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Guillaume Z, Allory Y, Auclin E, Gervais C, Auvray M, Rochand A, Mejean A, Audenet F, Vano YA, Oudard S, Thibault C. [Collecting duct carcinoma and renal medullary carcinoma in the age of new therapies]. Bull Cancer 2023; 110:450-462. [PMID: 36906403 DOI: 10.1016/j.bulcan.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/12/2023]
Abstract
Collecting duct carcinoma (also known as Bellini tumour) and renal medullary carcinoma are two extremely rare and aggressive renal cancers. They are both less responsive to conventional treatments used in clear cell renal carcinoma. There are very few studies evaluating their optimal management and currently, at the metastatic stage, polychemotherapy based on platinum salts remains the most widely used. The emergence of new treatments such as anti-angiogenic TKIs, immunotherapy or treatments targeting specific genetic abnormalities, opens up a new field of possibilities in the management of these cancers. The evaluation of the response to these treatments is therefore essential. In this article, we will review the status of their management and the various studies that have evaluated recent treatments in these two cancers.
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Affiliation(s)
- Zoé Guillaume
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | | | - Edouard Auclin
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Claire Gervais
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Marie Auvray
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Adrien Rochand
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Arnaud Mejean
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - François Audenet
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Yann-Alexandre Vano
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Stéphane Oudard
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Constance Thibault
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France.
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Su Y, Hong AL. Recent Advances in Renal Medullary Carcinoma. Int J Mol Sci 2022; 23:ijms23137097. [PMID: 35806102 PMCID: PMC9266801 DOI: 10.3390/ijms23137097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 02/05/2023] Open
Abstract
Renal medullary carcinoma (RMC) is a rare renal malignancy that has been associated with sickle hemoglobinopathies. RMC is aggressive, difficult to treat, and occurs primarily in adolescents and young adults of African ancestry. This cancer is driven by the loss of SMARCB1, a tumor suppressor seen in a number of primarily rare childhood cancers (e.g., rhabdoid tumor of the kidney and atypical teratoid rhabdoid tumor). Treatment options remain limited due in part to the limited knowledge of RMC biology. However, significant advances have been made in unraveling the biology of RMC, from genomics to therapeutic targets, over the past 5 years. In this review, we will present these advances and discuss what new questions exist in the field.
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Affiliation(s)
- Yongdong Su
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA;
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Andrew L. Hong
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA;
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
- Correspondence:
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Wilson NR, Wiele AJ, Surasi DS, Rao P, Sircar K, Tamboli P, Shah AY, Genovese G, Karam JA, Wood CG, Tannir NM, Msaouel P. Efficacy and safety of gemcitabine plus doxorubicin in patients with renal medullary carcinoma. Clin Genitourin Cancer 2021; 19:e401-e408. [PMID: 34625389 DOI: 10.1016/j.clgc.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Renal medullary carcinoma (RMC) is a rare and lethal renal cell carcinoma characterized by the loss of tumor suppressor SMARCB1. Molecular profiling studies have suggested that RMC cells may be vulnerable to therapies that generate DNA damage, such as the combination of the nucleoside analog gemcitabine, and topoisomerase inhibitor doxorubicin. PATIENTS AND METHODS We retrospectively analyzed the records of patients with RMC treated with gemcitabine plus doxorubicin at our institution between January 2005 and September 2020. Best radiographic response and disease progression (RECIST v1.1) were assessed by a blinded radiologist. RESULTS Sixteen patients were included in the study. All but 1 patient (93.8%) received prior platinum-based chemotherapy. Gemcitabine was given intravenously at 900-1200 mg/m2 and doxorubicin at 40-50 mg/m2 intravenously every 2 weeks. Three patients (18.8%) achieved partial response and 7 (43.8%) patients achieved stable disease. The median progression-free survival was 2.8 months (95% CI, 0-6.0). Median overall survival (OS) from gemcitabine plus doxorubicin initiation was 8.1 months (95% CI, 4.6-11.7) and OS from diagnosis was 15.5 months (95% CI, 4.2-26.8 months). There were no grade ≥ 4 AEs; grade 3 AEs were cytopenias (18.8%), nausea (12.5%), fatigue (12.5%), and cardiotoxicity (6.2%). No somatic alterations were detected in the 9 patients tested by targeted next generation sequencing assays. CONCLUSION Gemcitabine plus doxorubicin was well tolerated and demonstrated clinical activity in patients with platinum-refractory RMC, with a subset of patients experiencing durable responses lasting longer than 6 months. Further investigation is warranted to determine biomarkers of sensitivity and target mechanisms of resistance.
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Affiliation(s)
- Nathaniel R Wilson
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX
| | - Andrew J Wiele
- Division of Cancer Medicine, Unive rsity of Texas MD Anderson Cancer Center, Houston, TX
| | - Devaki Shilpa Surasi
- Department of Nuclear Imaging, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priya Rao
- Department of Pathology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kanishka Sircar
- Department of Pathology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pheroze Tamboli
- Department of Pathology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amishi Y Shah
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Giannicola Genovese
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Genomic Medicine, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jose A Karam
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher G Wood
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX.
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Sanajou D, Nazari Soltan Ahmad S, Hosseini V, Kalantary-Charvadeh A, Marandi Y, Roshangar L, Bahrambeigi S, Mesgari-Abbasi M. β-Lapachone protects against doxorubicin-induced nephrotoxicity via NAD +/AMPK/NF-kB in mice. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2019; 392:633-640. [PMID: 30671613 DOI: 10.1007/s00210-019-01619-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 01/15/2019] [Indexed: 01/02/2023]
Abstract
β-Lapachone (B-LAP) is a natural naphtaquinone with established anti-oxidative stress and anti-cancer activities. We aimed to investigate B-LAP protective potential against doxorubicin (DOX)-induced nephrotoxicity in mice. The mice received an oral dose of B-LAP followed by a single intraperitoneal injection of 20 mg/kg DOX a day later. They were then treated for 4 days with 1.25 mg/kg, 2.5 mg/kg, and 5 mg/kg doses of B-LAP. Renal levels of NAD+/NADH ratios, p-AMPKα, p-NF-κB p65, inducible nitric oxide synthase (iNOS), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6) along with renal expressions of TNF-α, IL-1β, and IL-6 were examined. Serum levels of kidney function markers as well as renal histopathology were also investigated. In addition to increasing the activities of p-AMPKα, B-LAP elevated NAD+/NADH ratios in the kidneys and decreased the renal levels of nuclear p-NF-κB and its correspondent downstream effectors TNF-α, IL-1β, IL-6, and iNOS in the kidneys. Also, B-LAP effectively ameliorated renal architectural changes and attenuated serum levels of urea, creatinine, and cystatin C. Collectively, these findings suggest the protective actions of B-LAP against DOX-induced nephrotoxicity in mice.
