Epidemiology of Renal Cell Carcinoma: 2022 Update

Discovery of a potent and selective peptide inhibitor with d-amino acids targeting the BRD4 ET domain for renal cancer therapy

Renal cancer is a highly aggressive tumor that poses a serious threat to human health. BRD4, as an important epigenetic regulator, is tightly associated with the development of renal cancer. Given the unique biological stability of d-amino acids, they have shown great potential for application in the field of cancer therapy. Currently, there are no reports on d-amino acid inhibitors targeting the ET domain of BRD4. Herein, we discovered a peptide inhibitor containing d-amino acids (BEP-2) targeting the BRD4 ET domain through virtual screening. BEP-2 showed an excellent binding affinity for BRD4 (Kd = 0.45 ± 0.03 nM). MD simulations demonstrate that BEP-2 can stably bind to the BRD4 ET domain. Moreover, BEP-2 displayed good inhibitory activity against 786-O and ACHN renal cancer cells and maintained high stability in serum. Additionally, BEP-2 inhibited the growth of 786-O cell xenograft tumors in nude mice. In summary, these data imply that BEP-2 is a promising antitumor drug that offers new perspectives for the treatment of renal cancer.

DDX24 inhibits clear cell renal cell carcinoma progression by directly regulating AKR1B10

Clear cell renal cell carcinoma (ccRCC) is one of the most common malignancies worldwide, but only a few markers have been used to diagnose ccRCC. Here, we report the critical roles of DEAD-box helicase 24 (DDX24), a member of the DEAD-box RNA helicase family, in ccRCC. The DDX24 expression level and its prognostic value were initially detected in public data and then verified in a ccRCC tissue microarray. Subsequent in vitro and in vivo experiments were conducted on representative ccRCC cell lines. RNA sequencing and experimental studies were performed to explore the underlying mechanisms, and the associations between DDX24 expression and immune characteristics were evaluated. DDX24 levels were significantly lower in ccRCC tissues and negatively correlated with advanced clinical stage and overall survival. Functional analyses showed that DDX24 overexpression inhibited ccRCC cell proliferation, migration, and invasion, while DDX24 knockdown enhanced these phenotypes. Mechanistic studies revealed that DDX24 regulated the expression of aldo-keto reductase family 1 member B10 (AKR1B10) and epithelial-mesenchymal transition (EMT)-related transcription factors. Given the low expression of DDX24, ccRCC patients may benefit more from immunotherapies. In conclusion, these findings demonstrate that DDX24 suppresses ccRCC progression through direct regulation of AKR1B10, potentially mediated by EMT-related pathways, which provides potential therapeutic targets for ccRCC.

Anti-nuclear cytoplasmic antibody-associated vasculitis and kidney cancer: A mini review

This mini review explores the links between anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and kidney cancer. Several studies suggest an increased incidence of cancer for patients with AAV. Different cancer types have shown different standardized incidence ratios (SIRs) in association with AAV. The SIRs of kidney cancer were found to be between 1.7 and 3.3 as per three retrospective data analyses. This association is likely multifactorial, with increased de novo cancer risks associated with inflammatory diseases; carcinogenic therapies such as cyclophosphamide; and reduced immune surveillance of neoplastic cells in immunocompromised individuals. Some studies have proposed that cancers, including kidney cancer, could be a potential trigger for AAV. Due to variability in SIRs and a lack of multicenter studies looking specifically into the incidence of kidney cancer at AAV diagnosis and on follow-up post initiation of AAV treatment, there remains a lack of evidence to support formal screening for kidney cancer in the AAV patient cohort. Greater awareness on the increased risk of cancer in AAV patients, prompt urological assessment of “red flag” symptoms of kidney cancer, and smoking cessation advice to reduce cancer risk should be standard of care for patients with AAV.

Impact of contrast enhancement phase on CT-based radiomics analysis for predicting post-surgical recurrence in renal cell carcinoma

PURPOSE

To investigate the effect of CT enhancement phase on radiomics features for predicting post-surgical recurrence of clear cell renal cell carcinoma (ccRCC).

METHODS

This retrospective study included 144 patients who underwent radical or partial nephrectomy for ccRCC. Preoperative multiphase abdominal CT scans (non-contrast, corticomedullary, and nephrographic phases) were obtained for each patient. Automated segmentation of renal masses was performed using the nnU-Net framework. Radiomics signatures (RS) were developed for each phase using ensembles of machine learning-based models (Random Survival Forests [RSF], Survival Support Vector Machines [S-SVM], and Extreme Gradient Boosting [XGBoost]) with and without feature selection. Feature selection was performed using Affinity Propagation Clustering. The primary endpoint was disease-free survival, assessed by concordance index (C-index).

RESULTS

The study included 144 patients. Radical and partial nephrectomies were performed in 81% and 19% of patients, respectively, with 81% of tumors classified as high grade. Disease recurrence occurred in 74 patients (51%). A total of 1,316 radiomics features were extracted per phase per patient. Without feature selection, C-index values for RSF, S-SVM, XGBoost, and Penalized Cox models ranged from 0.43 to 0.61 across phases. With Affinity Propagation feature selection, C-index values improved to 0.51-0.74, with the corticomedullary phase achieving the highest performance (C-index up to 0.74).

CONCLUSIONS

The results of our study indicate that radiomics analysis of corticomedullary phase contrast-enhanced CT images may provide valuable predictive insight into recurrence risk for non-metastatic ccRCC following surgical resection. However, the lack of external validation is a limitation, and further studies are needed to confirm these findings in independent cohorts.

European Association of Urology Guidelines on Renal Cell Carcinoma: The 2025 Update

BACKGROUND AND OBJECTIVE

The European Association of Urology (EAU) renal cell carcinoma (RCC) guideline panel has updated their evidence-based guidelines and recommendations for the management of RCC. Here we present a summary of the 2025 RCC guidelines updated with standardised methodology to provide reproducible evidence for the management of RCC.

METHODS

For the 2025 update, a literature search was performed covering the period from May 1, 2023 to May 1, 2024 using the Medline, EMBASE, and Cochrane Libraries. The data search focused on meta-analyses, systematic reviews, randomised controlled trials (RCTs), and retrospective or controlled comparator-arm studies. Evidence was synthesised as outlined for all EAU guidelines.

KEY FINDINGS AND LIMITATIONS

Clinical practise recommendations were updated in all chapters of the RCC guidelines on the basis of a structured literature search. The studies included were predominantly retrospective with matched or unmatched cohorts based on single- or multi-institutional data. Several prospective studies and RCTs provided data that resulted in recommendations based on higher levels of evidence. Specifically, updates include new recommendations on stereotactic body radiotherapy for localised RCC, adjuvant therapy, systemic therapy for clear-cell RCC in later lines, other subtypes, and a new chapter on hereditary RCC.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The 2025 RCC guidelines have been updated by a multidisciplinary panel of experts using methodological standards to provide a contemporary evidence base for the management of RCC.

Insights into the impact of chromosome 3p mutations in advanced renal cell carcinoma treated with immune-based combinations or targeted therapy: A single-center experience

BACKGROUND

Immune-based combinations have transformed first-line treatment for metastatic renal cell carcinoma (mRCC), but reliable biomarkers for patient selection remain elusive. Chromosome 3p mutations (e.g., VHL, PBRM1, SETD2, BAP1) have shown inconsistent prognostic and predictive value. This retrospective study assessed the prognostic impact of tissue-based biomarkers, focusing on 3p mutations in mRCC.

PATIENTS AND METHODS

A single-center retrospective analysis included mRCC patients treated with immunocombinations or tyrosine kinase inhibitors (TKIs). We evaluated mutations in 14 genes, including VHL, PBRM1, SETD2, and BAP1. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Prognostic factors were analyzed using univariate and multivariate models.

RESULTS

Among the included 38 patients, the most common mutations were in VHL (45 %), PBRM1 (42 %), and SETD2 (26 %), with these latter more frequent in males (p = 0.012). Most patients (74 %) received immune-based combinations; 26 % received TKIs. SETD2 mutations were associated with primary refractoriness (30 %). Median OS was not reached; brain metastases (p = 0.001) and BAP1 mutations (p = 0.025) predicted worse OS, while PBRM1 mutations trended toward improved OS (p = 0.845). Median PFS was 14.1 months. Higher tumor grade (p = 0.038) and worse ECOG PS (p = 0.008) negatively impacted PFS, while 3p mutations showed no significant effect on PFS.

CONCLUSIONS

ECOG PS and brain metastases were confirmed as poor prognostic factors. VHL and PBRM1 mutations may suggest a better prognosis, while SETD2 and BAP1 mutations portend worse outcomes. Larger studies are needed to confirm these findings.

Is Frequent Imaging Necessary? Impact of Computed Tomography During Follow-up After Surgical Treatment for Nonmetastatic Renal Cell Carcinoma: A Systematic Review

BACKGROUND AND OBJECTIVE

Current guidelines on radiological follow-up (FU) for patients after treatment for nonmetastatic renal cell carcinoma (RCC) are not based on robust evidence. This review aims to evaluate whether the 2022 European Association of Urology (EAU) guidelines are noninferior, in terms of recurrence and (overall) survival, to a higher imaging frequency of computed tomography (CT) of the chest and abdomen.

METHODS

A literature search of relevant search machines (PubMed/Medline and EMBASE) was performed up to May 29, 2024. Studies describing patients with nonmetastatic RCC who underwent curative treatment by means of partial or radical nephrectomy were included. Studies with a higher number of CT scans than recommended by the EAU were compared with those that followed guidelines by examining recurrences and survival data. Outcomes were classified into risk groups according to the 2022 EAU guidelines.

KEY FINDINGS AND LIMITATIONS

Twenty studies met our inclusion criteria. Sixteen (80%) studies employed a higher imaging frequency during FU compared with 2022 EAU guideline recommendations, two studies (10%) followed the guidelines, and two studies (10%) performed less imaging. Recurrences were rare in low-risk studies (0-7.6%) and varied among high-risk studies, ranging between 33% and 40% in randomized controlled trials and 11% and 28% in retrospective studies. A meta-analysis was not suited due to clinical diversity, and the risk of bias was high among cohort studies.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Most studies employ a higher imaging frequency during FU after treatment for nonmetastatic RCC than recommended by the 2022 EAU guidelines. Survival and recurrence rates suggest that more frequent imaging than recommended by the EAU may not be advantageous, although high-quality evidence is needed to further improve guidelines.

