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Chen B, Zhou M, Guo L, Sun X, Huang H, Wu K, Chen W, Wu D. A new perspective: deciphering the aberrance and clinical implication of disulfidptosis signatures in clear cell renal cell carcinoma. Aging (Albany NY) 2024; 16:10033-10062. [PMID: 38862242 PMCID: PMC11210246 DOI: 10.18632/aging.205916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/03/2024] [Indexed: 06/13/2024]
Abstract
Recent research has discovered disulfidptosis as a form of programmed cell death characterized by disulfide stress. However, its significance in clear cell renal cell carcinoma (ccRCC) remains unclear. To investigate this, data from The Cancer Genome Atlas were collected and used to identify ccRCC subgroups. Unsupervised clustering was employed to determine ccRCC heterogeneity. The mutation landscape and immune microenvironment of the subgroups were analyzed. The Disulfidptosis-Related Score was calculated using the LASSO-penalized Cox regression algorithm. The E-MATB-1980 cohort was used to validate the signature. The role of SLC7A11 in ccRCC metastasis was explored using western blotting and Transwell assays. Disulfidptosis-related genes are commonly downregulated in cancers and are linked to hypermethylation and copy number variation. The study revealed that ccRCC is divided into two sub-clusters: the disulfidptosis-desert sub-cluster, which is associated with a poor prognosis, a higher mutation frequency, and an immunosuppressive microenvironment. A 14-gene prognostic model was developed using differentially expressed genes and was validated in the E-MATB-1980 cohort. The low-risk group demonstrated longer overall and disease-free survival and responded better to targeted immunotherapy. Results from in vitro experiments identified SLC7A11 as a key participant in ccRCC metastasis.
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Affiliation(s)
- Bohong Chen
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
| | - Mingguo Zhou
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
| | - Li Guo
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
| | - Xinyue Sun
- Department of neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
| | - Haoxiang Huang
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
| | - Kaijie Wu
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
| | - Wei Chen
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
| | - Dapeng Wu
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
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Mata M, Tabbara MM, Alvarez A, González J, Ciancio G. Renal cell carcinoma with an "uncoiling" tumor thrombus: intraoperative shift from level III to level IV. World J Surg Oncol 2024; 22:76. [PMID: 38454471 PMCID: PMC10918875 DOI: 10.1186/s12957-024-03355-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The gold standard treatment for renal cell carcinoma (RCC) with tumor thrombus (TT) is complete surgical excision. The surgery is complex and challenging to the surgeon, especially with large tumor thrombus extending into the inferior vena cava (IVC) and right atrium. Traditionally, these difficult cases required the use of cardiopulmonary bypass (CPB) with or without deep hypothermic cardiac arrest, but in recent years, different surgical techniques derived from the field of liver transplantation have been used in efforts to avoid CPB. CASE PRESENTATION We present a case of RCC with TT level IIIc (extending above major hepatic veins) that "uncoiled" intraoperatively into the right atrium after division of the IVC ligament, transforming into a level IV TT. Despite the new TT extension, the surgery was successfully completed exclusively through an abdominal approach without CPB and while using intraoperative transesophageal echocardiography (TEE) monitoring and a cardiothoracic team standby. CONCLUSIONS This case highlights the need for a multidisciplinary approach and the utility of intraoperative continous TEE monitoring which helped to visualize the change of the TT venous extension, allowing the surgical teamto modify their surgical approach as needed avoiding a catastrophic event.
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Affiliation(s)
- Marina Mata
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
- Unidad de Cirugia Renal, Trasplante e Investigación, Hospital Ramón y Cajal, Madrid, Spain
| | - Marina M Tabbara
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Angel Alvarez
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Javier González
- Servicio de Urología, Unidad de Trasplante Renal, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gaetano Ciancio
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
- Department of Surgery and Urology, University of Miami Miller School of Medicine, 1801 NW 9th Ave, 7th Floor, Miami, FL, 33136, USA.
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Liu W, Xiao Z, Dong M, Li X, Huang Z. Decreased expression of TXNIP is associated with poor prognosis and immune infiltration in kidney renal clear cell carcinoma. Oncol Lett 2024; 27:97. [PMID: 38288038 PMCID: PMC10823309 DOI: 10.3892/ol.2024.14230] [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: 08/07/2023] [Accepted: 11/16/2023] [Indexed: 01/31/2024] Open
Abstract
The most prevalent and insidious type of kidney cancer is kidney clear cell carcinoma (KIRC). Thioredoxin-interacting protein (TXNIP) encodes a thioredoxin-binding protein involved in cellular energy metabolism, redox homeostasis, apoptosis induction and inflammatory responses. However, the relationship between TXNIP, immune infiltration and its prognostic value in KIRC remains unclear. Thus, the present study evaluated the potential for TXNIP as a prognostic marker in patients with KIRC. Data from The Cancer Genome Atlas were used to assess relative mRNA expression levels of TXNIP in different types of cancer. The protein expression levels of TXNIP were evaluated using the Human Protein Atlas. Enrichment analysis of genes co-expressed with TXNIP was performed to assess relevant biological processes that TXNIP may be involved in. CIBERSORT was used to predict the infiltration of 21 tumor-infiltrating immune cells (TIICs). Univariate and multivariate Cox regression analyses were used to assess the relationship between TXNIP expression and prognosis. Single-cell RNA-sequencing datasets were used to evaluate the mRNA expression levels of TXNIP in certain immune cells in KIRC. The CellMiner database was used to analyze the relationship between TXNIP mRNA expression and drug sensitivity in KIRC. The results from the present study demonstrated that TXNIP expression was significantly decreased in KIRC tissue compared with that in normal tissue, as confirmed by western blotting and reverse transcription-quantitative PCR. In addition, downregulated TXNIP expression was significantly associated with poor prognosis, a high histological grade and an advanced stage. The Cell Counting Kit-8 assay demonstrated that TXNIP overexpression significantly suppressed tumor cell proliferation. Univariate and multivariate Cox regression analyses indicated that TXNIP served as a separate prognostic factor in KIRC. Moreover, TXNIP expression was significantly correlated with the accumulation of several TIICs and its overexpression significantly downregulated the mRNA expression levels of CD25 and cytotoxic T-lymphocyte-associated protein 4, immune cell surface markers in CD4+ T lymphocytes. In conclusion, TXNIP may be used as a possible biomarker to assess unfavorable prognostic outcomes and identify immunotherapy targets in KIRC.
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Affiliation(s)
- Wanlu Liu
- School of Basic Medical Sciences, Youjiang Medical University for Nationalities, Baise, Guangxi 533000, P.R. China
| | - Zhen Xiao
- School of Basic Medical Sciences, Youjiang Medical University for Nationalities, Baise, Guangxi 533000, P.R. China
| | - Mingyou Dong
- The Key Laboratory of Molecular Pathology of Hepatobiliary Diseases of Guangxi, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi 533000, P.R. China
| | - Xiaolei Li
- Scientific Experiment Center, Affiliated Southwest Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi 533000, P.R. China
| | - Zhongshi Huang
- School of Basic Medical Sciences, Youjiang Medical University for Nationalities, Baise, Guangxi 533000, P.R. China
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Taweemonkongsap T, Suk-Ouichai C, Jitpraphai S, Woranisarakul V, Hansomwong T, Chotikawanich E. Survival benefits after radical nephrectomy and IVC thrombectomy of renal cell carcinoma patients with inferior vena cava thrombus. Heliyon 2024; 10:e25835. [PMID: 38390094 PMCID: PMC10881333 DOI: 10.1016/j.heliyon.2024.e25835] [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: 08/21/2023] [Revised: 12/15/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Objective The role of tumor thrombus as a predictor of survival in patients with renal cell carcinoma (RCC) is controversial. This study aims to evaluate surgical and oncological outcomes after surgery in RCC with inferior vena cava (IVC) tumor thrombus patients. Materials and methods A total of 58 patients (2002-2019) underwent radical nephrectomy and IVC thrombectomy at our institute, were retrospectively reviewed. Kaplan-Meier analysis was utilized to compare survival benefits between cohorts and Cox-regression to evaluate potential predictors of patient survival. Results There were 5(8.6%), 21(36.2%), 23(39.7%) and 9 (15.5%) patients with tumor thrombus level I, II, III and IV respectively. The major complications (Clavien 3-5) were observed in 15 patients (25.8%) and 12 patients (80%) were patients with high thrombus level (III-IV). There was 9%mortality (5patients): 2 intraoperatively and 3 postoperatively. Median follow-up was 15 months (IQR:5-41). Two-year overall survival (OS) was 80% and 75% in all patients and pN0M0 cohort, respectively. There was significant difference in OS among each IVC thrombus level cohort (p < 0.02). Two-year OS of metastatic RCC patients was 67% and not significantly different when compared to non-metastatic cohort (p = 0.12). On multivariate analysis, only sarcomatoid dedifferentiation was associated with OS(p = 0.04). Disease-free survival was not significantly different among thrombus-level cohorts (p = 0.65). Conclusions Our study suggested that surgical treatment for RCC with IVC thrombus provided substantial OS outcomes. Although survival was significantly reduced with higher IVC thrombus level cohort, the level of thrombus itself was not an independent factor. Only sarcomatoid dedifferentiation was a predictor for reduced OS after radical nephrectomy and tumor thrombectomy. Meticulous patient selection and prompt counselling are substantial step for the operation.
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Affiliation(s)
- Tawatchai Taweemonkongsap
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalairat Suk-Ouichai
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Siros Jitpraphai
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varat Woranisarakul
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thitipat Hansomwong
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekkarin Chotikawanich
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Chen J, Liu Z, Peng R, Liu Y, Zhang H, Wang G, Tian X, Pei X, Wang J, Zhang S, Wang H, Ma L. Neoadjuvant stereotactic ablative body radiotherapy combined with surgical treatment for renal cell carcinoma and inferior vena cava tumor thrombus: a prospective pilot study. BMC Urol 2024; 24:31. [PMID: 38310214 PMCID: PMC10838433 DOI: 10.1186/s12894-024-01405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/11/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Surgical treatment for renal cell carcinoma (RCC) and inferior vena cava (IVC) tumor thrombus (TT) is difficult, and the postoperative complication rate is high. This study aimed to explore the safety and oncologic outcomes of neoadjuvant stereotactic ablative body radiotherapy (SABR) combined with surgical treatment for RCC and IVC-TT. METHODS Patients with RCC and IVC-TTs were enrolled in this study. All patients received neoadjuvant SABR focused on the IVC at a dose of 30 Gy in 5 fractions, followed by 2 ~ 4 weeks of rest. Then, radical nephrectomy and IVC tumor thrombectomy were performed for each patient. Adverse effects, perioperative outcomes, and long-term prognoses were recorded. RESULTS From June 2018 to January 2019, 8 patients were enrolled-4 with Mayo grade II TT and 4 with Mayo grade III TT. Four (50%) patients had complicated IVC wall invasion according to CT/MRI. All patients received neoadjuvant SABR as planned. Short-term local control was observed in all 8 patients. Only Grade 1-2 adverse events were reported. In total, 3 (37.5%) laparoscopic surgeries and 5 (62.5%) open surgeries were performed. The median operation time was 359 (IQR: 279-446) min, with a median intraoperative bleeding volume of 750 (IQR: 275-2175) ml. The median postoperative hospital stay was 7 (5-10) days. With a 26-month (range: 5-41) follow-up period, the estimated mean overall survival was 30.67 ± 5.38 months. CONCLUSIONS This is the first preoperative radiotherapy study in Asia that focused on patients with TT. This study revealed the considerable safety of neoadjuvant SABR for RCC with IVC-TT. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trials Registry on 2018-03-08 (ChiCTR1800015118). For more information, please see the direct link ( https://www.chictr.org.cn/showproj.html?proj=25747 ).
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Affiliation(s)
- Jiyuan Chen
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Ran Peng
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, 100191, China
| | - Yunchong Liu
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Xinlong Pei
- Department of Radiology, Peking University Third Hospital, Beijing, 100191, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, 100191, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China.
| | - Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, 100191, China.
- Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China.
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Yao Q, Zhang X, Wang Y, Wang C, Wei C, Chen J, Chen D. Comprehensive analysis of a tryptophan metabolism-related model in the prognostic prediction and immune status for clear cell renal carcinoma. Eur J Med Res 2024; 29:22. [PMID: 38183155 PMCID: PMC10768089 DOI: 10.1186/s40001-023-01619-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/24/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Clear cell renal cell carcinoma (ccRCC) is characterized as one of the most common types of urological cancer with high degrees of malignancy and mortality. Due to the limited effectiveness of existing traditional therapeutic methods and poor prognosis, the treatment and therapy of advanced ccRCC patients remain challenging. Tryptophan metabolism has been widely investigated because it significantly participates in the malignant traits of multiple cancers. The functions and prognostic values of tryptophan metabolism-related genes (TMR) in ccRCC remain virtually obscure. METHODS We employed the expression levels of 40 TMR genes to identify the subtypes of ccRCC and explored the clinical characteristics, prognosis, immune features, and immunotherapy response in the subtypes. Then, a model was constructed for the prediction of prognosis based on the differentially expressed genes (DEGs) in the subtypes from the TCGA database and verified using the ICGC database. The prediction performance of this model was confirmed by the receiver operating characteristic (ROC) curves. The relationship of Risk Score with the infiltration of distinct tumor microenvironment cells, the expression profiles of immune checkpoint genes, and the treatment benefits of immunotherapy and chemotherapy drugs were also investigated. RESULTS The two subtypes revealed dramatic differences in terms of clinical characteristics, prognosis, immune features, and immunotherapy response. The constructed 6-gene-based model showed that the high Risk Score was significantly connected to poor overall survival (OS) and advanced tumor stages. Furthermore, increased expression of CYP1B1, KMO, and TDO2 was observed in ccRCC tissues at the translation levels, and an unfavorable prognosis for these patients was also found. CONCLUSION We identified 2 molecular subtypes of ccRCC based on the expression of TMR genes and constructed a prognosis-related model that may be used as a powerful tool to guide the prediction of ccRCC prognosis and personalized therapy. In addition, CYP1B1, KMO, and TDO2 can be regarded as the risk prognostic genes for ccRCC.
