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Xu W, Gaborieau V, Niman SM, Mukeria A, Liu X, Maremanda KP, Takakura A, Zaridze D, Freedman ML, Xie W, McDermott DF, Choueiri TK, Catalano PJ, Sabbisetti V, Bonventre JV, Pierorazio PM, Singla N, Brennan P, Bhatt RS. Plasma Kidney Injury Molecule-1 for Preoperative Prediction of Renal Cell Carcinoma Versus Benign Renal Masses, and Association With Clinical Outcomes. J Clin Oncol 2024; 42:2691-2701. [PMID: 38701382 DOI: 10.1200/jco.23.00699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 11/17/2023] [Accepted: 02/20/2024] [Indexed: 05/05/2024] Open
Abstract
PURPOSE Both clear cell and papillary renal cell carcinomas (RCCs) overexpress kidney injury molecule-1 (KIM-1). We investigated whether plasma KIM-1 (pKIM-1) may be a useful risk stratification tool among patients with suspicious renal masses. METHODS Prenephrectomy pKIM-1 was measured in two independent cohorts of patients with renal masses. Cohort 1, from the prospective K2 trial, included 162 patients found to have clear cell RCC (cases) and 162 patients with benign renal masses (controls). Cohort 2 included 247 patients with small (cT1a) renal masses from an academic biorepository, of whom 184 had RCC. We assessed the relationship between pKIM-1, surgical pathology, and clinical outcomes. RESULTS In Cohort 1, pKIM-1 distinguished RCC versus benign masses with area under the receiver operating curve (AUC-ROC, 0.81 [95% CI, 0.76 to 0.86]). In Cohort 2 (cT1a only), pKIM-1 distinguished RCC versus benign masses (AUC-ROC, 0.74 [95% CI, 0.67 to 0.80]) and the addition of pKIM-1 to an established nomogram for predicting malignancy improved the model AUC-ROC (0.65 [95% CI, 0.57 to 0.74] v 0.78 [95% CI, 0.72 to 0.85]). A pKIM-1 cutpoint identified using Cohort 2 demonstrated sensitivity of 92.5% and specificity of 60% for identifying RCC in Cohort 1. In long-term follow-up of RCC cases (Cohort 1), higher prenephrectomy pKIM-1 was associated with worse metastasis-free survival (multivariable MFS hazard ratio [HR] 1.29 per unit increase in log pKIM-1, 95% CI, 1.10 to 1.53) and overall survival (multivariable OS HR 1.31 per unit increase in log pKIM-1, 95% CI, 1.10 to 1.54). In long-term follow-up of Cohort 2, no metastatic events occurred, consistent with the favorable prognosis of resected cT1a RCC. CONCLUSION Among patients with renal masses, pKIM-1 is associated with malignant pathology, worse MFS, and risk of death. pKIM-1 may be useful for selecting patients with renal masses for intervention versus surveillance.
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Affiliation(s)
- Wenxin Xu
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Anush Mukeria
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - Xiaowen Liu
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - David Zaridze
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | | | | | | | | | | | | | | | | | - Nirmish Singla
- Brady Urological Institute, Johns Hopkins University, Baltimore, MD
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
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Zhao J, Ding X, Zhou S, Wang M, Peng C, Bai X, Zhang X, Liu K, Ma X, Zhang X, Wang H. Renal cell carcinoma and venous tumor thrombus: predicting sarcomatoid dedifferentiation through preoperative IVIM-based MR imaging. Abdom Radiol (NY) 2024; 49:1961-1974. [PMID: 38411691 DOI: 10.1007/s00261-024-04210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To evaluate the value of preoperative intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and conventional MRI indicators in identifying sarcomatoid dedifferentiation in renal cell carcinoma (RCC) and tumor thrombus. METHODS From September 2016 to April 2023, consecutive patients with RCC and tumor thrombus who received routine MRI examination and IVIM-DWI before radical resection were enrolled prospectively. Kaplan-Meier method with log-rank test was used to calculate and compare the survival probability. The preoperative imaging features were analyzed. Univariate and multivariable logistic regression analyses were employed to identify independent predictors of sarcomatoid dedifferentiation. The predictive ability was evaluated by receiver operating characteristic (ROC) curves. RESULTS Twenty-two patients (15.3%) of the 144 patients in the training set (median age, 58.0 years [IQR, 52.0-65.0 years]; 108 men) and 11 patients (22.4%) of the 49 patients in the test set (median age, 58.0 years [IQR, 53.0-63.0 years]; 38 men) had sarcomatoid dedifferentiated tumors. Patients with sarcomatoid-differentiated tumors had poor progress-free survival in the training set and test set (P < 0.001 and P = 0.007). f value (P = 0.011), mN stage (P = 0.007), and necrosis (P = 0.041) were independent predictors for predicting sarcomatoid dedifferentiation in the training set. The model combining conventional MRI features and f value had AUCs of 0.832 (95% CI 0.755-0.909) and 0.825 (95% CI 0.702-0.948) in predicting sarcomatoid dedifferentiation in the training set and test set. CONCLUSION It is feasible to preoperatively identify sarcomatoid dedifferentiation based on IVIM-DWI and conventional MR imaging indicators.
