Epidemiology of Renal Cell Carcinoma

Exosome-derived hsa-miR-200c-3p, hsa-miR-25-3p and hsa-miR-301a-3p as potential biomarkers and therapeutic targets for restoration of PTEN expression in clear cell renal cell carcinoma

Clear cell renal cell carcinoma (ccRCC) is an aggressive kidney cancer subtype with limited biomarkers and therapeutic options. Thus, the present study aimed to evaluate the biomarker and therapeutic potential of Phosphatase and Tensin Homologue (PTEN)-regulating microRNAs (miRNAs) in 2D and 3D ccRCC models. Extracellular vesicles (EVs) from four renal cell lines were characterized, and selected miRNAs (hsa-miR-200c-3p, hsa-miR-25-3p, and hsa-miR-301a-3p) were quantified in cells and EVs. PTEN mRNA levels were measured intracellularly. 786-O cells were transfected with miRNA inhibitors in both models and effects on miRNA and PTEN expression were assessed alongside phenotypic alterations. The expression of target miRNAs increased with ccRCC cell aggressiveness, both intracellularly and in EVs, while PTEN mRNA expression decreased. Combined inhibition of these miRNAs significantly increased PTEN expression, reducing tumor cell proliferation and migration in 2D models and decreasing spheroid size and metabolic capacity in 3D models. These miRNAs show potential as biomarkers for monitoring disease aggressiveness and as therapeutic targets in ccRCC, potentially leading to more effective and personalized treatment approaches for ccRCC patients.

Blood pressure elevations post-lenvatinib treatment in hepatocellular carcinoma: a potential marker for better prognosis

Lenvatinib is a tyrosine kinase inhibitor that effectively inhibits vascular endothelial growth factor signaling and is used for treating hepatocellular carcinoma. However, angiogenesis inhibitors often cause hypertension. Although lenvatinib-induced hypertension has been proposed as a potential surrogate marker for better prognosis, studies on blood pressure elevations and outcomes following lenvatinib initiation are limited. This study included 67 patients who underwent lenvatinib therapy at the Department of Gastroenterology, Kagoshima University Hospital, between May 2018 and December 2023. The median age of the cohort was 71 years, and 82.1% of the patients were male. The median blood pressure at admission was 128/73 mmHg, which significantly increased to 136/76 mmHg the day after lenvatinib administration. Grade 3 hypertension (≥160/100 mmHg) occurred in 37.3% of patients during hospitalization. The median increase in systolic blood pressure from admission to its peak during hospitalization was 26 mmHg. Patients who experienced an increase in blood pressure of ≥26 mmHg were classified into the blood pressure elevation group, which showed a significantly lower mortality rate than that of the blood pressure non-elevation group (35.3% vs. 81.8%, log-rank p = 0.007), even after adjusting for age, sex, disease stage, performance status, and liver reserve function. This study demonstrated that patients who experienced earlier blood pressure elevation after lenvatinib administration had lower overall mortality rates. These findings suggest that blood pressure elevations after lenvatinib initiation may serve as valuable prognostic indicators in patients with cancer undergoing lenvatinib therapy. • Early Blood Pressure Elevation Following Lenvatinib Administration Significant blood pressure elevation was observed from the day after Lenvatinib administration, with a median systolic blood pressure increase of 26 mmHg. Grade 3 hypertension (≥160/100 mmHg) was observed in 38% of patients during hospitalization. •Blood Pressure Control Antihypertensive therapy was intensified in 39% of patients during hospitalization, yet 12% still had Grade 3 hypertension the day before discharge. • Association Between Blood Pressure Elevation and Prognosis Even after adjusting for age, sex, disease stage, performance status, and liver function reserve, blood pressure elevation was suggested as a better prognostic factor.

MAGI3 enhances sensitivity to sunitinib in renal cell carcinoma by suppressing the MAS/ERK axis and serves as a prognostic marker

Clear cell renal cell carcinoma (ccRCC) exhibits considerable heterogeneity, with approximately 25% of localized cases susceptible to relapse, highlighting the challenge of the absence of reliable predictive biomarkers for personalized treatment. Meanwhile, metastatic renal cell carcinoma is characterized by unfavorable survival rates, and although Sunitinib offers partial benefits, the clinical advantages are often constrained by drug resistance and adverse side effects. Here, MAGI3 was associate with ccRCC progression, as identified through comprehensive bioinformatics analysis of clinical datasets. A low level of MAGI3 emerged as a high-risk factor for ccRCC, indicating its potential as a prognostic marker. Individuals with MAGI3 expression in middle-to-low levels displayed a significantly poorer survival rate, indicating a need for additional treatment even in the early stages of ccRCC. Furthermore, patients with MAGI3 expression in middle-to-high levels exhibited increased sensitivity to Sunitinib compared to those with lower MAGI3 levels, suggesting that individuals with MAGI3 expression at middle levels may potentially benefit from Sunitinib treatment even in the early stages of ccRCC. Through its interaction with the MAS receptor, MAGI3 has been identified as a regulator of cell proliferation and a determinant of Sunitinib resistance in ccRCC, operating via the Ang-(1-7)/MAS/ERK axis. The loss of MAGI3 expression in ccRCC patients activated the ERK signaling pathway, contributing to both cancer progression and Sunitinib resistance. Therefore, our study not only highlight MAGI3's pivotal role in ccRCC progression and Sunitinib resistance, but also reinforces MAGI3's prospective value as a predictive marker.

Laparoscopic oncological surgery for renal tumors in patients aged 85 years or older

OBJECTIVE

To analyze our series of radical nephrectomies and laparoscopic nephroureterectomies in elderly patients.

MATERIALS AND METHODS

A retrospective review of patients aged 85 years and older who underwent major laparoscopic surgery for renal tumors at our center between April 2005 and March 2022 was conducted. Clinical-pathological characteristics, complications, and postoperative outcomes were analyzed.

RESULTS

Forty-seven patients were included, with a median age of 87 years. Fifteen nephrectomies for renal tumors (Group 1), and 32 nephroureterectomies for urinary tract tumors, (Group 2) were performed. In Group 1, four postoperative complications were observed: two Clavien 1, one Clavien 2, and one Clavien 4a. The most common histology was clear cell carcinoma. Nine patients had locally advanced tumors (TNM ≥ T3) at diagnosis. Five-year cancer-specific survival and overall survival rates were 73% and 40%, respectively. In Group 2, 14 postoperative complications occurred: six (18.8%) Clavien 1, four (12.5%) Clavien 2, and five (15.6%) Clavien 5. All patients had urothelial carcinoma in their pathology reports. Twenty (62.5%) had invasive tumors (TNM ≥ T2) at diagnosis. Five-year cancer-specific survival and overall survival rates were 45% and 30%, respectively.

CONCLUSION

Laparoscopic renal oncologic surgery in elderly patients is feasible, although it is associated with a high morbimortality rate, particularly in those with urinary tract tumors. It is essential to provide this patient group with adequate information regarding the elevated surgical risks associated with the procedure.

Human immunodeficiency virus-related renal cell carcinoma: a 13.5-year experience

BACKGROUND

Few reports have focused on renal cell carcinoma (RCC) in the people with HIV(PWH).

METHODS

We analyzed patients diagnosed with RCC at our center between January 2011 and June 2024, divided into groups based on their HIV status. Categorical variables were compared using the chi-square test, and continuous variables were analyzed with the t-test. We estimated median and 1-, 3-, and 5-year cancer-specific survival (CSS) using Kaplan-Meier curves and conducted univariate and multivariate Cox analyses to evaluate variables associated with CSS.

RESULTS

In total, 144 RCC patients were assigned to either PWH group (n = 48) or PWoH (people without HIV) group (n = 96). Patients in the PWH group were significantly more likely to be male (91.7% vs. 71.8%, p = 0.014), and their median age was 7 years younger than that in the PWoH group (51 vs. 58 years, p < 0.01). Both groups had small-diameter, early-stage, low-grade tumors, with no significant differences in short-term outcomes. Higher tumor stage (> T1 vs. T1: hazard ratio = 8.621, 95% confidence interval = 3.76-20, p < 0.01) and larger tumor diameter (≥ 7 vs. <7 cm: hazard ratio = 3.525, 95% confidence interval = 1.697-7.321, p < 0.01) were significantly associated with CSS, whereas the HIV status did not significantly affect long-term survival.

CONCLUSIONS

RCC tends to be diagnosed at a younger age in PWH, highlighting the need for earlier RCC screening in this population. The HIV status does not affect postoperative recovery, short-term outcomes, or long-term survival in patients with RCC.

Results of Stereotactic Body Radiation Therapy for Primary Renal Cell Carcinoma in a Large Multicenter Series

BACKGROUND AND OBJECTIVE

For inoperable patients, stereotactic body radiation therapy (SBRT) is a noninvasive treatment approach for primary renal cell carcinoma (RCC). We aimed to evaluate local control (LC) of primary RCC treated with SBRT.

METHODS

This multicenter retrospective study involved 16 centers in Australia, France, Italy, and the Netherlands. The primary endpoint was the LC probability, and the secondary endpoints were progression-free survival, overall survival (OS), cumulative incidence of cancer-related deaths, toxicities, and renal function evolution after SBRT.

KEY FINDINGS AND LIMITATIONS

A total of 144 patients, treated between 2008 and 2020, with a median follow-up of 43 mo (interquartile range [IQR], 24.0-81.2), were included. The median age was 76 yr (IQR, 67.0-82.0) and the median tumor size was 4.4 cm (IQR, 3.3-5.6). The median baseline estimated glomerular filtration rate (eGFR) was 60 ml/min/1.73 m2. Of the patients, 40% had mild to moderate eGFR (30-60 ml/min). The two main treatment regimens were 42 Gy in three fractions and 26 Gy in one fraction. The LC probability was 98% at 1 yr (95% confidence interval [CI], 94-99) and 96% (95% CI, 92-99) at 5 yr. The median OS was 58 mo and the cumulative incidence of cancer-related deaths was 8% (95% CI, 3-15) at 5 yr. Seventy-one patients (49%) experienced at least one toxicity, including grade 1 in the majority (32%), grade 2 (14%), and grade 3 (1%). Two patients (1%) underwent dialysis (grade 4). The median eGFR loss was -7 ml/min (IQR, -17; 0) at the last follow-up.