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Affiliation(s)
- Qinfan Yao
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
- Institute of Nephropathy, Zhejiang University, Hangzhou, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Xiuyuan Zhang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
- Institute of Nephropathy, Zhejiang University, Hangzhou, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Yucheng Wang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
- Institute of Nephropathy, Zhejiang University, Hangzhou, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Cuili Wang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
- Institute of Nephropathy, Zhejiang University, Hangzhou, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Chunchun Wei
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
- Institute of Nephropathy, Zhejiang University, Hangzhou, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China.
- Institute of Nephropathy, Zhejiang University, Hangzhou, China.
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China.
| | - Dajin Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China.
- Institute of Nephropathy, Zhejiang University, Hangzhou, China.
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China.
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Jiang Y, Wang Y, Wang Z, Zhang Y, Hou Y, Wang X. Anoikis-related genes signature development for clear cell renal cell carcinoma prognosis and tumor microenvironment. Sci Rep 2023; 13:18909. [PMID: 37919386 PMCID: PMC10622575 DOI: 10.1038/s41598-023-46398-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/31/2023] [Indexed: 11/04/2023] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is one of the most common primary malignancies of the urinary tract, highly heterogeneous, and increasing in incidence worldwide. Anoikis is a specific type of programmed cell death in which solid tumor cells or normal epithelial cells that do not have metastatic properties lose adhesion to the extracellular matrix or undergo inappropriate cell adhesion-induced apoptosis. Anoikis is thought to play a critical role in tumorigenesis, maintenance, and treatment, according to an increasing amount of research. However, there is still some uncertainty regarding the general impact of anoikis-related genes (ARGs) on the prognostic importance, tumor microenvironment characteristics, and treatment reaction of ccRCC patients. For this study, we used The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus datasets to access the RNA sequencing results and clinical information from ccRCC patients. 29 ARGs related to survival were found using differential analysis and univariate Cox regression analysis. The samples were then divided into two clusters that had different immune traits via unsupervised cluster analysis using 29 prognosis-associated differently expressed ARGs. Then, to build an ARGs signature, 7 genes (PLAU, EDA2R, AFP, PLG, TUBB3, APOBEC3G, and MALAT1) were found using Least Absolute Shrinkage and Selection Operator regression analysis. The new ARGs signature demonstrated outstanding prognostic capability for ccRCC patients' overall survival. In conclusion, for ccRCC patients, we created an ARGs signature that strongly connects to immunological traits and therapy response. Clinicians may find this ARGs signature helpful in developing more individualized and detailed treatment strategies for ccRCC patients.
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Affiliation(s)
- Yinglei Jiang
- Dialysis Room, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, 120000, China
| | - Ying Wang
- Dialysis Room, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, 120000, China
| | - Zhengyan Wang
- Changchun University of Chinese Medicine, Changchun, 120000, China
| | - Yinzhen Zhang
- Changchun University of Chinese Medicine, Changchun, 120000, China
| | - Yulong Hou
- Changchun University of Chinese Medicine, Changchun, 120000, China
| | - Xukai Wang
- Dialysis Room, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, 120000, China.
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Liu H, Wei Z, Xv Y, Tan H, Liao F, Lv F, Jiang Q, Chen T, Xiao M. Validity of a multiphase CT-based radiomics model in predicting the Leibovich risk groups for localized clear cell renal cell carcinoma: an exploratory study. Insights Imaging 2023; 14:167. [PMID: 37816901 PMCID: PMC10564697 DOI: 10.1186/s13244-023-01526-2] [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: 04/05/2023] [Accepted: 09/10/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE To develop and validate a multiphase CT-based radiomics model for preoperative risk stratification of patients with localized clear cell renal cell carcinoma (ccRCC). METHODS A total of 425 patients with localized ccRCC were enrolled and divided into training, validation, and external testing cohorts. Radiomics features were extracted from three-phase CT images (unenhanced, arterial, and venous), and radiomics signatures were constructed by the least absolute shrinkage and selection operator (LASSO) regression algorithm. The radiomics score (Rad-score) for each patient was calculated. The radiomics model was established and visualized as a nomogram by incorporating significant clinical factors and Rad-score. The predictive performance of the radiomics model was evaluated by the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA). RESULTS The AUC of the triphasic radiomics signature reached 0.862 (95% CI: 0.809-0.914), 0.853 (95% CI: 0.785-0.921), and 0.837 (95% CI: 0.714-0.959) in three cohorts, respectively, which were higher than arterial, venous, and unenhanced radiomics signatures. Multivariate logistic regression analysis showed that Rad-score (OR: 4.066, 95% CI: 3.495-8.790) and renal vein invasion (OR: 12.914, 95% CI: 1.118-149.112) were independent predictors and used to develop the radiomics model. The radiomics model showed good calibration and discrimination and yielded an AUC of 0.872 (95% CI: 0.821-0.923), 0.865 (95% CI: 0.800-0.930), and 0.848 (95% CI: 0.728-0.967) in three cohorts, respectively. DCA showed the clinical usefulness of the radiomics model in predicting the Leibovich risk groups. CONCLUSIONS The radiomics model can be used as a non-invasive and useful tool to predict the Leibovich risk groups for localized ccRCC patients. CRITICAL RELEVANCE STATEMENT The triphasic CT-based radiomics model achieved favorable performance in preoperatively predicting the Leibovich risk groups in patients with localized ccRCC. Therefore, it can be used as a non-invasive and effective tool for preoperative risk stratification of patients with localized ccRCC. KEY POINTS • The triphasic CT-based radiomics signature achieves better performance than the single-phase radiomics signature. • Radiomics holds prospects in preoperatively predicting the Leibovich risk groups for ccRCC. • This study provides a non-invasive method to stratify patients with localized ccRCC.
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Affiliation(s)
- Huayun Liu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zongjie Wei
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yingjie Xv
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Hao Tan
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Fangtong Liao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Jiang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Chen
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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9
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Trifoi M, Levine M, Kim A, Eden B, Albert A. Inferior vena cava thrombosis extension into the right atrium: An unusual case report of renal cell carcinoma. SAGE Open Med Case Rep 2023; 11:2050313X231204768. [PMID: 37811349 PMCID: PMC10559693 DOI: 10.1177/2050313x231204768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
Inferior vena cava filling defects are common findings on computed tomography and magnetic resonance imaging, and accurate determination of pseudo, benign, or malignant thrombus is essential for clinical management. Inferior vena cava thrombosis involvement extending into the right atrium is a rare presentation of renal cell carcinoma. The degree of inferior vena cava and right atrium involvement is critical in determining management and prognosis of patients. Inferior vena cava thrombosis surgical thrombectomy is often a risky procedure due to the intraoperative determination of inferior vena cava thrombosis involvement. Accurate recognition of inferior vena cava thrombosis with right atrial involvement is critical in determining appropriate treatment options and preoperative level of involvement for surgical intervention. This case features a unique presentation of inferior vena cava thrombosis in renal cell carcinoma with right atrial involvement.
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Affiliation(s)
- Mara Trifoi
- Penn State College of Medicine, Hershey, PA, USA
| | - Marc Levine
- Penn State College of Medicine, Hershey, PA, USA
| | - Andrew Kim
- Penn State College of Medicine, Hershey, PA, USA
| | - Brandon Eden
- Penn State College of Medicine, Hershey, PA, USA
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10
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Jia Z, Tang L, Liu K, Guo A, Huang Q, Peng C, Ding X, Zhang L, Liu G, Yang G, Wang B, Li H, Zhang X, Ma X. Venous tumor thrombus consistency: is it a prognostic factor of survival for patients with renal cell carcinoma? Updates Surg 2023; 75:2033-2038. [PMID: 37395931 DOI: 10.1007/s13304-023-01544-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/20/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES To evaluate whether venous tumor thrombus (VTT) consistency is a risk factor for the patient's prognosis with renal cell carcinoma (RCC). MATERIALS AND METHODS A total of 190 RCC patients with VTT, who were treated at Department of Urology, Chinese PLA General Hospital, were retrospectively analyzed in this study. The baseline clinical characteristics, postoperative outcomes, and pathological findings were analyzed. Tumor thrombus was classified as solid and friable based on their respective characteristics. Survival curves were estimated using the Kaplan-Meier survival curve analysis, and univariable and multivariable cox proportional hazard regression models were used. RESULTS Among the total 190 patients included in this study, 145 (76.3%) patients had solid VTT, and 45 (23.7%) patients had friable VTT in their renal veins and inferior vena cava (IVC). There were no significant differences in the age, gender, BMI, symptoms, complex diseases, tumor side, tumor size, TNM stage, Mayo stage, tumor grade, sarcomatous differentiation, pelvic invasion, and sinus fat invasion of patients. Solid VTT consistency was more likely to have a capsule as compared to those with friable VTT (P = 0.007). Kaplan-Meier survival curve analysis demonstrated no statistically significant differences in the overall survival (OS) (P = 0.973) and progression-free survival (PFS) (P = 0.667) of patients. Moreover, VTT consistency was not associated with OS (P = 0.706) of PFS (P = 0.504) in multivariate cox regression analysis. CONCLUSIONS RCC VTT consistency was not a prognostic risk factor for predicting the OS and PFS of patients.
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Affiliation(s)
- Zhuo Jia
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Lu Tang
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Kan Liu
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Aitao Guo
- Department of Pathology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Qingbo Huang
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Cheng Peng
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Xiaohui Ding
- Department of Pathology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Lifeng Zhang
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Guojun Liu
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Guoqiang Yang
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Baojun Wang
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Hongzhao Li
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Xu Zhang
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China.
| | - Xin Ma
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China.
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11
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Stout TE, Gellhaus PT, Tracy CR, Steinberg RL. Robotic Partial vs Radical Nephrectomy for Clinical T3a Tumors: A Narrative Review. J Endourol 2023; 37:978-985. [PMID: 37358403 PMCID: PMC10623454 DOI: 10.1089/end.2023.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Abstract
Introduction: T3a renal masses include a diverse group of tumors that invade the perirenal and/or sinus fat, pelvicaliceal system, or renal vein. The majority of cT3a renal masses represent renal cell carcinoma (RCC) and have historically been treated with radical nephrectomy (RN) given their aggressive nature. With the adoption of minimally invasive approaches to renal surgery, the combination of improved observation, pneumoperitoneum, and robotic articulation has allowed urologists to consider partial nephrectomy (PN) for more complex tumors. Herein, we review the existing literature regarding robot-assisted PN (RAPN) and robot-assisted RN (RARN) in the management of T3a renal masses. Methods: A literature search was performed using PubMed for articles evaluating the role of RARN and RAPN for T3a renal masses. Search parameters were limited to English language studies. Applicable studies were abstracted and included in this narrative review. Results: T3a RCC caused by renal sinus fat or venous involvement is associated with ∼50% lower cancer-specific survival than those with perinephric fat invasion alone. CT and MRI can both be used to stage cT3a tumors, however, MRI is more accurate when assessing venous involvement. Upstaging to pT3a RCC during RAPN does not confer a worse prognosis than pT3a tumors treated with RARN; however, patients who undergo RAPN for T3a RCC with venous involvement have relatively higher rates of recurrence and metastasis. Intraoperative tools including drop-in ultrasound, near-infrared fluorescence, and 3D virtual models improve the ability to perform RAPN for T3a tumors. In well-selected cases, warm ischemia times remain reasonable. Conclusions: cT3a renal masses represent a diverse group of tumors. Depending on substratification of cT3a, RARN or RAPN can be employed for treatment of such masses.
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Affiliation(s)
- Thomas E. Stout
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Paul T. Gellhaus
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Chad R. Tracy
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Ryan L. Steinberg
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
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12
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Almatari AL, Sathe A, Wideman L, Dewan CA, Vaughan JP, Bennie IC, Buscarini M. Renal cell carcinoma with tumor thrombus: A review of relevant anatomy and surgical techniques for the general urologist. Urol Oncol 2023; 41:153-165. [PMID: 36804205 DOI: 10.1016/j.urolonc.2022.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 02/19/2023]
Abstract
Renal cell carcinoma (RCC) is estimated to account for 4.1% of all new cancer diagnoses and 2.4% of all cancer deaths in 2020 according to the National Cancer Institute SEER database. This will likely total 73,000 new cases and 15,000 deaths. RCC is one of the most lethal of the common cancers urologists will encounter with a 5-year relative survival of 75.2%. Renal cell carcinoma is one of a small subset of malignancies that are associated with tumor thrombus formation, which is tumor extension into a blood vessel. An estimated 4% to 10% of patients with RCC will have some degree of tumor thrombus extending into the renal vein or inferior vena cava at the time of diagnosis. Tumor thrombi change the staging of RCC and therefore are an important part of initial patient workup. It is known that such tumors are more aggressive with higher Fuhrman grades, N+ or M+ at time of surgery and have higher probability of recurrence with lower cancer-specific survival. Aggressive surgical intervention with radical nephrectomy and thrombectomy can be performed with survival benefits. Classifying the level of the tumor thrombus becomes vitally important in surgical planning as it will dictate the surgical approach. Level 0 thrombi may be amenable to simple renal vein ligation while level 4 can require thoracotomy and possible open-heart surgery with coordination of many surgical teams. Here we will review the anatomy associated with each level of tumor thrombus and attempt to construct an outline for surgical techniques that may be used. We aim to give a concise overview so that general urologists may use it to understand these potentially complicated cases.
