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Cimadamore A, Caliò A, Marandino L, Marletta S, Franzese C, Schips L, Amparore D, Bertolo R, Muselaers S, Erdem S, Ingels A, Pavan N, Pecoraro A, Kara Ö, Roussel E, Carbonara U, Campi R, Marchioni M. Hot topics in renal cancer pathology: implications for clinical management. Expert Rev Anticancer Ther 2022; 22:1275-1287. [PMID: 36377655 DOI: 10.1080/14737140.2022.2145952] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The updated European Association of Urology (EAU) Guidelines issued a weak recommendation for adjuvant pembrolizumab for patients with high-risk operable clear cell Renal Cell Carcinoma (ccRCC). High risk of recurrence was defined, as per protocol-criteria, as T2 with nuclear grade 4 or sarcomatoid differentiation, T3 or higher, regional lymph node metastasis, or stage M1 with no evidence of disease. Considering the heterogeneous population included in the recommendation, it has been questioned if adjuvant pembrolizumab may lead to overtreatment of some patients as well as undertreatment of patients with worse prognosis. AREAS COVERED In this review, we discuss the issues related to the assessment of pathological features required to identify those patients harboring a high-risk tumor, highlighting the issue related to interobserver variability and discuss the currently available prognostic scoring systems in ccRCC. EXPERT OPINION PPathologist assessment of prognostic features suffers from interobserver variability which may depend on gross sampling and the pathologist's expertise. The presence of clear cell feature is not sufficient criteria by itself to define ccRCC since clear cell can be also found in other histotypes. Application of molecular biomarkers may be useful tools in the near future to help clinicians identify patients harboring tumors with worse prognosis.
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Affiliation(s)
- Alessia Cimadamore
- Institute of Pathological Anatomy, Department of Medical Area, University of UdineUdineItaly
| | - Anna Caliò
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Laura Marandino
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Stefano Marletta
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Carmine Franzese
- Department of Urology, Polytechnic University of Marche, Ancona, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Science, "Ss. Annunziata" Hospital Urology Unit, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Stijn Muselaers
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Selcuk Erdem
- Division of Urologic Oncology, Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alexandre Ingels
- Department of Urology, University Hospital Henri Mondor, Créteil, France
| | - Nicola Pavan
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Angela Pecoraro
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Önder Kara
- Department of Urology, Kocaeli University School of Medicine, Izmit, Turkey
| | - Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Umberto Carbonara
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Science, "Ss. Annunziata" Hospital Urology Unit, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
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Syed M, Loya A, Hameed M, Akhtar N, Mushtaq S, Hassan U. Prognostic Significance of Percentage Necrosis in Clear Cell Renal Cell Carcinoma. Am J Clin Pathol 2022; 157:374-380. [PMID: 34643216 DOI: 10.1093/ajcp/aqab136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/17/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The consensus conference of the International Society of Urological Pathology (ISUP), held in 2012, made recommendations regarding prognostic parameters of renal tumors. There was a strong consensus that tumor morphotype, pathologic tumor stage, and tumor grade are prognostic indicators of poor outcome. It was also agreed upon that prognostic significance of tumor necrosis is in evolution, and both microscopic and macroscopic tumor necrosis should be documented in percentages. The aim of our study was to explore the impact of tumor necrosis on metastasis-free survival in clear cell renal carcinomas (ccRCCs) in Pakistani patients. METHODS We retrieved 318 consecutive in-house cases of ccRCC resections from 2014 to 2020 through hospital archives. Histologic slide review was done for assessment of tumor necrosis, tumor stage, and World Health Organization/ISUP grade. The follow-up data to assess metastasis-free survival were available in hospital archives. RESULTS In multivariable analysis performed by logistic regression model, tumor necrosis was an independent poor prognostic indicator (P = .0001): group 1 (reference group), 0% necrosis; group 2, 1% to 10% necrosis (adjusted odds ratio [AOR], 8.71; 95% confidence interval [CI], 3.62-20.98); and group 3, more than 10% necrosis (AOR, 9.48; 95% CI, 3.99-22.725). CONCLUSIONS Tumor necrosis is an independent predictor of poor outcome in ccRCCs.
