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Li X, Lin J, Qi H, Dai C, Guo Y, Lin D, Zhou J. Radiomics predict the WHO/ISUP nuclear grade and survival in clear cell renal cell carcinoma. Insights Imaging 2024; 15:175. [PMID: 38992169 PMCID: PMC11239644 DOI: 10.1186/s13244-024-01739-z] [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: 02/26/2024] [Accepted: 06/08/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVES This study aimed to assess the predictive value of radiomics derived from intratumoral and peritumoral regions and to develop a radiomics nomogram to predict preoperative nuclear grade and overall survival (OS) in patients with clear cell renal cell carcinoma (ccRCC). METHODS The study included 395 patients with ccRCC from our institution. The patients in Center A (anonymous) institution were randomly divided into a training cohort (n = 284) and an internal validation cohort (n = 71). An external validation cohort comprising 40 patients from Center B also was included. Computed tomography (CT) radiomics features were extracted from the internal area of the tumor (IAT) and IAT combined peritumoral areas of the tumor at 3 mm (PAT 3 mm) and 5 mm (PAT 5 mm). Independent predictors from both clinical and radiomics scores (Radscore) were used to construct a radiomics nomogram. Kaplan-Meier analysis with a log-rank test was performed to evaluate the correlation between factors and OS. RESULTS The PAT 5-mm radiomics model (RM) exhibited exceptional predictive capability for grading, achieving an area under the curves of 0.80, 0.80, and 0.90 in the training, internal validation, and external validation cohorts. The nomogram and RM gained from the PAT 5-mm region were more clinically useful than the clinical model. The association between OS and predicted nuclear grade derived from the PAT 5-mm Radscore and the nomogram-predicted score was statistically significant (p < 0.05). CONCLUSION The CT-based radiomics and nomograms showed valuable predictive capabilities for the World Health Organization/International Society of Urological Pathology grade and OS in patients with ccRCC. CRITICAL RELEVANCE STATEMENT The intratumoral and peritumoral radiomics are feasible and promising to predict nuclear grade and overall survival in patients with clear cell renal cell carcinoma, which can contribute to the development of personalized preoperative treatment strategies. KEY POINTS The multi-regional radiomics features are associated with clear cell renal cell carcinoma (ccRCC) grading and prognosis. The combination of intratumoral and peritumoral 5 mm regional features demonstrated superior predictive performance for grading. The nomogram and radiomics models have a broad range of clinical applications.
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Affiliation(s)
- Xiaoxia Li
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China
| | - Jinglai Lin
- Department of Urology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China
| | - Hongliang Qi
- Department of Clinical Engineering, Southern Medical University, Nanfang Hospital, Guangzhou, 510515, China
| | - Chenchen Dai
- Department of Radiology, Zhongshan Hospital, Fudan University, No 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yi Guo
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China
| | - Dengqiang Lin
- Department of Urology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China.
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China.
- Department of Radiology, Zhongshan Hospital, Fudan University, No 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.
- Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, 361015, China.
- Fujian Province Key Clinical Specialty for Medical Imaging, Xiamen, 361015, China.
- Xiamen Key Laboratory of Clinical Transformation of Imaging Big Data and Artificial Intelligence, Xiamen, 361015, China.
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Zheng Q, Yang R, Xu H, Fan J, Jiao P, Ni X, Yuan J, Wang L, Chen Z, Liu X. A Weakly Supervised Deep Learning Model and Human-Machine Fusion for Accurate Grading of Renal Cell Carcinoma from Histopathology Slides. Cancers (Basel) 2023; 15:3198. [PMID: 37370808 DOI: 10.3390/cancers15123198] [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: 05/08/2023] [Revised: 05/23/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: The Fuhrman grading (FG) system is widely used in the management of clear cell renal cell carcinoma (ccRCC). However, it is affected by observer variability and irreproducibility in clinical practice. We aimed to use a deep learning multi-class model called SSL-CLAM to assist in diagnosing the FG status of ccRCC patients using digitized whole slide images (WSIs). (2) Methods: We recruited 504 eligible ccRCC patients from The Cancer Genome Atlas (TCGA) cohort and obtained 708 hematoxylin and eosin-stained WSIs for the development and internal validation of the SSL-CLAM model. Additionally, we obtained 445 WSIs from 188 ccRCC eligible patients in the Clinical Proteomic Tumor Analysis Consortium (CPTAC) cohort as an independent external validation set. A human-machine fusion approach was used to validate the added value of the SSL-CLAM model for pathologists. (3) Results: The SSL-CLAM model successfully diagnosed the five FG statuses (Grade-0, 1, 2, 3, and 4) of ccRCC, and achieved AUCs of 0.917 and 0.887 on the internal and external validation sets, respectively, outperforming a junior pathologist. For the normal/tumor classification (Grade-0, Grade-1/2/3/4) task, the SSL-CLAM model yielded AUCs close to 1 on both the internal and external validation sets. The SSL-CLAM model achieved a better performance for the two-tiered FG (Grade-0, Grade-1/2, and Grade-3/4) task, with AUCs of 0.936 and 0.915 on the internal and external validation sets, respectively. The human-machine diagnostic performance was superior to that of the SSL-CLAM model, showing promising prospects. In addition, the high-attention regions of the SSL-CLAM model showed that with an increasing FG status, the cell nuclei in the tumor region become larger, with irregular contours and increased cellular pleomorphism. (4) Conclusions: Our findings support the feasibility of using deep learning and human-machine fusion methods for FG classification on WSIs from ccRCC patients, which may assist pathologists in making diagnostic decisions.
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Affiliation(s)
- Qingyuan Zheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Institute of Urologic Disease, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Rui Yang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Institute of Urologic Disease, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Huazhen Xu
- Department of Pharmacology, School of Basic Medical Sciences, Wuhan University, Wuhan 430072, China
| | - Junjie Fan
- University of Chinese Academy of Sciences, Beijing 100049, China
- Trusted Computing and Information Assurance Laboratory, Institute of Software, Chinese Academy of Sciences, Beijing 100190, China
| | - Panpan Jiao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Institute of Urologic Disease, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xinmiao Ni
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Institute of Urologic Disease, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jingping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Lei Wang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Institute of Urologic Disease, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zhiyuan Chen
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Institute of Urologic Disease, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xiuheng Liu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Institute of Urologic Disease, Renmin Hospital of Wuhan University, Wuhan 430060, China
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Local recurrence of renal cell carcinoma after partial nephrectomy: applicability of the apparent diffusion coefficient of MRI as an imaging marker - a multicentre study. Pol J Radiol 2022; 87:e325-e332. [PMID: 35892067 PMCID: PMC9288198 DOI: 10.5114/pjr.2022.117593] [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: 05/16/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The goal of the study was an assessment of the diagnostic performance of diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) of magnetic resonance imaging (MRI) in distinguishing local recurrence (LR) of renal cell carcinoma (RCC) from benign conditions after partial nephrectomy. Material and methods Thirty-nine patients after partial nephrectomy for solid RCC were enrolled in the study. Patients were followed up using MRI, which included DWI sequence (b = 800 s/mm2). All patients with MRI features of LR were included in the main group (n = 14) and patients without such features – into the group of comparison (n = 25). Apparent diffusion coefficient (ADC) values of suspicious lesions were recorded. In all patients with signs of locally recurrent RCC, surgical treatment was performed followed by pathologic analysis. Results The mean ADC values of recurrent RCC demonstrated significantly higher numbers compared to benign fibrous tissues and were 1.64 ± 0.15 × 10-3 mm2/s vs. 1.02 ± 0.26 × 10-3 mm2/s (p < 0.001). The mean ADC values of RCCs’ LR and benign post-op changes in renal scar substantially differed from mean ADC values of healthy kidneys’ parenchyma; the latter was 2.58 ± 0.05 × 10-3 mm2/s (p < 0.001). In ROC analysis, the use of ADC with a threshold value of 1.28 × 10-3 mm2/s allowed us to differentiate local recurrence of RCC from benign postoperative changes with 100% sensitivity, 80% specificity, and accuracy: AUC = 0.980 (p < 0.001). Conclusions The apparent diffusion coefficient of DWI of MRI can be used as a potential imaging marker for the diagnosis of local recurrence of RCC.
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Sun Z, Li T, Xiao C, Zou S, Zhang M, Zhang Q, Wang Z, Zhan H, Wang H. Prediction of overall survival based upon a new ferroptosis-related gene signature in patients with clear cell renal cell carcinoma. World J Surg Oncol 2022; 20:120. [PMID: 35422048 PMCID: PMC9008912 DOI: 10.1186/s12957-022-02555-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/07/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Clear cell renal cell carcinoma (ccRCC) is the most common and lethal renal cell carcinoma (RCC) histological subtype. Ferroptosis is a newly discovered programmed cell death and serves an essential role in tumor occurrence and development. The purpose of this study is to analyze ferroptosis-related gene (FRG) expression profiles and to construct a multi-gene signature for predicting the prognosis of ccRCC patients. METHODS RNA-sequencing data and clinicopathological data of ccRCC patients were downloaded from The Cancer Genome Atlas (TCGA). Differentially expressed FRGs between ccRCC and normal tissues were identified using 'limma' package in R. GO and KEGG enrichment analyses were conducted to elucidate the biological functions and pathways of differentially expressed FRGs. Consensus clustering was used to investigate the relationship between the expression of FRGs and clinical phenotypes. Univariate and the least absolute shrinkage and selection operator (LASSO) Cox regression analysis were used to screen genes related to prognosis and construct the optimal signature. Then, a nomogram was established to predict individual survival probability by combining clinical features and prognostic signature. RESULTS A total of 19 differentially expressed FRGs were identified. Consensus clustering identified two clusters of ccRCC patients with distinguished prognostic. Functional analysis revealed that metabolism-related pathways were enriched, especially lipid metabolism. A 7-gene ferroptosis-related prognostic signature was constructed to stratify the TCGA training cohort into high- and low-risk groups where the prognosis was significantly worse in the high-risk group. The signature was identified as an independent prognostic indicator for ccRCC. These findings were validated in the testing cohort, the entire cohort, and the International Cancer Genome Consortium (ICGC) cohort. We further demonstrated that the signature-based risk score was highly associated with the ccRCC progression. Further stratified survival analysis showed that the high-risk group had a significantly lower overall survival (OS) rate than those in the low-risk group. Moreover, we constructed a nomogram that had a strong ability to forecast the OS of the ccRCC patients. CONCLUSIONS We constructed a ferroptosis-related prognostic signature, which might provide a reliable prognosis assessment tool for the clinician to guide clinical decision-making and outcomes research.
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Affiliation(s)
- Zhuolun Sun
- Department of Urology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Tengcheng Li
- Department of Urology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Chutian Xiao
- Department of Urology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Shaozhong Zou
- College of Life Science and Technology, Jinan University, Guangzhou, 510630, China
| | - Mingxiao Zhang
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Qiwei Zhang
- Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, China
| | - Zhenqing Wang
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Hailun Zhan
- Department of Urology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
| | - Hua Wang
- Department of Urology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
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Zhang Q, Chen P, Tian R, He J, Han Q, Fan L. Metabolic Syndrome is an Independent Risk Factor for Fuhrman Grade and TNM Stage of Renal Clear Cell Carcinoma. Int J Gen Med 2022; 15:143-150. [PMID: 35023952 PMCID: PMC8743490 DOI: 10.2147/ijgm.s346972] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background More and more evidences show that metabolic syndrome (MS) is closely related to clear cell renal cell carcinoma (ccRCC), but the impact of MS on Fuhrman grade and TNM stage of ccRCC is rarely reported. Purpose To explore the relationship between MS and its components of Fuhrman grade and TNM stage in ccRCC. Objective The clinical data of 247 patients with ccRCC diagnosed in our hospital from January 2016 to November 2020 were retrospectively collected and analyzed. Based on diagnostic criteria of MS, the patients were divided into MS and non-MS group. Logistic regression analysis was used to analyze the independent risk factors of ccRCC. Results The incidence of MS was 32.79% (81/247). There was no significant difference in age, gender, smoking and drinking between MS group and non-MS group (P > 0.05). In MS group, BMI ≥25kg/m2, hypertension, diabetes, hyperlipidemia, tumor diameter, poorly differentiated renal cancer, high-stage renal cancer, triglyceride, fasting blood glucose, glycated hemoglobin, fasting insulin and homeostasis model assessment index were significantly higher than those in non-MS group (P < 0.001), while in high density lipoprotein cholesterol (p < 0.005), islet beta cell secretory index (P < 0.001), well-differentiated renal cell carcinoma (P= 0.009), and low-stage renal cell carcinoma (P = 0.019) were significantly lower than that of non-MS group. Logistic regression analysis showed that hypertension (P = 0.005), diabetes (P = 0.012), hyperlipidemia (P = 0.021) are independent risk factors for Fuhrman grade of ccRCC, while diabetes (P = 0.002), hyperlipidemia (P = 0.007) are independent risk factors for TNM staging of ccRCC. Conclusion The patients with ccRCC and MS had higher Fuhrman grade and TNM stage. MS is an independent risk factor for Fuhrman grade and TNM stage of ccRCC.
