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van Riel L, Kets CM, van Hest LP, Menko FH, Boerrigter BG, Franken SM, Wolthuis RMF, Dubbink HJ, Zondervan PJ, van Moorselaar RJA, Houweling AC, van de Beek I. Metastatic disease after removal of a renal cell carcinoma smaller than 3 cm in a patient with Birt-Hogg-Dubé syndrome, a case report. Fam Cancer 2024:10.1007/s10689-024-00408-w. [PMID: 38900222 DOI: 10.1007/s10689-024-00408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Affiliation(s)
- L van Riel
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
- Department of Human Genetics, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - C M Kets
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L P van Hest
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - F H Menko
- Department of Clinical Genetics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B G Boerrigter
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - S M Franken
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - R M F Wolthuis
- Department of Human Genetics, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - H J Dubbink
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - P J Zondervan
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - R J A van Moorselaar
- Department of Urology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - A C Houweling
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - I van de Beek
- Department of Clinical Genetics, Netherlands Cancer Institute, Amsterdam, the Netherlands
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2
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Zhang H, Andreou A, Bhatt R, Whitworth J, Yngvadottir B, Maher ER. Characteristics, aetiology and implications for management of multiple primary renal tumours: a systematic review. Eur J Hum Genet 2024:10.1038/s41431-024-01628-5. [PMID: 38802529 DOI: 10.1038/s41431-024-01628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/16/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
In a subset of patients with renal tumours, multiple primary lesions may occur. Predisposition to multiple primary renal tumours (MPRT) is a well-recognised feature of some inherited renal cancer syndromes. The diagnosis of MPRT should therefore provoke a thorough assessment for clinical and genetic evidence of disorders associated with predisposition to renal tumourigenesis. To better define the clinical and genetic characteristics of MPRT, a systematic literature review was performed for publications up to 3 April 2024. A total of 7689 patients from 467 articles were identified with MPRT. Compared to all patients with renal cell carcinoma (RCC), patients with MPRT were more likely to be male (71.8% versus 63%) and have an earlier age at diagnosis (<46 years, 32.4% versus 19%). In 61.1% of cases MPRT were synchronous. The proportion of cases with similar histology and the proportion of cases with multiple papillary renal cell carcinoma (RCC) (16.1%) were higher than expected. In total, 14.9% of patients with MPRT had a family history of cancer or were diagnosed with a hereditary RCC associated syndrome with von Hippel-Lindau (VHL) disease being the most common one (69.7%), followed by Birt-Hogg-Dubé (BHD) syndrome (14.2%). Individuals with a known or likely genetic cause were, on average, younger (43.9 years versus 57.1 years). In rare cases intrarenal metastatic RCC can phenocopy MPRT. We review potential genetic causes of MPRT and their implications for management, suggest an approach to genetic testing for individuals presenting with MPRT and considerations in cases in which routine germline genetic testing does not provide a diagnosis.
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Affiliation(s)
- Huairen Zhang
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Avgi Andreou
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Rupesh Bhatt
- Department of Urology, Queen Elizabeth Hospital, Birmingham, B15, UK
| | - James Whitworth
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Bryndis Yngvadottir
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Eamonn R Maher
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK.
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK.
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3
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Gopal N, Anari PY, Chaurasia A, Antony M, Wakim P, Linehan WM, Ball M, Turkbey E, Malayeri A. The kidney imaging surveillance scoring system (KISSS): using qualitative MRI features to predict growth rate of renal tumors in patients with von-Hippel Lindau (VHL) syndrome. Abdom Radiol (NY) 2024; 49:542-550. [PMID: 38010527 DOI: 10.1007/s00261-023-04087-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To determine the reliability of an MRI-based qualitative kidney imaging surveillance scoring system (KISSS) and assess which imaging features predict growth rate (GR) of renal tumors in patients with VHL. MATERIALS AND METHODS We identified 55 patients with VHL with 128 renal tumors who underwent intervention from 2015 to 2020 at the National Cancer Institute. All patients had 2 preoperative MRIs at least 3 months apart. Two fellowship-trained radiologists scored each tumor on location and MR-sequence-specific imaging parameters from the earlier MRI. Weighted kappa was used to determine the degree of agreement between radiologists for each parameter. GR was calculated as the difference in maximum tumor dimension over time (cm/year). Differences in mean growth rate (MGR) within categories of each imaging variable were assessed by ANOVA. RESULTS Apart from tumor margin and renal sinus, reliability was at least moderate (K > 0.40) for imaging parameters. Median initial tumor size was 2.1 cm, with average follow-up of 1.2 years. Tumor MGR was 0.42 cm/year. T2 hypointense, mixed/predominantly solid, and high restricted diffusion tumors grew faster. When comparing different combinations of these variables, the model with the lowest mean error among both radiologists utilized only solid/cystic and restricted diffusion features. CONCLUSIONS We demonstrate a novel MR-based scoring system (KISSS) that has good precision with minimal training and can be applied to other qualitative radiology studies. A subset of imaging variables (T2 intensity; restricted diffusion; and solid/cystic) were independently associated with growth rate in VHL renal tumors, with the combination of the latter two most optimal. Additional validation, including in sporadic RCC population, is warranted.
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Affiliation(s)
- Nikhil Gopal
- Urology Oncology Branch, National Cancer Institutes, National Institutes of Health, Bethesda, MD, USA
| | - Pouria Yazdian Anari
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Aditi Chaurasia
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Maria Antony
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Paul Wakim
- Center for the Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, USA
| | - W Marston Linehan
- Urology Oncology Branch, National Cancer Institutes, National Institutes of Health, Bethesda, MD, USA
| | - Mark Ball
- Urology Oncology Branch, National Cancer Institutes, National Institutes of Health, Bethesda, MD, USA
| | - Evrim Turkbey
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA
| | - Ashkan Malayeri
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1109, USA.
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Tekin B, Erickson LA, Gupta S. von Hippel-Lindau disease-related neoplasia with an emphasis on renal manifestations. Semin Diagn Pathol 2024; 41:20-27. [PMID: 37980175 DOI: 10.1053/j.semdp.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
von Hippel-Lindau (VHL) disease is characterized by biallelic inactivation of the VHL gene leading to abnormal or absent VHL protein function, and constitutive activation of hypoxia-inducible factors (HIF) that leads to pro-tumorigenic signaling. Individuals with VHL disease develop numerous cysts and tumors involving multiple organs including the kidneys, central nervous system, endolymphatic sac, lungs, pancreatobiliary system, adrenal glands, epididymis, and/or broad ligament. On histologic examination, these lesions show morphologic overlap as they are frequently characterized by cells with clear cytoplasm and prominent vascularity. In addition to distinguishing non-renal tumors from metastatic clear cell renal cell carcinoma, understanding site-specific histopathologic and immunophenotypic features of these tumors has several applications. This includes distinguishing VHL-related tumors from those that arise sporadically and lack VHL gene alterations, guiding further genetic workup, and helping distinguish between different genetic predisposition syndromes. In this context, immunohistochemical studies for markers such as paired box 8 (PAX-8), carbonic anhydrase 9 (CA9), and glucose transporter 1 (GLUT-1) have an important role in routine clinical practice and represent cost-effective diagnostic tools. The recent development of targeted therapeutics directed against HIF-mediated signaling represents a significant milestone in the management of VHL disease and highlights the importance of accurately diagnosing and characterizing the wide spectrum of VHL disease-associated lesions.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA.
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5
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Jacoba IM, Lu Z. Hereditary papillary renal cell carcinoma. Semin Diagn Pathol 2024; 41:28-31. [PMID: 38135585 DOI: 10.1053/j.semdp.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/14/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
Hereditary papillary renal cell carcinoma (HPRCC) is an autosomal dominant syndrome characterized by the occurrence of bilateral and multifocal, classic type papillary renal cell carcinomas. In the recent decades, extensive molecular studies have narrowed the molecular underpinnings of this syndrome to missense mutations in tyrosine kinase domain of MET proto-oncogene. Although MET mutations are specific to HPRCC, it has been found in sporadic papillary renal cell carcinomas and as recently reported, in biphasic squamoid alveolar variant of papillary renal cell carcinoma. Dual MET/VEGFR2 kinase inhibitor and tyrosine kinase inhibitors have shown promising results in systemic therapy for HPRCC.
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Affiliation(s)
- Isa Mulingbayan Jacoba
- Boston Medical Center/Boston University Chobanian and Avedisian School of Medicine, Department of Pathology and Laboratory Medicine, United States
| | - Zhichun Lu
- Boston Medical Center/Boston University Chobanian and Avedisian School of Medicine, Department of Pathology and Laboratory Medicine, United States.
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6
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Li L, Bao H, Xu Y, Yang W, Zhang Z, Ma K, Zhang K, Zhou J, Gong Y, Ci W, Gong K. Preliminary Study of Whole-Genome Bisulfite Sequencing and Transcriptome Sequencing in VHL Disease-Associated ccRCC. Mol Diagn Ther 2023; 27:741-752. [PMID: 37587253 DOI: 10.1007/s40291-023-00663-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Von Hippel-Lindau (VHL) disease is an autosomal dominant hereditary tumor syndrome with an incidence of approximately 1/36,000. VHL disease-associated clear cell renal cell carcinoma (ccRCC) is the most common congenital RCC. Although recent advances in treating RCC have improved the long-term prognosis of patients with VHL disease, kidney cancer is still the leading cause of death in these patients. Therefore, finding new targets for diagnosing and treating VHL disease-associated ccRCC is still essential. METHODS In this study, we collected matched tumor tissues and normal samples from 25 patients with VHL disease-associated ccRCC, diagnosed and surgically treated in the Department of Urology, Peking University First Hospital. After screening, we performed whole genome bisulfite sequencing (WGBS) on 23 pairs of tissues and RNA-seq on 6 pairs of tissues. And we also compared the VHL disease-associated ccRCC transcriptome data with the sporadic ccRCC transcriptome data from the The Cancer Genome Atlas (TCGA) public database RESULTS: We found that the methylation level of VHL disease-associated ccRCC tumor tissues was significantly lower than that of normal tissues. The tumor tissues showed a difference in the copy number of 3p loss and 5q and 7q gain compared with normal tissues. We integrated RNA-seq and WGBS data to reveal methylation candidate genes associated with VHL disease-associated ccRCC; our results showed 124 hypermethylated and downregulated genes, and 245 hypomethylated and upregulated genes. By comparing the VHL disease-associated ccRCC transcriptome data with the sporadic ccRCC transcriptome data from the TCGA public database, we found that the major pathways of differential gene enrichment differed between them. CONCLUSIONS Our study mapped the multiomics of copy number variation, methylation and mRNA level changes in tumor and normal tissues of clear cell renal cell carcinoma with VHL syndrome, which provides a solid foundation for the mechanistic study, biomarker screening, and therapeutic target discovery of clear cell renal cell carcinoma.
