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Daugherty M, Sedaghatpour D, Shapiro O, Vourganti S, Kutikov A, Bratslavsky G. The metastatic potential of renal tumors: Influence of histologic subtypes on definition of small renal masses, risk stratification, and future active surveillance protocols. Urol Oncol 2017; 35:153.e15-153.e20. [DOI: 10.1016/j.urolonc.2016.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/06/2016] [Accepted: 11/13/2016] [Indexed: 12/25/2022]
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Gayed BA, Gillen J, Christie A, Peña-Llopis S, Xie XJ, Yan J, Karam JA, Raj G, Sagalowsky AI, Lotan Y, Margulis V, Brugarolas J. Prospective evaluation of plasma levels of ANGPT2, TuM2PK, and VEGF in patients with renal cell carcinoma. BMC Urol 2015; 15:24. [PMID: 25885592 PMCID: PMC4411704 DOI: 10.1186/s12894-015-0019-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022] Open
Abstract
Background To assess pathological correlations and temporal trends of Angiopoietin-2 (ANGPT2), vascular endothelial growth factor (VEGF) and M2 Pyruvate kinase (TuM2PK), markers of tumor vascular development and metabolism, in patients with renal cell carcinoma (RCC). Methods We prospectively collected plasma samples from 89 patients who underwent surgical/ablative therapy for RCC and 38 patients with benign disease (nephrolithiasis, hematuria without apparent neoplastic origin, or renal cysts). In RCC patients, marker levels were compared between at least 1 preoperative and 1 postoperative time point generally 3 weeks after surgery. Marker temporal trends were assessed using the Wilcoxon sign-rank test. Plasma VEGF, ANGPT2, and TuM2PK levels were determined by ELISA and tested for association with pathological variables. Results Median age was comparable between groups. 83/89 (93%) of the cohort underwent surgical extirpation. 82% of the tumors were organ confined (T ≤2, N0). Only ANGPT2 exhibited significantly elevated preoperative levels in patients with RCC compared to benign disease (p = 0.046). Elevated preoperative levels of ANGPT2 and TuM2PK significantly correlated with increased tumor size and advanced grade (p < 0.05). Chromophobe RCC exhibited higher levels of ANGPT2 compared to other histologies (p < 0.05). A decline in marker level after surgery was not observed, likely due to the timing of the analyses. Conclusion Our results suggest that ANGPT2 is a marker of RCC. Additionally, ANGPT2 and TuM2PK significantly correlated with several adverse pathological features. Further studies are needed to determine clinical applicability.
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Affiliation(s)
- Bishoy A Gayed
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Jessica Gillen
- Department Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Alana Christie
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Samuel Peña-Llopis
- Department of Developmental Biology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Xian-Jin Xie
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Jingsheng Yan
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Jose A Karam
- Department of Urology, MD Anderson Cancer Center, Houston, Texas, USA.
| | - Ganesh Raj
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Arthur I Sagalowsky
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. .,Department of Urology, UT Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, 75390-9110, Texas, USA.
| | - James Brugarolas
- Department Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. .,Department of Developmental Biology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Chen Z, Wen J, Ju H, Fang Z. Magnetic nano-Fe3O4 particles targeted gathering and bio-effects on nude mice loading human hepatoma Bel-7402 cell lines model under external magnetic field exposure in vivo. Electromagn Biol Med 2014; 34:309-16. [PMID: 24856871 DOI: 10.3109/15368378.2014.919589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Magnetic nano-Fe3O4 particles (MNPs), static magnetic field (SMF) and extremely low-frequency altering electric magnetic field (ELFF) were utilized to treat nude mice loading hepatoma Bel-7402 cell lines to investigate the therapeutic values of MNPs combined with ELFF in vivo. Magnetic resonance image (MRI) figures showed that about 98.9% MNPs injected into mice body through tail vein were gathered in tumor focal by SMF directing exposure. Single ELFF and MNPs treatments did not influence mice physiological function obviously. However, gathered MNPs combined with ELFF treatment prolonged mice survival time and inhibited loading tumor cells proliferation significantly compared to other mice groups (p < 0.05); furthermore, the tumor cells early apoptosis ratio of mice group was significantly higher than other groups (p < 0.05), and ELFF combined with gathered MNPs treatment improved tumor cells early apoptosis associated with Bcl group protein expression: Bax protein expression was higher than Bcl-2 and the combined treatment improved cells Heat shock protein-27 (Hsp-27) expression which could protect cells avoiding early apoptosis. The possible mechanism that this kind of combination inducing more cells into early apoptosis could be due to ELFF exposure influencing cells ion metabolism, MNPs strengthening the effects, and the ELFF vibrating MNPs to generate extra heat and activate cellular heat shock signal channel.