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Affiliation(s)
- Qian Zhang
- Department of Urology, General Hospital of Northern Theater Command PLA, Shenyang, Liaoning, 110000, People's Republic of China
| | - Peng Chen
- Department of Urology, General Hospital of Northern Theater Command PLA, Shenyang, Liaoning, 110000, People's Republic of China
| | - Renli Tian
- Department of Urology, General Hospital of Northern Theater Command PLA, Shenyang, Liaoning, 110000, People's Republic of China
| | - Jingteng He
- Department of Urology, General Hospital of Northern Theater Command PLA, Shenyang, Liaoning, 110000, People's Republic of China
| | - Qipeng Han
- Department of Urology, General Hospital of Northern Theater Command PLA, Shenyang, Liaoning, 110000, People's Republic of China
| | - Lianhui Fan
- Department of Urology, General Hospital of Northern Theater Command PLA, Shenyang, Liaoning, 110000, People's Republic of China
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Prediction of histologic grade and type of small (< 4 cm) papillary renal cell carcinomas using texture and neural network analysis: a feasibility study. Abdom Radiol (NY) 2021; 46:4266-4277. [PMID: 33813624 DOI: 10.1007/s00261-021-03044-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To predict the histologic grade and type of small papillary renal cell carcinomas (pRCCs) using texture analysis and machine learning algorithms. METHODS This was a retrospective HIPAA-compliant study. 24 noncontrast (NC), 22 corticomedullary (CM) phase, and 24 nephrographic (NG) phase CTs of small (< 4 cm) surgically resected pRCCs were identified. Surgical pathology classified the tumors as low- or high-Fuhrman histologic grade and type 1 or 2. The axial image with the largest cross-sectional tumor area was exported and segmented. Six histogram and 31 texture (20 gray-level co-occurrences and 11 gray-level run-lengths) features were calculated for each tumor in each phase. Feature values in low- versus high-grade and type 1 versus 2 pRCCs were compared. Area under the receiver operating curve (AUC) was calculated for each feature to assess prediction of histologic grade and type of pRCCs in each phase. Histogram, texture, and combined histogram and texture feature sets were used to train and test three classification algorithms (support vector machine (SVM), random forest, and histogram-based gradient boosting decision tree (HGBDT)) with stratified shuffle splits and threefold cross-validation; AUCs were calculated for each algorithm in each phase to assess prediction of histologic grade and type of pRCCs. RESULTS Individual histogram and texture features did not have statistically significant differences between low- and high-grade or type 1 and type 2 pRCCs across all phases. Individual features had low predictive power for tumor grade or type in all phases (AUC < 0.70). HGBDT was highly accurate at predicting pRCC histologic grade and type using histogram, texture or combined histogram and texture feature data from the CM phase (AUCs = 0.97-1.0). All algorithms had highest AUCs using CM phase feature data sets; AUCs decreased using feature sets from NC or NG phases. CONCLUSIONS The histologic grade and type of small pRCCs can be predicted with classification algorithms using CM histogram and texture features, which outperform NC and NG phase image data. The accurate prediction of pRCC histologic grade and type may be able to further guide management of patients with small (< 4 cm) pRCCs being considered for active surveillance.
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Sun J, Pan L, Zha T, Xing W, Chen J, Duan S. The role of MRI texture analysis based on susceptibility-weighted imaging in predicting Fuhrman grade of clear cell renal cell carcinoma. Acta Radiol 2021; 62:1104-1111. [PMID: 32867506 DOI: 10.1177/0284185120951964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Fuhrman nuclear grade system is one of the most important independent indicators in patients with clear cell renal cell carcinoma (ccRCC) for aggressiveness and prognosis. Preoperative assessment of tumor aggressiveness is important for surgical decision-making. PURPOSE To explore the role of magnetic resonance imaging (MRI) texture analysis based on susceptibility-weighted imaging (SWI) in predicting Fuhrman grade of ccRCC. MATERIAL AND METHODS A total of 45 patients with SWI and surgically proven ccRCC were divided into two groups: the low-grade group (Fuhrman I/II, n = 29) and the high-grade group (Fuhrman III/IV, n = 16). Texture features were extracted from SWI images. Feature selection was performed, and multivariable logistic regression analysis was performed to develop the SWI-based texture model for grading ccRCCs. Receiver operating characteristic (ROC) curve analysis and leave-group-out cross-validation (LGOCV) were performed to test the reliability of the model. RESULTS A total of 396 SWI-based texture features were extracted from each SWI image. The SWI-based texture model developed by multivariable logistic regression analysis was: SWIscore = -0.59 + 1.60 * ZonePercentage. The area under the ROC curve of the SWI-based texture model for differentiating high-grade ccRCC from low-grade ccRCC was 0.81 (95% confidence interval 0.67-0.94), with 80% accuracy, 56.25% sensitivity, and 93.10% specificity. After 100 LGOCVs, the mean accuracy, sensitivity, and specificity were 90.91%, 91.83%, and 89.89% for the training sets, and 77.29%, 80.52%, and 71.44% for the test sets, respectively. CONCLUSION SWI-based texture analysis might be a reliable quantitative approach for differentiating high-grade ccRCC from low-grade ccRCC.
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Affiliation(s)
- Jun Sun
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, PR China
| | - Liang Pan
- GE Healthcare China, Shanghai, Shanghai, PR China
| | - Tingting Zha
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, PR China
| | - Wei Xing
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, PR China
| | - Jie Chen
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, PR China
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Association of tumor grade, enhancement on multiphasic CT and microvessel density in patients with clear cell renal cell carcinoma. Abdom Radiol (NY) 2020; 45:3184-3192. [PMID: 31650375 DOI: 10.1007/s00261-019-02271-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Clear cell renal cell carcinoma (ccRCC) comprises nearly 90% of all diagnosed RCC subtypes and has the worst prognosis and highest metastatic potential. The strongest prognostic factors for patients with ccRCC include histological subtype and Fuhrman grade, which are incorporated into prognostic models. Since ccRCC is a highly vascularized tumor, there may be differences in enhancement patterns on multidetector CT (MDCT) due to the hemodynamics and microvessel density (MVD) of the lesions. This may provide a noninvasive method to characterize incidentally detected low- and high-grade ccRCCs on MDCT. The purpose of our study was to determine the correlation between MDCT enhancement parameters, ccRCC MVD, and Fuhrman grade to determine its utility and value in assessing tumor vascularity and grade in vivo. METHODS In this retrospective, HIPAA-compliant, institutional review board-approved study with waiver of informed consent, 127 consecutive patients with 89 low-grade (LG), and 43 high-grade (HG) ccRCCs underwent preoperative four-phase MDCT. A 3D volume of interest (VOI) was obtained for every tumor and absolute enhancement and the wash-in/wash-out of enhancement for each phase was assessed. Immunohistochemistry on resected specimens was used to quantify MVD. Linear regression and Pearson correlation were used to investigate the strength of the association between 3D VOI enhancement and MVD. Stepwise logistic regression analysis determined independent predictors of HG ccRCC. Cut-off values and odds Ratio (OR) with 95% CIs were reported. The clinical, radiomic, and pathologic features with the highest performance in the stepwise logistic regression analysis were evaluated using receiver operator characteristics (ROC) and area under the curve (AUC). RESULTS Absolute enhancement in the nephrographic phase < 52.1 Hounsfield Units (HU) (HR 0.979, 95% CI 0.964-0.994, p value = 0.006), lesion size > 4.3 cm (HR 1.450, 95% CI 1.211-1.738, p value < 0.001), and an intratumoral MVD < 15% (HR 0.932, 95% CI 0.867-1.002, p value = 0.058) were independent predictors of HG ccRCC with an AUC of 0.818 (95% CI 0.725-0.911). HG ccRCCs had a significant association between 3D VOI enhancement and MVD in each post-contrast phase (r2 = 0.238 to 0.455, p < 0.05). CONCLUSIONS Absolute enhancement of the entire lesion obtained from a 3D VOI in the nephrographic phase on preoperative MDCT can provide quantitative data that are a significant, independent predictor of a high-grade clear cell RCC and can be used to assess tumor vascularity and grade in vivo.
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Han D, Yu Y, Yu N, Dang S, Wu H, Jialiang R, He T. Prediction models for clear cell renal cell carcinoma ISUP/WHO grade: comparison between CT radiomics and conventional contrast-enhanced CT. Br J Radiol 2020; 93:20200131. [PMID: 32706977 DOI: 10.1259/bjr.20200131] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Comparing the prediction models for the ISUP/WHO grade of clear cell renal cell carcinoma (ccRCC) based on CT radiomics and conventional contrast-enhanced CT (CECT). METHODS The corticomedullary phase images of 119 cases of low-grade (I and II) and high-grade (III and IV) ccRCC based on 2016 ISUP/WHO pathological grading criteria were analyzed retrospectively. The patients were randomly divided into training and validation set by stratified sampling according to 7:3 ratio. Prediction models of ccRCC differentiation were constructed using CT radiomics and conventional CECT findings in the training setandwere validated using validation set. The discrimination, calibration, net reclassification index (NRI) and integrated discrimination improvement index (IDI) of the two prediction models were further compared. The decision curve was used to analyze the net benefit of patients under different probability thresholds of the two models. RESULTS In the training set, the C-statistics of radiomics prediction model was statistically higher than that of CECT (p < 0.05), with NRI of 9.52% and IDI of 21.6%, both with statistical significance (p < 0.01).In the validation set, the C-statistics of radiomics prediction model was also higher but did not show statistical significance (p = 0.07). The NRI and IDI was 14.29 and 33.7%, respectively, both statistically significant (p < 0.01). Validation set decision curve analysis showed the net benefit improvement of CT radiomics prediction model in the range of 3-81% over CECT. CONCLUSION The prediction model using CT radiomics in corticomedullary phase is more effective for ccRCC ISUP/WHO grade than conventional CECT. ADVANCES IN KNOWLEDGE As a non-invasive analysis method, radiomics can predict the ISUP/WHO grade of ccRCC more effectively than traditional enhanced CT.
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Affiliation(s)
- Dong Han
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Yong Yu
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Nan Yu
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Shan Dang
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Hongpei Wu
- Department of Pathology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | | | - Taiping He
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
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Renal cell carcinoma incidence rates and trends in young adults aged 20-39 years. Cancer Epidemiol 2020; 67:101762. [DOI: 10.1016/j.canep.2020.101762] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 11/20/2022]
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Palumbo C, Pecoraro A, Knipper S, Rosiello G, Luzzago S, Deuker M, Tian Z, Shariat SF, Simeone C, Briganti A, Saad F, Berruti A, Antonelli A, Karakiewicz PI. Contemporary Age-adjusted Incidence and Mortality Rates of Renal Cell Carcinoma: Analysis According to Gender, Race, Stage, Grade, and Histology. Eur Urol Focus 2020; 7:644-652. [PMID: 32456993 DOI: 10.1016/j.euf.2020.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recent data showed that North America has the highest incidence of renal cell carcinoma (RCC) worldwide. OBJECTIVE To assess contemporary gender-, race-, and stage-specific incidence; survival rates; and trends of RCC patients in the USA. DESIGN, SETTING, AND PARTICIPANTS Within the Surveillance, Epidemiology, and End Results database (2001-2016), all patients aged ≥18 yr with histologically confirmed renal parenchymal tumors were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Age-adjusted incidence rates and 5-yr cancer-specific survival (CSS) rates were estimated. Temporal trends were calculated through Joinpoint regression analyses to describe the average annual percent change (AAPC). RESULTS AND LIMITATIONS The age-adjusted incidence rate of RCC was 11.3/100 000 person years (AAPC+2.0%, p<0.001). Five-year CSS rates increased from 78.4% to 84.5% (AAPC +0.8%, p<0.001). Male incidence was double that of females (15.5 and 7.7, respectively). CSS marginally favored females (84.5% vs 82.0%), but improved equally in both genders (both AAPC +0.8%). The highest incidence (14.1/100 000 person years, AAPC +2.8%) and lowest survival (80.1%) were recorded in non-Hispanic American Indian/Alaska Native populations. T1aN0M0 had the highest incidence rates (4.6/100 000 person years), the highest increase over time (AAPC +3.6%), and the highest CSS (97.6%) of all stages. Limitations include retrospective nature and lack of information on risk factors. CONCLUSIONS The incidence of RCC increased significantly from 2001 to 2016, and 5-yr CSS after RCC improved. This was mainly due to T1aN0M0 tumors that showed the highest increase in the incidence and highest CSS. Unfavorable outcomes in specific ethnic groups warrant further research. PATIENT SUMMARY We examined contemporary incidence and cancer-specific survival rates of kidney cancer. Males had double the incidence rates of females, but lower survival. Natives showed the highest incidence rates and the lowest survival rates. Small renal masses showed the highest incidence and survival rates.
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Affiliation(s)
- Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.
| | - Angela Pecoraro
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Sophie Knipper
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Luzzago
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Marina Deuker
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Departments of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - 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
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alfredo Berruti
- Medical Oncology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Alessandro Antonelli
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
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12
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Texture analysis and machine learning algorithms accurately predict histologic grade in small (< 4 cm) clear cell renal cell carcinomas: a pilot study. Abdom Radiol (NY) 2020; 45:789-798. [PMID: 31822969 DOI: 10.1007/s00261-019-02336-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To predict the histologic grade of small clear cell renal cell carcinomas (ccRCCs) using texture analysis and machine learning algorithms. METHODS Fifty-two noncontrast (NC), 26 corticomedullary (CM) phase, and 35 nephrographic (NG) phase CTs of small (< 4 cm) surgically resected ccRCCs were retrospectively identified. Surgical pathology classified the tumors as low- or high-Fuhrman histologic grade. The axial image with the largest cross-sectional tumor area was exported and segmented. Six histogram and 31 texture (gray-level co-occurrences (GLC) and gray-level run-lengths (GLRL)) features were calculated for each tumor in each phase. T testing compared feature values in low- and high-grade ccRCCs, with a (Benjamini-Hochberg) false discovery rate of 10%. Area under the receiver operating curve (AUC) was calculated for each feature to assess prediction of low- and high-grade ccRCCs in each phase. Histogram, texture, and combined histogram and texture data sets were used to train and test four algorithms (k-nearest neighbor (KNN), support vector machine (SVM), random forests, and decision tree) with tenfold cross-validation; AUCs were calculated for each algorithm in each phase to assess prediction of low- and high-grade ccRCCs. RESULTS Zero, 23, and 0 features in the NC, CM, and NG phases had statistically significant differences between low and high-grade ccRCCs. CM histogram skewness and GLRL short run emphasis had the highest AUCs (0.82) in predicting histologic grade. All four algorithms had the highest AUCs (0.97) predicting histologic grade using CM histogram features. The algorithms' AUCs decreased using histogram or texture features from NC or NG phases. CONCLUSION The histologic grade of small ccRCCs can be accurately predicted with machine learning algorithms using CM histogram features, which outperform NC and NG phase image data.
