Serum haptoglobins: a preoperative detector of metastatic renal carcinoma

Biomarkers of renal cell carcinoma. Past and future considerations

Renal cancer includes several distinct entities with a range of biologic and clinical behaviors from relatively indolent to extremely aggressive tumors. Although conventional prognostic factors such as stage and grade are quite useful, other clinical, laboratory, and pathologic findings are now believed to have additional predictive values. This article reviews the literature on the potential utility of biomarkers in renal cell carcinoma. To date, only a few biomarkers, such as Ki-67, appeared to be potentially useful for monitoring renal cancer patients. New biomarkers including MN/CA9 and circulating cell detection require further and extensive studies to assess their potential clinical utility.

Serum acute phase reactants and prognosis in renal cell carcinoma

BACKGROUND

Inflammatory parameters as acute phase proteins commonly are elevated in patients with renal cell carcinoma. Some of these acute phase reactants have been proposed to influence survival.

METHODS

In 170 patients with renal cell carcinoma, the authors studied six acute phase reactant parameters (erythrocyte sedimentation rate [ESR], C-reactive protein, haptoglobin, ferritin, orosomucoid, and alpha 1-antitrypsin) that were compared with stage and grade.

RESULTS

The acute phase reactants correlated well with each other and with stage and grade. All acute phase reactants separately were found to be significant prognostic factors of survival using the log rank test. However, when a multivariate Cox analysis was performed, only stage, grade, and ESR were identified as independent prognostic factors, whereas the other factors were not.

CONCLUSIONS

The study suggests that all acute phase reactants separately were found to be significant univariate prognostic factors, but in a multivariate analysis, ESR was the only independent prognostic parameter for survival.

An immunochemical and immunohistochemical study of S100 protein in renal cell carcinoma

The authors localized S100 protein in renal tubules and renal cell carcinoma by immunohistochemical study and quantitative analysis by enzyme immunoassay. The alpha subunit of S100 protein (S100-alpha) was localized in epithelial cells of proximal tubules, thin limbs of loops of Henle, collecting tubules, and a few of Bowman's capsules. The beta subunit (S100-beta) was immunostained in the distal tubules, thick and thin loops of Henle, collecting tubules, and a few proximal tubules. In renal cell carcinoma, S100-alpha was immunohistochemically demonstrated in 82% (41/50) of patients including sarcomatoid variants, whereas S100-beta was detected in 46% (23/50). Both the number of positively stained tumor cells and the staining intensity were greater in S100-alpha than in S100-beta. Concentrations of S100-alpha in the cortex were 80.3 +/- 22.5 ng/mg protein (n = 7), whereas those of renal cell carcinoma were 387 +/- 533 ng/mg protein (n = 19), i.e., about five times higher. Concentrations of S100-beta in both normal kidney (1.96 +/- 0.74 ng/mg protein) and renal cell carcinoma (2.05 +/- 2.16 ng/mg protein) were much lower than those of S100-alpha. The authors also localized S100-alpha and S100-beta in tissues of other renal tumors and tumors arising from other organs. S100a0 appears to be a useful immunohistochemical marker for renal cell carcinoma.

The relationship of lactoferrin to the anemia of renal cell carcinoma

This study was designed to examine whether lactoferrin, a glycoprotein contained in neutrophils which binds free iron, mediates the anemia associated with renal cell carcinoma. Preoperative hematocrit, urinalysis, serum iron, total iron binding capacity, and ferritin levels were obtained in 24 patients with hypernephroma. At the time of radical nephrectomy, a tumor specimen was obtained from all 24 patients and corresponding normal renal tissue was obtained from eight patients. Fifteen patients had low serum iron, whereas nine patients had normal serum iron. All tissue samples were snap frozen at the time of surgery and were subsequently sectioned into 3-microns slices using the cryostat. Then all the sectioned specimens were stained with FITC (fluorescein isothiocyanate) and peroxidase conjugated rabbit derived anti-human lactoferrin. Ten of the 15 patients with low serum iron had positive anti-lactoferrin staining in both the FITC and peroxidase systems. None of the tumors from patients with normal serum iron and none of the normal renal parenchyma exhibited positive anti-lactoferrin uptake. Stains for iron in the bone marrow of two patients with low serum iron showed increased iron stores. These studies suggest that lactoferrin mediates the anemia often seen in association with renal cell carcinoma.