CONCLUSIONS AND CLINICAL IMPLICATIONS

This large series of primary RCC treated with SBRT demonstrates excellent LC and renal function preservation, and is associated with an acceptable toxicity profile. SBRT is an alternative treatment for inoperable patients.

Percutaneous microwave ablation of cT1b renal cell carcinoma: safety and oncologic efficacy in a large, single-center elderly and comorbid cohort

PURPOSE

To evaluate safety and oncologic efficacy of percutaneous microwave ablation (MWA) for treating clinically localized T1b (cT1b) renal cell carcinoma (RCC).

METHODS

This single-center retrospective study was performed under a waiver of informed consent. Seventy-four consecutive patients (49M/25F) with 76 cT1b RCC (median tumor diameter 4.5 cm) were treated with percutaneous MWA between 5/2012 and 8/2020. Patients were stratified into two groups by technique, depending on whether antennas were repositioned for additional ablation or not. Primary efficacy, complications, and local tumor progression (LTP) were compared using the Wilcoxon rank sum and Fisher's exact tests. The Kaplan Meier method was used for survival analysis.

RESULTS

Patients were elderly (median age 69.5), obese (median BMI 34.5), and comorbid (Charlson Comorbidity Index = 4). Most tumors were low-grade (grade 1-2) (67/89, 88%) and clear cell RCC was the most common histology (62/76, 82%). A median of three MWA antennas were powered at 65 W for 7 min for treatment. Renal masses were larger (4.6 vs 4.5 cm, p = 0.01) and procedure times longer (100 min vs 80.5 min, p = 0.04) for the antenna reposition cohort (n = 34, 45%). Primary efficacy and high-grade complication rates were 93% and 8%, respectively. The local tumor progression rate (LTP), at a median follow-up was 28.2 months, was 16%. Primary efficacy, low and high-grade complications, change in estimated glomerular filtration rate and LTP were similar between cohorts (p = 0.20-0.55).

CONCLUSION

Percutaneous MWA for cT1b RCC is safe in elderly and comorbid patients with acceptable oncologic efficacy. Repeat ablation is well-tolerated and can improve oncologic efficacy.

Can multiparametric MRI clear cell likelihood scores differentiate fat-Poor AML from CcRCC in subcentimeter lesions?

OBJECTIVE

To investigate the potential of multiparametric MRI clear cell likelihood scores (ccLS) for differentiating between fat-poor angiomyolipoma (AML) and clear cell renal cell carcinoma (ccRCC) in subcentimeter Lesions (1 cm or smaller).

MATERIALS AND METHODS

This retrospective study included consecutive patients with subcentimeter renal masses who underwent multiparametric MRI between September 2009 and September 2022 across three hospitals. Clinical and MRI findings were analyzed to differentiate between fat-poor AML and ccRCC. Lesions were categorized using the ccLS and receiver operating characteristic curve analysis was performed to assess ccLS performance.

RESULTS

Thirty-eight patients (mean age: 52 years ± 12; 19 women) with 39 lesions were included. Of the 39 lesions [mean size: 9.1 mm ± 1.0 (range, 6.0-10.0 mm)], 20 (51%) were ccRCC and 19 (49%) were fat-poor AML. Compared to the ccRCC, subcentimeter fat-poor AMLs were more likely to show hypointensity on T2WI (P < 0.001), homogeneous enhancement (P = 0.010), the presence of microscopic fat (P = 0.036), and the absence of a pseudocapsule (P = 0.020). The diagnostic percentage of fat-poor AML was 47% for a ccLS of 1 or 2, and ccRCC accounted for 75% in the ccLS 4 or 5 category. The AUC for discrimination was 0.846 (95% CI: 0.695-0.941, P < 0.001), with a sensitivity of 75.00% (95% CI: 50.9-91.3) and a specificity of 89.47% (95% CI: 66.9-98.7).

CONCLUSION

Multiparametric MRI clear cell likelihood scores can potentially be used to differentiate between fat-poor AML and ccRCC in lesions 1 cm or smaller.

Hemangioma-Like Clear Cell Renal Cell Carcinoma Exhibiting Aggressive Behavior and High Stage: A Case Report

Clear cell renal cell carcinoma (CCRCC) displays a variety of architectural patterns, which are often intermingled. However, a predominant or purely multicystic growth with diffuse intracystic hemorrhage leading to hemangioma-like histomorphology, is extremely rare in CCRCC. In this article, we describe a CCRCC exhibiting a pure hemangioma-like architecture and aggressive behavior. The patient was a 73-year-old man with a tumor of the left kidney measuring 70 mm in the largest dimension. Histological examination of the nephrectomy specimen revealed a tumor composed entirely of blood filled spaces lined by a single layer of flattened or low cuboidal cells lacking high-grade features or voluminous clear cytoplasm. These cells showed diffuse immunohistochemical positivity for keratin AE1/AE3 and carbonic anhydrase 9 and focal positivity for PAX8, CD10, and alpha-methylacyl-CoA racemase. The tumor invaded the renal vein; no lymph nodes or extension of the tumor into the soft tissues of the hilum were detected (stage pT3a pNx). Using the Illumina TruSight Oncology 500 kit, a clinically significant c.3481dup, p.(Arg1161LysfsTer13) and c.2050del, p.(Gln684Asnfs4) mutations of the tet methylcytosine dioxygenase 2 (TET2) gene and c.296, p.(Pro99GlnfsTer60) mutation of the von Hippel-Lindau (VHL) gene were identified. The immunophenotype and molecular genetics of our tumor were consistent with CCRCC, suggesting that the unusual hemangioma-like growth pattern is most likely the result of extensive regressive changes. In contrast to all previously published reports, our study demonstrated that, despite the bland histological appearance, renal cell carcinomas with hemangioma-like features can invade the renal vein and follow an aggressive clinical course.

Incidence and survival patterns of clear cell renal cell carcinoma from 2000 to 2017: A SEER Database Analysis

Background: Clear cell renal cell carcinoma (ccRCC) incidence and death have considerably changed in recent years. Our study aimed to investigate the incidence, survival, and tumor characteristics of ccRCC in the year of diagnosis. Methods: Our study participants were selected from the SEER database (2000-2017). Age-standardized incidence rates were calculated to compare incidence rates across time. In addition, we used Kaplan-Meier curves to calculate overall survival (OS) and Cox proportional hazards models to explore risk factors associated with mortality outcomes in patients with ccRCC. Results: In the SEER analysis from 2000 to 2017, the increasing trend in age-adjusted incidence of ccRCC has remained relatively stable over the years, increasing from 2.63 per 100,000 in 2000 to 8.79 per 100,000 in 2017. The increase in the incidence of patients at a localized stage plays a decisive role in the overall increase in the incidence of ccRCC. Conclusions: In the general population, patients diagnosed between 2009-2017 had a higher survival rate than those diagnosed between 2000-2008, which is consistent with all stages of the tumor. The incidence of ccRCC increases steadily with the year of diagnosis, while overall survival has significantly improved.

Metastatic Clear Renal Cell Carcinoma in Urinary Bladder at Presentation-A Rare Incidental Case Report and Literature Review

This case highlights the rare occurrence of concurrent clear cell renal carcinoma with metastatic urinary bladder involvement, presenting as hematuria and flank pain. Initial screening revealed both renal and bladder tumors, confirmed as metastases. Histopathology emphasized thorough investigations for unexplained urinary symptoms and the need for multimodal treatment and follow-up.

FDA-Approved Chimeric Antigen Receptor (CAR)-T Cell Therapy for Different Cancers-A Recent Perspective

Cancer is one of the most prevalent diseases in the world, and their rate of occurence has been increased in recent decades. Current review article, summarizes the novel treatment options Chimeric Antigen Receptor-T (CAR-T) cell therapy for various cancers constitute a major health and development challenge, impacting every aspect of sustainable development quoted by goal 3 good health and well-being of UN sustainable goals. WHO estimates that 70% of cancer deaths occur in low- and middle- income countries (LMICs) by 2030, LMICs are expected to bear the brunt of the expected 24.1 million new cancer cases per year. This current review article focuses and discussed about CAR-T cell therapy for various cancers against most prevalent non-communicable disease cancer disease stipulated by WHO and UN sustainable goals. Three literature databases Google scholar, Science Direct, PubMed was utilized to search and collect CAR-T cell treatment options for different cancers published articles sources in between January 2000 and December 2023. There were a total of 18,700 papers found, with 48 of them being found to be eligible focusing various cancer treatment by CAR-T cells utilized for the study. Based on the information gathered, CAR-T cell therapy treating different cancers and their merit and its advantages in heal and improve certain cancers was also discussed in this review article with their detailed molecular mechanisms. This article also gives an insight to utilize CAR-T cell treatment protocols for rejuvenating cancer patient from such ruthless cancer disease condition thereby improving life span of cancer patients and eradication of disease in some cases.

Precision oncology: The role of minimally-invasive ablation therapy in the management of solid organ tumors

Solid organ tumors present a significant healthcare challenge, both economically and logistically, due to their high incidence and treatment complexity. In 2023, out of the 1.9 million new cancer cases in the United States, over 73% were solid organ tumors. Ablative therapies offer minimally invasive solutions for malignant tissue destruction in situ, often with reduced cost and morbidity compared to surgical resection. This review examines the current Food and Drug Administration-approved locoregional ablative therapies (radiofrequency, microwave, cryogenic, high-intensity focused ultrasound, histotripsy) and their evolving role in cancer care. Data were collected through a comprehensive survey of the PubMed-indexed literature on tumor ablation techniques, their clinical indications, and outcomes. Over time, emerging clinical data will help establish these therapies as the standard of care in solid organ tumor treatment, supported by improved long-term outcomes and progression-free survival.

Bispecific antibodies as powerful immunotherapeutic agents for urological cancers: Recent innovations based on preclinical and clinical evidence

Conventional immunotherapy has emerged as a key option for cancer treatment. However, its efficacy has been limited in urological cancers, especially prostate cancer, because of the immunosuppressive tumor microenvironment (TME), difficulty in drug delivery, aberrant immune response, and damage to normal cells. Bispecific antibodies (BsAbs) are engineered proteins with two different antigen-binding domains, designed using different technologies and in various formats. BsAb-based tumor immunotherapy has yielded optimistic results in preclinical and clinical investigations of many tumor types, including urological cancers. However, a series of challenges, including tumor heterogeneity, TME, Ab immunogenicity, adverse effects, serum half-life, low response rates, and drug resistance, hamper the application of BsAbs. In this review, we provide insights into the most common BsAb platforms with different mechanisms of action, which are under preclinical and clinical research, along with ways to overcome the challenges in BsAb administration for treating urological cancer.