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Affiliation(s)
- Davoud Sanajou
- Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Nazari Soltan Ahmad
- Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Hosseini
- Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Yasser Marandi
- Department of Biochemistry, Faculty of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Leila Roshangar
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saman Bahrambeigi
- Department of Basic Sciences, Faculty of Veterinary Medicine, Tabriz, Iran
| | - Mehran Mesgari-Abbasi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Golgasht Avenue, Tabriz, Iran.
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Jia L, Yang X, Tian W, Guo S, Huang W, Zhao W. Increased Expression of c-Met is Associated with Chemotherapy-Resistant Breast Cancer and Poor Clinical Outcome. Med Sci Monit 2018; 24:8239-8249. [PMID: 30444219 PMCID: PMC6251073 DOI: 10.12659/msm.913514] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The relevance of c-Met expression as a prognostic or predictive clinical indicator in chemotherapy-resistant breast cancer remains unknown. The aims of this study were to investigate the expression of c-Met in breast cancer tissues and its association with expression of type II topoisomerase (TOPO II), including in patients who received neoadjuvant chemotherapy (NAC), and to investigate chemotherapy resistance in vitro in breast cancer cell lines. Material/Methods Tissue samples from 255 patients with breast cancer, with matched adjacent normal breast tissue, were used in tissue microarrays (TMAs). c-Met protein expression levels were determined using immunohistochemistry. Forty-five cases of breast cancer treated with NAC were studied to investigate the association between c-Met and TOPO II expression and clinical outcome. Chemotherapy resistance was evaluated in vitro in the MCF-7 and MDA-MB-231 breast cancer cell lines. Results Expression of c-Met protein was increased in breast cancer tissue compared with normal breast tissue. In breast cancer tissue samples, increased c-Met expression was significantly associated with increased Ki-67 expression, tumor size, tumor stage, and TOPO II expression, and with reduced overall survival (OS) rates. Increased c-Met expression and reduced TOPO II expression were associated with chemotherapy resistance. In breast cancer cell lines, knockdown of c-Met expression induced TOPO II expression and increased tumor cell sensitivity to chemotherapy. Conclusions The findings of this study support a role for c-Met as a clinical prognostic marker and for c-Met and TOPO II as predictive markers for response to chemotherapy in patients with breast cancer.
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Affiliation(s)
- Lizhou Jia
- Key Laboratory of Antibody Technique of National Health and Family Planning Commission, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Department of Pathology, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Xiaobing Yang
- Department of Pathology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Wei Tian
- Department of Pathology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China (mainland)
| | - Siqi Guo
- Department of Pathology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Wenbin Huang
- Department of Pathology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Wei Zhao
- Department of Pathology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
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Updated Recommendations on the Diagnosis, Management, and Clinical Trial Eligibility Criteria for Patients With Renal Medullary Carcinoma. Clin Genitourin Cancer 2018; 17:1-6. [PMID: 30287223 DOI: 10.1016/j.clgc.2018.09.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/17/2018] [Accepted: 09/05/2018] [Indexed: 02/06/2023]
Abstract
Renal medullary carcinoma (RMC) is one of the most aggressive renal cell carcinomas. It predominantly afflicts young adults and adolescents with sickle cell trait and other sickle hemoglobinopathies, and is refractory to targeted and antiangiogenic therapies used in patients with clear-cell renal cell carcinoma. Platinum-based cytotoxic chemotherapy is the mainstay for RMC treatment. On the basis of recent advances in the diagnosis, management, and clinical trial development for RMC, a panel of experts met in October 2017 and developed updated consensus recommendations to inform clinicians, researchers, and patients. Because RMC often aggressively recurs while patients are still recovering from nephrectomy, upfront chemotherapy should be considered for most patients, including those with localized disease. After safety and dosing information has been established in adults, phase II and III trials enrolling patients with RMC should allow patients aged 12 years and older to be accrued. Patients with the very rare unclassified renal cell carcinoma with medullary phenotype variant should be included in RMC trials. Medical providers should be aware that RMC can afflict subjects of all races, and not only those of African descent, and that the presence of sickle cell trait, or of other sickle hemoglobinopathies, can affect drug responses and toxicity.
