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Charkviani M, Gregoire JR. Enhancing Nephrology Education: A 10-Year Experience on Fellow-Led Quality Improvement Projects in a Hemodialysis Unit. Mayo Clin Proc 2024; 99:1342-1345. [PMID: 39097339 DOI: 10.1016/j.mayocp.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/12/2024] [Indexed: 08/05/2024]
Affiliation(s)
| | - James R Gregoire
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
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2
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Zhang H, Andreou A, Bhatt R, Whitworth J, Yngvadottir B, Maher ER. Characteristics, aetiology and implications for management of multiple primary renal tumours: a systematic review. Eur J Hum Genet 2024; 32:887-894. [PMID: 38802529 PMCID: PMC11291654 DOI: 10.1038/s41431-024-01628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/16/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
In a subset of patients with renal tumours, multiple primary lesions may occur. Predisposition to multiple primary renal tumours (MPRT) is a well-recognised feature of some inherited renal cancer syndromes. The diagnosis of MPRT should therefore provoke a thorough assessment for clinical and genetic evidence of disorders associated with predisposition to renal tumourigenesis. To better define the clinical and genetic characteristics of MPRT, a systematic literature review was performed for publications up to 3 April 2024. A total of 7689 patients from 467 articles were identified with MPRT. Compared to all patients with renal cell carcinoma (RCC), patients with MPRT were more likely to be male (71.8% versus 63%) and have an earlier age at diagnosis (<46 years, 32.4% versus 19%). In 61.1% of cases MPRT were synchronous. The proportion of cases with similar histology and the proportion of cases with multiple papillary renal cell carcinoma (RCC) (16.1%) were higher than expected. In total, 14.9% of patients with MPRT had a family history of cancer or were diagnosed with a hereditary RCC associated syndrome with von Hippel-Lindau (VHL) disease being the most common one (69.7%), followed by Birt-Hogg-Dubé (BHD) syndrome (14.2%). Individuals with a known or likely genetic cause were, on average, younger (43.9 years versus 57.1 years). In rare cases intrarenal metastatic RCC can phenocopy MPRT. We review potential genetic causes of MPRT and their implications for management, suggest an approach to genetic testing for individuals presenting with MPRT and considerations in cases in which routine germline genetic testing does not provide a diagnosis.
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Affiliation(s)
- Huairen Zhang
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Avgi Andreou
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Rupesh Bhatt
- Department of Urology, Queen Elizabeth Hospital, Birmingham, B15, UK
| | - James Whitworth
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Bryndis Yngvadottir
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Eamonn R Maher
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK.
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK.
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3
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Pliszka M, Szablewski L. Associations between Diabetes Mellitus and Selected Cancers. Int J Mol Sci 2024; 25:7476. [PMID: 39000583 PMCID: PMC11242587 DOI: 10.3390/ijms25137476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/15/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
Cancer is one of the major causes of mortality and is the second leading cause of death. Diabetes mellitus is a serious and growing problem worldwide, and its prevalence continues to grow; it is the 12th leading cause of death. An association between diabetes mellitus and cancer has been suggested for more than 100 years. Diabetes is a common disease diagnosed among patients with cancer, and evidence indicates that approximately 8-18% of patients with cancer have diabetes, with investigations suggesting an association between diabetes and some particular cancers, increasing the risk for developing cancers such as pancreatic, liver, colon, breast, stomach, and a few others. Breast and colorectal cancers have increased from 20% to 30% and there is a 97% increased risk of intrahepatic cholangiocarcinoma or endometrial cancer. On the other hand, a number of cancers and cancer therapies increase the risk of diabetes mellitus. Complications due to diabetes in patients with cancer may influence the choice of cancer therapy. Unfortunately, the mechanisms of the associations between diabetes mellitus and cancer are still unknown. The aim of this review is to summarize the association of diabetes mellitus with selected cancers and update the evidence on the underlying mechanisms of this association.
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Affiliation(s)
- Monika Pliszka
- Chair and Department of General Biology and Parasitology, Medical University of Warsaw, Chałubińskiego Str. 5, 02-004 Warsaw, Poland
| | - Leszek Szablewski
- Chair and Department of General Biology and Parasitology, Medical University of Warsaw, Chałubińskiego Str. 5, 02-004 Warsaw, Poland
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Cohen SM. Cell proliferation and carcinogenesis: an approach to screening for potential human carcinogens. Front Oncol 2024; 14:1394584. [PMID: 38868530 PMCID: PMC11168196 DOI: 10.3389/fonc.2024.1394584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/22/2024] [Indexed: 06/14/2024] Open
Abstract
Cancer arises from multiple genetic errors occurring in a single stem cell (clonality). Every time DNA replicates, mistakes occur. Thus, agents can increase the risk of cancer either by directly damaging DNA (DNA-reactive carcinogens) or increasing the number of DNA replications (increased cell proliferation). Increased cell proliferation can be achieved either by direct mitogenesis or cytotoxicity with regenerative proliferation. Human carcinogens have a mode of action of DNA reactivity, immunomodulation (mostly immunosuppression), increased estrogenic activity (mitogenesis), or cytotoxicity and regeneration. By focusing on screening for these four effects utilizing in silico, in vitro, and short-term in vivo assays, a biologically based screening for human chemical carcinogens can be accomplished with greater predictivity than the traditional 2-year bioassay with considerably less cost, less time, and the use of fewer animals.
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Affiliation(s)
- Samuel M. Cohen
- Havlik-Wall Professor of Oncology, Department of Pathology, Microbiology, and Immunology and the Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
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5
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Gerard AO, Barbosa S, Parassol N, Andreani M, Merino D, Cremoni M, Laurain A, Pinel S, Bourneau-Martin D, Rocher F, Esnault VLM, Borchiellini D, Sicard A, Drici MD. Risk factors associated with immune checkpoint inhibitor-induced acute kidney injury compared to other immune-related adverse events: a case-control study. Clin Kidney J 2022; 15:1881-1887. [PMID: 36158153 PMCID: PMC9494514 DOI: 10.1093/ckj/sfac109] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Indexed: 11/27/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) foster anti-cancer immune responses. Their efficacy comes at the cost of immune-related adverse events (IRAEs). The latter affects various organs, including kidneys, mostly as acute tubulointerstitial nephritis, the pathophysiology of which remains unclear. We conducted a multicentre case–control study to compare the characteristics of patients with renal IRAEs (ICI-AKI) with those of patients diagnosed with other IRAEs. Methods We queried the French pharmacovigilance database for all adverse events involving ICIs. Reports were classified as ICI-AKI or extrarenal IRAE. For each ICI-AKI report, four reports of extrarenal IRAEs were randomly included (control group, 4:1 ratio). Variables showing an association with a P < 0.05 were included as covariates in a multivariate analysis. Results Therefore, 167 ICI-AKI reports were compared with 668 extrarenal IRAEs. At least one concomitant extrarenal IRAE was mentioned in 44.3% of ICI-AKI reports. Patients with ICI-AKI were significantly older than patients with extrarenal IRAEs (69.1 versus 64.6 years; P = 0.0135), and chronic kidney disease was significantly more prevalent (12.0% versus 3.3%; P = 0.0125). Patients with ICI-AKI were significantly more likely to be treated with fluindione [adjusted odds ratio (OR) 6.53, 95% confidence interval (95% CI) 2.21–19.31; P = 0.0007], a non-steroidal anti-inflammatory drug (NSAID, OR 3.18, 95% CI 1.07–9.4; P = 0.0368) or a proton-pump inhibitor (PPI, OR 2.18, 95% CI 1.42–3.34; P = 0.0004). Conclusion This study is limited by a lack of data, preventing confirmation of numerous reports therefore not included in the analysis. We are unable to draw definite pathophysiological conclusions from our data. Nonetheless, we suggest that ICIs may be a ‘second-hit’ that precipitates acute kidney injury caused by another concomitant drug (fluindione, NSAID or PPI).