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Affiliation(s)
- Madiha Syed
- Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore, Lahore, Pakistan
| | - Asif Loya
- Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore, Lahore, Pakistan
| | - Maryam Hameed
- Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore, Lahore, Pakistan
| | - Noreen Akhtar
- Department of Histopathology Queens Medical Center, Nottingham University Hospital, Nottingham, UK
| | - Sajid Mushtaq
- Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore, Lahore, Pakistan
| | - Usman Hassan
- Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore, Lahore, Pakistan
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Mattila KE, Vainio P, Jaakkola PM. Prognostic Factors for Localized Clear Cell Renal Cell Carcinoma and Their Application in Adjuvant Therapy. Cancers (Basel) 2022; 14:cancers14010239. [PMID: 35008402 PMCID: PMC8750145 DOI: 10.3390/cancers14010239] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/23/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Approximately one fifth of patients with newly diagnosed renal cell carcinoma (RCC) present with metastatic disease and over one third of the remaining patients with localized RCC will eventually have metastases spread to distant sites after complete resection of the primary tumor in the kidney. Usually, disease recurrence is observed within the first five years of follow-up, but late recurrences after five years are seen in up to 10% of patients. Despite novel biomarkers, simple histopathological factors, such as tumor size, tumor grade, and tumor extension into the blood vessels or beyond the kidney, are still valid features in predicting the risk of disease recurrence after surgery. The optimal set of prognostic factors remains unclear. The results from ongoing placebo-controlled adjuvant therapy trials may elucidate prognostic features that help to define high-risk patients for disease recurrence. Abstract Approximately 20% of patients with renal cell carcinoma (RCC) present with primarily metastatic disease and over 30% of patients with localized RCC will develop distant metastases later, after complete resection of the primary tumor. Accurate postoperative prognostic models are essential for designing personalized surveillance programs, as well as for designing adjuvant therapy and trials. Several clinical and histopathological prognostic factors have been identified and adopted into prognostic algorithms to assess the individual risk for disease recurrence after radical or partial nephrectomy. However, the prediction accuracy of current prognostic models has been studied in retrospective patient cohorts and the optimal set of prognostic features remains unclear. In addition to traditional histopathological prognostic factors, novel biomarkers, such as gene expression profiles and circulating tumor DNA, are extensively studied to supplement existing prognostic algorithms to improve their prediction accuracy. Here, we aim to give an overview of existing prognostic features and prediction models for localized postoperative clear cell RCC and discuss their role in the adjuvant therapy trials. The results of ongoing placebo-controlled adjuvant therapy trials may elucidate prognostic factors and biomarkers that help to define patients at high risk for disease recurrence.
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Affiliation(s)
- Kalle E. Mattila
- Department of Oncology and Radiotherapy, FICAN West Cancer Centre, University of Turku, Turku University Hospital, Hämeentie 11, 20521 Turku, Finland;
- Correspondence: ; Tel.: +358-2-3130000
| | - Paula Vainio
- Department of Pathology, University of Turku, Turku University Hospital, Hämeentie 11, 20521 Turku, Finland;
| | - Panu M. Jaakkola
- Department of Oncology and Radiotherapy, FICAN West Cancer Centre, University of Turku, Turku University Hospital, Hämeentie 11, 20521 Turku, Finland;
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Sprooten J, De Wijngaert P, Vanmeerbeerk I, Martin S, Vangheluwe P, Schlenner S, Krysko DV, Parys JB, Bultynck G, Vandenabeele P, Garg AD. Necroptosis in Immuno-Oncology and Cancer Immunotherapy. Cells 2020; 9:E1823. [PMID: 32752206 PMCID: PMC7464343 DOI: 10.3390/cells9081823] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
Immune-checkpoint blockers (ICBs) have revolutionized oncology and firmly established the subfield of immuno-oncology. Despite this renaissance, a subset of cancer patients remain unresponsive to ICBs due to widespread immuno-resistance. To "break" cancer cell-driven immuno-resistance, researchers have long floated the idea of therapeutically facilitating the immunogenicity of cancer cells by disrupting tumor-associated immuno-tolerance via conventional anticancer therapies. It is well appreciated that anticancer therapies causing immunogenic or inflammatory cell death are best positioned to productively activate anticancer immunity. A large proportion of studies have emphasized the importance of immunogenic apoptosis (i.e., immunogenic cell death or ICD); yet, it has also emerged that necroptosis, a programmed necrotic cell death pathway, can also be immunogenic. Emergence of a proficient immune profile for necroptosis has important implications for cancer because resistance to apoptosis is one of the major hallmarks of tumors. Putative immunogenic or inflammatory characteristics driven by necroptosis can be of great impact in immuno-oncology. However, as is typical for a highly complex and multi-factorial disease like cancer, a clear cause versus consensus relationship on the immunobiology of necroptosis in cancer cells has been tough to establish. In this review, we discuss the various aspects of necroptosis immunobiology with specific focus on immuno-oncology and cancer immunotherapy.
