sweden
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8
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Vasudev NS, Scelo G, Glennon KI, Wilson M, Letourneau L, Eveleigh R, Nourbehesht N, Arseneault M, Paccard A, Egevad L, Viksna J, Celms E, Jackson SM, Abedi-Ardekani B, Warren AY, Selby PJ, Trainor S, Kimuli M, Cartledge J, Soomro N, Adeyoju A, Patel PM, Wozniak MB, Holcatova I, Brisuda A, Janout V, Chanudet E, Zaridze D, Moukeria A, Shangina O, Foretova L, Navratilova M, Mates D, Jinga V, Bogdanovic L, Kovacevic B, Cambon-Thomsen A, Bourque G, Brazma A, Tost J, Brennan P, Lathrop M, Riazalhosseini Y, Banks RE. Application of Genomic Sequencing to Refine Patient Stratification for Adjuvant Therapy in Renal Cell Carcinoma. Clin Cancer Res 2023; 29:1220-1231. [PMID: 36815791 PMCID: PMC10068441 DOI: 10.1158/1078-0432.ccr-22-1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/12/2022] [Accepted: 01/10/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Patients with resected localized clear-cell renal cell carcinoma (ccRCC) remain at variable risk of recurrence. Incorporation of biomarkers may refine risk prediction and inform adjuvant treatment decisions. We explored the role of tumor genomics in this setting, leveraging the largest cohort to date of localized ccRCC tissues subjected to targeted gene sequencing. EXPERIMENTAL DESIGN The somatic mutation status of 12 genes was determined in 943 ccRCC cases from a multinational cohort of patients, and associations to outcomes were examined in a Discovery (n = 469) and Validation (n = 474) framework. RESULTS Tumors containing a von-Hippel Lindau (VHL) mutation alone were associated with significantly improved outcomes in comparison with tumors containing a VHL plus additional mutations. Within the Discovery cohort, those with VHL+0, VHL+1, VHL+2, and VHL+≥3 tumors had disease-free survival (DFS) rates of 90.8%, 80.1%, 68.2%, and 50.7% respectively, at 5 years. This trend was replicated in the Validation cohort. Notably, these genomically defined groups were independent of tumor mutational burden. Amongst patients eligible for adjuvant therapy, those with a VHL+0 tumor (29%) had a 5-year DFS rate of 79.3% and could, therefore, potentially be spared further treatment. Conversely, patients with VHL+2 and VHL+≥3 tumors (32%) had equivalent DFS rates of 45.6% and 35.3%, respectively, and should be prioritized for adjuvant therapy. CONCLUSIONS Genomic characterization of ccRCC identified biologically distinct groups of patients with divergent relapse rates. These groups account for the ∼80% of cases with VHL mutations and could be used to personalize adjuvant treatment discussions with patients as well as inform future adjuvant trial design.
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Affiliation(s)
- Naveen S. Vasudev
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Ghislaine Scelo
- World Health Organisation (WHO), International Agency for Research on Cancer (IARC), The Genomic Epidemiology Branch, Lyon, France
| | - Kate I. Glennon
- Victor Philip Dahdaleh Institute of Genomic Medicine at McGill University, Montreal, Québec, Canada
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
| | - Michelle Wilson
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Louis Letourneau
- Victor Philip Dahdaleh Institute of Genomic Medicine at McGill University, Montreal, Québec, Canada
| | - Robert Eveleigh
- Victor Philip Dahdaleh Institute of Genomic Medicine at McGill University, Montreal, Québec, Canada
| | - Nazanin Nourbehesht
- Victor Philip Dahdaleh Institute of Genomic Medicine at McGill University, Montreal, Québec, Canada
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
| | - Madeleine Arseneault
- Victor Philip Dahdaleh Institute of Genomic Medicine at McGill University, Montreal, Québec, Canada
| | - Antoine Paccard
- Victor Philip Dahdaleh Institute of Genomic Medicine at McGill University, Montreal, Québec, Canada
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Juris Viksna
- Institute of Mathematics and Computer Science, University of Latvia, Riga, Latvia
| | - Edgars Celms
- Institute of Mathematics and Computer Science, University of Latvia, Riga, Latvia
| | - Sharon M. Jackson
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Behnoush Abedi-Ardekani
- World Health Organisation (WHO), International Agency for Research on Cancer (IARC), The Genomic Epidemiology Branch, Lyon, France
| | - Anne Y. Warren
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom
| | - Peter J. Selby
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Sebastian Trainor
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Michael Kimuli
- Pyrah Department of Urology, Leeds Teaching Hospitals NHS Trust, Lincoln Wing, St James's University Hospital, Leeds, United Kingdom
| | - Jon Cartledge
- Pyrah Department of Urology, Leeds Teaching Hospitals NHS Trust, Lincoln Wing, St James's University Hospital, Leeds, United Kingdom
| | - Naeem Soomro
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Poulam M. Patel
- Division of Cancer & Stem Cells, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Magdalena B. Wozniak
- World Health Organisation (WHO), International Agency for Research on Cancer (IARC), The Genomic Epidemiology Branch, Lyon, France
| | - Ivana Holcatova
- Charles University in Prague, First Faculty of Medicine, Institute of Hygiene and Epidemiology, Prague, Czech Republic
| | | | - Vladimir Janout
- Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | - Estelle Chanudet
- World Health Organisation (WHO), International Agency for Research on Cancer (IARC), The Genomic Epidemiology Branch, Lyon, France
| | - David Zaridze
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russian Federation
| | - Anush Moukeria
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russian Federation
| | - Oxana Shangina
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russian Federation
| | - Lenka Foretova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Marie Navratilova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Dana Mates
- National Institute of Public Health, Bucuresti, Romania
| | - Viorel Jinga
- Carol Davila University of Medicine and Pharmacy, Prof. Dr. Th. Burghele Clinical Hospital, Bucharest, Romania
| | - Ljiljana Bogdanovic
- Institute of Pathology, School of Medicine Belgrade, University of Belgrade, Belgrade, Serbia
| | - Bozidar Kovacevic
- Institute of Pathology and Forensic Medicine, Military Medical Academy, Belgrade, Serbia
| | - Anne Cambon-Thomsen
- Institut National de la Santé et de la Recherche Médicale (INSERM) and Université Toulouse III Paul Sabatier (UPS), Toulouse, France
| | - Guillaume Bourque
- Victor Philip Dahdaleh Institute of Genomic Medicine at McGill University, Montreal, Québec, Canada
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
| | - Alvis Brazma
- European Bioinformatics Institute, European Molecular Biology Laboratory, EMBL-EBI, Wellcome Trust Genome Campus, Hinxton, United Kingdom
| | - Jörg Tost
- Centre National de Recherche en Génomique Humaine, CEA - Institut de Biologie Francois Jacob, University Paris Saclay, Evry, France
| | - Paul Brennan
- World Health Organisation (WHO), International Agency for Research on Cancer (IARC), The Genomic Epidemiology Branch, Lyon, France
| | - Mark Lathrop
- Victor Philip Dahdaleh Institute of Genomic Medicine at McGill University, Montreal, Québec, Canada
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
| | - Yasser Riazalhosseini
- Victor Philip Dahdaleh Institute of Genomic Medicine at McGill University, Montreal, Québec, Canada
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
| | - Rosamonde E. Banks
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
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9
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Yap NY, Ong TA, Pailoor J, Gobe G, Rajandram R. The significance of CD14 in clear cell renal cell carcinoma progression and survival prognosis. Biomarkers 2023; 28:24-31. [PMID: 36315054 DOI: 10.1080/1354750x.2022.2142292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose: CD14-positive tumour and immune cells have been implicated in cancer progression. This study evaluated the prognostic significance of CD14 immunostaining in clear cell renal cell carcinoma (ccRCC) compared to the adjacent non-cancer kidney, and serum soluble CD14 (sCD14) levels in patients versus controls.Methods: Immunohistochemistry was performed for CD14 on ccRCC and the corresponding adjacent non-cancer kidney tissue from 88 patients. Staining intensity was determined using Aperio ImageScope morphometry. Serum sCD14 was evaluated for 39 ccRCC patients and 38 non-cancer controls using ELISA. CD14 levels were compared with tumour characteristics and survival status.Results: CD14 overall and nuclear immunostaining was higher in ccRCC compared to the adjacent non-cancer kidney tissue. CD14 nuclear immunostaining in the adjacent non-cancer kidney was significantly associated with advanced stage and adverse RCC survival prognosis. Serum sCD14 concentration was elevated in ccRCC patients compared to non-cancer controls and was also significantly associated with tumour stage and worse survival prognosis. Higher CD14 expression, in particular CD14 positive immune cell infiltrates found in the adjacent non-RCC kidney tissue, were associated with tumour progression and poorer prognosis.Conclusion: The levels of CD14 in non-RCC adjacent kidney and serum could be potential prognostic indicators.
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Affiliation(s)
- Ning Yi Yap
- Department of Surgery, Faculty of Medicine, Universiti Malaya, Malaysia.,Laboratory, Subang Jaya Medical Centre, Malaysia
| | - Teng Aik Ong
- Department of Surgery, Faculty of Medicine, Universiti Malaya, Malaysia.,Universiti Malaya Medical Centre, Malaysia
| | - Jayalakshmi Pailoor
- Laboratory, Subang Jaya Medical Centre, Malaysia.,Department of Pathology, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Glenda Gobe
- Kidney Disease Research Collaborative, School of Biomedical Sciences, Translational Research Institute, The University of Queensland, Brisbane, Australia
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10
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Impact of COVID-19 on Uro-Oncological Patients: A Comprehensive Review of the Literature. Microorganisms 2023; 11:microorganisms11010176. [PMID: 36677468 PMCID: PMC9865028 DOI: 10.3390/microorganisms11010176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
Background: The aim of this paper is to discuss the impact of COVID-19 on patients with urological malignancies (prostate cancer, bladder and upper tract urothelial cancer, kidney cancer, penile and testicular cancer) and to review the available recommendations reported in the literature. Methods: A review was performed, through the PubMed database, regarding available recommendations reported in the literature, to identify studies examining the impact of COVID-19 on treatment and clinical outcomes (including upstaging, recurrence, and mortality) for uro-oncological patients. Results: The COVID-19 pandemic dramatically changed the urological guidelines and patients' access to screening programs and follow-up visits. Great efforts were undertaken to guarantee treatments to high-risk patients although follow up was not always possible due to recurrent surges, and patients with lower risk cancers had to wait for therapies. Conclusions: Physically and mentally, uro-oncological patients paid a heavy price during the COVID-19 pandemic. Long term data on the "costs" of clinical decisions made during the COVID-19 pandemic are still to be revealed and analyzed.
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11
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Ell J, Balz P, Manava P, Hüttenbrink C. Downstaging and Pathological Complete Response of Locally Recurrent Sarcomatoid Renal Cell Carcinoma under Pembrolizumab and Lenvatinib: A Case Report and Review of Literature. Case Rep Oncol 2023; 16:1245-1252. [PMID: 37915993 PMCID: PMC10616667 DOI: 10.1159/000534000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/04/2023] [Indexed: 11/03/2023] Open
Abstract
The advent of immune checkpoint inhibition opened new perspectives for patients with recurrent or metastasized renal cell carcinoma. In case of recurrent disease, surgical resection remains the most promising therapeutic option. Surgical resection is associated with improved overall survival and demonstrated curative potential given complete resection of metastases can be performed. This report presents the case of a patient with local recurrence of dedifferentiated sarcomatoid renal cell carcinoma approximately 1 year after initial open lumbar nephrectomy. After initial evaluation, surgical removal was deemed infeasible and an induction therapy with pembrolizumab and lenvatinib was initiated. After 3 months, corresponding to 5 cycles of pembrolizumab, the tumor showed a partial response on imaging control and was successfully resected en bloc. Histopathological examination of the specimen revealed no evidence of viable neoplastic cells. This is the first report describing a complete pathological response of a locally recurrent dedifferentiated sarcomatoid renal cell carcinoma after treatment with pembrolizumab and lenvatinib. Overall, the combination therapy was well tolerated with a maximum Common Terminology Criteria for Adverse Events Level of Two. These findings underline the potential of multimodal therapeutic strategies for recurrent renal cell carcinoma, such as induction therapies to downstage initially nonresectable masses, and highlight the need for prospective studies to allow for evidence-based treatment plans.