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Mir M, Parmley M, Molberg K, Hinson S, Thibodeaux J, Lucas E. Lung tumor in a young African American patient with sickle trait: Pieces of a puzzle. Cytojournal 2018; 15:21. [PMID: 30197662 PMCID: PMC6118160 DOI: 10.4103/cytojournal.cytojournal_57_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mariam Mir
- Address: Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Michelle Parmley
- Address: Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Kyle Molberg
- Address: Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Stacy Hinson
- Address: Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Joel Thibodeaux
- Address: Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Elena Lucas
- Address: Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
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Dong B, Wang G, Yao J, Yuan P, Kang W, Zhi L, He X. Predicting novel genes and pathways associated with osteosarcoma by using bioinformatics analysis. Gene 2017; 628:32-37. [PMID: 28687333 DOI: 10.1016/j.gene.2017.06.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 04/27/2017] [Accepted: 06/30/2017] [Indexed: 12/24/2022]
Abstract
This aim of this study was to explore novel biomarkers related to osteosarcoma. The mRNA expression profile GSE41293 dataset was downloaded from the Gene Expression Omnibus (GEO) database, which included seven osteosarcoma and six control samples. After preprocessing, the FASTQ format reads of 13 samples were mapped to the reference sequences to screen for unique mapping reads. Differentially expressed genes (DEGs) were selected, which were then used for pathway and protein-protein interaction (PPI) network analyses. Moreover, the microarray data GSE63631 were downloaded from GEO database to verify our results. The percentages of unique mapping reads for osteosarcomas and control samples were both >85%. A total of 6157 DEGs were identified between the two groups. DEGs that were upregulated were significantly enriched in 19 pathways, and those that were downregulated were enriched in 14 pathways. In the PPI network, DEGs such as SRC, ERBB2, and CAV3 in cluster 1 were enriched in the pathway responsible for focal adhesions. The DEGs in cluster 2, such as CDK4 and CDK6, were enriched in the cell cycle pathway. In GSE63631, DEGs were significantly enriched in focal adhesion pathway, which was in accordance with the result in GSE41293. Thus, the focal adhesion and cell cycle pathways may play important roles in osteosarcoma progression, and SRC, ERBB2, CAV3, CDK4, and CDK6 may be used as critical biomarkers of osteosarcoma.
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Affiliation(s)
- Bo Dong
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710004, Shaanxi, China; Department of Qrthopedics, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712000, Shaanxi, China
| | - Guozhu Wang
- Department of Orthopedics, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712083, Shaanxi, China
| | - Jie Yao
- Nursing School, Shaanxi University of Chinese Medicine, Xianyang 712000, Shaanxi, China
| | - Puwei Yuan
- Department of Qrthopedics, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712000, Shaanxi, China
| | - Wulin Kang
- Department of Qrthopedics, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712000, Shaanxi, China
| | - Liqiang Zhi
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, Shaanxi, China
| | - Xijing He
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710004, Shaanxi, China.
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Clinicopathologic and Molecular Pathology of Collecting Duct Carcinoma and Related Renal Cell Carcinomas. Adv Anat Pathol 2017; 24:65-77. [PMID: 28181950 DOI: 10.1097/pap.0000000000000138] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Collecting duct carcinoma (CDC) and related tumors [ie, renal medullary carcinoma (RMC)] are rare types of highly aggressive renal cell carcinomas (RCC) with poor prognosis. Because of the rarity and diagnostic uncertainty of them, their molecular pathology and significance have not yet been fully elucidated. CDC, RMC, fumarate hydratase-deficient RCC (including hereditary leiomyomatosis and RCC-associated RCC HLRCC-RCC), and recently reported anaplastic lymphoma kinase (ALK)-rearrangement RCC have significant morphologic overlaps, but they are separately distinct entities having different molecular pathway and clinical settings. CDC is more likely to occur in middle to old age population with immunoreactivity for PAX8 and integrase interactor-1 proteins (INI-1). Various chromosomal and genomic alterations have been reported with inconsistent results. In contrast, RMC is more likely to occur in younger patients with sickle cell trait. In RMC, loss of INI-1 expression and OCT3/4 expression are distinguished compared with other RCCs. Finally, ALK-rearrangement RCC seems to have 2 different clinical settings, one with sickle cell trait (VCL-ALK fusion) and the other without (other fusions such as TPM3-ALK, EML4-ALK, and STRN-ALK fusions). Interestingly, VCL-ALK fusion was found in pediatric patients with sickle cell trait, whereas other fusions were detected in adolescent or adult without sickle cell trait. Taken together, CDC and related tumors such as RMC, fumarate hydratase-deficient RCC (including hereditary leiomyomatosis and RCC-associated RCC), and ALK-rearrangement RCC are the distinct entities and their recognition is important for the development of future personalized therapeutic options. This review updates the clinicopathologic features of these tumors with overlapping morphology and outcome.
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Shah AY, Karam JA, Malouf GG, Rao P, Lim ZD, Jonasch E, Xiao L, Gao J, Vaishampayan UN, Heng DY, Plimack ER, Guancial EA, Fung C, Lowas SR, Tamboli P, Sircar K, Matin SF, Kimryn Rathmell W, Wood CG, Tannir NM. Management and outcomes of patients with renal medullary carcinoma: a multicentre collaborative study. BJU Int 2016; 120:782-792. [PMID: 27860149 DOI: 10.1111/bju.13705] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the management strategies and outcomes of patients with renal medullary carcinoma (RMC) and characterise predictors of overall survival (OS). PATIENTS AND METHODS RMC is a rare and aggressive malignancy that afflicts young patients with sickle cell trait; there are limited data on management to date. This is a study of patients with RMC who were treated in 2000-2015 at eight academic institutions in North America and France. The Kaplan-Meier method was used to estimate OS, measured from initial RMC diagnosis to date of death. Cox regression analysis was used to determine predictors of OS. RESULTS In all, 52 patients (37 males) were identified. The median (range) age at diagnosis was 28 (9-48) years and 49 patients (94%) had stage III/IV. The median OS for all patients was 13.0 months and 38 patients (75%) had nephrectomy. Patients who underwent nephrectomy had superior OS compared to patients who were treated with systemic therapy only (median OS 16.4 vs 7.0 months, P < 0.001). In all, 45 patients received chemotherapy and 13 (29%) had an objective response; 28 patients received targeted therapies, with 8-week median therapy duration and no objective responses. Only seven patients (13%) survived for >24 months. CONCLUSIONS RMC carries a poor prognosis. Chemotherapy provides palliation and remains the mainstay of therapy, but <20% of patients survive for >24 months, underscoring the need to develop more effective therapy for this rare tumour. In this study, nephrectomy was associated with improved OS.