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Affiliation(s)
- Jian Zhao
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
- Department of Radiology, Armed Police Force Hospital of Sichuan, Leshan, 614000, Sichuan, People's Republic of China
| | - Xiaohui Ding
- Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Shaopeng Zhou
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Meifeng Wang
- Department of Radiology, Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100037, People's Republic of China
| | - Cheng Peng
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Xu Bai
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Xiaojing Zhang
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Kan Liu
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Xin Ma
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Xu Zhang
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Haiyi Wang
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China.
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Kaur J, Patil G, Geynisman DM, Ghatalia P. Role of perioperative immunotherapy in localized renal cell carcinoma. Ther Adv Med Oncol 2023; 15:17588359231181497. [PMID: 37529159 PMCID: PMC10387776 DOI: 10.1177/17588359231181497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 05/24/2023] [Indexed: 08/03/2023] Open
Abstract
Immunotherapy has proven effective in metastatic renal cell carcinoma (RCC). The current standard of treatment in localized RCC is partial or complete nephrectomy. However, after surgery, there is a high recurrence rate and survival rates ranging from 53% to 85% depending on the stage of disease at presentation. Given clinical response to immunotherapies in metastatic RCC, these therapies are being tested as monotherapy and in combination with vascular endothelial growth factor receptor tyrosine kinase inhibitors in the (neo)adjuvant setting. Here we describe the current landscape of these treatments in localized RCC.
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Affiliation(s)
- Jasmeet Kaur
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Daniel M. Geynisman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Harada KI, Miyake H, Furukawa J, Fujimoto N, Fujisawa M. Comprehensive assessments of immuno-oncology drug-based combination therapies as first-line treatment for advanced renal cell carcinoma. Int J Urol 2022; 29:816-822. [PMID: 35636920 DOI: 10.1111/iju.14922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/19/2022] [Indexed: 12/12/2022]
Abstract
Over the last decade, there have been substantial progress in the field of systemic therapy for advanced renal cell carcinoma. Through the transition from treatment with cytokines to molecular-targeted agents, and currently to immuno-oncology drugs, the prognostic outcomes of patients with advanced renal cell carcinoma have been markedly improved. In particular, based on the promising outcomes of recently conducted pivotal randomized clinical trials, immuno-oncology drug-based combination therapy by either dual immune checkpoint inhibition or combined inhibition of an immune checkpoint and tyrosine kinase, is currently regarded as a standard of care for treatment-naïve advanced renal cell carcinoma patients. However, insufficient data are available with respect to the selection of optimal systemic therapies for advanced renal cell carcinoma in the first-line setting due to the lack of a head-to-head comparison between approved immuno-oncology drug-based combination therapies. In this review, therefore, we summarize interesting findings associated with first-line combination therapies for advanced renal cell carcinoma obtained from both randomized clinical trials and real-world clinical practices, in order to present useful guidance to help make treatment decisions for patients with treatment-naïve advanced renal cell carcinoma.
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Affiliation(s)
- Ken-Ichi Harada
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Junya Furukawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naohiro Fujimoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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