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Affiliation(s)
- Zhiqiang Chen
- a Chemistry and Chemical Engineering College, Central South University , Changsha , China and.,b The Second Hospital Affiliated to Medical College, South East University , Nanjing , China
| | - Jian Wen
- b The Second Hospital Affiliated to Medical College, South East University , Nanjing , China
| | - Huixiang Ju
- b The Second Hospital Affiliated to Medical College, South East University , Nanjing , China
| | - Zheng Fang
- a Chemistry and Chemical Engineering College, Central South University , Changsha , China and
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Abstract
OBJECTIVES Treatment options for advanced renal cell carcinoma have increased dramatically over the past 6 years as a result of improved understanding of the biology of renal cancer and the development of therapies to target pathways relevant to tumor progression. DATA SOURCES Research-based articles. CONCLUSION New therapies to treat advanced renal cell cancer results in a need for evidence-based decision making when discussing treatment choices. IMPLICATIONS FOR NURSING PRACTICE Knowledge of therapeutic strategies, their proposed mechanism of action, potential adverse events, and management strategies provides nurses with a foundation to provide appropriate patient education and effective management of treatment-related side effects, assisting patients to maximize clinical outcomes.
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Affiliation(s)
- Peg Esper
- Medical Oncology, University of Michigan Comprehensive Cancer Center, 1500 East Medical Center Drive, C434 Med Inn, SPC 5843, Ann Arbor, MI 48109-5843, USA.
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Consolidative surgery after targeted therapy for renal cell carcinoma. Urol Oncol 2011; 31:914-9. [PMID: 22153755 DOI: 10.1016/j.urolonc.2011.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/04/2011] [Accepted: 10/05/2011] [Indexed: 01/16/2023]
Abstract
Renal cell carcinoma is the most lethal of the common genitourinary neoplasms, with 30% to 40% of patients eventually dying from disease progression. Although the recent development of targeted therapies against kidney cancer has yielded substantially improved tumor response rates and progression-free survival, these agents are still not curative. The integration of systemic therapies with surgery still represents the best management for select patients with advanced disease. Specifically, consolidative surgery may play a vital role in the management of this challenging patient population. However, concerns remain regarding the potential for increased surgical morbidity complicating the integration of surgery after targeted therapy. Careful patient selection and specific precautions to increase surgical safety should be implemented.
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Teloken PE, Thompson RH, Tickoo SK, Cronin A, Savage C, Reuter VE, Russo P. Prognostic impact of histological subtype on surgically treated localized renal cell carcinoma. J Urol 2009; 182:2132-6. [PMID: 19758615 DOI: 10.1016/j.juro.2009.07.019] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Indexed: 11/25/2022]
Abstract
PURPOSE Despite the clear demonstration that different histological subtypes of renal cell carcinoma show distinct pathogenesis and genetic alterations, the impact of histology on prognosis remains controversial. We evaluated our experience with tumor histology in patients with localized renal cell carcinoma. MATERIALS AND METHODS We identified 1,863 patients with localized clear cell, papillary or chromophobe renal cell carcinoma who were treated surgically between 1989 and 2006 at our tertiary care center. Cox proportional hazards regression models were used to evaluate the relationship between tumor histology and outcome, defined as metastasis or death from disease, adjusting for age, sex, operation type, American Society of Anesthesiologists score, TNM stage and tumor size. RESULTS Of 1,863 patients 1,333 (72%) had clear cell histology, and 310 (17%) and 220 (12%) had papillary and chromophobe renal cell carcinoma, respectively. Median followup in patients without an event was 3.4 years. On univariate analysis patients with clear cell histology had a worse clinical outcome. Five-year probability of freedom from metastasis or death from disease was 86% (95% CI 84, 88), 95% (95% CI 91, 97) and 92% (95% CI 85, 96) in patients with clear cell, papillary and chromophobe histology, respectively (p <0.001). On multivariate analysis chromophobe (HR 0.40; 95% CI 0.20, 0.80) and papillary (HR 0.62; 95% CI 0.34, 1.14) histology was also significantly associated with better outcome (p = 0.014). CONCLUSIONS Clear cell histology seems to be independently associated with worse outcomes in patients who undergo surgery for renal cell carcinoma even after controlling for widely accepted factors influencing prognosis.
