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A Phase I, Open-label, Dose-escalation, and Cohort Expansion Study to Evaluate the Safety and Immune Response to Autologous Dendritic Cells Transduced With AdGMCA9 (DC-AdGMCAIX) in Patients With Metastatic Renal Cell Carcinoma. J Immunother 2021; 43:273-282. [PMID: 32925563 DOI: 10.1097/cji.0000000000000336] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Expression of carbonic-anhydrase IX (CAIX) in clear cell renal cell carcinoma (RCC) makes it an attractive vaccine target. We developed a fusion-gene construct, granulocyte-macrophage (GM) colony-stimulating factor+CAIX, delivered by an adenoviral vector (Ad) into autologous dendritic cells (DCs) in this phase 1 study. The injected immature DCs were expected to stimulate an antigen-specific immune response against CAIX expressing RCC. Three dose-escalation cohorts (5, 15, and 50×10 cells/administration) were injected intradermally q2wk×3 doses based on a 3+3 design. The primary objective was the safety of the injections. Secondary objectives were immune responses using enzyme-linked immunosorbent spot, a serum biomarker panel, and clinical response. Fifteen patients with metastatic RCC were enrolled, and 9 patients received all 3 doses. No serious adverse events were seen. There were 3 (33%) patients with grade 1 fatigue, 1 of whom subsequently experienced grade 2 fatigue. One patient (11%) experienced grade 1-2 leukopenia. Only 1 patient (11%) experienced grade 2 flu-like symptoms. Of the 9 patients who received treatment, 1 expired of progressive disease, 2 patients were lost to follow-up and 6 patients are alive. Of the 6 patients, 5 have progressive disease, and 1 has completed treatment with stable disease at 27 months follow-up. Immune response measurements appeared more robust in higher dose cohorts, which appeared to be related to patients with stable disease at 3 months. These early data show that autologous immature DC-AdGMCAIX can be safely given to metastatic RCC patients without any serious adverse events with CAIX-specific immune response elicited by the treatment. These preliminary data support further study of Ad-GMCAIX, particularly with combination therapies that may enhance clinical activity.
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Li G, Feng G, Zhao A, Péoc’h M, Cottier M, Mottet N. CA9 as a biomarker in preoperative biopsy of small solid renal masses for diagnosis of clear cell renal cell carcinoma. Biomarkers 2016; 22:123-126. [DOI: 10.1080/1354750x.2016.1252948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Guorong Li
- Department of Urology, CHU de Saint-Etienne, Saint-Etienne, France
| | - Gang Feng
- Clinical Genetics Laboratory, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - An Zhao
- Laboratory of Cancer Research, Zhejiang Cancer Research Institute, Zhejiang Province Cancer Hospital, Hangzhou, China
| | - Michel Péoc’h
- Laboratory of Pathology, CHU Saint-Etienne, Saint-Etienne, France
| | - Michèle Cottier
- Inserm U1059, F-42055, Saint-Etienne, France
- Laboratory of Cytopathology, CHU Saint-Etienne, Saint-Etienne, France
| | - Nicolas Mottet
- Department of Urology, CHU de Saint-Etienne, Saint-Etienne, France
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Cheng F, Wang X, Zhong D, Sun L, Wang Q, Liu C. [Significance of detection of serum carbonic anhydrase IX in the diagnosis of lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 18:29-33. [PMID: 25603870 PMCID: PMC5999739 DOI: 10.3779/j.issn.1009-3419.2015.01.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Carbonic anhydrase IX (CAIX) is a transmembrane protein involved in the metabolism of tumor cells. CAIX is expressed in only a few normal tissues but is overexpressed in various tumor types. The aim of this study is to detect the serum CAIX level of patients with lung cancer, evaluate the significance of CAIX detection in the diagnosis of lung cancer, and analyze the serum CAIX level among different pathological types and TNM stages of lung cancer. METHODS Forty-seven patients with lung cancer and 31 healthy subjects were selected to participate in this study. Serum CAIX level was examined through enzyme-linked immunosorbent assay (ELISA). The subjects were grouped according to histological type and TNM staging, and serum CAIX level was compared among the groups. With pathological diagnosis as the gold standard, receiver operating characteristic curve of the serum CAIX level was established for the diagnosis of lung cancer. RESULTS The CAIX serum level was significantly higher in patients with lung cancer than that in the healthy group (P<0.001). The serum CAIX level in patients with squamous cell carcinoma and small cell carcinoma was also significantly higher than that in patients with adenocarcinoma. No statistically significant differences were observed in the serum CAIX level between I+II and III+IV staging. The AUC of serum CAIX level was 0.961. At a threshold level of 115.115 pg/mL, sensitivity and specificity were 95.7% and 90.3%, respectively. CONCLUSIONS Detection of the serum CAIX level through ELISA exhibits high sensitivity and specificity and is important for the diagnosis of lung cancer.