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Affiliation(s)
- Jascha Ell
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Philipp Balz
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Panagiota Manava
- Department of Radiology, Neuroradiology and Nuclear Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Clemens Hüttenbrink
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
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12
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Marconi L, Kuusk T, Capitanio U, Beisland C, Lam T, Pello SF, Stewart GD, Klatte T, Volpe A, Ljungberg B, Dabestani S, Bex A. Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups. EUR UROL SUPPL 2022; 47:65-72. [PMID: 36601038 PMCID: PMC9806698 DOI: 10.1016/j.euros.2022.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/16/2022] Open
Abstract
Background Retrospective comparative studies suggest a survival benefit after complete local treatment of recurrence (LTR) in renal cell carcinoma (RCC), which may be largely due to an indication bias. Objective To determine the role of LTR in a homogeneous population characterised by limited and potentially resectable recurrence. Design setting and participants RECUR is a protocol-based multicentre European registry capturing patient and tumour characteristics, risk of recurrence (RoR), recurrence patterns, and survival of those curatively treated for nonmetastatic RCC from 2006 to 2011. Per-protocol resectable disease (RD) recurrence was defined as (1) solitary metastases, (2) oligometastases, or (3) renal fossa or renal recurrence after radical or partial nephrectomy, respectively. Intervention Local treatment of recurrence. Outcome measurements and statistical analysis Overall survival (OS) and cancer-specific survival was compared in the RD population that underwent LTR versus no LTR. We constructed a multivariate model to predict risk factors for overall mortality and analysed the effect of LTR across RoR groups. Results and limitations Of 3039 patients with localised RCC treated with curative intent, 505 presented with recurrence, including 176 with RD. Of these patients, 97 underwent LTR and 79 no LTR. Patients in the LTR group were younger (64.3 [40-80] vs 69.2 [45-87] yr; p = 0.001). The median OS was 70.3 mo (95% confidence interval [CI] 58-82.6) versus 27.4 mo (95% CI 23.6-31.15) in the LTR versus no-LTR group (p < 0.001). After a multivariate analysis, having LTR (hazard ratio [HR] 0.37 [95% CI 0.2-0.6]), having low- versus high-risk RoR (HR 0.42 [95% CI [0.20-0.83]), and not having extra-abdominal/thoracic metastasis (HR 1.96 [95% CI 1.02-3.77]) were prognostic factors of longer OS. The LTR effect on survival was consistent across risk groups. OS HR for high, intermediate, and low risks were 0.36 (0.2-0.64), 0.27 (0.11-0.65), and 0.26 (0.08-0.8), respectively. Limitations include retrospective design. Conclusions This is the first study assessing the effectiveness of LTR in RCC in a comparable population with RD. This study supports the role of LTR across all RoR groups. Patient summary We assessed the effectiveness of local treatment of resectable recurrent renal cell carcinoma after surgical treatment of the primary kidney tumour. Local treatment of recurrence was associated with longer survival across groups with a risk of recurrence.
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Affiliation(s)
- Lorenzo Marconi
- Department of Urology and Renal Transplantation, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Teele Kuusk
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy,Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Christian Beisland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway,Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Thomas Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK,Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Grant D. Stewart
- Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tobias Klatte
- Department of Urology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Borje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Saeed Dabestani
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Malmö, Sweden
| | - Axel Bex
- Department of Urology, The Royal Free London NHS Foundation Trust, London, UK,Division of Surgery and Interventional Science, University College London, London, UK,Surgical Oncology Division, Urology Department, The Netherlands Cancer Institute, Amsterdam, The Netherlands,Corresponding author. Department of Urology, The Royal Free London NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; Surgical Oncology Division, Urology Department, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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13
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Yang RN, Zhou FR, Wang HY, Wang QH, Ji JL, Huang T, Guo C, Dong Z, Cao YW. Antitumor activity of RUNX3: Upregulation of E-cadherin and downregulation of the epithelial–mesenchymal transition in clear-cell renal cell carcinoma. Open Life Sci 2022; 17:1579-1590. [DOI: 10.1515/biol-2022-0494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
RUNX3 is a transcription factor and tumor suppressor that is silenced or inactivated in diverse tumors. The effect of RUNX3 on the epithelial–mesenchymal transition in clear-cell renal cell carcinoma (CCRCC) remains unclear. We determined the expression of RUNX3 and E-cadherin in tumor tissues and adjacent normal tissues of 30 CCRCC patients; established cultured CCRCC cells with the overexpression of RUNX3; and examined the in vivo tumorigenic function of RUNX3 in a nude mouse xenograft model of CCRCC. RUNX3 and E-cadherin were downregulated in human CCRCC samples. Cell lines with RUNX3 overexpression had reduced cell proliferation, invasion, and migration, a prolonged cell cycle, increased apoptosis, and increased expression of E-cadherin. In the nude mouse xenograft model of CCRCC, tumors with the overexpression of RUNX3 had smaller volumes and weights and had increased expression of E-cadherin. In conclusion, RUNX3 overexpression increased the level of E-cadherin and inhibited the proliferation, invasion, and migration of CCRCC in vitro and in vivo. RUNX3 has potential use as a biomarker for prognostic monitoring of CCRCC and as a therapeutic target for the treatment of this cancer.
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Affiliation(s)
- Ruo-Nan Yang
- Department of Renal Transplantation and Urology, The Affiliated Hospital of Qingdao University , No. 59 Haier Road , Qingdao , Shandong , China
| | - Fu-Rong Zhou
- Department of Pharmacy, Yantai Yuhuangding Hospital , Yantai , Shandong , China
| | - Hong-Yang Wang
- Department of Renal Transplantation and Urology, The Affiliated Hospital of Qingdao University , No. 59 Haier Road , Qingdao , Shandong , China
| | - Qing-Hai Wang
- Department of Renal Transplantation and Urology, The Affiliated Hospital of Qingdao University , No. 59 Haier Road , Qingdao , Shandong , China
| | - Jian-Lei Ji
- Department of Renal Transplantation and Urology, The Affiliated Hospital of Qingdao University , No. 59 Haier Road , Qingdao , Shandong , China
| | - Tao Huang
- Department of Renal Transplantation and Urology, The Affiliated Hospital of Qingdao University , No. 59 Haier Road , Qingdao , Shandong , China
| | - Chen Guo
- Department of Renal Transplantation and Urology, The Affiliated Hospital of Qingdao University , No. 59 Haier Road , Qingdao , Shandong , China
| | - Zhen Dong
- Department of Renal Transplantation and Urology, The Affiliated Hospital of Qingdao University , No. 59 Haier Road , Qingdao , Shandong , China
| | - Yan-Wei Cao
- Department of Renal Transplantation and Urology, The Affiliated Hospital of Qingdao University , No. 59 Haier Road , Qingdao , Shandong , China
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14
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French AFU Cancer Committee Guidelines - Update 2022-2024: management of kidney cancer. Prog Urol 2022; 32:1195-1274. [DOI: 10.1016/j.purol.2022.07.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
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15
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Sundaram M, Song Y, Rogerio JW, Zhang S, Bhattacharya R, Adejoro O, Carley C, Zhu JJ, Signorovitch J, Haas NB. Clinical and economic burdens of recurrence following nephrectomy for intermediate high- or high-risk renal cell carcinoma: A retrospective analysis of Surveillance, Epidemiology, and End Results–Medicare data. J Manag Care Spec Pharm 2022; 28:1149-1160. [DOI: 10.18553/jmcp.2022.22133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Murali Sundaram
- Merck Sharp & Dohme LLC., a subsidiary of Merck & Co., Inc., Rahway, NJ
| | - Yan Song
- Analysis Group, Inc., Boston, MA
| | | | - Su Zhang
- Analysis Group, Inc., Boston, MA
| | | | - Oluwakayode Adejoro
- Merck Sharp & Dohme LLC., a subsidiary of Merck & Co., Inc., Rahway, NJ
- Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA
| | | | - Jing Jing Zhu
- Analysis Group, Inc., Boston, MA
- Student at School of Medicine, Washington University, St Louis, MO
| | | | - Naomi B Haas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
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16
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Fallara G, Larcher A, Dabestani S, Fossati N, Järvinen P, Nisen H, Gudmundsson E, Lam TB, Marconi L, Fernandéz-Pello S, Meijer RP, Volpe A, Beisland C, Klatte T, Stewart GD, Bensalah K, Ljungberg B, Bertini R, Montorsi F, Bex A, Capitanio U. Recurrence pattern in localized RCC: results from a European multicenter database (RECUR). Urol Oncol 2022; 40:494.e11-494.e17. [DOI: 10.1016/j.urolonc.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/08/2022] [Accepted: 08/18/2022] [Indexed: 10/14/2022]
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17
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Gatto F, Dabestani S, Bratulic S, Limeta A, Maccari F, Galeotti F, Volpi N, Stierner U, Nielsen J, Lundstam S. Plasma and Urine Free Glycosaminoglycans as Monitoring Biomarkers in Nonmetastatic Renal Cell Carcinoma—A Prospective Cohort Study. EUR UROL SUPPL 2022; 42:30-39. [PMID: 35911082 PMCID: PMC9334826 DOI: 10.1016/j.euros.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Francesco Gatto
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Corresponding authors. Department of Oncology-Pathology, Karolinska Institute, 171 64 Stockholm, Sweden (F. Gatto). Department of Urology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden (S. Lundstam).
| | - Saeed Dabestani
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Kristianstad Central Hospital, Region Skane, Lund, Sweden
- Department of Urology, Kristianstad Central Hospital, Region Skane, Kristianstad, Sweden
| | - Sinisa Bratulic
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Angelo Limeta
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Francesca Maccari
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Galeotti
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Volpi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ulrika Stierner
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jens Nielsen
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
- BioInnovation Institute, Copenhagen N, Denmark
| | - Sven Lundstam
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Corresponding authors. Department of Oncology-Pathology, Karolinska Institute, 171 64 Stockholm, Sweden (F. Gatto). Department of Urology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden (S. Lundstam).
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18
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Koudonas A, Papaioannou M, Kampantais S, Anastasiadis A, Hatzimouratidis K, Dimitriadis G. Methylation of PCDH17 and NEFH as prognostic biomarker for nonmetastatic RCC: A cohort study. Medicine (Baltimore) 2022; 101:e29599. [PMID: 35838992 PMCID: PMC11132415 DOI: 10.1097/md.0000000000029599] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/01/2022] [Indexed: 11/27/2022] Open
Abstract
DNA methylation makes up a main part of the molecular mechanism of cancer evolution and has shown promising results in the prognosis of renal cell cancer (RCC). In this study, we investigated the possible association of promoter methylation of PCDH17, NEFH, RASSF1A, and FHIT, genes with the prognosis of nonmetastatic RCC patients. Cancerous and normal adjacent tissues from surgical specimens of 41 patients with long follow-up were treated for DNA isolation and bisulfite conversion. The gene promoter methylation was determined with quantitative methylation-specific PCR (qMSP). Wilcoxon signed-rank test was used for paired methylation comparisons, while univariate linear regression and Mann-Whitney test were applied for associating methylation status with clinical and disease characteristics. Cox regression proportional hazards models and Kaplan-Meier plots were used for survival analyses in reference to methylation status. Paired comparisons showed tissue-specific hypermethylation for PCDH17 (P < .001), NEFH (P < .001), RASSF1A (P = .032), while a positive association of methylation in normal tissues with age was demonstrated for PCDH17 (P < .001), RASSF1A (P < .001), FHIT (P < .001). PCDH17 was more methylated in cases with clear cell RCC (P = .015) and high-grade tumor (P = .013), while NEFH methylation was higher in locally advanced cases (P = .032). PCDH17 hypermethylation in cancerous and normal tissues was linked to shorter disease-specific survival (DSS, P = .026, P = .004), disease-free survival (DFS, P = .004, P = .019) while NEFH hypermethylation in cancerous tissues was related to shorter DSS (P = .032). Increased methylation difference of NEFH was also associated with shorter DSS (P = .041) and DFS (P = .020), while the corresponding parameter for PCDH17 was associated with poor DFS (P = .014). Kaplan-Meier curves for hypermethylation in cancer tissues demonstrated different clinical courses for PCDH17 (P = .017), NEFH (P = .023) regarding DSS, and PCDH17 (P = .001) regarding DFS. Our study not only highlights the prognostic value of promoter methylation of PCDH17 and NEFH in cancer tissues but also is the first report of the prognostic value of methylation alterations in normal tissues. Our findings are the first report of the prognostic value of methylation alterations in normal tissues, which can contribute to improved assessment of recurrence risk.