PATIENT SUMMARY

In this review, we assessed radiological follow-up schedules for patients after surgery for kidney cancer and compared these with the follow-up schedules recommended by the European Association of Urology guidelines. We found that most studies apply more frequent imaging during follow-up than recommended by guidelines, although survival and recurrence rates are similar among studies with different imaging frequencies. We conclude that more frequent imaging than recommended by guidelines may not be necessary and that prospective studies are needed to determine whether imaging can be reduced further during follow-up.

Investigating the association of VHL gene variants with disease risk and clinicopathological outcomes in ccRCC patients from West Bengal, India

BACKGROUND

Clear cell renal cell carcinoma (ccRCC) is a prevalent and aggressive malignancy, with the von Hippel-Lindau (VHL) gene playing a critical role in its pathogenesis. However, the association between VHL gene variants and sporadic ccRCC risk remains unexplored in the Indian population. This study aimed to investigate the somatic and germline variants of the VHL gene in sporadic ccRCC patients from West Bengal, India, and their association with disease risk and clinicopathological parameters.

METHODS

A total of 210 ccRCC patients and 255 ethnicity-matched healthy controls were enrolled. Genomic DNA from blood and tissue samples was analyzed using PCR-based Sanger sequencing. The association of VHL variants with ccRCC risk was assessed using Chi-square tests. The impact of genetic variants on patient clinicopathological features and overall survival was evaluated using Kaplan-Meier survival analysis and Cox proportional hazards models.

RESULTS

We identified twenty-three single nucleotide variants (SNVs) in the VHL gene, including 3 novel variants, OR250433 T > G, OR125589 C > T and OQ627404 G > C. The intronic variant rs61758376 G > C and 3'UTR variant rs1642742 A > G were significantly associated with an increased risk of ccRCC (OR = 1.676, P = 0.0074; OR = 1.735, P = 0.0171, respectively). The rs1642742 GG genotype was also significantly associated with larger tumor size (P < 0.05) and advanced tumor stage (pT4). Kaplan-Meier analysis indicated poorer overall survival for patients with the rs1642742 GG genotype (log-rank P = 0.029).

CONCLUSION

Our study is the first to document the association of VHL gene variants with sporadic ccRCC risk and clinical outcomes in the Indian population. The identified variants, particularly rs61758376 and rs1642742, could serve as potential biomarkers for ccRCC susceptibility and prognosis.

Global insight of early-onset genitourinary cancers in adolescents and adults from 1990 to 2021: temporal trends and health inequalities analyses

BACKGROUND

Prostate, bladder, and kidney cancers represent the three most prevalent genitourinary malignancies, posing substantial global health burdens. Given the limited epidemiological research on early-onset genitourinary cancers (EOGCs), this study aims to investigate the temporal trends and health disparities in EOGCs from 1990 to 2021.

METHODS

Based on the Global Burden of Disease Study 2021 (GBD), we extracted data on the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of the three major genitourinary cancers (prostate, bladder, kidney cancer) among individuals aged 15 to 49. We described the distribution of EOGCs at the global, regional and national levels, and analyzed the overall and local time trends through the estimated annual percentage change (EAPC) and joinpoint regression. Spearman's test and health inequality analysis were used to examine the relationship between the disease burden of EOGCs and the Socio-demographic Index (SDI).

RESULTS

In 2021, the incident cases of early-onset kidney cancer (EOKC), early-onset bladder cancer (EOBC), and early-onset prostate cancer (EOPC) were 52,631, 31,054, and 17,865, respectively, with 10,978, 6,328, and 2,861 death cases. The most significant attributable risk factors for EOGC-related deaths and DALYs were smoking and high body mass index. Of particular note, male EOKC consistently demonstrated the highest age-standardized incidence rate (ASIR) and mortality rate (ASMR), with both metrics exhibiting sustained increases from 1990 to 2021, corresponding to EAPCs of 1.33% and 0.3%, respectively. The disease burdens of EOGCs were distributed differently across various regions and countries, and their local trends also varied during the period from 1990 to 2021 globally. The incidence burden of EOGCs was disproportionately concentrated in high-SDI countries, with the concentration indices of EOPC, EOBC and EOKC in 2021 being 0.26, 0.17 and 0.27 respectively. Notably, in regions or countries with a higher SDI, the incidence risk of EOGCs was relatively high, but the mortality risk decreased significantly.

CONCLUSIONS

EOGCs are a major global public health challenge. There is an urgent need for personalized healthcare strategies to alleviate the burden of genitourinary cancers, particularly kidney cancer and prostate cancer, among adolescents and adults.

Small Organic Carbonic Anhydrase IX Ligands from DNA-Encoded Chemical Libraries for Tumor-Targeted Delivery of Radionuclides

Carbonic anhydrase IX (CAIX) is a membrane protein that is highly expressed in clear cell renal cell carcinoma (ccRCC) and in hypoxic tumors. Being virtually absent in most healthy tissues, CAIX became an attractive target for the selective delivery of diagnostic and therapeutic payloads. Here, we report the discovery and characterization of DNA-encoded chemical library (DEL)-derived CAIX ligands for radionuclide-based imaging applications.

METHODS

DELs were screened against CAIX and CAII to prioritize hits based on their selectivity and enrichment against CAIX. In vitro characterization of hits was performed by fluorescence polarization (FP), surface plasmon resonance (SPR), and flow cytometry. In vivo biodistribution studies of Lutetium-177 and Gallium-68-radiolabeled compounds were performed in SK-RC-52 tumor-bearing mice.

RESULTS

DEL-based CAIX ligands with different affinities and selectivities could be identified. Selectivity and high affinity toward the target correlated with higher tumor-to-organ ratios and improved tumor retention. The best candidate, named OncoCAIX, reached up to ∼55% injected dose per gram in SK-RC-52 lesions at early time points with very low healthy organ uptake (tumor-to-kidney ratio of >23).

CONCLUSION

OncoCAIX demonstrated rapid and selective tumor uptake, which is a key feature for the development of radionuclide-based imaging agents for early and late-stage ccRCC and hypoxic tumors.

The global burden of bladder, kidney, and prostate cancers attributable to smoking from 1990 to 2021 and projections for the next two decades: A cross-sectional study

INTRODUCTION

Smoking increases the risk of bladder and kidney cancers and is associated with a poorer prognosis in prostate cancer (PCa) patients, which poses a significant health and socioeconomic burden. Understanding the epidemiologic trends of urological cancers attributable to smoking is critical to developing targeted prevention strategies. This study examines global trends in the three urological cancers attributable to smoking from 1990 to 2021 and projects future trends over the next two decades.

METHODS

Data were obtained from the Global Burden of Disease (GBD) 2021. Metrics included deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR), with uncertainty intervals (UIs). Burden comparisons were stratified by sex, age, and sociodemographic index (SDI). Temporal trends were analyzed using Joinpoint regression to calculate annual percentage change (APC) and average annual percentage change (AAPC), with 95% confidence intervals (CIs). Future trends were predicted using the autoregressive integrated moving average (ARIMA) model.

RESULTS

Compared with 1990, the number of deaths of bladder cancer, kidney cancer and PCa attributable to smoking increased by 43%, 67%, and 31%, and the number of DALYs increased by 31%, 52%, and 29% in 2021. However, the corresponding age-standardized rates showed a downward trend (AAPCASMR of bladder cancer, -1.53; AAPCASDR of bladder cancer, -1.68; AAPCASMR of kidney cancer, -0.89; AAPCASDR of kidney cancer, -1.11; AAPCASMR of PCa, -2.10; AAPCASDR of PCa, -1.97). The burden was higher among males than females, with the highest burden observed in high-SDI regions. The ASMR and ASDR were found to have a non-linear positive correlation with SDI (RASMR of bladder cancer=0.574, p<0.001; RASDR of bladder cancer=0.580, p<0.001; RASMR of kidney cancer=0.792, p<0.001; RASDR of kidney cancer=0.783, p<0.001; RASMR of PCa=0.417, p<0.001; RASDR of PCa=0.436, p<0.001), although the greatest improvements over the past three decades were observed in high-SDI regions. Joinpoint regression analysis indicated a downward trend in global deaths and DALYs burden, and the ARIMA model predicted that the burden of related diseases will continue to decline through 2041 (ASMRbladder cancer=0.44; ASDRbladder cancer=8.56; ASMRkidney cancer=0.13; ASDRkidney cancer=2.82; ASMRPCa=0.28; ASDRPCa=4.28).

CONCLUSIONS

Smoking has imposed a substantial disease burden on urological cancers over the past three decades. While overall ASDR and ASMR are declining, the disease burden remains high among men, especially those in high-SDI areas. This emphasizes the need for increased tobacco control for these populations or regions.

Global Burden of Kidney Cancer Attributable to High Body Mass Index in Adults Aged 60 and Older from 1990 to 2021 and Projections to 2040: A Systematic Analysis for the Global Burden of Disease Study

Background

With global aging, cancer burden rises. Kidney cancer is significantly influenced by high body mass index (BMI), especially in the elderly. This study analyzes the burden of kidney cancer attributable to high BMI in those aged ≥60, clarifying causes and future trends.

Methods

Using Global Burden of Disease (GBD) 2021 study, we assessed kidney cancer burden due to high BMI in population aged ≥60 from 1990 to 2021, comparing deaths, disability-adjusted life years (DALYs), age-standardized rate (ASR) of DALYs (ASDR), and mortality (ASMR). Stratified by Socio-Demographic Index (SDI), region, sex, and age, we evaluated spatiotemporal trends and inequalities. Finally, the Bayesian Age-Period-Cohort (BAPC) model predicted burden changes through 2040.