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Affiliation(s)
- Abraham L Almatari
- Department of Urology, The University of Tennessee Health Science Center, Memphis, TN
| | - Aditya Sathe
- Department of Urology, The University of Tennessee Health Science Center, Memphis, TN
| | - Lauren Wideman
- Department of Urology, The University of Tennessee Health Science Center, Memphis, TN
| | - Christian A Dewan
- Department of Urology, The University of Tennessee Health Science Center, Memphis, TN
| | - Joseph P Vaughan
- Department of Urology, The University of Tennessee Health Science Center, Memphis, TN
| | - Ian C Bennie
- Department of Urology, The University of Tennessee Health Science Center, Memphis, TN
| | - Maurizio Buscarini
- Department of Urology, The University of Tennessee Health Science Center, Memphis, TN.
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13
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Das CJ, Aggarwal A, Singh P, Nayak B, Yadav T, Lal A, Gorsi U, Batra A, Shamim SA, Duara BK, Arulraj K, Kaushal S, Seth A. Imaging Recommendations for Diagnosis, Staging, and Management of Renal Tumors. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractRenal cell carcinomas accounts for 2% of all the cancers globally. Most of the renal tumors are detected incidentally. Ultrasound remains the main screening modality to evaluate the renal masses. A multi -phase contrast enhanced computer tomography is must for characterizing the renal lesions. Imaging plays an important role in staging, treatment planning and follow up of renal cancers. In this review , we discuss the imaging guidelines for the management of renal tumors.
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Affiliation(s)
- Chandan J Das
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | - Ankita Aggarwal
- Department of Radiodiagnosis, VMMC and SJH, New Delhi, India
| | | | - B Nayak
- Department of Urology, AIIMS, New Delhi, India
| | - Taruna Yadav
- Department of Radiodiagnosis, Jodhpur, Rajasthan, India
| | - Anupam Lal
- Department of Radiodiagnosis, PGI, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis, PGI, Chandigarh, India
| | - Atul Batra
- Department of Medical Oncology, AIIMS, IRCH, New Delhi, India
| | | | | | | | | | - Amlesh Seth
- Department of Urology, AIIMS, New Delhi, India
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14
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Nagamoto S, Urakami S, Oka S, Ogawa K, Kono K, Sakaguchi K, Kinowaki K, Yamada D, Kume H. Impact of the neutrophil-to-lymphocyte ratio as a surgical prognostic factor in renal cell carcinoma with inferior-vena-cava tumor thrombus. Asian J Surg 2023; 46:192-200. [PMID: 35331592 DOI: 10.1016/j.asjsur.2022.03.023] [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: 11/27/2021] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate the efficacy of radical nephrectomy with thrombectomy and to identify the prognostic factors for patients with renal cell carcinoma (RCC) and inferior vena cava tumor thrombus (IVCTT). The role of the neutrophil-to-lymphocyte ratio (NLR), which has been reported to be a useful prognostic predictor for various solid cancers, was also investigated. METHODS Fifty-five patients with RCC and IVCTT who underwent radical nephrectomy and thrombectomy in our hospital were retrospectively analyzed. The relationship between clinical characteristics and surgical outcome was examined using the Kaplan-Meier method. Univariate and multivariate analyses were carried out to determine the prognostic factors. RESULTS The median follow-up time after surgery was 44.2 months. Twenty-seven patients died of RCC, and 4 died of other disease at last follow-up. There were no patients with postoperative pulmonary embolism (PE) or deaths from PE. The median cancer-specific survival (CSS) and overall survival (OS) were 81.0 (95% confidence interval [CI]: 42.0-103.2) and 69.0 (95% CI: 34.3-81.5) months, respectively. Significant prognostic factors for CSS were distant metastasis (p = 0.045) and NLR ≥ 2.9 (p = 0.009). The only independent predictor for OS was the NLR ≥ 2.9 (p = 0.034). CONCLUSIONS A high preoperative NLR level was an independent poor prognostic factor influencing CSS and OS of patients with RCC and IVCTT who underwent radical nephrectomy and thrombectomy. The NLR may be an available biomarker that helps with preoperative risk stratification.
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Affiliation(s)
- Shoichi Nagamoto
- Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Shinji Urakami
- Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan; Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Suguru Oka
- Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Kohei Ogawa
- Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Kazushige Sakaguchi
- Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Keiichi Kinowaki
- Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Daisuke Yamada
- Department of Urology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Haruki Kume
- Department of Urology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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15
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Elajami MK, Mansour E, Bahmad HF, Chaaya G, DeBeer S, Poppiti R, Omarzai Y. Renal Cell Carcinoma Presenting as Syncope due to Saddle Pulmonary Tumor Embolism. Diseases 2022; 10:diseases10040119. [PMID: 36547205 PMCID: PMC9778154 DOI: 10.3390/diseases10040119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/10/2022] [Accepted: 11/30/2022] [Indexed: 12/11/2022] Open
Abstract
Pulmonary embolism (PE) is defined as the obstruction of the pulmonary artery or one of its branches by a blood clot, tumor, air, or fat emboli originating elsewhere in the body. A saddle PE occurs when the obstruction affects the bifurcation of the main pulmonary artery trunk. We present a case of a 46-year-old man who presented to our hospital due to an episode of syncope. Computed tomography angiography (CTA) of the chest showed extensive PE and abdominal CT scan showed a large 8 cm left renal mass with inferior vena cava (IVC) thrombus. Emergent embolectomy, left total nephrectomy, and IVC tumor removal were performed yielding the diagnosis of clear cell renal cell carcinoma (RCC). Interestingly, our patient did not experience any symptoms related to his RCC until the diagnosis of PE due to syncope, and the asymptomatic tumor was found out to be the possible cause of this PE due to the presence of tumor cells constituting the tumor embolus. It is thus recommended to improve the early screening process for RCC. Besides, clinicians should pay attention to patients presenting with uncharacteristic symptoms of RCC who might present with symptoms of saddle PE.
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Affiliation(s)
- Mohamad K. Elajami
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Ephraim Mansour
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Hisham F. Bahmad
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Correspondence: or ; Tel.: +1-305-674-2277
| | - Gerard Chaaya
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Steven DeBeer
- Division of Cardiac Surgery, Mount Sinai Heart Institute, Columbia University, Miami Beach, FL 33140, USA
| | - Robert Poppiti
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Department of Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA
| | - Yumna Omarzai
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Department of Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA
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16
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Zhu T, Wang T, Feng Z, Gao F, Zhang J, Jin C, Tian H, Xu J, Chen H, Ou Q, Wang J, Xu G, Lu L. Glia Maturation Factor β as a Novel Independent Prognostic Biomarker and Potential Therapeutic Target of Kidney Renal Clear Cell Carcinoma. Front Oncol 2022; 12:880100. [PMID: 35860559 PMCID: PMC9292986 DOI: 10.3389/fonc.2022.880100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Kidney renal clear cell carcinoma (KIRC) has the highest mortality rate and potential for invasion among renal cancers. The diagnosis and treatment of KIRC are becoming challenging because of its diverse pathogenic mechanisms. Glia (GMFB) is a highly conserved growth and differentiation factor for glia cells and neurons, and it is closely associated with neurodegenerative diseases. However, its role in KIRC remains unknown. The present study integrated bioinformatics approaches with suitable meta-analyses to determine the position of GMFB in KIRC. There was a significant decrease in Gmfb expression in KIRC kidneys compared with normal controls. Gmfb expression was negatively associated with pathologic stage, T and M stages, and histologic grade. Univariate and multivariate analyses showed that elevated Gmfb expression was an independent factor for a favorable prognosis. Furthermore, the nomogram verified that Gmfb is a low-risk factor for KIRC. Knockdown of Gmfb in Caki-2 cells increased viability and decreased p21 and p27 levels. Overexpression of Gmfb inhibited Caki-2 cell proliferation, migration, and invasion and decreased mitochondrial membrane potential. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses considering Gmfb co-expressed differentially expressed genes (DEGs) showed that collecting duct acid secretion and mineral absorption ranked were the most important upregulated and downregulated DEGs, respectively. The upregulated hub genes for DEGs were mainly involved in nucleosome assembly, nucleosome organization, and chromatin assembly, and the downregulated hub genes were primarily associated with keratinization. The ratio of tumor-infiltrating immune cells in KIRC tissues was evaluated using CIBERSORTx. The results showed that the Gmfb expression was significantly positively correlated with macrophage M2 cells and mast resting cell infiltration levels and negatively correlated with T follicular helper, T regulatory, and B plasma cell infiltration levels. The former cell types were associated with a beneficial outcome, while the latter had a worse outcome in patients with KIRC. In summary, this study identified GMFB as a novel independent biomarker and therapeutic target for KIRC, and it provides a helpful and distinct individualized treatment strategy for KIRC with a combination of molecular targets and tumor microenvironment.
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Affiliation(s)
- Tong Zhu
- Department of Ophthalmology of Shanghai Tongji Hospital, Laboratory of Clinical Visual Science of Tongji Eye Institute, School of Medicine, Tongji University, Shanghai, China
- Department of Biochemistry and Molecular Biology, Tongji University School of Medicine, Shanghai, China
| | - Tianyu Wang
- Department of Ophthalmology of Shanghai Tongji Hospital, Laboratory of Clinical Visual Science of Tongji Eye Institute, School of Medicine, Tongji University, Shanghai, China
- Department of Ophthalmology of Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zijun Feng
- Department of Biochemistry and Molecular Biology, Tongji University School of Medicine, Shanghai, China
| | - Furong Gao
- Department of Ophthalmology of Shanghai Tongji Hospital, Laboratory of Clinical Visual Science of Tongji Eye Institute, School of Medicine, Tongji University, Shanghai, China
- Department of Biochemistry and Molecular Biology, Tongji University School of Medicine, Shanghai, China
| | - Jieping Zhang
- Department of Ophthalmology of Shanghai Tongji Hospital, Laboratory of Clinical Visual Science of Tongji Eye Institute, School of Medicine, Tongji University, Shanghai, China
- Department of Pharmacology, Tongji University School of Medicine, Shanghai, China
| | - Caixia Jin
- Department of Ophthalmology of Shanghai Tongji Hospital, Laboratory of Clinical Visual Science of Tongji Eye Institute, School of Medicine, Tongji University, Shanghai, China
- Department of Biochemistry and Molecular Biology, Tongji University School of Medicine, Shanghai, China
| | - Haibin Tian
- Department of Ophthalmology of Shanghai Tongji Hospital, Laboratory of Clinical Visual Science of Tongji Eye Institute, School of Medicine, Tongji University, Shanghai, China
- Department of Biochemistry and Molecular Biology, Tongji University School of Medicine, Shanghai, China
| | - Jingying Xu
- Department of Ophthalmology of Shanghai Tongji Hospital, Laboratory of Clinical Visual Science of Tongji Eye Institute, School of Medicine, Tongji University, Shanghai, China
- Department of Biochemistry and Molecular Biology, Tongji University School of Medicine, Shanghai, China
| | - Hao Chen
- Department of Ophthalmology of Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qingjian Ou
- Department of Ophthalmology of Shanghai Tongji Hospital, Laboratory of Clinical Visual Science of Tongji Eye Institute, School of Medicine, Tongji University, Shanghai, China
| | - Juan Wang
- Department of Ophthalmology of Shanghai Tongji Hospital, Laboratory of Clinical Visual Science of Tongji Eye Institute, School of Medicine, Tongji University, Shanghai, China
- Department of Human Genetics, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Lixia Lu, ; Guotong Xu, ; Juan Wang,
| | - Guotong Xu
- Department of Ophthalmology of Shanghai Tongji Hospital, Laboratory of Clinical Visual Science of Tongji Eye Institute, School of Medicine, Tongji University, Shanghai, China
- Department of Pharmacology, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Lixia Lu, ; Guotong Xu, ; Juan Wang,
| | - Lixia Lu
- Department of Ophthalmology of Shanghai Tongji Hospital, Laboratory of Clinical Visual Science of Tongji Eye Institute, School of Medicine, Tongji University, Shanghai, China
- Department of Biochemistry and Molecular Biology, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Lixia Lu, ; Guotong Xu, ; Juan Wang,
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17
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Tariq A, McGeorge S, Pearce A, Rhee H, Wood S, Kyle S, Marsh P, Raveenthiran S, Wong D, McBean R, Westera J, Dunglison N, Esler R, Navaratnam A, Yaxley J, Thomas P, Pattison DA, Roberts MJ. Characterization of tumor thrombus in renal cell carcinoma with prostate specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT). Urol Oncol 2022; 40:276.e1-276.e9. [DOI: 10.1016/j.urolonc.2022.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/06/2022] [Accepted: 03/12/2022] [Indexed: 02/04/2023]
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18
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Zhang H, Yin F, Chen M, Yang L, Qi A, Cui W, Yang S, Wen G. Development and Validation of a CT-Based Radiomics Nomogram for Predicting Postoperative Progression-Free Survival in Stage I-III Renal Cell Carcinoma. Front Oncol 2022; 11:742547. [PMID: 35155180 PMCID: PMC8830916 DOI: 10.3389/fonc.2021.742547] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background Many patients experience recurrence of renal cell carcinoma (RCC) after radical and partial nephrectomy. Radiomics nomogram is a newly used noninvasive tool that could predict tumor phenotypes. Objective To investigate Radiomics Features (RFs) associated with progression-free survival (PFS) of RCC, assessing its incremental value over clinical factors, and to develop a visual nomogram in order to provide reference for individualized treatment. Methods The RFs and clinicopathological data of 175 patients (125 in the training set and 50 in the validation set) with clear cell RCC (ccRCC) were retrospectively analyzed. In the training set, RFs were extracted from multiphase enhanced CT tumor volume and selected using the stability LASSO feature selection algorithm. A radiomics nomogram final model was developed that incorporated the RFs weighted sum and selected clinical predictors based on the multivariate Cox proportional hazard regression. The performances of a clinical variables-only model, RFs-only model, and the final model were compared by receiver operator characteristic (ROC) analysis and DeLong test. Nomogram performance was determined and validated with respect to its discrimination, calibration, reclassification, and clinical usefulness. Results The radiomics nomogram included age, clinical stage, KPS score, and RFs weighted sum, which consisted of 6 selected RFs. The final model showed good discrimination, with a C-index of 0.836 and 0.706 in training and validation, and good calibration. In the training set, the C-index of the final model was significantly larger than the clinical-only model (DeLong test, p = 0.008). From the clinical variables-only model to the final model, the reclassification of net reclassification improvement was 18.03%, and the integrated discrimination improvement was 19.08%. Decision curve analysis demonstrated the clinical usefulness of the radiomics nomogram. Conclusion The CT-based RF is an improvement factor for clinical variables-only model. The radiomics nomogram provides individualized risk assessment of postoperative PFS for patients with RCC.