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Affiliation(s)
- Antonios Koudonas
- First Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Papaioannou
- Laboratory of Biological Chemistry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyridon Kampantais
- First Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Anastasiadis
- First Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Georgios Dimitriadis
- First Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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19
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Risk of recurrence after nephrectomy: Comparison of predictive ability of validated risk models. Urol Oncol 2022; 40:167.e1-167.e7. [DOI: 10.1016/j.urolonc.2021.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
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20
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Staehler M, Schuler T, Spek A, Rodler S, Tamalunas A, Fürweger C, Muacevic A. Propensity Score-Matched Analysis of Single Fraction Robotic Radiosurgery Versus Open Partial Nephrectomy in Renal Cell Carcinoma: Oncological Outcomes. Cureus 2022; 14:e21623. [PMID: 35233307 PMCID: PMC8881236 DOI: 10.7759/cureus.21623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction High-dose local stereotactic robotic radiosurgery (RRS) is a non-invasive alternative to surgery in renal masses and selected patients. We have, so far, limited its use to the elderly and patients at high risk from surgery. In this study, we matched patients with renal tumors who were treated with single fraction RRS to patients who underwent open partial nephrectomy (OPN). Methods Between January 2009 and December 2017, we included 571 consecutive patients undergoing OPN and 99 patients who underwent RRS in this retrospective analysis. Patients had to have a follow-up of at least six months and we were able to match 35 with a propensity score. Matching criteria were Eastern Cooperative Oncology Group (ECOG) status, age, clinical tumor, nodes, and metastases (TNM), and tumor diameter. Tumor response, renal function, survival, and adverse events were evaluated every three months until progression or death. Results Median age was 65 years for RRS (range 58-75) and 71 (range 56-76) for OPN (p=0.131). Median diameter of renal tumors was 2.8 cm (range 2.4-3.9) for RRS and 3.5 cm (2.8-4.5) for OPN, p=0.104. Median follow-up was 28.1 months (range 6.0-78.3 months). Local tumor control nine months after RRS and OPN was 98% (95% CI: 89-99%). Renal function remained stable with a median creatinine clearance (Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)) at baseline of 76.8mlmin/1.73m2 (range 25.3-126.3) and 70.3ml/min/1.73m2 (range 18.6-127.3) at follow-up (p=0.89). Median overall survival was not reached. No difference in overall survival (OS) was seen in RRS compared to OPN (p=0.459). Conclusions Single fraction RRS is an alternative to OPN in patients unfit for surgery. Oncological and functional results are comparable to those of OPN. Further studies are needed to determine long-term results and limits of RRS in this setting and in younger patients.
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Affiliation(s)
- Michael Staehler
- Urology, University Hospital, Ludwig Maximilians University Munich, Munich, DEU
| | - Tina Schuler
- Urology, University Hospital, Ludwig Maximilians University Munich, Munich, DEU
| | - Annabel Spek
- Urology, University Hospital, Ludwig Maximilians University Munich, Munich, DEU
| | - Severin Rodler
- Urology, University Hospital, Ludwig Maximilians University Munich, Munich, DEU
| | - Alexander Tamalunas
- Urology, University Hospital, Ludwig Maximilians University Munich, Munich, DEU
| | - Christoph Fürweger
- Medical Physics, European CyberKnife Center, Munich, DEU
- Stereotaxy and Neurosurgery, University Hospital Cologne, Cologne, DEU
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21
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Surgical Treatment for Metastatic Kidney Cancer. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Staehler M, Rodler S, Schott M, Casuscelli J, Stief C, Spek A, Schlenker B. Polyethylene glycol-coated collagen patch (hemopatch ®) in open partial nephrectomy. World J Urol 2022; 40:127-132. [PMID: 34480235 PMCID: PMC8813698 DOI: 10.1007/s00345-021-03827-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To describe the results of a polyethylene glycol-coated collagen patch, Hemopatch® on blood loss, surgical time and renal function in partial nephrectomy (PN) for renal cell carcinoma (RCC). METHODS Out of a single surgeon cohort of n = 565 patients undergoing conventional open PN (CPN) between 01/2015 and 12/2017 at the University of Munich a consecutive subgroup (n = 42) was operated on using a polyethylene glycol-coated collagen-based sealant Hemopatch® (Baxter International Inc., Deerfield, IL, USA) (HPN). RESULTS Median age was 65.2 years (range 12.7-95.2) with median follow-up of 9.43 months (0.03-49.15). Baseline renal function (CKD-EPI) was 78.56 ml/min/1.73 m2 (range 20.38-143.09) with a non-significant decline to 74.78 ml/min/1.73 m2 (range 3.75-167.74) at follow-up. In CPN 46% had low complexity, 33% moderate complexity and 20% high complexity lesions with 33% low, 40% moderate and 27% high complexity masses in HPN. Median tumor size was 4.3 cm (range 1-38 cm) in CPN with 4.8 cm (range 3.8-18.3 cm) with HPN, p = 0.293. Median blood loss and duration of surgery was significantly lower in the HPN group vs. CPN (146 ml ± 195 vs. 114 ml ± 159 ml; p = 0.021; 43 min ± 27 for HPN vs. 53 min ± 49; p = 0.035) with no difference in clamping time (12.6 min ± 8.6 for HPN vs. 12.0 min ± 9.5; p = 0.701). CONCLUSIONS Hemopatch® supported renoraphy shows promising results compared to standard renoraphy in PN. No side effects were seen. Further studies should evaluate the prevention of arterio-venous or urinary fistulas. In complex partial nephrectomies Hemopatch® supported renoraphy should be considered.
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Affiliation(s)
- Michael Staehler
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany.
- Multidisciplinary Center On Renal Tumors, Department of Urology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - S Rodler
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - M Schott
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - J Casuscelli
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - C Stief
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - A Spek
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - B Schlenker
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
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Prunty M, Bukavina L, Psutka SP. Metastasectomy in kidney cancer: current indications and treatment approaches. Curr Opin Support Palliat Care 2021; 15:266-275. [PMID: 34610626 DOI: 10.1097/spc.0000000000000574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Although systemic agents for the treatment of metastatic renal cell carcinoma (mRCC) have improved survival, remission and cure for mRCC remains rare with systemic therapy alone. However, there is a body of observational evidence supporting a survival benefit in mRCC among patients who undergo complete surgical consolidation including resection of the primary tumor and all metastatic deposits. In this review, we aim to synthesize recent evidence regarding metastasectomy (MTS), with or without concurrent systemic therapy, in mRCC. RECENT FINDINGS MTS is a critical component of mRCC patient care, alongside modern systemic therapy. Presently, there is a robust body of observational data supporting the association between surgical MTS and improved oncologic outcomes, especially when complete MTS is feasible. SUMMARY Among a retrospective, observational body of literature, MTS is associated with improved oncologic outcomes. However, it is impossible to discern to what degree these findings are biased by favorable tumor biology and patient selection, as opposed to being related to surgical MTS itself.
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Affiliation(s)
- Megan Prunty
- Department of Urology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Laura Bukavina
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, Washington, USA
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24
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Kanesvaran R, Porta C, Wong A, Powles T, Ng QS, Schmidinger M, Ye D, Malhotra H, Miura Y, Lee JL, Chong FLT, Pu YS, Yen CC, Saad M, Lee HJ, Kitamura H, Bhattacharyya GS, Curigliano G, Poon E, Choo SP, Peters S, Lim E, Yoshino T, Pentheroudakis G. Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with renal cell carcinoma. ESMO Open 2021; 6:100304. [PMID: 34864348 PMCID: PMC8645910 DOI: 10.1016/j.esmoop.2021.100304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/22/2021] [Accepted: 10/17/2021] [Indexed: 01/05/2023] Open
Abstract
The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of renal cell carcinoma was published in 2019 with an update planned for 2021. It was therefore decided by both the ESMO and the Singapore Society of Oncology (SSO) to convene a special, virtual guidelines meeting in May 2021 to adapt the ESMO 2019 guidelines to take into account the ethnic differences associated with the treatment of renal cell carcinomas in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with renal cell carcinoma representing the oncological societies of China (CSCO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug access restrictions in the different Asian countries. The latter were discussed when appropriate.
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Affiliation(s)
- R Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
| | - C Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari 'A. Moro' and Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - A Wong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - T Powles
- Barts Cancer Institute, Queen Mary University, London, UK
| | - Q S Ng
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - M Schmidinger
- Department of Urology I, and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - D Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - H Malhotra
- Department of Medical Oncology, Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, India
| | - Y Miura
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - J L Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - F L T Chong
- Department of Radiotherapy and Oncology, Sabah Women and Children's Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Y-S Pu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - C-C Yen
- Division of Clinical Research, Department of Medical Research and Division of Medical Oncology, Center for Immuno-oncology, Department of Oncology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - M Saad
- Department of Clinical Oncology, University of Malaya Medical Centre, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - H J Lee
- Department of Medical Oncology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - H Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - G Curigliano
- Istituto Europeo di Oncologia, IRCCS and University of Milano, Milan, Italy
| | - E Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - S P Choo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore; Medical Oncology, Curie Oncology, Singapore, Singapore
| | - S Peters
- Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - E Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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25
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Unveiling the World of Circulating and Exosomal microRNAs in Renal Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13215252. [PMID: 34771419 PMCID: PMC8582552 DOI: 10.3390/cancers13215252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Liquid biopsies have emerged as a new tool for early diagnosis. In renal cell carcinoma, this need is also evident and may represent an improvement in disease management. Hence, in this review we discuss the most updated advances in the assessment of miRNAs in liquid biopsies. Moreover, we explore the potential of circulating or exosome miRNAs in renal cell carcinoma to overcome the tissue biopsies limitations. Abstract Renal cell carcinoma is the third most common urological cancer. Despite recent advances, late diagnosis and poor prognosis of advanced-stage disease remain a major problem, entailing the need for novel early diagnosis tools. Liquid biopsies represent a promising minimally invasive clinical tool, providing real-time feedback of tumor behavior and biological potential, addressing its clonal evolution and representing its heterogeneity. In particular, the study of circulating microRNAs and exosomal microRNAs in liquid biopsies experienced an exponential increase in recent years, considering the potential clinical utility and available technology that facilitates implementation. Herein, we provide a systematic review on the applicability of these biomarkers in the context of renal cell carcinoma. Issues such as additional benefit from extracting microRNAs transported in extracellular vesicles, use for subtyping and representation of different histological types, correlation with tumor burden, and prediction of patient outcome are also addressed. Despite the need for more conclusive research, available data indicate that exosomal microRNAs represent a robust minimally invasive biomarker for renal cell carcinoma. Thus, innovative research on microRNAs and novel detection techniques are likely to provide clinically relevant biomarkers, overcome current clinical challenges, and improve patient management.