Results

From 1990 to 2021, DALYs and deaths from high BMI-induced kidney cancer in those aged ≥60 increased by 165.82% and 186.39%, driven by population growth. In 2021, ASDR was 45.55/100,000 and ASMR 2.39/100,000. Regional differences were significant. DALYs and deaths expanded, especially in those aged ≥95. Males had higher burden than females. SDI correlated positively with ASDR and ASMR (r>0, P<0.05). Health inequalities continue to rise. By 2040, burden is projected to rise, especially in low-middle and low SDI regions, more in males.

Conclusion

This study shows a significant increase in kidney cancer burden due to high BMI in those aged ≥60 over 32 years, driven by population growth. Disparities across regions, genders, and age groups highlight the need for targeted prevention and early intervention, especially for high-risk groups (males, elderly, low-middle SDI regions), to reduce burden and optimize healthcare resource allocation.

Synergistic Provoking of Pyroptosis and STING Pathway by Multifunctional Manganese-Polydopamine Nano-Immunomodulator for Enhanced Renal Cell Carcinoma Immunotherapy

Manganese ions are known to enhance anti-tumor immunity by activating the cGAS-STING signaling pathway. However, precise modulation of the tumor microenvironment using manganese ions remains a challenge. Dopamine, with its controlled release properties within the tumor microenvironment, offers significant potential for precision drug delivery systems. Metastatic renal cell carcinoma (RCC), being refractory to conventional treatments, necessitates innovative therapeutic approaches. In this study, a multifunctional manganese-polydopamine nano-immunomodulator coated with hyaluronic acid (PDA-Mn-HA NPs) is developed. These nanoparticles selectively bind to CD44 molecules, which are highly expressed in tumor-associated macrophages and RCC cells, and release manganese ions in a tumor microenvironment-responsive manner. Treatment with PDA-Mn-HA NPs effectively induces macrophage M1 polarization, triggers the production of pro-inflammatory cytokines and chemokines. Transcriptomic analysis reveals that PDA-Mn-HA NPs polarize and activate macrophages through the reactive oxygen species(ROS)-STING-p38/MAPK signaling pathway. Additionally, PDA-Mn-HA NPs induce ROS-caspase-3/GSDME-dependent pyroptosis in RCC cells via a Fenton-like reaction. In RCC mouse models, PDA-Mn-HA NPs remodel the macrophage-mediated immune microenvironment, enhance immune cell infiltration, and significantly suppress tumor growth. In conclusion, multifunctional PDA-Mn-HA NPs demonstrate translational potential by addressing the limitations of precision manganese delivery and achieving synergistic targeting of macrophages and tumor cells, offering a promising therapeutic strategy for RCC.

Dialysis and the risk of early urological cancer: A nationwide population-based cohort study in Taiwan

Patients with end-stage renal disease (ESRD) are predisposed to a higher risk of developing malignancies. This study aimed to explore the association between chronic dialysis with ESRD treated and the subsequent development of urothelial cell carcinoma or renal cell carcinoma (UC/RCC). Data spanning 13 years were retrieved from Taiwan's National Health Insurance Research Database. A total of 11,820 patients with ESRD undergoing maintenance dialysis between January 1, 2000, and December 31, 2013, and 35,460 controls matched for sex, age, and index year, were identified. After adjusting for confounding factors, Cox proportional hazards analysis was performed to compare the risk of UC/RCC during the 13-year follow-up period, and Kaplan-Meier analysis was used to evaluate the cumulative UC/RCC incidence between the ESRD and non-ESRD cohorts. The average time before developing UC/RCC was 4.18 years after dialysis initiation in the ESRD group compared to 5.39 years in the control group. After adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities, the hazard ratio for UC/RCC was 1.186 (95% confidence interval, 1.071-1.448; P = .005). Stratified by age, the odds ratios (ORs) for developing UC/RCC were 2.105, 1.498, 1.371, and 0.925 among patients with ESRD aged 40 to 49, 50 to 59, 60 to 69, and ≥ 70 years, respectively. Stratification by comorbidities revealed ORs of 1.204, 1.179, 1.186,1.172, 1.211, and 1.210 for patients without diabetes mellitus, hyperlipidemia, obesity, coronary artery disease, chronic obstructive pulmonary disease, and hematuria, respectively. The mean time to UC/RCC occurrence was 4.18 years after dialysis. Furthermore, younger male patients undergoing dialysis with fewer comorbidities were at higher risk of developing UC/RCC. Early or more intensive surveillance for urological cancers post-dialysis initiation is recommended for patients undergoing dialysis with longer life expectancies or a higher likelihood of undergoing renal transplantation.

Identification and validation of SLC16A8 as a prognostic biomarker in clear cell renal cell carcinoma: a six-gene solute carrier signature

Solute carrier (SLC) proteins are essential for nutrient transport, influencing tumor metabolism and growth while preserving cellular homeostasis. Despite the critical biological functions of these transporters, their applicability as therapeutic targets in clear cell renal cell carcinoma (ccRCC) remains largely unexplored. In the current study, we analyzed transcriptomic data and discovered 77 differentially expressed SLC genes in ccRCC, with 24 demonstrating predictive potential. Using Lasso regression, we developed a prognostic signature comprising six key genes: SLC2A3, SLC11A1, SLC14A1, SLC16A8, SLC22A6, and SLC28A1. This signature demonstrated strong diagnostic performance and served as an independent predictor of patient survival. Further analysis integrating clinical variables and risk scores enabled the construction of nomograms, which exhibited high predictive accuracy for patient outcomes. Immune profiling revealed distinct infiltration patterns between risk groups: high-risk patients showed elevated levels of memory B cells, activated CD4+ T cells, regulatory T cells (Tregs), M0 macrophages, and neutrophils. In contrast, their low-risk counterparts showed M1 macrophages, resting dendritic cells, and resting mast cells. Validation experiments confirmed that SLC16A8 was significantly overexpressed in ccRCC tissues compared to normal samples, correlating with poor prognosis. Functional studies demonstrated that SLC16A8 knockdown impaired tumor progression in vitro. Consistent with these findings, in vivo experiments demonstrated reduced tumor growth upon SLC16A8 knockdown. Mechanistically, decreased SLC16A8 attenuated PI3K/AKT signaling, suggesting a potential regulatory pathway in ccRCC progression. In summary, we established a six-gene SLC signature with significant prognostic value in ccRCC. Among these genes, SLC16A8 emerged as a promising biomarker and therapeutic target, warranting further investigation.

Association between intravenous 5 % albumin administration and acute kidney injury after partial nephrectomy. A retrospective study

BACKGROUND

Acute kidney injury (AKI) after partial nephrectomy is a frequent postoperative complication that can affect nearly half of patients, according to various studies. In the current study, we investigated the association of intraoperative administration of 5 % albumin, compared with crystalloids alone, with AKI after partial nephrectomy.

METHODS

This single-center retrospective study included adult patients undergoing partial nephrectomy. The primary endpoint was AKI within 72 h after surgery using the KIDGO definition. Secondary endpoints were time-to-AKI, reoperations, AKI severity and length of hospital stay. We used propensity score-based nearest-neighbor methods balance the patient baseline characteristics.

RESULTS

A total of 1688 patients were included in the analysis, with 809 receiving 5 % albumin and 879 in the control group. After matching, 729 patients received 5 % albumin, while 674 were controls. The incidence of acute kidney injury (AKI) was significantly higher in the 5 % albumin group (32.78 %) compared to the control group (25.51 %). Multivariate analysis revealed that receiving 5 % albumin was associated with a 32 % increased risk of developing AKI. Furthermore, the analysis indicated that this association was dose-dependent.

CONCLUSION

Our study suggests that intraoperative administration of 5 % albumin may not be a risk factor for AKI after partial nephrectomy. Given the discrepancy between these results and previous studies, a future prospective randomized controlled trial is needed to confirm our findings.

Trends in kidney cancer: exploring the impact of sex and age on stage of disease, and prognosis during the past three decades in Denmark-a DaRenCa study

Renal cell carcinoma (RCC) management has advanced due to increased imaging-based diagnoses and improved therapies for metastatic disease. This nationwide registry-based cohort study examines changes in the number of primary RCC cases, stage at diagnosis, prognosis during the past 30 years in Denmark, and how these are associated with sex and age. All Danish patients aged 18 and older diagnosed with primary RCC from 1992 to 2021 with no prior cancer history (except non-melanoma skin cancer) were included and followed from diagnosis until death or end of follow-up (31-12-2023). Statistical analyses included Pearson's χ2, Cramer's V, Wilcoxon rank-sum test, Kruskal-Wallis, competing risk regression, Cox proportional hazard regression, and Kaplan-Meier. 17,423 RCC patients were identified. Primary RCC cases increased from 2,244 in 1992-1996 to 3,947 in 2017-2021. In this period, the proportion of male patients increased from 59 to 72% (P < 0.001). Male patients were younger at diagnosis than female patients (median age 65 vs. 69 years, P < 0.001). Localized cancer cases increased from 44% (N = 983) in 1992-1996 to 70% (N = 2,766) in 2017-2021, while metastatic cases declined from 29% (N = 640) to 17% (N = 652). Median survival for metastatic RCC improved from 4.1 months in 1992-1996 to 13.3 months in 2017-2021. Over three decades, RCC incidence in Denmark has grown, particularly among men, largely due to localized disease, adding pressure on urological departments. The number of metastatic cases remained stable, but survival improved, reflecting advances in early detection and treatment.