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Affiliation(s)
- Jenny Sprooten
- Department of Cellular and Molecular Medicine, Laboratory of Cell Stress & Immunity (CSI), KU Leuven, 3000 Leuven, Belgium
| | - Pieter De Wijngaert
- Department of Cellular and Molecular Medicine, Laboratory of Cell Stress & Immunity (CSI), KU Leuven, 3000 Leuven, Belgium
| | - Isaure Vanmeerbeerk
- Department of Cellular and Molecular Medicine, Laboratory of Cell Stress & Immunity (CSI), KU Leuven, 3000 Leuven, Belgium
| | - Shaun Martin
- Department of Cellular and Molecular Medicine, Laboratory of Cellular Transport Systems, KU Leuven, 3000 Leuven, Belgium
| | - Peter Vangheluwe
- Department of Cellular and Molecular Medicine, Laboratory of Cellular Transport Systems, KU Leuven, 3000 Leuven, Belgium
| | - Susan Schlenner
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Dmitri V Krysko
- Department of Human Structure and Repair, Cell Death Investigation and Therapy Laboratory, Ghent University, 9000 Ghent, Belgium
- Department of Pathophysiology, Sechenov First Moscow State Medical University (Sechenov University), 119146 Moscow, Russia
| | - Jan B Parys
- Department of Cellular and Molecular Medicine and Leuven Kanker Instituut (LKI), Laboratory of Molecular and Cellular Signaling, KU Leuven, 3000 Leuven, Belgium
| | - Geert Bultynck
- Department of Cellular and Molecular Medicine and Leuven Kanker Instituut (LKI), Laboratory of Molecular and Cellular Signaling, KU Leuven, 3000 Leuven, Belgium
| | - Peter Vandenabeele
- Department of Biomedical Molecular Biology, Ghent University, 9000 Ghent, Belgium
- VIB Center for Inflammation Research, 9052 Ghent, Belgium
- Methusalem Program, Ghent University, 9000 Ghent, Belgium
| | - Abhishek D Garg
- Department of Cellular and Molecular Medicine, Laboratory of Cell Stress & Immunity (CSI), KU Leuven, 3000 Leuven, Belgium
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Delahunt B, Eble JN, Egevad L, Samaratunga H. Grading of renal cell carcinoma. Histopathology 2019; 74:4-17. [PMID: 30565310 DOI: 10.1111/his.13735] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/18/2022]
Abstract
Grading of renal cell carcinoma (RCC) has been recognised as a prognostic factor for almost 100 years. Numerous grading systems have been proposed, initially focusing upon a constellation of cytological features and more recently on nuclear morphology. It has been recommended that grading of RCC should be based upon nucleolar prominence/eosinophilia for grades 1-3, while grade 4 requires nuclear anaplasia (including tumour giant cells, sarcomatoid differentiation and/or rhabdoid morphology). The grading system was adopted formally by the International Society of Urological Pathology (ISUP) and subsequently by the World Health Organisation (WHO), being designated the WHO/ISUP grading classification in the fourth edition of the WHO classification tumours of the urinary system and male genital organs (2016). This grading system has been validated for both clear cell and papillary RCC. Validation studies for chromophobe RCC failed to demonstrate a correlation between grade and outcome for both the superseded Fuhrman grading system and the WHO/ISUP grading classification, and it has been recommended that these tumours not be graded. The WHO/ISUP system has been incorporated into the structured reports of the International Cancer Collaboration on Cancer Reporting for both clear cell and papillary RCC. It is also noted that other types of RCC may be graded, but it must be emphasised in the report that this is for descriptive and diagnostic purposes, and not outcome prediction. More recent studies have shown the incorporation of the presence of tumour necrosis into RCC grading to improve outcome prediction, and this has been validated in several studies.