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Affiliation(s)
- Alexandre O Gerard
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
- Department of Pharmacology and Pharmacovigilance Centre of Nice, University Hospital Centre of Nice, Nice, France
| | - Susana Barbosa
- Institute of Molecular and Cellular Pharmacology (IPMC), UMR 7275, CNRS, University Côte d'Azur, Valbonne, France
| | - Nadège Parassol
- Department of Pharmacology and Pharmacovigilance Centre of Nice, University Hospital Centre of Nice, Nice, France
| | - Marine Andreani
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
| | - Diane Merino
- Department of Pharmacology and Pharmacovigilance Centre of Nice, University Hospital Centre of Nice, Nice, France
| | - Marion Cremoni
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
| | - Audrey Laurain
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
| | - Sylvine Pinel
- Pharmacovigilance Center of Paris - Fernand Widal, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Fanny Rocher
- Department of Pharmacology and Pharmacovigilance Centre of Nice, University Hospital Centre of Nice, Nice, France
| | - Vincent L M Esnault
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
| | - Delphine Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, University Côte d'Azur, Nice, France
| | - Antoine Sicard
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
- Laboratory of Molecular Physio Medicine (LP2M), UMR 7370, CNRS, University Côte d'Azur, Nice, France
- Clinical Research Unit of University Côte d'Azur (UR2CA), University Côte d'Azur, Nice France
| | - Milou-Daniel Drici
- Department of Pharmacology and Pharmacovigilance Centre of Nice, University Hospital Centre of Nice, Nice, France
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Guo K, Wang Z, Luo R, Cheng Y, Ge S, Xu G. Association between chronic kidney disease and cancer including the mortality of cancer patients: national health and nutrition examination survey 1999-2014. Am J Transl Res 2022; 14:2356-2366. [PMID: 35559400 PMCID: PMC9091102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/18/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This study aimed to investigate the association between chronic kidney disease (CKD) and different types of cancer and the effect of CKD on mortality among types of cancer. METHODS 30559 participants from NHANES 1999-2014 were included in our analysis, which had 2824 participants with cancer. Subgroups were grouped by cancer location. The association of different types of cancer with CKD was assessed using logistic regression models. Kaplan-Meier estimates and Cox proportional hazards models were used to evaluate the correlation between CKD and all-cause mortality in different cancer groups. RESULTS Age, gender, race, education level, income level, hypertension, diabetes, smoking status, alcohol consumption, TG, HDL-C, UA and eGFR were significantly different between the cancer and non-cancer group. The three cancers with highest prevalence of CKD were kidney cancer (72.3%), bladder cancer (54.7%), and colon cancer (43.0%) in this study. The prevalence of CKD was higher in cancer patients compared to non-cancer ones. Only genitourinary cancer showed a positive association with CKD (OR=1.23, 95% CI: 1.05-1.44) after adjusting for confounding factors. However, CKD was an independent risk factor for mortality from cancer regardless of the type of cancer. CONCLUSION CKD is significantly associated only with genitourinary cancer among different types of cancer. CKD is an independent risk factor for survival in cancer patients, regardless of the type of cancer. Monitoring and maintaining the renal function of cancer patients is essential for prolonging their life.
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Affiliation(s)
- Kanglin Guo
- Department of Nephrology, Division of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China
| | - Zufeng Wang
- Department of Nephrology, Division of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China
| | - Ran Luo
- Department of Nephrology, Division of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China
| | - Yichun Cheng
- Department of Nephrology, Division of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China
| | - Shuwang Ge
- Department of Nephrology, Division of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China
| | - Gang Xu
- Department of Nephrology, Division of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China
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White JD, Bosward KL, Norris JM, Malik R, Lindsay SA, Canfield PJ. Renal Crest Proliferative Lesions in Cats with Chronic Kidney Disease. J Comp Pathol 2021; 187:52-62. [PMID: 34503654 DOI: 10.1016/j.jcpa.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/25/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022]
Abstract
In a histopathological study of the renal crest (RC) of kidneys of cats with chronic kidney disease (CKD), 58/90 (64%) had epithelial proliferation. Of these, 33 cats had hyperplasia of the collecting duct (CD) epithelium (CDH) alone, eight had hyperplasia of the urothelium covering the RC (RCUH), of which one had concurrent abaxial renal pelvic urothelial hyperplasia (UH), and eight had both CDH and RCUH. CDH or RCUH were present in five cats with marked dysplasia of the CD epithelium (CDD) and four cats with invasive carcinomas, which also had epithelial dysplasia. All nine cats with marked dysplasia or neoplasia of the RC also had substantially altered RC contours due to focal haemorrhage, papillary necrosis or fibrosis. Three of the carcinomas had a strong desmoplastic response. In control cats, both urothelial (RC and renal pelvis) and tubular (CD and distal tubular) cells were immunopositive for cytokeratin (CK; AE1/AE3), tubular epithelial cells were positive for vimentin (Vim) and aquaporin 2 (Aq2), while urothelial cells were positive for p63. PAX8 immunolabelling was difficult to validate. CD and UH labelling was similar to control tissue. While urothelial dysplasia had the same immunolabelling pattern as UH and control tissue, CDD was generally immunonegative for Aq2. As immunolabelling of the four carcinomas did not distinguish between tubular and urothelial origin, with three positive for both Vim and p63, all were broadly designated as RC carcinomas. Overall, proliferative epithelial lesions are common in cats with CKD and form a continuum from simple hyperplasia to neoplasia of the urothelium or CD of the RC.
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Affiliation(s)
- Joanna D White
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia.
| | - Katrina L Bosward
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
| | - Jacqueline M Norris
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Malik
- Centre for Veterinary Education, Veterinary Science Conference Centre B22, University of Sydney, Sydney, New South Wales, Australia
| | - Scott A Lindsay
- School of Animal and Veterinary Sciences, Faculty of Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Paul J Canfield
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
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8
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Abstract
As early detection and advances in the treatment for renal cell carcinoma continue to lead to excellent oncologic outcomes, the preservation of renal function in kidney cancer patients has emerged as an increasingly important clinical objective. Given that diabetes, hypertension, obesity, cigarette smoking, and aging are independent risk factors for renal cell carcinoma, the corresponding non-neoplastic kidney diseases frequently are present, but often undiagnosed. In addition, the subsequent clinical management of the ensuing chronic kidney disease historically has not included nephrologists. Awareness of these practice gaps remain low among nephrologists, surgeons, and pathologists. This article discusses the common non-neoplastic kidney diseases that are encountered in cancer nephrectomy specimens. The accurate and timely diagnosis of these disorders will result in additional gains in clinical outcomes. There is a unique opportunity for the nephrology community to play a central role in the management of chronic kidney disease that often is present in kidney cancer patients.
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Affiliation(s)
- Kammi J Henriksen
- Department of Pathology, University of Chicago Medicine, Chicago, IL
| | - Anthony Chang
- Department of Pathology, University of Chicago Medicine, Chicago, IL.
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Huang Y, Wang J, Jiang K, Chung EJ. Improving kidney targeting: The influence of nanoparticle physicochemical properties on kidney interactions. J Control Release 2021; 334:127-137. [PMID: 33892054 DOI: 10.1016/j.jconrel.2021.04.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/23/2022]
Abstract
Kidney-targeted nanoparticles have become of recent interest due to their potential to deliver drugs directly to diseased tissue, decrease off-target adverse effects, and increase overall tolerability to patients with chronic kidney disease that require lifelong drug exposure. Given the physicochemical properties of nanoparticles can drastically affect their ability to extravasate past cellular and biological barriers and access the kidneys, we surveyed the literature from the past decade and analyzed how nanoparticle size, charge, shape, and material density affects passage and interaction with the kidneys. Specifically, we found that nanoparticle size impacted the mechanism of nanoparticle entry into the kidneys such as glomerular filtration or tubular secretion. In addition, we found charge, aspect ratio, and material density influences nanoparticle renal retention and provide insights for designing nanoparticles for passive kidney targeting. Finally, we conclude by highlighting active targeting strategies that bolster kidney retention and discuss the clinical status of nanomedicine for kidney diseases.
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Affiliation(s)
- Yi Huang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Jonathan Wang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Kairui Jiang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Eun Ji Chung
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA; Department of Chemical Engineering and Materials Science, University of Southern California, Los Angeles, CA, USA; Department of Medicine, Division of Nephrology and Hypertension, University of Southern California, Los Angeles, CA, USA; Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA, USA.