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Affiliation(s)
- Haijie Zhang
- Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China.,PET/CT Center, Department of Nuclear Medicine, First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Fu Yin
- College of Information Engineering, Shenzhen University, Shenzhen, China
| | - Menglin Chen
- Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liyang Yang
- Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Anqi Qi
- Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weiwei Cui
- Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shanshan Yang
- Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ge Wen
- Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China
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19
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Surgical treatment of renal cell carcinoma with inferior vena cava tumor thrombus. Surg Today 2022; 52:1125-1133. [PMID: 34977987 DOI: 10.1007/s00595-021-02429-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The present report discusses the indications of cardiopulmonary bypass (CPB) in open nephrectomy and surgical outcomes of conventional and minimally invasive surgical techniques for treating advanced renal cell carcinoma with inferior vena cava tumor thrombus. METHODS The present study involved a comprehensive retrieval of pertinent literature from the most recent two decades. RESULTS Comparisons between radical nephrectomy procedures in terms of open, laparoscopic and robotic-assisted surgeries revealed that open surgery had more blood loss, a longer operation time and higher mortality rates than laparoscopic and robotic-assisted surgeries. Furthermore, surgery with CPB was associated with more blood loss than non-CPB surgery. Rates of early and late deaths were much higher in patients with CPB than in those without CPB. CONCLUSIONS Different surgical techniques had different indications in terms of levels of inferior vena cava tumor thrombus. The laparoscopic, robotic-assisted, open surgical techniques and CPB with deep hypothermic circulatory arrest were indicated for Levels I, II, III and III-IV inferior vena cava tumor thrombus, respectively. Laparoscopic and robotic-assisted surgeries cause less trauma than open surgery but require more complicated equipments to support the procedure. CPB should be avoided in radical nephrectomy whenever possible. The increased application of laparoscopic and robotic techniques in the future is anticipated.
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20
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Liu Z, Zhang Q, Zhao X, Zhu G, Tang S, Hong P, Ge L, Zhang S, Wang G, Tian X, Zhang H, Liu C, Ma L. Inferior vena cava interruption in renal cell carcinoma with tumor thrombus: surgical strategy and perioperative results. BMC Surg 2021; 21:402. [PMID: 34802447 PMCID: PMC8607562 DOI: 10.1186/s12893-021-01400-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 11/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background To analyze the influence of inferior vena cava (IVC) interruption for perioperative and oncological results in patients with renal cell carcinoma and tumor thrombus and summarize the surgical strategies of IVC interruption for different situations. Methods We retrospectively analyzed the clinical and pathological data of 103 patients in our center. Patients were divided into two groups with 32 cases (31.1%) underwent IVC interruption (Group 1) while 71 cases (68.9%) did not. For comparison of continuous variables, the Mann–Whitney U test was used. For comparison of categorical variables, Chi-square tests were used. A propensity score based matching method was used to eliminate possible bias. Kaplan–Meier plots were performed to evaluate the influence of IVC interruption on overall survival and cancer specific survival. All the statistical analyses were performed using SPSS 24. A P value < 0.05 was considered statistically significant. Results Among the 32 patients who underwent IVC interruption, the median age was 61 years and the median tumor size was 7.7 cm. There were 28 males and 23 tumors were on the right side. We successfully matched 29 patients who underwent IVC interruption to 29 patients without this procedure in 1:1 ratio. No significant differences existed in baseline characteristics between the groups. The comparison of perioperative data showed that patients who underwent IVC interruption had significantly longer median postoperative hospital stays (13 vs 9 days, P = 0.022) and a higher overall postoperative complication rate (79.3 vs 51.7%, P = 0.027). According to the side and shape of tumor thrombus, it could be divided into four categories. There were 15 cases (46.9%) with right filled-type tumor thrombus (RFTT), 8 cases (25.0%) with right non-filled-type tumor thrombus (RNFTT), 1 case (3.1%) with left filled-type tumor thrombus (LFTT) and 8 cases (25.0%) with left non-filled-type tumor thrombus (LNFTT). According to different categories, different surgical procedures were adopted. Conclusions IVC interruption will increase the incidence of overall postoperative complications, but not the risk of major postoperative complications. Tumor thrombus should be divided into four categories, and different sides and shapes of renal tumor thrombus need different operative procedure of IVC interruption.
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Affiliation(s)
- Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Qiming Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guodong Zhu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shiying Tang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Liyuan Ge
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Beijing, China.
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China.
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21
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Jiang H, Chen H, Wan P, Chen N. Decreased expression of HADH is related to poor prognosis and immune infiltration in kidney renal clear cell carcinoma. Genomics 2021; 113:3556-3564. [PMID: 34391866 DOI: 10.1016/j.ygeno.2021.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/15/2021] [Accepted: 08/10/2021] [Indexed: 02/05/2023]
Abstract
Kidney renal clear cell carcinoma (KIRC) is the subtype pf kidney cancer having the highest mortality as well as the highest potential of invasion and metastasis. The expression of HADH, encoding a key enzyme in fatty acid β-oxidation, has rarely been reported to correlate with prognosis and immune infiltration in cancers. This study aimed to explore the prognostic value of HADH in patients with KIRC. Gene expression profiles and clinical data of KIRC patients were acquired from The Cancer Genome Atlas. We compared the expression of HADH between KIRC tissues and normal tissues. Then, the relationship between HADH expression and the clinicopathological characteristics (survival, age, gender, stage, and grade) of KIRC was explored. Data from several online databases and paraffin-embedded specimens from two cohorts were used for external validation (10 cases from Meizhou People's Hospital and another 75 cases from a tissue chip, with both cohorts including KIRC samples and paired normal tissues). We also predicted the fractions of tumor-infiltrating immune cells (TIICs) in various tissues using CIBERSORT. Next, we estimated the prognostic value of differences in TIIC proportions between the high and low HADH expression groups. Finally, gene set enrichment analysis (GSEA) was performed to explore the potential mechanisms by which HADH expression influences patient survival. The expression of HADH was significantly lower in KIRC tissue than in normal tissue. Decreased expression of HADH was significantly correlated with high histologic grade, advanced stage, and poor prognosis. The differential expression of HADH was validated at the protein level by immunohistochemistry. Multivariate Cox regression analysis indicated that HADH was an independent prognostic factor for KIRC. In addition, HADH expression was significantly associated with the accumulation of several TIICs, especially regulatory T cells. Finally, GSEA revealed that the transcriptome of the low HADH expression group was significantly enriched in genes involved in not only epithelial-mesenchymal transition and inflammatory response but also TNF-α, IL-6-JAK-STAT3, and interferon-γ signaling. In conclusion, our study demonstrated that decreased expression of HADH is related to poor prognosis and immune infiltration in KIRC; this finding may provide crucial information for the development of immunotherapies.
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Affiliation(s)
- Huiming Jiang
- Department of Urology, Meizhou People's Hospital, Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, No. 63, Huang Tang Road, Meizhou, Guangdong Province 514031, PR China.
| | - Haibin Chen
- Department of Histology and Embryology, Shantou University Medical College, No. 22 Xinling Road, Shantou, Guangdong Province 515041, PR China
| | - Pei Wan
- Department of Urology, Meizhou People's Hospital, Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, No. 63, Huang Tang Road, Meizhou, Guangdong Province 514031, PR China
| | - Nanhui Chen
- Department of Urology, Meizhou People's Hospital, Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, No. 63, Huang Tang Road, Meizhou, Guangdong Province 514031, PR China.
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22
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Prevalence and risk factors of myocardial and acute kidney injury following radical nephrectomy with vena cava thrombectomy: a retrospective cohort study. BMC Anesthesiol 2021; 21:243. [PMID: 34641781 PMCID: PMC8513361 DOI: 10.1186/s12871-021-01462-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radical nephrectomy with thrombectomy is the mainstay treatment for patients with renal cell carcinoma with vena cava thrombus. But the procedure is full of challenge, with high incidence of major complications and mortality. Herein, we investigated the incidence and predictors of myocardial injury and acute kidney injury (AKI) in patients following radical nephrectomy with inferior vena cava thrombectomy. METHODS Patients who underwent nephrectomy with thrombectomy between January 2012 and June 2020 were retrospectively reviewed. Myocardial injury was diagnosed when peak cardiac troponin I was higher than 0.03 ng/ml. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regression models were used to identify predictors of myocardial injury or AKI after surgery. RESULTS A total of 143 patients were included in the final analysis. Myocardial injury and AKI occurred in 37.8 and 42.7% of patients after this surgery, respectively. Male sex (odds ratio [OR] 0.27, 95% confidence interval [CI] 0.10-0.71; P = 0.008) was associated with a lower risk, whereas high level Mayo classification (compared with Mayo level I + II, Mayo level III + IV: OR 4.21, 95% CI 1.42-12.4; P = 0.009), acute normovolemic hemodilution before surgery (OR 2.66, 95% CI 1.10-6.41; P = 0.029), long duration of intraoperative tachycardia (per 20 min: OR 1.49, 95% CI 1.10-2.16; P = 0.036), and long duration of surgery (per 1 h, OR 1.48, 95% CI 1.03-2.16, P = 0.009) were associated with a higher risk of myocardial injury. High body mass index (OR 1.18, 95% CI 1.06-1.33; P = 0.004) and long duration of intraoperative hypotension (per 20 min: OR 1.30, 95% CI 1.04-1.64; P = 0.024) were associated with a higher risk, whereas selective renal artery embolism before surgery (OR 0.20, 95% CI 0.07-0.59, P = 0.004) was associated with a lower risk of AKI. CONCLUSION Myocardial injury and AKI were common in patients recovering from radical nephrectomy with inferior vena cava thrombectomy. Whether interventions targeting the above modifiable factors can improve outcomes require further studies.
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23
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Determinants of renal cell carcinoma invasion and metastatic competence. Nat Commun 2021; 12:5760. [PMID: 34608135 PMCID: PMC8490399 DOI: 10.1038/s41467-021-25918-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/30/2021] [Indexed: 01/06/2023] Open
Abstract
Metastasis is the principal cause of cancer related deaths. Tumor invasion is essential for metastatic spread. However, determinants of invasion are poorly understood. We addressed this knowledge gap by leveraging a unique attribute of kidney cancer. Renal tumors invade into large vessels forming tumor thrombi (TT) that migrate extending sometimes into the heart. Over a decade, we prospectively enrolled 83 ethnically-diverse patients undergoing surgical resection for grossly invasive tumors at UT Southwestern Kidney Cancer Program. In this study, we perform comprehensive histological analyses, integrate multi-region genomic studies, generate in vivo models, and execute functional studies to define tumor invasion and metastatic competence. We find that invasion is not always associated with the most aggressive clone. Driven by immediate early genes, invasion appears to be an opportunistic trait attained by subclones with diverse oncogenomic status in geospatial proximity to vasculature. We show that not all invasive tumors metastasize and identify determinants of metastatic competency. TT associated with metastases are characterized by higher grade, mTOR activation and a particular immune contexture. Moreover, TT grade is a better predictor of metastasis than overall tumor grade, which may have implications for clinical practice.