Identification and validation of prognostic biomarkers in ccRCC: immune-stromal score and survival prediction

BACKGROUND

The tumor microenvironment (TME) is integral to tumor progression. However, its prognostic implications and underlying mechanisms in clear cell renal cell carcinoma (ccRCC) are not yet fully elucidated. This study aims to examine the prognostic significance of genes associated with immune-stromal scores and to explore their underlying mechanisms in ccRCC.

METHODS

Data from the Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) were subjected to analysis to compute immune and stromal scores utilizing the ESTIMATE algorithm. The weighted gene co-expression network analysis (WGCNA) was employed to identify gene modules associated with these scores. Differentially expressed genes were assessed using the limma package. Prognostic biomarkers were subsequently identified through univariate, LASSO, and multivariate Cox regression analyses, culminating in the development of a risk score model. Gene expression was confirmed in ccRCC cell lines (786-O, Caki-1) and tumor tissues. Functional assays, such as wound healing and Transwell assays, were employed to evaluate tumor invasion and migration. The prognostic accuracy was assessed through ROC curve analysis, and a nomogram integrating risk scores with clinical variables was constructed. Analyses of immune infiltration, human leukocyte antigen (HLA) expression, immune checkpoint expression, immunophenoscore (IPS), tumor immune dysfunction and exclusion (TIDE) scores, and responses to six targeted therapies were conducted across different risk groups.

RESULTS

Twelve critical prognostic markers, including CAPRIN1, CXCR3, FERMT3, HAPLN3, HBP1, MACF1, MPEG1, OSCAR, STAT1, UBA7, VAMP1, and VSIG4, were identified. The risk score model exhibited a high degree of predictive accuracy for survival outcomes in ccRCC. Immune profiling revealed significant differences in the TME between risk groups, with high-risk patients displaying elevated expression of HLA and immune checkpoints. Drug sensitivity analyses suggested that high-risk patients had a better response to erlotinib, temsirolimus, axitinib, and sunitinib, whereas low-risk patients demonstrated greater sensitivity to pazopanib. Variability in immunotherapy responsiveness between groups was observed based on IPS and TIDE analyses.

CONCLUSION

This study highlights the prognostic value and TME-related mechanisms of immune-stromal score signatures in ccRCC, developing a risk score model and nomogram for predicting patient prognosis.

Vesicles Secreted by Renal Cell Carcinoma Cells Cause Vascular Endothelial Cells to Express PSMA and Drive Tumor Progression

Prostate-specific membrane antigen (PSMA) protein expression is induced during prostate cancer progression and metastasis. Recently, we reported that PSMA-positive vesicles released by prostate cancer cell lines enhanced vascular endothelial cell angiogenesis and that PSMA may be involved in tumor angiogenesis. Similarly, it is known that PSMA is upregulated in peritumoral vessels in renal cell carcinoma (RCC). In this study, we investigated the significance and molecular function of PSMA in RCC. PSMA immunohistochemical staining confirmed PSMA presence only in perinephric tumor vessels, and PSMA intensity was strongly correlated with recurrence rate and venous invasion. Spatial gene expression analysis revealed that FOLH1 expression, which codes PSMA, was upregulated in tumor blood vessels around renal cancer, and that angiogenesis-related pathways were enhanced. The 10,000 g pellet fraction of the renal cancer cell lines Caki1- and ACHN-conditioned medium (CM) induced PSMA positivity in human umbilical vein endothelial cells (HUVECs) and enhanced tube formation. Mass spectrometry indicated that the 10,000 g pellet fraction contained various kinds of growth factors, like GDF15 and MYDGF. RNA sequencing showed that supplementing HUVECs with RCC cell CM-enhanced angiogenesis-related signaling pathways. Conclusively, microvesicle components secreted by RCC cells transform vascular endothelial cells into PSMA-positive cells, enhancing angiogenesis.

Urogenital Cancer Epidemiology in Poland (1980-2020): A Narrative Review

Despite advances in prophylaxis, early diagnosis, and treatment, urogenital cancers represent a significant challenge to public health in Poland due to their relatively high prevalence and mortality rates. This narrative review aims to explore contemporary evidence on the epidemiology of urogenital cancers in Poland, such as prostate cancer, bladder cancer, kidney cancer, testicular cancer, and penile cancer, focusing on current and historical status and trends in the broader context of healthcare delivery. The literature consistently indicates that urogenital cancer continues to be a significant contributor to cancer incidence and mortality rates in Poland. Although the body of evidence is expanding, its quantity remains limited, primarily attributable to the scarcity of top-notch epidemiological investigations targeting particular forms of cancer, such as testicular and penile cancers, which are characterized by sporadic occurrences.

The pan-immune-inflammation value: A novel independent predictive factor for overall survival in ≥pT2a nonmetastatic renal cell carcinoma

PURPOSE

Aimed to evaluate the prognostic value of Pan-Immune-Inflammation Value (PIV) for overall survival (OS) in the localized RCC. We also tested the feasibility of incorporating the PIV into UCLA Integrated Staging System (UISS).

MATERIALS AND METHODS

Retrospectively evaluated 197 consecutive ≥pT2a radical nephrectomy patients. PIV and other blood based inflammatory markers were calculated. The optimal cut-offs of inflammatory markers were determined. The C-index was calculated. Cox regression analyses were done.

RESULTS

Median age and follow-up time were 59 yrs. and 49 mo., respectively. Two, 5 and 10 years OS was 81.4%, 69.4% and 45.6%. Age, BMI, anemia, lymph node positivity, UISS and all inflammatory markers were found to be significant predictive factors. However, PIV had the highest hazard ratio [HR: 2.39 (1.38-4.14)] and also had highest C-index contribution (+0.24%) in multivariable analyses. Furthermore, both UISS and PIV remained independent predictive factors (P = 0.027 and P = 0.002, respectively). Additionally, pre- and postoperative low PIV provided about half reduction in the risk of death [HR: 0.44 (0.24-0.81), P = 0.008].

CONCLUSIONS

PIV was found to be an independent predictive factor in localized RCC. When PIV was included to the model, both UISS and PIV remained significant predictors and also PIV increased the C-index of the model.

Prediction of Distant Metastasis of Renal Cell Carcinoma Based on Interpretable Machine Learning: A Multicenter Retrospective Study

Background 

The traditional tool for predicting distant metastasis in renal cell carcinoma (RCC) is still insufficient. We aimed to establish an interpretable machine learning model for predicting distant metastasis in RCC patients.

Methods

We involved a population-based cohort of 121433 patients (mean age = 63 years; 63.58% men) diagnosed with RCC between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. The lightGBM algorithm was used to develop prediction model and assessed by the area under the receiver-operating characteristic curve (AUC), accuracy, sensitivity, and specificity. The LightGBM model was then externally validated in 36395 RCC patients enrolled from the SEER database between 2016 and 2018. Shapley Additive exPlanations (SHAP) method was applied to provide insights into the model's outcome or prediction.

Results

Of 121433 patients involved in the study cohort, 10730 (8.84%) had distant metastasis. The LightGBM model showed good performance in the internal validation set (AUC: 0.955, 95% CI: 0.951-0.959) and temporal external validation sets (0.963, 95% CI: 0.959-0.967; 0.961, 95% CI: 0.954-0.966). Performance for the prediction model was also well performed in different sub-cohort stratified by age, gender, and ethnicity. The calibration curve indicated that the predicted values are highly consistent with the actual observed values. SHAP plots demonstrated that chemotherapy was the most vital variable for prediction of distant metastasis of RCC patients.

Conclusion

We developed an interpretable machine learning model that is capable of accurately predicting the risk of distant metastasis of RCC patients. The presented model could help identify high-risk patients who require additional treatment strategies and follow-up regimens.

Regional Variations in the Prevalence of Risk Factors and Non-Communicable Diseases in Papua New Guinea: A Scoping Review

Often referred to as 'the last unknown', Papua New Guinea's largely unexplored environments across its four distinct regions, the Highlands, New Guinea Islands, Momase, and Southern, exhibit remarkable diversity. Understanding this diversity is significant in contextualising the risk factors associated with developing non-communicable diseases. This review aims to map and summarise the literature to provide region-specific prevalence data for risk factors and non-communicable diseases. Four databases and grey literature were searched. Two reviewers completed the screening and data extraction. Twenty-one studies were included, with five reporting the data by region and the remaining reporting the data nationwide. Six studies reported on risk factors, thirteen reported on non-communicable diseases, and two reported on risk factors and non-communicable diseases. The Southern region, which includes the Capital, Port Moresby, reported the highest prevalence for most risk factors: anthropometric (overweight, obesity, and waist circumference), lifestyle (betel nut, alcohol, unhealthy diet, and stress), and biochemical (cholesterol, triglycerides, HbA1c, and metabolic syndrome). The findings of this review highlight the limited evidence base for region-specific risk factor data and the lack of objective diagnosis of non-communicable diseases. There were variations in the prevalence of specific risk factors by region; however, the Southern region stands out as requiring immediate attention for health promotion program interventions.

A Novel Nomogram for the Prediction and Evaluation of Prognosis in Patients with Early-onset Kidney Cancer: a Population-based Study

Background: Early-onset kidney cancer (EOKC) is often associated with genetic factors and a high risk of metastasis. However, there is a lack of accurate prediction models for the prognosis of EOKC. The aim of this study is to establish an effective nomogram for predicting and evaluating the prognosis of patients with EOKC. Methods: The patients with EOKC were selected from the latest SEER database during 2004-2015. Patients between 2004 and 2014 were randomly divided into a training cohort and a validation cohort at a ratio of 7:3, and patients in 2015 were used for temporal external validation. Additionally, we included patients from First Hospital of Shanxi Medical University between 2013 and 2021 for spatial external validation. The performance of the nomogram was assessed using the concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Patients were stratified based on the nomogram, and Kaplan-Meier (KM) curves were plotted to compare the survival probability of patients. Results: In the temporal and spatial external validation cohort, the C-index of the nomogram for OS was 0.872 and 0.875, respectively, and the C-index of the nomogram for CSS were 0.872 and 0.851, respectively. In the temporal external validation cohort, the 1-year, 3-year and 5-year AUC of the nomogram for OS were 0.906, 0.899 and 0.876, respectively. In addition, the AUC showed that the nomogram had also high predictive ability for CSS. The calibration curves and DCA also indicated that the nomogram had a strong clinical utility. The KM curve revealed that patients in the low-risk group had a better prognosis than those in the high-risk group. Conclusion: Our study developed a novel high-performance nomogram for assessing the prognosis of patients with EOKC, and it has great potential for clinicians to assess patient prognosis and formulate effective intervention and follow-up strategies.