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Affiliation(s)
| | | | - Gabriel G Malouf
- Groupe Hospitalier Pitié-Salpêtrière, University Pierre and Marie Curie, Paris, France
| | - Priya Rao
- MD Anderson Cancer Center, Houston, TX, USA
| | - Zita D Lim
- MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | | | | | | | | | - Stefanie R Lowas
- University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, USA
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Ali Y, Abd Hamid S. Human topoisomerase II alpha as a prognostic biomarker in cancer chemotherapy. Tumour Biol 2015; 37:47-55. [DOI: 10.1007/s13277-015-4270-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/15/2015] [Indexed: 12/12/2022] Open
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12
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Alvarez O, Rodriguez MM, Jordan L, Sarnaik S. Renal medullary carcinoma and sickle cell trait: A systematic review. Pediatr Blood Cancer 2015; 62:1694-9. [PMID: 26053587 DOI: 10.1002/pbc.25592] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 04/03/2015] [Indexed: 11/11/2022]
Abstract
Sickle cell trait (SCT) carries a small risk of renal medullary carcinoma (RMC). We conducted a systematic literature review and reported new four RMC cases (total N = 217). Eighty eight percent had SCT and 8% had sickle cell disease; 50% were children. Males had 2.4× risk than females. Isolated hematuria or in combination with abdominal or flank pain was the presenting sign in 66% cases. Tumor-related mortality was 95%. Four non-metastatic patients were long-term disease-free survivors. Although risk appears to be very low, individuals with SCT should be informed about the low risk of RMC with the hope of early diagnosis. Hematuria should prompt immediate investigation.
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Affiliation(s)
- Ofelia Alvarez
- Division of Pediatric Hematology-Oncology, University of Miami, Miami, Florida
| | - Maria M Rodriguez
- Division of Pediatric Pathology, University of Miami, Miami, Florida
| | - Lanetta Jordan
- Department of Public Health Sciences, University of Miami, Miami, Florida
| | - Sharada Sarnaik
- Division of Pediatric Hematology-Oncology, Children's Hospital of Michigan, Detroit, Michigan
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Iacovelli R, Modica D, Palazzo A, Trenta P, Piesco G, Cortesi E. Clinical outcome and prognostic factors in renal medullary carcinoma: A pooled analysis from 18 years of medical literature. Can Urol Assoc J 2015; 9:E172-7. [PMID: 26085875 DOI: 10.5489/cuaj.2373] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We describe clinical features and prognostic factors of renal medullary carcinoma (RMC) by performing a pooled analysis of all reported cases since 1995. METHODS A systematic search was performed to identify all articles describing patients with medullary renal cancer until February 2013. Survivals were estimated using Kaplan-Meier method with 95% confidence intervals and compared across the groups using the log-rank test. The following factors were evaluated using the Cox proportional hazards model: association of extension of disease at diagnosis, response to therapy, and surgical treatment of primary tumour with overall. RESULTS A total 47 articles were selected; these described 165 patients with RMC plus 1 from our centre. The median age was 21 years and 98% of cases had the sickle cell trait. The mean size of the primary tumours was 6.0 cm, with an involvement of loco-regional lymph nodes in 71% of cases. The overall survival at diagnosis was 4.0 months in metastatic patients and 17.0 months in non-metastatic patients. Patients who received platinum-paclitaxel-gemcitabine had longer control of the disease when compared to topoisomerase inhibitors or targeted therapies. The multivariate analysis confirmed that the advanced stage at diagnosis increased the risk of death of about threefold. CONCLUSION RMC is a tumour with poorer prognosis; based on these results, platinum-based chemotherapy is the preferred systemic treatment. Even if radical nephrectomy as an up-front strategy did not report a survival benefit, it may be considered to palliate local symptoms and to perform a correct diagnosis.
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Affiliation(s)
- Roberto Iacovelli
- Sapienza University of Rome; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Rome, Italy
| | - Daniela Modica
- Sapienza University of Rome; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Rome, Italy
| | - Antonella Palazzo
- Sapienza University of Rome; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Rome, Italy
| | - Patrizia Trenta
- Sapienza University of Rome; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Rome, Italy
| | - Gabriele Piesco
- Sapienza University of Rome; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Rome, Italy
| | - Enrico Cortesi
- Sapienza University of Rome; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Rome, Italy
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Onishi R, Noguchi M, Kaida H, Moriya F, Chikui K, Kurata S, Kawahara A, Kage M, Ishibashi M, Matsuoka K. Assessment of cell proliferation in renal cell carcinoma using dual-phase 18F-fluorodeoxyglucose PET/CT. Oncol Lett 2015; 10:822-828. [PMID: 26622577 DOI: 10.3892/ol.2015.3372] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 04/08/2015] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to examine the association between 18F-fluorodeoxyglucose (18F-FDG) uptake and cell proliferation markers; in addition, the correlation between 18F-FDG uptake and biological characteristic in patients with renal cell carcinoma (RCC) was investigated using dual-phase 18F-FDG-positron emission tomography/computed tomography (PET/CT). Dual-phase 18F-FDG PET/CT was performed on 31 RCC patients and the maximum standardized uptake values at 1 h (SUV1) and 2 h (SUV2) as well as the retention index (RI; %) in the primary tumors were calculated. Monoclonal antibodies for Ki-67, minichromosome maintenance 2 (MCM2) and topoisomerase II α (topo II α) were used to assess the expression levels of their respective proteins in excised tumor tissue using immunohistochemistry. The results demonstrated that RI and SUV2 in patients with Stage I/II + grade 1 (G1) RCC were significantly decreased compared with all patients with other stages/grades (RI, P=0.0065; SUV2, P=0.043); in addition, significantly increased uptake and RI were detected in patients with metastases compared with patients without metastases (SUV1, P=0.029; SUV2, P=0.0003; RI, P<0.001). All proliferation markers significantly correlated with RI (Ki-67, r=0.501, P=0.004; MCM2, r=0.359, P=0.047; topo II α, r=0.402, P=0.024), while SUV1 and SUV2 correlated with Ki-67 only. In conclusion, the results of the present study demonstrated that dual-phase 18F-FDG-PET/CT was more useful for predicting cell proliferation in RCC compared with single-phase imaging alone. However, follow-ups are required in order to determine whether dual-phase 18F-FDG-PET/CT provides independent prognostic information.