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10
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Chen Y, Zelnick LR, Huber MP, Wang K, Bansal N, Hoofnagle AN, Paranji RK, Heckbert SR, Weiss NS, Go AS, Hsu CY, Feldman HI, Waikar SS, Mehta RC, Srivastava A, Seliger SL, Lash JP, Porter AC, Raj DS, Kestenbaum BR. Association Between Kidney Clearance of Secretory Solutes and Cardiovascular Events: The Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2021; 78:226-235.e1. [PMID: 33421453 PMCID: PMC8260620 DOI: 10.1053/j.ajkd.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/11/2020] [Indexed: 01/11/2023]
Abstract
RATIONALE & OBJECTIVE The clearance of protein-bound solutes by the proximal tubules is an innate kidney mechanism for removing putative uremic toxins that could exert cardiovascular toxicity in humans. However, potential associations between impaired kidney clearances of secretory solutes and cardiovascular events among patients with chronic kidney disease (CKD) remains uncertain. STUDY DESIGN A multicenter, prospective, cohort study. SETTING & PARTICIPANTS We evaluated 3,407 participants from the Chronic Renal Insufficiency Cohort (CRIC) study. EXPOSURES Baseline kidney clearances of 8 secretory solutes. We measured concentrations of secretory solutes in plasma and paired 24-hour urine specimens using liquid chromatography-tandem mass spectrometry (LC-MS/MS). OUTCOMES Incident heart failure, myocardial infarction, and stroke events. ANALYTICAL APPROACH We used Cox regression to evaluate associations of baseline secretory solute clearances with incident study outcomes adjusting for estimated GFR (eGFR) and other confounders. RESULTS Participants had a mean age of 56 years; 45% were women; 41% were Black; and the median estimated glomerular filtration rate (eGFR) was 43 mL/min/1.73 m2. Lower 24-hour kidney clearance of secretory solutes were associated with incident heart failure and myocardial infarction but not incident stroke over long-term follow-up after controlling for demographics and traditional risk factors. However, these associations were attenuated and not statistically significant after adjustment for eGFR. LIMITATIONS Exclusion of patients with severely reduced eGFR at baseline; measurement variability in secretory solutes clearances. CONCLUSIONS In a national cohort study of CKD, no clinically or statistically relevant associations were observed between the kidney clearances of endogenous secretory solutes and incident heart failure, myocardial infarction, or stroke after adjustment for eGFR. These findings suggest that tubular secretory clearance provides little additional information about the development of cardiovascular disease events beyond glomerular measures of GFR and albuminuria among patients with mild-to-moderate CKD.
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Affiliation(s)
- Yan Chen
- Department of Epidemiology, University of Washington, Seattle, WA; Kidney Research Institute, Seattle, WA
| | - Leila R Zelnick
- Kidney Research Institute, Seattle, WA; Department of Medicine, Division of Nephrology, University of Washington, Seattle, WA
| | - Matthew P Huber
- Department of Medicine, University of Washington, Seattle, WA
| | - Ke Wang
- Kidney Research Institute, Seattle, WA; Department of Medicine, Division of Nephrology, University of Washington, Seattle, WA
| | - Nisha Bansal
- Kidney Research Institute, Seattle, WA; Department of Medicine, Division of Nephrology, University of Washington, Seattle, WA
| | - Andrew N Hoofnagle
- Kidney Research Institute, Seattle, WA; Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Rajan K Paranji
- Department of Chemistry, University of Washington, Seattle, WA
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Noel S Weiss
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Chi-Yuan Hsu
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA
| | - Harold I Feldman
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | | | - Rupal C Mehta
- Department of Medicine, Division of Nephrology and Hypertension, Northwestern University, Chicago, IL
| | - Anand Srivastava
- Department of Medicine, Division of Nephrology and Hypertension, Northwestern University, Chicago, IL
| | - Stephen L Seliger
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD
| | - James P Lash
- Department of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, IL
| | - Anna C Porter
- Department of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, IL
| | - Dominic S Raj
- Department of Medicine, Division of Kidney Disease and Hypertension, George Washington University, Washington, DC
| | - Bryan R Kestenbaum
- Kidney Research Institute, Seattle, WA; Department of Medicine, Division of Nephrology, University of Washington, Seattle, WA.
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Hua ST, Garzotto M. EDITORIAL COMMENT. Urology 2020; 145:157. [DOI: 10.1016/j.urology.2020.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022]
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12
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Higgins MI, Martini DJ, Patil DH, Steele S, Evans S, Petrinec BP, Psutka SP, Sekhar A, Bilen MA, Master VA. Quantification of body composition in renal cell carcinoma patients: Comparing computed tomography and magnetic resonance imaging measurements. Eur J Radiol 2020; 132:109307. [PMID: 33010681 DOI: 10.1016/j.ejrad.2020.109307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Body composition measures provide valuable information for prognostication and treatment election in cancer patients. We investigated the novel use of magnetic resonance imaging (MRI) for skeletal muscle and adipose tissue cross-sectional area measurements in preoperative renal cell carcinoma (RCC) patients. MATERIALS AND METHODS RCC patients with pre-operative CT and MRI abdominal imaging were identified. Semi-automatic segmentation measurement of skeletal muscle area (SMA), intramuscular fat area (IMFA), visceral fat area (VFA), subcutaneous fat area (SFA), linear measurements of psoas, paraspinal muscles were performed. Pearson correlation coefficients, Bland-Altman plot analyses were done. Multivariable regression analysis examined the relationship between patient characteristics and skeletal muscle. RESULTS Image analysis was performed on 58 RCC patients with preoperative CT and MRI imaging. For segmentation measures, r = 0.99, 0.99, 0.99, and 0.98 for SMA, IMFA, VFA, SFA, respectively, and 0.96 for linear measures of skeletal muscle. Bland-Altman analysis revealed a bias toward larger CT value for SMA (1.35 %), linear muscle measures (2.79 %), and SFA (10.34 %), and toward larger MRI values for IMFA (0.75 %) and VFA (5.81 %). ECOG ≥ 1 was associated with lower skeletal muscle than ECOG 0 for all measurements. CONCLUSIONS Strong correlation of CT and MRI cross sectional measurements of skeletal muscle and adipose tissues supports the use of axial MRI images for comprehensive measurement of body composition. This has widespread implications for body composition research and cancer patient care.
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Affiliation(s)
- Michelle I Higgins
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Dylan J Martini
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States; Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Dattatraya H Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Sean Steele
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Sean Evans
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Benjamin P Petrinec
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, United States
| | - Aarti Sekhar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States; Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States.
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Wang S, Li J, Zhu D, Hua T, Zhao B. Contrast-enhanced magnetic resonance (MR) T1 mapping with low-dose gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) is promising in identifying clear cell renal cell carcinoma histopathological grade and differentiating fat-poor angiomyolipoma. Quant Imaging Med Surg 2020; 10:988-998. [PMID: 32489923 DOI: 10.21037/qims-19-723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background This study aimed to identify clear cell renal cell carcinoma (ccRCC) histopathological grade and differentiate it from fat-poor angiomyolipoma (AML). This was achieved through contrast-enhanced magnetic resonance (MR) T1 mapping with intravenous low-dose gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). Methods In total, 56 consecutive patients received MR scanning between January 2016 and December 2018 using the pre- and post- contrast-enhanced T1 mapping sequences with low-dose Gd-DTPA (0.036 mmol/kg). RCCs were pathologically proven in 40 patients after surgery and graded according to the International Society of Urological Pathology (ISUP) classification system. Ten AMLs were pathologically proven by surgery histopathology and six AMLs were diagnosed by magnetic resonance imaging (MRI). Patients were followed up for more than half a year. The mean T1 values of the renal lesion and ipsilateral normal renal parenchyma were measured before and after Gd-DTPA administration (T1p and T1e). The reduction of T1 value (T1d) and the ratio of its reduction (T1d %) were calculated and compared. Results In 40 ccRCCs, higher-grade [International Society of Urologic Pathology (ISUP) grade 3 and 4] and lower-grade (ISUP grade 1 and 2) ccRCCs were noted in 13 and 27 patients, respectively. The mean T1p was 1,514.8±139.4 ms and the mean T1d was 907.7±193.7 ms in the higher-grade ccRCCs, which were significantly higher than in the lower-grade ccRCCs (T1p =1,251.7±151.5 ms and T1d =648.5±218.2 ms, respectively; P<0.001). Fat-poor AMLs had higher T1p (1,677.3±104.8 ms) and T1e (865.6±251.5 ms) as compared to ccRCCs (P<0.001). Combined T1p + T1d showed the highest area under the curve (AUC) (0.912) in the differentiation of higher-grade ccRCCs from lower-grade ccRCCs (P=0.010). Combined T1p + T1e had the highest AUC (0.956) in the differentiation between ccRCCs and fat-poor AMLs (P=0.010). All T1 mapping metrics could discriminate between normal renal parenchyma and renal lesions (P<0.001). No significant difference was found in the T1p and T1e at different parts of the ipsilateral normal renal parenchyma. Interobserver agreement for quantitative longitudinal relaxation time in the T1 maps was excellent. Conclusions Contrast-enhanced T1 mapping with low-dose Gd-DTPA may provide a more reliable and accurate approach in identifying ccRCCs histopathological grade and differentiating ccRCCs from fat-poor AMLs.