The impact of radiotherapy on the prognosis of metastatic clear cell renal cell carcinoma after surgery

Clear cell renal cell carcinoma, one of the most common types of renal cell carcinoma, has been increasing in incidence year by year. This study aims to investigate the impact of radiotherapy on the prognosis of patients with metastatic clear cell renal cell carcinoma (mccRCC) undergoing cytoreductive surgery. Clinical data of patients with mccRCC who underwent cytoreductive surgery were collected from the SEER database (2000-2021). This study employed propensity score matching (PSM) and R software to evaluate the overall survival (OS) of radiotherapy. Univariate and multivariate COX regression analyses were conducted to explore the impact of different variables on prognosis. Finally, a nomogram was developed to predict patient survival rates. A total of 2076 patients with mccRCC who underwent cytoreductive surgery were included in this study, with 538 (25.92%) in the radiotherapy group and 1539 (74.08%) in the non-radiotherapy group. After propensity score matching (PSM), there were 300 cases in each group. Kaplan-Meier values and the Cox proportional hazards model were used to plot the overall survival (OS) curves, which showed that the median survival time in the radiotherapy group was significantly lower than that in the non-radiotherapy group. Additionally, multivariate Cox regression analysis revealed that tumor grade, N stage, radiotherapy, lung metastasis, and liver metastasis were independent factors affecting the prognosis of patients with mccRCC undergoing cytoreductive surgery. Lastly, a nomogram was developed to estimate the survival rates of patients with mccRCC after cytoreductive surgery. Radiotherapy after cytoreductive surgery may have an adverse impact on the prognosis of patients with mccRCC.

Comparative analysis of oncologic outcomes in surgically treated patients with renal cell carcinoma and renal vein thrombosis by pathologic subtypes

This study compares recurrence-free survival (RFS) and overall survival (OS) in patients with non-clear cell (nccRCC) and clear cell renal cell carcinoma (ccRCC) undergoing surgical nephrectomy with thrombectomy (SNTx) for RCC with venous thrombus. Data from patients who underwent SNTx at two tertiary centers (June 1990-December 2022) were retrospectively reviewed. Patients were grouped as ccRCC or nccRCC and stratified by metastasis status at surgery. Primary endpoints were RFS and OS for metastasis-naive RCC and OS for the entire cohort, including both metastasis-naive and metastatic RCC. Kaplan-Meier analysis with log-rank tests and adjusted multivariable Cox proportional hazards models were performed, with TN adjustments for the metastasis-naive group and TNM adjustments for the entire population. Among 604 patients, 504 (83.5%) were ccRCC. In nccRCC, 44 (44.0%) were papillary, 17 (17.0%) were chromophobe, and 39 (39.0%) were rare subtypes, most commonly TFE3 rearranged RCC, followed by the RCC not otherwise specified subtype (according to the 2022 World Health Organization Classification of RCC). Median OS was 85.8 months for ccRCC, 37.7 for papillary, 90.2 for chromophobe, and 16.9 for rare subtypes. Rare RCC histology was significantly associated with worse RFS (HR 1.63, p = 0.038) and OS (HR 1.82, p = 0.039) in metastasis-naive RCC. For the entire cohort including metastatic diseases, rare subtypes had worse OS (HR 2.20, p < 0.001), while other nccRCC subtypes did not differ significantly from ccRCC in OS. In patients with RCC with venous thrombosis, rare nccRCC subtypes exhibited poorer survival outcomes, even after adjustment for TN(M) stage.

Deep Learning for Classification of Solid Renal Parenchymal Tumors Using Contrast-Enhanced Ultrasound

The purpose of this study is to assess the ability of deep learning models to classify different subtypes of solid renal parenchymal tumors using contrast-enhanced ultrasound (CEUS) images and to compare their classification performance. A retrospective study was conducted using CEUS images of 237 kidney tumors, including 46 angiomyolipomas (AML), 118 clear cell renal cell carcinomas (ccRCC), 48 papillary RCCs (pRCC), and 25 chromophobe RCCs (chRCC), collected from January 2017 to December 2019. Two deep learning models, based on the ResNet-18 and RepVGG architectures, were trained and validated to distinguish between these subtypes. The models' performance was assessed using sensitivity, specificity, positive predictive value, negative predictive value, F1 score, Matthews correlation coefficient, accuracy, area under the receiver operating characteristic curve (AUC), and confusion matrix analysis. Class activation mapping (CAM) was applied to visualize the specific regions that contributed to the models' predictions. The ResNet-18 and RepVGG-A0 models achieved an overall accuracy of 76.7% and 84.5% across all four subtypes. The AUCs for AML, ccRCC, pRCC, and chRCC were 0.832, 0.829, 0.806, and 0.795 for the ResNet-18 model, compared to 0.906, 0.911, 0.840, and 0.827 for the RepVGG-A0 model, respectively. The deep learning models could reliably differentiate between various histological subtypes of renal tumors using CEUS images in an objective and non-invasive manner.

Management of Metastatic Renal Cell Carcinoma: Guideline Updates

Metastatic clear-cell renal cell carcinoma (mccRCC) remains a major cause of morbidity and mortality among patients with kidney cancer. Over the past two decades, mccRCC treatment has significantly evolved with the incorporation of antiangiogenic tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) as the cornerstone of systemic therapy. In response, major international guidelines have continuously updated their recommendations according to emerging evidence from clinical trials. We provide an overview of current management recommendations for mccRCC, including cytoreductive nephrectomy (CN), active surveillance (AS), first-line treatment, and subsequent-line treatment. While upfront CN is no longer recommended for unselected patients, it remains an option for carefully selected patients with a limited metastatic burden. AS can be considered for those with slow-growing, asymptomatic, low-volume disease. First-line treatment strategies now prioritize ICI based combinations tailored to patient risk factors, comorbidities, and disease characteristics. In subsequent lines, treatment sequencing remains a challenge, with ongoing research needed to refine therapeutic choices. As new evidence emerges, treatment strategies must continue to adapt, underscoring the need for ongoing updates to clinical guidelines. PATIENT SUMMARY: Clinical trials are continuously identifying new treatments for advanced kidney cancer. Our guideline provides updated treatment recommendations from international societies that are based on evidence from these trials. Personalized treatment can improve the care and outcomes for patients with advanced kidney cancer.

Increased ZNF83 is a potential prognostic biomarker and regulates oxidative stress-induced ferroptosis in clear cell renal cell carcinoma

While zinc finger proteins (ZFPs) are known to be crucial in various cellular activities such as gene expression regulation and energy metabolism, their specific roles in tumor progression are not well-documented. This study focuses on Zinc Finger Protein 83 (ZNF83) to explore its impact on clear cell renal cell carcinoma (ccRCC) and assess its viability as a prognostic biomarker. Public datasets were utilized to analyze ZNF83's expression and functions in ccRCC systematically. Further, in vitro and in vivo experiments were conducted to delve deeper into ZNF83's functional role. Techniques like electron microscopy for mitochondrial morphology and ROS level quantification were used to assess ferroptosis. RNA sequencing and metabolomic mass spectrometry were employed to understand ZNF83's role in oxidative stress modulation and ferroptosis resistance. Our findings demonstrated that ZNF83 overexpression significantly enhanced tumor cell survival and proliferation, while ZNF83 knockout suppressed these processes. Under oxidative stress or upon treatment with ferroptosis inducers, ZNF83 expression was markedly upregulated, and the protein predominantly localized to the cell nucleus. Notably, ZNF83 overexpression conferred resistance to ferroptosis, promoting tumor cell survival under ferroptosis-inducing conditions. Conversely, ZNF83 knockout sensitized cells to ferroptosis, increasing tumor cell death. RNA-seq and metabolomic analyses revealed that ZNF83 is intricately involved in the regulation of NRF2, a master regulator of the antioxidant response, and associated signaling pathways. ZNF83 represents a key ferroptosis regulator in ccRCC, serving as both a promising prognostic biomarker and therapeutic target. Targeting ZNF83 may improve treatment strategies for ccRCC patients. KEY MESSAGES: ZNF83 as a crucial regulator of tumor cell survival and proliferation in renal cancer, a novel discovery in the context of renal cancer progression. ZNF83 overexpression confers resistance to ferroptosis, enhancing tumor cell survival under oxidative stress or ferroptosis-inducing conditions. Utilizing both RNA sequencing and metabolomic mass spectrometry, we provide comprehensive insights into the molecular pathways, particularly NRF2-related, regulated by ZNF83 in ccRCC. ZNF83's potential as a novel prognostic biomarker for ccRCC is proposed, offering a new avenue for personalized treatment strategies and improving treatment outcomes for patients.

On integrative analysis of multi-level gene expression data in Kidney cancer subgrouping

Kidney cancer is one of the most dangerous cancer mainly targeting men. In 2020, around 430, 000 people were diagnosed with this disease worldwide. It can be divided into three prime subgroups such as kidney renal cell carcinoma (KIRC), kidney renal papilliary cell carcinoma (KIRP) and kidney chromophobe (KICH). Correct identification of these subgroups on time is crucial for the initiation and determination of proper treatment. On-time identification of this disease and its subgroup can help both the clinicians and patients to improve the situation. Hence, this study checks the possibility of using multi-omics data in the kidney cancer subgrouping, whether integrating multiple omics data will increase the subgrouping accuracy or not. Four different molecular data such as genomics, proteomics, epigenomics and miRNA from The Cancer Genome Atlas (TCGA) are used in this study. As the data is in a very high dimension world, this study starts with selecting the relevant features of the study using Pearson's correlation coefficient. Those selected features are used with three different classification algorithms such as k-nearest neighbor (KNN), supporting vector machines (SVMs) and random forest. Performances are compared to see whether the integration of multi-omics data can improve the accuracy of kidney cancer subgrouping. This study shows that integration of multi-omics data can improve the performance of the kidney cancer subgrouping. The highest performance (accuracy value of 0.98±0.03) is gained by top 400 features selected from integrated multi-omics data, with support vector machines.

The complement system and kidney cancer: pathogenesis to clinical applications

Kidney cancer poses unique clinical challenges because of its resistance to conventional treatments and its tendency to metastasize. The kidney is particularly susceptible to dysfunction of the complement system, an immune network that tumors often exploit. Recent discoveries have highlighted that the complement system not only plays a crucial role in immune surveillance and defense in the circulatory system, but also functions intracellularly and autonomously. This concept has shifted the focus of investigation toward understanding how complement proteins influence cancer progression by regulating the tumor microenvironment (TME), cell signaling, proliferation, metabolism, and the immune response. With the complement system and its inhibitors emerging as a promising new class of immunotherapeutics and potential complement-targeted treatments advancing through development pipelines and clinical trials, this Review provides a timely examination of how harnessing the complement system could lead to effective tumor treatments and how to strategically combine complement inhibitors with other cancer treatments, offering renewed hope in the fight against kidney cancer.