Transcription factor MAZ activates the transcription of hypomethylated TYMP in ccRCC

Clear cell renal cell carcinoma (ccRCC) is a highly malignant tumor characterized by a significant propensity for recurrence and metastasis. DNA methylation has emerged as a critical epigenetic mechanism with substantial utility in cancer diagnosis. In this study, multi-omics data were utilized to investigate the target genes regulated by the transcription factor MYC-associated zinc finger protein (MAZ) in ccRCC, leading to the identification of thymidine phosphorylase (TYMP) as a gene with notably elevated expression in ccRCC. The interaction between MAZ and TYMP was confirmed through chromatin immunoprecipitation (ChIP) assays and bioinformatics analysis. It was found that the binding of MAZ to the TYMP promoter is associated with the methylation status of this promoter region. Furthermore, the methylation of the TYMP promoter appears to be correlated with both the clinicopathological stage and overall survival of ccRCC patients. Further exploration of genes within the "nucleotide metabolism" pathway, identified through Gene Ontology (GO) enrichment analysis, revealed that uridine phosphorylase 1 (UPP1) interacts with TYMP. Interestingly, UPP1 was also shown to be activated by MAZ, suggesting a coordinated regulatory mechanism. Based on these findings, we propose that the TYMP-UPP1 complex, co-regulated by MAZ, plays a pivotal role in nucleotide metabolism in ccRCC. These results suggest that TYMP may contribute to the pathophysiology of ccRCC and that promoter methylation offers potential as a prognostic indicator, providing novel insights into the molecular underpinnings of ccRCC and potential avenues for therapeutic intervention.

Bioinformatics analysis of mitochondrial metabolism-related genes demonstrates their importance in renal cell carcinoma

PURPOSE

Clear cell renal cell carcinoma (ccRCC) is resistant to radiotherapy and chemotherapy. Thus, it is necessary to find new diagnostic markers and therapeutic targets to increase the overall outcomes of ccRCC. Recent studies have shown that therapeutic methods that interfere with the energy transfer system can also positively affect the treatment process.

METHODS

The present study is focused on finding markers associated with mitochondrial metabolic pathways that affect the outcome of ccRCC. For this purpose, we investigated various aspects of the relationship between mitochondrial metabolism and ccRCC based on analysis of gene network connections and differentially expressed genes, through assessment of protein-protein interaction, mutations, and promoter methylation on the related genes. We also investigated gene interaction with miRNAs and immune infiltration analysis.

RESULTS

Through these steps, we provided a list of possible diagnostic markers and therapeutic targets for ccRCC.

CONCLUSION

The current study further proved the importance of mitochondrial metabolic pathways in the pathogenesis of ccRCC and provided a list of possible diagnostic markers and therapeutic targets from these pathways that can be used in ccRCC.

The Transcription Factor ATF2 Accelerates Clear Cell Renal Cell Carcinoma Progression Through Activating the PLEKHO1/NUS1 Pathway

Clear cell renal cell carcinoma (ccRCC) is a common malignant cancer with high mortality rate. Activating transcription factor 2 (ATF2) and pleckstrin homology domain containing O1 (PLEKHO1) were reported to participate in numerous cancers. However, their roles and the detailed mechanisms in ccRCC development remain largely unknown. RT-qPCR and western blot were used to measure the levels of PLEKHO1, ATF2, and nuclear undecaprenyl pyrophosphate synthase 1 (NUS1). Cell proliferation, apoptosis, invasion, migration and stemness were evaluated using CCK-8 assay, flow cytometry, transwell invasion assay, wound-healing assay and sphere formation assay, respectively. Dual-luciferase reporter assay was conducted to verify the relationship between ATF2 and PLEKHO1. The interaction between PLEKHO1 and NUS1 was proved by Co-IP assay. Xenograft models were utilized to evaluate the tumorigenic capability of ccRCC cells upon PLEKHO1 knockdown. PLEKHO1, ATF2 and NUS1 expression were significantly elevated in ccRCC, and PLEKHO1 might be a prognosis biomarker for ccRCC. PLEKHO1 depletion significantly inhibited cell proliferation, invasion, migration, stemness, and induced cell apoptosis in ccRCC cells. ATF2 activated PLEKHO1 expression via transcription regulation, and PLEKHO1 overexpression could reverse the suppressive effects of ATF2 knockdown on the malignant behaviors of ccRCC cells. Moreover, PLEKHO1 directly bound to NUS1, and PLEKHO1 depletion markedly restrained ccRCC progression through targeting NUS1 in vitro and in vivo. Our findings suggested that ATF2 transcriptionally activated PLEKHO1 to promote the development of ccRCC via regulating NUS1 expression.

Prognostic significance of body mass index in patients with metastatic renal cell carcinoma receiving first-line therapies

OBJECTIVES

Higher body mass index (BMI) is reportedly associated with improved prognosis of patients with various cancers. However, it is unclear whether this phenomenon, also known as the obesity paradox, applies to metastatic renal cell carcinoma (mRCC). We aimed to determine the prognostic significance of BMI in patients with mRCC receiving first-line therapies.

MATERIALS AND METHODS

We retrospectively reviewed patients with mRCC receiving first-line immune checkpoint inhibitor (ICI)-based combination therapy or tyrosine kinase inhibitor monotherapy. Overall survival (OS) was defined as the time from systemic therapy initiation to death from any cause or last follow-up. Baseline patient characteristics were compared by Mann-Whitney U test or Fisher's exact test. OS curves were constructed by Kaplan-Meier estimates and were compared by log-rank test. Multivariable analysis was performed via Cox proportional-hazards regression.

RESULTS

Of the 183 patients included, 130 (71 %) were overweight (≥22 and 18 kg/m2 in men and women, respectively), and 63 (34 %) received ICI-based combination therapy. There was a significantly higher proportion of men in the overweight subgroup (87 % versus 64 %; P = 0.002). During the study period, 97 patients died, and median (95 % confidence interval) OS was 39.0 months (31.5-66.3 months) and 28.1 months (17.6-39.7 months) in overweight and normoweight patients, respectively (P = 0.015). On multivariable analysis, overweight was independently associated with longer OS (HR 0.57; P = 0.014). Subgroup analyses of patients receiving ICI-based combination therapy yielded similar results.

CONCLUSION

Overweight is associated with favorable outcomes in patients with mRCC receiving first-line therapies.

ALKBH5 promotes malignant proliferation of renal clear cell carcinoma by activating the MAPK pathway through binding to HNRNPDL

It is well established that ALKBH5 plays a crucial role in the malignant progression of various types of tumors. However, its role in clear cell renal cell carcinoma (ccRCC) and the underlying regulatory mechanisms remain unclear. In this study, we employed a range of techniques, including protein blotting, real-time quantitative PCR, silver staining, mass spectrometry, co-immunoprecipitation (Co-IP), GST-pull down, and immunofluorescence, to investigate the functions of ALKBH5 in ccRCC and elucidate the specific mechanisms involved. Our results demonstrated that ALKBH5 expression was significantly upregulated in ccRCC. In vitro experiments revealed that ALKBH5 promoted tumor proliferation, invasion, migration, and stemness. In vivo, ALKBH5 was shown to enhance tumor growth and lung metastasis. Mechanistically, our studies suggest that ALKBH5 accelerates the malignant progression of ccRCC by binding to heterogeneous nuclear ribonucleoprotein D-like (HNRNPDL), facilitating the nuclear translocation of MEK, ERK, and p38, and activating downstream targets such as c-Myc and PCNA.

Association of body mass index with clinicopathological features among patients with clear cell renal cell carcinoma treated with surgery: a retrospective study

To investigate the potential association between body mass index (BMI) and the clinicopathological features of patients with clear cell renal cell carcinoma (ccRCC). We retrospectively analyzed data from 2541 patients who underwent partial or radical nephrectomy for renal masses between 2013 and 2023 in a single institution. Patients were divided into normal-weight, overweight, and obese groups based on the Chinese BMI classification. Clinicopathological features, including pathologic tumor size, pathologic T (pT) stage, Fuhrman grade or WHO/ISUP grade, renal capsular invasion, perirenal fat or renal sinus fat invasion, and vein cancerous embolus were compared among the groups using Student's t-test or one-way ANOVA for normally distributed continuous variables, and the chi-square or Fisher's test for categorical variables. A total of 2541 ccRCC patients having a median BMI of 24.9 (interquartile range 22.7-27.0) were evaluated. No significant association was found between the pathological tumor diameter and BMI among the normal-weight, overweight, and obese groups (normal-weight vs. overweight, p = 0.31; normal-weight vs. obese, p = 0.21). There was no statistical difference in pT stage (normal-weight vs. overweight, p = 0.28; normal-weight vs. obese, p = 0.23). No statistically significant difference was observed in the distribution of Fuhrman/ISUP grade (p = 0.12), proportion of patients with renal capsular invasion (p = 0.49), perirenal fat or renal sinus fat invasion (p = 1.00), and vein cancerous embolus (p = 0.11) between the normal-weight and overweight groups. However, patients in the obese group tended to have low Fuhrman or WHO/ISUP grades (p < 0.001), and decreased rates of renal capsular invasion (p < 0.05), perirenal fat or renal sinus fat invasion (p < 0.05), and vein cancerous embolus (p < 0.05). Obesity was associated with less aggressive pathological features such as low tumor nuclear grade, low rate of renal capsular invasion, perirenal fat or renal sinus fat invasion, and vein cancerous embolus. This finding may provide clinicopathological evidence and explanations for the "obesity paradox" of RCC.

Cardiovascular Disease and Other Competing Causes of Death in Older Kidney Cancer Patients

Background

To study the risk of cardiovascular disease (CVD) and other competing causes of death in older kidney cancer patients.

Methods

Data on older patients (aged 65 and above) diagnosed with kidney cancer between 1975 and 2018 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. We delved into the distribution of CVD and other competing causes of death across the entire cohort and in various patient subgroups. The competing risk analysis was used to produce cumulative mortality curves based on cumulative mortality for the primary outcomes by follow-up period. Utilizing the standardized mortality ratios (SMRs) and absolute excess risks (AERs), we contrasted the risk of CVD and other competing causes of death in older kidney cancer patients to that observed in the general population.