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Affiliation(s)
- Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, Wellington, New Zealand
| | - John N Eble
- Department of Pathology, Indiana University, Indianapolis, IN, USA
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Hemamali Samaratunga
- Aquesta Uropathology, Brisbane, Qld, Australia.,University of Queensland School of Medicine, Brisbane, Qld, Australia
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Dagher J, Delahunt B, Rioux-Leclercq N, Egevad L, Coughlin G, Dunglison N, Gianduzzo T, Kua B, Malone G, Martin B, Preston J, Pokorny M, Wood S, Samaratunga H. Assessment of tumour-associated necrosis provides prognostic information additional to World Health Organization/International Society of Urological Pathology grading for clear cell renal cell carcinoma. Histopathology 2018; 74:284-290. [PMID: 30129659 DOI: 10.1111/his.13737] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/18/2018] [Indexed: 11/27/2022]
Abstract
AIMS The aims of this study were to evaluate the impact of tumour-associated necrosis (TAN) on metastasis-free survival for clear cell renal cell carcinoma (RCC), and to determine whether TAN provides survival information additional to World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grading. METHODS AND RESULTS The study consisted of 376 cases of clear cell RCC treated by nephrectomy, for which follow-up was available. WHO/ISUP grade was assigned, and sections were assessed for the presence of TAN. American Joint Committee on Cancer (AJCC) pT staging category and tumour size were also recorded. The development of metastatic disease was taken as the clinical endpoint, and survival analyses, utilising univariate and multivariate models, were performed. WHO/ISUP grades were: grade 1, 35 cases (9.3%); grade 2, 188 cases (50.0%); grade 3, 91 cases (24.2%); and grade 4, 62 cases (16.5%). Staging categories were pT1-pT2 [234 tumours (62.2%)] and pT3-pT4 [139 tumours (37.0%)]. TAN was seen in 128 cases (34.0%). Neither TAN nor metastases were seen in grade 1 tumours. Among grade 2-4 tumours, those with TAN had a significantly worse prognosis than those without TAN (P = 0.017, P = 0.04, and P = 0.006, respectively). Multivariate analysis (WHO/ISUP grade, pT staging category, and TAN) showed all three variables to be independently associated with outcome (P = 0.009, P = 0.005, and P = 0.001, respectively). For all tumour grades and pT staging categories, it was found that the presence of TAN was associated with a 2.91-fold greater risk of metastatic disease. CONCLUSION Tumour-associated necrosis is an important prognostic factor for clear cell RCC, independently of WHO/ISUP grade. This supports the suggestion that TAN could be incorporated into tumour grading criteria.
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Affiliation(s)
- Julien Dagher
- Aquesta Specialized Uropathology, Brisbane, Qld, Australia.,Rennes University Hospital, Rennes, France.,University of Rennes, Rennes, France
| | - Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, Wellington, New Zealand
| | | | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | | | | | | | - Boon Kua
- Wesley Hospital, Brisbane, Qld, Australia
| | - Greg Malone
- Greenslopes Hospital, Brisbane, Qld, Australia
| | - Ben Martin
- Holy Spirit Northside Hospital, Brisbane, Qld, Australia
| | | | | | - Simon Wood
- Greenslopes Hospital, Brisbane, Qld, Australia
| | - Hemamali Samaratunga
- Aquesta Specialized Uropathology, Brisbane, Qld, Australia.,University of Queensland School of Medicine, Brisbane, Qld, Australia
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Collins J, Epstein JI. Prognostic significance of extensive necrosis in renal cell carcinoma. Hum Pathol 2017; 66:108-114. [PMID: 28669641 DOI: 10.1016/j.humpath.2017.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/05/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
Few studies using the current classification of renal cell carcinoma (RCC) have looked at a large number of cases with near total necrosis. We identified 21 cases of resections of RCC with >90% necrosis from the archives of Johns Hopkins Hospital between 2000 and 2015. Patients' mean age was 59 years (43-77) with 16 men (76%); 12 cases (57%) were papillary RCC, 4 clear cell papillary RCC (19%), 4 clear cell RCC (19%), and 1 unclassified with sarcomatoid differentiation (5%). International Society of Urological Pathology (ISUP) nucleolar grade was grade 1 (9 cases) or grade 2 (9 cases). Two cases were ISUP nucleolar grade 3, and 1 case was grade 4. Pathological stage was low (pT1-2) in 20 (95%) with the unclassified RCC with sarcomatoid differentiation RCC stage pT3a. Mean tumor size was 6.3 cm (1.2-17). In 52% (11) of cases, it was difficult