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Affiliation(s)
- Lei Li
- Department of Urology, Peking University First Hospital, Beijing, 100034, China
- Institution of Urology, Peking University, Beijing, 100034, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, 100034, China
- National Urological Cancer Center, Beijing, 100034, China
| | - Hainan Bao
- Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, and China National Center for Bioinformation, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yawei Xu
- Department of Urology, Peking University First Hospital, Beijing, 100034, China
- Institution of Urology, Peking University, Beijing, 100034, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, 100034, China
- National Urological Cancer Center, Beijing, 100034, China
| | - Wuping Yang
- Department of Urology, Peking University First Hospital, Beijing, 100034, China
- Institution of Urology, Peking University, Beijing, 100034, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, 100034, China
- National Urological Cancer Center, Beijing, 100034, China
| | - Zedan Zhang
- Department of Urology, Peking University First Hospital, Beijing, 100034, China
- Institution of Urology, Peking University, Beijing, 100034, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, 100034, China
- National Urological Cancer Center, Beijing, 100034, China
| | - Kaifang Ma
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomingxiang Street, Dongcheng District, Beijing, 100730, China
| | - Kenan Zhang
- Department of Urology, Peking University First Hospital, Beijing, 100034, China
- Institution of Urology, Peking University, Beijing, 100034, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, 100034, China
- National Urological Cancer Center, Beijing, 100034, China
| | - Jingcheng Zhou
- Department of Urology, Peking University First Hospital, Beijing, 100034, China
- Institution of Urology, Peking University, Beijing, 100034, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, 100034, China
- National Urological Cancer Center, Beijing, 100034, China
| | - Yanqing Gong
- Department of Urology, Peking University First Hospital, Beijing, 100034, China
- Institution of Urology, Peking University, Beijing, 100034, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, 100034, China
- National Urological Cancer Center, Beijing, 100034, China
| | - Weimin Ci
- Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, and China National Center for Bioinformation, Chinese Academy of Sciences, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China.
| | - Kan Gong
- Department of Urology, Peking University First Hospital, Beijing, 100034, China.
- Institution of Urology, Peking University, Beijing, 100034, China.
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, 100034, China.
- National Urological Cancer Center, Beijing, 100034, China.
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7
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Pandolfo SD, Cerrato C, Wu Z, Franco A, Del Giudice F, Sciarra A, Verze P, Lucarelli G, Imbimbo C, Perdonà S, Cherullo EE, Porpiglia F, Derweesh IH, Autorino R. A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications: Large tumors (cT2-T3), solitary kidney, completely endophytic, hilar, recurrent, and multiple renal tumors. Asian J Urol 2023; 10:390-406. [PMID: 38024426 PMCID: PMC10659988 DOI: 10.1016/j.ajur.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/18/2023] [Accepted: 06/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Robot-assisted partial nephrectomy (RAPN) has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses. The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses, large tumors (cT2-T3), renal cell carcinoma in solitary kidney, recurrent tumors, completely endophytic and hilar masses, and simultaneous and multiple tumors. Methods A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers. The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered. The secondary endpoint was to evaluate the surgical and functional outcomes. Results After screening 1250 records, 43 full-text manuscripts were selected, comprising over 8500 patients. Twelve and thirteen studies reported data for endophytic and hilar renal masses, respectively. Five and three studies reported outcomes for cT2-T3 and solitary kidney patients, respectively. Four studies focused on redo-RAPN for recurrent tumors. Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney. Conclusion Over the past decade, evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown. Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes, the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result. Certainly, a higher likelihood of complication might be expected when facing extremely challenging cases. However, none of these indications should be considered per se an exclusion criterion for performing RAPN. Ultimately, a risk-adapted approach should be employed.
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Affiliation(s)
- Savio Domenico Pandolfo
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, “Federico II” University, Naples, Italy
| | - Clara Cerrato
- Department of Urology, University of Verona, Verona, Italy
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Urology, Sant’ Andrea Hospital, La Sapienza University, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urologic Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, “Federico II” University, Naples, Italy
| | - Sisto Perdonà
- Department Uro-Gynecology, IRCCS G. Pascale Foundation, Naples, Italy
| | | | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Ithaar H. Derweesh
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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8
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Vocke CD, Fleming LR, Piskorski AM, Amin A, Phornphutkul C, de la Monte S, Vilboux T, Duncan F, Pellegrino J, Braddock B, Middelton LA, Schmidt LS, Merino MJ, Cowen EW, Introne WJ, Linehan WM, Smith ACM. A diagnosis of Birt-Hogg-Dubé syndrome in individuals with Smith-Magenis syndrome: Recommendation for cancer screening. Am J Med Genet A 2023; 191:490-497. [PMID: 36513625 PMCID: PMC10117402 DOI: 10.1002/ajmg.a.63049] [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: 09/30/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 12/15/2022]
Abstract
We report a series of four unrelated adults with Smith-Magenis syndrome (SMS) and concomitant features of Birt-Hogg-Dubé (BHD) syndrome based upon haploinsufficiency for FLCN and characteristic renal cell carcinomas and/or evidence of cutaneous fibrofolliculomas. Three of the cases constitute the first known association of histopathologically verified characteristic BHD-associated renal tumors in adults with SMS; the fourth was identified to have histologically confirmed skin fibrofolliculomas. Molecular analysis documented second-hit FLCN mutations in two of the three cases with confirmed BHD renal pathology. These cases suggest the need to expand management recommendations for SMS to include kidney cancer surveillance starting at 20 years of age, as per the screening recommendations for BHD syndrome.
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Affiliation(s)
- Cathy D. Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Leah R. Fleming
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
- Department of Genetics, Saint Luke’s Genetics and Metabolic Clinic, Boise, Idaho, USA
| | - Anna M. Piskorski
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ali Amin
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Chanika Phornphutkul
- Division of Human Genetics, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Suzanne de la Monte
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Thierry Vilboux
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
- Medical Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - Folami Duncan
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
- Department of Pediatric Emergency Medicine, Johns Hopkins Children’s Center, Baltimore, Maryland, USA
| | - Joan Pellegrino
- Medical Genetics, Upstate Medical University, Syracuse, New York, USA
| | - Bonnie Braddock
- Medical Genetics, Upstate Medical University, Syracuse, New York, USA
| | - Lindsay A. Middelton
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Laura S. Schmidt
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Maria J. Merino
- Laboratory of Pathology Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Edward W. Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, USA
| | - Wendy J. Introne
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - W. Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Ann C. M. Smith
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
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9
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Webster BR, Gopal N, Ball MW. Tumorigenesis Mechanisms Found in Hereditary Renal Cell Carcinoma: A Review. Genes (Basel) 2022; 13:2122. [PMID: 36421797 PMCID: PMC9690265 DOI: 10.3390/genes13112122] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 09/29/2023] Open
Abstract
Renal cell carcinoma is a heterogenous cancer composed of an increasing number of unique subtypes each with their own cellular and tumor behavior. The study of hereditary renal cell carcinoma, which composes just 5% of all types of tumor cases, has allowed for the elucidation of subtype-specific tumorigenesis mechanisms that can also be applied to their sporadic counterparts. This review will focus on the major forms of hereditary renal cell carcinoma and the genetic alterations contributing to their tumorigenesis, including von Hippel Lindau syndrome, Hereditary Papillary Renal Cell Carcinoma, Succinate Dehydrogenase-Deficient Renal Cell Carcinoma, Hereditary Leiomyomatosis and Renal Cell Carcinoma, BRCA Associated Protein 1 Tumor Predisposition Syndrome, Tuberous Sclerosis, Birt-Hogg-Dubé Syndrome and Translocation RCC. The mechanisms for tumorigenesis described in this review are beginning to be exploited via the utilization of novel targets to treat renal cell carcinoma in a subtype-specific fashion.
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Affiliation(s)
| | | | - Mark W. Ball
- Center for Cancer Research, Urologic Oncology Branch, National Cancer Institute/NIH, 10 Center Drive, CRC Room 2W-5940, Bethesda, MD 20892, USA
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10
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Evaluation of tumour surveillance protocols and outcomes in von Hippel-Lindau disease in a national health service. Br J Cancer 2022; 126:1339-1345. [PMID: 35184155 PMCID: PMC8857742 DOI: 10.1038/s41416-022-01724-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 11/08/2022] Open
Abstract
Abstract
Background
Von Hippel-Lindau (VHL) disease is an inherited tumour predisposition syndrome and a paradigm for the importance of early diagnosis and surveillance. However, there is limited information on the “real world” management of VHL disease.
Methods
A national audit of VHL disease in the United Kingdom.
Results
VHL disease was managed mostly via specialist clinics coordinated through regional clinical genetics services (but frequently involving additional specialties). Over the study period, 19 genetic centres saw 842 individuals (393 males, 449 females) with a clinical and/or molecular diagnosis of VHL disease and 74 individuals (35 male, 39 female) with a prior risk of 50% (affected parent). All centres offered retinal, central nervous system and abdominal surveillance to affected individuals and at-risk relatives though surveillance details differed between centres (but complied with international recommendations). Renal lesions detected on the first surveillance scan were, on average, larger than those detected during subsequent scans and the larger the diameter at detection the greater the likelihood of early intervention.