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Affiliation(s)
- Patrick E Teloken
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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Campbell L, Nuttall R, Griffiths D, Gumbleton M. Activated extracellular signal-regulated kinase is an independent prognostic factor in clinically confined renal cell carcinoma. Cancer 2009; 115:3457-67. [PMID: 19526593 DOI: 10.1002/cncr.24389] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Extracellular signal-regulated kinase (ERK) promotes proliferation, metastasis, and poor survival in cancers of the breast, lung, and liver. Advanced localized renal cell carcinoma (RCC) is extraordinarily treatment resistant and has high recurrence rates despite surgery. Limited data exist regarding the prognostic significance of activated (phosphorylated) ERK in RCC. The authors hypothesized that activated ERK (pERK) promotes disease progression and metastasis in localized RCC and may be of value as a biomarker to predict disease recurrence. METHODS The expression profile of pERK was examined by immunocytochemistry using a tissue microarray constructed from 174 drug treatment-naive patients who had undergone radical nephrectomy for localized RCC. Levels of tumor-cell specific pERK were scored and correlated with clinicopathologic parameters of RCC and disease-free survival. RESULTS Immunostaining for pERK was present in 36% of all RCCs, with a predominance found in the clear cell histologic subtype. High expression was associated with increased tumor size, increased TNM stage, and vascular invasion. Patients with pERK-positive tumors had a mean disease-free survival of 4.19 years, compared with 6.38 years for patients with pERK-negative tumors (P<.001). Cox regression models revealed pERK to be a significant independent predictor of disease-free survival, with a hazards score of 2.9 (P<.001), a value similar to tumor grade (hazards ratio, 3.01; P<.001). CONCLUSIONS Expression of pERK is an independent prognostic factor in RCC that is associated with advanced and aggressive pathologic features of renal tumors and predicts the onset of metastasis in patients with localized disease.
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Affiliation(s)
- Lee Campbell
- Welsh School Of Pharmacy, Department of Pathology, Cardiff University, Cardiff, United Kingdom
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Thomas AA, Rini BI, Stephenson AJ, Garcia JA, Fergany A, Krishnamurthi V, Novick AC, Gill IS, Klein EA, Zhou M, Campbell SC. Surgical resection of renal cell carcinoma after targeted therapy. J Urol 2009; 182:881-6. [PMID: 19616232 DOI: 10.1016/j.juro.2009.05.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Indexed: 12/29/2022]
Abstract
PURPOSE The development of targeted agents for renal cell carcinoma has renewed interest in consolidative surgery due to the robust clinical responses seen with these agents. The integration of targeted therapy and surgery requires careful consideration due to the potential for increased perioperative morbidity. MATERIALS AND METHODS We retrospectively identified patients with renal cell carcinoma treated with sunitinib, sorafenib or bevacizumab plus interleukin-2 before tumor resection. RESULTS Between June 2005 and August 2008, 19 patients were treated with targeted therapy and subsequently underwent resection. Surgical extirpation involved an open and a laparoscopic approach in 18 and 3 cases, respectively, for locally advanced (8), locally recurrent (6) and metastatic disease (3). Two patients with extensive bilateral renal cell carcinoma were also treated to downsize the tumors to enable partial nephrectomy. Perioperative complications were noted in 16% of patients. One patient had a significant intraoperative hemorrhage and disseminated intravascular coagulopathy from a concomitant liver resection. An anastomotic bowel leak and abscess were noted postoperatively in another patient who underwent en bloc resection of a retroperitoneal recurrence and adjacent colon. Two patients (11%) had minor wound complications, including a wound seroma and a ventral hernia. Pathological analysis of 20 specimens revealed clear cell, chromophobe and unclassified renal cell carcinoma in 80%, 5% and 10% of cases, respectively. One patient (5%) had a pathological complete response. CONCLUSIONS Surgical resection of renal cell carcinoma after targeted therapy is feasible with low morbidity in most patients. However, significant complications can occur, raising concern for possible compromise of tissue and/or vascular integrity associated with surgery in this setting.