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26
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Oza B, Frangou E, Smith B, Bryant H, Kaplan R, Choodari-Oskooei B, Powles T, Stewart GD, Albiges L, Bex A, Choueiri TK, Davis ID, Eisen T, Fielding A, Harrison D, McWhirter A, Mulhere S, Nathan P, Rini B, Ritchie A, Scovell S, Shakeshaft C, Stockler MR, Thorogood N, Parmar MKB, Larkin J, Meade A. RAMPART: A phase III multi-arm multi-stage trial of adjuvant checkpoint inhibitors in patients with resected primary renal cell carcinoma (RCC) at high or intermediate risk of relapse. Contemp Clin Trials 2021; 108:106482. [PMID: 34538402 PMCID: PMC8520913 DOI: 10.1016/j.cct.2021.106482] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND 20-60% of patients with initially locally advanced Renal Cell Carcinoma (RCC) develop metastatic disease despite optimal surgical excision. Adjuvant strategies have been tested in RCC including cytokines, radiotherapy, hormones and oral tyrosine-kinase inhibitors (TKIs), with limited success. The predominant global standard-of-care after nephrectomy remains active monitoring. Immune checkpoint inhibitors (ICIs) are effective in the treatment of metastatic RCC; RAMPART will investigate these agents in the adjuvant setting. METHODS/DESIGN RAMPART is an international, UK-led trial investigating the addition of ICIs after nephrectomy in patients with resected locally advanced RCC. RAMPART is a multi-arm multi-stage (MAMS) platform trial, upon which additional research questions may be addressed over time. The target population is patients with histologically proven resected locally advanced RCC (clear cell and non-clear cell histological subtypes), with no residual macroscopic disease, who are at high or intermediate risk of relapse (Leibovich score 3-11). Patients with fully resected synchronous ipsilateral adrenal metastases are included. Participants are randomly assigned (3,2:2) to Arm A - active monitoring (no placebo) for one year, Arm B - durvalumab (PD-L1 inhibitor) 4-weekly for one year; or Arm C - combination therapy with durvalumab 4-weekly for one year plus two doses of tremelimumab (CTLA-4 inhibitor) at day 1 of the first two 4-weekly cycles. The co-primary outcomes are disease-free-survival (DFS) and overall survival (OS). Secondary outcomes include safety, metastasis-free survival, RCC specific survival, quality of life, and patient and clinician preferences. Tumour tissue, plasma and urine are collected for molecular analysis (TransRAMPART). TRIAL REGISTRATION ISRCTN #: ISRCTN53348826, NCT #: NCT03288532, EUDRACT #: 2017-002329-39, CTA #: 20363/0380/001-0001, MREC #: 17/LO/1875, ClinicalTrials.gov Identifier: NCT03288532, RAMPART grant number: MC_UU_12023/25, TransRAMPART grant number: A28690 Cancer Research UK, RAMPART Protocol version 5.0.
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Affiliation(s)
- Bhavna Oza
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK.
| | - Eleni Frangou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Ben Smith
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Hanna Bryant
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Rick Kaplan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Babak Choodari-Oskooei
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Tom Powles
- St Bartholomew's Hospital, W Smithfield, London EC1A 7B, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Laurence Albiges
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France
| | - Axel Bex
- Royal Free London NHS Foundation Trust UCL Division of Surgery and Interventional Science, Pond Street, London NW3 2QG; Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, United States
| | - Ian D Davis
- Monash University Eastern Health Clinical School, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; Department of Medical Oncology, Eastern Health, Melbourne, Australia; ANZUP Cancer Trials Group, Sydney, Australia
| | - Tim Eisen
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus Hill's Road, Cambridge CB2 0QQ, UK
| | - Alison Fielding
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - David Harrison
- University of St Andrews, North Haugh, St Andrews KY16 9TF, UK
| | - Anita McWhirter
- Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - Salena Mulhere
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Paul Nathan
- Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood HA6 2RN, UK
| | - Brian Rini
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, United States
| | - Alastair Ritchie
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Sarah Scovell
- St Bartholomew's Hospital, W Smithfield, London EC1A 7B, UK
| | - Clare Shakeshaft
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Martin R Stockler
- ANZUP Cancer Trials Group, Sydney, Australia; NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW 2006, Australia
| | - Nat Thorogood
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Mahesh K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - James Larkin
- Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - Angela Meade
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
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Marchioni M, Sountoulides P, Furlan M, Mir MC, Aretano L, Rubio-Briones J, Alvarez-Maestro M, Di Nicola M, Bazán AA, Antonelli A, Simeone C, Schips L. Management of local recurrence after radical nephrectomy: surgical removal with or without systemic treatment is still the gold standard. Results from a multicenter international cohort. Int Urol Nephrol 2021; 53:2273-2280. [PMID: 34417970 PMCID: PMC8494713 DOI: 10.1007/s11255-021-02966-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/30/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the survival outcomes of patients with local recurrence after radical nephrectomy (RN) and to test the effect of surgery, as monotherapy or in combination with systemic treatment, on cancer-specific mortality (CSM). METHODS Patients with local recurrence after RN were abstracted from an international dataset. The primary outcome was CSM. Cox's proportional hazard models tested the main predictors of CSM. Kaplan-Meier method estimates the 3-year survival rates. RESULTS Overall, 96 patients were included. Of these, 44 (45.8%) were metastatic at the time of recurrence. The median time to recurrence after RN was 14.5 months. The 3-year cancer-specific survival rates after local recurrence were 92.3% (± 7.4%) for those who were treated with surgery and systemic therapy, 63.2% (± 13.2%) for those who only underwent surgery, 22.7% (± 0.9%) for those who only received systemic therapy and 20.5% (± 10.4%) for those who received no treatment (p < 0.001). Receiving only medical treatment (HR: 5.40, 95% CI 2.06-14.15, p = 0.001) or no treatment (HR: 5.63, 95% CI 2.21-14.92, p = 0.001) were both independently associated with higher CSM rates, even after multivariable adjustment. Following surgical treatment of local recurrence 8 (16.0%) patients reported complications, and 2/8 were graded as Clavien-Dindo ≥ 3. CONCLUSIONS Surgical treatment of local recurrence after RN, when feasible, should be offered to patients. Moreover, its association with a systemic treatment seems to warrantee adjunctive advantages in terms of survival, even in the presence of metastases.
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Affiliation(s)
- Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, Urology Unit, SS Annunziata Hospital, Chieti, Italy.
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. d'Annunzio" Chieti-Pescara, Via dei Vestini, Campus universitario, 66100, Chieti, Italy.
| | | | - Maria Furlan
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Maria Carmen Mir
- Department of Urology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - Lucia Aretano
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Jose Rubio-Briones
- Department of Urology, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Chieti, Italy
| | | | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, Urology Unit, SS Annunziata Hospital, Chieti, Italy
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Capitanio U, Larcher A, Fallara G, Trevisani F, Porrini E, Di Marco F, Baiamonte G, Re C, Bettiga A, Dell'Antonio G, Doglioni C, De Cobelli F, Bertini R, Salonia A, Montorsi F. Parenchymal biopsy in the management of patients with renal cancer. World J Urol 2021; 39:2961-2968. [PMID: 33385247 DOI: 10.1007/s00345-020-03572-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/12/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The role of non-tumour renal biopsy in predicting renal function after surgery for renal cell carcinoma (RCC) is poorly investigated. The aim of the study was to assess the impact of renal parenchymal histology on renal function after radical nephrectomy in a cohort of patients with RCC. METHODS This cohort study included 171 patients with RCC submitted to radical nephrectomy between 2006 and 2018. Two biopsy samples from normal parenchyma were collected at nephrectomy and renal parenchyma damage (RPD) was scored on histologic samples according to validated methodology. The outcomes were eGFR after surgery and its reduction > 25% relative to baseline at maximum 12 months' follow-up. Linear and logistic multivariable regression were used, adjusting for age at surgery, presence of hypertension, diabetes, clinical tumour size, time from surgery and basal eGFR. RESULTS 171 patients were enrolled and RPD was demonstrated in 64 (37%). Patients with RPD had more comorbidities (CCI > 2 in 25 vs. 9%, p < 0.001), in particular hypertension (70 vs. 53%; p = 0.03), diabetes with (5% vs. 0%, p = 0.007) or without (31 vs. 18%; p = 0.007) organ damage, cerebrovascular disease (19 vs. 5%; p = 0.006) and nephropathy (20 vs. 3%; p = 0.0004). At multivariable analyses, RPD was associated with lower eGFR (Est. - 5.48; 95% CI - 9.27: - 1.7; p = 0.005) and with clinically significant reduction of eGFR after surgery (OR 3.06; 95% CI 1.17: 8.49; p = 0.026). CONCLUSIONS Presence of RPD in non-tumour renal tissue is an independent predictor of functional impairment in patients with RCC. Such preliminary finding supports the use of parenchyma biopsy during clinical decision making.
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Affiliation(s)
- Umberto Capitanio
- Unit of Urology, Department of Urology, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy. .,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Alessandro Larcher
- Unit of Urology, Department of Urology, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Fallara
- Unit of Urology, Department of Urology, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Trevisani
- Unit of Urology, Department of Urology, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Esteban Porrini
- Center for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna, Tenerife, Spain
| | - Federico Di Marco
- Unit of Urology, Department of Urology, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Gianfranco Baiamonte
- Unit of Urology, Department of Urology, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Re
- Unit of Urology, Department of Urology, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Arianna Bettiga
- Unit of Urology, Department of Urology, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | | | | | | | - Roberto Bertini
- Unit of Urology, Department of Urology, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Andrea Salonia
- Unit of Urology, Department of Urology, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Department of Urology, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
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29
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Perri D, Palumbo C, Billia M, Umari P, Zacchero M, D'Agate D, Bondonno G, Volpe A. Assessment of predictors of renal cell carcinoma progression after nephrectomy at short and intermediate term follow-up and implication on surveillance protocols. Minerva Urol Nephrol 2021; 74:599-606. [PMID: 34114786 DOI: 10.23736/s2724-6051.21.04322-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prediction of risk of RCC progression after surgery is important for follow-up planning. We identified predictors of progression-free survival (PFS) and cancer-specific survival (CSS) in a large single institutional cohort and investigated patterns and sites of progression according to stage and grade. METHODS Node-negative non-metastatic clear-cell RCC (ccRCC) patients treated with radical or partial nephrectomy from 2000 to 2020 were included. Sites of progression were defined as thoracic, abdominal and others (bone/brain). Kaplan Meier curves and multivariable Cox regression (MCR) models tested for PFS and CSS. RESULTS Of 384 clear cell RCC N0M0 patients, 301 (78.4%) vs. 83 (21.6%) were pT1-2 vs. pT3-4, respectively; 253 (65.9%) vs. 130 (33.9%) were G1-G2 vs. G3-G4. Thoracic progressions occurred in 2.7% pT1-T2 vs. 21.7% pT3-T4 and 2.8% G1-G2 vs. 14.6% G3-G4 tumors. Abdominal progressions occurred in 4.0% pT1-T2 vs. 13.3% pT3-T4 and 4.3% G1-G2 vs. 9.2% G3-G4. Other progressions occurred in 0.3% pT1-T2 vs. 9.6% pT3-T4 and 0.8% G1-G2 vs. 5.4% G3-G4 (5.4%). Five-year PFS and CSS were 81.7 and 90.6%, respectively. At MCR models, pT3-4 (HR 9.1, p<0.001), G3-G4 (HR 2.7, p=0.003) and PSMs (HR 6.1, p<0.001) independently predicted PFS. Similarly, pT3-4 (HR 10.1, p<0.001), G3-G4 (HR 4.1, p=0.02), and PSMs (HR 5.2, p=0.04) independently predicted CSS. CONCLUSIONS In ccRCC N0M0 patients, G3-G4, pT3-4, PSMs were independent predictors of progression after surgery. Lower stage and grade ccRCCs progress predominantly in the abdominal sites and may be followed with less frequent extra-abdominal imaging compared to more advanced/aggressive tumors.