Conclusions
In a state-funded health care system individuals with a rare inherited cancer predisposition syndrome are generally able to access appropriate surveillance and patient management is improved compared to historical data. The “real world” data from this study will inform the future development of VHL management protocols.
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Von Hippel-Lindau disease-associated renal cell carcinoma: a call to action. Curr Opin Urol 2022; 32:31-39. [PMID: 34783716 DOI: 10.1097/mou.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW While the molecular and genetic bases of Von Hippel-Lindau (VHL) disease have been extensively investigated, limited evidence is available to guide diagnosis, local or systemic therapy, and follow-up. The aim of the current review is to summarize the ongoing trials both in preclinical and clinical setting regarding VHL disease management. RECENT FINDINGS Although genotype/phenotype correlations have been described, there is considerable inter and intra-familiar heterogeneity in VHL disease. Genetic anticipation has been reported in VHL disease. From a clinical point of view, expert-opinion-based protocols suggest testing those patients with any blood relative of an individual diagnosed with VHL disease, those with at least 1 or more suggestive neoplasms or patients presenting with clear cell renal cell carcinoma (ccRCC) diagnosed at a less than 40 years old, and/or multiple ccRCC. Clinical research is focused on safety and efficacy of systemic agents for patients with VHL-related ccRCC, with the aim to possibly preserve kidney function and improve patient survival. SUMMARY To date, preclinical and clinical research on the topic is scarce and clinical guidelines are not supported by strong validation studies.
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Lebastchi AH, Haynes B, Gurram S, Bratslavsky G, Metwalli AR, Linehan WM, Ball MW. X-Capsular Incision for Tumor Enucleation (X-CITE)-Technique: A Method to Maximize Renal Parenchymal Preservation for Completely Endophytic Renal Tumors. Urology 2021; 154:315-319. [PMID: 33831400 DOI: 10.1016/j.urology.2021.03.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To describe the X-Capsular Incision for Tumor Enucleation (X-CITE) technique to resect endophytic renal tumors while preserving the overlying renal parenchyma. SUBJECTS AND METHODS We reviewed 1-year outcomes of 12 consecutive patients with a history of bilateral or multifocal renal tumors who presented to our institution with completely endophytic renal masse(s) between August 2017 and August 2018. Endophytic tumors were resected by making an X-shaped incision in the renal capsule and developing parenchymal flaps overlying the tumor pseudocapsule. Following tumor enucleation, the overlying parenchymal flaps were reapproximated. RESULTS Median follow up was 19.9 months (range 10.6-14.9). Most patients also had additional exophytic tumors with a median of 5 renal tumors removed per operation with a median largest renal tumor size of 3.2 cm. No intraoperative or postoperative complications occurred. There was no decline in renal function after surgery when comparing median pre- and 12-month postoperative eGFR (94.5 vs 91.5, P= 0.18).). Postoperative nuclear mercaptoacetyltriglycine (MAG-3) renal scans demonstrated equal differential kidney function after surgery. Limitations include short-term follow-up and referral bias at center specializing in multi-focal kidney surgery. CONCLUSION The X-Capsular Incision for Tumor Enucleation technique is feasible, safe and effective with minimal collateral damage in the treatment of completely endophytic renal masses. Further investigation should identify which patients may benefit from this procedure and explore intermediate and long-term outcomes.
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Affiliation(s)
- Amir H Lebastchi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Brittnee Haynes
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Adam R Metwalli
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Division of Urology, Department of Surgery, Howard University Hospital, Washington, DC
| | - W Marston Linehan
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mark W Ball
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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Gomella PT, Linehan WM, Ball MW. Precision Surgery and Kidney Cancer: Knowledge of Genetic Alterations Influences Surgical Management. Genes (Basel) 2021; 12:genes12020261. [PMID: 33670168 PMCID: PMC7916897 DOI: 10.3390/genes12020261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 01/07/2023] Open
Abstract
Renal cell carcinoma is a term that represents multiple different disease processes, each driven by different genetic alterations, with distinct histology, and biological potential which necessitates divergent management strategies. This review discusses the genetic alterations seen in several forms of hereditary kidney cancer and how that knowledge can dictate when and how to intervene with a focus on the surgical management of these tumors.
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Clinical, surgical, pathological and follow-up features of kidney cancer patients with Von Hippel-Lindau syndrome: novel insights from a large consortium. World J Urol 2021; 39:2969-2975. [PMID: 33416974 DOI: 10.1007/s00345-020-03574-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/15/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To investigate the natural history and follow-up after kidney tumor treatment of Von Hippel-Lindau (VHL) patients. MATERIALS AND METHODS A multi-institutional European consortium of patients with VHL syndrome included 96 non-metastatic patients treated at 9 urological departments (1987-2018). Descriptive and survival analyses were performed. RESULTS AND LIMITATIONS Median age at VHL diagnosis was 34 years (IQR 25-43). Two patients (2.1%) showed only renal manifestations at VHL diagnosis. Concomitant involvement of Central Nervous System (CNS) vs. pancreas vs. eyes vs. adrenal gland vs. others were present in 60.4 vs. 68.7 vs. 30.2 vs. 15.6 vs. 15.6% of patients, respectively. 45% of patients had both CNS and pancreatic diseases alongside kidney. The median interval between VHL diagnosis and renal cancer treatment resulted 79 months (IQR 0-132), and median index tumor size leading to treatment was 35.5 mm (IQR 28-60). Of resected malignant tumours, 73% were low grade. Of high-grade tumors, 61.1% were large > 4 cm. With a median follow-up of 8 years, clinical renal progression rate was 11.7% and 29.3% at 5 and 10 years, respectively. Overall mortality was 4% and 7.5% at 5 and 10 years, respectively. During the follow-up, 50% of patients did not receive a second active renal treatment. Finally, 25.3% of patients had CKD at last follow-up. CONCLUSIONS Mean period between VHL diagnosis and renal cancer detection is roughly three years, with significant variability. Although, most renal tumors are small low-grade, clinical progression and mortality are not negligible. Moreover, kidney function represents a key issue in VHL patients.
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Daccord C, Good JM, Morren MA, Bonny O, Hohl D, Lazor R. Birt-Hogg-Dubé syndrome. Eur Respir Rev 2020; 29:29/157/200042. [PMID: 32943413 PMCID: PMC9489184 DOI: 10.1183/16000617.0042-2020] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/22/2020] [Indexed: 12/22/2022] Open
Abstract
Birt–Hogg–Dubé syndrome (BHD) is a rare inherited autosomal dominant disorder caused by germline mutations in the tumour suppressor gene FLCN, encoding the protein folliculin. Its clinical expression typically includes multiple pulmonary cysts, recurrent spontaneous pneumothoraces, cutaneous fibrofolliculomas and renal tumours of various histological types. BHD has no sex predilection and tends to manifest in the third or fourth decade of life. Multiple bilateral pulmonary cysts are found on chest computed tomography in >80% of patients and more than half experience one or more episodes of pneumothorax. A family history of pneumothorax is an important clue, which suggests the diagnosis of BHD. Unlike other cystic lung diseases such as lymphangioleiomyomatosis and pulmonary Langerhans cell histiocytosis, BHD does not lead to progressive loss of lung function and chronic respiratory insufficiency. Renal tumours affect about 30% of patients during their lifetime, and can be multiple and recurrent. The diagnosis of BHD is based on a combination of genetic, clinical and/or skin histopathological criteria. Management mainly consists of early pleurodesis in the case of pneumothorax, periodic renal imaging for tumour detection, and diagnostic work-up in search of BHD in relatives of the index patient. Birt–Hogg–Dubé syndrome is a rare genetic disorder characterised by multiple lung cysts, recurrent pneumothoraces, skin lesions and kidney tumours. As the presenting symptoms may be respiratory, chest physicians should be able to identify this disease.https://bit.ly/2xsOTuk
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Affiliation(s)
- Cécile Daccord
- Respiratory Medicine Dept, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Marc Good
- Division of Genetic Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie-Anne Morren
- Pediatric Dermatology Unit, Dept of Pediatrics and Dermatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Bonny
- Service of Nephrology, Dept of Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Dept of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Daniel Hohl
- Dermatology Dept, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Romain Lazor
- Respiratory Medicine Dept, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Sebastià C, Corominas D, Musquera M, Paño B, Ajami T, Nicolau C. Active surveillance of small renal masses. Insights Imaging 2020; 11:63. [PMID: 32372194 PMCID: PMC7200970 DOI: 10.1186/s13244-020-00853-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 03/02/2020] [Indexed: 12/15/2022] Open
Abstract
Most renal masses incidentally detected by cross-sectional images are benign, being mainly cysts, and if they are malignant, they are indolent in nature with limited metastatic potential. Enhanced renal masses less than 4 cm in size are known as small renal masses (SRMs), and their growth rate (GR) and the possibility of developing metastasis are extremely low. Delayed intervention of SRMs by closed and routine imaging follow-up known as active surveillance (AS) is now an option according to urological guidelines. Radiologists have a key position in AS management of SRMs even unifocal and multifocal (sporadic or associated with genetic syndromes) and also in the follow-up of complex renal cysts by Bosniak cyst classification system. Radiologists play a key role in the AS of both unifocal and multifocal (sporadic or associated with genetic syndromes) SRMs as well as in the follow-up of complex renal cysts using the Bosniak cyst classification system. Indeed, radiologists must determine which patients with SRMs or complex renal cysts can be included in AS, establish the follow-up radiological test algorithm to be used in different scenarios, perform measurements in follow-up tests, and decide when AS should be discontinued. The purpose of this article is to review the indications and management of AS in SRMs, especially focused on specific scenarios, such as complex renal cysts and multifocal renal tumors (sporadic or hereditary). In this work, the authors aimed to provide a thorough review of imaging in the context of active surveillance of renal masses.