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Affiliation(s)
- Shuai Wang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Junheng Li
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Diru Zhu
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Ting Hua
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Binghui Zhao
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
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Chang EH, Tan HJ, Nielsen M. Management of small renal masses in patients with chronic kidney disease: Perspectives from a nephrologist. Urol Oncol 2019; 38:533-536. [PMID: 31889616 DOI: 10.1016/j.urolonc.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/04/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Emily H Chang
- Division of Nephrology, UNC Kidney Center, Chapel Hill, NC.
| | - Hung-Jui Tan
- Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew Nielsen
- Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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15
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Hsu T, Nguyen-Tran HH, Trojanowska M. Active roles of dysfunctional vascular endothelium in fibrosis and cancer. J Biomed Sci 2019; 26:86. [PMID: 31656195 PMCID: PMC6816223 DOI: 10.1186/s12929-019-0580-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/09/2019] [Indexed: 12/15/2022] Open
Abstract
Chronic inflammation is the underlying pathological condition that results in fibrotic diseases. More recently, many forms of cancer have also been linked to chronic tissue inflammation. While stromal immune cells and myofibroblasts have been recognized as major contributors of cytokines and growth factors that foster the formation of fibrotic tissue, the endothelium has traditionally been regarded as a passive player in the pathogenic process, or even as a barrier since it provides a physical divide between the circulating immune cells and the inflamed tissues. Recent findings, however, have indicated that endothelial cells in fact play a crucial role in the inflammatory response. Endothelial cells can be activated by cytokine signaling and express inflammatory markers, which can sustain or exacerbate the inflammatory process. For example, the activated endothelium can recruit and activate leukocytes, thus perpetuating tissue inflammation, while sustained stimulation of endothelial cells may lead to endothelial-to-mesenchymal transition that contributes to fibrosis. Since chronic inflammation has now been recognized as a significant contributing factor to tumorigenesis, it has also emerged that activation of endothelium also occurs in the tumor microenvironment. This review summarizes recent findings characterizing the molecular and cellular changes in the vascular endothelium that contribute to tissue fibrosis, and potentially to cancer formation.
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Affiliation(s)
- Tien Hsu
- Department of Biomedical Sciences and Engineering, National Central University, 300 Jhongda Rd, Taoyuan City, Taiwan, Republic of China. .,Center for Chronic Disease Research, National Central University, 300 Jhongda Rd, Taoyuan City, Taiwan, Republic of China.
| | - Hieu-Huy Nguyen-Tran
- Department of Biomedical Sciences and Engineering, National Central University, 300 Jhongda Rd, Taoyuan City, Taiwan, Republic of China
| | - Maria Trojanowska
- Arthritis Center, Boston University School of Medicine, 75 E. Newton St. Evans Building, Boston, MA, 02118, USA
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16
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Friend BD, Wolfe Schneider K, Garrington T, Truscott L, Martinez-Agosto JA, Venick RS, Tsai Chambers E, Weng P, Farmer DG, Chang VY, Federman N. Is polycystic kidney disease associated with malignancy in children? Mol Genet Genomic Med 2019; 7:e00725. [PMID: 31197971 PMCID: PMC6625336 DOI: 10.1002/mgg3.725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/18/2019] [Accepted: 04/08/2019] [Indexed: 01/16/2023] Open
Abstract
Background Polycystic kidney disease (PKD) is an inherited condition characterized by progressive development of end‐stage renal disease, hypertension, hepatic fibrosis, and cysts in the kidney, liver, pancreas, spleen, thyroid, and epididymis. While malignancies have been reported in association with PKD in adults, the incidence of malignancies in children with PKD is not currently known. Methods We report on five patients with a known history of PKD who developed a malignancy as children at the University of California, Los Angeles and the University of Colorado Anschutz Medical Campus. Patients were included from 2012 to 2017. Results We present five patients with a history of PKD diagnosed with a malignancy during childhood without any additional known mutations to suggest a genetic predisposition to develop cancer. This includes the first reported case of hepatocellular carcinoma in a patient with autosomal recessive polycystic kidney disease. Conclusion Our report illustrates the potential that PKD may be associated with an increased risk for developing cancer, even in children. Further research is necessary to better understand this relationship.
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Affiliation(s)
- Brian D Friend
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California
| | - Kami Wolfe Schneider
- Section of Hematology, Oncology, and Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
| | - Timothy Garrington
- Section of Hematology, Oncology, and Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
| | - Laurel Truscott
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Julian A Martinez-Agosto
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,Department of Human Genetics, UCLA David Geffen School of Medicine, Los Angeles, California.,UCLA Clinical Genomics Center, Los Angeles, California
| | - Robert S Venick
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Eileen Tsai Chambers
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,Division of Pediatric Nephrology, Department of Pediatrics, Duke University, Durham, North Carolina
| | - Patricia Weng
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Douglas G Farmer
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Vivian Y Chang
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,UCLA's Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Noah Federman
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,UCLA's Jonsson Comprehensive Cancer Center, Los Angeles, California.,Department of Orthopaedics, UCLA David Geffen School of Medicine, Los Angeles, California
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17
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Yim K, Bindayi A, McKay R, Mehrazin R, Raheem OA, Field C, Bloch A, Wake R, Ryan S, Patterson A, Derweesh IH. Rising Serum Uric Acid Level Is Negatively Associated with Survival in Renal Cell Carcinoma. Cancers (Basel) 2019; 11:cancers11040536. [PMID: 30991671 PMCID: PMC6520981 DOI: 10.3390/cancers11040536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 12/31/2022] Open
Abstract
Aim and Background: To investigate the association of serum uric acid (SUA) levels along with statin use in Renal Cell Carcinoma (RCC), as statins may be associated with improved outcomes in RCC and SUA elevation is associated with increased risk of chronic kidney disease (CKD). Methods: Retrospective study of patients undergoing surgery for RCC with preoperative/postoperative SUA levels between 8/2005–8/2018. Analysis was carried out between patients with increased postoperative SUA vs. patients with decreased/stable postoperative SUA. Kaplan-Meier analysis (KMA) calculated overall survival (OS) and recurrence free survival (RFS). Multivariable analysis (MVA) was performed to identify factors associated with increased SUA levels and all-cause mortality. The prognostic significance of variables for OS and RFS was analyzed by cox regression analysis. Results: Decreased/stable SUA levels were noted in 675 (74.6%) and increased SUA levels were noted in 230 (25.4%). A higher proportion of patients with decreased/stable SUA levels took statins (27.9% vs. 18.3%, p = 0.0039). KMA demonstrated improved 5- and 10-year OS (89% vs. 47% and 65% vs. 9%, p < 0.001) and RFS (94% vs. 45% and 93% vs. 34%, p < 0.001), favoring patients with decreased/stable SUA levels. MVA revealed that statin use (Odds ratio (OR) 0.106, p < 0.001), dyslipidemia (OR 2.661, p = 0.004), stage III and IV disease compared to stage I (OR 1.887, p = 0.015 and 10.779, p < 0.001, respectively), and postoperative de novo CKD stage III (OR 5.952, p < 0.001) were predictors for increased postoperative SUA levels. MVA for all-cause mortality showed that increasing BMI (OR 1.085, p = 0.002), increasing ASA score (OR 1.578, p = 0.014), increased SUA levels (OR 4.698, p < 0.001), stage IV disease compared to stage I (OR 7.702, p < 0.001), radical nephrectomy (RN) compared to partial nephrectomy (PN) (OR 1.620, p = 0.019), and de novo CKD stage III (OR 7.068, p < 0.001) were significant factors. Cox proportional hazard analysis for OS revealed that increasing age (HR 1.017, p = 0.004), increasing BMI (Hazard Ratio (HR) 1.099, p < 0.001), increasing SUA (HR 4.708, p < 0.001), stage III and IV compared to stage I (HR 1.537, p = 0.013 and 3.299, p < 0.001), RN vs. PN (HR 1.497, p = 0.029), and de novo CKD stage III (HR 1.684, p < 0.001) were significant factors. Cox proportional hazard analysis for RFS demonstrated that increasing ASA score (HR 1.239, p < 0.001, increasing SUA (HR 9.782, p < 0.001), and stage II, III, and IV disease compared to stage I (HR 2.497, p < 0.001 and 3.195, p < 0.001 and 6.911, p < 0.001) were significant factors. Conclusions: Increasing SUA was associated with poorer outcomes. Decreased SUA levels were associated with statin intake and lower stage disease as well as lack of progression to CKD and anemia. Further investigation is requisite.