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Affiliation(s)
- Fangyuan Cheng
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xiao'e Wang
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Diansheng Zhong
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China;Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Linlin Sun
- Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qian Wang
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Chang Liu
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
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Zerati M, Leite KRM, Pontes-Junior J, Segre CC, Reis ST, Srougi M, Dall'Oglio MF. Carbonic Anhydrase IX is not a predictor of outcomes in non-metastatic clear cell renal cell carcinoma - a digital analysis of tissue microarray. Int Braz J Urol 2014; 39:484-92. [PMID: 24054396 DOI: 10.1590/s1677-5538.ibju.2013.04.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 08/30/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The knowledge about the molecular biology of clear cell renal cell carcinoma (ccRCC) is evolving, and Carbonic Anhydrase type IX (CA-IX) has emerged as a potential prognostic marker in this challenging disease. However, most of the literature about CA-IX on ccRCC comes from series on metastatic cancer, with a lack of series on non-metastatic cancer. The objective is to evaluate the expression of CA-IX in a cohort of non-metastatic ccRCC, correlating with 1) overall survival, and 2) with established prognostic parameters (T stage, tumor size, Fuhrman nuclear grade, microvascular invasion and peri-renal fat invasion). MATERIALS AND METHODS This is a retrospective cohort study. We evaluated 95 patients with non-metastatic clear cell renal cell carcinoma, as to the expression of CA-IX. The analyzed parameters where: overall survival (OS), TNM stage, tumor size (TS), Fuhrman nuclear grade (FNG), microvascular invasion (MVI), peri-renal fat invasion (PFI). We utilized a custom built tissue microarray, and the immunoexpression was digitally quantified using the Photoshop ® software. RESULTS The mean follow-up time was 7.9 years (range 1.9 to 19.5 years). The analysis of CA-IX expression against the selected prognostic parameters showed no correlation. The results are as follows: Overall survival (p = 0.790); T stage (p = 0.179); tumor size (p = 0.143); grouped Fuhrman nuclear grade (p = 0.598); microvascular invasion (p = 0.685), and peri-renal fat invasion (p = 0.104). CONCLUSION Carbonic anhydrase type IX expression does not correlate with overall survival and conventional prognostic parameters in non-metastatic clear cell renal cell carcinoma.
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Affiliation(s)
- Marcelo Zerati
- Laboratory of Medical Investigation (LIM55), Urology Department, University of Sao Paulo Medical School and Uro-Oncology Group, Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Ordóñez NG. Value of PAX8, PAX2, napsin A, carbonic anhydrase IX, and claudin-4 immunostaining in distinguishing pleural epithelioid mesothelioma from metastatic renal cell carcinoma. Mod Pathol 2013; 26:1132-43. [PMID: 23503645 DOI: 10.1038/modpathol.2013.34] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/12/2012] [Accepted: 12/28/2012] [Indexed: 01/05/2023]
Abstract
Both mesotheliomas and renal cell carcinomas can present a wide variety of cytomorphologic features and histologic patterns. Because of this, renal cell carcinomas metastatic to the pleura and lung can be confused with mesotheliomas. Recently, a variety of positive carcinoma markers, including kidney-associated markers, have become available. The aim of this study is to investigate the value of some of these markers, specifically PAX8, PAX2, napsin A, carbonic anhydrase IX, and claudin-4, for assisting in distinguishing pleural epithelioid mesotheliomas from metastatic renal cell carcinomas. To do so, a total of 40 pleural epithelioid mesotheliomas and 55 renal cell carcinomas (33 clear cell, 10 papillary, and 12 chromophobe) were investigated. In all, 91% of the renal cell carcinomas expressed claudin-4, 89% PAX8, 60% PAX2, 71% carbonic anhydrase IX, and 29% napsin A. All of the mesotheliomas were positive for carbonic anhydrase IX and were negative for all of the other markers. On the basis of these results, it is concluded that claudin-4 and PAX8 have a higher sensitivity and specificity for assisting in discriminating between pleural epithelioid mesotheliomas and renal cell carcinomas when compared with all of the other positive carcinoma markers that are, at present, recommended to be included in the immunohistochemical panels used in this differential diagnosis. Even though PAX2 and napsin A are highly specific, because of their low sensitivity, they have only a limited value. Carbonic anhydrase IX is not useful.
