Prognostic models for renal cell carcinoma recurrence: external validation in a Japanese population

Development of novel nomograms to predict renal functional outcomes after laparoscopic adrenalectomy in patients with primary aldosteronism

PURPOSE

Most patients with primary aldosteronism (PA) show a significant decrease in kidney function after surgery. Glomerular hyperfiltration peculiar to PA can mask mild renal failure before surgery. The aim of this retrospective study was to investigate postoperative renal functional outcomes in PA patients from different viewpoints and to develop novel nomograms that can predict renal functional outcomes in PA patients after surgery.

METHODS

130 Japanese PA patients treated by unilateral laparoscopic adrenalectomy were retrospectively surveyed. Pre- and postoperative changes of estimated glomerular filtration rates (eGFRs) and the distribution of eGFR classification were compared. Furthermore, predictors of the following renal functional outcomes were investigated: (I) the percentage decrease >25% in eGFR and (II) the presence of new-onset eGFR <45 ml/min/1.73 m². Finally, two nomograms that predicted postoperative renal functional outcomes were developed and internally validated.

RESULTS

At 6 months, the average decrease in eGFR was 16.7 mL/min/1.73 m² (corresponding percent decrease: 19.7%). Upstaging of eGFR classification was observed in 54.6% of patients. Age, potassium, plasma aldosterone concentration, and initial eGFR were incorporated into a nomogram predicting a >25% postoperative decrease in eGFR. Duration of hypertension and initial eGFR were incorporated into a nomogram predicting new-onset eGFR <45 ml/min/1.73 m². The value of the area under the receiver operating characteristics curve for each nomogram was 0.82 and 0.74, respectively.

CONCLUSION

The first nomograms that can predict postoperative renal outcomes in PA patients were developed. They will help clinicians calculate the probability of renal dysfunction in PA patients after laparoscopic adrenalectomy.

Accuracy capabilities comparisons between Karakiewicz, Kattan and Cindolo nomograms in predicting outcomes for renal cancer carcinoma: A systematic review and meta-analysis

INTRODUCTION

Several prognostic models have been proposed to predict outcomes of patients affected by renal cell carcinoma. We analyze the discriminative capabilities of Karakiewicz, Kattan and Cindolo nomograms and perform a meta-analysis to yield pooled area under the receiver operator curves (AUCs) for model comparison. The end points of interest were disease-recurrence free survival (DFS) and cancer-specific survival (CSS).

METHODS

An electronic search of the Medline and Embase was undertaken until July 2014. The AUC value, total number of patients, number of disease recurrence, and cancer-related deaths were extracted from the included references. AUCs of the models were converted to odds ratios (ORs). For the meta-analysis, ln(OR) was used for data pooling. For each nomogram, the combined OR was transformed back to a converted AUC (cAUC).

RESULTS

A total of 16 studies were identified including 26 710 patients. The derived comparison of cAUC values revealed better predictive capability of DFS for the postoperative Karakiewicz nomogram versus Kattan nomogram (p < 0.01), but not versus Cindolo (p = 0.432) and between Cindolo versus Kattan (p = 0.03). The Mantel-Haenszel derived comparison of cAUC values revealed better predictive capability for the preoperative Karakiewicz nomogram versus the Kattan nomogram (p < 0.01) and versus the Cindolo model (p < 0.01), but also between the postoperative Karakiewicz model versus the Kattan model (p < 0.01) and the Cindolo model (p < 0.01). The Kattan model showed better discriminative capability versus the Cindolo model (p < 0.01).

CONCLUSIONS

The predictive abilities of the pre- and postoperative Karakiewicz models are higher than Kattan or Cindolo in predicting DFS and CSS.

Inactivation of bone morphogenetic protein 2 may predict clinical outcome and poor overall survival for renal cell carcinoma through epigenetic pathways

We investigated whether impaired regulation of bone morphogenetic protein-2 (BMP-2) via epigenetic pathways is associated with renal cell carcinoma (RCC) pathogenesis. Expression and CpG methylation of the BMP-2 gene were analyzed using RCC cell lines, and 96 matched RCC and normal renal tissues. We also performed functional analysis using BMP-2 restored RCC cells. A significant association of BMP-2 mRNA expression was also found with advanced tumor stage and lymph node involvement, while lower BMP-2 mRNA expression was significantly associated with poor overall survival after radical nephrectomy. In RCC cells, BMP-2 restoration significantly inhibited cell proliferation, migration, invasion, and colony formation. In addition, BMP-2 overexpression induced p21(WAF1/CIP1) and p27(KIP1) expression, and cellular apoptosis in RCC cells. BMP-2 mRNA expression was significantly enhanced in RCC cells by 5-aza-2'-deoxycitidine treatment. The prevalence of BMP-2 promoter methylation was significantly greater and BMP-2 mRNA expression was significantly lower in RCC samples as compared to normal kidney samples. Furthermore, a significant correlation was found between BMP-2 promoter methylation and mRNA transcription in tumors. Aberrant BMP-2 methylation and the resultant loss of BMP-2 expression may be a useful molecular marker for designing improved diagnostic and therapeutic strategies for RCC.

Prognostic factors of overall survival in renal cancer patients - single oncological center study

INTRODUCTION

The clinical course of renal cancer remains difficult to predict. Attempts to appoint new independent prognostic factors (IPFs) and comparisons of already identified ones among populations are inevitable to develop more effective prognostic instruments. The aim of this study was to evaluate IPFs of overall survival in a given population of patients with renal cancer.

MATERIALS AND METHODS

Retrospective analysis of 148 patients with renal cancer treated at the Oncological Institute in Cracow from 2000 to 2007 was performed. Mean follow-up was 51 months. Using the log-rang test, a group of clinicopathological and biochemical features was analyzed in respect to their influence on overall survival. Results were presented as Kaplan-Meier curves. Final identification of IPFs was made by multivariate Cox regression analysis.

RESULTS

Overall survival rate at 1, 2, and 5-year follow-up was 58.8%, 38.2%, and 21.4%, respectively. The set of identified IPFs consisted of performance status, smoking history, hemoglobin concentration, anatomical staging, tumor grade, and the presence of microvascular invasion. It was confirmed that only nephrectomy increases significantly overall survival.

CONCLUSIONS

Apart from smoking history, the role of all other IPFs identified in our study is well documented in the literature. Smoking history seems to be a new IPF with strong negative impact on survival in patients with RCC.