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Affiliation(s)
- Kendrick Yim
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Ahmet Bindayi
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Rana McKay
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Reza Mehrazin
- Department of Urology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA.
| | - Omer A Raheem
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Charles Field
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Aaron Bloch
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Robert Wake
- Department of Urology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA.
| | - Stephen Ryan
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Anthony Patterson
- Department of Urology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA.
| | - Ithaar H Derweesh
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
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18
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Russo P. Editorial Comment. Urology 2019; 126:139. [PMID: 30929687 DOI: 10.1016/j.urology.2018.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Paul Russo
- Memorial Sloan Kettering Cancer Center, Weill Cornell School of Medicine, New York, NY
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19
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Vartolomei MD, Matei DV, Renne G, Tringali VM, Crișan N, Musi G, Mistretta FA, Russo A, Conti A, Cozzi G, Luzzago S, Catellani M, Cioffi A, Cordima G, Bianchi R, Di Trapani E, Serino A, Delor M, Bianco R, Bottero D, Ferro M, De Cobelli O. Long-term oncologic and functional outcomes after robot-assisted partial nephrectomy in elderly patients. MINERVA UROL NEFROL 2019; 71:31-37. [DOI: 10.23736/s0393-2249.18.03006-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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Native T1 Mapping as an In Vivo Biomarker for the Identification of Higher-Grade Renal Cell Carcinoma. Invest Radiol 2019; 54:118-128. [DOI: 10.1097/rli.0000000000000515] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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21
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Pan HC, Sun CY, Wu IW, Tsai TL, Sun CC, Lee CC. Higher risk of malignant neoplasms in young adults with end-stage renal disease receiving haemodialysis: A nationwide population-based study. Nephrology (Carlton) 2018; 24:1165-1171. [PMID: 30584693 PMCID: PMC6849784 DOI: 10.1111/nep.13555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2018] [Indexed: 12/22/2022]
Abstract
Aim Previous investigations have shown that end‐stage renal disease (ESRD) is associated with an increased risk of malignancies. The aim of this study was to explore the association between ESRD in patients undergoing maintenance haemodialysis (HD) and the incidence of malignancies according to age. Methods We analysed a nationwide cohort retrieved from Taiwan's National Health Insurance Research Database to study the incidence of malignancies in patients who were and were not receiving HD. One million beneficiaries were randomly selected and followed from 2005 to 2013. Of these 1 000 000 patients, 3055 developed ESRD and commenced maintenance HD during this period. For each HD patient, four age‐, gender‐ and diabetes‐matched controls were selected from the database (n = 12 220). We further stratified the patients according to age. The study endpoint was the occurrence of malignancy. Results The incidence rates of malignancy were 6.8% and 4.9% in the HD and control groups, respectively. Competing risk regression analysis indicated that age, HD, male gender and diabetes were associated with an increased risk of malignancy. When further stratified according to age, the odds ratios of developing cancer were 5.8, 1.9, 1.9 and 1.5 among the HD patients aged <40 years, 40–49 years, 50–59 years and 60–69 years, respectively. Conclusion The patients with ESRD who received HD had a significantly higher cumulative risk of malignancy, especially those with a young age. Therefore, specialized cancer screening protocols for young HD patients might help to prolong their lifespan. End‐stage kidney disease is associated with an increased risk of many malignancies. This epidemiological study from Taiwan reviews the incidence rates of malignancies in a large haemodialysis cohort compared to a control group, revealing a higher cumulative risk of malignancies especially in those of a young age on dialysis.
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Affiliation(s)
- Heng-Chih Pan
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Chiao-Yin Sun
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taipei, Taiwan
| | - I-Wen Wu
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Tien-Ling Tsai
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chi-Chin Sun
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taipei, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chin-Chan Lee
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taipei, Taiwan
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22
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Gabelova A, Kozics K, Kapka-Skrzypczak L, Kruszewski M, Sramkova M. Nephrotoxicity: Topical issue. Mutat Res 2018; 845:402988. [PMID: 31561894 DOI: 10.1016/j.mrgentox.2018.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 12/12/2022]
Abstract
Drug-induced kidney injury is one of the most significant adverse events and dose limiting factor in chemotherapy as well a major cause of prospective drug attrition during pharmaceutical development. Moreover, kidney injury can also occur as a consequence of exposures to environmental xenobiotics such as heavy metals, fungal toxins and nanomaterials. The lack of adequate in vitro human kidney models that mimic more realistically the in vivo conditions and the absence of suitable and robust, cost-effective and predictive cell-based in vitro assays contribute to an underestimation of the kidney toxic potential of new drugs and xenobiotics. Therefore, a rapid screening system capable to detect potential nephrotoxicity at early stages of drug discovery is an urgent need. Here we provide an overview of human cell lines currently used as a surrogate in vitro kidney models in nephrotoxicity studies, including their advantages and limitations. In addition, the capacity of the single cell gel electrophoresis (SCGE)/comet assay as a potential tool in kidney toxicants screening is discussed. Despite a limited number of studies using the comet assay to evaluate the drug-induced kidney damage potential, a considerable variability in SCGE methodology (e.g. lysis, unwinding, and electrophoresis conditions) has been observed. Before the comet assay can be included in nephrotoxicity testing, a basic guideline has to be developed. To test its feasibility, additional in vitro experiments including inter-laboratory validation studies based on this guideline have to be performed.
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Affiliation(s)
- Alena Gabelova
- Cancer Research Institute, Biomedical Research Center SAS, Dubravska cesta 9, 845 05 Bratislava, Slovakia.
| | - Katarina Kozics
- Cancer Research Institute, Biomedical Research Center SAS, Dubravska cesta 9, 845 05 Bratislava, Slovakia
| | - Lucyna Kapka-Skrzypczak
- Department of Molecular Biology and Translational Research, Institute of Rural Health, Jaczewskiego 2, 20-090 Lublin, Poland; Department of Medical Biology and Translational Research, Faculty of Medicine, University of Information Technology and Management, Sucharskiego 2, 35-225, Rzeszów, Poland
| | - Marcin Kruszewski
- Department of Molecular Biology and Translational Research, Institute of Rural Health, Jaczewskiego 2, 20-090 Lublin, Poland; Department of Medical Biology and Translational Research, Faculty of Medicine, University of Information Technology and Management, Sucharskiego 2, 35-225, Rzeszów, Poland; Centre for Radiobiology and Biological Dosimetry, Institute of Nuclear Chemistry and Technology, Dorodna 16, 03-195, Warsaw, Poland
| | - Monika Sramkova
- Cancer Research Institute, Biomedical Research Center SAS, Dubravska cesta 9, 845 05 Bratislava, Slovakia
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Inflammation-Related Mechanisms in Chronic Kidney Disease Prediction, Progression, and Outcome. J Immunol Res 2018; 2018:2180373. [PMID: 30271792 PMCID: PMC6146775 DOI: 10.1155/2018/2180373] [Citation(s) in RCA: 324] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/08/2018] [Indexed: 12/13/2022] Open
Abstract
Persistent, low-grade inflammation is now considered a hallmark feature of chronic kidney disease (CKD), being involved in the development of all-cause mortality of these patients. Although substantial improvements have been made in clinical care, CKD remains a major public health burden, affecting 10–15% of the population, and its prevalence is constantly growing. Due to its insidious nature, CKD is rarely diagnosed in early stages, and once developed, its progression is unfortunately irreversible. There are many factors that contribute to the setting of the inflammatory status in CKD, including increased production of proinflammatory cytokines, oxidative stress and acidosis, chronic and recurrent infections, altered metabolism of adipose tissue, and last but not least, gut microbiota dysbiosis, an underestimated source of microinflammation. In this scenario, a huge step forward was made by the increasing progression of omics approaches, specially designed for identification of biomarkers useful for early diagnostic and follow-up. Recent omics advances could provide novel insights in deciphering the disease pathophysiology; thus, identification of circulating biomarker panels using state-of-the-art proteomic technologies could improve CKD early diagnosis, monitoring, and prognostics. This review aims to summarize the recent knowledge regarding the relationship between inflammation and CKD, highlighting the current proteomic approaches, as well as the inflammasomes and gut microbiota dysbiosis involvement in the setting of CKD, culminating with the troubling bidirectional connection between CKD and renal malignancy, raised on the background of an inflammatory condition.