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Affiliation(s)
- Nelson G Ordóñez
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Buti S, Bersanelli M, Donini M, Ardizzoni A. Systemic adjuvant therapies in renal cell carcinoma. Oncol Rev 2012; 6:e18. [PMID: 25992216 PMCID: PMC4419621 DOI: 10.4081/oncol.2012.e18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 07/03/2012] [Accepted: 07/05/2012] [Indexed: 12/11/2022] Open
Abstract
Renal cell carcinoma (RCC) is one of the ten most frequent solid tumors worldwide. Recent innovations in the treatment of metastatic disease have led to new therapeutic approaches being investigated in the adjuvant setting. Observation is the only current standard of care after radical nephrectomy, although there is evidence of efficacy of adjuvant use of vaccine among all the strategies used. This article aims to collect published experiences with systemic adjuvant approaches in RCC and to describe the results of past and ongoing phase III clinical trials in this field. We explored all the systemic treatments, including chemotherapy, immunotherapy and targeted drugs while alternative approaches have also been described. Appropriate selection of patients who would benefit from adjuvant therapies remains a crucial dilemma. Although the international guidelines do not actually recommend any adjuvant treatment after radical surgery for RCC, no conclusions have yet been drawn pending the results of the promising ongoing clinical trials with the target therapies. The significant changes that these new drugs have made on advanced disease outcome could represent the key to innovation in terms of preventing recurrence, delaying relapse and prolonging survival after radical surgery for RCC.
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Affiliation(s)
- Sebastiano Buti
- Operative Unit of Medical Oncology, University Hospital of Parma
| | | | | | - Andrea Ardizzoni
- Operative Unit of Medical Oncology, University Hospital of Parma
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Lhermitte B, de Leval L. Interpretation of needle biopsies of the kidney for investigation of renal masses. Virchows Arch 2012; 461:13-26. [PMID: 22678078 DOI: 10.1007/s00428-012-1255-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/17/2012] [Accepted: 05/18/2012] [Indexed: 01/14/2023]
Abstract
The development of new therapeutic options for renal tumors has lead to the need of a pretherapeutic diagnosis for an increasing proportion of patients presenting with a renal mass. This need is particularly important for a small, incidentally discovered renal mass (less than 4 cm) as it can be a benign lesion in a significant percentage of cases. Recent studies have shown that needle biopsy is an accurate and safe method allowing for a precise histopathological diagnosis of the mass in most cases. The aims of the biopsy are (1) to assess the benign or malignant nature of the lesion, (2) to assess the primary or secondary nature of the lesion, and (3), in case of a primary malignancy, to determine histological prognostic factors, such as the tumor type. This review, based on the most recent literature and our own experience, is intended to provide a practical approach to the diagnosis, relying on appropriate morphologic assessment and the use of immunohistochemistry.
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Affiliation(s)
- Benoît Lhermitte
- University Institute of Pathology, Centre Hospitalier Universitaire Vaudois (CHUV), 25 rue du Bugnon, 1011 Lausanne, Switzerland.