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24
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Zhu W, Jiang H, Xie S, Xiao H, Liu Q, Chen N, Wan P, Lu S. Downregulation of PPA2 expression correlates with poor prognosis of kidney renal clear cell carcinoma. PeerJ 2021; 9:e12086. [PMID: 34567842 PMCID: PMC8428262 DOI: 10.7717/peerj.12086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Kidney renal clear cell carcinoma (KIRC) is the most common subtype of kidney cancer. Inorganic pyrophosphatase (PPA2) is an enzyme that catalyzes the hydrolysis of pyrophosphate to inorganic phosphate; few studies have reported its significance in cancers. Therefore, we aimed to explore the prognostic value of PPA2 in KIRC. Methods PPA2 expression was detected via immunohistochemistry in a tissue chip containing specimens from 150 patients with KIRC. We evaluated the correlation between PPA2 expression, clinicopathological characteristics, and survival. Data from online databases and another cohort (paraffin-embedded specimens from 10 patients with KIRC) were used for external validation. Results PPA2 expression was significantly lower in KIRC tissues than in normal renal tissues (p < 0.0001). Low expression of PPA2 was significantly associated with a high histologic grade and poor prognosis. The differential expression of PPA2 was validated at the gene and protein levels. Multivariate Cox regression analysis showed that PPA2 expression was an independent prognostic factor in patients with KIRC. Gene set enrichment analysis suggested that decreased expression of PPA2 might be related to the epithelial-mesenchymal transition in KIRC. Conclusions Our study demonstrated that PPA2 is an important energy metabolism-associated biomarker correlated with a favorable prognosis in KIRC.
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Affiliation(s)
- Wenbiao Zhu
- Department of Pathology, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - Huiming Jiang
- Department of Urology, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - Shoucheng Xie
- Department of Pathology, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - Huanqin Xiao
- Department of Pathology, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - Qinghua Liu
- Department of Pathology, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - Nanhui Chen
- Department of Urology, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - Pei Wan
- Department of Urology, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - Shanming Lu
- Department of Pathology, Meizhou People's Hospital, Meizhou, Guangdong, China
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25
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Shiff B, Breau RH, Mallick R, Pouliot F, So A, Tanguay S, Kapoor A, Lattouf JB, Lavallée L, Fairey A, Finelli A, Bhindi B, Kawakami J, Rendon R, Bansal RK. Prognostic significance of extent of venous tumor thrombus in patients with non-metastatic renal cell carcinoma: Results from a Canadian multi-institutional collaborative. Urol Oncol 2021; 39:836.e19-836.e27. [PMID: 34556430 DOI: 10.1016/j.urolonc.2021.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The prognostic significance of level of venous tumor thrombus (VTT) extension in patients with non-metastatic renal cell carcinoma (RCC) has been controversial. The aim of this study was to examine the prognostic significance of VTT extent in patients who underwent surgery for non-metastatic RCC. MATERIALS AND METHODS The Canadian Kidney Cancer information system database was used to identify patients who underwent surgery for non-metastatic RCC and VTT from January 2011 to December 2019. Association between VTT level and recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) was examined. Univariable and multivariable analyses were performed to estimate predictors of survival. RESULTS Out of 6,340 patients during the study period, 228 patients (3.6%) had VTT. VTT was level 0 in 84 (37%), level I to II in 112 (49%), and level III to IV in 33 (14%) patients as per the Mayo Clinic classification. Median age was 65.4 years (interquartile range [IQR] 57.6-72.2) and 169 (74.1%) were male. After a median follow-up of 21.2 months, VTT level did not significantly impact the RFS, CSS, or OS. For VTT level 0, I to II, and III to IV, there was no significant difference in estimated 5-year RFS (31%, 23%, and 30.5%; P > 0.05), CSS (70%, 69%, and 55%; P > 0.05) and OS (64%, 66%, and 50%; P > 0.05). Adjusting for known prognostic factors, thrombus level was not associated with risk of recurrence or death. CONCLUSION In a large, multi-institutional cohort of patients undergoing surgery for non-metastatic RCC with tumor thrombus, thrombus extent was not independently associated with recurrence or death.
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Affiliation(s)
- Benjamin Shiff
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Frédéric Pouliot
- Division of Urology, Université Laval, Quebec City, Quebec, Canada
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, British Columbia, Canada, Vancouver
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, Quebec, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | | | - Luke Lavallée
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | - Adrian Fairey
- Division of Urology, University of Alberta, Edmonton, Alberta, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Bimal Bhindi
- Section of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Jun Kawakami
- Section of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rahul K Bansal
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada.
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26
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Zhang H, Yin F, Chen M, Qi A, Yang L, Cui W, Yang S, Wen G. [Predicting postoperative recurrence of stage Ⅰ-Ⅲ renal clear cell carcinoma based on preoperative CT radiomics feature nomogram]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1358-1365. [PMID: 34658350 DOI: 10.12122/j.issn.1673-4254.2021.09.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To explore the preoperative radiomics features (RFs) and construct a nomogram for predicting postoperative recurrence of stage Ⅰ-Ⅲ clear cell renal carcinoma (ccRCC). METHODS The clinicopathological data and preoperative enhanced CT images collected from 256 patients with ccRCC were used as the training dataset (175 patients) and test dataset (81 patients). The enhanced CT images of the tumor were segmented using ITK-SNAP software, and the RFs were extracted using the PyRadiomics computing platform. In the training dataset, the RFs were screened based on Lasso-CV algorithm, and the Rad_score was calculated. The Clinic factors were screened by univariate and multivariate logistic regression analysis of the clinical and pathological factors and CT characteristics. The Rad_score, Clinic、Rad_score + Clinic nomograms were constructed and verified using the test dataset. The performance, discrimination power and calibration of the nomograms were compared, and their clinical value was evaluated using decision curve analysis. RESULTS Six RFs were retained to calculate the Rad_score. The Clinic factors included Rad_score, KPS score, platelet, calcification and TNM clinical stage. In terms of discrimination, the Rad_score + Clinic nomogram showed better performance (AUC=0.84 for training set; AUC=0.85 for test set) than the Rad_score nomogram (AUC=0.78 for training set, P=0.029; AUC=0.77 for Test set, P=0.025) and Clinic nomogram (AUC=0.77 for training set, P=0.014; AUC=0.77 for test set, P=0.011). In terms of calibration, the P value for goodness of fit test of the Rad_score+Clinic nomogram was 0.065 for the training set and 0.628 for the test set. Decision curve analysis showed a greater clinical value of the Rad_score+Clinic nomogram with Rad_score than the Clinic nomogram without Rad_score. CONCLUSION The nomogram based on preoperative CT RFs has a high value for predicting postoperative recurrence of stage Ⅰ-Ⅲ ccRCC to facilitate individualized treatment of RCC.
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Affiliation(s)
- H Zhang
- PET/CT Center, First Affiliated Hospital of Shenzhen University, Shenzhen 518052, China.,Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - F Yin
- Shenzhen University School of Information Engineering, Shenzhen 518052, China
| | - M Chen
- Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - A Qi
- Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - L Yang
- Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - W Cui
- Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - S Yang
- Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - G Wen
- Department of Imaging, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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27
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Li SJ, Lee J, Hall J, Sutherland TR. The inferior vena cava: anatomical variants and acquired pathologies. Insights Imaging 2021; 12:123. [PMID: 34460015 PMCID: PMC8405820 DOI: 10.1186/s13244-021-01066-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/07/2021] [Indexed: 01/05/2023] Open
Abstract
The inferior vena cava (IVC) is the largest vein in the body, draining blood from the abdomen, pelvis and lower extremities. This pictorial review summarises normal anatomy and embryological development of the IVC. In addition, we highlight a wide range of anatomical variants, acquired pathologies and a common pitfall in imaging of the IVC. This information is essential for clinical decision making and to reduce misdiagnosis.
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Affiliation(s)
- Simon J Li
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Jean Lee
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jonathan Hall
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Department of Radiology, Austin Health, Heidelberg, VIC, Australia
| | - Tom R Sutherland
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
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28
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Zapała Ł, Sharma S, Kunc M, Zapała P, Kłącz J, Korczyński P, Lipowski M, Późniak M, Suchojad T, Drewa T, Matuszewski M, Radziszewski P. Analysis of Clinicopathological Factors Influencing Survival in Patients with Renal Cell Carcinoma and Venous Tumor Thrombus. J Clin Med 2021; 10:jcm10173852. [PMID: 34501296 PMCID: PMC8432091 DOI: 10.3390/jcm10173852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 12/04/2022] Open
Abstract
This study aimed to define patients with renal cell cancer and coexisting tumor thrombus in order to address concerns regarding survival and prognostic factors after radical surgery. Several prognostic factors for overall survival (OS) were assessed in patients treated surgically at five institutions from 2012 to 2018. Univariate and multivariate analyses were used to determine the independent risk factors of OS. A total of 142 patients were eligible for further analysis (mean age of 64.75 years, 56% males). Most patients presented with clear cell carcinoma (95%). The Mayo stage was predominantly 0–1 (88%). Distant visceral metastases at the time of diagnosis were present in 36 patients (25%), whereas nodal metastases were present in 24 patients (16.9%). During the follow-up period (mean of 32.5 months), the 3-year OS rate reached 68.2%. The majority of patients received no adjuvant treatment (n = 107). In a multivariable model predicting OS, regional lymph node status (p < 0.001), distant metastases (p = 0.009), tumor grade (p = 0.002), duration of hospitalization (p = 0.016), and Clavien–Dindo grade (p = 0.047) were identified as independent prognostic factors. A subgroup of patients with specific clinicopathological factors may benefit most from the radical surgery, including patients without regional lymph node or distant metastases and with low tumor grades, whereas short hospitalization and low Clavien–Dindo grades represent additional independent prognostic factors.
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Affiliation(s)
- Łukasz Zapała
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, Poland; (S.S.); (P.Z.); (P.R.)
- Correspondence: (Ł.Z.); (M.K.)
| | - Sumit Sharma
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, Poland; (S.S.); (P.Z.); (P.R.)
| | - Michał Kunc
- Department of Pathomorphology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
- Correspondence: (Ł.Z.); (M.K.)
| | - Piotr Zapała
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, Poland; (S.S.); (P.Z.); (P.R.)
| | - Jakub Kłącz
- Department of Urology, Faculty of Medicine, Medical University of Gdańsk, 80-402 Gdańsk, Poland; (J.K.); (M.M.)
| | - Piotr Korczyński
- Department of Urology, Regional Specialist Hospital, 26-060 Czerwona Góra, Poland; (P.K.); (T.S.)
| | - Michał Lipowski
- Department of Urology, St. Lukas Specialist Hospital, 26-200 Końskie, Poland;
| | - Michał Późniak
- Clinic of Urology, Dr Jurasz University Hospital, 85-094 Bydgoszcz, Poland; (M.P.); (T.D.)
| | - Tomasz Suchojad
- Department of Urology, Regional Specialist Hospital, 26-060 Czerwona Góra, Poland; (P.K.); (T.S.)
| | - Tomasz Drewa
- Clinic of Urology, Dr Jurasz University Hospital, 85-094 Bydgoszcz, Poland; (M.P.); (T.D.)
| | - Marcin Matuszewski
- Department of Urology, Faculty of Medicine, Medical University of Gdańsk, 80-402 Gdańsk, Poland; (J.K.); (M.M.)
| | - Piotr Radziszewski
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, Poland; (S.S.); (P.Z.); (P.R.)
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29
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Chen Z, Yang F, Ge L, Qiu M, Liu Z, Liu C, Tian X, Zhang S, Ma L. Outcomes of renal cell carcinoma with associated venous tumor thrombus: experience from a large cohort and short time span in a single center. BMC Cancer 2021; 21:766. [PMID: 34215223 PMCID: PMC8254310 DOI: 10.1186/s12885-021-08508-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background The surgical management and outcomes of renal cell carcinoma (RCC) with venous tumor thrombus (VTT) have been reported in limited sample size, and there remain discrepancies over the factors that influence oncologic outcomes after radical nephrectomy with thrombectomy (RNTE). The aim of the study was to analyze the outcomes of the patients with RCC with VTT in our institution and identify the independent prognostic factors. Methods Patients with RCC with VTT were enrolled for the study from February 2015 to December 2018. All patients underwent RNTE. Clinical data were compared using Mann-Whitney U test and the chi-square test for continuous and categorical variables respectively. Survival analysis was estimated using the Kaplan-Meier method. Univariable and multivariable survival analyses were performed using Cox regression model. Results 121 patients (91 men & 30 women) were identified with a median age of 60 years. VTT level was 0 in 25 patients, I in 20, II in 50, III in 12 and IV in 14. The median follow-up time was 24 months. During the follow-up period, 51 (42%) patients died and 69 (57%) patients experienced recurrence or metastasis. The 3-year and 5-year over-all survival (OS) were 58 and 39%. Among the several factors examined, positive lymph node (P = 0.016), metastasis at surgery (P = 0.034), tumor necrosis (P = 0.023) and sarcomatoid differentiation (P < 0.001) were demonstrated as independent significant risk factors on multivariable analysis. Conclusion The OS was poor for patients with RCC with VTT. Rather than VTT level, positive lymph node, metastasis at surgery, tumor necrosis and sarcomatoid differentiation were independent prognostic predictors.
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Affiliation(s)
- Zhigang Chen
- Peking University Health Science Centre, No.49 North Garden Road, Haidian District, Beijing, P. R. China.,Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Feilong Yang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China.,Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Liyuan Ge
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Min Qiu
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China.
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China.