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24
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Maxim LD, Utell MJ. Review of refractory ceramic fiber (RCF) toxicity, epidemiology and occupational exposure. Inhal Toxicol 2018; 30:49-71. [PMID: 29564943 DOI: 10.1080/08958378.2018.1448019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This literature review on refractory ceramic fibers (RCF) summarizes relevant information on manufacturing, processing, applications, occupational exposure, toxicology and epidemiology studies. Rodent toxicology studies conducted in the 1980s showed that RCF caused fibrosis, lung cancer and mesothelioma. Interpretation of these studies was difficult for various reasons (e.g. overload in chronic inhalation bioassays), but spurred the development of a comprehensive product stewardship program under EPA and later OSHA oversight. Epidemiology studies (both morbidity and mortality) were undertaken to learn more about possible health effects resulting from occupational exposure. No chronic animal bioassay studies on RCF have been conducted since the 1980s. The results of the ongoing epidemiology studies confirm that occupational exposure to RCF is associated with the development of pleural plaques and minor decrements in lung function, but no interstitial fibrosis or incremental lung cancer. Evidence supporting a finding that urinary tumors are associated with RCF exposure remains, but is weaker. One reported, but unconfirmed, mesothelioma was found in an individual with prior occupational asbestos exposure. An elevated SMR for leukemia was found, but was absent in the highly exposed group and has not been observed in studies of other mineral fibers. The industry will continue the product stewardship program including the mortality study.
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Affiliation(s)
- L Daniel Maxim
- a Everest Consulting Associates , West Windsor , NJ , USA
| | - Mark J Utell
- b University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
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Peng D, He ZS, Li XS, Tang Q, Zhang L, Yang KW, Yu XT, Zhang CJ, Zhou LQ. Partial nephrectomy for T3aN0M0 renal cell carcinoma: shall we step forward? Int Braz J Urol 2017; 43:849-856. [PMID: 28792193 PMCID: PMC5678515 DOI: 10.1590/s1677-5538.ibju.2016.0598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 05/16/2017] [Indexed: 12/26/2022] Open
Abstract
Objectives: To evaluate the prognosis of non-metastatic T3a renal cell carcinoma (RCC) with partial nephrectomy (PN). Patients and Methods: We retrospectively evaluated 125 patients with non-metastatic T3a RCC. Patients undergoing PN and radical nephrectomy (RN) were strictly matched by clinic-pathologic characteristics. Log-rank test and Cox regression model were used for univariate and multivariate analysis. Results: 18 pair patients were matched and the median follow-up was 35.5 (10-86) months. PN patients had a higher postoperative eGFR than RN patients (P=0.034). Cancer-specific survival (CSS) and recurrence-free survival (RFS) did not differ between two groups (P=0.305 and P=0.524). On multivariate analysis, CSS decreased with positive surgical margin and anemia (both P <0.01) and RFS decreased with Furhman grade, positive surgical margin, and anemia (all P<0.01). Conclusions: For patients with non-metastatic pT3a RCC, PN may be a possible option for similar oncology outcomes and better renal function.
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Affiliation(s)
- Ding Peng
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Zhi-Song He
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Xue-Song Li
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Qi Tang
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Lei Zhang
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Kai-Wei Yang
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Xiao-Teng Yu
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Cui-Jian Zhang
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Li-Qun Zhou
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
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Bindayi A, Hamilton ZA, McDonald ML, Yim K, Millard F, McKay RR, Campbell SC, Rini BI, Derweesh IH. Neoadjuvant therapy for localized and locally advanced renal cell carcinoma. Urol Oncol 2017; 36:31-37. [PMID: 28802883 DOI: 10.1016/j.urolonc.2017.07.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/28/2017] [Accepted: 07/16/2017] [Indexed: 12/28/2022]
Abstract
Neoadjuvant Targeted Molecular Therapy in the setting of localized and locally advanced renal cell carcinoma has emerged as a strategy to render primary renal tumors amenable to planned surgical resection in settings where radical resection or nephron-sparing surgery was not thought to be safe or feasible. Presurgical tumor reduction has been demonstrated in a number of studies including a recently published randomized double-blind placebo-controlled study, and an expanding body of literature suggests benefit in select patients. Nonetheless, most reports are small phase II clinical trials or retrospective reports. Thus, large randomized clinical trial data are not present to support this approach, and guidelines for use of presurgical therapy have not been promulgated. The advent of immunomodulation through checkpoint inhibition represents an exciting horizon for neoadjuvant strategies. This article reviews the current status and future prospects of neoadjuvant therapy in nonmetastatic renal cell carcinoma.
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Affiliation(s)
- Ahmet Bindayi
- Department of Urology, Moores UCSD Cancer Center, University of California San Diego School of Medicine, La Jolla, CA
| | - Zachary A Hamilton
- Department of Urology, Moores UCSD Cancer Center, University of California San Diego School of Medicine, La Jolla, CA
| | - Michelle L McDonald
- Department of Urology, Moores UCSD Cancer Center, University of California San Diego School of Medicine, La Jolla, CA
| | - Kendrick Yim
- Department of Urology, Moores UCSD Cancer Center, University of California San Diego School of Medicine, La Jolla, CA
| | - Frederick Millard
- Department of Internal Medicine, Moores UCSD Cancer Center, University of California San Diego School of Medicine, La Jolla, CA
| | - Rana R McKay
- Department of Internal Medicine, Moores UCSD Cancer Center, University of California San Diego School of Medicine, La Jolla, CA
| | - Steven C Campbell
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH
| | - Brian I Rini
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Center, Lerner College of Medicine, Cleveland, OH
| | - Ithaar H Derweesh
- Department of Urology, Moores UCSD Cancer Center, University of California San Diego School of Medicine, La Jolla, CA.
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Karami S, Yanik EL, Moore LE, Pfeiffer RM, Copeland G, Gonsalves L, Hernandez B, Lynch CF, Pawlish K, Engels EA. Risk of Renal Cell Carcinoma Among Kidney Transplant Recipients in the United States. Am J Transplant 2016; 16:3479-3489. [PMID: 27160653 PMCID: PMC5104677 DOI: 10.1111/ajt.13862] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/24/2016] [Accepted: 04/28/2016] [Indexed: 01/25/2023]
Abstract
Renal cell carcinoma (RCC) is a common malignancy following kidney transplantation. We describe RCC risk and examine RCC risk factors among US kidney recipients (1987-2010). The Transplant Cancer Match Study links the US transplant registry with 15 cancer registries. Standardized incidence ratios (SIRs) were used to compare RCC risk (overall and for clear cell [ccRCC] and papillary subtypes) to the general population. Associations with risk factors were assessed using Cox models. We identified 683 RCCs among 116 208 kidney recipients. RCC risk was substantially elevated compared with the general population (SIR 5.68, 95% confidence interval 5.27-6.13), especially for papillary RCC (SIR 13.3 versus 3.98 for ccRCC). Among kidney recipients, RCC risk was significantly elevated for blacks compared to whites (hazard ratio [HR] 1.50) and lower in females than males (HR 0.56). RCC risk increased with prolonged dialysis preceding transplantation (p-trend < 0.0001). Risk was variably associated for RCC subtypes with some medical conditions that were indications for transplantation: ccRCC risk was reduced with polycystic kidney disease (HR 0.54), and papillary RCC was increased with hypertensive nephrosclerosis (HR 2.02) and vascular diseases (HR 1.86). In conclusion, kidney recipients experience substantially elevated risk of RCC, especially for papillary RCC, and multiple factors contribute to these cancers.