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Affiliation(s)
- Davide Perri
- Division of Urology, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Carlotta Palumbo
- Division of Urology, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Michele Billia
- Division of Urology, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Paolo Umari
- Division of Urology, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Monica Zacchero
- Division of Urology, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Daniele D'Agate
- Division of Urology, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Gianmarco Bondonno
- Division of Urology, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Alessandro Volpe
- Division of Urology, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy -
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30
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Abu-Ghanem Y, Powles T, Capitanio U, Beisland C, Järvinen P, Stewart GD, Gudmundsson E, Lam TBL, Marconi L, Fernandéz-Pello S, Nisen H, Meijer RP, Volpe A, Ljungberg B, Klatte T, Bensalah K, Dabestani S, Bex A. Should patients with low-risk renal cell carcinoma be followed differently after nephron-sparing surgery vs radical nephrectomy? BJU Int 2021; 128:386-394. [PMID: 33794055 DOI: 10.1111/bju.15415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/10/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether pT1 renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multicentre database (RECUR). SUBJECTS A retrospective study was conducted in 3380 patients treated for nonmetastatic RCC between January 2006 and December 2011 across 15 centres from 10 countries, as part of the RECUR database project. For patients with pT1 clear-cell RCC, patterns of recurrence were compared between RN and PN according to recurrence site. Univariate and multivariate models were used to evaluate the association between surgical approach and recurrence-free survival (RFS) and cancer-specific mortality (CSM). RESULTS From the database 1995 patients were identified as low-risk patients (pT1, pN0, pNx), of whom 1055 (52.9%) underwent PN. On multivariate analysis, features associated with worse RFS included tumour size (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14-1.39; P < 0.001), nuclear grade (HR 2.31, 95% CI 1.73-3.08; P < 0.001), tumour necrosis (HR 1.5, 95% CI 1.03-2.3; P = 0.037), vascular invasion (HR 2.4, 95% CI 1.3-4.4; P = 0.005) and positive surgical margins (HR 4.4, 95% CI 2.3-8.5; P < 0.001). Kaplan-Meier analysis of CSM revealed that the survival of patients with recurrence after PN was significantly better than those with recurrence after RN (P = 0.02). While the above-mentioned risk factors were associated with prognosis, type of surgery alone was not an independent prognostic variable for RFS nor CSM. Limitations include the retrospective nature of the study. CONCLUSION Our results showed that follow-up protocols should not rely solely on stage and type of primary surgery. An optimized regimen should also include validated risk factors rather than type of surgery alone to select the best imaging method and to avoid unnecessary imaging. A follow-up of more than 3 years should be considered in patients with pT1 tumours after RN. A novel follow-up strategy is proposed.
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Affiliation(s)
- Yasmin Abu-Ghanem
- UCL Division of Surgical and Interventional Science, Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Petrus Järvinen
- Urology, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | | | - Thomas B L Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | | | - Harry Nisen
- Urology, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alessandro Volpe
- Department of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Karim Bensalah
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Saeed Dabestani
- Division of Urological Cancers, Department of Translational Medicine, Central Hospital Kristianstad, Lund University, Lund, Sweden
| | - Axel Bex
- UCL Division of Surgical and Interventional Science, Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.,Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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31
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Marchioni M, Rivas JG, Autran A, Socarras M, Albisinni S, Ferro M, Schips L, Scarpa RM, Papalia R, Esperto F. Biomarkers for Renal Cell Carcinoma Recurrence: State of the Art. Curr Urol Rep 2021; 22:31. [PMID: 33886004 PMCID: PMC8062344 DOI: 10.1007/s11934-021-01050-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW We aim to summarize the current state of art about the possible use of biomarkers for predicting renal cell carcinoma (RCC) recurrence after curative treatment. In addition, we aim to provide a snapshot about the clinical implication of biomarkers use for follow-up planification. RECENT FINDINGS A wide variety of biomarkers have been proposed. RCC biomarkers have been individuated in tumoral tissue, blood, and urine. A variety of molecules, including proteins, DNA, and RNA, warrant a good accuracy for RCC recurrence and progression prediction. Their use in prediction models might warrant a better patients' risk stratification. Future prognostic models will probably include a combination of classical features (tumor grade, stage, etc.) and novel biomarkers. Such models might allow a more accurate treatment and follow-up planification.
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Affiliation(s)
- Michele Marchioni
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, "G. d'Annunzio University", Chieti, Italy.
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio" Chieti-Pescara, Via dei Vestini, Campus universitario, 66100, Chieti, Italy.
| | | | - Anamaria Autran
- Department of Urology, Fundacion Jimemez Diaz, Madrid, Spain
| | - Moises Socarras
- Instituto de Cirugia Urologica Avanzada (ICUA), Madrid, Spain
| | - Simone Albisinni
- Urology Department, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Luigi Schips
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, "G. d'Annunzio University", Chieti, Italy
| | | | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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32
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Neves JB, Vanaclocha Saiz L, Abu-Ghanem Y, Marchetti M, Tran-Dang MA, El-Sheikh S, Barod R, Beisland C, Capitanio U, Cullen D, Klatte T, Ljungberg B, Mumtaz F, Patki P, Stewart GD, Dabestani S, Tran MGB, Bex A. Pattern, timing and predictors of recurrence after surgical resection of chromophobe renal cell carcinoma. World J Urol 2021; 39:3823-3831. [PMID: 33851271 DOI: 10.1007/s00345-021-03683-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/24/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Currently there are no specific guidelines for the post-operative follow-up of chromophobe renal cell carcinoma (chRCC). We aimed to evaluate the pattern, location and timing of recurrence after surgery for non-metastatic chRCC and establish predictors of recurrence and cancer-specific death. METHODS Retrospective analysis of consecutive surgically treated non-metastatic chRCC cases from the Royal Free London NHS Foundation Trust (UK, 2015-2019) and the international collaborative database RECUR (15 institutes, 2006-2011). Kaplan-Meier curves were plotted. The association between variables of interest and outcomes were analysed using univariate and multivariate Cox proportional hazards regression models with shared frailty for data source. RESULTS 295 patients were identified. Median follow-up was 58 months. The five and ten-year recurrence-free survival rates were 94.3% and 89.2%. Seventeen patients (5.7%) developed recurrent disease, 13 (76.5%) with distant metastases. 54% of metastatic disease diagnoses involved a single organ, most commonly the bone. Early recurrence (< 24 months) was observed in 8 cases, all staged ≥ pT2b. 30 deaths occurred, of which 11 were attributed to chRCC. Sarcomatoid differentiation was rare (n = 4) but associated with recurrence and cancer-specific death on univariate analysis. On multivariate analysis, UICC/AJCC T-stage ≥ pT2b, presence of coagulative necrosis, and positive surgical margins were predictors of recurrence and cancer-specific death. CONCLUSION Recurrence and death after surgically resected chRCC are rare. For completely excised lesions ≤ pT2a without coagulative necrosis or sarcomatoid features, prognosis is excellent. These patients should be reassured and follow-up intensity curtailed.
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Affiliation(s)
- Joana B Neves
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | | | - Yasmin Abu-Ghanem
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Marta Marchetti
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - My-Anh Tran-Dang
- Department of Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Soha El-Sheikh
- Department of Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Ravi Barod
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Christian Beisland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - David Cullen
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Faiz Mumtaz
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Prasad Patki
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Saeed Dabestani
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Maxine G B Tran
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Axel Bex
- Division of Surgery and Interventional Science, University College London, London, UK.
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK.
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33
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Rini B, Abel EJ, Albiges L, Bex A, Brugarolas J, Bukowski RM, Coleman JA, Drake CG, Figlin RA, Futreal A, Hammers H, Powles T, Rathmell WK, Ricketts CJ, Turajlic S, Wood CG, Leibovich BC. Summary from the Kidney Cancer Association's Inaugural Think Thank: Coalition for a Cure. Clin Genitourin Cancer 2021; 19:167-175. [PMID: 33358149 DOI: 10.1016/j.clgc.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/29/2022]
Abstract
Close to 74,000 cases of renal cell carcinoma (RCC) are diagnosed each year in the United States. The past 2 decades have shown great developments in surgical techniques, targeted therapy and immunotherapy agents, and longer complete response rates. However, without a global cure, there is still room for further advancement in improving patient care in this space. To address some of the gaps restricting this progress, the Kidney Cancer Association brought together a group of 27 specialists across the areas of clinical care, research, industry, and advocacy at the inaugural "Think Tank: Coalition for a Cure" session. Topics addressed included screening, imaging, rarer RCC subtypes, combination drug therapy options, and patient response. This commentary summarizes the discussion of these topics and their respective clinical challenges, along with a proposal of projects for collaboration in overcoming those needs and making a greater impact on care for patients with RCC moving forward.
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Affiliation(s)
- Brian Rini
- Medicine Department, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN.
| | - E Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Laurence Albiges
- Department of Cancer Medicine, Genitourinary Group, Institut Gustave Roussy, Villejuif, France
| | - Axel Bex
- Specialist Centre for Kidney Cancer, UCL Division of Surgery and Interventional Science, Royal Free London NHS Foundation Trust, London, England
| | - James Brugarolas
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Jonathan A Coleman
- Weill-Cornell Medical Center, Department of Surgery, Urology, Memorial Sloan Kettering, New York, NY
| | - Charles G Drake
- Departments of Oncology & Urology, Columbia University Medical Center, New York, NY
| | - Robert A Figlin
- Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Andy Futreal
- Department of Genomic Medicine, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hans Hammers
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Thomas Powles
- Division of Hematology and Oncology, Kidney Cancer Program, St. Bartholomew's Hospital, London, England
| | - W Kimryn Rathmell
- Medicine Department, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher J Ricketts
- Bart's Cancer Centre, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Samra Turajlic
- Medicine Department, Division of Hematology/Oncology, The Royal Marsden Hospital NHS Foundation Trust, London, England
| | - Christopher G Wood
- Department of Genomic Medicine, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bradley C Leibovich
- Urologic Oncology Branch, Center for Cancer Research, Mayo Clinic, Rochester, MN
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34
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Bex A. Increasing the evidence for surveillance of metastatic renal cancer. Cancer 2021; 127:2184-2186. [PMID: 33765328 DOI: 10.1002/cncr.33490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/05/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Axel Bex
- Specialist Center for Kidney Cancer, Royal Free London National Health Service Foundation Trust, London, United Kingdom.,University College London Division of Surgery and Interventional Science, London, United Kingdom
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35
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Rossi SH, Klatte T, Usher-Smith JA, Fife K, Welsh SJ, Dabestani S, Bex A, Nicol D, Nathan P, Stewart GD, Wilson ECF. A Decision Analysis Evaluating Screening for Kidney Cancer Using Focused Renal Ultrasound. Eur Urol Focus 2021; 7:407-419. [PMID: 31530498 DOI: 10.1016/j.euf.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Screening for renal cell carcinoma (RCC) has been identified as a key research priority; however, no randomised control trials have been performed. Value of information analysis can determine whether further research on this topic is of value. OBJECTIVE To determine (1) whether current evidence suggests that screening is potentially cost-effective and, if so, (2) in which age/sex groups, (3) identify evidence gaps, and (4) estimate the value of further research to close those gaps. DESIGN, SETTING, AND PARTICIPANTS A decision model was developed evaluating screening in asymptomatic individuals in the UK. A National Health Service perspective was adopted. INTERVENTION A single focused renal ultrasound scan compared with standard of care (no screening). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Expected lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER), discounted at 3.5% per annum. RESULTS AND LIMITATIONS Given a prevalence of RCC of 0.34% (0.18-0.54%), screening 60-yr-old men resulted in an ICER of £18 092/QALY (€22 843/QALY). Given a prevalence of RCC of 0.16% (0.08-0.25%), screening 60-yr-old women resulted in an ICER of £37327/QALY (€47 129/QALY). In the one-way sensitivity analysis, the ICER was <£30000/QALY as long as the prevalence of RCC was ≥0.25% for men and ≥0.2% for women at age 60yr. Given the willingness to pay a threshold of £30000/QALY (€37 878/QALY), the population-expected values of perfect information were £194 million (€244 million) and £97 million (€123 million) for 60-yr-old men and women, respectively. The expected value of perfect parameter information suggests that the prevalence of RCC and stage shift associated with screening are key research priorities. CONCLUSIONS Current evidence suggests that one-off screening of 60-yr-old men is potentially cost-effective and that further research into this topic would be of value to society. PATIENT SUMMARY Economic modelling suggests that screening 60-yr-old men for kidney cancer using ultrasound may be a good use of resources and that further research on this topic should be performed.
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Affiliation(s)
- Sabrina H Rossi
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK; Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kate Fife
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Sarah J Welsh
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Saeed Dabestani
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Lund, Sweden
| | - Axel Bex
- The Royal Free London NHS Foundation Trust, Specialist Centre for Kidney Cancer, UK; Netherlands Cancer Institute, Division of Surgical Oncology, Department of Urology, Amsterdam, The Netherlands
| | - David Nicol
- Department of Urology, Royal Marsden Hospital, London, UK; Institute of Cancer Research, London, UK
| | - Paul Nathan
- Department of Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
| | - Edward C F Wilson
- Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge, UK; Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK.
