Renal cell carcinoma, part 1

Diagnostic value of contrast-enhanced CT in clear cell renal cell carcinoma: a systematic review and meta-analysis

OBJECTIVE

Contrast-enhanced computed tomography (CECT) improves lesion contrast with surrounding tissues through the injection of contrast agents. This enhancement allows for more precise lesion characterization, aiding in the early diagnosis of clear cell renal cell carcinoma (ccRCC). This meta-analysis aims to assess the diagnostic efficacy of CECT in ccRCC and to provide an ideal imaging examination method for the preoperative diagnosis of ccRCC.

METHODS

We conducted a comprehensive search across six major online databases: PubMed, Web of Science, Cochrane Library, WANFANG DATA, China National Knowledge Infrastructure, and Chinese BioMedical Literature Database (CBM). The objective was to collate and analyze studies that evaluate the diagnostic utility of CECT in the identification of ccRCC. Meta-disc 1.4 and Stata 16.0 were used to conduct a meta-analysis and evaluate the diagnostic accuracy of CECT for ccRCC.

RESULTS

The meta-analysis included 17 relevant studies investigating the diagnostic value of CECT for ccRCC. The combined sensitivity and specificity of CECT were 0.88 (95% confidence interval: 0.83-0.91) and 0.82 (95%CI: 0.75-0.87), respectively. Positive diagnostic likelihood ratio = 4.87 (95%CI: 3.47-6.84), negative diagnostic likelihood ratio = 0.15 (95%CI: 0.11-0.21), and diagnostic odds ratio = 32.67 (95%CI: 18.21-58.61). In addition, the area under the ROC curve was 0.92 (95%CI: 0.89-0.94), indicating that CECT has a decent discriminative ability in diagnosing ccRCC.

CONCLUSIONS

CECT is recognized as a highly effective imaging tool for diagnosing ccRCC. It provides valuable guidance in the preoperative assessment and planning of surgical strategies for patients with ccRCC.

Crescentic Glomerulonephritis in Association With Renal Cell Carcinoma: A Case Report

Clear renal cell carcinoma (RCC) is the most common primary renal tumor originating within the renal cortex. It is responsible for 75% to 85% of all primary renal neoplasms. Multiple risk factors are associated with the development of RCC, the most common being smoking. On some occasions, RCC has been linked to some autoimmune conditions, but data is limited. Especially, its association with glomerulonephritis (GN) is rare in literature and not fully understood. In this case report, we discuss a presentation of RCC associated with crescentic GN.

CircPRELID2 functions as a promoter of renal cell carcinoma through the miR-22-3p/ETV1 cascade

BACKGROUND

Emerging evidence has indicated that a number of circular RNAs (circRNAs) participate in renal cell carcinoma (RCC) carcinogenesis. Nevertheless, the activity and molecular process of circPRELID2 (hsa_circ_0006528) in RCC progression remain unknown.

METHODS

CircPRELID2, miR-22-3p and ETS variant 1 (ETV1) levels were gauged by qRT-PCR. Effect of the circPRELID2/miR-22-3p/ETV1 axis was evaluated by detecting cell growth, motility, and invasion. Immunoblotting assessed related protein levels. The relationships of circPRELID2/miR-22-3p and miR-22-3p/ETV1 were confirmed by RNA immunoprecipitation (RIP), luciferase reporter or RNA pull-down assay.

RESULTS

CircPRELID2 was up-regulated in RCC. CircPRELID2 silencing suppressed RCC cell growth, motility and invasion. Moreover, circPRELID2 silencing weakened M2-type macrophage polarization in THP1-induced macrophage cells. CircPRELID2 sequestered miR-22-3p, and circPRELID2 increased ETV1 expression through miR-22-3p. Moreover, the inhibitory impact of circPRELID2 silencing on RCC cell malignant behaviors was mediated by the miR-22-3p/ETV1 axis. Furthermore, circPRELID2 knockdown in vivo hampered growth of xenograft tumors.

CONCLUSION

Our study demonstrates that circPRELID2 silencing can mitigate RCC malignant development through the circPRELID2/miR-22-3p/ETV1 axis, highlighting new therapeutic targets for RCC treatment.

Pseudoenhancement in Cystic Renal Lesions - Impact of Virtual Monoenergetic Images of Photon-Counting Detector CT on Lesion Classification

RATIONALE AND OBJECTIVES

To investigate the impact of virtual monoenergetic images (VMI) from photon-counting detector CT (PCD-CT) on the enhancement and classification of renal cysts.