Pre- and post-diagnosis body weight trajectories in patients with localized renal cell cancer

PURPOSE

Obesity in mid-life is a well-established risk factor for developing renal cell carcinoma (RCC); however, patients with RCC who are obese at the time of diagnosis have more favorable survival outcomes. To get better insight into the obesity paradox and determine the extent to which weight around diagnosis is stable, we examined pre- and post-diagnosis weight changes in patients with localized RCC.

METHODS

We included 334 patients with localized RCC from the prospective cohort ReLife who self-reported body weight at multiple time points ranging from 2 years before to 2 years after diagnosis. Multivariable linear mixed-effects regression models were used to compare weight at each timepoint to weight at diagnosis for the overall study population, as well as stratified by BMI at diagnosis, tumor stage, and tumor grade.

RESULTS

Most patients were classified as overweight (38.3%) or obese (29.6%) at diagnosis. Overall, patients experienced on average 1.45 kg (95% confidence interval (CI) 0.84, 2.06) weight loss in the 2 years before diagnosis. Pre-diagnosis weight loss was higher in patients who were non-obese at diagnosis, and who presented with higher tumor stage and grade. On average, pre-diagnosis weight loss was at least partially regained within two years after diagnosis.

CONCLUSION

Patients who were non-obese and patients with higher stage and grade tumors had higher pre-diagnosis weight loss, which was at least partially regained after treatment. These patterns suggest there are subgroups of patients with localized RCC who experience disease-related weight loss, which could contribute to the obesity paradox.

Mefloquine Suppresses Metastasis in Renal Cell Carcinoma Through Targeting SPC25

Renal cell carcinoma (RCC) is the third most common malignant tumor in the urinary system, often presenting with distant metastases at diagnosis. Approximately one-quarter of patients undergoing nephrectomy experience distant recurrence. Despite the recent advancements in combination-targeted and immune checkpoint inhibitor therapies, the development of new therapeutic strategies and the identification of biomarkers for metastatic risk remain crucial. The study found that high SPC25 expression is closely associated with poor clinical outcomes, and knocking down SPC25 significantly inhibits tumor cell proliferation and migration. Non-targeted metabolomics analysis also revealed that SPC25 knockdown reduces tumor cell activity, resulting in a low-invasive state. Additionally, this study utilized high-throughput molecular docking to screen small molecule drugs targeting SPC25, aiming to find drugs that inhibit RCC metastasis. The research discovered that mefloquine, at concentrations that do not significantly kill tumor cells, can markedly inhibit RCC metastasis. It was the first to report that mefloquine achieves its anti-metastatic effects by binding to SPC25 and inhibiting epithelial-mesenchymal transition. These results suggest that SPC25 has the potential to serve as an early biomarker for metastatic risk in RCC and highlight a novel strategy where mefloquine inhibits RCC metastasis through SPC25 binding, offering new avenues to improve the prognosis of RCC patients.

The intersection of histologies: navigating the complexity of a renal collision tumor

Renal cell carcinoma is a heterogeneous group of renal tumors characterized by several histological subtypes. Herein, we discuss an unusual case of a 55-year-old male who presented as a consultation to our urology clinic with an incidentally found renal mass. After shared decision making patient proceeded with a Robotic Assisted Laparoscopy (RAL) left sided partial nephrectomy. Final pathology confirmed the presence of high nuclear grade mixed clear cell and papillary renal cell carcinoma (RCC) of the left kidney (pT3aN0M0). This case elucidates a very rare incidence of a patient seen to have a collision tumor, and furthermore demonstrates guideline-based treatment.

DERL3 facilitates the progression of clear cell renal cell carcinoma by promoting epithelial-mesenchymal transition via regulation of the TGFB1 pathway

BACKGROUND

Clear cell renal cell carcinoma (ccRCC) is a highly prevalent malignancy within the urinary system. The intrinsic heterogeneity and resistance to conventional chemotherapy and radiotherapy contribute to the poor prognosis of advanced ccRCC patients. DERL3, part of the Derlin protein family, was first identified for its critical role in endoplasmic reticulum stress. Subsequent studies have revealed its involvement in the progression of multiple tumor types; however, its role in ccRCC remains unclear.

METHODS

In this study, we utilized bioinformatics analysis and in vitro experimental approaches to investigate the role of DERL3 expression in the metastasis of renal clear cell carcinoma cells. Additionally, we analyzed the correlation between DERL3 expression and the prognosis of renal clear cell carcinoma patients, while exploring its potential mechanisms of action.

RESULTS

We demonstrate for the first time that DERL3 promotes tumor progression in ccRCC, showing significantly elevated expression, especially in metastatic ccRCC cell lines. Further studies suggest that this overexpression of DERL3 may promote the epithelial-mesenchymal transition in ccRCC by upregulating TGF-β1, thereby enhancing ccRCC metastasis.

CONCLUSION

In conclusion, our study clarifies the role and potential mechanisms of DERL3 in ccRCC progression, providing promising therapeutic avenues for improving the prognosis of ccRCC patients.

Burden of Urological Cancers in the Labour Force from 1990 to 2021 and Projections to 2050

BACKGROUND

Urological cancers represent an increasing public health concern in the labour force, mainly including prostate cancer (PCA), kidney cancer (KCA), testicular cancer (TCA), and bladder cancer (BLCA). Limited data exist on their occurrence, deaths, and disability-adjusted life years (DALYs). The objective of this study was to analyse three-decade trends in these cancers globally and forecast future patterns.

METHODS

The study used Global Burden of Disease 2021 data from 1990 to 2021 to evaluate urological cancer stats, including prevalence, incidence, mortality, and DALYs. For people aged 15-64 years, it was then manually age-standardized once. Herein, we employed a range of analytical techniques, including decomposition analysis, a Bayesian Age-Period-Cohort model, a Concentration index and slope index, and frontier analysis, to examine the trends in 204 countries and regions. Furthermore, the relationship between the Socio-Demographic Index (SDI) and the burden of disease is addressed.

RESULTS

Over the past 30 years, PCA, TCA, and KCA rates have risen among the global labour force population. North America, North Asia, and Europe have high incidence and mortality rates. TCA mortality and BLCA and TCA prevalence are expected to continue rising globally until 2050. Urological cancer impacts vary by region and development with more burden in areas with a higher SDI.

CONCLUSIONS

Urological cancers represent a substantial disease burden on labour force populations, emphasizing the imperative for targeted interventions and healthcare resources for affected populations. It is therefore crucial to have a comprehensive understanding of the global and regional epidemiological trends, as well as the findings of health economics studies.

The role of adherent-to-suspension transition factors in clear cell renal cell carcinoma progression: a comprehensive analysis

Recent studies have identified a biological process called adherent-to-suspension transition (AST) as a key factor in promoting metastasis. The involvement of AST in the progression of clear cell renal cell carcinoma (ccRCC) remains largely unexplored. We comprehensively investigated the overall landscape of all 20 AST factors at the pan-cancer level. The risk stratification method and the prognostic model based on AST factors were established with consensus clustering analysis and LASSO regression algorithm. The potential molecular mechanism of AST was further investigated by multi-omics analysis and cell experiments. We found that AST factors play distinct roles in different cancer types. Consequently, we utilized AST factors to develop a risk stratification method and a prognostic model, which can effectively guide the treatment of ccRCC patients. We proposed that the promotion of AST is facilitated by SPIB through the SAA1-AKT pathway, enhancing the likelihood of ccRCC metastasis, and conducted rigorous analyses using multi-omics data and cellular experiments. Our study presents a novel risk stratification method and prognostic model for ccRCC. And we identified the SPIB-SAA1-AKT pathway as one of the potential mechanisms by which AST factors promote ccRCC metastasis.

Examining the evolving landscape of kidney cancer mortality in the United States

BACKGROUND

Kidney cancer (KC) remains a significant contributor to cancer-related mortality in the United States, with an alarming increase in disease burden. To address this critical health issue, this study aims to investigate trends in KC mortality.

METHODS

We retrieved mortality data from the Center for Disease Control WONDER database using the International Classification of Diseases 10 code C64. Age Standardized Mortality Rates (ASMRs) per 100 000 population were divided by age/gender/race/ethnicity-American Indian or Alaskan Native (AIAN)/Asian/African American (AA)/White/Hispanic/non-Hispanic-from 1999 to 2020. Joinpoint regression is conducted to calculate Average Annual Percentage Changes (AAPCs) and compare trends.

RESULTS

A total of 284 224 deaths were reported. In 2020, the greatest ASMR was in Whites (3.9/100.000), followed by AIANs (3.5), AA (3.3), and Asians (1.6). ASMRs were 3.2 for Hispanics and 3.5 for non-Hispanics, with decreases of 11.4% and 12.5%; 5.0 for males and 2.1 for females, with decreases of 13.8% and 22.2%, respectively. AIAN males experienced the greatest ASMR decrease (44.3%), White males the smallest (1.7%). AIAN (AAPC = -1.9%), and AA (AAPC = -1.3%) showed a single negative trend line, while ASMRs in Asian (AAPC = -0.6%) and White population (AAPC = -0.6%) initially increased then declined. Younger populations experienced greater decreases, whereas populations over 85 had increasing ASMRs.

CONCLUSIONS

Over 20 years, the greatest ASMR shifted from AIAN to White individuals, with a nationally decreasing trend. The elderly and male populations continue to experience greater ASMRs. Overall, our findings provide key insights for identifying at-risk populations, guiding the development of targeted strategies to reduce disparities.

KIF14 plays a role in the regulation of the cell cycle and has implications for prognosis in clear cell renal cell carcinoma

BACKGROUND

Kinesin family member 14 (KIF14) is a significant multifunctional protein that has been linked to several malignancies. However, the varied expression profiles of KIF14 and its prognostic relevance in Clear cell renal cell carcinoma (ccRCC) have yet to be elucidated.