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Affiliation(s)
- Carmen Sebastià
- Radiology Department, CDIC, Hospital Clínic de Barcelona, C/Villaroel no. 170, 08036, Barcelona, Spain
| | - Daniel Corominas
- Radiology Department, CDIC, Hospital Clínic de Barcelona, C/Villaroel no. 170, 08036, Barcelona, Spain.
| | - Mireia Musquera
- Urology Department, ICNU, Hospital Clínic de Barcelona, C/Villaroel no. 170, 08036, Barcelona, Spain
| | - Blanca Paño
- Radiology Department, CDIC, Hospital Clínic de Barcelona, C/Villaroel no. 170, 08036, Barcelona, Spain
| | - Tarek Ajami
- Urology Department, ICNU, Hospital Clínic de Barcelona, C/Villaroel no. 170, 08036, Barcelona, Spain
| | - Carlos Nicolau
- Radiology Department, CDIC, Hospital Clínic de Barcelona, C/Villaroel no. 170, 08036, Barcelona, Spain
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Ball MW, An JY, Gomella PT, Gautam R, Ricketts CJ, Vocke CD, Schmidt LS, Merino MJ, Srinivasan R, Malayeri AA, Metwalli AR, Linehan WM. Growth Rates of Genetically Defined Renal Tumors: Implications for Active Surveillance and Intervention. J Clin Oncol 2020; 38:1146-1153. [PMID: 32083993 PMCID: PMC7145590 DOI: 10.1200/jco.19.02263] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Published series of growth rates of renal tumors on active surveillance largely consist of tumors without pathologic or genetic data. Growth kinetics of genetically defined renal tumors are not well known. Here, we evaluate the growth of genetically defined renal tumors and their association with patient clinical and genetic characteristics. PATIENTS AND METHODS We evaluated patients with an inherited kidney cancer susceptibility syndrome as a result of a pathologic germline alteration of VHL, MET, FLCN, or BAP1 with at least 1 solid renal mass managed with active surveillance at our institution. Tumor growth rates (GR) were calculated and patients were stratified by genetic alteration and other clinical and genetic factors to analyze differences in growth rates using linear regression and comparative statistics. RESULTS A total of 292 patients with 435 genetically defined tumors were identified, including 286 VHL-deficient, 91 FLCN-deficient, 52 MET-activated, and 6 BAP1-deficient tumors. There were significant differences in GRs when stratified by genetic alteration. BAP1-deficient tumors had the fastest median GR (0.6 cm/y; interquartile range [IQR], 0.57-0.68 cm/y), followed by VHL-deficient tumors (GR, 0.37 cm/y; IQR, 0.25-0.57 cm/y), FLCN-deficient tumors (GR, 0.10 cm/y; IQR, 0.04-0.24 cm/y), and tumors with MET activation (GR, 0.15 cm/y; IQR, 0.053-0.32 cm/y; P < .001). Tumors from the same patient had similar GRs. Younger age was independently associated with higher GR (P = .005). CONCLUSION In a cohort of genetically defined tumors, tumor growth rates varied in a clinically and statistically different manner according to genetic subtype. Rapid growth of BAP1-deficient tumors indicates that these patients should be managed with caution. The faster growth of tumors in younger patients may support more frequent imaging, whereas the slower growth of other tumors may support extended surveillance beyond annual imaging in some instances.
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Affiliation(s)
- Mark W. Ball
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Julie Y. An
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Patrick T. Gomella
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Rabindra Gautam
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Christopher J. Ricketts
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Cathy D. Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Laura S. Schmidt
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Maria J. Merino
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Ramaprasad Srinivasan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Ashkan A. Malayeri
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Adam R. Metwalli
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - W. Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
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18
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Erdogan S, Ozcan A, Truong LD. Molecular Pathology of Kidney Tumors. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Ozcan A, Erdogan S, Truong LD. Hereditary Syndromes Associated with Kidney Tumors. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Carlo MI, Hakimi AA, Stewart GD, Bratslavsky G, Brugarolas J, Chen YB, Linehan WM, Maher ER, Merino MJ, Offit K, Reuter VE, Shuch B, Coleman JA. Familial Kidney Cancer: Implications of New Syndromes and Molecular Insights. Eur Urol 2019; 76:754-764. [PMID: 31326218 PMCID: PMC7673107 DOI: 10.1016/j.eururo.2019.06.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/12/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT Hereditary cases account for about 5% of all cases of renal cell carcinoma (RCC). With advances in next-generation sequencing, several new hereditary syndromes have been described in the last few years. OBJECTIVE To review and summarise the recent preclinical and clinical literature in hereditary renal cancer. EVIDENCE ACQUISITION A systematic review of the literature was performed in November 2018 using PubMed and OMIM databases, with an emphasis on kidney cancer, genetics and genomics, clinical criteria, and management. EVIDENCE SYNTHESIS Several autosomal dominant hereditary RCC syndromes have been described, including those related to germline pathogenic variants in VHL, MET, FH, TSC1/TSC2, FLCN, SDHA/B/C/D, BAP1, CDC73, and MITF. Clinical spectrum of SDH, BAP1, and MITF is still being defined, although these appear to be associated with a lower incidence of RCC. FH and likely BAP1 RCC are associated with more aggressive disease. Preclinical and clinical studies show that using systemic therapy that exploits specific genetic pathways is a promising strategy. CONCLUSIONS There are several well-described hereditary RCC syndromes, as well as recently identified ones, for which the full clinical spectrum is yet to be defined. In the new era of precision medicine, identification of these syndromes may play an important role in management and systemic treatment selection. PATIENT SUMMARY This review covers updates in the diagnosis and management of familial kidney cancer syndromes. We describe updates in testing and management of the most common syndromes such as von Hippel-Lindau, and hereditary leiomyomatosis and renal cell carcinoma. We also provide insights into recently described familial kidney cancer syndromes.
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Affiliation(s)
- Maria I Carlo
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - A Ari Hakimi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | | | | | - Ying-Bei Chen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - W Marston Linehan
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eamonn R Maher
- Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre, and Cancer Research UK Cambridge Cenre, Cambridge, UK
| | - Maria J Merino
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Brian Shuch
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Johannesma PC, van de Beek I, van der Wel TJWT, Reinhard R, Rozendaal L, Starink TM, van Waesberghe JHTM, Horenblas S, Gille HJJP, Jonker MA, Meijers-Heijboer HEJ, Postmus PE, Houweling AC, van Moorselaar JRA. Renal imaging in 199 Dutch patients with Birt-Hogg-Dubé syndrome: Screening compliance and outcome. PLoS One 2019; 14:e0212952. [PMID: 30845233 PMCID: PMC6405080 DOI: 10.1371/journal.pone.0212952] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/12/2019] [Indexed: 01/04/2023] Open
Abstract
Birt-Hogg-Dubé syndrome is associated with an increased risk for renal cell carcinoma. Surveillance is recommended, but the optimal imaging method and screening interval remain to be defined. The main aim of our study was to evaluate the outcomes of RCC surveillance to get insight in the safety of annual US in these patients. Surveillance data and medical records of 199 patients with Birt-Hogg-Dubé syndrome were collected retrospectively using medical files and a questionnaire. These patients were diagnosed in two Dutch hospitals and data were collected until June 2014. A first screening for renal cell carcinoma was performed in 172/199 patients (86%). Follow-up data were available from 121 patients. The mean follow-up period per patient was 4.2 years. Of the patients known to be under surveillance, 83% was screened at least annually and 94% at least every two years. Thirty-eight renal cell carcinomas had occurred in 23 patients. The mean age at diagnosis of the first tumour was 51. Eighteen tumours were visualized by ultrasound. Nine small tumours (7–27 mm) were visible on MRI or CT and not detected using ultrasound. Our data indicate that compliance to renal screening is relatively high. Furthermore, ultrasound might be a sensitive, cheap and widely available alternative for MRI or part of the MRIs for detecting clinically relevant renal tumours in BHD patients,but the limitations should be considered carefully. Data from larger cohorts are necessary to confirm these observations.
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Affiliation(s)
- Paul C. Johannesma
- Department of Pulmonary Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Utrecht University Medical Center, Utrecht, the Netherlands
| | - Irma van de Beek
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | | | - Rinze Reinhard
- Department of Radiology, OLVG, Amsterdam, the Netherlands
| | - Lawrence Rozendaal
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Theo M. Starink
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Simon Horenblas
- Department of Urology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hans J. J. P. Gille
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marianne A. Jonker
- Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Pieter E. Postmus
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjan C. Houweling
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Peng X, Chen J, Wang J, Peng S, Liu S, Ma K, Zhou J, Hong B, Zhou B, Zhang J, Cai L, Gong K. Natural history of renal tumours in von Hippel-Lindau disease: a large retrospective study of Chinese patients. J Med Genet 2019; 56:380-387. [DOI: 10.1136/jmedgenet-2018-105567] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 01/10/2019] [Accepted: 01/19/2019] [Indexed: 12/20/2022]
Abstract
BackgroundHistorically, renal cell carcinoma (RCC) is one of the main causes of death in von Hippel-Lindau (VHL) disease. However, the natural history of VHL-related RCC has not been thoroughly elucidated to date. This report described the natural history of VHL-related RCC in a large Chinese VHL cohort and might be helpful in the surveillance and treatment of VHL disease.MethodsIn this retrospective study, we included 196 renal tumours from 150 patients with VHL disease. Statistical analysis was used to evaluate the influence of age of onset, sex, family history, unilateral or bilateral tumour, VHL disease type, mutation type, mutation location, and tumour size on tumour growth, metastasis and survival in patients with VHL disease.ResultsThe mean age of onset was 38.8 years, and the mean initial tumour size was 3.1 cm. The mean linear growth rate was 0.49 cm/year. Patients experienced faster tumour growth when they had later age of onset, larger initial tumour size, missense mutation, mutations locating in exon 3, and when they were not affected by cerebral or retinal haemangioblastomas. Tumours larger than 4 cm grew faster than those smaller than 4 cm. Bilateral tumours, large initial tumours, fast tumour growth and metastasis were risk factors for poor prognosis in VHL-related RCC.ConclusionThis large study demonstrated that age of onset, initial tumour size, concomitant tumours, mutation type and mutation location had an effect on growth rate in VHL-related RCC. Active surveillance may be safe for patients with tumour size less than 4 cm, which is helpful in clinical decision-making.