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Giménez-Bachs JM, Salinas-Sánchez AS, Serrano-Oviedo L, Nam-Cha SH, Rubio-Del Campo A, Sánchez-Prieto R. Carbonic anhydrase IX as a specific biomarker for clear cell renal cell carcinoma: comparative study of Western blot and immunohistochemistry and implications for diagnosis. ACTA ACUST UNITED AC 2012; 46:358-64. [PMID: 22571179 DOI: 10.3109/00365599.2012.685493] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate the usefulness of carbonic anhydrase IX (CA-IX) expression in clear cell renal cell carcinoma (CCRCC) using two different techniques to detect protein expression. MATERIAL AND METHODS An experimental, cross-sectional, analytical study was conducted to analyse proteins in renal tumour and healthy tissue specimens from 38 consecutive patients who underwent nephrectomy for renal cancer. CA-IX protein expression was measured by immunohistochemistry and Western blot analysis and quantified. Statistical analysis was performed with the positive and negative specific agreements and kappa coefficient. The sensitivity and specificity of both techniques were assessed. Statistical tests were conducted to analyse the association between CA-IX expression quantitation and normal prognosis factors (TNM stage and Fuhrman nuclear grade), only in CCRCC. RESULTS The mean patient age was 65 years, 78.9% of patients were men and 57.9% of tumours were CCRCC. CA-IX protein expression was positive in 63.2% of tumours by immunohistochemistry and in 60.5% by Western blot. Both techniques detected CA-IX expression only in CCRCC and unclassifiable tumours. High concordance indices were observed for CCRCC diagnosis. Western blot and immunohistochemistry had a sensitivity of 95.5% and 100%, respectively; the specificity was 100% in both techniques. CA-IX expression quantitation did not correlate with tumour stage or Fuhrman nuclear grade. CONCLUSIONS Immunochemistry and Western blot techniques can be used to detect abnormal CA-IX protein expression in CCRCC and to support morphology-based diagnostic techniques.
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Carbonic anhydrase IX is expressed in mesothelioma and metastatic clear cell renal cell carcinoma of the lung. Virchows Arch 2011; 460:89-93. [DOI: 10.1007/s00428-011-1178-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 11/10/2011] [Accepted: 11/22/2011] [Indexed: 11/26/2022]
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Algaba F. Rereading the renal cell tumors. Int J Surg Pathol 2010; 18:94S-97S. [PMID: 20484270 DOI: 10.1177/1066896910370468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ferrán Algaba
- Department of Pathology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Thirabanjasak D, Basturk O, Altinel D, Cheng JD, Adsay NV. Is serous cystadenoma of the pancreas a model of clear-cell-associated angiogenesis and tumorigenesis? Pancreatology 2009; 9:182-8. [PMID: 19077470 PMCID: PMC2835376 DOI: 10.1159/000178890] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Accepted: 07/02/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND Similar to the other von Hippel-Lindau (VHL)-related tumors such as renal cell carcinomas and capillary hemangioblastomas, serous cystadenomas (SCAs) of the pancreas are also characterized by clear cells. Over the years, we have also noticed that the tumor epithelium shows a prominent capillary network. METHODS Eighteen cases of SCA were reviewed histologically, and immunohistochemical analysis was performed for CD31 and vascular endothelial growth factor (VEGF) as well as the molecules implicated in clear-cell tumorigenesis: GLUT-1, hypoxia-inducible factor-1 (HIF-1alpha), and carbonic anhydrase IX (CA IX). RESULTS There was an extensively rich capillary network that appears almost intraepithelially in all cases of SCA, which was confirmed by CD31 stain that showed, on average, 26 capillaries per every 100 epithelial cells. VEGF expression was identified in 10/18 cases. Among the clear-cell tumorigenesis markers, CA IX was detected in all cases, GLUT-1 and HIF-1alpha in most cases. CONCLUSION As in other VHL-related clear-cell tumors, there is a prominent capillary network immediately adjacent to the epithelium of SCA, confirming that the clear-cell- angiogenesis association is also valid for this tumor type. Molecules implicated in clear-cell tumorigenesis are also consistently expressed in SCA. This may have biologic and therapeutic implications, especially considering the rapidly evolving drugs against these pathways. More importantly, SCA may also serve as a model of clear-cell-associated angiogenesis and tumorigenesis, and the information gained from this tumor type may also be applicable to other clear-cell tumors.