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Watanabe S, Ishihara H, Takagi T, Kondo T, Ishiyama R, Fukuda H, Yoshida K, Iizuka J, Kobayashi H, Ishida H, Tanabe K. Impact of sarcopenia on post-operative outcomes following nephrectomy and tumor thrombectomy for renal cell carcinoma with inferior vena cava thrombus. Jpn J Clin Oncol 2021; 51:819-825. [PMID: 33558883 DOI: 10.1093/jjco/hyaa275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/29/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Sarcopenia is associated with oncological outcomes in various types of cancer. However, the impact of sarcopenia in renal cell carcinoma with inferior vena cava thrombus remains unclear. We herein evaluated the prognostic significance of sarcopenia for renal cell carcinoma with inferior vena cava thrombus following nephrectomy and thrombectomy. METHODS Patients who underwent nephrectomy and thrombectomy for renal cell carcinoma with inferior vena cava thrombus at our department between 2004 and 2019 were retrospectively evaluated. Their sarcopenic status, determined by sex, body mass index and skeletal muscle index, was calculated using pre-surgical radiographic imaging. We compared the post-operative cancer-specific survival and overall survival, surgical data and duration of post-operative hospitalization of sarcopenic and non-sarcopenic patients. RESULTS Out of 83 patients, 54 (65%) were sarcopenic. Sarcopenic patients had significantly shorter cancer-specific survival (median: 33.3 months vs. not reached, P = 0.0323) and overall survival (32.0 months vs. not reached, P = 0.0173) than non-sarcopenic patients. Furthermore, multivariate analyses showed that sarcopenia was an independent factor for cancer-specific survival (hazard ratio: 2.76, P = 0.0212) and overall survival (hazard ratio: 2.93, P = 0.014). The incidence rate of surgical complications (any grade: 35.2% vs. 27.6%, P = 0.482; grades ≥ 3: 7.4% vs. 10.3%, P = 0.648) or duration of post-operative hospitalization (median: 11 vs. 10 days, P = 0.148) was not significantly different between sarcopenic and non-sarcopenic patients. CONCLUSIONS In conclusion, this study showed that sarcopenia was an independent prognostic factor for renal cell carcinoma with inferior vena cava thrombus after nephrectomy and tumor thrombectomy. Thus, sarcopenia evaluation can be utilized as an effective prognosticator of post-operative survival.
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Affiliation(s)
- Shun Watanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Ryo Ishiyama
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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31
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Jurado A, Romeo A, Gueglio G, Marchiñena PG. Current Trends in Management of Renal Cell Carcinoma with Venous Thrombus Extension. Curr Urol Rep 2021; 22:23. [PMID: 33554309 DOI: 10.1007/s11934-021-01036-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW To review the evidence regarding the current trends in surgical management of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombosis. Recent published series have shown the role of minimally invasive surgery in IVC thrombectomy. This review article evaluates the present RCC with venous extent literature to assess the role of open and minimally invasive surgery in this scenario. RECENT FINDINGS Robotic urological surgery has shown to have known benefits in radical prostatectomy, partial nephrectomy, and pyeloplasty. Recent published series showed feasibility of robotic IVC thrombectomy even for level IV cases. With growing number of robot-assisted and laparoscopic surgeries worldwide, there is a current tendency to treat this complex and challenging pathology with a minimally invasive approach, without compromising oncological outcomes.
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Affiliation(s)
- Alberto Jurado
- Urology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Agustin Romeo
- Urology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
| | - Guillermo Gueglio
- Urology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Patricio Garcia Marchiñena
- Urology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
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Abstract
Minimally invasive renal surgery has revolutionized the surgical management of renal cancer since the initial report of laparoscopic nephrectomy in 1991. Laparoscopic nephrectomy became the mainstay of management in surgically resectable renal masses since the 1990s. The growing body of literature supporting nephron-sparing surgery over the last two decades has meant that minimally invasive radical nephrectomy (MI-RN) is now the preferred treatment for renal tumors not amenable to partial nephrectomy. While there is a well-described experience with complex radical nephrectomy using standard laparoscopy, robot-assisted surgery has shortened the learning curve and facilitated greater uptake of minimally invasive surgery in difficult surgical scenarios traditionally performed open surgically. Increased experience and expertise with robot-assisted renal surgery has led to expansion of the indications for MI-RN to include larger masses, locally advanced renal masses invading adjacent tissues or regional hilar/retroperitoneal lymph nodes, cytoreductive nephrectomy (CN) in metastatic disease, and concurrent venous tumor thrombectomy for renal vein or inferior vena cava (IVC) involvement. In this article, we review the various surgical techniques and adjunctive procedures associated with MI-RN.
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Affiliation(s)
- Akbar N Ashrafi
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Division of Surgery, North Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Inderbir S Gill
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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33
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Kalapara AA, Frydenberg M. The role of open radical nephrectomy in contemporary management of renal cell carcinoma. Transl Androl Urol 2020; 9:3123-3139. [PMID: 33457285 PMCID: PMC7807349 DOI: 10.21037/tau-19-327] [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] [Indexed: 12/24/2022] Open
Abstract
Radical nephrectomy (RN) remains a cornerstone of the management of localised renal cell carcinoma (RCC). RN involves the en bloc removal of the kidney along with perinephric fat enclosed within Gerota's fascia. Key principles of open RN include appropriate incision for adequate exposure, dissection and visualisation of the renal hilum, and early ligation of the renal artery and subsequently renal vein. Regional lymph node dissection (LND) facilitates local staging but its therapeutic role remains controversial. LND is recommended in patients with high risk clinically localised disease, but its benefit in low risk node-negative and clinically node-positive patients is unclear. Concomitant adrenalectomy should be reserved for patients with large tumours with radiographic evidence of adrenal involvement. Despite a recent downtrend in utilisation of open RN due to nephron-sparing and minimally invasive alternatives, there remains a vital role for open RN in the management of RCC in three domains. Firstly, open RN is important to the management of large, complex tumours which would be at high risk of complications if treated with partial nephrectomy (PN). Secondly, open RN plays a crucial role in cytoreductive nephrectomy (CN) for metastatic RCC, in which the laparoscopic approach achieves similar results but is associated with a high reoperation rate. Finally, open RN is the current standard of care in the management of inferior vena caval (IVC) tumour thrombus. Management of tumour thrombus requires a multidisciplinary approach and varies with cranial extent of thrombus. Higher level thrombus may require hepatic mobilisation and circulatory support, whilst the presence of bland thrombus may warrant post-operative filter insertion or ligation of the IVC.
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Affiliation(s)
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Australia.,Cabrini Institute, Cabrini Health, Melbourne, Australia
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34
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Jiang H, Chen H, Wan P, Song S, Chen N. Downregulation of enhancer RNA EMX2OS is associated with poor prognosis in kidney renal clear cell carcinoma. Aging (Albany NY) 2020; 12:25865-25877. [PMID: 33234727 PMCID: PMC7803531 DOI: 10.18632/aging.202151] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/29/2020] [Indexed: 02/05/2023]
Abstract
Enhancer RNAs are a subclass of long non-coding RNAs transcribed from enhancer regions that play an important role in the transcriptional regulation of genes. However, their role in kidney renal clear cell carcinoma (KIRC) is largely unknown. Herein, we identified the key enhancer RNAs in KIRC via an integrated data analysis method. Gene expression profiles and clinical data of KIRC and 32 other cancer types were acquired using the University of California Santa Cruz Xena platform. Reported enhancer RNAs and genes regulated by them were selected as putative enhancer RNA-target pairs. Kaplan-Meier survival and correlation analyses were performed to identify the key enhancer RNAs. Finally, EMX2OS was identified as the enhancer RNA most associated with survival, with EMX2 as its target. EMX2OS downregulation was significantly associated with higher histological grade, advanced stage, and poorer prognosis. The results were validated in pan-cancer data from The Cancer Genome Atlas and RT-qPCR analysis of 12 pairs of KIRC and normal real-world samples. Functional enrichment analysis indicated that several metabolism-associated signaling pathways were enriched. This study demonstrated that EMX2OS is a key metabolism-associated enhancer RNA in KIRC with a favorable impact on survival and may be a novel therapeutic target in KIRC.
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Affiliation(s)
- Huiming Jiang
- Department of Urology, Meizhou People’s Hospital, Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou 514031, Guangdong Province, P.R. China
| | - Haibin Chen
- Department of Histology and Embryology, Shantou University Medical College, Shantou 515041, Guangdong Province, P.R. China
| | - Pei Wan
- Department of Urology, Meizhou People’s Hospital, Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou 514031, Guangdong Province, P.R. China
| | - Shengda Song
- Department of Urology, Meizhou People’s Hospital, Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou 514031, Guangdong Province, P.R. China
| | - Nanhui Chen
- Department of Urology, Meizhou People’s Hospital, Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou 514031, Guangdong Province, P.R. China
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35
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Delahunt B, Eble JN, Samaratunga H, Thunders M, Yaxley JW, Egevad L. Staging of renal cell carcinoma: current progress and potential advances. Pathology 2020; 53:120-128. [PMID: 33121821 DOI: 10.1016/j.pathol.2020.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 12/14/2022]
Abstract
Formal staging classifications for renal cell carcinoma (RCC) were first proposed in 1978 and were incorporated into the Tumour, Nodes, Metastases (TNM) system initially published by the Union Internationale Contre le Cancer (UICC) in 1978. There has been a gradual evolution of grading criteria through six separate editions of the UICC TNM Classification, with the latest edition being published in 2016. Somewhat surprisingly there were no changes to the T category criteria from the 2009 to the 2016 editions of the classification, although an erratum has subsequently been published that incorporated the minor changes included in the eighth edition of the TNM Classification published by the American Joint Committee on Cancer. Localised tumours are staged according to the size of the primary tumour, with the TNM classification recognising that these tumours may exceed 10 cm in diameter. This is unfortunate as there is good evidence to demonstrate that, for clear cell RCC, virtually all tumours >7 cm in diameter and a substantial proportion of tumours <7 cm in diameter, show extra-renal spread. Infiltration of tumour beyond the renal capsule into the peri-renal fat is also categorised as T3a, however the clinical importance of this remains unclear. The classification of microvascular invasion within the renal sinus requires clarification, as does the prognostic significance of tumour in small vessels within the kidney.
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Affiliation(s)
- Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
| | - John N Eble
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, USA
| | | | - Michelle Thunders
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - John W Yaxley
- Department of Medicine, University of Queensland, Wesley Urology Clinic, Royal Brisbane and Womens Hospital, Brisbane, Qld, Australia
| | - Lars Egevad
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
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36
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He X, Mao X, Li J, Guo S. Comparison of T2N0M0 and T3aN0M0 in Predicting the Prognosis of Patients With Renal Cell Carcinoma. Front Oncol 2020; 10:564631. [PMID: 33072592 PMCID: PMC7539120 DOI: 10.3389/fonc.2020.564631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/25/2020] [Indexed: 11/13/2022] Open
Abstract
Background: To investigate the prognostic role of tumor size in patients with pathological T2N0M0 and T3aN0M0 renal cell carcinoma (RCC) treated by radical surgery. Methods: A total of 3,662 cases were retrospectively analyzed from the Surveillance, Epidemiology and End Results (SEER) from 2010 to 2012. Overall survival (OS) and cancer-specific survival (CSS) data were obtained. The log-rank test was used to compare survival distributions and Cox proportional hazards model was used for univariate and multivariate analyses, respectively. Results: In the low-risk T3aN0M0 (perinephric fatty infiltration or sinus fatty infiltration only) group, patients with tumor size ≤ 7 cm were associated with a better OS (P = 0.009) and CSS (P < 0.001) than those with tumor size >7 cm. However, there was no difference in OS (P = 0.129) and CSS (P = 0.539) between T2bN0M0 patients and low-risk T3aN0M0 patients with tumor size ≤ 7 cm. A new T classification grouping patients with both T2bN0M0 and T3aN0M0 with tumor diameter ≤ 7 cm into the same staging category (pT2aN0M0, pT2bN0M0+low-risk pT3aN0M0 [tumor diameter ≤ 7cm], low-risk pT3aN0M0 [tumor diameter >7 cm], high-risk pT3aN0M0) was proposed and it was found as an independent predictive variable for OS and CSS. Conclusions: Findings from the present study suggest that the reclassification of pT2N0M0 and pT3aN0M0 RCC can lead to better prediction of OS and CSS.
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Affiliation(s)
- Xiaobo He
- State Key Laboratory of Oncology in South China, Department of Urology, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaopeng Mao
- Department of Urology Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jibin Li
- State Key Laboratory of Oncology in South China, Department of Clinical Research, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shengjie Guo
- State Key Laboratory of Oncology in South China, Department of Urology, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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37
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Zhao X, Liu Z, Zhang H, Li L, Tang S, Wang G, Zhang S, Wang S, Tian X, Ma L. PKUTHLP score: A comprehensive system to predict surgical approach in radical nephrectomy and thrombectomy. Oncol Lett 2020; 20:201-208. [PMID: 32565947 PMCID: PMC7285736 DOI: 10.3892/ol.2020.11571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/26/2020] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to develop an accurate preoperative scoring system to predict the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy. The clinical data of 123 patients with renal cell carcinoma with renal vein or inferior vena cava tumour thrombus admitted to the Department of Urology at Peking University Third Hospital between January 2015 and May 2018 were retrospectively analysed. Univariate and multivariate regression analyses were used to create the scoring system with an emphasis on the area improvement under the receiver operating characteristic curve. A total of 58 (47.2%) patients underwent complete laparoscopic surgery, 56 (45.5%) underwent complete open surgery and 9 (7.3%) underwent laparoscopic conversion to open surgery. The final multivariable model included the following three factors: Clinical node stage (P=0.030), Mayo classification (P<0.001) and tumour diameter (P=0.001). These three variables were then used to construct the score system named Peking University Third Hospital Laparoscopic Probability (PKUTHLP), which ranges from 0-5. The proportion of patients undergoing laparoscopic surgery for each level of the PKUTHLP score were as follows: 0 (n=20), 100%; 1 (n=34), 67.6%; 2 (n=21), 33.3%; 3 (n=21), 19.0%; 4 (n=23), 17.4%; and 5 (n=4), 0.0%. Overall, the PKUTHLP score accurately predicted the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy; however, prospective validation of the PKUTHLP scoring system is required.