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Bensalah K, Albiges L, Bernhard JC, Bigot P, Bodin T, Boissier R, Correas JM, Gimel P, Hetet JF, Long JA, Nouhaud FX, Ouzaïd I, Rioux-Leclercq N, Méjean A. Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : prise en charge du cancer du rein. Prog Urol 2018; 28 Suppl 1:R5-R33. [DOI: 10.1016/j.purol.2019.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 12/15/2022]
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24
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Bensalah K, Albiges L, Bernhard JC, Bigot P, Bodin T, Boissier R, Correas JM, Gimel P, Hetet JF, Long JA, Nouhaud FX, Ouzaïd I, Rioux-Leclercq N, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : prise en charge du cancer du reinFrench ccAFU guidelines – Update 2018–2020: Management of kidney cancer. Prog Urol 2018; 28:S3-S31. [PMID: 30473002 DOI: 10.1016/j.purol.2018.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 12/15/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: DOI:10.1016/j.purol.2019.01.004.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the DOI:10.1016/j.purol.2019.01.004.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- K Bensalah
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033, Rennes cedex, France.
| | - L Albiges
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Département d'oncologie génito-urinaire, Gustave-Roussy, 94805, Villejuif cedex, France
| | - J-C Bernhard
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie et transplantation rénale, CHU de Bordeaux, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - P Bigot
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, CHU d'Angers, 4, rue Larrey, 49000, Angers, France
| | - T Bodin
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre d'urologie Prado-Louvain, 188, rue du Rouet, 13008, Marseille, France
| | - R Boissier
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie et transplantation rénale, CHU Conception, 147, boulevard Baille, 13005, Marseille, France
| | - J-M Correas
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'imagerie médicale (radiologie), hôpital universitaire Necker-Enfants-malades, 149, rue de Sèvres, 75015, Paris, France
| | - P Gimel
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre d'urologie, site Médipôle, 5, avenue Ambroise-Croizat, 66330, Cabestany, France
| | - J-F Hetet
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de chirurgie urologique, clinique Jules-Verne, 2-4, route de Paris, 44314, Nantes, France
| | - J-A Long
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de chirurgie urologique et de la transplantation rénale, hôpital Michallon, CHU Grenoble, boulevard de la Chantourne, 38700, La Tronche, France
| | - F-X Nouhaud
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, CHU de Rouen, 1, rue de Germont, 76000, Rouen, France
| | - I Ouzaïd
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Clinique urologique, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018, Paris, France
| | - N Rioux-Leclercq
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'anatomie et cytologie pathologiques, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033, Rennes cedex 9, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015, Paris, France
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Ather H, Zahid N. Recurrent renal cancer in Birt-Hogg-Dubé syndrome: A case report. Int J Surg Case Rep 2017; 42:75-78. [PMID: 29223882 PMCID: PMC5726742 DOI: 10.1016/j.ijscr.2017.11.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal dominant disease. It is caused by constitutional mutations in the FLCN gene. Since BHDS is a rare syndrome therefore it is unknown to many physicians. However, it is important to identify this rare syndrome at early stages because incidence of renal cancer in BHD patients is very high and its detection at early stages can prevent its metastasis. Hence, we want to present a case of BHDS and draw the attention of the treating physician to this rare inherited disorder and discuss its appropriate diagnosis and management. CASE PRESENTATION We present a case of a 50-year old male presented to the consulting clinics of a University Hospital with right flank pain since the last 2 months. The Computed Tomography (CT) and biopsy on the right renal mass indicated clear cell type renal cell carcinoma with significant lymphadenopathy. Past history of cystic lung disease and pneumothorax along with positive finding of renal cell carcinoma on CT and biopsy suggested Birt-Hogg-Dub́e (BHD) syndrome. The patient underwent right radical nephrectomy and lymph node dissection. His 3 months post- surgery follow up CT scan indicated disease recurrence. CONCLUSION In conclusion, it is important to identify this rare syndrome at early stages. Diagnosis for the patients with a positive family history for renal cell cancer and pneumothorax should be considered. FLCN sequencing should also be taken into account in patients and their families because incidence of renal cancer in BHD patients is very high and detection at early stages can prevent its metastasis.
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Affiliation(s)
- Hammad Ather
- Department of Surgery, Aga Khan University, Karachi, Pakistan.
| | - Nida Zahid
- Department of Surgery, Aga Khan University, Karachi, Pakistan.
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Dillman JR, Trout AT, Smith EA, Towbin AJ. Hereditary Renal Cystic Disorders: Imaging of the Kidneys and Beyond. Radiographics 2017; 37:924-946. [PMID: 28493804 DOI: 10.1148/rg.2017160148] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this article is to review the hereditary renal cystic diseases that can manifest in children and adults, with specific attention to pathogenesis and imaging features. Various common and uncommon hereditary renal cystic diseases are reviewed in terms of their underlying etiology, including the involved genetic mutations and the affected proteins and cellular structures. Focus is placed on the morphologic findings in each condition and the features that distinguish one disorder from another. The two most common categories of hereditary renal cystic disease are (a) the ciliopathic disorders, which are related to mutations affecting the primary cilia (called "ciliopathies"), and (b) the phakomatoses. Autosomal dominant polycystic kidney disease, autosomal recessive polycystic kidney disease, and the "medullary cystic disease complex" are all ciliopathies but have different phenotypes. Tuberous sclerosis complex and the associated "contiguous gene syndrome," as well as von Hippel-Lindau syndrome, are phakomatoses that can manifest with cystic renal lesions but have uniquely different extrarenal manifestations. Finally, DICER1 mutations can manifest with renal cystic lesions (typically, cystic nephromas) in patients predisposed to other malignancies in the chest, ovaries, and thyroid. Although some overlap exists in the appearance of the renal cysts associated with each of these diseases, there are clear morphologic differences (eg, cyst size, location, and complexity) that are emphasized in this review. To improve patient outcomes, it is important for the radiologist to recognize the various hereditary renal cystic diseases so that a correct diagnosis is assigned and so that the patient is adequately evaluated and followed up. ©RSNA, 2017.
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Affiliation(s)
- Jonathan R Dillman
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (J.R.D., A.T.T., A.J.T.); and the Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.S.)
| | - Andrew T Trout
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (J.R.D., A.T.T., A.J.T.); and the Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.S.)
| | - Ethan A Smith
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (J.R.D., A.T.T., A.J.T.); and the Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.S.)
| | - Alexander J Towbin
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (J.R.D., A.T.T., A.J.T.); and the Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.S.)
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Abstract
The study of hereditary forms of kidney cancer has vastly increased our understanding of metabolic and genetic pathways involved in the development of both inherited and sporadic kidney cancers. The recognition that diverse molecular events drive different forms of kidney cancers has led to the preclinical and clinical development of specific pathway-directed strategies tailored to treat distinct subgroups of kidney cancer. Here, we describe the molecular mechanisms underlying the pathogenesis of several different types of hereditary renal cancers, review their clinical characteristics, and summarize the treatment strategies for the management of these cancers.
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Affiliation(s)
- Abhinav Sidana
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10 - Hatfield CRC, Room 1-5940, Bethesda, MD, 20892, USA.
| | - Ramaprasad Srinivasan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10 - Hatfield CRC, Room 1-5940, Bethesda, MD, 20892, USA
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Jensen DK, Villumsen A, Skytte AB, Madsen MG, Sommerlund M, Bendstrup E. Birt-Hogg-Dubé syndrome: a case report and a review of the literature. Eur Clin Respir J 2017; 4:1292378. [PMID: 28326182 PMCID: PMC5345590 DOI: 10.1080/20018525.2017.1292378] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/31/2017] [Indexed: 01/12/2023] Open
Abstract
Background: Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal dominant inherited syndrome caused by mutations in the folliculin coding gene (FLCN). The clinical manifestations of the syndrome involve the skin, lungs, and kidneys. Because of the rarity of the syndrome, guidelines for diagnosis and management of the patients with BHDS are lacking. Objective: To present a case story and a review of the literature on BHDS in order to give an update on genetics, clinical manifestations, diagnosis, treatment, prognosis and follow-up strategies. Design: Literature review and case story. Results: A PubMed and Embase search identified 330 papers. BHDS is characterized by small benign tumors in the skin, spontaneous pneumothoraces caused by cysts in the lungs and a seven-fold increased risk of renal cancer. A case story of a young female patient presenting with pneumothorax and a family history of recurrent pneumothoraces in many relatives illustrates how the history and the diagnostic work up resulted in a diagnosis of BHDS. Conclusion: BHDS is a rare inherited disorder. In patients with spontaneous pneumothorax or cystic lung disease without any obvious explanation, BHDS should be considered. Concomitant skin manifestations, a family history of familiar pneumothorax, renal cancers and skin manifestations supports the suspicion of BHDS. Early diagnosis is important in order to subject patients to systematic screening for renal cancers. A radiological surveillance strategy for renal cancer is proposed.
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Affiliation(s)
- Dea Kejlberg Jensen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital , Aarhus , Denmark
| | - Anders Villumsen
- Institute of Clinical Medicine, Aarhus University , Aarhus , Denmark
| | - Anne-Bine Skytte
- Department of Clinical Genetics, Aarhus University Hospital , Aarhus , Denmark
| | | | - Mette Sommerlund
- Department of Dermatology, Aarhus University Hospital , Aarhus , Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital , Aarhus , Denmark
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Abstract
It is estimated that up to 2% of renal cell cancer (RCC) clusters in families. Several forms of hereditary RCC have been characterized with specific clinical, histopathological, and genetic features. The most common of these is von Hippel-Lindau (VHL) disease caused by mutations in the VHL gene and predisposing to clear cell RCC. Predisposition to papillary RCC is present in hereditary leiomyomatosis and renal cell cancer (HLRCC) and hereditary papillary renal cell carcinoma (HPRC). Identification of the genetic defects causing these diseases has enlightened the molecular pathogenesis of RCC, and moreover, provided means to improve patient management. Genetic testing enables early diagnosis of the disease, after which individuals at-risk can be guided to regular surveillance. Screening facilitates detection of presymptomatic early tumors broadening treatment options and potentially improving prognosis. Thus, identification of individuals with inherited cancer susceptibility is important as special management of these patients improves disease outcome. The purpose of this review is to provide clues for identification and management of hereditary renal cancer patients in clinical practice.