Results

The analysis included 29,349 older kidney cancer patients, of which included 4563 CVD deaths. As survival time extended, the proportion of non-cancer deaths increased in older kidney cancer patients, with CVD accounting for the largest share of non-cancer deaths. At 10-15 years after diagnosis, cumulative non-cancer mortality exceeded primary kidney cancer as the predominant cause of death, and cumulative CVD mortality is higher among all non-cancer causes. Older kidney cancer patients exhibited a greater risk of CVD and other non-cancer deaths than their counterparts in the general older population did (SMR: 1.38-2.81; AER: 1.1-143.69).

Conclusions

As survival time increases, the risk of non-cancer death in older kidney cancer patients gradually surpassed that of primary cancer, and CVD death accounted for the majority of non-cancer deaths. Among older kidney cancer patients, the risk of CVD mortality was higher than in the general population. Managing non-cancer deaths, especially CVD deaths, should be a focus in the care of older kidney cancer patients.

Clinical, pathological, and oncological outcomes in unclassified renal cell carcinoma compared to clear cell renal cell carcinoma

Purpose

This study aims to assess the impact of unclassified renal cell carcinoma (uRCC) on clinical, pathological, and oncological outcomes compared with clear cell renal cell carcinoma (ccRCC).

Materials and Methods

We analyzed the data of 48 uRCC and 688 ccRCC cases, collected from a histopathological database at a single center from July 2011 to August 2019. uRCC cases were confirmed according to the 2016 World Health Organization classification. Baseline characteristics, clinical findings, and oncological outcomes were compared between the groups.

Results

Patients with uRCC exhibited the same clinical symptoms as ccRCC patients, a higher prevalence of lymphadenopathy (31.2% vs. 15.8%, P < 0.01), and greater sarcomatoid/rhabdoid differentiation on histology (12.5% vs. 5%, P = 0.03) compared to ccRCC patients. Although there was no difference regarding overall metastasis at initial diagnosis, distant lymphadenopathy (16.7% vs. 7.8%, P = 0.04) and liver metastasis (8.9% vs. 2.8%, P = 0.04) were more common in the uRCC group. The two groups had similar high-grade (HG) frequency on histology (62.5% for uRCC vs. 53.7% for ccRCC, P = 0.23). The estimated recurrence-free survival at 48 months was 94.3% for uRCC, 92.5% for low-grade (LG) ccRCC (P = 0.91), and 66.5% for HG ccRCC (P < 0.01). The estimated overall survival at 48 months was 66.1% for uRCC, 87.4% for LG ccRCC (P = 0.75), and 63.4% for HG ccRCC (P < 0.01).

Conclusion

Our study demonstrates that uRCC has significantly higher rates of lymphadenopathy, sarcomatoid differentiation, and liver metastasis compared to ccRCC. Despite these differences, uRCC presents with similar clinical symptoms and histological grade as ccRCC. Furthermore, uRCC exhibits a recurrence rate comparable to LG ccRCC and an overall survival rate similar to HG ccRCC.

Is Ablation Suitable For Small Renal Masses? A Meta-Analysis

RATIONALE AND OBJECTIVES

To compare perioperative and oncology outcomes of ablation and partial nephrectomy in small renal masses (SRMs).

METHODS

We conduct this meta-analysis strictly according to the PRISMA standard, and the quality evaluation follows the AMSTAR standard. Four databases, Embase, PubMed, Cochrane Library, and Web of Science, were systematically searched. The search time range is from database creation to November 2023. Stata16 statistical software was used for statistical analysis. Weighted mean difference (WMD) represented continuity variables, odds ratio or relative risk (OR/RR) represented dichotomies variables, and 95% confidence intervals (95%CI) were calculated.

RESULTS

A total of 27 studies, including 6030 patients. Results showed that patients undergoing partial nephrectomy were younger (WMD = -5.45 years, 95%CI [-7.44, -3.46], P < 0.05), had longer operation time (WMD = 64.91 min, 95%CI [44.47, 85.34], P < 0.05), had longer length of stay (WMD = 2.91 days, 95%CI [2.04, 3.78], P < 0.05), and had more estimated blood loss (WMD = 97.76 ml, 95%CI [69.48, 126.04]. P < 0.05), the overall complication rate was higher (OR = 1.84, 95%CI [1.48, 2.29], P < 0.05), the major complication rate was higher (OR = 1.98, 95%CI [1.36, 2.88], P < 0.05), and the recurrence rate was lower (OR = 0.32, 95%Cl [0.20, 0.50], P < 0.05). However, there were no differences between ablation and partial nephrectomy in cancer-specific survival (CSS) (HR = 2.07, 95%CI [0.61, 7.04], P > 0.05), overall survival (OS) (HR = 1.24, 95%CI [0.58, 2.65], P > 0.05), and recurrence-free survival (RFS) (HR = 2.68, 95%CI [0.91, 7.88], P > 0.05).

CONCLUSION

Patients undergoing partial nephrectomy are younger, have longer operation time and length of stay, and have higher complication rate. However, there was no significant difference in CSS, OS, and RFS between partial nephrectomy and ablation, but more well-designed, high-quality studies are needed to confirm this.

Aggressiveness classification of clear cell renal cell carcinoma using registration-independent radiology-pathology correlation learning

BACKGROUND

Renal cell carcinoma (RCC) is a common cancer that varies in clinical behavior. Clear cell RCC (ccRCC) is the most common RCC subtype, with both aggressive and indolent manifestations. Indolent ccRCC is often low-grade without necrosis and can be monitored without treatment. Aggressive ccRCC is often high-grade and can cause metastasis and death if not promptly detected and treated. While most RCCs are detected on computed tomography (CT) scans, aggressiveness classification is based on pathology images acquired from invasive biopsy or surgery.

PURPOSE

CT imaging-based aggressiveness classification would be an important clinical advance, as it would facilitate non-invasive risk stratification and treatment planning. Here, we present a novel machine learning method, Correlated Feature Aggregation By Region (CorrFABR), for CT-based aggressiveness classification of ccRCC.

METHODS

CorrFABR is a multimodal fusion algorithm that learns from radiology and pathology images, and clinical variables in a clinically-relevant manner. CorrFABR leverages registration-independent radiology (CT) and pathology image correlations using features from vision transformer-based foundation models to facilitate aggressiveness assessment on CT images. CorrFABR consists of three main steps: (a) Feature aggregation where region-level features are extracted from radiology and pathology images at widely varying image resolutions, (b) Fusion where radiology features correlated with pathology features (pathology-informed CT biomarkers) are learned, and (c) Classification where the learned pathology-informed CT biomarkers, together with clinical variables of tumor diameter, gender, and age, are used to distinguish aggressive from indolent ccRCC using multi-layer perceptron-based classifiers. Pathology images are only required in the first two steps of CorrFABR, and are not required in the prediction module. Therefore, CorrFABR integrates information from CT images, pathology images, and clinical variables during training, but for inference, it relies solely on CT images and clinical variables, ensuring its clinical applicability. CorrFABR was trained with heterogenous, publicly-available data from 298 ccRCC tumors (136 indolent tumors, 162 aggressive tumors) in a five-fold cross-validation setup and evaluated on an independent test set of 74 tumors with a balanced distribution of aggressive and indolent tumors. Ablation studies were performed to test the utility of each component of CorrFABR.

RESULTS

CorrFABR outperformed the other classification methods, achieving an ROC-AUC (area under the curve) of 0.855 ± 0.0005 (95% confidence interval: 0.775, 0.947), F1-score of 0.793 ± 0.029, sensitivity of 0.741 ± 0.058, and specificity of 0.876 ± 0.032 in classifying ccRCC as aggressive or indolent subtypes. It was found that pathology-informed CT biomarkers learned through registration-independent correlation learning improves classification performance over using CT features alone, irrespective of the kind of features or the classification model used. Tumor diameter, gender, and age provide complementary clinical information, and integrating pathology-informed CT biomarkers with these clinical variables further improves performance.

CONCLUSION

CorrFABR provides a novel method for CT-based aggressiveness classification of ccRCC by enabling the identification of pathology-informed CT biomarkers, and integrating them with clinical variables. CorrFABR enables learning of these pathology-informed CT biomarkers through a novel registration-independent correlation learning module that considers unaligned radiology and pathology images at widely varying image resolutions.

Diagnostic and prognostic potential of FBXO8 expression in kidney renal clear cell carcinoma and its regulation of renal adenocarcinoma cells

BACKGROUND

The F-box protein 8 Gene (FBXO8) has been shown to suppress invasion and metastasis in various cancer types. Recurrence and drug resistance pose significant challenges in renal cell carcinoma (RCC). Identifying novel biomarkers is crucial for addressing these issues.

METHODS

Data on RNA sequencing and patient survival for KIRC was obtained from The Cancer Genome Atlas (TCGA), UALCAN, and Gene Expression Omnibus (GEO) databases. We confirmed FBXO8 gene expression and its impact on survival. Clinical characteristics were classified, and FBXO8 expression differences among various categories were observed. We conducted biofunctional predictions and analyzed the tumor microenvironment (TME), immune cell infiltration, and immune checkpoints in relation to FBXO8 expression. FBXO8 was overexpressed using a plasmid, and we assessed Kidney renal clear cell carcinoma (KIRC) cell proliferation, migration, and apoptosis through CCK8, wound healing tests, and western blot analysis.

RESULTS

Our findings revealed decreased FBXO8 expression in KIRC, with patients exhibiting low FBXO8 expression experiencing shorter survival times. The low expression group showed elevated TME immune and estimate scores. Biofunctional analyses indicated that FBXO8 expression was notably linked to drug metabolism cytochrome P450, nutrition disease, receptor-ligand activity, and neuroactive ligand-receptor interaction. Furthermore, we discovered significant correlations between FBXO8 expression and immune cell infiltration, as well as checkpoints such as CD274. Overexpression (OE) of FBXO8 led to a marked reduction in cell proliferation and migration, along with increased apoptosis, as evidenced by apoptosis-related protein expression.

CONCLUSION

This study demonstrates that FBXO8 serves as a biomarker for KIRC and plays a role in regulating cell proliferation, migration, and apoptosis.