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36
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Chandrasekar T, Boorjian SA, Capitanio U, Gershman B, Mir MC, Kutikov A. Collaborative Review: Factors Influencing Treatment Decisions for Patients with a Localized Solid Renal Mass. Eur Urol 2021; 80:575-588. [PMID: 33558091 DOI: 10.1016/j.eururo.2021.01.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT With the addition of active surveillance and thermal ablation (TA) to the urologist's established repertoire of partial (PN) and radical nephrectomy (RN) as first-line management options for localized renal cell carcinoma (RCC), appropriate treatment decision-making has become increasingly nuanced. OBJECTIVE To critically review the treatment options for localized, nonrecurrent RCC; to highlight the patient, renal function, tumor, and provider factors that influence treatment decisions; and to provide a framework to conceptualize that decision-making process. EVIDENCE ACQUISITION A collaborative critical review of the medical literature was conducted. EVIDENCE SYNTHESIS We identify three key decision points when managing localized RCC: (1) decision for surveillance versus treatment, (2) decision regarding treatment modality (TA, PN, or RN), and (3) decision on surgical approach (open vs minimally invasive). In evaluating factors that influence these treatment decisions, we elaborate on patient, renal function, tumor, and provider factors that either directly or indirectly impact each decision point. As current nomograms, based on preselected patient datasets, perform poorly in prospective settings, these tools should be used with caution. Patient decision aids are an underutilized tool in decision-making. CONCLUSIONS Localized RCC requires highly nuanced treatment decision-making, balancing patient- and tumor-specific clinical variables against indirect structural influences to provide optimal patient care. PATIENT SUMMARY With expanding treatment options for localized kidney cancer, treatment decision is highly nuanced and requires shared decision-making. Patient decision aids may be helpful in the treatment discussion.
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Affiliation(s)
- Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Maria Carmen Mir
- Department of Urology, Fundación Instituto Valenciano Oncologia, Valencia, Spain
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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37
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Marconi L, Sun M, Beisland C, Klatte T, Ljungberg B, Stewart GD, Dabestani S, Choueiri TK, Bex A. Prevalence, Disease-free, and Overall Survival of Contemporary Patients With Renal Cell Carcinoma Eligible for Adjuvant Checkpoint Inhibitor Trials. Clin Genitourin Cancer 2021; 19:e92-e99. [PMID: 33526329 DOI: 10.1016/j.clgc.2020.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/13/2020] [Accepted: 12/27/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Designing adjuvant trials is challenging because of uncertainties of prevalence and outcome of high-risk renal cell cancer (RCC) despite use of validated risk scores. Our objective is to investigate how differences in eligibility criteria may impact on potential study results in RCC adjuvant trials. PATIENTS AND METHODS RECUR is a multicenter European database capturing patient and tumor characteristics, recurrence patterns, and survival of those curatively treated for non-metastatic RCC from 2006 to 2011 without any adjuvant therapy. We used RECUR to evaluate prevalence, disease-free survival (DFS), and overall survival (OS) according to eligibility criteria of immunotherapy-based adjuvant trials IMMotion 010 (NCT03024996), Checkmate 914 (NCT03138512), Keynote-564 (NCT03142334), RAMPART (NCT03288532), and PROSPER (NCT03055013). RESULTS Of 3024 relevant patients in RECUR, 408 (13.5%), 725 (24%), 609 (20.1%), 1363 (45.1%), and 1071 (35.4%) met eligibility criteria for IMMotion-010, CheckMate-914, Keynote-564, RAMPART, and PROSPER, respectively. The median and 5-year DFS Kaplan-Meier estimates in RECUR corresponding to each trial eligibility criteria were: not reached and 69.6% for RAMPART; not reached and 64.5% for PROSPER; 109.3 months (95% confidence interval [CI], 83.9-134.6 months) and 57% for CheckMate-914; 75.8 months (95% CI, 52.7-98.8 months) and 54.3% for Keynote-564; and 43.6 months (95% CI, 30.8-56.4 months) and 45% for IMMotion-010. Our analysis may be limited by the retrospective design. CONCLUSIONS RECUR provides estimated DFS and OS benchmarks for placebo arms of adjuvant checkpoint inhibitor studies and hence likely time to trial reporting. Well-documented contemporary registries rather than past risk models should be used to design future adjuvant trials.
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Affiliation(s)
- Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Maxine Sun
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Cambridge, UK; Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Boerje Ljungberg
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Grant D Stewart
- Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Saeed Dabestani
- Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Axel Bex
- Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, UCL Division of Surgical and Interventional Science, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Bensalah K, Bigot P, Albiges L, Bernhard J, Bodin T, Boissier R, Correas J, Gimel P, Hetet J, Long J, Nouhaud F, Ouzaïd I, Rioux-Leclercq N, Méjean A. Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : prise en charge du cancer du rein. Prog Urol 2020; 30:S2-S51. [DOI: 10.1016/s1166-7087(20)30749-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Ustundağ Y, Huysal K, Guzelsoy M, Genim CE, Yavuz A. Urine and serum glycosaminoglycan levels in the diagnosis of urological diseases and conditions: A narrative review of the literature. Urologia 2020; 88:103-109. [PMID: 33043817 DOI: 10.1177/0391560320960003] [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: 11/15/2022]
Abstract
Glycosaminoglycans (GAGs) are sulfated, negatively charged polysaccharides produced in almost every cell of the human body. As GAGs are extracellularly localized, the changes in body fluids such as blood and urine may reflect pathological changes in the urinary system as observed in other pathologies. In this review, we determined the potential of urinary and/or serum GAG levels as a marker for kidney and urothelial system diseases. We performed a search in the PubMed, MEDLINE, and ScienceDirect databases until September 30, 2019. A number of studies reported changes in the urinary and/or plasma GAG levels or composition in urological diseases and conditions, such as renal cell carcinoma, kidney stone, bladder carcinoma, and overactive bladder. GAGs were found to have a predictive biomarker potential that could be limited by generalizability concerns.
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Affiliation(s)
- Yasemin Ustundağ
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Kağan Huysal
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Muhammet Guzelsoy
- Department of Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Canan Erdem Genim
- Department of Obstetrics and Gynecology,Department of Obstetrics and Gynecology, Acıbadem Maslak Hospital, Istanbul, Turkey
| | - Ayca Yavuz
- Department of Physiology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Staehler M, Battle D, Pal SK, Bergerot CD. Counterbalancing COVID-19 with Cancer Surveillance and Therapy: A Survey of Patients with Renal Cell Carcinoma. Eur Urol Focus 2020; 7:1355-1362. [PMID: 32943372 PMCID: PMC7486070 DOI: 10.1016/j.euf.2020.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/27/2020] [Accepted: 09/07/2020] [Indexed: 12/20/2022]
Abstract
Background While providers are challenged with treatment decisions during the coronavirus disease 2019 (COVID-19) crisis, decision making ultimately falls in the hands of patients—at present, their perspective is poorly understood. Objective To ascertain renal cell carcinoma (RCC) patients’ perspectives on COVID-19 and understand the associated implications for treatment. Design, setting, and participants An online survey of RCC patients was conducted from March 22 to March 25, 2020, disseminated through social media and patient networking platforms. The survey comprised 45 items, including baseline demographic, clinicopathologic, and treatment-related information. Patients were additionally queried regarding their anxiety level related to COVID-19 and associated implications for their cancer diagnosis. Intervention An online survey study. Outcome measurements and statistical analysis Descriptive statistics with graphical outputs were used to characterize survey results. Results and limitations A total of 539 patients (male:female 39%:58%) from 14 countries responded. Of them, 71% felt that their risk of COVID-19 infection was higher than the general population, and 27% contacted their physician to establish this. Among patients with localized disease (40%), most (42%) had scheduled surveillance scans within 6 wk–65% were unwilling to delay scans. Among patients with metastatic disease, 76% were receiving active therapy. While most patients preferred not to defer therapy (51%), patients receiving immune therapy regimens were less amenable to deferring therapy than those receiving targeted treatment (20% vs 47%). Conclusions Despite high levels of anxiety surrounding COVID-19, many patients with RCC were inclined to adhere to existing schedules of surveillance (localized disease) and systemic treatment (metastatic disease). Patient summary The coronavirus disease 2019 (COVID-19) pandemic has prompted many doctors to develop different treatment strategies for cancer and other chronic conditions. Given the importance of the patient voice in these strategies, we conducted a survey of patients with kidney cancer to determine their treatment preferences. Our survey highlighted that most patients prefer to continue their current strategies of kidney cancer treatment and monitoring.
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Affiliation(s)
- Michael Staehler
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Dena Battle
- Kidney Cancer Research Alliance (KCCure), Alexandria, VA, USA
| | - Sumanta Kumar Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Cristiane Decat Bergerot
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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Wu C, Cui Y, Zhao Y, Chen X, Liao X, Di L, Yin L, Liu M, Wang R. Elevated tumor-to-liver standardized uptake value ratio (TLR) from preoperative 18F-FDG PET/CT predicts poor prognosis of patients with clear cell renal cell carcinoma after nephrectomy. Eur J Radiol 2020; 131:109218. [PMID: 32882538 DOI: 10.1016/j.ejrad.2020.109218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/20/2020] [Accepted: 08/05/2020] [Indexed: 01/22/2023]
Abstract
AIM To assess the potential of using preoperative 18F-FDG PET/CT to predict the prognosis of patients with clear cell renal cell carcinoma (ccRCC) after nephrectomy. METHODS Sixty-nine patients with newly diagnosed ccRCC who underwent 18F-FDG PET/CT prior to surgery were retrospectively reviewed. The metabolic parameters of maximum standardized uptake value (SUVmax) and tumor-to-liver ratio (TLR) from 18F-FDG PET/CT were obtained. Clinicopathological characteristics, including the World Health Organization/the International Society of Urological Pathology (WHO/ISUP) grade, pathological tumor node metastasis (pTNM) stage, venous tumor thrombus, and so on, were acquired. Univariate and multivariate Cox proportional hazards analyses were performed to identify the prognostic factors for disease-free survival (DFS). RESULTS Of the 69 patients, 25 patients (36.2%) experienced disease progression during the follow-up period. In univariate analysis, the primary tumor size (>4.85 cm), pTNM stage (Ⅲ/Ⅳ), WHO/ISUP grade (G3/4), venous tumor thrombus, adjuvant therapy, SUVmax (>3.55), and TLR (>1.66) were found to correlate with the incidence of decreased DFS (P < 0.05). In multivariate analysis, TLR (P = 0.007, HR: 5.489, 95%CI: 1.605-18.774) and pTNM stage (P = 0.024, HR: 10.385, 95%CI: 1.361-79.238) were revealed to serve as independent prognostic predictors for DFS after adjustment for other variables. Only 3 cases (8.3%) with normal TLR showed disease progression, while 22 cases (66.7%) with elevated TLR experienced disease progression. CONCLUSION ccRCC patients with preoperatively elevated TLR (>1.66) and high pTNM stages (Ⅲ/Ⅳ) had significantly unfavorable survival outcomes. These patients should be carefully monitored to detect the possibility of disease progression after nephrectomy as early as possible.
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Affiliation(s)
- Caixia Wu
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Yonggang Cui
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Yanyan Zhao
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Xueqi Chen
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Xuhe Liao
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Lijuan Di
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Lei Yin
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Meng Liu
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China.
| | - Rongfu Wang
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China.