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Affiliation(s)
- Rei Onishi
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Masanori Noguchi
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan ; Clinical Research Division, Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Hayato Kaida
- Division of Nuclear Medicine, PET Center and Department of Radiology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Fukuko Moriya
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Katsuaki Chikui
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Seiji Kurata
- Division of Nuclear Medicine, PET Center and Department of Radiology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Akihiko Kawahara
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Masayoshi Kage
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Masatoshi Ishibashi
- Division of Nuclear Medicine, PET Center and Department of Radiology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Kei Matsuoka
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
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Abstract
Tumours of the distal nephron are uncommon but can create diagnostic difficulties. They may be divided into three groups-tumours of intercalated cell phenotype, those of principal cell phenotype and others with an unconfirmed distal nephron origin. Oncocytomas, chromophobe carcinoma and hybrid oncocytoma chromophobe carcinoma, all show features of intercalated cells and the distinction amongst these is one of the most common areas of diagnostic dilemma. Collecting duct carcinoma and renal medullary carcinoma are the most aggressive forms of renal cancer but recent evidence suggests they may respond to targeted therapy so their recognition becomes crucial to the management of these patients. There remains debate over the precise phenotype of both tubulocystic carcinoma and mucinous tubular and spindle cell carcinoma.
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Affiliation(s)
- Stewart Fleming
- Department of Cellular and Molecular Pathology, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK.
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16
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Ip JCY, Pang TCY, Glover AR, Soon P, Zhao JT, Clarke S, Robinson BG, Gill AJ, Sidhu SB. Immunohistochemical validation of overexpressed genes identified by global expression microarrays in adrenocortical carcinoma reveals potential predictive and prognostic biomarkers. Oncologist 2015; 20:247-56. [PMID: 25657202 PMCID: PMC4350804 DOI: 10.1634/theoncologist.2014-0392] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 01/02/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis. The aim of this study was to identify novel protein signatures that would predict clinical outcomes in a large cohort of patients with ACC based on data from previous gene expression microarray studies. MATERIALS AND METHODS A tissue microarray was generated from the paraffin tissue blocks of 61 patients with clinical outcomes data. Selected protein biomarkers based on previous gene expression microarray profiling studies were selected, and immunohistochemistry staining was performed. Staining patterns were correlated with clinical outcomes, and a multivariate analysis was undertaken to identify potential biomarkers of prognosis. RESULTS Median overall survival was 45 months, with a 5-year overall survival rate of 44%. Median disease-free survival was 58 months, with a 5-year disease-free survival rate of 44%. The proliferation marker Ki-67 and DNA topoisomerase TOP2A were associated with significantly poorer overall and disease-free survival. The results also showed strong correlation between the transcriptional repressor EZH2 and TOP2A expression, suggesting a novel role for EZH2 as an additional marker of prognosis. In contrast, increased expression of the BARD1 protein, with its ubiquitin ligase function, was associated with significantly improved overall and disease-free survival, which has yet to be documented for ACC. CONCLUSION We present novel biomarkers that assist in determining prognosis for patients with ACC. Ki-67, TOP2A, and EZH2 were all significantly associated with poorer outcomes, whereas BARD1 was associated with improved overall survival. It is hoped that these biomarkers may help tailor additional therapy and be potential targets for directed therapy.
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Affiliation(s)
- Julian C Y Ip
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Tony C Y Pang
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony R Glover
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Patsy Soon
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jing Ting Zhao
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Clarke
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Bruce G Robinson
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony J Gill
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Stan B Sidhu
- Kolling Institute of Medical Research, Endocrine and Oncology Surgical Unit, and Department of Anatomical Pathology, Royal North Shore Hospital, Faculty of Medicine, Northern Clinical School, and Department of Surgery, Westmead Hospital, University of Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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17
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Rioux-Leclercq N, Ferran A, Mahul A, Argani P, Billis A, Bonsib S, Cheng L, Cheville J, Eble J, Egevad L, Epstein J, Grignon D, Hes O, Humphrey P, Magi-Galluzzi C, Martignoni G, McKenney J, Merino M, Moch H, Montironi R, Netto G, Reuter V, Samaratunga H, Shen S, Srigley J, Tamboli P, Tan PH, Tickoo S, Trpkov K, Zhou M, Delahunt B, Comperat E. Les tumeurs rénales : recommandations de la conférence de consensus de l’International Society of Urologic Pathology (ISUP) 2012. Ann Pathol 2014; 34:448-61. [DOI: 10.1016/j.annpat.2014.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/04/2014] [Accepted: 10/06/2014] [Indexed: 01/06/2023]
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Cystic presentation of a renal medullary carcinoma in a young woman. Urologia 2014; 82:124-6. [PMID: 25451881 DOI: 10.5301/uro.5000097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2014] [Indexed: 11/20/2022]
Abstract
Renal medullary carcinoma (RMC) is a rare tumor, originating in the epithelial papillary cells, that primarily affects young black men with sickle cell trait. We report the case of a 29-year-old Caucasian woman, who at ultrasound showed a cystic mass at the right kidney, with a vascular pattern at the level of the cystic wall. A CT-guided biopsy of the lesion was performed, revealing the presence of unspecified tumor cells. A total nephrectomy was then performed. Microscopically, a tumor resulting from the epithelial papillary cells was observed; several areas of lymphoplasmacytic infiltrates were seen at the junction between the normal kidney tissue and the tumor, and a renal medullary carcinoma was diagnosed. Six months later, the patient developed multiple pulmonary metastases and started chemotherapy with Carboplatin, Paclitaxel and Gemcitabine. The patient died after 27 months of follow-up.RMC is a tumor that usually occurs in young black men, at an average age of 25 years with extremes of 11 and 39 years. Sickle-cell disease or sickle-cell trait is often present. The longest documented survival (until now) for RMC was 16 months. The best treatment is surgery with enlarged nephrectomy. There are still no appropriate chemotherapy protocols.