to identify viable tumor, requiring multiple sections; 4 cases of papillary RCC were diagnosed in part due to necrotic tumor "ghost" architecture. Follow-up was available in 17 cases (81%) with a mean follow-up of 59 months. Thirteen patients (62%) are alive without disease. The patient with unclassified carcinoma with sarcomatoid differentiation died of cancer, and 2 died due to causes unrelated to cancer. One patient (5%) with low-grade clear cell RCC developed metastases but had a contralateral RCC. In the setting of a low-grade RCC, extensive necrosis does not have an adverse prognosis. In summary, our data, together with a prior study from our institution, comprise one of the largest cohorts of extensively (>90%) necrotic RCCs and suggests that in the setting of a low-grade RCC, it portends a good prognosis (only 2/36 cases showing progression (6%) on follow-up). However, we did identify a single case of high-grade RCC with an adverse prognosis and therefore, careful attention to tumor grade and classification is critical. The presence of tumor necrosis as a prognosticator in RCCs is complex, and despite its well-accepted role as an indicator of poor prognosis, our data would suggest otherwise under specific conditions. Importantly, in diagnosing a renal mass with extensive cystic necrosis, careful and extensive sampling to identify small foci of viable tumor or "ghost" architecture may be necessary for classification. As such, evaluation of its presence should not only be quantitative, but critical attention should be made to tumor grade and stage, whereby in high-grade carcinomas, necrosis likely imparts a worse prognosis; however, in low-grade carcinomas with extensive necrosis, the histological subtype, grade, and stage drive prognosis.
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Affiliation(s)
- Jennifer Collins
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231
| | - Jonathan I Epstein
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231; Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231; Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231.
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8
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Delahunt B, Samaratunga H, Kenwright DN. Histologic prognostic markers for renal cell neoplasia. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.mpdhp.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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10
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The International Society of Urological Pathology (ISUP) Grading System for Renal Cell Carcinoma and Other Prognostic Parameters. Am J Surg Pathol 2013; 37:1490-504. [DOI: 10.1097/pas.0b013e318299f0fb] [Citation(s) in RCA: 509] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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11
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Dominietto M, Lehmann S, Keist R, Rudin M. Pattern analysis accounts for heterogeneity observed in MRI studies of tumor angiogenesis. Magn Reson Med 2012; 70:1481-90. [PMID: 23280475 DOI: 10.1002/mrm.24590] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 11/14/2012] [Indexed: 12/26/2022]
Abstract
MRI is a method of choice for assessing anatomical structures or angiogenesis-related parameters noninvasively during tumor progression. Typically, tumor tissue displays a high degree of heterogeneity that can be evaluated using pattern analysis (PA), which comprises shape and texture analysis. This work aims at implementing PA methods to study angiogenesis in a murine tumor model and testing its sensitivity with regard to detecting changes elicited by administration of a drug. Twelve balb/c-nude mice were injected subcutaneously with 10(6) C51 cells (colon carcinoma). A first group (N = 6) of animals was treated with dimethyloxalylglycine, a drug known to stabilize hypoxia-inducible-factor-α, which among other functions, is involved in angiogenesis. The second group (N = 6) was treated with saline. MRI experiments assessing tumor blood volume and permeability-maps (K(trans) ) were performed immediately before and 6 days after drug treatment. Data have been analyzed using standard histogram analysis and PA. Standard histogram analysis did not reveal any difference between the two groups, neither before nor after the treatment. In contrast, PA revealed significant differences between drug and placebo treated mice in the texture of the TBV and K(trans) maps after drug treatment, but not with regard to tumors shapes. The results indicated that in view of the heterogeneity of tumor tissue, standard histogram analysis appears insensitive in picking-up differences in response to treatment, while PA appears to be particularly sensitive to changes in texture.