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Peng H, Zhang R, Zhang H. A-kinase interacting protein 1 high expression correlates with advanced tumor stage and poor overall survival in surgical patients with clear cell renal cell carcinoma. Medicine (Baltimore) 2020; 99:e20742. [PMID: 32541526 PMCID: PMC7302652 DOI: 10.1097/md.0000000000020742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The present study aimed to detect the A-kinase interacting protein 1 (AKIP1) expression in clear cell renal cell carcinoma (ccRCC) tumor tissues and adjacent tissues, and further investigate the correlation of tumor AKIP1 expression with clinicopathological features and survival profile in ccRCC patients.Totally 210 ccRCC patients who underwent resection were retrospectively reviewed, and their tumor and adjacent tissue specimens were acquired for immunohistochemical detection of AKIP1 expression. The survival data of patients were collected for overall survival (OS) assessment.AKIP1 was upregulated in ccRCC tumor tissues compared with adjacent tissues (P < .001). Tumor AKIP1 expression was positively associated with T stage (P = .019), N stage (P = .032), and TNM stage (P = .005) in ccRCC patients. According to AKIP1 expression in tumor tissues, all patients were grouped as AKIP1 low and high expression (AKIP1 high expression were further divided into AKIP1 high+, high++, and high+++ expression). OS was the lowest in the patients with AKIP1 high+++ expression, followed by those with AKIP1 high++ expression and AKIP1 high+ expression, and then patients with AKIP1 low expression (P < .001). Furthermore, multivariate Cox regression exhibited tumor AKIP1 high expression (P = .017), age (>60 years) (P = .030), pathological grade (G2/G3 vs G1) (P = .037), and TNM stage (II/III vs I) (P < .001) were independent predictive factors for decreased OS in ccRCC patients.AKIP1 presents potency to be a novel biomarker for tumor progression and prognosis surveillance in ccRCC.
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Affiliation(s)
- Huimin Peng
- Department of Medicine Laboratory, The Hospital of Bayannaoer, Inner Mongolia Autonomous Rogion, Bayannur
| | - Rong Zhang
- Department of Basic Medicine and Forensic Medicine, Medical College of Baotou, Baotou
| | - Hao Zhang
- Department of Neurology, The Hospital of Bayannaoer, Inner Mongolia Autonomous Rogion, Bayannur, China
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Dr Hall B, Abel EJ. The Evolving Role of Metastasectomy for Patients with Metastatic Renal Cell Carcinoma. Urol Clin North Am 2020; 47:379-388. [PMID: 32600539 DOI: 10.1016/j.ucl.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Surgical metastasectomy continues to be utilized for patients with solitary or low-volume metastatic renal cell carcinoma (mRCC). Although few high-quality data are available to evaluate outcomes, local treatment is recommended when feasible because it may allow a subset of patients to delay or avoid systemic treatments. With the development of improved mRCC therapies, utilization of metastasectomy has increased because most patients have incomplete responses to systemic treatment of their metastases. This review discusses the rationale and history of metastasectomy, trends in utilization, prognostic factors for patient selection, site-specific considerations, alternatives for nonsurgical local treatment, and risk of morbidity associated with metastasectomy.
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Affiliation(s)
- Bryan Dr Hall
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA
| | - Edwin Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA.
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Dias F, Teixeira AL, Nogueira I, Morais M, Maia J, Bodo C, Ferreira M, Silva A, Vilhena M, Lobo J, Sequeira JP, Maurício J, Oliveira J, Kok K, Costa-Silva B, Medeiros R. Extracellular Vesicles Enriched in hsa-miR-301a-3p and hsa-miR-1293 Dynamics in Clear Cell Renal Cell Carcinoma Patients: Potential Biomarkers of Metastatic Disease. Cancers (Basel) 2020; 12:cancers12061450. [PMID: 32498409 PMCID: PMC7352268 DOI: 10.3390/cancers12061450] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 12/18/2022] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is the most aggressive subtype of kidney cancer and up to 40% of patients submitted to surgery with a curative intent will relapse. Thus, the aim of this study was to analyze the applicability of an Extracellular vesicle (EV) derived miRNA profile as potential prognosis biomarkers in ccRCC patients. We analyzed a nine-miRNA profile in plasma EVs from 32 ccRCC patients with localized disease (before and after surgery) and in 37 patients with metastatic disease. We observed that the levels of EV-derived hsa-miR-25-3p, hsa-miR-126-5p, hsa-miR-200c-3p, and hsa-miR-301a-3p decreased after surgery, whereas hsa-miR-1293 EV-levels increased. Furthermore, metastatic patients presented higher levels of hsa-miR-301a-3p and lower levels of hsa-miR-1293 when compared to patients with localized disease after surgery. Functional enrichment analysis of the targets of the four miRNAs that decreased after surgery resulted in an enrichment of terms related to cell cycle, proliferation, and metabolism, suggesting that EV-miRNA enrichment in the presence of the tumor could represent an epigenetic mechanism to sustain tumor development. Taken together, these results suggest that EVs content varies depending on the presence or absence of the disease and that an increase of EV-derived hsa-miR-301a-3p, and decrease of EV-derived hsa-miR-1293, may be potential biomarkers of metastatic ccRCC.
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Affiliation(s)
- Francisca Dias
- Molecular Oncology and Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Research Center- LAB2, E Bdg 1st floor, Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal; (F.D.); (I.N.); (M.M.); (R.M.)
- Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, 4050-513 Porto, Portugal
| | - Ana Luísa Teixeira
- Molecular Oncology and Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Research Center- LAB2, E Bdg 1st floor, Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal; (F.D.); (I.N.); (M.M.); (R.M.)
- Correspondence: ; Tel.: +351-225084000 (ext. 5410)
| | - Inês Nogueira
- Molecular Oncology and Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Research Center- LAB2, E Bdg 1st floor, Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal; (F.D.); (I.N.); (M.M.); (R.M.)
- Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, 4050-513 Porto, Portugal
- Research Department of the Portuguese League Against Cancer Regional Nucleus of the North (LPCC-NRN), Estrada da Circunvalação 6657, 4200-177 Porto, Portugal
| | - Mariana Morais
- Molecular Oncology and Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Research Center- LAB2, E Bdg 1st floor, Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal; (F.D.); (I.N.); (M.M.); (R.M.)
- Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, 4050-513 Porto, Portugal
- Research Department of the Portuguese League Against Cancer Regional Nucleus of the North (LPCC-NRN), Estrada da Circunvalação 6657, 4200-177 Porto, Portugal
| | - Joana Maia
- Systems Oncology Group, Champalimaud Research, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038 Lisbon, Portugal; (J.M.); (C.B.); (B.C.-S.)
- Graduate Program in Areas of Basic and Applied Biology (GABBA), University of Porto, 4200-135 Porto, Portugal
| | - Cristian Bodo
- Systems Oncology Group, Champalimaud Research, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038 Lisbon, Portugal; (J.M.); (C.B.); (B.C.-S.)
| | - Marta Ferreira
- Department of Medical Oncology, Portuguese Oncology Institute of Porto (IPO-Porto), Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal; (M.F.); (J.M.)
| | - Alexandra Silva
- Department of Urology, Portuguese Oncology Institute of Porto (IPO-Porto), Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal; (A.S.); (M.V.); (J.O.)
| | - Manuela Vilhena
- Department of Urology, Portuguese Oncology Institute of Porto (IPO-Porto), Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal; (A.S.); (M.V.); (J.O.)
| | - João Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto (IPO-Porto), Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal;
- Cancer Biology and Epigenetics Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Research Center- LAB3, F Bdg 1st floor, Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal;
| | - José Pedro Sequeira
- Cancer Biology and Epigenetics Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Research Center- LAB3, F Bdg 1st floor, Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal;
| | - Joaquina Maurício
- Department of Medical Oncology, Portuguese Oncology Institute of Porto (IPO-Porto), Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal; (M.F.); (J.M.)
| | - Jorge Oliveira
- Department of Urology, Portuguese Oncology Institute of Porto (IPO-Porto), Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal; (A.S.); (M.V.); (J.O.)
| | - Klaas Kok
- Department of Genetics, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9713 GZ Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands;
| | - Bruno Costa-Silva
- Systems Oncology Group, Champalimaud Research, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038 Lisbon, Portugal; (J.M.); (C.B.); (B.C.-S.)
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Research Center- LAB2, E Bdg 1st floor, Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal; (F.D.); (I.N.); (M.M.); (R.M.)
- Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, 4050-513 Porto, Portugal
- Research Department of the Portuguese League Against Cancer Regional Nucleus of the North (LPCC-NRN), Estrada da Circunvalação 6657, 4200-177 Porto, Portugal
- Faculty of Medicine, University of Porto (FMUP), Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Biomedical Research Center (CEBIMED), Faculty of Health Sciences of Fernando Pessoa University (UFP), Praça 9 de Abril 349, 4249-004 Porto, Portugal
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Kim H, Kim Y, Bang S, Park S, Jee S, Sim J, Shin SJ, Paik SS, Jang K. Low Expression of Single-stranded DNA Binding Protein 2 (SSBP2) Predicts Unfavourable Postoperative Outcomes in Patients With Clear Cell Renal Cell Carcinoma. In Vivo 2020; 34:101-107. [PMID: 31882468 DOI: 10.21873/invivo.11750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Single-stranded DNA binding protein 2 (SSBP2) is a subunit of a single-stranded DNA binding complex, which is involved in the maintenance of hematopoietic stem cells and stress responses. Numerous studies have suggested that SSBP2 functions as a tumor suppressor and is silenced through a pathway mediated by promoter hypermethylation. However, the role of SSBP2 in human renal cell carcinoma has not been reported, to date. Herein, we investigated the clinicopathological significance of SSBP2 expression in clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS We constructed tissue micro arrays consisting of 173 ccRCC tissues, and SSBP2 expression was evaluated semi-quantitatively based on the staining intensity and the proportion of stained cells. Regarding statistical analysis, the tissues were divided into two groups according to SSBP2 expression, and correlation of SSBP2 expression with various clinicopathological characteristics and patient outcomes was evaluated. RESULTS Low SSBP2 expression was observed in 114 of 175 (65.9%) of ccRCC cases, and low SSBP2 expression was significantly correlated with larger tumor size (p=0.005, Chi-square test), higher WHO/ISUP histological grade (p<0.001, Chi-square test), tumor necrosis (p=0.008, Chi-square test), sarcomatoid change (p=0.021, Chi-square test), and higher pT AJCC stage (p=0.002, Chi-square test). Kaplan-Meier survival curves revealed that patients with low SSBP2 expression had worse recurrence-free survival (p=0.041, log-rank test). CONCLUSION ccRCC with low SSBP2 expression was associated with adverse clinicopathological characteristics and poor patient outcomes.
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Affiliation(s)
- Hyunsung Kim
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yeseul Kim
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seongsik Bang
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seongeon Park
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seungyun Jee
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jongmin Sim
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Su-Jin Shin
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seung Sam Paik
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kiseok Jang
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Sebastià C, Corominas D, Musquera M, Paño B, Ajami T, Nicolau C. Active surveillance of small renal masses. Insights Imaging 2020; 11:63. [PMID: 32372194 PMCID: PMC7200970 DOI: 10.1186/s13244-020-00853-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 03/02/2020] [Indexed: 12/15/2022] Open
Abstract
Most renal masses incidentally detected by cross-sectional images are benign, being mainly cysts, and if they are malignant, they are indolent in nature with limited metastatic potential. Enhanced renal masses less than 4 cm in size are known as small renal masses (SRMs), and their growth rate (GR) and the possibility of developing metastasis are extremely low. Delayed intervention of SRMs by closed and routine imaging follow-up known as active surveillance (AS) is now an option according to urological guidelines. Radiologists have a key position in AS management of SRMs even unifocal and multifocal (sporadic or associated with genetic syndromes) and also in the follow-up of complex renal cysts by Bosniak cyst classification system. Radiologists play a key role in the AS of both unifocal and multifocal (sporadic or associated with genetic syndromes) SRMs as well as in the follow-up of complex renal cysts using the Bosniak cyst classification system. Indeed, radiologists must determine which patients with SRMs or complex renal cysts can be included in AS, establish the follow-up radiological test algorithm to be used in different scenarios, perform measurements in follow-up tests, and decide when AS should be discontinued. The purpose of this article is to review the indications and management of AS in SRMs, especially focused on specific scenarios, such as complex renal cysts and multifocal renal tumors (sporadic or hereditary). In this work, the authors aimed to provide a thorough review of imaging in the context of active surveillance of renal masses.