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Duan SQ, Liu L, Zhao QY, Bu ZD, Li J, Wang W, Wang HM. Relationship between TopoⅡ protein expression and lymph node metastasis in rectal cancer. Shijie Huaren Xiaohua Zazhi 2014; 22:3521-3526. [DOI: 10.11569/wcjd.v22.i23.3521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To detect topoisomerase Ⅱ (TopoⅡ) protein expression in colorectal cancer and to analyze its clinical significance.
METHODS: One hundred and twenty-six specimens were collected from patients with rectal cancer who were treated surgically from January 30, 2008 to January 29, 2012. The expression of TopoⅡ in the above specimens was detected by immunohistochemistry. The correlation between TopoⅡ expression and clinicopathologic parameters was then analyzed.
RESULTS: TopoⅡ was highly expressed in rectal cancer. TopoⅡ expression was positively correlated with rectal cancer pathological type (P = 0.007), cell differentiation (P = 0.004), depth of invasion (P = 0.042) and lymph node metastasis (P = 0.027), but not with sex, age, tumor location, histological type, or vascular thrombosis.
CONCLUSION: TopoⅡ is highly expressed in rectal cancer. TopoⅡ expression is closely associated with lymph node metastasis of rectal cancer, and can be used as a marker for lymph node metastasis of rectal cancer.
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20
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VCL-ALK renal cell carcinoma in children with sickle-cell trait: the eighth sickle-cell nephropathy? Am J Surg Pathol 2014; 38:858-63. [PMID: 24698962 DOI: 10.1097/pas.0000000000000179] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We report the third case of a renal cell carcinoma bearing a fusion of the vinculin (VCL) and anaplastic lymphoma kinase (ALK) genes. Like the 2 other reported cases, this neoplasm occurred in a young patient (6 y old) with sickle-cell trait and demonstrated distinctive morphologic features including medullary epicenter, discohesive polygonal or spindle-shaped cells with prominent cytoplasmic vacuoles, and prominent lymphocytic infiltrate. The neoplastic cells demonstrated focal membranous labeling for ALK protein by immunohistochemistry, ALK gene rearrangement by fluorescence in situ hybridization, and a specific VCL-ALK gene fusion by reverse transcriptase polymerase chain reaction. VCL-ALK renal cell carcinoma may represent the eighth sickle-cell nephropathy.
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21
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Shetty A, Matrana MR. Renal medullary carcinoma: a case report and brief review of the literature. Ochsner J 2014; 14:270-275. [PMID: 24940141 PMCID: PMC4052598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Renal medullary carcinoma (RMC) is an aggressive form of non-clear cell kidney cancer that typically affects young adults and is almost exclusively associated with sickle cell trait. Typical RMC patients tend to be young black males (2:1 male to female predominance) with sickle cell trait who present with pain and hematuria and are found to have metastatic disease at diagnosis. Prognosis is extremely poor, with a mean survival of less than a year in most cases. CASE REPORT We present a case illustrative of many of the classic findings of RMC. A 25-year-old female with a past medical history of sickle cell trait presented to the emergency room with right-sided flank pain. Initially, a computed tomography (CT) scan showed only a benign-appearing cystic lesion 4.5 cm in diameter in the right kidney. Six months later, the patient re-presented with hematuria, lightheadedness, and dizziness. A repeat CT scan showed that the renal cyst had enlarged to 5.6 cm. The patient underwent a decortication and fulguration procedure that revealed malignancy in the wall of the cyst. She was given a series of treatments but experienced progressive disease and passed away 2 years and 8 months after metastatic diagnosis. CONCLUSION Neither systemic therapy nor radiation therapy has been found to be particularly efficacious in the treatment of RMC. As the underlying biologic mechanisms of RMC are further elucidated on a basic science level, we expect new translational research opportunities will emerge and novel treatment options will be developed for this rare and dismal disease.
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Affiliation(s)
- Aditya Shetty
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marc R. Matrana
- Department of Hematology and Oncology, Ochsner Clinic Foundation, New Orleans, LA
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22
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de Resende MF, Vieira S, Chinen LTD, Chiappelli F, da Fonseca FP, Guimarães GC, Soares FA, Neves I, Pagotty S, Pellionisz PA, Barkhordarian A, Brant X, Rocha RM. Prognostication of prostate cancer based on TOP2A protein and gene assessment: TOP2A in prostate cancer. J Transl Med 2013; 11:36. [PMID: 23398928 PMCID: PMC3576277 DOI: 10.1186/1479-5876-11-36] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 01/30/2013] [Indexed: 01/19/2023] Open
Abstract
Background TOP2A encodes for topoisomerase IIα, a nuclear enzyme that controls DNA topological structure and cell cycle progression. This enzyme is a marker of cell proliferation in normal and neoplastic tissues; however, little information is available about its expression in prostate cancer (PCa). Methods Immunohistochemistry (IHC) was automated using mouse monoclonal antibody against TOP2A (clone SWT3D1; DAKO, Carpenteria, CA, USA) at dilution 1:800 and Flex Plus detection system in autostainer 48Ultra (DAKO). FISH was performed using TOP2A (17q21)/ CEP17 probe kit (Kreateck Biotechnology, San Diego, CA, USA). Biochemical and pathological data from 193 patients with PCa were retrieved for the analysis, whose significance was considered when p < 0.05. Also, fractal analysis was performed in a subset of 20 randomly selected cases. Results TOP2A protein expression correlated with higher Gleason scores and higher levels of preoperative PSA (p = 0.018 and p = 0.011). Patients with higher levels of TOP2A presented shorter biochemical recurrence-free survival (BRFS) (p = 0.001). In multivariate analysis, we found that TOP2A remained an independent prognostic factor of BRFS, with a relative risk of 1.98 (p = 0.001; 95% CI, 1.338–2.93); thus, cases that expressed high levels of this enzyme had a shorter BRFS compared with TOP2A-negative or TOP2A-low cases. No alterations in TOP2A gene status nor correlation between FISH and IHC results were observed. Concerning fractal analysis, patients who expressed higher levels of TOP2A have angiolymphatic invasion and presented higher Gleason scores (p = 0.033 and p = 0.025, respectively). Also, patients with higher expression of TOP2A presented shorter BRFS (p = 0.001). Conclusions This is the first study to perform TOP2A protein and gene digital assessment and fractal analysis in association with BRFS in a large series of PCa. Also, we show that TOP2A gene copy number alterations are not observed in this type of tumor. So, higher protein expression of TOP2A is not related to gene amplification in PCa. Furthermore, TOP2A protein assessment has prognostic importance and, due to its relation with poor outcome, TOP2A IHC evaluation in the biopsy can represent an important tool for selecting the most suitable surgical and clinical approach for patients with PCa.