MATERIALS AND METHODS

Adults with renal cysts (≥7 mm) who received a triphasic examination on a clinical PCD-CT (120 kVp; IQ level 68) between July 2021 and March 2022 were retrospectively identified. Only non-enhancing cysts (enhancement<10 HU between unenhanced and venous phase at 70 keV) were included. VMI from 40 to 190 keV with increments of 10 keV were reconstructed from the venous phase. Enhancement was measured to classify each lesion as non-enhancing (<10 HU), equivocally enhancing (10-19 HU), and definitely enhancing (≥20 HU). Classification changes as a function of VMI were assessed. Pearson correlation coefficient, the Kruskal-Wallis and the Chi-square test were used.

RESULTS

A total of 86 patients (mean age, 74 ± 9 years; 74 male) with 160 non-enhancing renal cysts (17.6 ± 10 mm) were included. CT attenuation of the cysts increased from higher to lower VMI levels with a mean attenuation of 4 ± 11 HU at 190 keV to 36 ± 17 HU at 40 keV. Mean attenuation of the renal parenchyma was 43 ± 4 HU at 190 keV and 414 ± 71 HU at 40 keV. No cyst exhibited enhancement from 70 keV to 190 keV. At 40, 50, and 60 keV, 35% (56/160), 29% (47/160) and 9% (15/160) of cysts showed equivocal and 46% (74/160), 10% (16/160), and 0% (0/160) definite enhancement, respectively. There was no significant influence of size (P=.13), cyst location (P=.9) and BMI (P=.19) on enhancement classification.

CONCLUSION

VMI has a relevant impact on enhancement and classification of renal cysts with misclassification in a large number of cases at energy levels below 70 keV.

Efficacy and safety analysis of TACE + sunitinib vs. sunitinib in the treatment of unresectable advanced renal cell carcinoma: a retrospective study

BACKGROUND

Since renal cell carcinoma(RCC) is insensitive to conventional chemoradiotherapy, molecularly targeted drugs are commonly used treatments for unresectable advanced RCC. The aim of this study was to explore the efficacy and safety of TACE + sunitinib vs. sunitinib in the treatment of unresectable advanced RCC.

METHODS

This study included 98 patients with unresectable advanced RCC who were treated in Union Hospital from January 2015 to December 2018, and they met the criteria. They were divided into two groups: TACE + Sunitinib group (N = 47) and Sunitinib group (N = 51). We conducted a retrospective study to analyze the efficacy and safety of the two groups of patients.

RESULTS

(1)TACE + Sunitinib group: 4 patients (8.5%) achieved CR, 27 patients (57.5%) achieved PR, 9 patients (19.1%) achieved SD, and 7 patients (14.9%) achieved PD. Sunitinib group, 0 patients (0%) achieved CR, 20 patients (39.2%) achieved PR, 14 patients (27.5%) achieved SD, and 17 patients (33.3%) achieved PD. (P = 0.017) (2)ORR: TACE + sunitinib group, 66.0%; sunitinib group, 39.2%. (P = 0.009) (3)DCR: TACE + sunitinib group, 85.1%; sunitinib group, 66.7%. (P = 0.038) (4) In the TACE + sunitinib group, mPFS was 15.6 months, mOS was 35.0 months; in the sunitinib group, the mPFS was 10.9 months, mOS was 25.7 months. (P < 0.001) (5) The incidence of abdominal pain, fever, and vomiting was higher in the TACE + sunitinib group than in the sunitinib group (abdominal pain: 55.3% vs. 13.7%; fever: 61.7% vs. 7.8%; vomiting: 40.4% vs. 19.6%; P < 0.05). The technical success rate of TACE in TACE + Sunitinib group is 100%.

CONCLUSIONS

The TACE + sunitinib group had higher ORR and DCR, longer OS and PFS than the sunitinib alone group. TACE combined with sunitinib can play a complementary role and is a safe and effective treatment for advanced RCC.

The Role of Fascin-1 in Human Urologic Cancers: A Promising Biomarker or Therapeutic Target?

Human cancer statistics show that an increased incidence of urologic cancers such as bladder cancer, prostate cancer, and renal cell carcinoma. Due to the lack of early markers and effective therapeutic targets, their prognosis is poor. Fascin-1 is an actin-binding protein, which functions in the formation of cell protrusions by cross-linking with actin filaments. Studies have found that fascin-1 expression is elevated in most human cancers and is related to outcomes such as neoplasm metastasis, reduced survival, and increased aggressiveness. Fascin-1 has been considered as a potential therapeutic target for urologic cancers, but there is no comprehensive review to evaluate these studies. This review aimed to provide an enhanced literature review, outline, and summarize the mechanism of fascin-1 in urologic cancers and discuss the therapeutic potential of fascin-1 and the possibility of its use as a potential marker. We also focused on the correlation between the overexpression of fascin-1 and clinicopathological parameters. Mechanistically, fascin-1 is regulated by several regulators and signaling pathways (such as long noncoding RNA, microRNA, c-Jun N-terminal kinase, and extracellular regulated protein kinases). The overexpression of fascin-1 is related to clinicopathologic parameters such as pathological stage, bone or lymph node metastasis, and reduced disease-free survival. Several fascin-1 inhibitors (G2, NP-G2-044) have been evaluated in vitro and in preclinical models. The study proved the promising potential of fascin-1 as a newly developing biomarker and a potential therapeutic target that needs further investigation. The data also highlight the inadequacy of fascin-1 to serve as a novel biomarker for prostate cancer.