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13
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Zhao Y, Yan Y, Ma R, Lv X, Zhang L, Wang J, Zhu W, Zhao L, Jiang L, Zhao L, Wen L, Yang B, Chen Y, He M, Liu M, Wei M. Expression signature of six-snoRNA serves as novel non-invasive biomarker for diagnosis and prognosis prediction of renal clear cell carcinoma. J Cell Mol Med 2020; 24:2215-2228. [PMID: 31943775 PMCID: PMC7011154 DOI: 10.1111/jcmm.14886] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/12/2019] [Accepted: 11/23/2019] [Indexed: 12/28/2022] Open
Abstract
Increasing evidence has verified that small nucleolar RNAs (snoRNAs) play significant roles in tumorigenesis and exhibit prognostic value in clinical practice. In the study, we analysed the expression profile and clinical relevance of snoRNAs from TCGA database including 530 ccRCC (clear cell renal cell carcinoma) and 72 control cases. By using univariate and multivariate Cox analysis, we established a six‐snoRNA signature and divided patients into high‐risk or low‐risk groups. We found patients in high‐risk group had significantly shorter overall survival and recurrence‐free survival than those in low‐risk group in test series, validation series and entire series by Kaplan‐Meier analysis. We also confirmed this signature had a great accuracy and specificity in 64 clinical tissue cases and 50 serum samples. Then, depending on receiver operating characteristic curve analysis we found the six‐snoRNA signature was an superior indicator better than conventional clinical factors (AUC = 0.732). Furthermore, combining the signature with TNM stage or Fuhrman grade were the optimal indicators (AUC = 0.792; AUC = 0.800) and processed the clinical applied value for ccRCC. Finally, we found the SNORA70B and its hose gene USP34 might directly regulate Wnt signalling pathway to promote tumorigenesis in ccRCC. In general, our study established a six‐snoRNA signature as an independent and superior diagnosis and prognosis indicator for ccRCC.
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Affiliation(s)
- Yanyun Zhao
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Engineering Technology Research Center for the Research, Development and Industrialization of Innovative Peptide Drugs, China Medical University, Shenyang, China
| | - Yuanyuan Yan
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Engineering Technology Research Center for the Research, Development and Industrialization of Innovative Peptide Drugs, China Medical University, Shenyang, China
| | - Rong Ma
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Engineering Technology Research Center for the Research, Development and Industrialization of Innovative Peptide Drugs, China Medical University, Shenyang, China
| | - Xuemei Lv
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Engineering Technology Research Center for the Research, Development and Industrialization of Innovative Peptide Drugs, China Medical University, Shenyang, China
| | - Liwen Zhang
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Engineering Technology Research Center for the Research, Development and Industrialization of Innovative Peptide Drugs, China Medical University, Shenyang, China
| | - Jinlong Wang
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Engineering Technology Research Center for the Research, Development and Industrialization of Innovative Peptide Drugs, China Medical University, Shenyang, China
| | - Wenjing Zhu
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Engineering Technology Research Center for the Research, Development and Industrialization of Innovative Peptide Drugs, China Medical University, Shenyang, China
| | - Lan Zhao
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Engineering Technology Research Center for the Research, Development and Industrialization of Innovative Peptide Drugs, China Medical University, Shenyang, China
| | - Longyang Jiang
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Engineering Technology Research Center for the Research, Development and Industrialization of Innovative Peptide Drugs, China Medical University, Shenyang, China
| | - Lin Zhao
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Engineering Technology Research Center for the Research, Development and Industrialization of Innovative Peptide Drugs, China Medical University, Shenyang, China
| | - Lijie Wen
- Urology Department, The Second Hospital of Dalian Medical University, Dalian, China
| | - Bo Yang
- Urology Department, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yuzong Chen
- Bioinformatics and Drug Design Group, Department of Pharmacy, National University of Singapore, Singapore City, Singapore
| | - Miao He
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Engineering Technology Research Center for the Research, Development and Industrialization of Innovative Peptide Drugs, China Medical University, Shenyang, China
| | - Mingyan Liu
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Engineering Technology Research Center for the Research, Development and Industrialization of Innovative Peptide Drugs, China Medical University, Shenyang, China
| | - Minjie Wei
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Engineering Technology Research Center for the Research, Development and Industrialization of Innovative Peptide Drugs, China Medical University, Shenyang, China
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14
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Holdbrook DA, Singh M, Choudhury Y, Kalaw EM, Koh V, Tan HS, Kanesvaran R, Tan PH, Peng JYS, Tan MH, Lee HK. Automated Renal Cancer Grading Using Nuclear Pleomorphic Patterns. JCO Clin Cancer Inform 2019; 2:1-12. [PMID: 30652593 DOI: 10.1200/cci.17.00100] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Nuclear pleomorphic patterns are essential for Fuhrman grading of clear cell renal cell carcinoma (ccRCC). Manual observation of renal histopathologic slides may lead to subjective and inconsistent assessment between pathologists. An automated, image-based system that classifies ccRCC slides by quantifying nuclear pleomorphic patterns in an objective and consistent interpretable fashion can aid pathologists in histopathologic assessment. METHODS In the current study, histopathologic tissue slides of 59 patients with ccRCC who underwent surgery at Singapore General Hospital were assembled retrospectively. An automated image classification pipeline detects and analyzes prominent nucleoli in ccRCC images to classify them as either low (Fuhrman grade 1 and 2) or high (Fuhrman grade 3 and 4). The pipeline uses machine learning and image pixel intensity-based feature extraction techniques for nuclear analysis. We trained classification systems that concurrently analyze different permutations of multiple prominent nucleoli image patches. RESULTS Given the parameters for feature combination and extraction, we present experimental results across various configurations for the classification of a given ccRCC histopathologic image. We also demonstrate that the image score used by the pipeline, termed fraction value, is correlated ( R = 0.59) with an existing multigene assay-based scoring system that has previously been demonstrated to be a strong indicator of prognosis in patients with ccRCC. CONCLUSION The current method provides an objective and fully automated way by which to process pathologic slides. The correlation study with a multigene assay-based scoring system also allows us to provide quantitative interpretation for already established nuclear pleomorphic patterns in ccRCC. This method can be extended to other cancers whose corresponding grading systems use nuclear pattern information.
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Affiliation(s)
- Daniel Aitor Holdbrook
- Daniel Aitor Holdbrook, Malay Singh, Emarene Mationg Kalaw, and Hwee Kuan Lee, Bioinformatics Institute; Malay Singh and Hwee Kuan Lee, National University of Singapore; Yukti Choudhury and Min-Han Tan, Lucence Diagnostics; Yukti Choudhury and Min-Han Tan, Institute of Bioengineering and Nanotechnology; Valerie Koh, Puay Hoon Tan, and John Yuen Shyi Peng, Singapore General Hospital; Hui Shan Tan, Ravindran Kanesvaran, and Min-Han Tan, National Cancer Center Singapore; and Hwee Kuan Lee, Institute for Infocomm Research, Singapore
| | - Malay Singh
- Daniel Aitor Holdbrook, Malay Singh, Emarene Mationg Kalaw, and Hwee Kuan Lee, Bioinformatics Institute; Malay Singh and Hwee Kuan Lee, National University of Singapore; Yukti Choudhury and Min-Han Tan, Lucence Diagnostics; Yukti Choudhury and Min-Han Tan, Institute of Bioengineering and Nanotechnology; Valerie Koh, Puay Hoon Tan, and John Yuen Shyi Peng, Singapore General Hospital; Hui Shan Tan, Ravindran Kanesvaran, and Min-Han Tan, National Cancer Center Singapore; and Hwee Kuan Lee, Institute for Infocomm Research, Singapore
| | - Yukti Choudhury
- Daniel Aitor Holdbrook, Malay Singh, Emarene Mationg Kalaw, and Hwee Kuan Lee, Bioinformatics Institute; Malay Singh and Hwee Kuan Lee, National University of Singapore; Yukti Choudhury and Min-Han Tan, Lucence Diagnostics; Yukti Choudhury and Min-Han Tan, Institute of Bioengineering and Nanotechnology; Valerie Koh, Puay Hoon Tan, and John Yuen Shyi Peng, Singapore General Hospital; Hui Shan Tan, Ravindran Kanesvaran, and Min-Han Tan, National Cancer Center Singapore; and Hwee Kuan Lee, Institute for Infocomm Research, Singapore
| | - Emarene Mationg Kalaw
- Daniel Aitor Holdbrook, Malay Singh, Emarene Mationg Kalaw, and Hwee Kuan Lee, Bioinformatics Institute; Malay Singh and Hwee Kuan Lee, National University of Singapore; Yukti Choudhury and Min-Han Tan, Lucence Diagnostics; Yukti Choudhury and Min-Han Tan, Institute of Bioengineering and Nanotechnology; Valerie Koh, Puay Hoon Tan, and John Yuen Shyi Peng, Singapore General Hospital; Hui Shan Tan, Ravindran Kanesvaran, and Min-Han Tan, National Cancer Center Singapore; and Hwee Kuan Lee, Institute for Infocomm Research, Singapore
| | - Valerie Koh
- Daniel Aitor Holdbrook, Malay Singh, Emarene Mationg Kalaw, and Hwee Kuan Lee, Bioinformatics Institute; Malay Singh and Hwee Kuan Lee, National University of Singapore; Yukti Choudhury and Min-Han Tan, Lucence Diagnostics; Yukti Choudhury and Min-Han Tan, Institute of Bioengineering and Nanotechnology; Valerie Koh, Puay Hoon Tan, and John Yuen Shyi Peng, Singapore General Hospital; Hui Shan Tan, Ravindran Kanesvaran, and Min-Han Tan, National Cancer Center Singapore; and Hwee Kuan Lee, Institute for Infocomm Research, Singapore
| | - Hui Shan Tan
- Daniel Aitor Holdbrook, Malay Singh, Emarene Mationg Kalaw, and Hwee Kuan Lee, Bioinformatics Institute; Malay Singh and Hwee Kuan Lee, National University of Singapore; Yukti Choudhury and Min-Han Tan, Lucence Diagnostics; Yukti Choudhury and Min-Han Tan, Institute of Bioengineering and Nanotechnology; Valerie Koh, Puay Hoon Tan, and John Yuen Shyi Peng, Singapore General Hospital; Hui Shan Tan, Ravindran Kanesvaran, and Min-Han Tan, National Cancer Center Singapore; and Hwee Kuan Lee, Institute for Infocomm Research, Singapore
| | - Ravindran Kanesvaran
- Daniel Aitor Holdbrook, Malay Singh, Emarene Mationg Kalaw, and Hwee Kuan Lee, Bioinformatics Institute; Malay Singh and Hwee Kuan Lee, National University of Singapore; Yukti Choudhury and Min-Han Tan, Lucence Diagnostics; Yukti Choudhury and Min-Han Tan, Institute of Bioengineering and Nanotechnology; Valerie Koh, Puay Hoon Tan, and John Yuen Shyi Peng, Singapore General Hospital; Hui Shan Tan, Ravindran Kanesvaran, and Min-Han Tan, National Cancer Center Singapore; and Hwee Kuan Lee, Institute for Infocomm Research, Singapore
| | - Puay Hoon Tan
- Daniel Aitor Holdbrook, Malay Singh, Emarene Mationg Kalaw, and Hwee Kuan Lee, Bioinformatics Institute; Malay Singh and Hwee Kuan Lee, National University of Singapore; Yukti Choudhury and Min-Han Tan, Lucence Diagnostics; Yukti Choudhury and Min-Han Tan, Institute of Bioengineering and Nanotechnology; Valerie Koh, Puay Hoon Tan, and John Yuen Shyi Peng, Singapore General Hospital; Hui Shan Tan, Ravindran Kanesvaran, and Min-Han Tan, National Cancer Center Singapore; and Hwee Kuan Lee, Institute for Infocomm Research, Singapore
| | - John Yuen Shyi Peng
- Daniel Aitor Holdbrook, Malay Singh, Emarene Mationg Kalaw, and Hwee Kuan Lee, Bioinformatics Institute; Malay Singh and Hwee Kuan Lee, National University of Singapore; Yukti Choudhury and Min-Han Tan, Lucence Diagnostics; Yukti Choudhury and Min-Han Tan, Institute of Bioengineering and Nanotechnology; Valerie Koh, Puay Hoon Tan, and John Yuen Shyi Peng, Singapore General Hospital; Hui Shan Tan, Ravindran Kanesvaran, and Min-Han Tan, National Cancer Center Singapore; and Hwee Kuan Lee, Institute for Infocomm Research, Singapore
| | - Min-Han Tan
- Daniel Aitor Holdbrook, Malay Singh, Emarene Mationg Kalaw, and Hwee Kuan Lee, Bioinformatics Institute; Malay Singh and Hwee Kuan Lee, National University of Singapore; Yukti Choudhury and Min-Han Tan, Lucence Diagnostics; Yukti Choudhury and Min-Han Tan, Institute of Bioengineering and Nanotechnology; Valerie Koh, Puay Hoon Tan, and John Yuen Shyi Peng, Singapore General Hospital; Hui Shan Tan, Ravindran Kanesvaran, and Min-Han Tan, National Cancer Center Singapore; and Hwee Kuan Lee, Institute for Infocomm Research, Singapore
| | - Hwee Kuan Lee
- Daniel Aitor Holdbrook, Malay Singh, Emarene Mationg Kalaw, and Hwee Kuan Lee, Bioinformatics Institute; Malay Singh and Hwee Kuan Lee, National University of Singapore; Yukti Choudhury and Min-Han Tan, Lucence Diagnostics; Yukti Choudhury and Min-Han Tan, Institute of Bioengineering and Nanotechnology; Valerie Koh, Puay Hoon Tan, and John Yuen Shyi Peng, Singapore General Hospital; Hui Shan Tan, Ravindran Kanesvaran, and Min-Han Tan, National Cancer Center Singapore; and Hwee Kuan Lee, Institute for Infocomm Research, Singapore
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15
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Liu N, Gan W, Qu F, Wang Z, Zhuang W, Agizamhan S, Xu L, Yin J, Guo H, Li D. Does the Fuhrman or World Health Organization/International Society of Urological Pathology Grading System Apply to the Xp11.2 Translocation Renal Cell Carcinoma?: A 10-Year Single-Center Study. THE AMERICAN JOURNAL OF PATHOLOGY 2019; 188:929-936. [PMID: 29571325 DOI: 10.1016/j.ajpath.2017.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/14/2017] [Accepted: 12/28/2017] [Indexed: 12/24/2022]
Abstract
The Fuhrman and World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading systems are widely used to predict survival for patients with conventional renal cell carcinoma. To determine the validity of nuclear grading systems (both the Fuhrman and the WHO/ISUP) and the individual components of the Fuhrman grading system in predicting the prognosis of Xp11.2 translocation renal cell carcinoma (Xp11.2 tRCC), we identified and followed up 47 patients with Xp11.2 tRCC in our center from January 2007 to June 2017. The Fuhrman and WHO/ISUP grading was reassigned by two pathologists. Nuclear size and shape were determined for each case based on the greatest degree of nuclear pleomorphism using image analysis software. Univariate and multivariate analyses were performed to evaluate the capacity of the grading systems and nuclear parameters to predict overall survival and progression-free survival. On univariate Cox regression analysis, the parameters of nuclear size were associated significantly with overall survival and progression-free survival, whereas the grading systems and the parameters of nuclear shape failed to reach a significant correlation. On multivariate analysis, however, none of the parameters was associated independently with survival. Our findings indicate that neither the Fuhrman nor the WHO/ISUP grading system is applicable to Xp11.2 tRCC. The assessment of nuclear size instead may be novel outcome predictors for patients with Xp11.2 tRCC.