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23
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Carcinoma of the collecting ducts of Bellini and renal medullary carcinoma: clinicopathologic analysis of 52 cases of rare aggressive subtypes of renal cell carcinoma with a focus on their interrelationship. Am J Surg Pathol 2012; 36:1265-78. [PMID: 22895263 DOI: 10.1097/pas.0b013e3182635954] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Carcinoma of the collecting ducts of Bellini and renal medullary carcinoma are rare aggressive neoplasms of putative distal nephron origin. First described in 1949, case reports and review articles constitute a major source of information on collecting duct carcinoma, whereas Davis and colleagues and the pediatric tumor registry have contributed the seminal works on renal medullary carcinoma. Here we present a detailed study of collecting duct carcinoma (n=39) and renal medullary carcinoma (n=13), characterizing these rare neoplasms and analyzing their interrelationship. Both collecting duct carcinoma and renal medullary carcinoma exhibited significant similarities, such as predilection for the right kidney, tumor mass with an epicenter in the renal medulla, and a mean size of 7 cm. Overall, both tumors exhibited a poorly differentiated adenocarcinoma histology with desmoplastic stromal response (100%), inflammatory infiltrate (100%), frequent perinephric extension (collecting duct carcinoma: 97%; renal medullary carcinoma: 83%), lymphovascular invasion (100%), intraluminal mucin (collecting duct carcinoma: 42%; renal medullary carcinoma: 73%), high nuclear grade (97%), overlapping immunoreactivity for Ulex europaeus agglutinin 1 (collecting duct carcinoma: 75%; renal medullary carcinoma:55%), CK7 (collecting duct carcinoma: 44%; renal medullary carcinoma: 71%), and high-molecular weight cytokeratin (collecting duct carcinoma: 26%; renal medullary carcinoma: 29%), and nonimmunoreactivity for Ksp-cadherin. Histologically, collecting duct carcinoma frequently had tubular, tubulopapillary, or irregular glandular architecture, whereas renal medullary carcinoma commonly demonstrated islands of anastomosing tubules and cords forming irregular microcystic spaces. Multiple metastases to the lymph nodes, lung, bone, and liver were observed in both categories at presentation (collecting duct carcinoma: 17%; renal medullary carcinoma: 36%). Only patients with organ-confined small tumors were disease free beyond the median survival time. Differential clinical features between collecting duct carcinoma and renal medullary carcinoma included proclivity for younger male individuals of African ancestry with hemoglobin abnormalities and a shorter median survival of 17 weeks (vs. 44 wk for collecting duct carcinoma) for renal medullary carcinoma. The markedly overlapping clinical features, histology, immunophenotype, metastasis patterns, and uniformly aggressive outcome in collecting duct and renal medullary carcinomas suggest that renal medullary carcinoma is a distinctive clinicopathologic subtype within the entity of collecting duct carcinoma. The extremely poor prognosis and ongoing clinical trials with specific therapeutic protocols argue for their accurate distinction from other renal cell carcinoma subtypes.
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24
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Meng H, Chen R, Li W, Xu L, Xu L. Correlations of TOP2A gene aberrations and expression of topoisomerase IIα protein and TOP2A mRNA expression in primary breast cancer: a retrospective study of 86 cases using fluorescence in situ hybridization and immunohistochemistry. Pathol Int 2012; 62:391-9. [PMID: 22612507 DOI: 10.1111/j.1440-1827.2012.02808.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Our aim in this study was to assess the status of TOP2A gene aberrations (no change/amplification or deletion) and its correlations with topoisomerase IIα (Topo IIα) protein and TOP2A mRNA expression, respectively. TOP2A amplification, Topo IIα protein expression and TOP2A mRNA expression were assessed using samples of 86 cases of breast cancer by fluorescence in fluorescence in situ hybridization, quantitative real-time polymerase chain reaction and immunohistochemistry, respectively. Twenty two (22.57%) had amplification/deletion of TOP2A gene. Twenty eight (32.56%) tumor samples were 17q polysomy or monosomy. Topo IIα protein was expressed in 57 cases (66.27%, 57/86): 22 cases (38.62%, 22/57) and 35 cases (61.40%, 35/57) had amplification/deletion and no change of TOP2A gene, respectively. These three groups showed significant differences by one-way analysis of variance (P < 0.001). The average Ct values of TOP2A mRNA expression in the tumors with deletion, amplification and no change of TOP2A gene were 27.00, 27.33 and 31.66, respectively. We demonstrated that the TOP2A gene was amplified or deleted in breast cancer, with a significant correlation with high expressions of Topo IIα protein and TOP2A mRNA expression. Ki-67 expression index (mean = 14.9) decreased significantly in cases wherein TOP2A gene had no change and Her2/neu protein expression was weakly positive (0-1+, P < 0.001).