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Affiliation(s)
- Duangpen Thirabanjasak
- Department of Pathology, Wayne State University and Karmanos Cancer Institute, Detroit, Mich., USA
| | - Olca Basturk
- Department of Pathology, New York University, New York, N.Y., USA
| | - Deniz Altinel
- Department of Pathology, Emory University and Winship Cancer Institute, Atlanta, Ga., USA
| | | | - N. Volkan Adsay
- Department of Pathology, Emory University and Winship Cancer Institute, Atlanta, Ga., USA,*N. Volkan Adsay, MD, Emory University Hospital and Winship Cancer Institute, Department of Pathology, Room H-185-B, 1364 Clifton Road NE, Atlanta, GA 30322 (USA), Tel. +1 404 712 4179, Fax +1 404 712 8802, E-Mail
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Abstract
Currently, the management of localized renal cell carcinoma (RCC) is surgical. Unfortunately, many cases of high-risk RCC recur following resection and develop metastatic disease, an event that usually results in death. Because previous attempts to improve survival with adjuvant therapy have been unsuccessful, the US Food and Drug Administration's approval of three new agents for metastatic RCC has generated renewed interest in evaluating agents in the adjuvant setting for high-risk RCC. This article discusses the rationale for the use of these and other novel agents and reviews currently ongoing adjuvant trials as well as considerations for the development of new trials for adjuvant therapies.
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Affiliation(s)
- Naomi B Haas
- Abramson Cancer Center, 12 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Lopez–Beltran A, Kirkali Z, Cheng L, Egevad L, Regueiro JC, Blanca A, Montironi R. Targeted therapies and biological modifiers in urologic tumors: pathobiology and clinical implications. Semin Diagn Pathol 2008; 25:232-44. [DOI: 10.1053/j.semdp.2008.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shuch B, Li Z, Belldegrun AS. Carbonic anhydrase IX and renal cell carcinoma: prognosis, response to systemic therapy, and future vaccine strategies. BJU Int 2008; 101 Suppl 4:25-30. [PMID: 18430119 DOI: 10.1111/j.1464-410x.2008.07645.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Brian Shuch
- David Geffen School of Medicine, University of California-Los Angeles (UCLA), Los Angeles, CA 90095-1738, USA
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Splitting and Lumping Adult Renal Epithelial Tumors Can Help the Urologists in the Prognostic Risk Stratification and in the Treatment Decision-Making. Eur Urol 2008. [DOI: 10.1016/j.eururo.2008.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ficarra V, Galfano A, Novara G, Iafrate M, Brunelli M, Secco S, Cavalleri S, Martignoni G, Artibani W. Risk stratification and prognostication of renal cell carcinoma. World J Urol 2008; 26:115-25. [PMID: 18392834 DOI: 10.1007/s00345-008-0259-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Accepted: 03/17/2008] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To review the most recent data on prognostic factors and describe the characteristics and prognostic accuracy of the most important prognostic systems available to predict the risk of recurrence, progression, and mortality in patients with renal cell carcinoma (RCC). METHODS The study was based on a non-systematic review of literature. RESULTS Clinical (performance status, and mode of presentation), anatomical (size and extension of the primary tumor, lymph node involvement, and distant metastasis), and histological factors (histological subtypes, nuclear grade, and tumor necrosis) are the most largely evaluated prognostic factors in RCC. Valuable prognostic accuracy has been shown for several laboratory parameters (erythrocyte sedimentation rate, platelet count, serum calcium, hemoglobin, and lactate dehydrogenase levels) and a few genetical and molecular markers (CAIX, B7-H1, and B7-H4). A few integrating systems have been proposed and validated, integrating both clinical and pathological (UCLA Integrating Staging Systems, Kattan nomogram, and Sorbellini nomogram) or only pathological variables (SSIGN score). CONCLUSIONS Several large and methodologically consistent studies have been published. The chance to integrate the data derived from each prognostic factor into prognostic algorithms and scores has allowed improving significantly the stratification of the prognosis of patients with RCC. The currently available prognostic systems can be further improved through the inclusion of molecular and genetic variables. Integrating prognostic systems should be used to design randomized controlled trials (RCTs), which will evaluate the efficacy of the new-targeted therapies in either neoadjuvant, adjuvant, or salvage treatments of patients with RCC.