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Affiliation(s)
- Ning Liu
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Weidong Gan
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
| | - Feng Qu
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhen Wang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wenyuan Zhuang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Sezim Agizamhan
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Linfeng Xu
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Juanjuan Yin
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Dongmei Li
- Immunology and Reproduction Biology Laboratory & State Key Laboratory of Analytical Chemistry for Life Science, Medical School, Nanjing University, Nanjing, China; Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, China.
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16
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Coy H, Young JR, Douek ML, Pantuck A, Brown MS, Sayre J, Raman SS. Association of qualitative and quantitative imaging features on multiphasic multidetector CT with tumor grade in clear cell renal cell carcinoma. Abdom Radiol (NY) 2019; 44:180-189. [PMID: 29987358 DOI: 10.1007/s00261-018-1688-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of the study was to determine if enhancement features and qualitative imaging features on multiphasic multidetector computed tomography (MDCT) were associated with tumor grade in patients with clear cell renal cell carcinoma (ccRCC). METHODS In this retrospective, IRB approved, HIPAA-compliant, institutional review board-approved study with waiver of informed consent, 127 consecutive patients with 89 low grade (LG) and 43 high grade (HG) ccRCCs underwent preoperative four-phase MDCT in unenhanced (UN), corticomedullary (CM), nephrographic (NP), and excretory (EX) phases. Previously published quantitative (absolute peak lesion enhancement, absolute peak lesion enhancement relative to normal enhancing renal cortex, 3D whole lesion enhancement and the wash-in/wash-out of enhancement within the 3D whole lesion ROI) and qualitative (enhancement pattern; presence of necrosis; pattern of; tumor margin; tumor-parenchymal interface, tumor-parenchymal interaction; intratumoral vascularity; collecting system infiltration; renal vein invasion; and calcification) assessments were obtained for each lesion independently by two fellowship-trained genitourinary radiologists. Comparisons between variables included χ2, ANOVA, and student t test. p values less than 0.05 were considered to be significant. Inter-reader agreement was obtained with the Gwet agreement coefficient (AC1) and standard error (SE) was reported. RESULTS No significant differences were observed between the LG and HG ccRCC cohorts with respect to absolute peak lesion enhancement and relative lesion enhancement ratio. There was a significant inverse correlation between low and high grade ccRCC and tumor enhancement the NP (71 HU vs. 54 HU, p < 0.001) and EX (52 HU vs. 39 HU, p < 0.001) phases using the 3D whole lesion ROI method. The percent wash-in of 3D enhancement from the UN to the CM phase was also significantly different between LG and HG ccRCCs (352% vs. 255%, p = 0.003). HG lesions showed significantly more calcification, necrosis, collecting system infiltration and ill-defined tumor margins (p < 0.05). Overall agreement between the two readers had a mean AC1 of 0.8172 (SE 0.0235). CONCLUSIONS Quantitatively, high grade ccRCC had significantly lower whole lesion enhancement in the NP and EX phases on MDCT. Qualitatively, high grade ccRCC were significantly more likely to be associated with calcifications, necrosis, collecting system infiltration, and an ill-defined tumor margin.
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Affiliation(s)
- Heidi Coy
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 924 Westwood Boulevard, Suite 650, Los Angeles, CA, 90024, USA.
| | - Jonathan R Young
- Department of Radiology, University of California, Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Michael L Douek
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 924 Westwood Boulevard, Suite 650, Los Angeles, CA, 90024, USA
| | - Alan Pantuck
- Department of Urology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Clark Urology Center-Westwood, 200 Medical Plaza, Suite 140, Los Angeles, CA, 90095, USA
| | - Matthew S Brown
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 924 Westwood Boulevard, Suite 650, Los Angeles, CA, 90024, USA
| | - James Sayre
- Department of Biostatistics, UCLA School of Public Heath, Room 51-253A, Los Angeles, CA, 90095, USA
| | - Steven S Raman
- UCLA Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, RRUMC 1621H, Box 957437, Los Angeles, CA, 90095, USA
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Zhang X, Wang Y, Yang L, Li T, Wu J, Chang R, Zhang J. Delayed enhancement of the peritumoural cortex in clear cell renal cell carcinoma: correlation with Fuhrman grade. Clin Radiol 2018; 73:982.e1-982.e7. [PMID: 30055766 DOI: 10.1016/j.crad.2018.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/08/2018] [Indexed: 01/20/2023]
Abstract
AIM To assess the delayed enhancement of the peritumoural cortex (DEC) sign in clear cell renal cell carcinoma (ccRCC), and investigate a possible correlation among DEC and Fuhrman grade. MATERIALS AND METHODS This retrospective study included 506 patients with 511 histopathologically proven ccRCCs evaluated by computed tomography (CT) angiography. DEC was detected and compared in groups divided by Fuhrman grades (low grade: 1 and 2, high grade: 3 and 4) using univariate and multivariate analyses. RESULTS DEC was detected in 89 of 511 (17.4%) ccRCCs (grade 1: 5.7%, 2/35; grade 2: 16.2%, 70/433; grade 3: 31.4%, 11/35; grade 4: 75%, 6/8; p<0.001). The incidence was higher in high-grade ccRCCs (39.5%, 17/43) than in low-grade ccRCCs (15.4%, 72/468; p<0.001). In multivariate analysis, tumour size >5.4 cm (p<0.001, odds ratio [OR]=3.57, 95% confidence interval [CI]: 1.76-7.23) and detection of DEC (p=0.021, OR=2.33, 95% CI: 1.13-4.80) were independent predictors of high-grade ccRCC. For all ccRCCs, the area under the receiver operating characteristic (ROC) curve (AUC) of DEC in predicting high-grade ccRCC was 0.62 (95% CI: 0.53-0.72) with 39.5% sensitivity and 84.6% specificity, while for ccRCCs of >5.4 cm diameter, the AUC was 0.66 (95% CI: 0.52-0.80) with 68.4% sensitivity and 62.7% specificity. CONCLUSIONS The DEC sign may predict aggressive biological behaviour of ccRCC, irrespective of tumour size.
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Affiliation(s)
- X Zhang
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing RD, Haidian District, Beijing 100853, China
| | - Y Wang
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing RD, Haidian District, Beijing 100853, China
| | - L Yang
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing RD, Haidian District, Beijing 100853, China.
| | - T Li
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing RD, Haidian District, Beijing 100853, China
| | - J Wu
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing RD, Haidian District, Beijing 100853, China
| | - R Chang
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing RD, Haidian District, Beijing 100853, China
| | - J Zhang
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing RD, Haidian District, Beijing 100853, China
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Prognostic factors and prognostic models for renal cell carcinoma: a literature review. World J Urol 2018; 36:1943-1952. [PMID: 29713755 DOI: 10.1007/s00345-018-2309-4] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/24/2018] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Following curative treatment for localised renal cell carcinoma (RCC), up to 30% of patients develop tumour recurrence. Prognostic scores are essential to guide individualised surveillance protocols, patient counselling and potentially in the future to guide adjuvant therapy. In metastatic RCC, prognostic scores are routinely used for treatment selection in clinical practice as well as in all major trials. METHODS We performed a literature review on the current evidence based on prognostic factors and models for localised and metastatic RCC. RESULTS A number of prognostic factors have been identified, of which tumour node metastasis classification remains the most important. Multiple prognostic models and nomograms have been developed for localised disease, based on a combination of tumour stage, grade, subtype, clinical features, and performance status. However, there is poor level of evidence for their routine use. Prognostic scores for patients with metastatic RCC receiving targeted treatments are used routinely, but have limited accuracy. Molecular markers can improve the accuracy of established prognostic models, but frequently lack external, independent validation. CONCLUSION Several factors and models predict prognosis of localised and metastatic RCC. They represent valuable tools to provide estimates of clinically important endpoints, but their accuracy should be improved further. Validation of molecular markers is a future research priority.
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Ding J, Xing Z, Jiang Z, Chen J, Pan L, Qiu J, Xing W. CT-based radiomic model predicts high grade of clear cell renal cell carcinoma. Eur J Radiol 2018; 103:51-56. [PMID: 29803385 DOI: 10.1016/j.ejrad.2018.04.013] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/14/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare the predictive models that can incorporate a set of CT image features for preoperatively differentiating the high grade (Fuhrman III-IV) from low grade (Fuhrman I-II) clear cell renal cell carcinoma (ccRCC). MATERIAL AND METHODS One hundred and fourteen patients with ccRCC treated with a partial or radical nephrectomy were enrolled in the training cohort. The six non-texture features, including Pseudocapsule, Round mass, maximal tumor diameter (Diametermax), intratumoral artery (Arterytumor), enhancement value of the tumor (TEV) and relative TEV (rTEV), were assessed for each tumor. The texture features were extracted from the CT images of the section with the largest area of renal mass at both corticomedullary and nephrographic phases. The least absolute shrinkage and selection operator (LASSO) was used to screen the most valuable texture features to calculate a texture score (Texture-score) for each patient. A logistic regression model was used in the training cohort to discriminate the high from low grade ccRCC at nephrectomy. The predictors would include all non-texture features in Model 1, all non-texture features and Texture-score in Model 2, and Texture-score in Model 3. The performance of the predictive models were tested and compared in an independent validation cohort composed of 92 cases with ccRCC. RESULTS Inter-rater agreement was good for each non-texture feature and Texture-score (the concordance correlation coefficient or Kappa coefficient > 0.70). The Texture-score was calculated via a linear combination of the 4 selected texture features. The three models shown good discrimination of the high from low grade ccRCC in the training cohort and the area under receiver operating characteristic curve (AUC) was 0.826 in Mode 1, 0.878 in Model 2 and 0.843 in Model 3, and a significant different AUC was found between Model 1 and Model 2. Application of the predictive models in the validation cohort still gave a discrimination (AUC > 0.670), and the Texture-score based models with or without the non-texture features (Model 2 and 3) showed a better discrimination of the high from low grade ccRCC (P < 0.05). CONCLUSION This study presented the Texture-score based models can facilitate the preoperative discrimination of the high from low grade ccRCC.
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Affiliation(s)
- Jiule Ding
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, China
| | - Zhaoyu Xing
- Department of Urology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, China
| | - Zhenxing Jiang
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, China
| | - Jie Chen
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, China
| | - Liang Pan
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, China
| | - Jianguo Qiu
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, China
| | - Wei Xing
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, China.
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The glucose and lipid metabolism reprogramming is grade-dependent in clear cell renal cell carcinoma primary cultures and is targetable to modulate cell viability and proliferation. Oncotarget 2017; 8:113502-113515. [PMID: 29371925 PMCID: PMC5768342 DOI: 10.18632/oncotarget.23056] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/14/2017] [Indexed: 01/06/2023] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) has a poor prognosis despite novel biological targeted therapies. Tumor aggressiveness and poor survival may correlate with tumor grade at diagnosis and with complex metabolic alterations, also involving glucose and lipid metabolism. However, currently no grade-specific metabolic therapy addresses these alterations. Here we used primary cell cultures from ccRCC of low- and high-grade to investigate the effect on energy state and reduced pyridine nucleotide level, and on viability and proliferation, of specific inhibition of glycolysis with 2-deoxy-D-glucose (2DG), or fatty acid oxidation with Etomoxir. Our primary cultures retained the tissue grade-dependent modulation of lipid and glycogen storage and aerobic glycolysis (Warburg effect). 2DG affected lactate production, energy state and reduced pyridine nucleotide level in high-grade ccRCC cultures, but the energy state only in low-grade. Rather, Etomoxir affected energy state in high-grade and reduced pyridine nucleotide level in low-grade cultures. Energy state and reduced pyridine nucleotide level were evaluated by ATP and reduced 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium (MTT) dye quantification, respectively. 2DG treatment impaired cell proliferation and viability of low-grade ccRCC and normal cortex cultures, whereas Etomoxir showed a cytostatic and cytotoxic effect only in high-grade ccRCC cultures. Our data indicate that in ccRCC the Warburg effect is a grade-dependent feature, and fatty acid oxidation can be activated for different grade-dependent metabolic needs. A possible grade-dependent metabolic therapeutic approach in ccRCC is also highlighted.