Positive associations between dietary potential acid load and renal cancer incidence and mortality: Results from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial

OBJECTIVES

To explore the relationships between dietary potential acid load and renal cancer (RC) incidence and mortality.

STUDY DESIGN

A prospective cohort study involving 97,166 U S. adults aged 55-74 years.

METHODS

Data utilized in this study were drawn from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Dietary potential acid load was assessed by dietary acid load (DAL), potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores using a validated Diet History Questionnaire (DHQ). Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for RC incidence and mortality with adjustment for potential confounders. Restricted cubic spline (RCS) plots were utilized to reveal whether there were nonlinear associations between the DAL, PRAL, and NEAP scores and RC incidence and mortality.

RESULTS

During a follow-up period of 859,907 and 1,467,573 person-years, 423 RC cases and 221 mortality cases were documented. DAL, PRAL, and NEAP scores were positively associated with RC incidence (DAL: HR 1.41; 95% CI 1.05, 1.90; P-trend = 0.010; PRAL: HR 1.45; 95% CI 1.10, 1.91; P-trend = 0.010; NEAP: HR 1.39; 95% CI 1.04, 1.85; P-trend = 0.029). Similar associations were observed between DAL, PRAL, and NEAP scores and RC mortality. The RCS plots demonstrated a nonlinear association between DAL score and RC risk, while a linear association was observed between DAL score and RC mortality. Similar linear associations were found between PRAL and NEAP scores and RC incidence and mortality.

CONCLUSION

A higher dietary potential acid load was associated with higher risk of RC incidence and mortality in American adults.

Mitochondrial respiratory complex II is altered in renal carcinoma

BACKGROUND

Renal cell carcinoma (RCC) is a disease typified by anomalies in cell metabolism. The function of mitochondria, including subunits of mitochondrial respiratory complex II (CII), in particular SDHB, are often affected. Here we investigated the state and function of CII in RCC patients.

METHODS

We evaluated tumour tissue as well as the adjacent healthy kidney tissue of 78 patients with RCC of different histotypes, focusing on their mitochondrial function. As clear cell RCC (ccRCC) is by far the most frequent histotype of RCC, we focused on these patients, which were grouped based on the pathological WHO/ISUP grading system to low- and high-grade patients, indicative of prognosis. We also evaluated mitochondrial function in organoids derived from tumour tissue of 7 patients.

RESULTS

ccRCC tumours were characterized by mutated von Hippel-Lindau gene and high expression of carbonic anhydrase IX. We found low levels of mitochondrial DNA, protein and function, together with CII function in ccRCC tumour tissue, but not in other RCC types and non-tumour tissues. Mitochondrial content increased in high-grade tumours, while the function of CII remained low. Tumour organoids from ccRCC patients recapitulated molecular characteristics of RCC tissue.

CONCLUSIONS

Our findings suggest that the state of CII, epitomized by its assembly and SDHB levels, deteriorates with the progressive severity of ccRCC. These observations hold the potential for stratification of patients with worse prognosis and may guide the exploration of targeted therapeutic interventions.

Renal Cell Carcinoma With Venous Tumor Thrombus Has a Predilection for the Lungs

OBJECTIVE

To investigate the association between venous tumor thrombus (VTT) and the risk of pulmonary metastases in patients with clear cell renal cell carcinoma (ccRCC).

METHODS

We queried our institutional registry for ccRCC patients undergoing radical nephrectomy (1970-2019). Cox proportional hazards regression models, adjusting for factors associated with ccRCC progression, were used to determine whether VTT was associated with pulmonary metastases.

RESULTS

Of 3410 patients studied, 1025 (30%) had VTT. Patients with VTT were more likely to present with synchronous pulmonary metastasis (20% vs 7%, P<.001). Within the VTT subset, level of VTT was not significantly associated with synchronous pulmonary metastasis (P=.3). Moreover, among patients with metastatic disease at nephrectomy (n=643), pulmonary metastases were more common in those with VTT versus those without VTT (68% vs 51%, P<.001). Further, excluding patients with synchronous pulmonary metastases, on multivariable analysis, VTT remained associated with an increased risk of developing metachronous pulmonary metastases (hazard ratio (HR) 1.31, P<.001). Interestingly, the presence of PE in the setting of VTT was also identified to be associated with an increased pulmonary metastases post-nephrectomy (HR 2.31, P<.001).

CONCLUSION

VTT is associated with disproportionately increased pulmonary metastases at presentation and post-nephrectomy in ccRCC. Further, the presence of PE at nephrectomy for VTT was associated with increased pulmonary metastases post-nephrectomy. These results support a metastatic predilection of ccRCC with VTT in the lungs.

Cuproptosis: A new mechanism for anti-tumour therapy

As an indispensable trace metal element in the organism, copper acts as a key catalytic cofactor in a wide range of biological processes. Copper homeostasis disorders can be caused by either copper excess or deficiency, and copper homeostasis disorders will affect the normal physiological functions of cells and induce cell death through a variety of mechanisms, such as the emerging cuproptosis model. The imbalance of copper homeostasis will lead to the occurrence of cancer, and copper is a key factor in cell signalling, so copper is involved in the development of cancer by promoting cell proliferation, angiogenesis and metastasis, etc. The therapeutic role of Cuproptosis as a hotspot of research in cancer has also attracted much attention. Therefore, this paper comprehensively searches the literature to review the roles and mechanisms of Cuproptosis in the treatment of malignant tumours, aiming to provide new insights into the role and mechanism of Cuproptosis in anti-malignant tumour therapy and present novel ideas and methods.

Construction and validation of a regulatory T cells-based classification of renal cell carcinoma: an integrated bioinformatic analysis and clinical cohort study

PURPOSE

Renal cell carcinoma (RCC), exhibiting remarkable heterogeneity, can be highly infiltrated by regulatory T cells (Tregs). However, the relationship between Treg and the heterogeneity of RCC remains to be explored.

METHODS

We acquired single-cell RNA-seq profiles and 537 bulk RNA-seq profiles of TCGA-KIRC cohort. Through clustering, monocle2 pseudotime and prognostic analyses, we identified Treg states-related prognostic genes (TSRPGs), then constructing the RCC Treg states-related prognostic classification (RCC-TSC). We also explored its prognostic significance and multi-omics landmarks. Additionally, we utilized correlation analysis to establish regulatory networks, and predicted candidate inhibitors. More importantly, in Xinhua cohort of 370 patients with kidney neoplasm, we used immunohistochemical (IHC) staining for classification, then employing statistical analyses including Chi-square tests and multivariate Cox proportional hazards regression analysis to explore its clinical relevance.

RESULTS

We defined 44 TSRPGs in four different monocle states, and identified high immune infiltration RCC (HIRC, LAG3+, Mki67+) as the highly exhausted subtype with the worst prognosis in RCC-TSC (p < 0.001). BATF-LAG3-immune cells axis might be its underlying metastasis-related mechanism. Immunotherapy and inhibitors including sunitinib potentially conferred best therapeutic effects for HIRC. Furthermore, we successfully validated HIRC subtype as an independent prognostic factor within the Xinhua cohort (OS, HR = 16.68, 95% CI = 1.88-148.1, p = 0.011; PFS, HR = 4.43, 95% CI = 1.55-12.6, p = 0.005).

CONCLUSION

Through integrated bioinformatics analysis and a large-sample retrospective clinical study, we successfully established RCC-TSC and a diagnostic kit, which could stratify RCC patients with different prognosis and to guide personalized treatment.

Integrated machine learning reveals the role of tryptophan metabolism in clear cell renal cell carcinoma and its association with patient prognosis

BACKGROUND

Precision oncology's implementation in clinical practice faces significant constraints due to the inadequacies in tools for detailed patient stratification and personalized treatment methodologies. Dysregulated tryptophan metabolism has emerged as a crucial factor in tumor progression, encompassing immune suppression, proliferation, metastasis, and metabolic reprogramming. However, its precise role in clear cell renal cell carcinoma (ccRCC) remains unclear, and predictive models or signatures based on tryptophan metabolism are conspicuously lacking.

METHODS

The influence of tryptophan metabolism on tumor cells was explored using single-cell RNA sequencing data. Genes involved in tryptophan metabolism were identified across both single-cell and bulk-cell dimensions through weighted gene co-expression network analysis (WGCNA) and its single-cell data variant (hdWGCNA). Subsequently, a tryptophan metabolism-related signature was developed using an integrated machine-learning approach. This signature was then examined in multi-omics data to assess its associations with patient clinical features, prognosis, cancer malignancy-related pathways, immune microenvironment, genomic characteristics, and responses to immunotherapy and targeted therapy. Finally, the genes within the signature were validated through experiments including qRT-PCR, Western blot, CCK8 assay, and transwell assay.

RESULTS

Dysregulated tryptophan metabolism was identified as a potential driver of the malignant transformation of normal epithelial cells. The tryptophan metabolism-related signature (TMRS) demonstrated robust predictive capability for overall survival (OS) and progression-free survival (PFS) across multiple datasets. Moreover, a high TMRS risk score correlated with increased tumor malignancy, significant metabolic reprogramming, an inflamed yet dysfunctional immune microenvironment, heightened genomic instability, resistance to immunotherapy, and increased sensitivity to certain targeted therapeutics. Experimental validation revealed differential expression of genes within the signature between RCC and adjacent normal tissues, with reduced expression of DDAH1 linked to enhanced proliferation and metastasis of tumor cells.

CONCLUSION

This study investigated the potential impact of dysregulated tryptophan metabolism on clear cell renal cell carcinoma, leading to the development of a tryptophan metabolism-related signature that may provide insights into patient prognosis, tumor biological status, and personalized treatment strategies. This signature serves as a valuable reference for further exploring the role of tryptophan metabolism in renal cell carcinoma and for the development of clinical applications based on this metabolic pathway.

Metastatic risk in clear cell renal cell carcinoma: a tool incorporating sex, size, and grade

OBJECTIVE

To identify predictors of metastases, estimate the proportion of metastatic clear cell renal cell carcinoma (ccRCC) cases according to these predictors, and subsequently create a risk table showing the absolute difference in metastasis proportion for each 10 mm increase in tumour size.

PATIENTS AND METHODS

Patients diagnosed with histopathological confirmed ccRCC in 2010-2018 in Denmark identified in the nationwide Danish Multidisciplinary Renal Cancer Group (DaRenCa) Study-3. Association between diagnostic variables and metastases were assessed with logistic regression analyses. Proportion of cases with metastases were assess based on tumour sizes using a logistic regression model.