METHODS

Patients with ccRCC were obtained from The Cancer Genome Atlas (TCGA), Gene Expression Omnibus (GEO) and ArrayExpress databases. A comparison of KIF14 expression levels between ccRCC and normal tissues was conducted using the Wilcoxon rank sum test. Logistic regression analysis was subsequently employed to evaluate the relationship between KIF14 expression and clinicopathological features. Furthermore, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) term analysis, gene set enrichment analysis (GSEA) and single sample gene set enrichment analysis (ssGSEA), as well as CIBERSORT, were utilized to elucidate the enriched pathways and functions linked to KIF14 and to quantify the level of immune cell infiltration. Kaplan-Meier analysis was conducted to assess the correlation between KIF14 expression and survival. Additionally, KIF14 expression was downregulated in A498 ccRCC cells, and their proliferation, expansion capacity, cell cycle, and apoptosis were assessed through CCK-8 assays, colony formation assays, 7-AAD staining, and Annexin V/PI staining, respectively.

RESULTS

The findings of this study demonstrate that KIF14 mRNA levels are notably increased in ccRCC. Furthermore, a positive association was observed between KIF14 expression and cancer stage, nodal metastasis, and the infiltration of various immune cells in ccRCC. High levels of KIF14 were also found to be indicative of poor survival outcomes among ccRCC patients. Knockdown of KIF14 in A498 cells resulted in reduced proliferation, diminished colony formation capacity, cell cycle arrest, increased apoptosis, and downregulation of CyclinD1 and CDK4.

CONCLUSIONS

KIF14 down-regulates cell cycle proteins CyclinD1 and CDK4 to facilitate the proliferation of ccRCC cells, suggesting its potential as a therapeutic target and prognostic biomarker in ccRCC.

Outcomes of Minimally Invasive Nephrectomy Following Immune-Checkpoint Inhibitor Therapy: A Multicenter Propensity Score-Matched Analysis

Objectives: To report the outcomes of minimally invasive (MIS) nephrectomy following immune checkpoint inhibitor (ICI) therapy. Materials and Methods: This multicenter retrospective cohort study included consecutive patients who underwent nephrectomy following ICI therapy at five high-volume US academic centers between 2015 and 2023. Baseline clinical features and perioperative findings were recorded. After propensity-score matching (PSM), outcomes were compared between MIS and open nephrectomies. The primary outcome was 90-day complications, and secondary outcomes included length of hospital stay (LOS) and 90-day readmission. Results: A total of 158 patients were included, of whom 76 and 82 underwent MIS and open nephrectomies, respectively. The MIS procedures included robotic (n = 56) and laparoscopic (n = 20). A total of six (8%) patients converted to open. On multivariable analysis, patients with nonmetastatic vs metastatic renal-cell carcinoma (RCC) (hazard ratio [HR] 3.1, p = 0.01), those with smaller tumor size (HR 1.2 for each cm, p = 0.001), and no clinical evidence of inferior vena cava thrombus (HR 29, p = 0.002) were more likely to undergo the MIS approach compared with open approach. After PSM, including 56 MIS and 36 open nephrectomies, the MIS group compared with the open group had lower estimated blood loss (100 vs 460 mL, p < 0.001) and shorter LOS (2 vs 4 days, p < 0.001). Nevertheless, 90-day complications and readmissions were similar between the two groups. There were no 90-day mortality rates in either group. Conclusion: The MIS approach appears safe and offers more favorable perioperative outcomes compared with open surgery in properly selected patients with advanced RCC who are candidates for nephrectomy following ICI therapy.

Profile and methodology of ancillary protective measures employed during percutaneous renal cryoablation in a single high-volume centre

OBJECTIVES

To evaluate the at-risk organs that require protection during percutaneous cryoablation (PCA) of renal tumours and the correlation with patient and target lesion characteristics, type of protective measure used and postoperative outcomes.

MATERIALS AND METHODS

Single-centre retrospective review of patients with renal tumours who underwent PCA between 2008 and 2020. Final analysis included 374 tumours. Patient, tumour, and procedure technical details were extracted and analysed. At-risk organs were classified according to tumour location relative to kidney side, pyelic axis, and polar lines.

RESULTS

There were 171 (46.0%) tumours in the left kidney, and 194 (52.0%) in the right. Cryoprotection was required for 272 (272/374; 73.0%) tumours, with hydrodissection (216/374; 58.0%) being the most common technique. Protective measures were used for 82 (82/93; 88.0%) tumours in under/normal-weight patients and 143 (143/196; 73.0%) in overweight/obese ones (P = 0.004). In the left kidney, colon was the most common at-risk organ (63/171; 37.0%), followed by spleen (21/171; 12.3%), small bowel (21/171; 12.3%), ureter (19/171; 11.1%), abdominal wall (15/171; 8.8%), psoas muscle (10/171; 5.8%), and pancreas (9/171; 5.3%). In the right kidney, common at-risk organs were the colon (67/194; 35.0%), liver (50/194; 25.7%), ureter (15/194; 15.5%), diaphragm (16/194; 8.2%), abdominal wall (14/194; 7.2%), and duodenum (12/194; 6.1%). No cryoinjuries to at-risk organs occurred.

CONCLUSION

Hydrodissection is the most common cryoprotective measure used for renal tumour PCA. Under/normal-weight patients are more likely to require cryoprotection. The colon is the most common adjacent at-risk organ requiring protection for both right- and left-sided tumours.

Epidemiological profile of kidney cancer in Brazil: a multiregional ecological study

INTRODUCTION

Renal neoplasia is a complex and heterogeneous disease, characterized by high morbidity and mortality.

OBJECTIVE

To analyze the temporal trend of hospitalization rates (HRs) for renal neoplasia in Brazil, segmented by region, states (UFs, Unidades da Federação in Portuguese), and population characteristics, from 2013 to 2023.

METHODS

Ecological study using data from the Hospital Information System, by analyzing Hospital Admission Authorizations, covering the period from 2013 to 2023. The annual trend of HRs was analyzed using generalized linear regression with the Prais-Winsten method by calculating the Annual Percentage Change (APC), considering sex, age, race/color, and region/state (UF). A significance level of 5% was adopted for the analyses.

RESULTS

A total of 31,388 hospitalizations for renal neoplasia were recorded in Brazil during the period, showing a significant upward trend in HRs (APC: 9.12; 95%CI: 5.30; 13.1; p < 0.001). The increase was observed in both sexes and in all regions. Among the states, most showed stationary trends. The highest average HRs were identified among young elderly individuals (3.31/100,000) and long-lived elderly individuals (2.51/100,000).

CONCLUSION

HRIs due to renal neoplasia in Brazil showed a significant upward trend between 2013 and 2023, with regional variations, a predominance in males, and a higher incidence in the over-60 age group.

Optimizing outcomes of partial nephrectomy in patients with tumors in solitary kidneys: a non-systematic review

This review consolidates recent evidence on managing renal cell carcinoma (RCC) in patients with solitary kidneys. It provides a comprehensive discussion of evolving strategies in partial nephrectomy-including open, laparoscopic, and particularly robot-assisted partial nephrectomy (RAPN)-along with thermal and advanced ablative therapies, non-surgical options (such as stereotactic ablative body radiotherapy [SABR] and active surveillance [AS]), and emerging neoadjuvant systemic treatments with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs). In addition, the integration of artificial intelligence (AI) for preoperative planning, intraoperative guidance, and postoperative outcome prediction is discussed. Given the limited renal reserve in these patients, preserving functional renal parenchyma is paramount. This multidisciplinary review synthesizes evidence from 2018 to the present and is supported by 70 contemporary references.

MIAT: A pivotal oncogenic long noncoding RNA tunning the hallmarks of solid malignancies

Long non-coding RNAs (LncRNAs) have emerged as intriguing players in cellular regulation, challenging the traditional view of non-coding RNAs as mere "dark genome". Non-coding DNA makes up most of the human genome and plays a pivotal role in cancer development. These RNA molecules, which do not code for proteins, have captivated researchers with their diverse and crucial roles in gene regulation, chromatin dynamics, and other cellular processes. In several physiological and pathological circumstances, lncRNAs serve critical functions. This review will tackle the complex function of the lncRNA myocardial infarction-associated transcript (MIAT) in various solid malignancies. A special emphasis would be directed on the correlation between cancer patients' clinicopathological features and the expression profile of MIAT. MIAT is a oncogenic regulator in many malignant tumors, where it can control the growth, invasion, metastasis, and resistance to death of cells. As a result, MIAT is thought to be a possible biomarker and therapeutic target for cancer patients. The biological functions, mechanisms and potential clinical implications of MIAT during carcinogenesis and finally the current possible therapeutic approaches targeting MIAT are also outlined in this review.

Role of artificial intelligence in predicting the renal function after nephrectomy in renal cell carcinoma: a systematic review and meta-analysis

PURPOSE

To explore and assess the role of artificial intelligence (AI) in predicting the postoperative renal function in Renal Cell Carcinoma (RCC) patients undergoing nephrectomy.

METHODS

A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Scopus, and Web of Science. PRISMA guidelines were followed throughout the systematic review and meta-analysis. The studies that used AI models to predict renal function after nephrectomy were included in our review. The details of different AI models, the input variables used to train and validate them, and the output generated from these models were recorded and analysed. The risk of bias was assessed using the Prediction Model Study Risk of Bias Assessment Tool (PROBAST).

RESULTS

After the screening, a total of nine studies were included for the final analysis. The most common AI algorithms that were used to predict were based on machine learning models, namely Random Forest (RF), support vector machine (SVM) and XGBoost. Different performance metrics of various AI models were analysed. The pooled AUROC (area under the receiver operating curve) of the AI models was 0.79 (0.75-0.84), I2 = 15.26%.

CONCLUSION

AI models exhibit significant potential for determining postoperative renal function in RCC patients. They integrate multimodal data to generate more accurate results. However, standardising the methodologies and reporting, utilising diverse datasets, and improving model interpretability can lead to widespread clinical adaptation.