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Affiliation(s)
- Marco Dominietto
- Institute for Biomedical Engineering, University of Zurich and ETH, Zurich, Switzerland
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Katz MD, Serrano MF, Grubb RL, Skolarus TA, Gao F, Humphrey PA, Kibel AS. Percent Microscopic Tumor Necrosis and Survival After Curative Surgery for Renal Cell Carcinoma. J Urol 2010; 183:909-14. [DOI: 10.1016/j.juro.2009.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew D. Katz
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Maria F. Serrano
- Division of Anatomic and Molecular Pathology (Department of Pathology and Immunology), Washington University School of Medicine, St. Louis, Missouri
| | - Robert L. Grubb
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Ted A. Skolarus
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Feng Gao
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Peter A. Humphrey
- Division of Anatomic and Molecular Pathology (Department of Pathology and Immunology), Washington University School of Medicine, St. Louis, Missouri
| | - Adam S. Kibel
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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Pflanz S, Brookman-Amissah S, Roigas J, Kendel F, Hoschke B, May M. Impact of macroscopic tumour necrosis to predict survival of patients with surgically resected renal cell carcinoma. ACTA ACUST UNITED AC 2009; 42:507-13. [PMID: 19031267 DOI: 10.1080/00365590802460633] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sandra Pflanz
- Department of Urology, Carl-Thiem Hospital, Cottbus, Germany
| | | | - Jan Roigas
- Department of Urology, Vivantes-Clinic Am Urban, Berlin, Germany
| | | | - Bernd Hoschke
- Department of Urology, Carl-Thiem Hospital, Cottbus, Germany
| | - Matthias May
- Department of Urology, Carl-Thiem Hospital, Cottbus, Germany
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Gacci M, Serni S, Lapini A, Vittori G, Alessandrini M, Nesi G, Palli D, Carini M. CXCR3-B Expression Correlates With Tumor Necrosis Extension in Renal Cell Carcinoma. J Urol 2009; 181:843-8. [DOI: 10.1016/j.juro.2008.10.063] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Indexed: 11/16/2022]
Affiliation(s)
- Mauro Gacci
- From the Departments of Urology (MG, SS, AL, GV, MC) and Pathology (GN) and Center for Tumor Study and Prevention (DP), University of Florence, Florence, Italy
| | - Sergio Serni
- From the Departments of Urology (MG, SS, AL, GV, MC) and Pathology (GN) and Center for Tumor Study and Prevention (DP), University of Florence, Florence, Italy
| | - Alberto Lapini
- From the Departments of Urology (MG, SS, AL, GV, MC) and Pathology (GN) and Center for Tumor Study and Prevention (DP), University of Florence, Florence, Italy
| | - Gianni Vittori
- From the Departments of Urology (MG, SS, AL, GV, MC) and Pathology (GN) and Center for Tumor Study and Prevention (DP), University of Florence, Florence, Italy
| | - Marco Alessandrini
- From the Departments of Urology (MG, SS, AL, GV, MC) and Pathology (GN) and Center for Tumor Study and Prevention (DP), University of Florence, Florence, Italy
| | - Gabriella Nesi
- From the Departments of Urology (MG, SS, AL, GV, MC) and Pathology (GN) and Center for Tumor Study and Prevention (DP), University of Florence, Florence, Italy
| | - Domenico Palli
- From the Departments of Urology (MG, SS, AL, GV, MC) and Pathology (GN) and Center for Tumor Study and Prevention (DP), University of Florence, Florence, Italy
| | - Marco Carini
- From the Departments of Urology (MG, SS, AL, GV, MC) and Pathology (GN) and Center for Tumor Study and Prevention (DP), University of Florence, Florence, Italy
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15
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Minervini A, Di Cristofano C, Gacci M, Serni S, Menicagli M, Lanciotti M, Salinitri G, Rocca CD, Lapini A, Nesi G, Bevilacqua G, Minervini R, Carini M. Prognostic role of histological necrosis for nonmetastatic clear cell renal cell carcinoma: correlation with pathological features and molecular markers. J Urol 2008; 180:1284-9. [PMID: 18707725 DOI: 10.1016/j.juro.2008.06.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE We defined the prognostic role of tumor necrosis and its extent in nonmetastatic clear cell renal cell carcinoma. Also, we further investigated its pathogenesis by correlating this tumor feature with other pathological characteristics and molecular markers related to the von Hippel Lindau-hypoxia inducible factor pathway and to tumor proliferation. MATERIALS AND METHODS A total of 213 patients with nonmetastatic clear cell renal cell carcinoma were evaluated. Mean followup was 66 months. The presence and extent of histological necrosis were correlated with clinicopathological factors, Ki-67 antigen expression calculated by the MIB-1 (Ki-67 antibody) index, pVHL, HIF-1alpha, the tumor infiltrating lymphocyte subset and cancer specific survival. RESULTS Histological necrosis was present in 63.8% of clear cell renal cell carcinoma cases. Necrosis was significantly associated with grade and the degree of tumor infiltrating lymphocytes, while its extent correlated significantly with grade, the degree of tumor infiltrating lymphocytes and stage. Tumor necrosis was a significant prognostic factor, which was confirmed even when limiting analysis to patients with intracapsular renal cell carcinoma. On multivariate analysis histological necrosis was not an independent predictor of cancer specific survival. The extent of tumor necrosis was not a significant prognostic factor. The presence and extent of histological necrosis was not associated with high Ki-67 expression and it did not correlate with pVHL expression or with nuclear and cytoplasmic HIF-1alpha expression. CONCLUSIONS Based on our results we cannot support histological necrosis and its extent as prognostic factors for clear cell renal cell carcinoma. Efforts should be made to develop nomograms that use routinely available and objective predictor variables. The precise mechanism that causes tumor necrosis remains unknown but the host immune response might significantly contribute to its development.