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21
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Survival of metastatic renal cell carcinoma patients continues to improve over time, even in targeted therapy era. Int Urol Nephrol 2017; 49:2143-2149. [DOI: 10.1007/s11255-017-1703-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
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22
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Ge YZ, Xu LW, Zhou CC, Lu TZ, Yao WT, Wu R, Zhao YC, Xu X, Hu ZK, Wang M, Yang XB, Zhou LH, Zhong B, Xu Z, Li WC, Zhu JG, Jia RP. A BAP1 Mutation-specific MicroRNA Signature Predicts Clinical Outcomes in Clear Cell Renal Cell Carcinoma Patients with Wild-type BAP1. J Cancer 2017; 8:2643-2652. [PMID: 28900502 PMCID: PMC5595094 DOI: 10.7150/jca.20234] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/25/2017] [Indexed: 12/16/2022] Open
Abstract
Background: Clear cell renal cell carcinoma (ccRCC) is the most prevalent histologic subtype of kidney cancers in adults, which could be divided into two distinct subgroups according to the BRCA1 associated protein-1 (BAP1) mutation status. In the current study, we comprehensively analyzed the genome-wide microRNA (miRNA) expression profiles in ccRCC, with the aim to identify the differentially expressed miRNAs between BAP1 mutant and wild-type tumors, and generate a BAP1 mutation-specific miRNA signature for ccRCC patients with wild-type BAP1. Methods: The BAP1 mutation status and miRNA profiles in BAP1 mutant and wild-type tumors were analyzed. Subsequently, the association of the differentially expressed miRNAs with patient survival was examined, and a BAP1 mutation-specific miRNA signature was generated and examined with Kaplan-Meier survival, univariate and multivariate Cox regression analyses. Finally, the bioinformatics methods were adopted for the target prediction of selected miRNAs and functional annotation analyses. Results: A total of 350 treatment-naïve primary ccRCC patients were selected from The Cancer Genome Atlas project, among which 35 (10.0%) subjects carried mutant BAP1 and had a shorter overall survival (OS) time. Furthermore, 33 miRNAs were found to be differentially expressed between BAP1 mutant and wild-type tumors, among which 11 (miR-149, miR-29b-2, miR-182, miR-183, miR-21, miR-365-2, miR-671, miR-365-1, miR-10b, miR-139, and miR-181a-2) were significantly associated with OS in ccRCC patients with wild-type BAP1. Finally, a BAP1 mutation-specific miRNA signature consisting of 11 miRNAs was generated and validated as an independent prognostic parameter. Conclusions: In summary, our study identified a total of 33 miRNAs differentially expressed between BAP1 mutant and wild-type tumors, and generated a BAP1 mutation-specific miRNA signature including eleven miRNAs, which could serve as a novel prognostic biomarker for ccRCC patients with wild-type BAP1.
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Affiliation(s)
- Yu-Zheng Ge
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Lu-Wei Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Chang-Cheng Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Tian-Ze Lu
- Department of Urology, Nantong Hospital of Traditional Chinese Medicine, 41 Jianshe Road, Nantong 226006, China
| | - Wen-Tao Yao
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Ran Wu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - You-Cai Zhao
- Department of Pathology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Xiao Xu
- Department of Radiation Oncology, JiangSu Armed Police General Hospital, 8 Jiangdu South Road, Yangzhou 225003, China
| | - Zhi-Kai Hu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Min Wang
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Xiao-Bing Yang
- Department of Pathology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Liu-Hua Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Bing Zhong
- Department of Urology, Huaian First People's Hospital, Nanjing Medical University, 6 Beijing West Road, Huaian 223300, China
| | - Zheng Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Wen-Cheng Li
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Jia-Geng Zhu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Rui-Peng Jia
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
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Lorente D, Trilla E, Meseguer A, Planas J, Placer J, Celma A, Salvador C, Regis L, Morote J. Systematic review of renal carcinoma prognostic factors. Actas Urol Esp 2017; 41:215-225. [PMID: 27659130 DOI: 10.1016/j.acuro.2016.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022]
Abstract
CONTEXT AND OBJECTIVES The natural history of renal cell carcinoma is heterogeneous. Some scenarios can be found in terms of clinical presentation, clinical evolution or type of recurrence (local/metastatic). The aim of this publication is to analyze the most important prognostic factors published in the literature. EVIDENCE ACQUISITION A literature review ob published papers was performed using the Pubmed, from first Motzer's classification published in 1999 to 2015, according to PRISMA declaration. Search was done using the following keywords: kidney neoplasm, kidney cancer, renal cell carcinoma, prognostic factors, mortality, survival and disease progression. Papers were classified according to level of evidence, the number of patients included and the type of study performed. EVIDENCE SYNTHESIS The evolution in the knowledge of molecular pathways related to renal oncogenesis and the new targeted therapies has left to remain obsolete the old prognostic models. It's necessary to perform a continuous review to actualize nomograms and to adapt them to the new scenarios. CONCLUSIONS Is necessary to perform a proper external validation of existing prognostic factors using prospective and multicentric studies to add them into the daily urologist clinical practice.
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Affiliation(s)
- D Lorente
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
| | - E Trilla
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España.
| | - A Meseguer
- Unidad de fisiología y fisiopatología renal (VHIR), Barcelona, España
| | - J Planas
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
| | - J Placer
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
| | - A Celma
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
| | - C Salvador
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
| | - L Regis
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
| | - J Morote
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
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Lesion Size and Iodine Quantification to Distinguish Low-Grade From High-Grade Clear Cell Renal Cell Carcinoma Using Dual-Energy Spectral Computed Tomography. J Comput Assist Tomogr 2017; 40:673-7. [PMID: 27224223 DOI: 10.1097/rct.0000000000000441] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study was to assess the utility of lesion size and iodine quantification using dual-energy spectral computed tomography to distinguish between low-grade and high-grade clear cell renal cell carcinomas (ccRCCs). METHODS Spectral parameters of 75 patients with pathologically proven ccRCCs who underwent preoperative dual-energy spectral computed tomography examinations were divided into low-grade and high-grade groups. Independent sample t test, receiver operating characteristic curve analysis, and Spearman rank correlation were analyzed. RESULTS The lesion size was significantly smaller, and spectral parameters were significantly higher in the low-grade ccRCC. The significant correlation (r = -0.412, P < 0.001) by the Spearman rank correlation was between the normalized iodine concentration and lesion size. The receiver operating characteristic analysis demonstrated that 0.710 was the optimal cutoff value, which yielded the following: sensitivity, 97.6%; specificity, 97.1%; positive predictive value, 97.6%; negative predictive value, 97.1%; and accuracy, 97.3%. CONCLUSIONS Iodine quantification can play an important role in distinguishing low-grade from high-grade ccRCC.
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25
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Wan F, Zhu Y, Han C, Xu Q, Wu J, Dai B, Zhang H, Shi G, Gu W, Ye D. Identification and validation of an eight-gene expression signature for predicting high Fuhrman grade renal cell carcinoma. Int J Cancer 2017; 140:1199-1208. [DOI: 10.1002/ijc.30535] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Fangning Wan
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai People's Republic of China
- Department of Oncology; Shanghai Medical College, Fudan University; Shanghai People's Republic of China
| | - Yao Zhu
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai People's Republic of China
- Department of Oncology; Shanghai Medical College, Fudan University; Shanghai People's Republic of China
| | - Chengtao Han
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai People's Republic of China
- Department of Oncology; Shanghai Medical College, Fudan University; Shanghai People's Republic of China
| | - Qinghua Xu
- Canhelp Genomics Co. Ltd.; Hangzhou China
| | - Junlong Wu
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai People's Republic of China
- Department of Oncology; Shanghai Medical College, Fudan University; Shanghai People's Republic of China
| | - Bo Dai
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai People's Republic of China
- Department of Oncology; Shanghai Medical College, Fudan University; Shanghai People's Republic of China
| | - Hailiang Zhang
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai People's Republic of China
- Department of Oncology; Shanghai Medical College, Fudan University; Shanghai People's Republic of China
| | - Guohai Shi
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai People's Republic of China
- Department of Oncology; Shanghai Medical College, Fudan University; Shanghai People's Republic of China
| | - Weijie Gu
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai People's Republic of China
- Department of Oncology; Shanghai Medical College, Fudan University; Shanghai People's Republic of China
| | - Dingwei Ye
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai People's Republic of China
- Department of Oncology; Shanghai Medical College, Fudan University; Shanghai People's Republic of China
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Mytsyk Y, Dutka I, Borys Y, Komnatska I, Shatynska-Mytsyk I, Farooqi AA, Gazdikova K, Caprnda M, Rodrigo L, Kruzliak P. Renal cell carcinoma: applicability of the apparent coefficient of the diffusion-weighted estimated by MRI for improving their differential diagnosis, histologic subtyping, and differentiation grade. Int Urol Nephrol 2016; 49:215-224. [PMID: 27853915 DOI: 10.1007/s11255-016-1460-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/10/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Renal cell carcinoma (RCC) represents the most common malignant epithelial neoplasm of the kidney. Accurate assessment of the renal masses, defining the histologic subtype and the grade of differentiation of the tumor, is vital to ensure an adequate case management as well as for staging and prognosis. Recently, diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) tends to be increasingly appealing for the clinicians as an imaging procedure of choice for the diagnosis and staging of the RCC, which is predetermined by several advantages over CT. The goal of the survey was to assess the applicability of the apparent diffusion coefficient (ADC) of the DWI MRI for the differential diagnostics, histologic subtyping, and defining the grade of differentiation of the RCC. METHODS The study enrolled 288 adult patients with renal lesions: 188 patients with solid RCC-126 patients with clear cell subtype (ccRCC), 32 patients with papillary RCC (pRCC), 30 patients with chromophobe RCC (chRCC); 27 patient with cystic form or RCC (Bosniak cyst, category IV); 32 patients with renal angiomyolipoma (AML); 25 patients with renal oncocytoma (OC); and 16 patients with the renal abscess (AB). In total, 245 lesions were pathologically verified. As a reference, 19 healthy volunteers were included into the study. All patients underwent MRI of the kidneys, involving DWI with subsequent evaluation of the ADC. RESULTS There was a reliable difference (p < 0.05) in mean ADC values between the normal renal parenchyma (NRP), solid RCC of different histologic subtypes and grades, cystic RCC, and benign renal lesions. The mean ADC values obtained in the result of the study were (×10-3 mm2/s): 2.47 ± 0.12 in NRP, 1.63 ± 0.29 in all solid RCCs, 1.82 ± 0.22 in solid ccRCC (1.92 ± 0.11-Fuhrman grade I, 1.84 ± 0.14-Fuhrman grade II, 1.79 ± 0.10-Fuhrman grade III, 1.72 ± 0.06-Fuhrman grade IV), 1.61 ± 0.07 in pRCC, 1.46 ± 0.09 in chRCC, 2.68 ± 0.11 in cystic RCC, 2.13 ± 0.08 in AML, 2.26 ± 0.06 in OC, and 3.30 ± 0.07 in AB. CONCLUSION The data received in our study demonstrate a substantial restriction of diffusion of hydrogen molecules in tissues of ccRCC in comparison with the healthy renal parenchyma preconditioned by the greater density of tumor. A statistically significant difference in mean ADC values of ccRCC with different grades of nuclear pleomorphism by Fuhrman was observed: Low-grade tumors showed higher mean ADC values compared to high-grade tumors. The modality of the MRI DWI along with ADC measurement allows to reliably differentiate between the solid RCC of main histologic subtypes and grades, cystic RCC, and the benign renal lesions.
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Affiliation(s)
- Yulian Mytsyk
- Department of Urology, Lviv National Medical University, Pekarska str. 69, Lviv, Ukraine.
| | - Ihor Dutka
- Euroclinic Medical Center, Lviv, Ukraine
| | - Yuriy Borys
- Department of Urology, Lviv National Medical University, Pekarska str. 69, Lviv, Ukraine
| | | | | | - Ammad Ahmad Farooqi
- Laboratory of Translational Oncology and Personalized Medicine, Rashid Latif Medical College, Lahore, Pakistan
| | - Katarina Gazdikova
- Department of Nutrition, Faculty of Nursing and Professional Health Studies, Slovak Medical University, Limbova 12, 833 03, Bratislava, Slovak Republic. .,Department of General Medicine, Faculty of Medicine, Slovak Medical University, Bratislava, Slovak Republic.
| | - Martin Caprnda
- University of Oviedo, Central University Hospital of Asturias (HUCA), Oviedo, Spain
| | - Luis Rodrigo
- University of Oviedo, Central University Hospital of Asturias (HUCA), Oviedo, Spain
| | - Peter Kruzliak
- Department of Chemical Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho tr 1946/1, 612 42, Brno, Czech Republic. .,2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Overexpression of autotaxin is associated with human renal cell carcinoma and bladder carcinoma and their progression. Med Oncol 2016; 33:131. [PMID: 27757783 DOI: 10.1007/s12032-016-0836-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/24/2016] [Indexed: 12/20/2022]
Abstract
Autotaxin (ATX) as an important tumor cell motility-stimulating factor is upregulated in many different types of cancer. ATX, a member of the ectonucleotide pyrophosphatase and phosphodiesterase family of enzymes, possesses lysophospholipase D activity which hydrolyzes lysophosphatidylcholine to generate the potent tumor growth factor and mitogen lysophosphatidic acid (LPA). LPA acts on specific G-protein-coupled receptors, thereby regulating cell growth, migration, and survival. This study aimed to investigate the differences in gene expression pattern of ATX between cancerous and adjacent normal tissue of human renal cell carcinoma (RCC) and bladder carcinoma (BC) and find the correlation between ATX expression and clinicopathological features of both of these carcinomas. Both the RCC and BC tissues and with the adjacent normal tissues were collected. Immunohistochemistry and Western blotting analysis were used to detect the extent of ATX expression in all of these samples. Immunohistochemistry and Western blot analysis revealed that expression of ATX protein in carcinoma tissues is significantly higher than that in the adjacent normal tissues. Immunohistochemistry analysis showed that ATX is localized in cytoplasm. Western blotting analysis showed that ATX protein is expressed in both RCC and BC, and the expression levels were 69.5 and 48.0 %, respectively, higher in RCC and BC carcinoma tissue samples than in the adjacent normal tissues, which is consistent with the results of immunohistochemistry study. Thus, this study provided the evidence that ATX is highly expressed in both RCC and BC. Further research can be done to identify the diagnosis and treatment significance of both these carcinomas.