Prospective randomized phase-II trial of ipilimumab/nivolumab versus standard of care in non-clear cell renal cell cancer - results of the SUNNIFORECAST trial

BACKGROUND

Non-clear cell renal cell cancers (nccRCCs) are a heterogeneous group of more than 20 different entities, but are rarely included in large, randomized trials. Tyrosine kinase inhibitors with or without immune checkpoint inhibition are considered as a standard of care (SOC), but optimal treatment is not yet defined. We designed the first prospective randomized trial comparing ipilimumab/nivolumab to SOC.

PATIENTS AND METHODS

We randomized adult patients with previously untreated advanced or metastatic nccRCC 1:1 to nivolumab 3 mg/kg plus ipilimumab 1 mg/kg every 3 weeks for 4 doses followed by fixed dose nivolumab of 240 mg every 2 weeks or 480 mg every 4 weeks or to SOC. Patients were stratified by histology and by IMDC risk score. Central pathology review was mandatory. The primary endpoint was the overall survival (OS) rate at 12 months, secondary endpoints included median OS, response rate, progression-free survival (PFS), safety and quality of life.

RESULTS

In total, 157 patients were assigned to receive ipilimumab/nivolumab, and 152 to SOC. The 12-month survival rate was 78% with ipilimumab/nivolumab [95% confidence interval (CI) 71-84%] compared to 68% with SOC (95% CI 60-75%, P = 0.026). Median OS was 33.2 months versus 25.2 months, P = 0.163 [HR 0.81 (0.61-1.099)]. PFS was similar in both arms [HR 0.99 (0.77-1.28)]. The ORR was 32.8% versus 19.3%. No major differences between papillary and non-papillary RCC subtypes were observed for any endpoint. Exploratory analysis showed a significant OS advantage [HR 0.56 (95% CI 0.37-0.86)] associated with a PD-L1 CPS score ≥1. Treatment discontinuation due to toxicity occurred in 27 patients (17%) with ipilimumab/nivolumab and 13 patients (9%) with SOC.

CONCLUSIONS

Ipilimumab/nivolumab demonstrated a significantly longer OS at the 12-month milestone and an acceptable toxicity profile. Our results therefore underline a relevant clinical benefit of ipilimumab/nivolumab in previously untreated nccRCC entities compared to current SOC.

The prognostic impact of PBRM1 immunohistochemical expression and its association with CD3 + and CD8 + immune cells in patients with renal cell carcinoma: A retrospective study

The objective of this study is to determine the prognostic implications of PBRM1 immunohistochemical (IHC) expression in renal cell carcinoma (RCC) patients. Additionally, the objective is extended to evaluate the association between PBRM1 expression and CD3 + and CD8 + immune infiltrates. This study retrospectively reviewed 115 RCC patients who underwent nephrectomy. Immunohistochemistry was performed for PBRM1, CD3, and CD8. The associations between the studied parameters and variable clinicopathological characteristics, including survival, were analyzed statistically. A significant association was observed between the low expression of PBRM1 (< 50 %) and aggressive clinicopathologic features (p value around 0.001), as well as a significantly worse 3-year overall survival (OS) and disease-free survival (DFS) (p value around 0.001). PBRM1 low expression was considered an independent predictor of shortened DFS in multivariate analysis (p = 0.030). In addition, PBRM1 expression was incorporated into the SSPN scoring system (stage, sarcomatoid, PBRM1 expression, and necrosis) for recurrence risk stratification. The four risk groups exhibited substantial disparities in OS and DFS (p < 0.001). Moreover, a robust correlation was observed between the high density of immune infiltrate (number of CD3 + and CD8 + immune cells/mm2) and the low expression of PBRM1 (p < 0.001). In conclusion, poor prognosis and tumor progression are strongly associated with a low expression of PBRM1. Postoperative recurrence can be accurately predicted by the SSPN score, which incorporates PBRM1 expression and clinicopathologic findings. Patients with high-risk factors associated with low expression of PBRM1 and a dense inflamed microenvironment could potentially benefit from effective immunotherapy and target treatment.

Osalmid sensitizes clear cell renal cell carcinoma to navitoclax through a STAT3/BCL-XL pathway

Clear cell renal cell carcinoma (ccRCC) is a common and lethal urinary malignancy characterized by its resistance to apoptosis. Despite the emerging treatment options available for ccRCC, only a small proportion of patients achieve long-term survival benefits. Previous studies have demonstrated that inducing tumor cell senescence, followed by treatment using senolytics, represents a potential strategy for triggering tumor cell apoptosis. However, it remains unclear whether this strategy is suitable for the treatment of ccRCC. Using the whole-genome CRISPR screening database Dependency Map portal (DepMap), we identified ribonucleotide reductase family member 2 (RRM2), which catalyzes the conversion of ribonucleotides to deoxyribonucleotides (dNTPs), as an essential targetable gene for ccRCC. Herein, we report that the combination of the choleretic drug osalmid targeting RRM2 and the senolytic compound navitoclax targeting BCL-XL represents a novel therapeutic approach for ccRCC. Furthermore, we have validated this approach across a panel of human ccRCC cells with different genetic backgrounds and multiple preclinical models, including cell line-derived xenografts (CDX), patient-derived xenografts (PDX), and patient-derived organoids (PDO). Mechanistically, osalmid-mediated inhibition of dNTPs generation induces cellular senescence in ccRCC, concomitant with STAT3 activation and upregulation of BCL-XL, thus rendering these cells vulnerable to navitoclax, which targets the BCL-2 protein family.

FABP4-mediated ERK phosphorylation promotes renal cancer cell migration

Clear cell Carcinoma (ccRCC) is the most common and lethal subtype among renal cancers. In the present study we investigated the potential role of fatty acid-binding protein 4 (FABP4), also known as adipocyte FABP (A-FABP) or aP2 on ccRCC progression. Firstly, we found that FABP4 median serum levels were significantly higher in ccRCC patients compared to HD. Based on this result and to evaluate whether FABP4 plays a role on renal cancer malignant phenotype, we analyzed proliferation and migration in 786-O and ACHN cell lines using recombinant FABP4. We found that FABP4 significantly increased cell migration, whereas it had no significant effect on proliferation. As FABP4 is mainly expressed by adipocytes, we measured FABP4 adipocyte conditioned media (Ad-CM) levels showing that Ad-CM from ccRCC (Ad-CM ccRCC) had significantly higher mean values compared to Ad-CM obtained from Healthy Donors (HD). To assess the effects of adipocyte-released FABP-4, on cancer malignant phenotype we evaluated 786-O and ACHN proliferation and migration, using Ad-CM from ccRCC and Ad-CM from HD alone or in combination with FABP4 inhibitor BMS309403. Our results showed that Ad-CM enhanced cell proliferation in ACHN, but not in 786-O and on cell motility in both cell lines and this effect was partially reverted by BMS309403 in both cell lines. Moreover, in both cell lines, FABP4 effect was associated with an increased ERK phosphorylation. Collectively these data support the role of FABP4 in ccRCC progression and its potential use as noninvasive biomarker and therapeutic target for ccRCC.

Factors that predict progression of von Hippel-Lindau disease-related malignancy: a longitudinal cohort study

BACKGROUND

Von Hippel-Lindau (vHL) disease encompasses various genetic subtypes with poorly defined progression patterns. This retrospective study of a longitudinal cohort aimed to characterize follow-up duration, treatment rates, and progression patterns according to genomic subtype, and to identify risk factors for progression.

METHODS

Between June 2003 and June 2020, the study enrolled 94 patients (mean age, 37.1 years; 49 females; 84 with missense mutations and 10 with truncating (i.e., insertion/deletion) mutations in the VHL tumor suppressor gene). MRI and CT imaging data were analyzed to compare tumor incidence between the two mutation groups. Cox regression analysis was used to assess predictors of hemangioblastoma (Hb) and renal cell carcinoma (RCC) progression based on genetic subtype, tumor volume, and clinical characteristics.

RESULTS

Patients with missense mutations were more often treated for RCC (p = 0.013) and adrenal pheochromocytoma (p < 0.001) than those with truncating mutations; however, genetic subtype was not a significant predictor of time-to-progression of Hb or RCC. Larger tumor volume at baseline was an independent predictor of Hb progression (HR, 1.029; 95% CI, 1.013-1.046; p < 0.001) and RCC (HR, 1.011; 95% CI, 1.005-1.017; p < 0.001). Male sex was also an independent predictor of RCC progression (HR, 3.368; 95% CI, 1.351-8.396; p = 0.009).

CONCLUSIONS

Genetic subtype was not associated with progression of vHL disease, but missense mutations were associated with higher treatment rates for RCC and adrenal pheochromocytoma. The finding that progression of Hb and RCC is linked to larger baseline tumor volume and male sex may facilitate clinical management.

Case Report: a giant liposarcoma of the spermatic cord

Background

Liposarcoma of the spermatic cord is an extremely rare urological malignancy, with fewer than 300 cases reported in the literature worldwide, and it is often difficult to distinguish from inguinal hernias and epididymal cysts. Typically, it presents as an asymptomatic, slow-growing paratesticular mass.

Case presentation

The case described herein involves a 59-year-old man who presented to our hospital with a painless mass in the left scrotum. Physical examination revealed a fixed, firm mass in the left scrotum. Ultrasonography of the scrotum demonstrated an inhomogeneous echogenic mass measuring approximately 113 x 83 x 62 mm on the left side. Testicular MRI showed a mass in the left scrotum measuring approximately 67 x 56 x 98 mm, exhibiting isointence T1 mixed with high T2 signals. The patient then underwent surgery and pathology confirmed a liposarcoma of the spermatic cord. Currently no signs of tumor recurrence on follow-up.

Conclusions

Liposarcoma of the spermatic cord is an exceedingly rare condition, for which surgical intervention is the preferred treatment option. While there is no definitive evidence supporting the use of adjuvant radiotherapy following surgery, it remains necessary in cases where surgical margins are uncertain.