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Affiliation(s)
- S. Karami
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - E. L. Yanik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - L. E. Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - R. M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - G. Copeland
- Michigan Cancer Surveillance Program, Michigan Department of Community Health, Lansing, Michigan, USA
| | - L. Gonsalves
- Connecticut Department of Public Health, Hartford, Connecticut, USA
| | - B.Y, Hernandez
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - C. F. Lynch
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - K. Pawlish
- New Jersey State Cancer Registry, Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey, USA
| | - E. A. Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Khan Z, Pandey M, Samartha RM. Role of cytogenetic biomarkers in management of chronic kidney disease patients: A review. Int J Health Sci (Qassim) 2016; 10:576-589. [PMID: 27833523 PMCID: PMC5085353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Chronic kidney disease (CKD) is much more common than people recognize, and habitually goes undetected and undiagnosed until the disease is well advanced or when their kidney functions is down to 25% of normal function. Genetic and non-genetic factors contribute to cause CKD. Non-genetic factors include hypertension, High level of DNA damage due to the production of reactive oxygen species and nucleic acid oxidation has been reported in CKD patients. Main genetic factor which causes CKD is diabetic nephropathy. A three- to nine-fold greater risk of End Stage Renal Disease (ESRD) is observed in individuals with a family history of ESRD. This greater risk have led researchers to search for genes linked to diabetic and other forms of nephropathy for the management of CKD. Multicenter consortia are currently recruiting large numbers of multiplex diabetic families with index cases having nephropathy for linkage and association analyses using various cytogenetic techniques. In addition, large-scale screening studies are underway, with the goals of better defining the overall prevalence of chronic kidney disease, as well as educating the population about risk factors for nephropathy, including family history. Cytogenetic biomarkers play an imperative role for the linkage study using G banding and detection of genomic instability in CKD patients. Classical and molecular cytogenetic tools with cytogenetic biomarkers provide remarkable findings in CKD patients. The aim of the present review is to draw outline of classical and molecular cytogenetic findings in CKD patients and their possible role in management to reduce genomic instability in CKD patients.
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Affiliation(s)
- Zeba Khan
- Department of Research, Bhopal Memorial Hospital and Research Centre (ICMR), Bhopal (MP), India-462038
| | - Manoj Pandey
- Department of Surgical Oncology, Bhopal Memorial Hospital and Research Centre (ICMR), Bhopal (MP), India-462038
| | - Ravindra M Samartha
- Department of Research, Bhopal Memorial Hospital and Research Centre (ICMR), Bhopal (MP), India-462038
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Parajuli S, Clark DF, Djamali A. Is Kidney Transplantation a Better State of CKD? Impact on Diagnosis and Management. Adv Chronic Kidney Dis 2016; 23:287-294. [PMID: 27742382 DOI: 10.1053/j.ackd.2016.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Patients with CKD are at increased risk for cardiovascular events, hospitalizations, and mortality. Kidney transplantation (KTx) is the preferred treatment for end-stage kidney disease. Although comorbidities including anemia and bone and mineral disease improve or are even halted after KTx, kidney transplant recipients carry higher cardiovascular mortality risk than the general population, as well as an increased risk of infections, malignancies, fractures, and obesity. When comparing CKD with CKD after transplantation (CKD-T), the rate of decline of estimated glomerular filtration rate (eGFR) is significantly lower in CKD-T. Higher rate of decline of eGFR has been associated with increased risk of mortality. However, due to the significant increased risk of mortality due to cardiovascular events, infections, and malignancies, many kidney transplant recipients may not benefit of decline in the rate of eGFR. Patients with CKD-T are a unique subset of patients with multiple traditional and transplant-specific risk factors. Proper management and appropriate preventive health measures may improve long-term patient and allograft survival in patients with CKD-T.
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NYPD Cancer Incidence Rates 1995-2014 Encompassing the Entire World Trade Center Cohort. J Occup Environ Med 2016; 57:e101-13. [PMID: 26461871 DOI: 10.1097/jom.0000000000000542] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare cancer incidence rates (CIRs), between preexposure (1995-2000) and postexposure (2002-2014) periods in the entire New York City Police Department cohort exposed to the 2001 World Trade Center (WTC) disaster. METHODS CIR derived from active duty officer records, including postexposure data on retired officers. RESULTS We observed 870 cancer cases in 859 officers (1995-2014), including 193 active duty cases pre-WTC and 677 cases (484 active duty, 193 retired) post-WTC. Overall, median CIR increased 1.44-fold compared with pre-WTC, with brain cancer increasing 3.27-fold, and kidney cancer increasing similarly. Thyroid cancer and non-Hodgkin's lymphoma increased 2.29 and 1.68-fold, respectively. CONCLUSIONS Findings should be interpreted cautiously, given the small number of cancers at specific sites, and possibility of confounders. However, apparent increases in cancers overall, and in highlighted sites, remain of concern, underscoring the need for continued monitoring of this cohort.
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Lotan Y, Karam JA, Shariat SF, Gupta A, Roupret M, Bensalah K, Margulis V. Renal-cell carcinoma risk estimates based on participants in the prostate, lung, colorectal, and ovarian cancer screening trial and national lung screening trial. Urol Oncol 2016; 34:167.e9-16. [DOI: 10.1016/j.urolonc.2015.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 09/12/2015] [Accepted: 10/19/2015] [Indexed: 01/20/2023]
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Kim KH, Kim JH, Lee JY, Kim HS, Heo SJ, Kim JH, Kim HY, Rha SY. Efficacy and Toxicity of Mammalian Target Rapamycin Inhibitors in Patients with Metastatic Renal Cell Carcinoma with Renal Insufficiency: The Korean Cancer Study Group GU 14-08. Cancer Res Treat 2016; 48:1286-1292. [PMID: 26875195 PMCID: PMC5080820 DOI: 10.4143/crt.2016.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/28/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose We evaluated the efficacy and toxicity of mammalian target rapamycin inhibitors in Korean patients with metastatic renal cell carcinoma (mRCC) with chronic renal insufficiency not requiring dialysis. Materials and Methods Korean patients with mRCC and chronic renal insufficiency not requiring dialysis treated with everolimus or temsirolimus between January 2008 and December 2014 were included. Patient characteristics, clinical outcomes, and toxicities were evaluated. Overall survival (OS) and progression-free survival (PFS) durations were evaluated according to the degree of renal impairment. Results Eighteen patients were considered eligible for the study (median age, 59 years). The median glomerular filtration rate was 51.5 mL/min/1.73 m2. The best response was partial response in six patients and stable disease in 11 patients. The median PFS and OS durations were 8 months (95% confidence interval [CI], 0 to 20.4) and 32 months (95% CI, 27.5 to 36.5), respectively. The most common non-hematologic and grade 3/4 adverse events included stomatitis, fatigue, flu-like symptoms, and anorexia as well as elevated creatinine level. Conclusion Mammalian target rapamycin inhibitors were efficacious and did not increase toxicity in Korean patients with mRCC and chronic renal insufficiency not requiring dialysis.
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Affiliation(s)
- Ki Hyang Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Joo Hoon Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Young Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyo Song Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Heo
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyung Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Young Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Non-neoplastic parenchymal changes in kidney cancer and post-partial nephrectomy recovery of renal function. Int Urol Nephrol 2015; 47:1499-502. [PMID: 26265107 DOI: 10.1007/s11255-015-1066-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the association of non-neoplastic parenchymal changes (nNPC) with patients' health and renal function recovery after partial nephrectomy (PN). MATERIALS AND METHODS This retrospective review identified 800 pT1a patients who underwent PN at Memorial Sloan Kettering Cancer Center from 2007 to 2012. Pathology reports were reviewed for nNPC graded as mild or severe: vascular sclerosis (VS), glomerulosclerosis (GS), and fibrosis/scarring. Correlations between nNPC and known preoperative predictors of renal function [age, sex, African-American race, estimated glomerular filtration rate (eGFR), American Society of Anesthesiologists (ASA) score, body mass index, coronary artery disease, and hypertension (HTN)] were assessed using Spearman's rank correlation (ρ). Multivariable linear regression, adjusted for the described known preoperative risk predictors, was performed to evaluate whether the parenchymal features were able to predict 6-month postoperative eGFR. RESULTS In this study, 46 % of tumors had benign surrounding parenchyma. We noted statistically significant yet weak associations of VS with age (ρ = 0.19; p < 0.001), ASA (ρ = 0.09; p < 0.001), preoperative eGFR (ρ = -0.14; p < 0.001), and HTN (ρ = 0.14; p < 0.001). GS also significantly correlated with HTN, but the correlation was again small (ρ = 0.12; p < 0.001). After adjusting for known risk predictors, only GS was a significant predictor of 6-month postoperative eGFR. When compared with no GS, mild and severe GS were negatively associated with a decrease of 4.9 and 10.8 mL/min/1.73 m(2) in 6-month postoperative eGFR, respectively. CONCLUSIONS Presence of VS and GS correlated with patients' baseline health, and presence of GS predicted postoperative renal function recovery.