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Affiliation(s)
- M Kiuru
- Department of Medical Genetics, University of Helsinki, Helsinki, Finland
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30
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Hankins RA, Walton-Diaz A, Truong H, Shih J, Bratslavsky G, Pinto PA, Marston Linehan W, Metwalli AR. Renal functional outcomes after robotic multiplex partial nephrectomy: the National Cancer Institute experience with robotic partial nephrectomy for 3 or more tumors in a single kidney. Int Urol Nephrol 2016; 48:1817-1821. [PMID: 27515314 PMCID: PMC5090974 DOI: 10.1007/s11255-016-1392-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/02/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To identify renal function outcomes after robotic multiplex partial nephrectomy (RMxPNx), we reviewed our institutional database at the National Institutes of Health, National Cancer Institute. To our knowledge, we present the largest series of RMxPNx renal function outcomes to date. Robotic partial nephrectomy has been employed for oncologic control and to prevent dialysis dependence in hereditary multifocal renal cell carcinoma conditions. We have termed robotic surgery on a single kidney with three or more lesions a RMxPNx. MATERIALS AND METHODS We evaluated patients from a prospectively maintained database at a single institution (NIH/NCI) that underwent RMxPNx from 2007 to 2013. Demographic and operative data were compiled with statistical analysis with T test performed to determine renal function outcomes. RESULTS A total of 54 patients underwent RMxPNx. Mean number of tumors removed was 8.63 (range 3-52). Mean preoperative creatinine and eGFR were 1.02 ± 0.26 mg/dL and 85.4 ± 21.5 mL/min, respectively. Postoperatively, creatinine increased from baseline by 0.45 mg/dL (p < 0.001). Similarly, a mean decrease in eGFR by 24.6 mL/min was observed (p < 0.001). At 3-month follow-up, the creatinine increase from baseline was 0.05 mg/dL (p = 0.10) and mean decrease in eGFR was 3.01 mL/min (p = 0.21). When stratifying based on preoperative CKD stages I-III, similar results were observed. CONCLUSION Robotic multiplex partial nephrectomy is a safe and feasible approach to patients with multifocal renal masses. These complex surgeries have a demonstrated learning curve, but this minimally invasive approach for nephron-sparing surgery allows patients to preserve renal function where they would otherwise require open surgery or a radical nephrectomy.
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Affiliation(s)
- Ryan A Hankins
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA
| | - Annerleim Walton-Diaz
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA
| | - Hong Truong
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA
| | - Joanna Shih
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA
| | - Gennady Bratslavsky
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA
| | - Peter A Pinto
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA
| | - Adam R Metwalli
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10, Room 2 W-5940, 10 Center Drive, MSC 1210, Bethesda, MD, 20892, USA.
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Zhang L, Xu B, Wang Y, Liu C, Lu K, Huang Y, Liu N, Zhang X, Chen S, Chen M. Advanced renal cell carcinoma associated with von Hippel-Lindau disease: A case report and review of the literature. Oncol Lett 2015; 10:1087-1090. [PMID: 26622630 DOI: 10.3892/ol.2015.3279] [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] [Received: 07/31/2014] [Accepted: 04/13/2015] [Indexed: 12/13/2022] Open
Abstract
The autosomal dominant hereditary disorder von Hippel-Lindau (VHL) disease is caused by a germline mutation in the VHL gene. The symptoms of VHL include hemangioblastoma of the central nervous system, retinal angiomas, visceral tumors and multiple visceral cysts. However, advanced renal cell carcinoma (RCC) occurs in few VHL patients at initial diagnosis; in addition, sporadic VHL disease with de novo germline mutation is rare. The current study reports the clinical case of a 33-year-old Asian male patient diagnosed with advanced bilateral multicentric renal carcinomas. The patient underwent radical nephrectomy with embolectomy of the right kidney for treatment of T3b-stage RCC and laparoscopic nephron-sparing surgery of the left kidney. Sunitinib was administered following histological diagnosis and during follow-up. Genetic analysis revealed a missense mutation, c.194C>G (p.Ser65Trp). In addition, genetic analysis of the patient's parents and brothers, who were unaffected, confirmed a diagnosis of de novo VHL disease. To the best of our knowledge, the present study reports the first known case of a sporadic de novo germline mutation of VHL at c.194C>G. Current understanding of the molecular genetics and pathophysiology of VHL disease, as well as developments in surgical and target therapies for RCC have advanced in recent years; however, early detection through genetic screening and regular clinical surveillance of VHL disease patients and their families continues to be the primary basis for managing the disease.
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Affiliation(s)
- Lei Zhang
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China ; Surgical Research Center, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China ; Institute of Urology, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Bin Xu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China ; Surgical Research Center, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China ; Institute of Urology, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Yiduo Wang
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Chunhui Liu
- Surgical Research Center, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China ; Institute of Urology, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Kai Lu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Yeqing Huang
- Surgical Research Center, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China ; Institute of Urology, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Ning Liu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Xiaowen Zhang
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China ; Surgical Research Center, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China ; Institute of Urology, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Shuqiu Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Ming Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, P.R. China ; Surgical Research Center, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China ; Institute of Urology, Southeast University, Nanjing, Jiangsu 210009, P.R. China
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Abstract
PURPOSE OF REVIEW Despite the controversy surrounding the benefits of nephron-sparing surgery, multiple absolute indications for nephron-sparing surgery still exist, including the classic indications of hereditary and bilateral kidney tumors. RECENT FINDINGS Multiple genetic mutations have been identified which lead to hereditary kidney cancer conditions. These are briefly reviewed because the surgical management of hereditary kidney tumors depends on the genetic and histologic subtypes involved. Clear understanding of these hereditary conditions is crucial for proper surgical management of these tumors. SUMMARY Complex partial nephrectomy for multiple renal tumors, or multiplex partial nephrectomy, requires not only exceptional surgical skills but expertise of numerous nonsurgical methodologies, such as hands-on intraoperative ultrasonography and interpretation of multiple imaging modalities. In addition, multidisciplinary management is crucial for optimal outcomes in patient care. This review evaluates the most advanced surgical techniques and perioperative management required to successfully care for these challenging cases.
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Pan S, Shuch B. Hereditary Kidney Cancer Syndromes. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Menko FH, Maher ER, Schmidt LS, Middelton LA, Aittomäki K, Tomlinson I, Richard S, Linehan WM. Hereditary leiomyomatosis and renal cell cancer (HLRCC): renal cancer risk, surveillance and treatment. Fam Cancer 2014; 13:637-44. [PMID: 25012257 PMCID: PMC4574691 DOI: 10.1007/s10689-014-9735-2] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hereditary leiomyomatosis and renal cell cancer (HLRCC) is an autosomal dominant condition in which susceptible individuals are at risk for the development of cutaneous leiomyomas, early onset multiple uterine leiomyomas and an aggressive form of type 2 papillary renal cell cancer. HLRCC is caused by germline mutations in the fumarate hydratase (FH) gene which inactivate the enzyme and alters the function of the tricarboxylic acid (Krebs) cycle. Issues surrounding surveillance and treatment for HLRCC-associated renal cell cancer were considered as part of a recent international symposium on HLRCC. The management protocol proposed in this article is based on a literature review and a consensus meeting. The lifetime renal cancer risk for FH mutation carriers is estimated to be 15 %. In view of the potential for early onset of RCC in HLRCC, periodic renal imaging and, when available, predictive testing for a FH mutation is recommended from 8 to 10 years of age. However, the small risk of renal cell cancer in the 10-20 years age range and the potential drawbacks of screening should be carefully discussed on an individual basis. Surveillance preferably consists of annual abdominal MRI. Treatment of renal tumours should be prompt and generally consist of wide-margin surgical excision and consideration of retroperitoneal lymph node dissection. The choice for systemic treatment in metastatic disease should, if possible, be part of a clinical trial. Screening procedures in HLRCC families should preferably be evaluated in large cohorts of families.
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Affiliation(s)
- Fred H Menko
- Netherlands Cancer Institute, Amsterdam, The Netherlands,
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Byler TK, Bratslavsky G. Hereditary renal cell carcinoma: genetics, clinical features, and surgical considerations. World J Urol 2014; 32:623-30. [PMID: 24710684 DOI: 10.1007/s00345-014-1287-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 03/19/2014] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Hereditary renal cancer syndromes have been described and have illuminated novel methods to treat sporadic renal cell carcinoma. In this work, we aimed to review the genetic basis, molecular pathology and clinical manifestations of hereditary syndromes, as well as outline principles of surgical management and use of targeted therapy. METHODS We performed a comprehensive review of selected peer-reviewed publications regarding hereditary renal cancer syndromes, their genetic basis, and recommendations for surgical management. RESULTS The major syndromes contributing to hereditary renal cell carcinoma are discussed along with relevant literature guiding their management. The evolving surgical and molecular treatments are discussed. CONCLUSIONS Identification of genetic basis of hereditary carcinomas provides opportunity for targeted therapy of metastatic sporadic renal cell carcinoma. Appropriate and timely surgical management of hereditary renal cancers decreases the possibility of development of metastatic disease, and allows for preservation of renal function despite the need for repeat surgical interventions.