Biochemical aids in the monitoring of patients with ovarian cancer

A study of possible biochemical markers of tumor recurrence and progression was made in 93 patients with ovarian cancer followed longitudinally for up to 2 years during treatment by moderate or aggressive chemotherapy regimens. A panel of potential indicators was tested; the combination of serum albumin, C-reactive protein, alpha 1-acid glycoprotein, and phosphohexose isomerase levels was found to provide information that is useful as an adjunct to the clinical assessment of patients with advanced disease. However, the system could not detect a small tumor burden. The level of beta 2-microglobulin may have value in those patients whose tumor is associated with an increase of this analyte (77%), but it would appear to reflect a large tumor mass. Serum CEA, carcino-placental alkaline phosphatase, transferrin, and prealbumin were not found to be helpful.

Randomized trial of drainage after cholecystectomy. Suction vaersus static drainage through a main wound versus a stab incision

One hundred eighty-four patients who underwent biliary surgery were randomly allocated to four groups arranaed in a 2 by 2 design. In 92 patients the drain was brought out through the wound and in the other 92 through a stab incision. In half of the patients in each group the drain was connected to a suction system and in the other half to a sterile bag. Suction was found to impair rather than enhance intraperitoneal drainage. In patients who underwent elective cholecystectomy and early operation for acute cholecystitis, the amount of discharge was more than twice as large when suction was omitted than when it was applied. After common duct operations the amount of discharge was very large and there was little difference in cases with and without suction. Prolonged drainage, static or suction, resulted in an increase in the serum haptoglobin level. Analysis of out data suggested that after a few days the drain starts to act as a traumatic stimulus. No difference was found between cases with the drain brought out through a stab incision and those with the drain brought out through the main wound. A number of studies have ascertained the superiority of closed to open drainage. The results of the present trial lead us to recommend that after biliary surgery the closed us to recommend that after biliary surgery the closed drain should not be connected to a suction apparatus and that after elective cholecystectomy the drain should preferably be removed after a few days.

Significance of protein-bound neuraminic acid levels in patients with prostatic and bladder carcinoma

The role of plasma N-acetyl neuraminic acid (NANA) level in detection and staging prostatic and bladder carcinomas was evaluated. Multiple determinations were obtained in 73 male subjects, including normal controls, patients with prostatic or bladder carcinoma or with benign prostatic hyperplasia. Patients with prostatic or bladder carcinoma had significantly higher NANA levels than normal individuals. Further, in patients with prostatic carcinoma, NANA values correlated well with both the stage of the disease and the response to therapy.

Coagulation factors in renal adenocarcinoma

Coagulation factors, including plasma fibrinogen, serum fibrinogen-fibrin degradation products, platelet counts and prothrombin times, were studied in patients with renal adenocarcinoma. Plasma fibrinogen levels were elevated and correlated with tumor stage, disease activity and therapy. Fibrinogen-fibrin degradation product levels also were elevated, although such elevations did not correlate with other parameters. Platelet count and prothrombin times were normal. Fibrinogen may be a valuable marker of disease activity in patients with renal carcinoma. In addition, since significant intratumoral fibrin deposits have been demonstrated anticoagulants or fibrinolytic agents may enhance cytotoxic therapy and should be considered in adjunctive chemotherapeutic protocols.

Urinary excretion of ten plasma proteins in patients with renal carcinoma

Urinary and serum proteins were studied preoperatively in 48 patients with renal carcinoma, using an automated immunoprecipitin reaction. The 24 h excretion and the renal clearance of albumin, transferrin, haptoglobin, IgG, IgA, and IgM and the 24 h excretion of the immunoglobulin lambda and kappa free light chains and beta2-microglobulin were significantly increased compared with a control group. The excretion of lysozyme was also increased, but not significantly. Increased protein excretion was the most common urinary finding in patients with renal carcinoma. The protein excretion was predominantly of the glomerular type, implying a glomerular injury. The serum concentrations of albumin and transferrin were significantly decreased and the serum concentration of haptoglobin significantly increased in patients with stage III and IV tumours compared with patients with stage I and II tumours. Abnormal serum concentrations of albumin, transferrin, and haptoglobin were indicative for advanced renal carcinoma.

Manifestations of renal cell carcinoma

Patients with renal cell carcinoma often have no specific localizing symptoms or signs, and their presentation will often involve many organ systems. Since 40 per cent of these patients do not have genitourinary symptoms, care must be taken to avoid being misled by normal findings on urinalysis. More than 50 per cent of patients with renal cell carcinoma have vague symptoms suggesting a gastrointestinal origin; thus if primary gastrointestinal studies do not disclose a cause for these symptoms, excretory urography must be included as a screening procedure.