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28
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Neely BA, Wilkins CE, Marlow LA, Malyarenko D, Kim Y, Ignatchenko A, Sasinowska H, Sasinowski M, Nyalwidhe JO, Kislinger T, Copland JA, Drake RR. Proteotranscriptomic Analysis Reveals Stage Specific Changes in the Molecular Landscape of Clear-Cell Renal Cell Carcinoma. PLoS One 2016; 11:e0154074. [PMID: 27128972 PMCID: PMC4851420 DOI: 10.1371/journal.pone.0154074] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/10/2016] [Indexed: 11/20/2022] Open
Abstract
Renal cell carcinoma comprises 2 to 3% of malignancies in adults with the most prevalent subtype being clear-cell RCC (ccRCC). This type of cancer is well characterized at the genomic and transcriptomic level and is associated with a loss of VHL that results in stabilization of HIF1. The current study focused on evaluating ccRCC stage dependent changes at the proteome level to provide insight into the molecular pathogenesis of ccRCC progression. To accomplish this, label-free proteomics was used to characterize matched tumor and normal-adjacent tissues from 84 patients with stage I to IV ccRCC. Using pooled samples 1551 proteins were identified, of which 290 were differentially abundant, while 783 proteins were identified using individual samples, with 344 being differentially abundant. These 344 differentially abundant proteins were enriched in metabolic pathways and further examination revealed metabolic dysfunction consistent with the Warburg effect. Additionally, the protein data indicated activation of ESRRA and ESRRG, and HIF1A, as well as inhibition of FOXA1, MAPK1 and WISP2. A subset analysis of complementary gene expression array data on 47 pairs of these same tissues indicated similar upstream changes, such as increased HIF1A activation with stage, though ESRRA and ESRRG activation and FOXA1 inhibition were not predicted from the transcriptomic data. The activation of ESRRA and ESRRG implied that HIF2A may also be activated during later stages of ccRCC, which was confirmed in the transcriptional analysis. This combined analysis highlights the importance of HIF1A and HIF2A in developing the ccRCC molecular phenotype as well as the potential involvement of ESRRA and ESRRG in driving these changes. In addition, cofilin-1, profilin-1, nicotinamide N-methyltransferase, and fructose-bisphosphate aldolase A were identified as candidate markers of late stage ccRCC. Utilization of data collected from heterogeneous biological domains strengthened the findings from each domain, demonstrating the complementary nature of such an analysis. Together these results highlight the importance of the VHL/HIF1A/HIF2A axis and provide a foundation and therapeutic targets for future studies. (Data are available via ProteomeXchange with identifier PXD003271 and MassIVE with identifier MSV000079511.)
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Affiliation(s)
- Benjamin A. Neely
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Christopher E. Wilkins
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, Virginia, United States of America
| | - Laura A. Marlow
- Department of Cancer Biology, Mayo Clinic Comprehensive Cancer Center, Jacksonville, Florida, United States of America
| | - Dariya Malyarenko
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Yunee Kim
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Maciek Sasinowski
- INCOGEN, Inc., Williamsburg, Virginia, United States of America
- Venebio Group, LLC, Richmond, Virginia, United States of America
| | - Julius O. Nyalwidhe
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, Virginia, United States of America
- Leroy T. Canoles Jr. Cancer Research Center, Eastern Virginia Medical School, Norfolk, Virginia, United States of America
| | - Thomas Kislinger
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - John A. Copland
- Department of Cancer Biology, Mayo Clinic Comprehensive Cancer Center, Jacksonville, Florida, United States of America
| | - Richard R. Drake
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, South Carolina, United States of America
- * E-mail:
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Trudeau V, Larcher A, Sun M, Boehm K, Dell’Oglio P, Sosa J, Tian Z, Fossati N, Briganti A, Shariat SF, Karakiewicz PI. Comparison of oncologic outcomes between sarcomatoid and clear cell renal cell carcinoma. World J Urol 2016; 34:1429-36. [DOI: 10.1007/s00345-016-1780-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022] Open
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Shen H, Yang P, Liu Q, Tian Y. Nuclear expression and clinical significance of phosphohistidine phosphatase 1 in clear-cell renal cell carcinoma. J Int Med Res 2015; 43:747-57. [PMID: 26537769 DOI: 10.1177/0300060515587576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/25/2015] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To explore expression and clinical relevance of phosphohistidine phosphatase 1 (PHPT1) in clear-cell renal cell carcinoma. METHODS Patients with clear-cell renal cell carcinoma who underwent radical or nephron-sparing nephrectomy were enrolled. Correlations between PHPT1 expression and demographic and clinical characteristics were analysed prospectively. RESULTS In total, 122 patients (78 male/44 female) were included. In normal kidney tissue, PHPT1 expression was observed only in the proximal tubule. High PHPT1 expression levels were associated with larger tumour size, higher Fuhrman nuclear grade and advanced pathological tumour-node-metastasis (pTNM) stage compared with low PHPT1 expression levels. Patients with low PHPT1 expression showed better overall survival and progression-free survival compared with those with high PHPT1 expression. In addition, multivariate analysis showed that nuclear grade and pTNM stage were independent predictors of progression-free survival and overall survival in patients with clear-cell renal cell carcinoma. PHPT1 expression was also an independent predictor of overall survival but not progression-free survival. CONCLUSIONS PHPT1 was expressed in the epithelium of proximal tubuli and nuclei of clear-cell renal cell carcinoma tissue samples. High levels of 14 kDa phosphohistidine phosphatase protein were negatively associated with overall survival and progression-free survival in patients with clear-cell renal cell carcinoma.
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Affiliation(s)
- Hongliang Shen
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peiqian Yang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qingjun Liu
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Becker A, Hickmann D, Hansen J, Meyer C, Rink M, Schmid M, Eichelberg C, Strini K, Chromecki T, Jesche J, Regier M, Randazzo M, Tilki D, Ahyai S, Dahlem R, Fisch M, Zigeuner R, Chun FKH. Critical analysis of a simplified Fuhrman grading scheme for prediction of cancer specific mortality in patients with clear cell renal cell carcinoma--Impact on prognosis. Eur J Surg Oncol 2015; 42:419-25. [PMID: 26520403 DOI: 10.1016/j.ejso.2015.09.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/17/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The traditional 4-tiered Fuhrman grading system (FGS) is widely accepted as histopathological classification for clear cell renal cell carcinoma (ccRCC) and has shown prognostic value. As intra- and inter-observer agreement are sub-optimal, simplified 2- or 3-tiered FGSs have been proposed. We aimed to validate these simplified 2- or 3-tiered FGSs for prediction of cancer-specific mortality (CSM) in a large study population from 2 European tertiary care centers. METHODS We identified and followed-up 2415 patients with ccRCC who underwent radical or partial nephrectomy in 2 European tertiary care centers. Univariable and multivariable analyses and prognostic accuracy analyses were performed to evaluate the ability of several simplified FGSs (i.e. grades I + II vs., grades III + IV, grades I + II vs. grade III and grade IV) to predict CSM. RESULTS Independent predictor status in multivariate analyses was proved for the simplified 2-tiered FGS (high-grade vs. low-grade), for the simplified 3-tiered FGS (grades I + II vs. grade III and grade IV) as well as for the traditional 4-tiered FGS. The prognostic accuracy of multivariable models of 77% was identical for all tested models. Prognostic accuracy of the model without FG was 75%. CONCLUSIONS A simplified 2- or 3-tiered FGS could predict CSM as accurate as the traditional 4-tiered FGS in a large European study population. Application of new simplified 2- or 3-tiered FGS may reduce inter-observer-variability and facilitate clinical practice without compromising the ability to predict CSM in ccRCC patients after radical or partial nephrectomy.
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Affiliation(s)
- A Becker
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - D Hickmann
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - J Hansen
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - C Meyer
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - M Rink
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - M Schmid
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - C Eichelberg
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Germany
| | - K Strini
- Department of Urology, Medical University of Graz, Auenbrugger Platz 1, 8036 Graz, Austria
| | - T Chromecki
- Department of Urology, Medical University of Graz, Auenbrugger Platz 1, 8036 Graz, Austria
| | - J Jesche
- Department of Urology, Medical University of Graz, Auenbrugger Platz 1, 8036 Graz, Austria
| | - M Regier
- Department of Diagnostic and Interventional Radiology, University Medical Center, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - M Randazzo
- Department of Urology, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - D Tilki
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - S Ahyai
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - R Dahlem
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - M Fisch
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - R Zigeuner
- Department of Urology, Medical University of Graz, Auenbrugger Platz 1, 8036 Graz, Austria
| | - F K H Chun
- Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Tupikowski K, Partyka A, Kolodziej A, Dembowski J, Debinski P, Halon A, Zdrojowy R, Frydecka I, Karabon L. CTLA-4 and CD28 genes' polymorphisms and renal cell carcinoma susceptibility in the Polish population--a prospective study. ACTA ACUST UNITED AC 2015; 86:353-61. [PMID: 26403483 DOI: 10.1111/tan.12671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/17/2015] [Accepted: 09/02/2015] [Indexed: 01/20/2023]
Abstract
Polymorphisms in co-stimulatory genes are associated with susceptibility to several malignances such as breast cancer, cervical cancer and chronic lymphocytic leukemia, but have been scarcely investigated in renal cell cancer (RCC). A total of 310 RCC patients and 518 controls were genotyped for single-nucleotide polymorphisms (SNPs) in the CTLA-4 and CD28 genes: CTLA-4c.49A>G (rs231775), CTLA-4g.319C>T (rs5742909), CTLA-4g.*6230G>A (CT60; rs3087243), CTLA-4g.*10223G>T (Jo31; rs11571302), CD28c.17+3T>C (rs3116496) and CD28c.-1042G>A (rs3181098). The distribution of the alleles, genotypes and haplotypes in the CTLA-4 and CD28 genes were similar in the RCC patients and in the controls. However, among the patients with a clear cell RCC (CCRCC), the G allele carriers of CT60 and Jo31 SNPs were overrepresented, and the overrepresentation became significant for the carriers of CT60[G] allele in CCRCC patients with necrosis in the primary tumor (P = 0.046). The CTLA-4c.49A>G[A]/CTLA-4g.319C>T[C]/CT60[A]/Jo31[T]/CD28c.17+3T>C[T]/ CD28c.1042G>A[G] haplotype was associated with an approximately threefold increased risk of primary tumor necrosis in CCRCC patients (P corrected = 0.0000007) and with the advanced stage of disease (IV) (P corrected = 0.001). When stratified by gender, CD28c.-1042G>A[GG] genotype was more frequent in the female CCRCC patients compared with healthy women (P = 0.042). Polymorphisms in the CTLA-4 and CD28 genes, in particular considered together as haplotypes, were associated with increased risk of CCRCC, especially with necrosis and with the advanced stage of disease. The CD28c.-1042G>A SNP modulates the risk of CCRCC in women. These findings indicate that the associations of the CTLA-4 and CD28 polymorphisms with the risk of renal cancer are worth further study in a larger group of patients.
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Affiliation(s)
- K Tupikowski
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wroclaw, Poland
| | - A Partyka
- Department of Experimental Therapy, L. Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - A Kolodziej
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wroclaw, Poland
| | - J Dembowski
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wroclaw, Poland
| | - P Debinski
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wroclaw, Poland
| | - A Halon
- Division of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland
| | - R Zdrojowy
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wroclaw, Poland
| | - I Frydecka
- Department of Experimental Therapy, L. Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - L Karabon
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wroclaw, Poland.,Department of Experimental Therapy, L. Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
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Huhdanpaa H, Hwang D, Cen S, Quinn B, Nayyar M, Zhang X, Chen F, Desai B, Liang G, Gill I, Duddalwar V. CT prediction of the Fuhrman grade of clear cell renal cell carcinoma (RCC): towards the development of computer-assisted diagnostic method. ACTA ACUST UNITED AC 2015; 40:3168-74. [DOI: 10.1007/s00261-015-0531-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Tsili AC, Argyropoulou MI. Advances of multidetector computed tomography in the characterization and staging of renal cell carcinoma. World J Radiol 2015; 7:110-127. [PMID: 26120380 PMCID: PMC4473304 DOI: 10.4329/wjr.v7.i6.110] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/18/2015] [Accepted: 04/29/2015] [Indexed: 02/06/2023] Open
Abstract
Renal cell carcinoma (RCC) accounts for approximately 90%-95% of kidney tumors. With the widespread use of cross-sectional imaging modalities, more than half of RCCs are detected incidentally, often diagnosed at an early stage. This may allow the planning of more conservative treatment strategies. Computed tomography (CT) is considered the examination of choice for the detection and staging of RCC. Multidetector CT (MDCT) with the improvement of spatial resolution and the ability to obtain multiphase imaging, multiplanar and three-dimensional reconstructions in any desired plane brought about further improvement in the evaluation of RCC. Differentiation of RCC from benign renal tumors based on MDCT features is improved. Tumor enhancement characteristics on MDCT have been found closely to correlate with the histologic subtype of RCC, the nuclear grade and the cytogenetic characteristics of clear cell RCC. Important information, including tumor size, localization, and organ involvement, presence and extent of venous thrombus, possible invasion of adjacent organs or lymph nodes, and presence of distant metastases are provided by MDCT examination. The preoperative evaluation of patients with RCC was improved by depicting the presence or absence of renal pseudocapsule and by assessing the possible neoplastic infiltration of the perirenal fat tissue and/or renal sinus fat compartment.