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Affiliation(s)
- Vincenzo Ficarra
- Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Monoblocco Ospedaliero - IV Floor, Via Giustiniani 2, 35128 Padua, Italy.
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Rioux-Leclercq N, Fergelot P, Zerrouki S, Leray E, Jouan F, Bellaud P, Epstein JI, Patard JJ. Plasma level and tissue expression of vascular endothelial growth factor in renal cell carcinoma: a prospective study of 50 cases. Hum Pathol 2007; 38:1489-95. [PMID: 17597181 DOI: 10.1016/j.humpath.2007.02.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 02/02/2007] [Accepted: 02/06/2007] [Indexed: 01/28/2023]
Abstract
Vascular endothelial growth factor (VEGF) is the major factor involved in angiogenesis. Although it is known that one of the functions of VEGF is to regulate neovascularization in renal cell carcinomas, the relationship between the production of VEGF in tumor tissue and its concentration in blood has not yet been studied. The aims of this study were to determine, in a series of conventional renal cell carcinoma (CRCC) cases, (1) VEGF expression and VEGF pattern in tumor cells, (2) the relationship between VEGF expression/pattern and VEGF levels in plasma (pVEGF), and (3) the association with usual clinical and pathologic prognostic factors. Fifty patients operated on for CRCC by radical nephrectomy were included. Clinical and histologic parameters were studied. VEGF expression and VEGF pattern in tumor cells was immunohistochemically recorded. pVEGF levels and platelet count were analyzed in relation to clinical and histologic parameters. Intratumoral VEGF expression associated with a cytoplasmic VEGF pattern was significantly higher in patients with high pVEGF levels (P = .01). Both VEGF expression and pVEGF levels were significantly correlated with Fuhrman grade (P = .002 and P = .01, respectively) and tumor stage (P = .006 and P = .008, respectively). In addition, VEGF expression was also correlated with tumor necrosis (P = .001) and progression (P = .001). We demonstrated that in CRCC with tumor necrosis, VEGF expression, pVEGF levels, and platelet count were significantly higher than in CRCC with no tumor necrosis (P = .001, P = .03, and P = .001, respectively). Our results revealed that cytoplasmic VEGF expression and pVEGF levels are associated with usual prognostic factors and progression in CRCC, which may allow VEGF to be used as a prognostic marker for CRCC, especially in patients with VEGF-targeted therapy.
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Affiliation(s)
- Nathalie Rioux-Leclercq
- Département d'Anatomie et de Cytologie Pathologiques, CHU Pontchaillou, 35033 Rennes Cedex 9, France; CNRS/UMR6061 IFR 140, Rennes University, 35043 Rennes Cedex, France.
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Polydorides AD, Rosenblum MK, Edgar MA. Metastatic renal cell carcinoma to hemangioblastoma in von Hippel-Lindau disease. Arch Pathol Lab Med 2007; 131:641-5. [PMID: 17425399 DOI: 10.5858/2007-131-641-mrccth] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2006] [Indexed: 11/06/2022]
Abstract
A case of metastatic renal cell carcinoma (RCC) to a capillary hemangioblastoma (HAB) of the central nervous system in a 52-year-old woman with von Hippel-Lindau (vHL) syndrome is described. We review the literature on metastatic RCC to HAB, summarize the histologic and immunohistochemical features that can distinguish between the 2 tumors, and comment on the significance of such a finding in terms of the clinical diagnosis of vHL. We found the expression of CAM 5.2, RCC antigen, and CD10 to be strong in RCC and absent in HAB and, conversely, staining with Leu-7, neural cell adhesion molecule, and inhibin-alpha was present in HAB but weak or absent in RCC. These antibodies can be used to differentiate these entities, provided one is astute in recognizing the possibility of their coexistence.