Liquid-based kidney injury molecule-1 as a diagnostic and prognostic indicator in renal cell carcinoma: A systematic review and meta-analysis

PURPOSE

Noninvasive biomarkers for renal cell carcinoma (RCC) are vital but scarce. Kidney injury molecule-1 (KIM-1) is a transmembranous glycoprotein that is sensitive and specific to kidney injury. KIM-1 is overexpressed in RCC, and its ectodomain can be detected in blood and urine. Here, we explored whether KIM-1 is a diagnostic or prognostic indicator in RCC.

METHODS

A comprehensive online literature search was performed in PubMed, Web of Science, Embase, Cochrane Library, ClinicalTrails, and Database of major urological or oncological congress. We screened the literature and extracted the data according to the selection criteria. The quality of eligible studies was measured via the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Newcastle-Ottawa scale. The certainty of the evidence (CoE) was assessed by the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) score. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the curve of the summary receiver operating characteristic curve (AUROC), and survival outcomes were subsequently estimated in Stata and MetaDisc. Subgroup analysis, meta-regression, and sensitivity analysis were performed to reveal the source of heterogeneity.

RESULTS

A total of eight studies were included for further analysis. The pooled sensitivity of KIM-1 for RCC diagnosis was 0.78 (95% CI: 0.69-0.85, I2 = 84.61%, p < 0.01), and the pooled specificity was 0.79 (95% CI: 0.65-0.89, I2 = 90.72%, p < 0.01). The AUROC was 0.85 (95% CI: 0.82-0.88). A moderate CoE was indicated by GRADE score. A higher KIM-1 level was associated with worse disease-free survival (HR = 1.76, 95% CI: 1.48-2.09, I2 = 0.00%, p < 0.001). Study continent, number of study center, and sample type are the potential contributors of heterogeneity.

CONCLUSION

Liquid-based KIM-1 is a promising noninvasive biomarker for early RCC detection, surveillance, and prognosis prediction. More validations in large cohorts are needed to confirm these findings.

Protective Effect of Semaglutide on Obesity-Induced Renal Disease and Obesity-Induced Kidney Renal Clear Cell Carcinoma

Purpose

Proteomics was used to study the effect of semaglutide on the expression of renal protein in obese mice, and looking for proteins that could improve the prognosis of Kidney Renal Clear Cell Carcinoma (KIRC).

Materials and Methods

Thirty-six mice were randomly divided into normal-fat diet group (NFD), high-fat diet group (HFD), high-fat diet plus semaglutide intervention group (HS). Collected mice serum, urine, kidney tissue samples, and detected urinary protein/creatinine, blood glucose, blood lipid, inflammation, oxidative stress and other related indicators. Different staining methods were used to analyze the pathological changes of mice's kidneys. Liquid chromatography-tandem mass spectrometry mass spectrometry (LC-MS/MS) analysis was used to analyze the total protein in the kidneys of mice. Finally, bioinformatics technology was used to analyze significantly different expressed proteins (DEPs).

Results

The mechanism of semaglutide protecting the kidneys were related to oxidative phosphorylation, PPAR signaling pathway, thiamine, butyric acid and tryptophan metabolism pathways. Moreover, semaglutide could significantly increase the expression of Man1a1 and Ntn4 in the kidneys of mice, while the high-expression of Man1a1 and Ntn4 in KIRC population had a better overall survival rate.

Conclusion

Semaglutide could regulate the development of KIRC by up-adjusting the expression of Man1a1 and Ntn4.

Comparing oncologic outcomes of partial and radical nephrectomy for T2 renal cell carcinoma: a propensity score matching cohort study and an external multicenter validation

PURPOSE

There is very limited evidence on the optimal surgical treatment for patients with larger T2 renal tumors. This study aims to evaluate the oncologic outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in T2 renal cell carcinoma (RCC).

METHODS

A retrospective data analysis was conducted on T2 RCC patients who underwent PN or RN between 2004 and 2019 using the SEER database, and validated with data from multiple centers in China from 2014 to 2019. Kaplan-Meier survival curves and multivariate Cox regression analysis were performed to assess the treatment effects of PN and RN.

RESULTS

The Kaplan-Meier survival curves showed that both in the SEER database and Chinese multicenter data, PN was associated with a higher overall survival (OS) compared to RN in the all patients, male and age ≤ 60 years groups after propensity score matching. The multivariate Cox regression analysis indicated that PN benefited the OS in the all patients (RN vs. PN, HR = 1.476; 95% CI, 1.113-1.957; P = 0.007), and T2a age ≤ 60 years subgroup (RN vs. PN, HR = 2.147; 95% CI, 1.228-3.754; P = 0.007).

CONCLUSION

PN is a viable treatment option for patients with T2 RCC, particularly for patients with T2a age ≤ 60 years, where PN is associated with a higher OS rate. However, patients with stage T2 tumors undergoing PN should be referred to high-volume centers for treatment.

Development and validation of prognostic and diagnostic models utilizing immune checkpoint-related genes in public datasets for clear cell renal cell carcinoma

Background

Clear cell renal cell carcinoma (ccRCC) is the most prevalent subtype of renal cell carcinoma, and immune checkpoint regulator-based immunotherapy has emerged as an effective treatment for advanced stages of the disease. However, the expression patterns, prognostic significance, and diagnostic value of immune checkpoint-related genes (ICRGs) in ccRCC remain underexplored. This study utilized large-scale ccRCC datasets from The Cancer Genome Atlas (TCGA), Gene Expression Omnibus (GEO), and the International Cancer Genome Consortium (ICGC) to analyze ICRGs and develop a prognostic and diagnostic model, which was validated using quantitative PCR in clinical samples from ccRCC patients.

Methods

RNA-seq data and clinical information were retrieved from TCGA, ICGC, and GEO databases. Differentially expressed genes (DEGs) were identified, and immune checkpoint-related genes (DICRGs) were selected by intersecting DEGs with ICRGs, followed by validation in independent datasets. Univariate and multivariate Cox regression analyses were used to develop the prognostic model. Protein expression of key genes was validated through immunohistochemistry (IHC) using data from the Human Protein Atlas (HPA). qRT-PCR confirmed gene expression levels in ccRCC and normal kidney tissues. Diagnostic models were constructed using machine learning, and functional enrichment and immune infiltration analyses were performed.

Results

Fourteen DICRGs were identified, with four (EGFR, TRIB3, ZAP70, and CD4) showing prognostic significance in Cox analyses. IHC revealed high expression of these genes in ccRCC tissues, and qRT-PCR confirmed increased expression of EGFR, TRIB3, and CD4, while ZAP70 expression showed no significant change. A prognostic risk score was developed based on gene expression levels. Functional analysis identified enriched pathways related to organic anion transport and metabolism, while immune infiltration analysis revealed associations between ZAP70, CD4, and risk scores.

Conclusion

This study establishes a prognostic model for ccRCC based on four ICRGs, providing valuable insights into the molecular mechanisms underlying prognosis and diagnosis in ccRCC.

The genomic landscape of metastatic clear-cell renal cell carcinoma and its prognostic value: a comprehensive analysis of a large real-world clinico-genomic database

BACKGROUND

Translating findings on the genomic landscape of metastatic clear-cell renal cell carcinoma (mccRCC) into clinical practice remains challenging. A better understanding of the molecular features of mccRCC could identify a prognostic and/or predictive role for ccRCC genomic alterations.

PATIENTS AND METHODS

In this real-world observational study based on the nationwide (US-based) de-identified Flatiron Health-Foundation Medicine, Inc. clinico-genomic database (FH-FMI-CGDB), we investigate the frequency and co-occurrence of genomic alterations in mccRCC patients and assess their prognostic role. Patients (n = 858) were adults diagnosed with mccRCC, with FH electronic health records between 2011 and 2022.

RESULTS

The top 10 mutated genes were VHL (73.9%), PBRM1 (42.4%), SETD2 (25.3%), CDKN2A (20.0%), BAP1 (16.4%), CDKN2B (16.0%), KDM5C (14.5%), TP53 (12.9%), PTEN (11.7%), and TERT (9.2%). Eight genes showed prognostic value: CDKN2A, CDKN2B, TP53, PTEN, NF2, PIK3CA, and MTAP were linked to worse prognosis, whereas PBRM1 was associated with better overall survival (OS). Two of the three identified gene clusters had prognostic value: cluster 1 (VHL, SETD2, PBRM1, KDM5C, NFE2L2) correlated with better OS [adjusted hazard ratio (aHR) 0.63, P < 0.001], whereas cluster 3 (CDKN2A, CDKN2B, BAP1, NF2, MTAP) correlated with shorter OS (aHR 1.36, P = 0.023).

CONCLUSION

We identified eight genes and two gene clusters with prognostic significance for mccRCC. Future research will explore the predictive value of gene clusters in various treatments.

Time trend and age-period-cohort effect on kidney cancer mortality in Spain, 1983-2022

OBJECTIVE

This study examines trends and disparities in kidney cancer (KC) mortality in Spain from 1983 to 2022, focusing on gender, birth cohort, and age influences.

METHODS

Data from the Spanish National Institute of Statistics were analyzed using age-standardized mortality rates (ASMRs). Joinpoint regression identified temporal trends and annual percentage changes, while Age-Period-Cohort (A-P-C) analysis assessed the impacts of age, calendar period, and birth cohort on mortality.

RESULTS

KC mortality increased significantly for both sexes, with men experiencing a steeper rise (1.2% annually) compared to women (0.6% annually). Joinpoint analysis revealed distinct phases: a sharp increase until the mid-1990s, followed by stabilization for men and a slight decline for women. Men aged over 50, particularly those above 80, showed pronounced increases. A-P-C analysis confirmed age as a significant risk factor, with consistently higher mortality rates observed among men across all age groups. Men born from the early 20th century until the 1960s faced increasing mortality risks, while women's risk, after an increase in the early 20th century, stabilized after the 1933 birth cohort. For those born after 1960, both sexes show a potential decline in KC mortality, with a slight upturn in men from the 1980s onwards. The period effect exhibited an increase during the 1980s-1990s, followed by stabilization for men and a continuous decrease for women.

CONCLUSION

This study reveals significant disparities in KC mortality trends in Spain across genders, birth cohorts, and age groups. Despite advancements in diagnosis and treatment, substantial public health challenges remain.