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Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, Kuczyk MA, Lam T, Marconi L, Merseburger AS, Mulders P, Powles T, Staehler M, Volpe A, Bex A. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 2015; 67:913-24. [PMID: 25616710 DOI: 10.1016/j.eururo.2015.01.005] [Citation(s) in RCA: 1781] [Impact Index Per Article: 197.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/02/2015] [Indexed: 02/09/2023]
Abstract
CONTEXT The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management. OBJECTIVES To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable. EVIDENCE ACQUISITION For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. EVIDENCE SYNTHESIS All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10,862 articles. A total of 151 studies reporting on 78,792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence. CONCLUSIONS The 2014 guideline has been updated by a multidisciplinary panel using the highest methodological standards, and provides the best and most reliable contemporary evidence base for RCC management. PATIENT SUMMARY The European Association of Urology Guideline Panel for Renal Cell Carcinoma has thoroughly evaluated available research data on kidney cancer to establish international standards for the care of kidney cancer patients.
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Affiliation(s)
- Borje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Steven Canfield
- Division of Urology, University of Texas Medical School at Houston, Houston, TX, USA
| | - Saeed Dabestani
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Fabian Hofmann
- Department of Urology, Sunderby Hospital, Sunderby, Sweden
| | - Milan Hora
- Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hanover University Medical School, Hanover, Germany
| | - Thomas Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Axel S Merseburger
- Department of Urology and Urologic Oncology, Hanover University Medical School, Hanover, Germany
| | - Peter Mulders
- Department of Urology, Radboud University, Nijmegen, The Netherlands
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, St. Bartholomew's Hospital, London, UK
| | - Michael Staehler
- Urologische Klinik, Klinikum der Ludwig-Maximilians Universität, Munich, Germany
| | - Alessandro Volpe
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Ball MW, Bezerra SM, Gorin MA, Cowan M, Pavlovich CP, Pierorazio PM, Netto GJ, Allaf ME. Grade Heterogeneity in Small Renal Masses: Potential Implications for Renal Mass Biopsy. J Urol 2015; 193:36-40. [DOI: 10.1016/j.juro.2014.06.067] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 01/29/2023]
Affiliation(s)
- Mark W. Ball
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephania M. Bezerra
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael A. Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Morgan Cowan
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian P. Pavlovich
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Phillip M. Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George J. Netto
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohamad E. Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Yeh FC, Parwani AV, Pantanowitz L, Ho C. Automated grading of renal cell carcinoma using whole slide imaging. J Pathol Inform 2014; 5:23. [PMID: 25191622 PMCID: PMC4141422 DOI: 10.4103/2153-3539.137726] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 06/08/2014] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Recent technology developments have demonstrated the benefit of using whole slide imaging (WSI) in computer-aided diagnosis. In this paper, we explore the feasibility of using automatic WSI analysis to assist grading of clear cell renal cell carcinoma (RCC), which is a manual task traditionally performed by pathologists. MATERIALS AND METHODS Automatic WSI analysis was applied to 39 hematoxylin and eosin-stained digitized slides of clear cell RCC with varying grades. Kernel regression was used to estimate the spatial distribution of nuclear size across the entire slides. The analysis results were correlated with Fuhrman nuclear grades determined by pathologists. RESULTS The spatial distribution of nuclear size provided a panoramic view of the tissue sections. The distribution images facilitated locating regions of interest, such as high-grade regions and areas with necrosis. The statistical analysis showed that the maximum nuclear size was significantly different (P < 0.001) between low-grade (Grades I and II) and high-grade tumors (Grades III and IV). The receiver operating characteristics analysis showed that the maximum nuclear size distinguished high-grade and low-grade tumors with a false positive rate of 0.2 and a true positive rate of 1.0. The area under the curve is 0.97. CONCLUSION The automatic WSI analysis allows pathologists to see the spatial distribution of nuclei size inside the tumors. The maximum nuclear size can also be used to differentiate low-grade and high-grade clear cell RCC with good sensitivity and specificity. These data suggest that automatic WSI analysis may facilitate pathologic grading of renal tumors and reduce variability encountered with manual grading.
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Affiliation(s)
- Fang-Cheng Yeh
- Department of Biomedical Engineering, Pittsburgh NMR Center for Biomedical Research, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA ; Department of Biological Science, Pittsburgh NMR Center for Biomedical Research, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Anil V Parwani
- Department of Pathology, Division of Pathology Informatics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Liron Pantanowitz
- Department of Pathology, Division of Pathology Informatics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Chien Ho
- Department of Biomedical Engineering, Pittsburgh NMR Center for Biomedical Research, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA ; Department of Biological Science, Pittsburgh NMR Center for Biomedical Research, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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Minardi D, Santoni M, Lucarini G, Mazzucchelli R, Burattini L, Conti A, Bianconi M, Scartozzi M, Milanese G, Primio RD, Montironi R, Cascinu S, Muzzonigro G. Tumor VEGF expression correlates with tumor stage and identifies prognostically different groups in patients with clear cell renal cell carcinoma. Urol Oncol 2014; 33:113.e1-7. [PMID: 25069421 DOI: 10.1016/j.urolonc.2014.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 06/23/2014] [Accepted: 06/26/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Vascular endothelial growth factor (VEGF) is a potent inducer of tumor angiogenesis and represents the key element in the pathogenesis of clear cell renal cell carcinoma (ccRCC). The aim of this study was to investigate the use of tumor VEGF expression as a parameter to identify tumor stage and prognostically different patient groups. METHODS AND MATERIALS We retrospectively collected clinical data of 137 patients treated with partial or radical nephrectomy at our institutions for organ-confined, locally advanced, and metastatic ccRCCs between 1984 and 2013. Tumor cell VEGF immunohistochemical expression was compared with pathological and clinical features including age, sex, tumor stage, and Fuhrman grade. Comparison of VEGF expression levels between tumor stages was performed via Kruskal-Wallis nonparametric test. Survival analysis was conducted via Kaplan-Meier product-limit method, and Mantel-Haenszel log-rank test was employed to compare survival among groups. RESULTS Median age at diagnosis was 61 years (range: 33-85 y). Tumor stage was pT1N0M0 in 67 patients (49%), pT2N0M0 in 5 (4%), and pT3N0M0 in 25 (18%), while 40 patients (29%) had metastatic tumors at diagnosis. Fuhrman nuclear grade was G1 in 22 patients (16%), G2 in 60 (44%), G3 in 33 (24%), G4 in 13 patients (9%), and unknown in 9 patients. Tumor VEGF was differentially expressed among different stages (P<0.001) and in low (G1-2) and high (G3-4) Fuhrman grade tumors (P<0.001). No significant differences were found when stratifying by sex (P = 0.06) or age (P = 0.29). Median overall survival (OS) from partial or radical nephrectomy was 161 months (range: 1-366). We observed a significantly longer OS in patients with low (<25%) vs. high (>25%) VEGF expression levels (median OS 206 vs. 65 mo, P<0.001). CONCLUSIONS Our data show that tumor cell VEGF expression is significantly associated with tumor stage and Fuhrman grade and is able to predict patient outcome, suggesting a potential use of this parameter in identifying prognostically different patients with ccRCC.
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Affiliation(s)
- Daniele Minardi
- Dipartimento di Scienze Cliniche e Specialistiche, Sezione di Urologia, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
| | - Matteo Santoni
- Dipartimento di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Guendalina Lucarini
- Dipartimento di Scienze Cliniche e Molecolari, Sezione di Istologia, Università Politecnica delle Marche, Ancona, Italy
| | - Roberta Mazzucchelli
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Sezione di Anatomia Patologica ed Istopatologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Luciano Burattini
- Dipartimento di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Alessandro Conti
- Dipartimento di Scienze Cliniche e Specialistiche, Sezione di Urologia, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Maristella Bianconi
- Dipartimento di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Mario Scartozzi
- Dipartimento di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Giulio Milanese
- Dipartimento di Scienze Cliniche e Specialistiche, Sezione di Urologia, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Roberto Di Primio
- Dipartimento di Scienze Cliniche e Molecolari, Sezione di Istologia, Università Politecnica delle Marche, Ancona, Italy
| | - Rodolfo Montironi
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Sezione di Anatomia Patologica ed Istopatologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Stefano Cascinu
- Dipartimento di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Giovanni Muzzonigro
- Dipartimento di Scienze Cliniche e Specialistiche, Sezione di Urologia, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
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King SC, Pollack LA, Li J, King JB, Master VA. Continued increase in incidence of renal cell carcinoma, especially in young patients and high grade disease: United States 2001 to 2010. J Urol 2014; 191:1665-70. [PMID: 24423441 DOI: 10.1016/j.juro.2013.12.046] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE More than 50,000 Americans were diagnosed with kidney and renal pelvis cancer in 2010. The National Program of Cancer Registries and SEER (Surveillance, Epidemiology and End Results) combined data include cancer incidences from the entire United States. Our study presents updated incidence data, evaluates trends and adds geographic distribution to the literature. MATERIALS AND METHODS We examined invasive, microscopically confirmed kidney and renal pelvis cancers diagnosed from 2001 to 2010 that met United States Cancer Statistics reporting criteria for each year, excluding cases diagnosed by autopsy or death certificate. Histology codes classified cases as renal cell carcinoma. Rates and trends were estimated using SEER∗Stat. RESULTS A total of 342,501 renal cell carcinoma cases were diagnosed. The renal cell carcinoma incidence rate increased from 10.6/100,000 individuals in 2001 to 12.4/100,000 in 2010 and increased with age until ages 70 to 74 years. The incidence rate in men was almost double that in women. The annual percent change was higher in women than in men, in those 20 to 24 years old and in grade III tumors. CONCLUSIONS The annual percent change incidence increased from 2001 to 2010. Asian/Pacific Islanders and 20 to 24-year-old individuals had the highest annual percent change. While some increase resulted from localized disease, the highest annual percent change was in grade III tumors, indicating more aggressive disease. Continued monitoring of trends and epidemiological study are warranted to determine risk factors.
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Affiliation(s)
- Sallyann Coleman King
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Department of Urology and Winship Cancer Institute, School of Medicine, Emory University (VAM), Atlanta, Georgia.
| | - Lori A Pollack
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Department of Urology and Winship Cancer Institute, School of Medicine, Emory University (VAM), Atlanta, Georgia
| | - Jun Li
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Department of Urology and Winship Cancer Institute, School of Medicine, Emory University (VAM), Atlanta, Georgia
| | - Jessica B King
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Department of Urology and Winship Cancer Institute, School of Medicine, Emory University (VAM), Atlanta, Georgia
| | - Viraj A Master
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Department of Urology and Winship Cancer Institute, School of Medicine, Emory University (VAM), Atlanta, Georgia
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Bianchi M, Gandaglia G, Trinh QD, Hansen J, Becker A, Abdollah F, Tian Z, Lughezzani G, Roghmann F, Briganti A, Montorsi F, Karakiewicz PI, Sun M. A population-based competing-risks analysis of survival after nephrectomy for renal cell carcinoma. Urol Oncol 2014; 32:46.e1-7. [DOI: 10.1016/j.urolonc.2013.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/17/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
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Role of CT in the assessment of muscular venous branch invasion in patients with renal cell carcinoma. AJR Am J Roentgenol 2013; 201:847-52. [PMID: 24059374 DOI: 10.2214/ajr.12.10496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The purpose of this article is to determine whether the relationship between a renal cell carcinoma and the renal sinus fat on contrast-enhanced CT could predict muscular venous branch invasion and the type of surgery needed. MATERIALS AND METHODS A total of 115 consecutive patients underwent pre-operative contrast-enhanced CT between August 2011 and December 2011. Without access to histopathologic information, on nephrographic phase contrast-enhanced CT images, two radiologists independently determined whether the renal tumor was in contact with the renal sinus fat or separated from the renal sinus fat. Interreader agreements and performance characteristics of imaging tests were calculated, and histopathologic analysis served as the standard of reference. RESULTS Histopathologic analysis identified 115 renal tumors, 90% (103/115) of which were renal cell carcinomas. Thirty-nine percent (31/80) of renal cell carcinomas that abutted the renal sinus fat on CT displayed muscular venous branch invasion on histopathologic analysis. Patients with renal cell carcinomas separated from the renal sinus fat were more likely to undergo partial nephrectomies (96% [22/23]; p = 0.013). Sensitivity and specificity for the identification of muscular venous branch invasion on CT were 94% (95% CI, 80-99%) and 30% (20-42%), respectively. Interreader agreement of visual assessment was excellent (κ = 0.87; 95% CI, 0.81-0.92). CONCLUSION If a renal cell carcinoma was separated from the renal sinus fat on CT, the likelihood of muscular venous branch invasion being identified by histopathologic analysis was significantly decreased, and the patient was more likely to undergo a partial nephrectomy.