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Affiliation(s)
- Timothy K Byler
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
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Kwon T, Jeong IG, Pak S, You D, Song C, Hong JH, Ahn H, Kim CS. Renal tumor size is an independent prognostic factor for overall survival in von Hippel-Lindau disease. J Cancer Res Clin Oncol 2014; 140:1171-7. [PMID: 24671227 DOI: 10.1007/s00432-014-1654-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/15/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the effect of renal cell carcinoma (RCC) on survival in von Hippel-Lindau (VHL) disease and to assess the relationship between tumor size and survival. MATERIALS AND METHODS In this retrospective cohort study, the medical records of 72 patients who presented with VHL disease between 1994 and 2012 were reviewed. Clinical VHL-related characteristics were analyzed, and the prognostic value of renal tumor size for overall survival was assessed by using Cox regression models. RESULTS Of the 72 VHL patients, 42 (58.3 %) and 30 (41.7 %) were male and female, respectively. The mean age was 37.9 years, and the median follow-up period was 61.5 months. In terms of VHL-related manifestations, 40 (55.6 %) had RCC, 46 (63.8 %) had hemangioblastoma in the cerebellum, 10 (13.9 %) had hemangioblastoma in the spinal cord, 34 (47.2 %) had a pancreatic mass, 18 (25.0 %) had pheochromocytoma, and 14 (19.4 %) had retinal capillary hemangioma. RCC was a major cause of mortality: Of the 11 patients who died, nine (12.5 %) died due to RCC progression. The 5-year overall survival rate was 85.6 % for all patients, 96.9 % for patients without RCC, 83.6 % for patients with RCC < 3 cm, and 75.8 % for patients with RCC ≥ 3 cm. Multivariable analysis showed that RCC ≥ 3 cm was an independent predictor of overall survival (HR 9.87, 95 % CI 1.17-83.00, p = 0.035) along with age (HR 1.05, 95 % CI 1.01-1.10, p = 0.027). CONCLUSIONS Renal tumor size was an independent prognostic factor for overall survival in VHL disease. This observation will be helpful for planning RCC treatment in VHL disease.
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Affiliation(s)
- Taekmin Kwon
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2 dong, Songpa-gu, Seoul, 138-736, Korea
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Laryngakis NA, Van Arsdalen KN, Guzzo TJ, Malkowicz SB. Tumor enucleation: a safe treatment alternative for renal cell carcinoma. Expert Rev Anticancer Ther 2014; 11:893-9. [DOI: 10.1586/era.11.68] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Patard JJ, Baumert H, Bensalah K, Bernhard JC, Bigot P, Escudier B, Grenier N, Hétet JF, Long JA, Méjean A, Paparel P, Richard S, Rioux-Leclercq N, Coloby P, Soulié M. Recommandations en onco-urologie 2013 du CCAFU: Cancer du rein. Prog Urol 2013; 23 Suppl 2:S177-204. [DOI: 10.1016/s1166-7087(13)70055-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Linehan WM, Srinivasan R, Garcia JA. Non-clear cell renal cancer: disease-based management and opportunities for targeted therapeutic approaches. Semin Oncol 2013; 40:511-20. [PMID: 23972715 DOI: 10.1053/j.seminoncol.2013.05.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A better understanding of the biology of renal cell carcinoma (RCC) has significantly changed the treatment paradigm of the disease. Several novel vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) inhibitors have been approved recently by the US Food and Drug Administration. Unfortunately, the vast majority of clinical trials conducted today have been aimed to include patients with clear cell RCC, which remains the most common histologic subtype of the disease. Non-clear cell RCC represents approximately 20%-25% of all RCC patients. Non-clear cell RCC is made up of multiple histologic subtypes, each with a different molecular printing profile. Although VEGF and TORC inhibitors are commonly used in the management of this cohort of patients, non-clear cell histologies do not appear to be related to the von Hippel-Lindau gene (VHL). As such, the clinical efficacy of the existing agents is quite limited. There is a need to develop more rational therapeutic approaches that specifically target the biology of each of the different subtypes of non-clear cell RCC. In this review, we discuss molecular and clinical characteristics of each of the non-clear cell RCC subtypes and describe ongoing efforts to develop novel agents for this subset of patients.
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Affiliation(s)
- W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
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Bausch B, Jilg C, Gläsker S, Vortmeyer A, Lützen N, Anton A, Eng C, Neumann HPH. Renal cancer in von Hippel-Lindau disease and related syndromes. Nat Rev Nephrol 2013; 9:529-38. [PMID: 23897319 DOI: 10.1038/nrneph.2013.144] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sporadic and hereditary forms of renal cell carcinoma (RCC), von Hippel-Lindau (VHL) disease and the familial paraganglioma syndromes are closely related in terms of their clinical, molecular, and genetic aspects. Most RCCs occur sporadically and the heritable fraction of RCC is estimated to be just 2-4%. An understanding of the molecular genetic basis, the disease-specific and gene-specific biology and the clinical characteristics of these cancer syndromes is of utmost importance for effective genetic diagnosis and appropriate treatment. In addition, such insight will improve our understanding of sporadic RCCs. To date, 10 different heritable RCC syndromes have been described. VHL syndrome is the oldest known hereditary RCC syndrome. Similar to VHL disease, phaeochromocytoma is a major manifestation of the paraganglioma syndromes types 1, 3 and 4 in which RCCs have been reported. These syndromes are therefore regarded as VHL-related disorders and are included in this Review. Multifocal tumours, bilateral occurrence, a young age at diagnosis and/or family history are clinical red flags suggestive of hereditary disease and should trigger referral for genetic and molecular analysis. The identification of an underlying genetic alteration enables gene-specific risk assessment and opens up the possibility of a tailored follow-up strategy and specific surveillance protocols as the basis of effective preventive medicine. The important goals of preventive medicine are to increase the life expectancy of affected patients and to improve their quality of life. The study of seemingly rare hereditary syndromes and their susceptibility genes has consistently revealed clues regarding the aetiology and pathogenesis of these diseases, and can aid diagnosis and the development of therapeutics for patients affected by much more common sporadic counterparts.
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Affiliation(s)
- Birke Bausch
- Department of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, University Hospital, Hugstetter Strasse 55, D-79106 Freiburg, Germany
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Nephron sparing surgery in von Hippel-Lindau associated renal cell carcinoma; clinicopathological long-term follow-up. Fam Cancer 2013; 11:387-94. [PMID: 22426863 DOI: 10.1007/s10689-012-9525-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We evaluated the clinicopathological outcome of von Hippel-Lindau (VHL)-patients who had mainly undergone nephron sparing surgery (NSS) for renal cell carcinoma (RCC) when the tumour diameter has reached 4.0 cm. Multiple, bilateral RCC with high recurrence rates and subsequent repeated interventions, followed by increasing risk for end-stage renal failure and metastases is characteristic for VHL. NSS is widely used for VHL-associated RCC at 3.0 cm cut-off. 54 VHL patients underwent NSS, nephrectomy or thermal ablation for RCC. We analysed time to second treatment, overall and cancer specific survival, intra- and post-operative data as well as tumour characteristics. We also examined the effects of delaying removal of RCC to 4.0 cm cut-off. Median follow-up was 67 months. 54 patients underwent 97 kidney treatments. 96 % of first and 67 % of second interventions comprised of NSS. 0 % metastases were observed in the group with largest tumour size ≤4 cm. The probability for second surgery was 21 %, at 5 years and 42 % at 10 years. Median time to second NSS was 149.6 months. The overall and cancer specific survival rate was 96.5 and 100 % at 5-year follow-up, and 82.5 and 90.5 % respectively at 10-year follow-up. Median delay to second NSS at 4.0 cm cut-off versus 3.0 cm was 27.8 months. NSS was both successfully used in first and second surgery and to some extent even in third surgery. By following a strict surveillance protocol it is possible to support a 4.0 cm-threshold strategy for NSS, based on the assumption that delaying time to second NSS prevents patients from premature renal failure.
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Park BK, Kim CK, Park SY, Shen SH. Percutaneous radiofrequency ablation of renal cell carcinomas in patients with von Hippel Lindau disease: indications, techniques, complications, and outcomes. Acta Radiol 2013; 54:418-27. [PMID: 23446745 DOI: 10.1177/0284185113475441] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Renal cell carcinoma (RCC) in patients with von Hippel Lindau (VHL) disease tends to be multifocal, bilateral, and recur or develop new tumors after removal. These characteristics make treating hereditary RCCs difficult for urologists or radiologists compared to treating a sporadic RCC. Radiofrequency ablation (RFA) is a minimally-invasive treatment for small hereditary RCCs associated with a low complication rate and a minimal decrease in renal function. No RFA guidelines have been established about what to treat and when and how to ablate RCCs in patients with VHL disease. Besides, reports on complications and treatment outcomes in this patient group are rare. The purpose of this review is to discuss the indications, techniques, complications, and outcomes of RFA in treating RCC in patients with VHL disease.
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Affiliation(s)
- Byung Kwan Park
- The Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- The Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yoon Park
- The Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shu-Huei Shen
- The Department of Radiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
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Linehan WM, Rouault TA. Molecular pathways: Fumarate hydratase-deficient kidney cancer--targeting the Warburg effect in cancer. Clin Cancer Res 2013; 19:3345-52. [PMID: 23633457 DOI: 10.1158/1078-0432.ccr-13-0304] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is a hereditary cancer syndrome in which affected individuals are at risk for development of cutaneous and uterine leiomyomas and an aggressive form of type II papillary kidney cancer. HLRCC is characterized by germline mutation of the tricarboxylic acid (TCA) cycle enzyme, fumarate hydratase (FH). FH-deficient kidney cancer is characterized by impaired oxidative phosphorylation and a metabolic shift to aerobic glycolysis, a form of metabolic reprogramming referred to as the Warburg effect. Increased glycolysis generates ATP needed for increased cell proliferation. In FH-deficient kidney cancer, levels of AMP-activated protein kinase (AMPK), a cellular energy sensor, are decreased resulting in diminished p53 levels, decreased expression of the iron importer, DMT1, leading to low cellular iron levels, and to enhanced fatty acid synthesis by diminishing phosphorylation of acetyl CoA carboxylase, a rate-limiting step for fatty acid synthesis. Increased fumarate and decreased iron levels in FH-deficient kidney cancer cells inactivate prolyl hydroxylases, leading to stabilization of hypoxia-inducible factor (HIF)-1α and increased expression of genes such as VEGF and glucose transporter 1 (GLUT1) to provide fuel needed for rapid growth demands. Several therapeutic approaches for targeting the metabolic basis of FH-deficient kidney cancer are under development or are being evaluated in clinical trials, including the use of agents such as metformin, which would reverse the inactivation of AMPK, approaches to inhibit glucose transport, lactate dehydrogenase A (LDHA), the antioxidant response pathway, the heme oxygenase pathway, and approaches to target the tumor vasculature and glucose transport with agents such as bevacizumab and erlotinib. These same types of metabolic shifts, to aerobic glycolysis with decreased oxidative phosphorylation, have been found in a wide variety of other cancer types. Targeting the metabolic basis of a rare cancer such as FH-deficient kidney cancer will hopefully provide insights into the development of effective forms of therapies for other, more common forms of cancer.