RESULTS

The study included 2109 cases with non-metastatic ccRCC at diagnosis and 450 cases with metastatic ccRCC. Multivariable logistic regression analyses found sex, tumour size and grade were associated with metastatic ccRCC, whereas age was not. The proportion of cases with metastasis increased with larger tumours sizes and higher grade. As an example, the proportion of metastases in female cases with tumour size of 40 mm was 2.9% (95% confidence interval [CI] 1.7-4.8%) in Grade 1 and 16% (95% CI 12-22%) in cases with Grade 4. Comparable numbers in cases with a tumour size of 70 mm were 6.6% (95% CI 4.0-11%) and 31% (95% CI 25-38). The absolute increase in the proportion of cases with metastases with a 10 mm increase in size was <2% for tumours <40 mm and Grade 1-2. In contrast, cases with tumour sizes >50 mm and/or Grade 3-4 had a moderate (2-<4%) to high (≥4%) absolute increase in the proportion of cases with metastases with each 10 mm increase.

CONCLUSION

The risk table presented offers a valuable tool for discussing the risk of progression to metastases in patients under expected management for ccRCC, enabling clinicians to make more informed, evidence-based decisions.

Development and validation of intravoxel incoherent motion diffusion weighted imaging-based model for preoperative distinguishing nuclear grade and survival of clear cell renal cell carcinoma complicated with venous tumor thrombus

OBJECTIVE

To assess the utility of multiparametric MRI and clinical indicators in distinguishing nuclear grade and survival of clear cell renal cell carcinoma (ccRCC) complicated with venous tumor thrombus (VTT).

MATERIALS AND METHODS

This study included 105 and 27 patients in the training and test sets, respectively. Preoperative MRI, including intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), was performed. Renal lesions were evaluated for IVIM-DWI metrics and conventional MRI features. All the patients had postoperative histologically proven ccRCC and VTT. An expert uropathologist reviewed all specimens to confirm the nuclear grade of the World Health Organization/ International Society of Urological Pathology (WHO/ISUP) of the tumor. Univariate and multivariable logistic regression analyses were used to select the preoperative imaging features and clinical indicators. The predictive ability of the logistic regression model was assessed using receiver operating characteristic (ROC) analysis. Survival curves were plotted using the Kaplan-Meier method.

RESULTS

High WHO/ISUP nuclear grade was confirmed in 69 of 105 patients (65.7%) in the training set and 19 of 27 patients (70.4%) in the test set, respectively (P = 0.647). Dp_ROI_Low, tumor size, serum albumin, platelet count, and lymphocyte count were independently related to high WHO/ISUP nuclear grade in the training set. The model identified high WHO/ISUP nuclear grade well, with an AUC of 0.817 (95% confidence interval [CI]: 0.735-0.899), a sensitivity of 70.0%, and a specificity of 77.8% in the training set. In the independent test set, the model demonstrated an AUC of 0.766 (95% CI, 0.567-0.966), a sensitivity of 79.0%, and a specificity of 75.0%. Kaplan-Meier analysis showed that the predicted high WHO/ISUP nuclear grade group had poorer progression-free survival than the low WHO/ISUP nuclear grade group in both the training and test sets (P = 0.001 and P = 0.021).

CONCLUSIONS

IVIM-DWI-derived parameters and clinical indicators can be used to differentiate nuclear grades and predict progression-free survival of ccRCC and VTT.

Gemcitabine-Loaded Microbeads for Transarterial Chemoembolization of Rabbit Renal Tumor Monitored by 18F-FDG Positron Emission Tomography/X-Ray Computed Tomography Imaging

BACKGROUND/OBJECTIVES

The purpose of this study was to develop the gemcitabine-loaded drug-eluting beads (G-DEBs) for transarterial chemoembolization (TACE) in rabbit renal tumors and to evaluate their antitumor effect using 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography/X-ray computed tomography (18F-FDG PET/CT).

METHODS

DEBs were prepared by polyvinyl alcohol-based macromer crosslinked with N-acryl tyrosine and N,N'-methylenebis(acrylamide). Gemcitabine was loaded through ion change to obtain G-DEBs. Their particle size and drug release profile were characterized. VX2 tumors were implanted in the right kidney of rabbits to establish the renal tumor model. The tumor-bearing rabbits received pre-scan by 18F-FDG PET/CT, followed by targeted transarterial injection of G-DEBs under digital subtraction angiography (DSA) guidance. The rabbits received another 18F-FDG PET/CT scan 10 or 14 days after the treatment. The therapeutic effect was further validated by histopathological analysis of the dissected tumors.

RESULTS

The average particle size of the microspheres was 58.06 ± 0.50 µm, and the polydisperse index was 0.26 ± 0.002. The maximum loading rate of G-DEBs was 18.09 ± 0.35%, with almost 100% encapsulation efficiency. Within 24 h, GEM was eluted from G-DEBs rapidly and completely, and more than 20% was released in different media. DSA illustrated that G-DEBs were delivered to rabbit renal tumors. Compared with the untreated control group with increased tumor volume and intense 18F -FDG uptake, the G-DEBs group showed significant reductions in tumor volume and maximum standard uptake value (SUVmax) 10 or 14 days after the treatment. Histopathological analysis confirmed that the proliferating area of tumor cells was significantly reduced in the G-DEBs group.

CONCLUSIONS

Our results demonstrated that G-DEBs are effective in TACE treatment of rabbit VX2 renal tumors, and 18F-FDG PET/CT provides a non-invasive imaging modality to monitor the antitumor effects of TACE in renal tumors.

Renal cell carcinoma and macrophage research: A bibliometric analysis (2004-2023)

To analyze hotspots and trends in renal cell carcinoma (RCC)-macrophage research using bibliometric analysis, although numerous studies on macrophages in RCC have been recently reported, understanding the progressive trends in this field remains challenging. Publications focused on macrophages in RCC were extracted from the Web of Science Core Collection. VOSviewer, Citespace, and Bibliometrics online platforms were used to visualize hot topics and global trends in RCC-macrophage research. In total, 778 papers were collected. China produced the most articles; however, the United States accounted for the largest number of citations. Oncology journals published the most articles, and these were cited most frequently. Based on keyword analysis, "prognosis," "immunotherapy," "tumor microenvironment," and "immune infiltration" represented the primary research hotspots. In summary, RCC-macrophage studies have emerged as a key research focus; particularly, incorporating multiomics data and applying artificial intelligence for predictive modeling have demonstrated significant potential. Our study suggests that the resistance mechanism of immune checkpoint inhibitors and the interaction between macrophages and immune checkpoint inhibitors will be pivotal areas for future research.

Clinical outcomes and prognostic factors in metastatic nonclear cell renal cell carcinoma treated with immuno-oncology combination therapy

BACKGROUND

Metastatic nonclear cell renal cell carcinoma (nccRCC) is a heterogeneous disease with poor prognosis. The clinical characteristics and prognostic factors of immuno-oncology (IO) combination therapy for nccRCC are not well known. This study analyzed patients with metastatic nccRCC treated with IO combination therapy.

METHODS

We retrospectively collected data from 447 patients with metastatic RCC treated with IO-based combination therapy as first-line treatment between September 2018 and July 2023 in a Japanese multicenter study. The primary endpoints were objective response rate, progression-free survival (PFS), and overall survival (OS), comparing groups treated with IO-IO and IO-tyrosine kinase inhibitor (TKI) therapies.

RESULTS

Seventy-five patients with metastatic nccRCC were eligible for analysis: 39 were classified into the IO-IO group and 36 into the IO-TKI group. Median PFS was 5.4 months (95% CI: 1.6-9.1) for the IO-IO group and 5.6 (95% CI: 3.4-12.0) for the IO + TKI group. Median OS was 24.2 months (95% CI: 7.5-NA) for the IO-IO group and 23.4 (95% CI: 18.8-NA) for the IO + TKI group, with no significant difference. In univariate analysis, International Metastatic Renal Cell Carcinoma Database Consortium scores, Karnofsky performance status, neutrophil-to-lymphocyte ratio, and the presence of liver metastases were significantly associated with OS, whereas in multivariate analysis, only the presence of liver metastases was significantly associated with OS (P = .035).

CONCLUSIONS

There was no significant difference in OS or PFS between IO-IO and IO-TKI combination therapy as first-line treatment for patients with nccRCC. Liver metastasis is a poor prognostic factor for such patients.

Organoids as Sophisticated Tools for Renal Cancer Research: Extensive Applications and Promising Prospects

Background

Kidney cancer is a significant global health problem that affects nearly 1 in 25 of cancer patients. Prevalence, morbidity and mortality data associated with kidney cancer continue to increase every year, revealing a heavy economic and social burden. Organoid culture is a new research tool with great potential for many applications, particularly in cancer research. The integration of organoids with other emerging technologies has simultaneously expanded their potential applications. However, there is no thorough assessment of organoids in the field of renal cancer research.

Objectives

This paper presents a comprehensive review of the current development of renal cancer organoids and discusses the corresponding solutions and future directions of renal cancer organoids.

Methods

In this study, we have compared the operating procedures of different organoid culture protocols and proposed a summary of constituents in culture media. Extensive discussions of renal cancer organoids, including generation and maintenance approaches, application scenarios, current challenges and prospects, have also been made. The information required for this study is extracted from literature databases such as PubMed, SCOPUS and Web of Science.

Results

In this article, we systematically review thirteen successful methods for generating organoids to kidney cancer and provide practical guidelines for their construction as a reference. In addition, we also elucidate the clinical application of organoids, address the existing challenges and limitations, and highlight promising prospects.

Conclusion

Ultimately, we firmly believe that as kidney tumour organoids continue to develop and improve, they will become a crucial tool for treating kidney cancer.

Robot-assisted Partial Nephrectomy for Hilar and Nonhilar Renal Masses: Comparison of Perioperative, Oncological, and Functional Results in a Multicentre Prospective Cohort (NEPRAH Study, UroCCR 175)

BACKGROUND AND OBJECTIVE

A hilar location for a renal tumour is sometimes viewed as a limiting factor for safe partial nephrectomy. Our aim was to evaluate perioperative, oncological, and functional outcomes of robot-assisted partial nephrectomy (RAPN) for hilar tumours (RAPN-H) in comparison to RAPN for nonhilar tumours (RAPN-NH).