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Affiliation(s)
- Carmen Sebastià
- Radiology Department, CDIC, Hospital Clínic de Barcelona, C/Villaroel no. 170, 08036, Barcelona, Spain
| | - Daniel Corominas
- Radiology Department, CDIC, Hospital Clínic de Barcelona, C/Villaroel no. 170, 08036, Barcelona, Spain.
| | - Mireia Musquera
- Urology Department, ICNU, Hospital Clínic de Barcelona, C/Villaroel no. 170, 08036, Barcelona, Spain
| | - Blanca Paño
- Radiology Department, CDIC, Hospital Clínic de Barcelona, C/Villaroel no. 170, 08036, Barcelona, Spain
| | - Tarek Ajami
- Urology Department, ICNU, Hospital Clínic de Barcelona, C/Villaroel no. 170, 08036, Barcelona, Spain
| | - Carlos Nicolau
- Radiology Department, CDIC, Hospital Clínic de Barcelona, C/Villaroel no. 170, 08036, Barcelona, Spain
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Brassetti A, Anceschi U, Bertolo R, Ferriero M, Tuderti G, Costantini M, Capitanio U, Larcher A, Antonelli A, Mottrie A, Minervini A, Dell'oglio P, Veccia A, Amparore D, Flammia RS, Lombardo R, De Nunzio C, Benecchi L, Mari A, Porpiglia F, Montorsi F, Kaouk J, Autorino R, Gallucci M, Simone G. Comprehensive long-term assessment of outcomes following robot-assisted partial nephrectomy for renal cell carcinoma: the ROMe's achievement and its predicting nomogram. MINERVA UROL NEFROL 2020; 72:482-489. [PMID: 32298069 DOI: 10.23736/s0393-2249.20.03813-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We proposed a new tool (named ROMe's) to summarize long-term outcomes after partial nephrectomy (PN), identified its predictors and generated a predicting nomogram. METHODS A retrospective analysis of a multicenter dataset of patients with non-metastatic pT1-3a renal cell carcinoma was performed. Baseline demographic, clinical, pathologic and perioperative data were collected. ROMe's was defined as the concomitant lack of cancer-recurrences, death and newly onset Chronic Kidney Disease (CKD), at long term follow-up. Kaplan-Meier method investigated the predictive role of Trifecta on ROMe's achievement. Univariable and multivariable Cox regression analyses identified its predictors. A nomogram was generated and its accuracy was quantified using concordance index (CI). A calibration plot was obtained with 200 bootstraps resampling to explore nomogram performance at 5 years and decision curve analyses (DCA) assessed the net benefit of the model at 12, 36 and 60 months. RESULTS We included 927 patients. The rates of ROMe's were 82%, 72% and 56% at 1, 3 and 5 years follow-up. At Kaplan-Meier analysis, patients who achieved Trifecta displayed a significantly higher probability of ROMe's (log rank P<0.001). Young age (OR=0.982; P=0.001), low RENAL score (OR=0.86; P=0.037), high preoperative filtration rate (OR=1.02; P<0.001) and Trifecta achievement (OR=2.03; P=0.015), were independent predictors of ROMe's. The nomogram showed a CI of 0.76 at 60 months. The 5-years calibration plot confirmed a good discrimination accuracy (0.74); on DCA, the net benefit of using the model was evident for probabilities >30%. CONCLUSIONS We conceived a triad to summarize the main long-term oncologic and functional outcomes after PN and generated a predicting nomogram.
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Affiliation(s)
- Aldo Brassetti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy -
| | - Umberto Anceschi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Gabriele Tuderti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Manuela Costantini
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | | | - Daniele Amparore
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Rocco S Flammia
- Department of Urology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Riccardo Lombardo
- Division of Urology, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Cosimo De Nunzio
- Division of Urology, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Luigi Benecchi
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Autorino
- Department of Urology, Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Michele Gallucci
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy.,Department of Urology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
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48
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Bertelli E, Mercatelli L, Savi E, Pili A, Verna S, Palombella A, Caramella D, Minervini A, Serni S, Agostini S, Miele V. Surgical margin follow-up after nephron-sparing surgery: the possible role of CEUS. J Ultrasound 2019; 23:515-520. [PMID: 31741304 DOI: 10.1007/s40477-019-00413-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/25/2019] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To evaluate the possible role of CEUS in the management of patients who underwent nephron-sparing surgery (NSS) and presented questionable findings on the surgical margins at the CECT follow-up exam. METHODS In our retro-prospective study, we included 952 patients with small renal masses (SRMs) treated with NSS between 2012 and 2015 and followed with CECT for at least 3 years at Careggi University Hospital. Twenty-two of them presented solid masses on the site of surgery with questionable enhancement at CECT and were further studied with CEUS. This examination was followed by a quantitative analysis of the enhancement pattern. RESULTS Out of the 22 masses, 18 were considered possible granulomas, presenting slow wash-in and low enhancement peaks compared to the surrounding parenchyma and persistent delayed wash-out at CEUS. Four lesions presented a suspicious malignant enhancement pattern, with rapid wash-in, high peak and rapid wash-out. In accordance with instructions from the urologist, the first group of 18 patients was strictly monitored, revealing that the mass dimensions and enhancement pattern were stable for at least 3 years of follow-up, while the other 4 patients underwent a second intervention and their masses were confirmed as tumor recurrence at the histopathological evaluation. CONCLUSIONS CEUS can play a key role in the surgical margin follow-up after NSS when a suspicious enhancing mass is detected by CECT, giving an accurate depiction of the enhancement pattern and thus helping the clinician in the management of the patient.
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Affiliation(s)
- Elena Bertelli
- Department of Radiology, Careggi University Hospital, Florence, Italy. .,Clinical and Translational Sciences, University of Pisa, Florence, Italy.
| | - Laura Mercatelli
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Elena Savi
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Alessandro Pili
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Silvia Verna
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | | | - Davide Caramella
- Diagnostic and Interventional Radiology, University of Pisa, Florence, Italy
| | - Andrea Minervini
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Agostini
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Florence, Italy
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49
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Klatte T, Gallagher KM, Afferi L, Volpe A, Kroeger N, Ribback S, McNeill A, Riddick ACP, Armitage JN, 'Aho TF, Eisen T, Fife K, Bex A, Pantuck AJ, Stewart GD. The VENUSS prognostic model to predict disease recurrence following surgery for non-metastatic papillary renal cell carcinoma: development and evaluation using the ASSURE prospective clinical trial cohort. BMC Med 2019; 17:182. [PMID: 31578141 PMCID: PMC6775651 DOI: 10.1186/s12916-019-1419-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current World Health Organization classification recognises 12 major subtypes of renal cell carcinoma (RCC). Although these subtypes differ on molecular and clinical levels, they are generally managed as the same disease, simply because they occur in the same organ. Specifically, there is a paucity of tools to risk-stratify patients with papillary RCC (PRCC). The purpose of this study was to develop and evaluate a tool to risk-stratify patients with clinically non-metastatic PRCC following curative surgery. METHODS We studied clinicopathological variables and outcomes of 556 patients, who underwent full resection of sporadic, unilateral, non-metastatic (T1-4, N0-1, M0) PRCC at five institutions. Based on multivariable Fine-Gray competing risks regression models, we developed a prognostic scoring system to predict disease recurrence. This was further evaluated in the 150 PRCC patients recruited to the ASSURE trial. We compared the discrimination, calibration and decision-curve clinical net benefit against the Tumour, Node, Metastasis (TNM) stage group, University of California Integrated Staging System (UISS) and the 2018 Leibovich prognostic groups. RESULTS We developed the VENUSS score from significant variables on multivariable analysis, which were the presence of VEnous tumour thrombus, NUclear grade, Size, T and N Stage. We created three risk groups based on the VENUSS score, with a 5-year cumulative incidence of recurrence equalling 2.9% in low-risk, 15.4% in intermediate-risk and 54.5% in high-risk patients. 91.7% of low-risk patients had oligometastatic recurrent disease, compared to 16.7% of intermediate-risk and 40.0% of high-risk patients. Discrimination, calibration and clinical net benefit from VENUSS appeared to be superior to UISS, TNM and Leibovich prognostic groups. CONCLUSIONS We developed and tested a prognostic model for patients with clinically non-metastatic PRCC, which is based on routine pathological variables. This model may be superior to standard models and could be used for tailoring postoperative surveillance and defining inclusion for prospective adjuvant clinical trials.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK.
- Department of Surgery, University of Cambridge, Cambridge, UK.
- Department of Urology, The Royal Bournemouth and Christchurch Hospitals, Castle Lane East, Bournemouth, BH7 7DW, UK.
| | | | - Luca Afferi
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Alessandro Volpe
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Nils Kroeger
- Department of Urology, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Silvia Ribback
- Institute of Pathology, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Alan McNeill
- Department of Urology, Western General Hospital, Edinburgh, UK
| | | | | | - Tevita F 'Aho
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Tim Eisen
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Astra Zeneca, Cambridge, UK
| | - Kate Fife
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Axel Bex
- Division of Surgical Oncology, Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Allan J Pantuck
- Institute of Urologic Oncology, Department of Urology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Grant D Stewart
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
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50
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Franz A, Ralla B, Weickmann S, Jung M, Rochow H, Stephan C, Erbersdobler A, Kilic E, Fendler A, Jung K. Circular RNAs in Clear Cell Renal Cell Carcinoma: Their Microarray-Based Identification, Analytical Validation, and Potential Use in a Clinico-Genomic Model to Improve Prognostic Accuracy. Cancers (Basel) 2019; 11:E1473. [PMID: 31575051 PMCID: PMC6826865 DOI: 10.3390/cancers11101473] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 12/19/2022] Open
Abstract
Circular RNAs (circRNAs) may act as novel cancer biomarkers. However, a genome-wide evaluation of circRNAs in clear cell renal cell carcinoma (ccRCC) has yet to be conducted. Therefore, the objective of this study was to identify and validate circRNAs in ccRCC tissue with a focus to evaluate their potential as prognostic biomarkers. A genome-wide identification of circRNAs in total RNA extracted from ccRCC tissue samples was performed using microarray analysis. Three relevant differentially expressed circRNAs were selected (circEGLN3, circNOX4, and circRHOBTB3), their circular nature was experimentally confirmed, and their expression-along with that of their linear counterparts-was measured in 99 malignant and 85 adjacent normal tissue samples using specifically established RT-qPCR assays. The capacity of circRNAs to discriminate between malignant and adjacent normal tissue samples and their prognostic potential (with the endpoints cancer-specific, recurrence-free, and overall survival) after surgery were estimated by C-statistics, Kaplan-Meier method, univariate and multivariate Cox regression analysis, decision curve analysis, and Akaike and Bayesian information criteria. CircEGLN3 discriminated malignant from normal tissue with 97% accuracy. We generated a prognostic for the three endpoints by multivariate Cox regression analysis that included circEGLN3, circRHOBT3 and linRHOBTB3. The predictive outcome accuracy of the clinical models based on clinicopathological factors was improved in combination with this circRNA-based signature. Bootstrapping as well as Akaike and Bayesian information criteria confirmed the statistical significance and robustness of the combined models. Limitations of this study include its retrospective nature and the lack of external validation. The study demonstrated the promising potential of circRNAs as diagnostic and particularly prognostic biomarkers in ccRCC patients.
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Affiliation(s)
- Antonia Franz
- Department of Urology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
- Berlin Institute for Urologic Research, 10115 Berlin, Germany.
| | - Bernhard Ralla
- Department of Urology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Sabine Weickmann
- Department of Urology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Monika Jung
- Department of Urology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Hannah Rochow
- Department of Urology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
- Berlin Institute for Urologic Research, 10115 Berlin, Germany.
| | - Carsten Stephan
- Department of Urology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
- Berlin Institute for Urologic Research, 10115 Berlin, Germany.
| | | | - Ergin Kilic
- Institute of Pathology, Hospital Leverkusen, 51375 Leverkusen, Germany.
| | - Annika Fendler
- Department of Urology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
- Berlin Institute for Urologic Research, 10115 Berlin, Germany.
- Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Cancer Research Program, 13125 Berlin, Germany.
| | - Klaus Jung
- Department of Urology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
- Berlin Institute for Urologic Research, 10115 Berlin, Germany.
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