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Affiliation(s)
- Anil A Thomas
- Glickman Urological and Kidney Institute, Cleveland, Ohio 44195, USA
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Integration of surgery and systemic therapy in the management of metastatic renal cancer. Curr Urol Rep 2009; 10:35-41. [PMID: 19116094 DOI: 10.1007/s11934-009-0008-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Integration of surgery and systemic therapies represents the best management option for most patients with metastatic renal cell carcinoma. Cytoreductive nephrectomy, metastasectomy, and consolidative surgery can all play a vital role in this challenging patient population. Relevant issues in this era relate to the timing of surgery, the role of cytoreduction as systemic therapies become more effective, management of the residual mass, and surgical safety after targeted therapy.
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Gimenez SE, Secasan C, Raman JD. Prognostic markers and targeted therapies for renal cell carcinoma. Future Oncol 2009; 5:197-205. [PMID: 19284378 DOI: 10.2217/14796694.5.2.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Management of advanced renal cell carcinoma remains a persistent clinical challenge with high morbidity and mortality for a large proportion of patients. Until recently, available medical immunotherapy regimens yielded a therapeutic response in only 20% of patients. Advances in the understanding of molecular mechanisms of renal cell carcinoma have led to a rapidly expanding body of work exploring biomarkers for the disease and targeted therapeutics. We review current investigations into biomarkers and novel therapies for renal cell carcinoma, discuss the concept of anticancer vaccines, and propose a novel target for anticancer vaccine development.
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Affiliation(s)
- S Elena Gimenez
- James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, NY, USA
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Lopez–Beltran A, Kirkali Z, Cheng L, Egevad L, Regueiro JC, Blanca A, Montironi R. Targeted therapies and biological modifiers in urologic tumors: pathobiology and clinical implications. Semin Diagn Pathol 2008; 25:232-44. [DOI: 10.1053/j.semdp.2008.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Crispen PL, Boorjian SA, Lohse CM, Leibovich BC, Kwon ED. Predicting disease progression after nephrectomy for localized renal cell carcinoma: the utility of prognostic models and molecular biomarkers. Cancer 2008; 113:450-60. [PMID: 18523999 DOI: 10.1002/cncr.23566] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Disease progression after nephrectomy for pathologically localized renal cell carcinoma (RCC) is associated with a significant mortality rate, given the limited efficacy of available treatment regimens for metastatic disease. As such, several adjuvant trials have been designed to treat patients at particularly high risk for postsurgical RCC progression. Several different prognostic models designed to identify patients at high risk of disease progression are available. Although these available predictive models provide a reasonable assessment of patients' risks of disease progression, the accuracy of these models may further be improved via the incorporation of molecular prognostic biomarkers. Although numerous candidate molecules have been described, few have been specifically assessed for the association with disease progression after nephrectomy. IMP-3, CXCR3, p53, Survivin, cIAP1, B7-H1, and B7-H4 have all been associated with disease progression after nephrectomy. The incorporation of 1 or several of these biomarkers may increase the accuracy of currently available prognostic models and thereby facilitate the appropriate use of adjuvant therapies aimed at preventing future disease progression. As such, the authors review the current prognostic tools for predicting disease progression for localized RCC, and detail studies to date that have evaluated various biomarkers in this setting.
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Affiliation(s)
- Paul L Crispen
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55902, USA
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