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Affiliation(s)
- Alexandros D Polydorides
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY, USA.
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Abstract
For most cases of renal cell carcinoma (RCC), the standard of care is surgical resection as monotherapy or as part of a multimodal approach. In patients with early localized disease, radical nephrectomy is associated with a favorable prognosis, whereas patients with advanced disease are rarely cured. A significant number of patients undergoing surgery for localized RCC experience recurrence, suggesting that there are some individuals in whom surgical excision is necessary but insufficient. In these patients, the development of effective adjuvant strategies is imperative. In this article, we review the prognostic variables and comprehensive staging algorithms for identifying patients at high risk for disease recurrence. Additionally, we review data from completed adjuvant RCC trials and highlight relevant ongoing trials.
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Affiliation(s)
- David A Kunkle
- Department of Urologic Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
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Yao M, Huang Y, Shioi K, Hattori K, Murakami T, Nakaigawa N, Kishida T, Nagashima Y, Kubota Y. Expression of Adipose Differentiation-Related Protein: A Predictor of Cancer-Specific Survival in Clear Cell Renal Carcinoma. Clin Cancer Res 2007; 13:152-60. [PMID: 17200350 DOI: 10.1158/1078-0432.ccr-06-1877] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We recently found that adipose differentiation-related protein (ADFP) is a potential diagnostic and prognostic biomarker for clear cell subtype renal cell carcinoma (RCC). To further evaluate the correlation between ADFP expression levels and clinicopathologic characteristics and patient outcome, we retrospectively examined patients with clear cell RCC. EXPERIMENTAL DESIGN A series of 432 consecutive patients with sporadic clear cell RCC who underwent nephrectomy between March 1986 and June 2004 were enrolled in the study. ADFP expression levels in the primary tumors and in 18 metastases were measured by real-time quantitative PCR. The clinicopathologic and prognostic data were collected, as well as the von Hippel-Lindau disease (VHL) gene alteration status in selected cases. RESULTS ADFP expression was apparently high in cases without a symptomatic presentation, as well as in cases of low-stage, low-grade, or VHL alteration-positive clear cell RCC, whereas it was down-regulated in undifferentiated tumors with a spindle/pleomorphic component or metastatic lesions. Univariate analyses showed that high ADFP expression was associated with better cancer-specific survival and cancer-free survival. Further Cox multivariate analyses combined with the split-sample validation method showed that ADFP expression still remains an independent predictor for cancer-specific survival in all tumor stages and in advanced metastatic cases, whereas the predictive value of ADFP expression for cancer recurrence is rather weak. CONCLUSIONS The ADFP expression may represent the tumor differentiation status, and the detection of the expression levels provides useful prognostic information for cancer-specific survival in patients with clear cell RCC.
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Affiliation(s)
- Masahiro Yao
- Department of Urology and Molecular Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
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Sartini D, Muzzonigro G, Milanese G, Pierella F, Rossi V, Emanuelli M. Identification of Nicotinamide N-Methyltransferase as a Novel Tumor Marker for Renal Clear Cell Carcinoma. J Urol 2006; 176:2248-54. [PMID: 17070307 DOI: 10.1016/j.juro.2006.07.046] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Indexed: 12/19/2022]
Abstract
PURPOSE To explore the involvement of enzymes of drug metabolism in renal cell carcinoma we analyzed the gene expression profiles of tumor and nontumor tissues from the same patient by DNA macroarray. The enzyme nicotinamide N-methyltransferase was selected for further evaluation. MATERIALS AND METHODS Nicotinamide N-methyltransferase mRNA expression was investigated in paired tissue samples from cancerous and noncancerous parts of the kidneys of 30 patients with clear cell renal cell carcinoma who underwent tumor nephrectomy. Measurements were performed by semiquantitative reverse transcriptase-polymerase chain reaction and quantitative real-time polymerase chain reaction. Paired tissue samples were also obtained from 1 patient with chromophobe renal cell carcinoma and from another with oncocytoma to compare the specificity of changes in nicotinamide N-methyltransferase expression among tumors that are related to different renal epithelial cell types. Western blot analysis and catalytic activity assay were also performed to study nicotinamide N-methyltransferase expression. Expression correlated with tumor characteristics. RESULTS A marked increased expression in tumor tissue was found for nicotinamide N-methyltransferase, which is an enzyme involved in the biotransformation of many drugs and xenobiotic compounds. Differential gene expression measurements in tumor vs normal tissue revealed up-regulation in all clear cell renal cell carcinomas at between 3 and 294-fold (mean 41). In contrast, in chromophobe renal cell carcinoma and oncocytoma nicotinamide N-methyltransferase expression did not increase. In addition, nicotinamide N-methyltransferase expression significantly correlated inversely with tumor size. CONCLUSIONS Our results indicate that a marked nicotinamide N-methyltransferase increase is a peculiar feature of clear cell renal cell carcinoma. Additional studies may establish the role of nicotinamide N-methyltransferase in tumor formation and progression.