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Vilella-Arias SA, Rocha RM, da Costa WH, Zequi SDC, Guimarães GC, Verjovski-Almeida S, Soares FA, Reis EM. Loss of caspase 7 expression is associated with poor prognosis in renal cell carcinoma clear cell subtype. Urology 2013; 82:974.e1-7. [PMID: 23920448 DOI: 10.1016/j.urology.2013.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 06/10/2013] [Accepted: 06/17/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the expression of CASP7 protein in renal cell carcinoma clear cell subtype (ccRCC) and its value to predict cancer-specific survival (CSS). METHODS A tissue microarray containing 120 samples of ccRCC, 45 non-ccRCC, and 66 nontumor paired samples from patients who underwent partial or radical nephrectomy was hybridized with anti-CASP7 antibody. Tissue sections were scored according to intensity and the percentage of stained cells. CASP7 immunostaining scores were used to estimate the association with clinicopathologic parameters and calculate Kaplan-Meier survival curves. RESULTS Reduced CASP7 expression was observed in ccRCC and non-ccRCC subtypes in comparison with nontumor renal tissues (P <.0001). CASP7 immunostaining was associated (P <.05) with clinicopathologic parameters (size, incidental tumor, clinical stage, renal vein invasion, and tumor necrosis) and correlated with CSS (P = .032) and global survival (P = .046) of patients with ccRCC. In addition, CASP7 expression was able to substratify patients with ccRCC with favorable prognosis according to low clinical stage, in which negative CASP7 staining was associated with patients with lower CSS (P = .045). Finally, CASP7 staining was able to provide significant stratification according to CSS (P = .018) among patients with ccRCC with disease relapse. CONCLUSION Our results implicate the loss of CASP7 expression in the aggressiveness of ccRCC and indicate its potential use as a clinical prognostic marker of the disease.
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Meskawi M, Sun M, Ismail S, Bianchi M, Hansen J, Tian Z, Hanna N, Trinh QD, Graefen M, Montorsi F, Perrotte P, Karakiewicz PI. Fuhrman grade [corrected] has no added value in prediction of mortality after partial or [corrected] radical nephrectomy for chromophobe renal cell carcinoma patients. Mod Pathol 2013; 26:1144-9. [PMID: 23370773 DOI: 10.1038/modpathol.2012.230] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/26/2012] [Accepted: 12/06/2012] [Indexed: 11/09/2022]
Abstract
Our objective was to test whether Fuhrman grade [corrected] (FG) is applicable in the context of chromophobe renal cell carcinoma patients treated with partial and radical nephrectomy. Patients (n=1862) with chromophobe renal cell carcinoma treated with partial and radical nephrectomy were identified within the Surveillance, Epidemiology, and End Results (1988-2008). Univariable and multivariable Cox regression analyses were fitted to predict cancer-specific mortality. Discriminant properties were assessed for the conventional four-tiered FG scheme. Additionally, discrimination of the three-tiered FG scheme (1-2 vs 3 vs 4) and the two-tiered FG scheme (1-2 vs 3-4) was also assessed. The statistical significance of the differences in accuracy estimates was compared using the Mantel-Haenszel test. A total of 65 of the 1862 died of the disease. The overall 5-year cancer-specific mortality-free survival rate was 94.8% (95% confidence interval: 93.5-96.2). In univariable analyses, none of the FG strata were significantly associated with cancer-specific mortality. Furthermore, FG was less informative (63%) than tumor size (72%) and tumor stage (69%), using measures of discrimination in univariable analyses. After accounting for all covariates, prediction of 5-year cancer-specific mortality was 79.0% vs 80.3% accurate, respectively, with vs without the consideration of FG (P=0.01). Similar discrimination estimates were obtained for the modified three-tiered FG scheme (78.5%; P=0.009) and the modified two-tiered FG scheme (79.5%; P=0.02). In conclusion, FG is not an informative predictor of prognosis, defined as cancer-specific mortality, after partial and radical nephrectomy for chromophobe renal cell carcinoma patients.
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Affiliation(s)
- Malek Meskawi
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
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Shoji K, Murayama T, Mimura I, Wada T, Kume H, Goto A, Ohse T, Tanaka T, Inagi R, van der Hoorn FA, Manabe I, Homma Y, Fukayama M, Sakurai T, Hasegawa T, Aburatani H, Kodama T, Nangaku M. Sperm-associated antigen 4, a novel hypoxia-inducible factor 1 target, regulates cytokinesis, and its expression correlates with the prognosis of renal cell carcinoma. THE AMERICAN JOURNAL OF PATHOLOGY 2013; 182:2191-203. [PMID: 23602831 DOI: 10.1016/j.ajpath.2013.02.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/05/2013] [Accepted: 02/21/2013] [Indexed: 02/06/2023]
Abstract
Hypoxia plays a crucial role in many pathophysiological conditions, including cancer biology, and hypoxia-inducible factor (HIF) regulates transcriptional responses under hypoxia. To elucidate the cellular responses to hypoxia, we performed chromatin immunoprecipitation with deep sequencing in combination with microarray analysis and identified HIF-1 targets. We focused on one of the novel targets, sperm-associated antigen 4 (SPAG4), whose function was unknown. SPAG4, an HIF-1-specific target, is up-regulated in various cultured cells under hypoxia. Examination of SPAG4 expression using a tissue microarray consisting of 190 human renal cell carcinoma (RCC) samples revealed that SPAG4 is an independent prognostic factor of cancer-specific mortality. Live-cell imaging revealed localization of SPAG4 at the intercellular bridge in telophase. We also studied cells in which SPAG4 was knocked down. Hypoxia enhances tetraploidy, which disturbs cell proliferation, and knockdown of SPAG4 increased tetraploid formation and decreased cell proliferation under both normoxic and hypoxic conditions. Studies using deletion mutants of SPAG4 also suggested the involvement of SPAG4 in cytokinesis. Microarray analysis confirmed dysregulation of cytokinesis-related genes by knockdown of SPAG4. In conclusion, SPAG4 is an independent prognostic factor in RCC and plays a crucial role in cytokinesis to defend against hypoxia-induced tetraploid formation. This defensive mechanism may promote survival of cancer cells under hypoxic conditions, thus leading to poor prognosis.
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Affiliation(s)
- Kumi Shoji
- Division of Nephrology and Endocrinology, University of Tokyo, Tokyo, Japan
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Karlo CA, Di Paolo PL, Donati OF, Russo P, Tickoo S, Hricak H, Akin O. Renal cell carcinoma: role of MR imaging in the assessment of muscular venous branch invasion. Radiology 2013; 267:454-9. [PMID: 23418001 DOI: 10.1148/radiol.13121555] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess diagnostic performance and interreader agreement of tumor-to-sinus distance measurements and visual assessment of renal sinus fat invasion at T2-weighted magnetic resonance (MR) imaging as predictors of muscular venous branch invasion (MVBI) in patients with renal cell carcinoma (RCC). MATERIALS AND METHODS The institutional review board approved this retrospective study and waived the informed consent requirement. The study was HIPAA compliant. A total of 186 consecutive patients underwent preoperative 1.5-T MR imaging; 188 RCCs were identified. Blinded to histopathologic information, two readers independently measured the tumor-to-sinus distance and assessed renal sinus fat invasion on transverse and coronal T2-weighted MR images. Interreader agreement (intraclass correlation coefficient, Cohen κ) and performance characteristics of imaging tests were calculated. Histopathologic findings served as the standard of reference. RESULTS Histopathologic findings indicated MVBI in 35% (66 of 188) of tumors. At imaging, all tumors with MVBI had a tumor-to-sinus distance of 0 mm. All tumors with renal sinus fat invasion at imaging had MVBI. Sensitivity and specificity for the detection of renal sinus fat invasion were 100% (95% confidence interval [CI]: 92%, 100%) and 94% (95% CI: 89%, 98%). In the absence of renal sinus fat invasion at imaging, a tumor-to-sinus distance of 0 mm was associated with MVBI in 21% (18 of 86) of cases. Interreader agreement for quantitative (intraclass correlation coefficient = 0.92; 95% CI: 0.89, 0.94) and qualitative (κ = 0.89; 95% CI: 0.81, 0.96) assessments was excellent. CONCLUSION Tumor-to-sinus distance measurements and the assessment of renal sinus fat invasion at T2-weighted MR imaging can be used reliably to rule out MVBI in patients with RCC.
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Affiliation(s)
- Christoph A Karlo
- Departments of Radiology, Urology, and Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Radiology Academic Offices, Room C278, New York, NY 10065, USA
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Morán E, Rogel R, Soto A, Ruiz-Cerdá J, Budía A, Salom J, Jiménez-Cruz J. [Usefulness of new schemes to group Fuhrman grades in clinical practice for clear cell renal tumour]. Actas Urol Esp 2012; 36:352-8. [PMID: 22266258 DOI: 10.1016/j.acuro.2011.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 11/13/2011] [Accepted: 11/16/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate if re-grading renal cell carcinoma (CRCC) in two or three-tiered grading schemes versus the traditional Fuhrman classification maintains the same prognostic value. MATERIAL AND METHODS A study of a cohort of 383 treated CRCC with radical or partial nephrectomy between 1990-2009 was made. We analyzed the demographic data, evolution and survival of these patients. An uropathologist reassigned the Fuhrman grades blindly to the first classification. In order to study if the prognostic value was maintained with the different classification, three Cox multivariate regression analysis were performed, classifying the variable of grade into four categories: (I-II-III-IV), into three (I+II-III-IV) and into two (I+II-III+IV). The explanatory variables were: age, gender, tumor size, study stage and grade. The response variables were progression-free survival (local-regional recurrence/metastasis) and cancer specific survival time. RESULTS The median overall survival was 125 months (95% CI: 92-159). In the three multivariate analyses carried out, the Fuhrman classification showed independent predictive value (p=:0.0001) compared to progression-free survival and cancer specific survival. The predictive power was maintained in the new classifications. In the three categories, the changing from grade I+II to III meant RR: 2.31 (p=0.0001) and from grade III to IV RR: 2.47 (p=0.0001) and in two-tiered classification an RR: 2.8 (p=0.001) was found when changing from I+II to III+IV. CONCLUSIONS Our results show that categorizing the Fuhrman grade into three or two-tiered grading schemes provide the same predictive accuracy on progressive free survival and cancer specific survival. Grades III and IV have different outcomes so that the three-tiered classification seems to be more appropriate to described the course of these patients.
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Ghoneim TP, Ouzzane A, Leroy X, Lemaitre L, Berthon N, Fantoni JC, Villers A, Zini L. [Renal cell carcinoma of patients younger than 40 years old]. Prog Urol 2012; 22:93-9. [PMID: 22284593 DOI: 10.1016/j.purol.2011.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 10/17/2011] [Accepted: 11/24/2011] [Indexed: 01/13/2023]
Abstract
CONTEXT Clinical and pathological characteristics of renal cell carcinoma (RCC) of patients younger than 40 years old are not well known. The objective of this study was to analyze these characteristics by comparison to a group of patients aged 58 to 62. METHODS Retrospective study of a group of patients aged less than 40 years old (group 1, n=44) and a group of patients aged 58 to 62 years old (group 2; n=106) treated surgically for a renal mass from January 2000 to July 2009. A comparative analysis of clinical, pathological characteristics and of cancer-specific survival was performed. Specific survival was calculated with the Kaplan-Meier method and compared with the Log-Rank test. Univariate and multivariable analysis were performed to assess and quantify the effect of age on cancer-specific survival. Covariates were gender, age group, tumor size, pT stage, histological sub-type and Fuhrman grade. RESULTS Clinical and pathological characteristics were similar in both groups (P>0.05) except for histological sub-type (56% of clear cell RCC for group 1 versus 82% for group 2). In the group of patients younger than 40 years, translocation RCC represented 23% of all RCCs. Cancer-specific survival at five years was similar in both groups (80% and 76% for group 1 and 2 respectively, P>0.58). Fuhrman grade was the only independent prognostic factor of cancer-specific survival (P=0.001). CONCLUSION Patients younger than 40 years were more likely to have a translocation RCC than their older counterparts for who clear cell RCC represented the main histological sub-type. Cancer-specific survival was similar between both groups. Only a systematic specific immunostaining for TFE3 or TFEB will allow to assess the exact incidence and prognosis of this entity.
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Affiliation(s)
- T P Ghoneim
- Service d'urologie, université de Lille Nord-de-France, hôpital Claude Huriez, CHU de Lille, 2, rue Michel-Polonovski, 59000 Lille, France.
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Minervini A. APPLICATION OF SIMPLIFIED FUHRMAN GRADING SYSTEM IN CLEAR-CELL RENAL CELL CARCINOMA. BJU Int 2011. [DOI: 10.1111/j.1464-410x.2010.10267.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW To review the latest status on prognostic factors in renal cell carcinoma (RCC). RECENT FINDINGS Many predictive and prognostic factors can help differentiate between favorable and unfavorable RCC phenotypes. There currently exist several clinical and/or pathological, and biological factors, which have been exclusively tested and used in predictive and prognostic models. Nonetheless, the search for highly informative and reliable factors of disease characteristics and progression continues. CONCLUSION Over the last decade, an increase occurred in the number of models that can predict the treated natural history of RCC. Many of these novel models and previously developed models are tested in a head-to-head fashion, with the intent of identifying the most accurate and valuable tools for clinical practice. Novel prognostic factors and more up-to-date models are urgently needed for patients with metastatic RCC, especially in the era of targeted therapies. This should represent the focus of contemporary prognostic modeling in RCC.
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Ficarra V, Brunelli M, Cheng L, Kirkali Z, Lopez-Beltran A, Martignoni G, Montironi R, Novara G, Van Poppel H. Prognostic and Therapeutic Impact of the Histopathologic Definition of Parenchymal Epithelial Renal Tumors. Eur Urol 2010; 58:655-68. [DOI: 10.1016/j.eururo.2010.08.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 08/02/2010] [Indexed: 01/20/2023]
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