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Affiliation(s)
- Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
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16
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Zini L, Leroy X, Lemaitre L, Devos P, Aubert S, Biserte J, Villers A. Tumour necrosis in chromophobe renal cell carcinoma: Clinical data to distinguish aggressive variants. Eur J Surg Oncol 2008; 34:687-91. [DOI: 10.1016/j.ejso.2007.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 08/31/2007] [Indexed: 11/24/2022] Open
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17
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Sandlund J, Hedberg Y, Bergh A, Grankvist K, Ljungberg B, Rasmuson T. Evaluation of CD31 (PECAM-1) expression using tissue microarray in patients with renal cell carcinoma. Tumour Biol 2007; 28:158-64. [PMID: 17510564 DOI: 10.1159/000102980] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 11/01/2006] [Indexed: 11/19/2022] Open
Abstract
Intratumoural microvessel density (MVD) has prognostic significance in selected neoplasms. To evaluate the prognostic information of MVD in renal cell carcinoma (RCC) we assessed the immunohistochemical expression of CD31 in 208 tumours using the tissue microarray technique. The expression was related to tumour cell type, TNM stage, nuclear grade and survival. CD31 expression was significantly (p < 0.001) higher in 167 conventional RCCs (clear cell) compared to 28 papillary RCCs. In conventional RCC, CD31 expression was inversely correlated to TNM stage (p = 0.024) and nuclear grade (p = 0.010). To evaluate the impact of CD31 expression on tumour-specific survival, the conventional RCC tumours were subdivided into quartiles according to the CD31 expression. In univariate analysis, patients with tumours in the quartile with the highest expression had a more favourable prognosis (p = 0.01) compared to those with lower CD31 expression. A multivariate analysis of prognostic factors in conventional RCC showed that TNM stage and nuclear grade were independent predictors of prognosis, but CD31 expression did not add further prognostic information.
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Affiliation(s)
- Johanna Sandlund
- Division of Oncology, Department of Radiation Sciences, Umeå University, Umeå, Sweden
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18
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Lee SE, Byun SS, Oh JK, Lee SC, Chang IH, Choe G, Hong SK. Significance of Macroscopic Tumor Necrosis as a Prognostic Indicator for Renal Cell Carcinoma. J Urol 2006; 176:1332-7; discussion 1337-8. [PMID: 16952624 DOI: 10.1016/j.juro.2006.06.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE We investigated the prognostic significance of macroscopic tumor necrosis in renal cell carcinoma. MATERIALS AND METHODS We retrospectively analyzed the records of 485 patients who underwent surgical treatment for organ confined or metastatic renal cell carcinoma. The presence or absence of tumor necrosis was evaluated based on macroscopic description of the tumor, and tumors were considered necrotic only if they exhibited more than 10% macroscopic necrosis. RESULTS Macroscopic tumor necrosis was identified in 27% of total patients. Patients with macroscopic necrotic renal cell carcinoma were more likely to have larger tumor, metastatic disease, higher local stage and higher tumor grade (all p < 0.001). Pathological features of microvascular invasion (p = 0.026) and sarcomatoid differentiation (p = 0.002) along with several laboratory findings were also observed to be associated with macroscopic tumor necrosis. Among the total subjects those without macroscopic tumor necrosis had significantly higher progression-free (p < 0.0001) and disease specific survival (p < 0.0001). When survival analysis was limited to nonmetastatic tumors only, the same logic applied, which was not the case for the patients with metastatic disease (p > 0.05). Among the different histological subtypes of renal cell carcinoma, macroscopic tumor necrosis was observed to have a significant impact only for the clear cell subtype. In patients with nonmetastatic RCC multivariate analysis revealed that macroscopic tumor necrosis (p = 0.004) was an independent prognostic predictor of disease specific survival along with pathological T stage, tumor grade and tumor size. CONCLUSIONS Our results suggest that macroscopic tumor necrosis may be a reliable prognostic indicator for nonmetastatic clear cell renal cell carcinoma which should routinely be examined for during pathological analysis.