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Affiliation(s)
- Davide Sartini
- Institute of Biochemical Biotechnologies, Azienda Ospedaliero-Universitaria Umberto I-Lancisi-Salesi, Ancona, Italy
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Bibliography. Current world literature. Bladder cancer. Curr Opin Urol 2006; 16:386-9. [PMID: 16905987 DOI: 10.1097/01.mou.0000240314.93453.d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Li G, Cuilleron M, Cottier M, Gentil-Perret A, Lambert C, Genin C, Tostain J. The Use of MN/CA9 Gene Expression in Identifying Malignant Solid Renal Tumors. Eur Urol 2006; 49:401-5. [PMID: 16387417 DOI: 10.1016/j.eururo.2005.10.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Accepted: 10/05/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Small solid renal tumors are increasingly encountered. It is important to determine the malignancy of solid renal tumors for the choice of treatment. MN/CA9 is expressed in malignant renal cells but absent in normal cells. MN/CA9 is one of the most powerful gene markers available for RCC. The objective of this pilot study is to utilize MN/CA9 gene expression in FNA biopsy to determine the malignancy of imaging-indeterminate solid renal tumors. METHODS A total of 35 patients with an imaging-indeterminate solid renal mass entered into this study. The molecular protocol consisted of a rapid column extraction of RNA and one-step RT-PCR for the detection of MN/CA9 gene expression. The preoperative molecular diagnosis was compared with postoperative pathology. RESULTS There were 28 RCCs (19 clear cell carcinomas, 7 papillary carcinomas and 2 chromophobe carcinomas) and 7 benign tumors proved by postoperative pathology. The overall sensitivity and specificity for MN/CA9 were respectively 68% and 100%. MN/CA9 was positive in 16/19 (84%) FNA biopsies of clear cell RCCs. No false positive appeared for MN/CA9 gene expression. Moreover, MN/CA9 gene expression was positive in 8/13 (62%) of false negative or suspect cytology. CONCLUSION Detection of MN/CA9 gene expression in FNA biopsy is possible. Its detection can be helpful in identifying the malignancy among renal tumors.
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MESH Headings
- Adenocarcinoma, Clear Cell/chemistry
- Adenocarcinoma, Clear Cell/pathology
- Antigens, Neoplasm/analysis
- Antigens, Neoplasm/genetics
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biopsy
- Carbonic Anhydrase IX
- Carbonic Anhydrases/analysis
- Carbonic Anhydrases/genetics
- Carcinoma, Papillary/chemistry
- Carcinoma, Papillary/pathology
- Carcinoma, Renal Cell/chemistry
- Carcinoma, Renal Cell/pathology
- Cytological Techniques
- False Positive Reactions
- Female
- Gene Expression Regulation, Neoplastic
- Genetic Predisposition to Disease
- Humans
- Kidney Neoplasms/chemistry
- Kidney Neoplasms/pathology
- Male
- Middle Aged
- Pilot Projects
- RNA, Neoplasm/analysis
- Reverse Transcriptase Polymerase Chain Reaction
- Sensitivity and Specificity
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Affiliation(s)
- Guorong Li
- Department of Urology, North Hospital, CHU of Saint-Etienne, France.
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