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Affiliation(s)
- W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.
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Hereditary renal tumor syndromes: imaging findings and management strategies. AJR Am J Roentgenol 2013; 199:1294-304. [PMID: 23169721 DOI: 10.2214/ajr.12.9079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE It is not rare for the radiologist to identify multiple renal masses and be the first to raise the possibility of a hereditary renal tumor syndrome. Characteristic renal and extrarenal imaging findings aid in making the correct diagnosis. The imaging findings, screening guidelines, and management techniques for the most common hereditary renal tumor syndromes are reviewed. CONCLUSION Hereditary renal tumor syndromes have specific screening guidelines and unique management techniques in which imaging plays a central role.
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Abstract
Kidney cancer is not a single disease; it is made up of a number of different types of cancer that occur in the kidney. Each of these different types of kidney cancer can have a different histology, have a different clinical course, can respond differently to therapy and is caused by a different gene. Kidney cancer is essentially a metabolic disease; each of the known genes for kidney cancer, VHL, MET, FLCN, TSC1, TSC2, TFE3, TFEB, MITF, fumarate hydratase (FH), succinate dehydrogenase B (SDHB), succinate dehydrogenase D (SDHD), and PTEN genes is involved in the cells ability to sense oxygen, iron, nutrients or energy. Understanding the metabolic basis of kidney cancer will hopefully provide the foundation for the development of effective forms of therapy for this disease.
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Affiliation(s)
- W Marston Linehan
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, United States.
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Gupta GN, Boris R, Chung P, Linehan WM, Pinto PA, Bratslavsky G. Robot-assisted laparoscopic partial nephrectomy for tumors greater than 4 cm and high nephrometry score: feasibility, renal functional, and oncological outcomes with minimum 1 year follow-up. Urol Oncol 2013; 31:51-6. [PMID: 21292511 PMCID: PMC3123423 DOI: 10.1016/j.urolonc.2010.10.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 10/29/2010] [Accepted: 10/29/2010] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Minimally invasive robotic assistance is being increasingly utilized to treat larger complex renal masses. We report on the technical feasibility and renal functional and oncologic outcomes with minimum 1 year follow-up of robot-assisted laparoscopic partial nephrectomy (RALPN) for tumors greater than 4 cm. MATERIALS AND METHODS The urologic oncology database was queried to identify patients treated with RALPN for tumors greater than 4 cm and a minimum follow-up of 12 months. We identified 19 RALPN on 17 patients treated between June 2007 and July 2009. Two patients underwent staged bilateral RALPN. Demographic, operative, and pathologic data were collected. Renal function was assessed by serum creatinine levels, estimated glomerular filtration rate, and nuclear renal scans assessed at baseline, 3, and 12 months postoperatively. All tumors were assigned R.E.N.A.L. nephrometry scores (http://www.nephrometry.com). RESULTS The median nephrometry score for the largest tumor from each kidney was 9 (range 6-11) while the median size was 5 cm (range 4.1-15). Three of 19 cases (16%) required intraoperative conversion to open partial nephrectomy. No renal units were lost. There were no statistically significant differences between preoperative and postoperative creatinine and eGFR. A statistically significant decline of ipsilateral renal scan function (49% vs. 46.5%, P = 0.006) was observed at 3 months and at 12 mo postoperatively (49% vs. 45.5%, P = 0.014). None of the patients had evidence of recurrence or metastatic disease at a median follow-up of 22 months (range 12-36). CONCLUSIONS RALPN is feasible for renal tumors greater than 4 cm with moderate or high nephrometry scores. Although there was a modest decline in renal function of the operated unit, RALPN may afford the ability resect challenging tumors requiring complex renal reconstruction. The renal functional and oncologic outcomes are promising at a median follow-up of 22 months, but longer follow-up is required.
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Affiliation(s)
| | | | | | | | | | - Gennady Bratslavsky
- Correspondence: Gennady Bratslavsky, M.D., Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1107, Building 10, CRC, Room 2W-59424, Bethesda, MD 20892-1107, , Tel: (301) 496-6353, Fax: (301) 480-5626
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Singer EA, Vourganti S, Lin K, Gupta GN, Pinto PA, Rastinehad AR, Linehan WM, Bratslavsky G. Outcomes of patients with surgically treated bilateral renal masses and a minimum of 10 years of followup. J Urol 2012; 188:2084-8. [PMID: 23083858 PMCID: PMC3810017 DOI: 10.1016/j.juro.2012.08.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Indexed: 12/15/2022]
Abstract
PURPOSE Nephron sparing surgery has been advocated for patients with bilateral renal masses but long-term functional and oncological outcomes are lacking. We report the outcomes of patients with bilateral renal masses and a minimum 10-year followup. MATERIALS AND METHODS Patients with bilateral renal masses evaluated at our institution who were treated with initial surgery at least 10 years ago and underwent interventions on each renal unit were included in the analysis. Collected data included demographics, hereditary diagnosis, number of renal interventions, renal function and mortality status. Overall and renal cell carcinoma specific survival was assessed. Comparisons were made of renal function and overall survival between groups with 2 renal units and a surgically solitary kidney. RESULTS A total of 128 patients met study inclusion criteria. Median followup in our cohort was 16 years (mean 17, range 10 to 49). The median number of surgical interventions was 3 (range 2 to 10). Of the patients 87 (68%) required repeat interventions on the ipsilateral renal unit at last followup with a median of 6.2 years (range 0.7 to 21) between interventions. Overall and renal cell cancer specific survival was 88% and 97%, respectively. Six patients (4.7%) ultimately underwent bilateral nephrectomy. Although renal function was better preserved in patients with 2 kidneys (70 vs 53 ml/minute/1.73 m(2), p = 0.0002), there was no difference in overall survival between those with bilateral kidneys or a surgically solitary kidney. CONCLUSIONS At a minimum 10-year followup after initial surgery, nephron sparing surgery allowed for excellent oncological and functional outcomes. Despite the need for repeat surgical interventions, nephron sparing surgery enabled dialysis to be avoided in more than 95% of patients.
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Affiliation(s)
- Eric A. Singer
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Srinivas Vourganti
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kelly Lin
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gopal N. Gupta
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A. Pinto
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ardeshir R. Rastinehad
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - W. Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gennady Bratslavsky
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Urology, Upstate Medical University, Syracuse, NY
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Abstract
Kidney cancer is not a single disease; it is made up of a number of different types of cancer, including clear cell, type 1 papillary, type 2 papillary, chromophobe, TFE3, TFEB, and oncocytoma. Sporadic, nonfamilial kidney cancer includes clear cell kidney cancer (75%), type 1 papillary kidney cancer (10%), papillary type 2 kidney cancer (including collecting duct and medullary RCC) (5%), the microphalmia-associated transcription (MiT) family translocation kidney cancers (TFE3, TFEB, and MITF), chromophobe kidney cancer (5%), and oncocytoma (5%). Each has a distinct histology, a different clinical course, responds differently to therapy, and is caused by mutation in a different gene. Genomic studies identifying the genes for kidney cancer, including the VHL, MET, FLCN, fumarate hydratase, succinate dehydrogenase, TSC1, TSC2, and TFE3 genes, have significantly altered the ways in which patients with kidney cancer are managed. While seven FDA-approved agents that target the VHL pathway have been approved for the treatment of patients with advanced kidney cancer, further genomic studies, such as whole genome sequencing, gene expression patterns, and gene copy number, will be required to gain a complete understanding of the genetic basis of kidney cancer and of the kidney cancer gene pathways and, most importantly, to provide the foundation for the development of effective forms of therapy for patients with this disease.
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Mayer WA, Godoy G, Choi JM, Goh AC, Bian SX, Link RE. Higher RENAL Nephrometry Score is predictive of longer warm ischemia time and collecting system entry during laparoscopic and robotic-assisted partial nephrectomy. Urology 2012; 79:1052-6. [PMID: 22546382 DOI: 10.1016/j.urology.2012.01.048] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/15/2012] [Accepted: 01/27/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the predictive value of the RENAL Nephrometry Score (RNS) on operative outcomes during both laparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN). METHODS We reviewed 67 consecutive patients with suspicious renal lesions and available radiographic data who underwent LPN or RPN by a single surgeon. Data included operative type, body mass index (BMI), gender, age, and side of tumor. RNSs were recorded using either magnetic resonance imaging or computed tomography scans. Warm ischemia time (WIT), estimated blood loss (EBL), and collecting system entry (CSE) were the endpoints for the analyses. RESULTS Total RNS entered as a continuous or dichotomous variable (<7 or ≥ 7), R-score, and N-score were independent predictors of WIT on multivariable analyses (P <.001, P = .001, P = .026, and P <.01, respectively). The total RNS and N-score were predictive of CSE in univariate analysis (P <.001). Neither total RNS nor its individual components were predictive of EBL. CONCLUSION Total RNS, as well as the N- and R-scores, can help predict both longer WIT and CSE during LPN and RPN. The RNS and its individual components may be useful in the preoperative planning and counseling of patients undergoing LPN or RPN.
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Affiliation(s)
- Wesley A Mayer
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA.
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