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Affiliation(s)
- Xun Zhao
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Liwei Li
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Shiying Tang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Shumin Wang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
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38
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Wang K, Wu T, Chen Y, Song G, Chen Z. Prognostic Effect of Preoperative Apolipoprotein B Level in Surgical Patients with Clear Cell Renal Cell Carcinoma. Oncol Res Treat 2020; 43:340-345. [PMID: 32554963 DOI: 10.1159/000507964] [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: 02/18/2020] [Accepted: 04/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to assess the prognostic value of the preoperative apolipoprotein B (ApoB) level in surgical patients with clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS The study included 307 ccRCC patients receiving radical or partial nephrectomy between 2003 and 2012 in our center. The correlations among the preoperative ApoB, clinicopathological parameters, and overall survival (OS) were evaluated. RESULTS A total of 193 males (62.9%) and 114 females (37.1%) with ccRCC who underwent radical or partial nephrectomy were enrolled in the present study. The OS at 5 years after the operation was 90.6% for all patients, 87.4% for the lower ApoB group, and 97.0% for the higher-ApoB group. The cause-specific survival (CSS) at 5 years after surgery was 90.2% for all patients, 86.7% for the lower-ApoB group, and 97.0% for the higher-ApoB group. A higher-ApoB level was related to a better OS and CSS in ccRCC patients (p = 0.001 and p < 0.001, respectively). In multivariate analysis, age >60 years (p = 0.008 and p = 0.023) and a lower Apo B level (p = 0.019 and p = 0.018) were independent prognostic factors for OS and CSS, respectively. CONCLUSIONS In the Apo apolipoprotein family, the preoperative ApoB level had an important clinical significance for predicting the prognosis and survival rate of ccRCC patients.
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Affiliation(s)
- Kun Wang
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Tingchun Wu
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yiming Chen
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Guanglai Song
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhen Chen
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow University, Changzhou, China,
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39
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Jiang H, Chen H, Chen N. Construction and validation of a seven-gene signature for predicting overall survival in patients with kidney renal clear cell carcinoma via an integrated bioinformatics analysis. Anim Cells Syst (Seoul) 2020; 24:160-170. [PMID: 33209196 PMCID: PMC7651852 DOI: 10.1080/19768354.2020.1760932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023] Open
Abstract
Kidney renal clear cell carcinoma (KIRC) remains a significant challenge worldwide because of its poor prognosis and high mortality rate, and accurate prognostic gene signatures are urgently required for individual therapy. This study aimed to construct and validate a seven-gene signature for predicting overall survival (OS) in patients with KIRC. The mRNA expression profile and clinical data of patients with KIRC were obtained from The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC). Prognosis-associated genes were identified, and a prognostic gene signature was constructed. Then, the prognostic efficiency of the gene signature was assessed. The results obtained using data from the TCGA were validated using those from the ICGC and other online databases. Gene set enrichment analyses (GSEA) were performed to explore potential molecular mechanisms. A seven-gene signature (PODXL, SLC16A12, ZIC2, ATP2B3, KRT75, C20orf141, and CHGA) was constructed, and it was found to be effective in classifying KIRC patients into high- and low-risk groups, with significantly different survival based on the TCGA and ICGC validation data set. Cox regression analysis revealed that the seven-gene signature had an independent prognostic value. Then, we established a nomogram, including the seven-gene signature, which had a significant clinical net benefit. Interestingly, the seven-gene signature had a good performance in distinguishing KIRC from normal tissues. GSEA revealed that several oncological signatures and GO terms were enriched. This study developed a novel seven-gene signature and nomogram for predicting the OS of patients with KIRC, which may be helpful for clinicians in establishing individualized treatments.
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Affiliation(s)
- Huiming Jiang
- Department of Urology, Meizhou People’s Hospital (Huangtang Hospital), Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, People’s Republic of China
| | - Haibin Chen
- Department of Histology and Embryology, Shantou University Medical College, Shantou, People’s Republic of China
| | - Nanhui Chen
- Department of Urology, Meizhou People’s Hospital (Huangtang Hospital), Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, People’s Republic of China
- Nanhui Chen Department of Urology, Meizhou People’s Hospital (Huangtang Hospital), Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, No. 63, Huang Tang Road, Meizhou, Guangdong Province514031, P.R. China
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40
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Liu H, Ye T, Yang X, Lv P, Wu X, Zhou H, Zeng J, Tang K, Ye Z. A Panel of Four-lncRNA Signature as a Potential Biomarker for Predicting Survival in Clear Cell Renal Cell Carcinoma. J Cancer 2020; 11:4274-4283. [PMID: 32368310 PMCID: PMC7196268 DOI: 10.7150/jca.40421] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/06/2020] [Indexed: 12/16/2022] Open
Abstract
Long non-coding RNAs (lncRNAs) have been considered as biomarkers for the carcinogenesis and development of various cancers. However, the prognostic significance of lncRNAs in renal cell carcinoma (RCC) remains unclear. This study aimed to determine the predictive ability of lncRNAs in clear cell RCC (ccRCC). Among the cohort of kidney renal clear cell carcinoma (KIRC) of the The Cancer Genome Atlas (TCGA), 525 patients were enrolled in our study. Expression of lncRNAs based on RNAseq was obtained from TCGA. Kaplan-Meier prognostic analysis and a Cox proportional hazards regression model were used to assess related factors. The lncRNA signature was then validated in an independent cohort of an additional 60 ccRCC patients. Hierarchical clustering of the KIRC TCGA dataset identified 26 differentially expressed lncRNAs (11 down-regulated and 15 up-regulated) using average linkage clustering. Kaplan-Meier survival analysis identified 30 statistically significant lncRNAs that strongly predicted prognosis, with 4 ccRCC-specific lncRNAs (TCL6, PVT1, MIR155HG, and HAR1B) being differentially expressed and correlating significantly with OS. Patients assigned to the high-risk group were associated with poor OS compared with patients in the low-risk group (HR = 2.57; 95%CI, 1.89-3.50; p < 0.001). This finding was validated in the Tongji Hospital cohort, and the four-lncRNA signature was shown to be significantly predictive of ccRCC prognosis (p < 0.001). In this study, we constructed an applicable four-lncRNA-based classifier as a reliable prognostic and predictive tool for OS in patients with ccRCC.
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Affiliation(s)
- Haoran Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Hubei Institute of Urology, Wuhan 430030, China
| | - Tao Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Hubei Institute of Urology, Wuhan 430030, China
| | - Xiaoqi Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Hubei Institute of Urology, Wuhan 430030, China
| | - Peng Lv
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Hubei Institute of Urology, Wuhan 430030, China
| | - Xiaoliang Wu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Hubei Institute of Urology, Wuhan 430030, China
| | - Hui Zhou
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Hubei Institute of Urology, Wuhan 430030, China
| | - Jin Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Hubei Institute of Urology, Wuhan 430030, China
| | - Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Hubei Institute of Urology, Wuhan 430030, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Hubei Institute of Urology, Wuhan 430030, China
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Imaging and implications of tumor thrombus in abdominal malignancies: reviewing the basics. Abdom Radiol (NY) 2020; 45:1057-1068. [PMID: 31696267 DOI: 10.1007/s00261-019-02282-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Extension of tumor tissue within a vein is a recognized prognostic factor in abdominal malignancy because of its influence on tumor staging and selection of therapeutic management. With the advent of newer surgical techniques, and variable treatment strategies, imaging plays a crucial role in categorizing patients according to the tumor resectability and vascular reconstruction techniques during surgery. Understanding the clinical impact of tumor thrombus increases the awareness of the radiologist about the key findings in tumor staging and decision-making of surgical approach. Ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) can be used individually and in combination to accurately assess the tumor thrombus. In our pictorial review, we will discuss the imaging findings and clinical consequences of tumor thrombosis in abdominal malignancies, including hepatocellular carcinoma, pancreatic neuroendocrine tumor, renal cancer, and adrenal cortical carcinoma.
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Zhu D, Cao J, Zhi C, Guo T, Li Y, Lang Z, Li G. Prognostic significance of the sub-classification of stage pT3a renal tumors by perinephric and sinus fat invasion. Oncol Lett 2020; 19:1721-1726. [PMID: 32194664 PMCID: PMC7039076 DOI: 10.3892/ol.2020.11281] [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: 06/01/2019] [Accepted: 11/13/2019] [Indexed: 11/06/2022] Open
Abstract
In the current Tumor-Node-Metastasis (TNM) classification system for renal cell carcinoma (RCC), both perinephric fat invasion (PFI) and renal sinus fat invasion (SFI) are classified at the T3a stage. However, their associated prognoses are clinically controversial. The present study proposes a new sub-classification criterion for pathological T3a (pT3a) RCC with SFI or PFI to resolve this dispute. Data were collected from consecutive records of 2,765 patients with T1a renal cancer, who had undergone partial nephrectomy (PN) between 2001 and 2015 at one of four hospitals. Among these patients, 127 cases were diagnosed with stage pT3a RCC with SFI or PFI, according to final pathological examination. The pathological characteristics, clinical data and follow-up observations were analyzed. Of the 127 patients, with an average follow-up duration of 56 months (range, 15–60 months), 17 cases of tumor recurrence were found. After analysis of the pathological findings, the following new sub-classification criteria was proposed for pT3a RCC with SFI or PFI: i) Type A, renal tumor invades the pseudo-capsule and contacts with the perinephric adipose tissues directly (3 recurrences out of 57 patients); ii) type B, tumor protrudes into the perinephric adipose tissues like a tongue (4 recurrences out of 29 patients); and iii) type C, tumor nodules distribute in perinephric adipose tissues (10 recurrences out of 41 patients). There was statistically significant difference between the three subtypes in terms of recurrence rate (P=0.023). In conclusion, controversies remain in the current TNM classification system for pT3a RCC. The present study added to the available data and found that pT3a RCC with tumor nodules in perinephric adipose or/and with an irregular tumor protruding into adipose tissues showed a higher recurrence rate. Thus, it is recommended that pT3a RCC should be carefully analyzed and should be considered differently to other stages of RCC.
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Affiliation(s)
- Dongsheng Zhu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Jingyuan Cao
- Department of Urology, Binzhou Medical University Hospital, Binzhou, Shandong 256600, P.R. China
| | - Chao Zhi
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Tao Guo
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Yuhong Li
- Department of Pathology, The People's Hospital of Liaocheng, Liaocheng, Shandong 252000, P.R. China
| | - Zhiqiang Lang
- Department of Pathology, Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Gang Li
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
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Shao Y, Xiong S, Sun G, Dou W, Hu X, Yang W, Lia T, Deng S, Wei Q, Zeng H, Li X. Prognostic analysis of postoperative clinically nonmetastatic renal cell carcinoma. Cancer Med 2019; 9:959-970. [PMID: 31840431 PMCID: PMC6997064 DOI: 10.1002/cam4.2775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 02/05/2023] Open
Abstract
Objectives To investigate the survival characteristics of postoperative nonmetastatic renal cell carcinoma (RCC) patients, and the predictive value of a prognostic model. Materials and Methods We retrospectively evaluated data from 1202 postoperative nonmetastatic RCC patients who were treated between 1999 and 2012 at West China Hospital, Sichuan University (Chengdu, China). In addition, we also evaluated data relating to 53 205 cases acquired from the Surveillance, Epidemiology, and End Results (SEER) program. Survival analysis was performed on the cases, and subgroups, using the Kaplan‐Meier and Cox regression methods. The concordance index of the Stage Size Grade Necrosis (SSIGN), Leibovich, and the UCLA integrated staging system, scores was determined to evaluate the accuracy of these outcome prediction models. Results The 5‐year overall survival rate for RCC cases in West China Hospital was 87.6%; this was higher than that observed for SEER cases. Survival analysis identified several factors that exerted significant influence over prognosis, including the time of surgery, Eastern Cooperative Oncology Group performance status, tumor stage, size, nuclear differentiation, pathological subtypes, along with necrotic and sarcomatoid differentiation. Moreover tumor stage, size, and nuclear grade were all identified as independent predictors for both our cases and those from the SEER program. Patient groups with advanced RCC, and poorly differentiated RCC subgroups, were both determined to have a poor prognosis. The SSIGN model yielded the best predictive value as a prognostic model, followed by the Leibovich, and UCLA integrated staging system; this was the case for our patients, and for sub‐groups with a poor prognosis. Conclusion The prognosis of RCC was mostly influenced by tumor stage, size, and nuclear differentiation. SSIGN may represent the most suitable prognostic model for the Chinese population.