A novel biflavone from Reineckia carnea induces apoptosis of human renal cancer 786-O cells

Renal cell carcinoma (RCC) is a common malignant tumor of the urinary system, which is highly invasive, metastatic, and insensitive to radiotherapy and chemotherapy. Chinese herbal medicine has always been an important source of anti-tumor drug development. Reineckia carnea Kunth is a traditional herb commonly used by the Miao nationality in southwest China. In this study, the extract of Reineckia carnea was isolated and purified by reverse phase preparative chromatography and other chromatographic techniques. According to the physicochemical properties and spectral data, the structure of the compound was identified, and a novel biflavone compound named Reineckia-biflavone A (RFA) was obtained. The result of antiproliferative activity showed that RFA had cytotoxicity on 786-O cells with an IC50 value of 19.34 μmol/L. The results of CCK-8 and hemolysis assays showed that RFA was not significantly cytotoxic to both red blood cells (RBC) and peripheral blood mononuclear cells (PBMC). By Hoechst 33258 apoptosis staining, typical apoptotic morphology was observed under fluorescence microscope. RFA could induce the apoptosis of 786-O cells with the increase of apoptosis rate. The cell cycle tests showed that the cell proportion was obviously arrested in the S phase. At the same time, RFA could decrease the mitochondrial membrane potential and increase the intracellular free Ca2+ concentration. Western blot showed that the expression levels of pro-apoptotic proteins (Bax, Caspase-3, Cleaved Caspase-3, and Cytochrome c) in cells rose, while the expression level of anti-apoptotic proteins (Bcl-2) declined significantly. In conclusion, this study suggests that the RFA is a new biflavone determined by SciFinder retrieval. The apoptosis may be triggered by RFA through the mitochondrial pathway, which is mediated by up-regulating the intracellular calcium ion, down-regulating the mitochondrial membrane potential, and changing the apoptosis-related proteins.

A novel necroptosis-related lncRNAs signature for survival prediction in clear cell renal cell carcinoma

Clear cell renal cell carcinoma (ccRCC) is the most common kind of kidney cancer with poor prognosis. Necroptosis is a newly observed type of programmed cell death in recent years. However, the effects of necroptosis-related lncRNAs (NRlncRNAs) on ccRCC have not been widely explored. The transcription profile and clinical information were obtained from The Cancer Genome Atlas. Necroptosis-related lncRNAs were identified by utilizing a co-expression network of necroptosis-related genes and lncRNAs. Univariate Cox regression, least absolute shrinkage, and selection operator regression and multivariate Cox regression were performed to screen out ideal prognostic necroptosis-related lncRNAss and develop a multi-lncRNA signature. Finally, 6 necroptosis-related lncRNA markers were established. Patients were separated into high- and low-risk groups based on the performance value of the median risk score. Kaplan-Meier analysis identified that high-risk patients had poorer prognosis than low-risk patients. Furthermore, the area under time-dependent receiver operating characteristic curve reached 0.743 at 1 year, 0.719 at 3 years, and 0.742 at 5 years, which indicating that they can be used to predict ccRCC prognosis. In addition, the proposed signature was related to immunocyte infiltration. A nomogram model was also established to provide a more beneficial prognostic indicator for the clinic. Altogether, in the present study, the 6-lncRNA prognostic risk signature are trustworthy and effective indicators for predicting the prognosis of ccRCC.

Renal cell carcinoma, part 3

ABSTRACT

Renal cell carcinoma (RCC) accounts for most renal malignancies. This article, the last in a three-part series, presents treatment options for RCC using the American Joint Committee on Cancer Tumor, Node, and Metastasis staging system as a framework, as well as nursing-care options for patients undergoing partial or radical nephrectomy.

Renal cell carcinoma, part 2

ABSTRACT

Renal cell carcinoma (RCC) accounts for most renal malignancies. This article, the second in a three-part series, addresses how renal masses are classified, signs and symptoms of RCC, medical treatments for RCC, and priority nursing interventions for patients with RCC.