METHODS

We conducted an observational, multicentre cohort study using prospectively collected data from the French Research Network on Kidney Cancer (UroCCR). The registry includes data for 3551 patients who underwent RAPN for localised or locally advanced renal masses between 2010 and 2023 in 29 hospitals in France. We studied the impact of a hilar location on surgery, postoperative renal function, tumour characteristics, and survival. We also compared rates of trifecta achievement (warm ischaemia time [WIT] <25 min, negative surgical margins, and no perioperative complications) between the groups. Finally, we performed a subgroup analysis of RAPN without vascular clamping. Variables were compared in univariable analysis and using multivariable linear, logistic, and Cox proportional-hazards models adjusted for relevant patient and tumour covariates.

KEY FINDINGS AND LIMITATIONS

The analytical population included 3451 patients, of whom 2773 underwent RAPN-NH and 678 underwent RAPN-H. Longer WIT (β = 2.4 min; p < 0.01), longer operative time (β = 11.4 min; p < 0.01) and a higher risk of postoperative complications (odds ratio 1.33; p = 0.05) were observed in the hilar group. Blood loss, the perioperative transfusion rate, postoperative changes in the estimated glomerular filtration rate, and trifecta achievement rates were comparable between the groups (p > 0.05). At mean follow-up of 31.9 mo, there was no significant difference in recurrence-free survival (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.58-1.2; p = 0.3), cancer-specific survival (HR 1.1, 95% CI 0.48-2.6; p = 0.79), or overall survival (HR 0.89, 95% CI 0.52-1.53; p = 0.69).

CONCLUSIONS AND CLINICAL IMPLICATIONS

Patient and tumour characteristics rather than just hilar location should be the main determinants of the optimal surgical strategy for hilar tumours.

PATIENT SUMMARY

We found that kidney tumours located close to major kidney blood vessels led to a longer operation and a higher risk of complications during robot-assisted surgery to remove the tumour. However, tumours in these locations were not related to a higher risk of kidney function loss, cancer recurrence, or death.

Long-term Renal Function Outcomes After Stereotactic Ablative Body Radiotherapy for Primary Renal Cell Carcinoma Including Patients with a Solitary Kidney: A Report from the International Radiosurgery Oncology Consortium of the Kidney

BACKGROUND AND OBJECTIVE

Renal function preservation is particularly important following nonoperative treatment of localized renal cell carcinoma (RCC) since patients are often older with medical comorbidities. Our objective was to report long-term renal function outcomes after stereotactic ablative radiotherapy (SABR) including patients with a solitary kidney.

METHODS

Patients with primary RCC treated with SABR with ≥2 yr of follow-up at 12 International Radiosurgery Consortium for Kidney institutions were included. Renal function was measured by estimated glomerular filtration rate (eGFR).

KEY FINDINGS AND LIMITATIONS

In total, 190 patients (56 with a solitary kidney) underwent SABR and were followed for a median of 5.0 yr (interquartile range [IQR]: 3.4-6.8). In patients with a solitary kidney versus bilateral kidneys, pre-SABR eGFR (mean [standard deviation]) was 61.1 (23.2) versus 58.0 (22.3) ml/min (p = 0.32) and the median tumor size was 3.65 cm (IQR: 2.59-4.50 cm) versus 4.00 cm (IQR: 3.00-5.00 cm; p = 0.026). At 5 yr after SABR, eGFR decreased by -14.5 (7.6) and -13.3 (15.9) ml/min (p = 0.67), respectively, and there were similar rates of post-SABR dialysis (3.6% [n = 2/56] vs 3.7% [n = 5/134]). A multivariable analysis demonstrated that increasing tumor size (odds ratio [OR] per 1 cm: 1.57; 95% confidence interval [CI]: 1.14-2.16, p = 0.0055) and baseline eGFR (OR per 10 ml/min: 1.30; 95% CI: 1.02-1.66, p = 0.034) were associated with an eGFR decline of ≥15 ml/min at 1 yr.

CONCLUSIONS AND CLINICAL IMPLICATIONS

With long-term follow-up after SABR, kidney function decline remains moderate, with no observed difference between patients with a solitary kidney and bilateral kidneys. Tumor size and baseline eGFR are dominant factors predictive of long-term renal function decline.

PATIENT SUMMARY

With long-term follow-up, stereotactic ablative radiotherapy (SABR) yields moderate long-term renal function decline and low dialysis rates even in patients with a solitary kidney. SABR thus represents a promising noninvasive, nephron-sparing option for patients with localized renal cell carcinoma.

Protection from injury to organs adjacent to a renal tumor during Imaging-guided thermal ablation with hydrodissection and pyeloperfusion

PURPOSE

The treatment of renal tumors is dictated by the results acquired from renal imaging, which play a crucial role in determining the appropriate strategy and surgical plan. Radiofrequency ablation, microwave ablation, and cryoablation are established percutaneous thermal ablation procedures that have widespread recognition. The objective of this scholarly article is to present a comprehensive summary of the application of the primary thermal protection strategies of the structures adjacent to renal tumors, in particular the effectiveness in terms of safety of hydrodissection and pyeloperfusion, in the context of percutaneous thermal ablation for renal tumors.

METHODS

A literature search was conducted in PubMed in April 2023 using the keywords "hydrodissection", "hydrodisplacement", "renal", "kidney", "percutaneous ablation", "cryoablation", "microwave", "radiofrequency", and "pyeloperfusion". No language restriction was applied.

RESULTS

Our study yielded a total of 676 cases describing the use of either hydrodissection or pyeloperfusion in conjunction with percutaneous thermal ablation. The fluids employed for displacing the neighboring structures encompassed saline solution, a mixture of saline solution and iodinated contrast, 5% dextrose in water, iodinated contrast in dextrose solution, lactated singer solution, and iodinated contrast.

CONCLUSIONS

By using these procedures effectively, a greater number of ablations could be performed on anterior or lower polar renal tumors, sometimes excluded from these treatments due to the high risk of causing damage to adjacent anatomical structures.

Integrative analysis of bulk and single-cell RNA sequencing reveals sphingolipid metabolism and immune landscape in clear cell renal cell carcinoma

Clear cell renal cell carcinoma (ccRCC) is characterized by its aggressive behavior and complex molecular heterogeneity, posing significant challenges for treatment and prognostication. This study offers a comprehensive analysis of ccRCC by leveraging both bulk and single-cell RNA sequencing data, with a specific aim to unravel the complexities of sphingolipid metabolism and the intricate dynamics within the tumor microenvironment (TME). By examining ccRCC samples sourced from public databases, our investigation delves deep into the genetic and transcriptomic landscape of this cancer type. Employing advanced analytical techniques, we have identified pivotal patterns in gene expression and cellular heterogeneity, with a special focus on the roles and interactions of various immune cells within the TME. Significantly, our research has unearthed insights into the dynamics of sphingolipid metabolism in ccRCC, shedding light on its potential implications for tumor progression and strategies for immune evasion. A novel aspect of this study is the development of a risk score model designed to enhance prognostic predictions for ccRCC patients, which is currently pending external validation to ascertain its clinical utility. Despite its contributions, the study is mindful of its limitations, including a reliance on observational data from public sources and a primary focus on RNA sequencing data, which may constrain the depth and generalizability of the findings. The study does not encompass critical aspects, such as protein expression, posttranslational modifications, and comprehensive metabolic profiles. Moreover, its retrospective design underscores the necessity for future prospective studies to solidify these preliminary conclusions. Our findings illuminate the intricate interplay between genetic alterations, sphingolipid metabolism, and immune responses in ccRCC. This research not only enhances our understanding of the molecular foundations of ccRCC but also paves the way for the development of targeted therapies and personalized treatment modalities. The study underlines the importance of cautious interpretation of results and champions ongoing research using diverse methodologies to thoroughly comprehend and effectively combat this formidable cancer type.

Mechanical thrombectomy for inferior vena cava tumor thrombus secondary to renal cell carcinoma

This case describes the use of percutaneous mechanical thrombectomy to remove caval tumor thrombus in a 55-year-old male with renal cell carcinoma, using the Inari CloTriever system. The procedure was fast, safe, and effective, with complete tumor thrombus removal and no complications. This case demonstrates the expanding indications for large-bore thrombectomy devices offering minimally invasive options in place of high-risk open interventions.

NODESAFE Nomogram: A Novel Score System to Predict Lymph Node Involvement at the Time of Nephrectomy or Nodal Recurrence in Nonmetastatic Renal Cell Carcinoma

OBJECTIVE

We sought to develop a preoperative nomogram called NODESAFE (NODE SAFEty) to predict nodal involvement (NI) at time of surgery or subsequent follow up in localized renal cell carcinoma (RCC), as the role of lymphadenectomy in localized RCC remains controversial.

METHODS

We conducted a multicenter retrospective analysis of RCC patients who underwent primary surgical resection. Patients with clinical metastasis at presentation were excluded. NI was defined as presence of histological RCC with lymphadenectomy at time of surgery, or subsequent development histologically proven NI. The dataset was divided into training (70%) and testing subsets to facilitate model evaluation which was constructed through a stepwise multivariable logistic regression (MLR) model. Accuracy was tested with receiver operator characteristic estimated area under the curve (AUC).

RESULTS

Total 3308 patients (2221 [67.1%] male) met inclusion criteria. During follow-up 25 patients (0.76 %) experienced nodal recurrence, and 22/25 were preoperatively classified as cN0. In our cohort, 112 (3.4%) patients had clinical lymphadenopathy preoperatively (cN1), and 34/112 were pN1. The following covariates were found to be statically significant on a MLR model: hypertension (Odds ratio [OR] 3.35, < .001), Charlson Comorbidity Index ≥ 5 (OR 1.93 P = .025), tumor size ≥ 6 cm (OR 2.63, P = .001), tumor necrosis at CT scan (OR 1.83, P = .036), cN1 (OR 5.59, P < .001) and CRP ≥ 8.5 mg/L (1.96, P = .018). Testing the prediction performance of the model in the validation set AUC of the model was 0.89. NODESAFE demonstrated a sensitivity of 83.9%, specificity of 86.1% and 99.1% negative predictive values using a 4% threshold probability.

CONCLUSION

Combining clinical features, serum biomarkers and radiographic findings, we developed a model capable of predicting NI with high degree of accuracy. NODESAFE may refine clinical decision making with respect to the performance of lymphadenectomy at the time of surgery, postsurgical surveillance, and spur consideration for adjuvant therapy.