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Affiliation(s)
- Yanxiang Shao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Sanchao Xiong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Guangxi Sun
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Weichao Dou
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xu Hu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Weixiao Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Thongher Lia
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Deng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Gao Y, Qi JC, Li X, Sun JP, Ji H, Li QH. Decreased expression of TXNIP predicts poor prognosis in patients with clear cell renal cell carcinoma. Oncol Lett 2019; 19:763-770. [PMID: 31897192 PMCID: PMC6924160 DOI: 10.3892/ol.2019.11165] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/08/2019] [Indexed: 12/23/2022] Open
Abstract
Accumulating evidence has demonstrated that thioredoxin interacting protein (TXNIP) is abnormally expressed in a variety of malignant tumors and functions as a tumor suppressor. However, the association between TXNIP and clear cell renal cell carcinoma (CCRCC) has not yet been fully elucidated. The aim of the present study was to evaluate the role of TXNIP in CCRCC using The Cancer Genome Atlas (TCGA) database. The RNA sequencing data and corresponding clinical data were collected from TCGA database. The association between TXNIP and patient clinicopathological characteristics was analyzed using analysis of variance and logistic regression. The Kaplan-Meier method and Cox proportional hazards model were used to assess the association between TXNIP and overall survival. Gene Set Enrichment Analysis (GSEA) was used to explore the associated signaling pathways. TXNIP expression was identified to be decreased in CCRCC tissues compared with normal tissues. The decreased expression of TXNIP in CCRCC was significantly associated with clinical stage [OR=0.509 for III vs. I (P=0.002); OR=0.527 for IV vs. I (P=0.012)], T stage [OR=0.552 for T3 vs. T1 (P=0.002)] and grade [OR=0.261 for G4 vs. G1 (P=0.027)]. Kaplan-Meier survival analysis indicated that cases of CCRCC with low TXNIP expression were associated with poorer prognoses compared with those with a high expression level (P=0.002). Univariate and multivariate Cox analyses indicated that TXNIP was an independent prognostic factor in CCRCC. GSEA revealed that 6 pathways exhibited significant differential enrichment in the TXNIP high-expression phenotype, including the WNT signaling pathway, the mitogen-activated protein kinase (MAPK) signaling pathway, the phosphatidylinositol signaling system, the transforming growth factor-β (TGF-β) signaling pathway, autophagy and the Janus kinase (JAK)-STAT signaling pathway. Taken together, the results of the present study indicate that TXNIP expression may be a potential prognostic marker for patients with CCRCC. In addition, the WNT signaling pathway, MAPK signaling pathway, phosphatidylinositol signaling system, TGF-β signaling pathway, autophagy and the JAK-STAT signaling pathway may be the crucial pathways regulated by TXNIP in CCRCC.
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Affiliation(s)
- Yuan Gao
- Department of Hemodialysis, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, P.R. China
| | - Jin-Chun Qi
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, P.R. China
| | - Xiaoyu Li
- Department of General Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, P.R. China
| | - Jian-Ping Sun
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, P.R. China
| | - Hong Ji
- Department of General Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, P.R. China
| | - Qing-Huai Li
- Department of General Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050017, P.R. China
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45
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Hu F, Zeng W, Liu X. A Gene Signature of Survival Prediction for Kidney Renal Cell Carcinoma by Multi-Omic Data Analysis. Int J Mol Sci 2019; 20:ijms20225720. [PMID: 31739630 PMCID: PMC6888680 DOI: 10.3390/ijms20225720] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/09/2019] [Accepted: 11/13/2019] [Indexed: 02/07/2023] Open
Abstract
Kidney renal cell carcinoma (KIRC), which is the most common subtype of kidney cancer, has a poor prognosis and a high mortality rate. In this study, a multi-omics analysis is performed to build a multi-gene prognosis signature for KIRC. A combination of a DNA methylation analysis and a gene expression data analysis revealed 863 methylated differentially expressed genes (MDEGs). Seven MDEGs (BID, CCNF, DLX4, FAM72D, PYCR1, RUNX1, and TRIP13) were further screened using LASSO Cox regression and integrated into a prognostic risk score model. Then, KIRC patients were divided into high- and low-risk groups. A univariate cox regression analysis revealed a significant association between the high-risk group and a poor prognosis. The time-dependent receiver operating characteristic (ROC) curve shows that the risk group performs well in predicting overall survival. Furthermore, the risk group is contained in the best multivariate model that was obtained by a multivariate stepwise analysis, which further confirms that the risk group can be used as a potential prognostic biomarker. In addition, a nomogram was established for the best multivariate model and shown to perform well in predicting the survival of KIRC patients. In summary, a seven-MDEG signature is a powerful prognosis factor for KIRC patients and may provide useful suggestions for their personalized therapy.
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Affiliation(s)
- Fuyan Hu
- Department of Statistics, Faculty of Science, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China;
| | - Wenying Zeng
- Department of Water Resources and Hydro-elctricity Engineering, College of Water Resources and Architectural Engineering, Northwest A&F University, No.3 Taicheng Road, Yangling 712100, China;
| | - Xiaoping Liu
- School of Mathematics and Statistics, Shandong University at Weihai, Weihai 264209, China
- Correspondence: ; Tel.: +86-631-5688523
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Wang S, Chai K, Chen J. A novel prognostic nomogram based on 5 long non-coding RNAs in clear cell renal cell carcinoma. Oncol Lett 2019; 18:6605-6613. [PMID: 31788117 PMCID: PMC6865834 DOI: 10.3892/ol.2019.11009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/13/2019] [Indexed: 12/24/2022] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is the most common and invasive histological subtype of all kidney malignancies, with high levels of incidence and mortality. In the present study, long non-coding (lnc)RNA expression profiles of patients with ccRCC from The Cancer Genome Atlas database were comprehensively analyzed to identify differentially expressed lncRNAs (DElncRNAs). The patients with ccRCC were then divided into training and validation cohorts. Univariate and LASSO regression analyses were performed to select the most significant survival-associated candidate DElncRNAs in the training cohort. Multivariate Cox regression analysis was then performed to develop a risk score formula and a prognostic nomogram for predicting 3- and 5-year overall survival (OS). The accuracies of the nomogram predictions were evaluated by determining the area under the receiver operating characteristic curve (AUC) and a calibration plot. Finally, functional enrichment analysis and protein-protein interaction network prediction were implemented to predict the functions and molecular mechanisms of the candidate DElncRNAs in ccRCC. A total of 1,553 DElncRNAs were identified, and 5 candidate DElncRNAs (AC026992.2, AC245041.2, LINC00524, LINC01956 and LINC02080) were included in the nomogram. The AUC values for 3- and 5-year overall survival in the training cohort were 0.768 and 0.814, respectively, which were increased compared with that based on the clinical index (0.760 and 0.694, respectively). Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses revealed that the 521 mRNAs highly associated with 5 DElncRNAs were primarily involved in 17 terms and 25 pathways, respectively. Based on the 5 DElncRNAs, a novel and convenient prognostic nomogram for predicting 3- and 5-year OS for patients with ccRCC was developed. The results of the present study may be conducive to the development of a precise predictive tool for the prognosis of ccRCC and may provide information regarding the molecular mechanisms of ccRCC. However, additional experimental in vitro and in vivo studies investigating lncRNAs may be required.
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Affiliation(s)
- Sheng Wang
- The Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang 310053, P.R. China.,Department of Oncology, Tongde Hospital of Zhejiang, Hangzhou, Zhejiang 310012, P.R. China
| | - Kequn Chai
- Department of Oncology, Tongde Hospital of Zhejiang, Hangzhou, Zhejiang 310012, P.R. China
| | - Jiabin Chen
- Department of Oncology, Tongde Hospital of Zhejiang, Hangzhou, Zhejiang 310012, P.R. China
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Pure laparoscopic radical nephrectomy and inferior vena caval tumor thrombus removal in patients with complicated renal tumor. Chin Med J (Engl) 2019; 132:2384-2385. [PMID: 31503053 PMCID: PMC6819031 DOI: 10.1097/cm9.0000000000000436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Supplemental Digital Content is available in the text
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48
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Sugiyama Y, Yatsuda J, Murakami Y, Ito N, Yamasaki T, Mikami Y, Ogawa O, Kamba T. Impact of tumor size on patient survival after radical nephrectomy for pathological T3a renal cell carcinoma. Jpn J Clin Oncol 2019; 49:465-472. [PMID: 30793163 DOI: 10.1093/jjco/hyy200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/08/2018] [Accepted: 12/17/2018] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We recently reported the results from a multi-institutional retrospective outcome study involving 814 patients with renal cell carcinomas (RCCs) who had undergone radical surgery and whose diagnoses were confirmed via a central pathological review. This study aimed to clarify the impact of tumor size on survival outcomes in patients with pT3aN0M0 RCC after radical nephrectomy using this cohort. METHODS Using the Kaplan-Meier method, overall survival (OS), cancer-specific survival (CSS) and relapse-free survival (RFS) were estimated for 103 pT3aN0M0 patients. The differences in the OS, CSS and RFS according to tumor size were evaluated using the log-rank test. To identify independent prognostic factors that affected each survival outcome, clinicopathological factors were examined using univariate and multivariate analyses, and the Cox proportional hazards model. RESULTS The OS, CSS and RFS rates for 26 patients with pT3a RCCs ≤4 cm were significantly better than those for 77 patients with pT3a RCCs that were 4-7 cm or >7 cm (P = 0.0064, 0.0169 and 0.0001, respectively). Tumor size and venous invasion were independent prognosticators for OS, CSS and RFS. The OS and CSS for patients with pT3a tumors ≤4 cm were comparable with those for patients with pT1 RCCs, and the RFS for patients with pT3a RCCs ≤4 cm was similar to that for patients with pT1b RCCs. CONCLUSIONS Tumor size significantly influenced the prognosis for patients with pT3aN0M0 RCC. This study's results suggest that the postoperative management of pT3a RCCs could be individualized according to tumor size.
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Affiliation(s)
- Yutaka Sugiyama
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto
| | - Junji Yatsuda
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto
| | - Yoji Murakami
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto
| | - Noriyuki Ito
- Department of Urology, Japanese Red Cross Wakayama Medical Center, Wakayama
| | - Toshinari Yamasaki
- Department of Urology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto
| | - Tomomi Kamba
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto
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Chen W, Zhuang J, Wang PP, Jiang J, Lin C, Zeng P, Liang Y, Zhang X, Dai Y, Diao H. DNA methylation-based classification and identification of renal cell carcinoma prognosis-subgroups. Cancer Cell Int 2019; 19:185. [PMID: 31346320 PMCID: PMC6636124 DOI: 10.1186/s12935-019-0900-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/04/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Renal cell carcinoma (RCC) is the most common kidney cancer and includes several molecular and histological subtypes with different clinical characteristics. The combination of DNA methylation and gene expression data can improve the classification of tumor heterogeneity, by incorporating differences at the epigenetic level and clinical features. METHODS In this study, we identified the prognostic methylation and constructed specific prognosis-subgroups based on the DNA methylation spectrum of RCC from the TCGA database. RESULTS Significant differences in DNA methylation profiles among the seven subgroups were revealed by consistent clustering using 3389 CpGs that indicated that were significant differences in prognosis. The specific DNA methylation patterns reflected differentially in the clinical index, including TNM classification, pathological grade, clinical stage, and age. In addition, 437 CpGs corresponding to 477 genes of 151 samples were identified as specific hyper/hypomethylation sites for each specific subgroup. A total of 277 and 212 genes corresponding to DNA methylation at promoter sites were enriched in transcription factor of GKLF and RREB-1, respectively. Finally, Bayesian network classifier with specific methylation sites was constructed and was used to verify the test set of prognoses into DNA methylation subgroups, which was found to be consistent with the classification results of the train set. DNA methylation-based classification can be used to identify the distinct subtypes of renal cell carcinoma. CONCLUSIONS This study shows that DNA methylation-based classification is highly relevant for future diagnosis and treatment of renal cell carcinoma as it identifies the prognostic value of each epigenetic subtype.
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Affiliation(s)
- Wenbiao Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qing Chun Road, Hangzhou, China
| | - Jia Zhuang
- Department of Urinary Surgery, Puning People’s Hospital, Puning People’s Hospital Affiliated To Southern Medical University, 30 Liusha Avenue, Jieyang, Guangdong China
| | - Peizhong Peter Wang
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland Canada
| | - Jingjing Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qing Chun Road, Hangzhou, China
| | - Chenhong Lin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qing Chun Road, Hangzhou, China
| | - Ping Zeng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qing Chun Road, Hangzhou, China
| | - Yan Liang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qing Chun Road, Hangzhou, China
| | - Xujun Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qing Chun Road, Hangzhou, China
| | - Yong Dai
- Clinical Medical Research Center, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, 1017 Dongmen North Road, Luohu District, Shenzhen, Guangdong China
| | - Hongyan Diao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qing Chun Road, Hangzhou, China
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Selli C, Baldesi R, Manassero F, Mogorovich A, Galli L, Roffi N, Urbani L. Liver transplantation techniques avoid extracorporeal circulation in the treatment of renal cell carcinoma with cavo-atrial tumor thrombi. MINERVA UROL NEFROL 2019; 71:551-552. [PMID: 31287253 DOI: 10.23736/s0393-2249.19.03335-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Cesare Selli
- Divisions of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Ramona Baldesi
- Divisions of Urology, Department of Translational Research, University of Pisa, Pisa, Italy -
| | - Francesca Manassero
- Divisions of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Andrea Mogorovich
- Divisions of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Luca Galli
- Division of Oncology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Nicolò Roffi
- Division of General Surgery, Department of Surgery, Pisa University Hospital, Pisa, Italy
| | - Lucio Urbani
- Division of General Surgery, Department of Surgery, Pisa University Hospital, Pisa, Italy
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