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Affiliation(s)
- Hui Meng
- Pathology Department, Zhengzhou University No.1 Affiliated Hospital, Zhengzhou, China
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25
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Chowdhury S, Matrana MR, Tsang C, Atkinson B, Choueiri TK, Tannir NM. Systemic therapy for metastatic non-clear-cell renal cell carcinoma: recent progress and future directions. Hematol Oncol Clin North Am 2011; 25:853-69. [PMID: 21763971 PMCID: PMC4167832 DOI: 10.1016/j.hoc.2011.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Insights into the biology of clear-cell renal cell carcinoma (CCRCC) have identified multiple pathways associated with the pathogenesis and progression of this cancer. This progress has led to the development of multiple agents targeting these pathways, including the tyrosine kinase inhibitors sorafenib, sunitinib, and pazopanib, the monoclonal antibody bevacizumab, and the mTOR inhibitors temsirolimus and everolimus. With the exception of temsirolimus, phase 3 trials tested these agents in patients with clear-cell histology; therefore, their efficacy in non-CCRCC is unclear. To date, there is no established effective therapy for patients with advanced non-CCRCC. This article focuses on treatment options for metastatic non-CCRCC.
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26
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Walsh A, Kelly DR, Vaid YN, Hilliard LM, Friedman GK. Complete response to carboplatin, gemcitabine, and paclitaxel in a patient with advanced metastatic renal medullary carcinoma. Pediatr Blood Cancer 2010; 55:1217-20. [PMID: 20979179 DOI: 10.1002/pbc.22611] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Renal medullary carcinoma (RMC) is a rare and aggressive malignancy seen primarily in patients with sickle-cell trait. We report a complete response to carboplatin, paclitaxel, and gemcitabine in a patient with advanced metastatic RMC.
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Affiliation(s)
- Alexandra Walsh
- Division of Pediatric Hematology Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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27
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Lu Y, Liu P, Wen W, Grubbs CJ, Townsend RR, Malone JP, Lubet RA, You M. Cross-species comparison of orthologous gene expression in human bladder cancer and carcinogen-induced rodent models. Am J Transl Res 2010; 3:8-27. [PMID: 21139803 PMCID: PMC2981423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 09/15/2010] [Indexed: 05/30/2023]
Abstract
Genes differentially expressed by tumor cells represent promising drug targets for anti-cancer therapy. Such candidate genes need to be validated in appropriate animal models. This study examined the suitability of rodent models of bladder cancer in B6D2F1 mice and Fischer-344 rats to model clinical bladder cancer specimens in humans. Using a global gene expression approach cross-species analysis showed that 13-34% of total genes in the genome were differentially expressed between tumor and normal tissues in each of five datasets from humans, rats, and mice. About 20% of these differentially expressed genes overlapped among species, corresponding to 2.6 to 4.8% of total genes in the genome. Several genes were consistently dysregulated in bladder tumors in both humans and rodents. Notably, CNN1, MYL9, PDLIM3, ITIH5, MYH11, PCP4 and FM05 were found to commonly down-regulated; while T0P2A, CCNB2, KIF20A and RRM2 were up-regulated. These genes are likely to have conserved functions contributing to bladder carcinogenesis. Gene set enrichment analysis detected a number of molecular pathways commonly activated in both humans and rodent bladder cancer. These pathways affect the cell cycle, HIF-1 and MYC expression, and regulation of apoptosis. We also compared expression changes at mRNA and protein levels in the rat model and identified several genes/proteins exhibiting concordant changes in bladder tumors, including ANXA1, ANXA2, CA2, KRT14, LDHA, LGALS4, SERPINA1, KRT18 and LDHB. In general, rodent models of bladder cancer represent the clinical disease to an extent that will allow successful mining of target genes and permit studies on the molecular mechanisms of bladder carcinogenesis.
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Affiliation(s)
- Yan Lu
- Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of MedicineSt. Louis, MO 63110, USA
- Department of Physiology and the Cancer Center, Medical college of WisconsinMilwaukee, WI 53226, USA
| | - Pengyuan Liu
- Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of MedicineSt. Louis, MO 63110, USA
- Department of Physiology and the Cancer Center, Medical college of WisconsinMilwaukee, WI 53226, USA
| | - Weidong Wen
- Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of MedicineSt. Louis, MO 63110, USA
| | - Clinton J Grubbs
- Departments of Surgery, Genetics, and Medicine, University of Alabama at BirminghamBirmingham, AL 35294, USA
| | - Reid R Townsend
- Department of Internal Medicine, Washington University School of MedicineSt. Louis, MO 63110, USA
| | - James P Malone
- Department of Internal Medicine, Washington University School of MedicineSt. Louis, MO 63110, USA
| | - Ronald A Lubet
- Chemoprevention Agent Development Research Group, National Cancer InstituteRockville, MD 20892, USA
| | - Ming You
- Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of MedicineSt. Louis, MO 63110, USA
- Department of Pharmacology and Toxicology and the Cancer Center, Medical college of WisconsinMilwaukee, WI 53226, USA
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Schaeffer EM, Guzzo TJ, Furge KA, Netto G, Westphal M, Dykema K, Yang X, Zhou M, Teh BT, Pavlovich CP. Renal medullary carcinoma: molecular, pathological and clinical evidence for treatment with topoisomerase-inhibiting therapy. BJU Int 2009; 106:62-5. [PMID: 20002663 DOI: 10.1111/j.1464-410x.2009.09139.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
STUDY TYPE Aetiology (case series) Level of Evidence 4. OBJECTIVE To present the molecular rationale and potential clinical benefit of topoisomerase II (TopoII)-inhibiting therapy for renal medullary carcinoma (RMC), a rare but extremely lethal form of kidney cancer that classically afflicts young men with sickle-cell trait. The current therapeutic approach with these aggressive tumours is radical nephrectomy followed by systemic chemotherapy, but the prognosis remains dismal. MATERIALS AND METHODS The whole-genome expression was analysed in four RMC tumours. We also report a case of metastatic RMC in which a complete response was achieved for 9 months using a TopoII-inhibiting therapy. RESULTS Expanded whole-genome expression analysis showed increases of TopoII in all cases. There was also overall deregulation of DNA remodelling and repair, and an ontological association between RMC and urothelial carcinoma. Using a TopoII-inhibiting agent, there was a complete response for 9 months in a patient with metastatic RMC. CONCLUSION This report provides molecular evidence for the rational use of TopoII inhibitors in the treatment of RMC.
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Affiliation(s)
- Edward M Schaeffer
- The James Buchanan Brady Urologic Institute, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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