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Affiliation(s)
- Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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19
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Chang IH, Kim TB, Gil MC, Kim YJ, Hong SK, Byun SS, Choe G, Lee SE. The Clinicopathologic Correlations of Histologic Tumor Necrosis for the Patients with Renal Cell Carcinoma. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.5.449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- In Ho Chang
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
| | - Tae Beom Kim
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
| | - Myung Cheol Gil
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
| | - Yong Jun Kim
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
| | - Sung Kyu Hong
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
| | - Seok Soo Byun
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
| | - Gheeyoung Choe
- Department of Pathology, College of Medicine, Seoul National University, Seoul, Korea
| | - Sang Eun Lee
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
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20
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Han WK, Joo JM, Lee YS, Byun YJ, Rha KH, Hong SJ, Yang SC. Prognostic Influence of Coagulative Tumor Necrosis and the Tumor Location for T1a Renal Cell Carcinoma. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.5.456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Min Joo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Seong Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Joon Byun
- Department of Urology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Jun Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Choul Yang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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21
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Sengupta S, Lohse CM, Leibovich BC, Frank I, Thompson RH, Webster WS, Zincke H, Blute ML, Cheville JC, Kwon ED. Histologic coagulative tumor necrosis as a prognostic indicator of renal cell carcinoma aggressiveness. Cancer 2005; 104:511-20. [PMID: 15973740 DOI: 10.1002/cncr.21206] [Citation(s) in RCA: 203] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prognostic markers for renal cell carcinoma (RCC), such as patient symptoms, tumor stage, tumor size, and tumor grade, are useful for determining appropriate follow-up and selecting patients for adjuvant therapy. Histologic coagulative tumor necrosis, also reported to be a prognostic marker for RCC, has not previously been extensively described or investigated. Hence, the objective of the current study was to characterize tumor necrosis as a prognostic feature of RCC. METHODS The authors of the current study identified 3009 patients treated surgically for RCC between 1970 and 2002 from the Mayo Clinic Nephrectomy Registry (Rochester, MN). Associations of tumor necrosis with clinical, laboratory, and pathologic features were examined with chi-square, Fisher exact test, and Wilcoxon rank-sum tests. Cancer-specific survival was estimated with the Kaplan-Meier method, and associations with outcome were assessed with Cox proportional hazard models. RESULTS Tumor necrosis was present in 690 of 2445 (28%) clear cell, 196 of 421 (47%) papillary, and 28 of 143 (20%) chromophobe RCCs. The risk ratio for death from RCC in patients with necrotic compared with non-necrotic tumors was 5.27 (95% confidence interval [CI]: 4.56-6.09; P < 0.001) for clear cell, 4.20 (CI: 1.65-10.68; P < 0.001) for chromophobe, and 1.49 (CI: 0.81-2.74; P = 0.199) for papillary RCC. The survival difference for clear cell RCC persisted even after multivariate adjustment for tumor stage, size, and grade (risk ratio 1.90; P < 0.001). CONCLUSIONS Histologic coagulative tumor necrosis is an independent predictor of outcome for clear cell and chromophobe RCC, and it should be routinely reported and used in clinical assessment.
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Affiliation(s)
- Shomik Sengupta
- Department of Urology, Mayo Medical School and Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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