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Chopra S, Satkunasivam R, Kundavaram C, Liang G, Gill IS. Outlining the limits of partial nephrectomy. Transl Androl Urol 2015; 4:294-300. [PMID: 26236649 PMCID: PMC4520710 DOI: 10.3978/j.issn.2223-4683.2015.06.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Amongst nephron-sparing modalities, partial nephrectomy (PN) is the standard of care in the treatment of renal cell carcinoma (RCC). Despite the increasing utilization of PN, particularly propagated by robot-assisted, minimally invasive approaches for small renal masses (SRMs), the limits of PN appear to be also evolving. In this review, we sought to address the tumour stage beyond which PN may be oncologically perilous. While the evidence supports PN in the treatment of tumours < pT2a, PN may have a role in advanced or metastatic RCC. Other scenarios wherein PN has limited utility are also explored, including anatomical or surgical factors that dictate the difficulty of the case, such as prior renal surgery. Lastly, we discuss the emerging role of molecular biomarkers, specifically epigenetics, to aid in the risk stratification of SRMs and to select tumours optimally suited for PN.
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Affiliation(s)
- Sameer Chopra
- USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Raj Satkunasivam
- USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Chandan Kundavaram
- USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Gangning Liang
- USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Inderbir S Gill
- USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
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Abstract
PURPOSE OF REVIEW To review current status of partial nephrectomy for treatment of T1b and T2 renal mass, focusing oncological and renal functional outcomes reported in the last 18 months, and to understand the emerging role of minimally invasive surgery (MIS) techniques in nephron-sparing management of T1b/T2 tumors. RECENT FINDINGS With recent long-term oncological equivalence to radical nephrectomy and renal functional benefit, partial nephrectomy is becoming an alternate standard to radical nephrectomy in the management of T1b tumors. The role of partial nephrectomy in nonelective treatment of T2 tumors is more controversial; however, recent publication of two large North American series have added to other contemporary work that suggests oncologic equivalence and renal functional benefit compared to radical nephrectomy in select patients. Emerging data demonstrate feasibility of MIS for increasing the proportion of T1b/T2 tumors; however, recent trends analyses demonstrate that the majority of T1b/T2 partial nephrectomy are still carried out by open surgery, and concerns continue about prolonged ischemic times and risk of bleeding in various MIS settings. SUMMARY Management of T1b and T2 renal masses is transforming with adoption of partial nephrectomy as a safe and feasible surgical option with comparable oncological and improved renal function outcomes compared to radical nephrectomy. MIS techniques play an expanding, though still limited, role, and more robust prospective data is requisite before drawing overarching conclusions.
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36
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Chowdhury MKH, Montgomery MK, Morris MJ, Cognard E, Shepherd PR, Smith GC. Glucagon phosphorylates serine 552 of β-catenin leading to increased expression of cyclin D1 and c-Myc in the isolated rat liver. Arch Physiol Biochem 2015; 121:88-96. [PMID: 26135564 DOI: 10.3109/13813455.2015.1048693] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the last 20 years the prevalence of metabolic disorders, in particular type 2 diabetes (T2D), has more than doubled. Recently, a strong link between T2D and cancer, in particularly liver cancer has been reported. However, the mechanism connecting the development of type 2 diabetes and cancer remains unknown. One of the biggest drivers of liver cancer is alterations in the Wnt/β-catenin pathway. In this study, we aimed to identify the effect of glucagon on β-catenin in the isolated rat liver. We found glucagon, which is substantially raised in patients with T2D, rapidly phosphorylates β-catenin on serine 552 that is associated with increased expression of genes cyclin D1 (CCND1) and c-Myc (MYC), which are known to be involved in liver cancer. This finding may explain the increased risk of liver cancer in people with T2D.
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Bazzi WM, Sjoberg DD, Feuerstein MA, Maschino A, Verma S, Bernstein M, O'Brien MF, Jang T, Lowrance W, Motzer RJ, Russo P. Long-term survival rates after resection for locally advanced kidney cancer: Memorial Sloan Kettering Cancer Center 1989 to 2012 experience. J Urol 2014; 193:1911-6. [PMID: 25524244 DOI: 10.1016/j.juro.2014.12.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE We analyzed the 23-year Memorial Sloan Kettering Cancer Center experience with surgical resection, and concurrent adrenalectomy and lymphadenectomy for locally advanced nonmetastatic renal cell carcinoma. MATERIALS AND METHODS We retrospectively reviewed the records of 802 patients who underwent nephrectomy with or without concurrent adrenalectomy or lymphadenectomy for locally advanced renal cell carcinoma, defined as stage T3 or greater and M0. Patients who received adjuvant treatment within 3 months of surgery or had fewer than 3 months of followup or bilateral renal masses at presentation were excluded from analysis. Five and 10-year progression-free and overall survival was estimated by the Kaplan-Meier method. Differences between groups were analyzed by the log rank test. RESULTS A total of 596 (74%) and 206 patients (26%) underwent radical and partial nephrectomy, respectively. Renal cell carcinoma progressed in 189 patients and 104 died of the disease. Median followup in patients without progression was 4.6 years. Symptoms at presentation, ASA(®) classification, tumor stage, histological subtype, grade and lymph node status were significantly associated with progression-free and overall survival. On multivariate analysis adrenalectomy use decreased with time but lymphadenectomy use increased (OR 0.82 vs 1.16 per year). Larger tumors were associated with a higher likelihood of concurrent adrenalectomy and lymphadenectomy. CONCLUSIONS In our series of patients with locally advanced nonmetastatic renal cell carcinoma survival was favorable in those in good health who were asymptomatic at presentation with T3 tumors and negative lymph nodes. Further, there has been a trend toward more selective use of adrenalectomy and increased use of lymphadenectomy.
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Affiliation(s)
- Wassim M Bazzi
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Daniel D Sjoberg
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Michael A Feuerstein
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Alexandra Maschino
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Sweeney Verma
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Melanie Bernstein
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Matthew F O'Brien
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Thomas Jang
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - William Lowrance
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Robert J Motzer
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah
| | - Paul Russo
- Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah.
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Xu CX, Zhu HH, Zhu YM. Diabetes and cancer: Associations, mechanisms, and implications for medical practice. World J Diabetes 2014; 5:372-380. [PMID: 24936258 PMCID: PMC4058741 DOI: 10.4239/wjd.v5.i3.372] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/07/2014] [Accepted: 04/17/2014] [Indexed: 02/05/2023] Open
Abstract
Both diabetes mellitus and cancer are prevalent diseases worldwide. It is evident that there is a substantial increase in cancer incidence in diabetic patients. Epidemiologic studies have indicated that diabetic patients are at significantly higher risk of common cancers including pancreatic, liver, breast, colorectal, urinary tract, gastric and female reproductive cancers. Mortality due to cancer is moderately increased among patients with diabetes compared with those without. There is increasing evidence that some cancers are associated with diabetes, but the underlying mechanisms of this potential association have not been fully elucidated. Insulin is a potent growth factor that promotes cell proliferation and carcinogenesis directly and/or through insulin-like growth factor 1 (IGF-1). Hyperinsulinemia leads to an increase in the bioactivity of IGF-1 by inhibiting IGF binding protein-1. Hyperglycemia serves as a subordinate plausible explanation of carcinogenesis. High glucose may exert direct and indirect effects upon cancer cells to promote proliferation. Also chronic inflammation is considered as a hallmark of carcinogenesis. The multiple drugs involved in the treatment of diabetes seem to modify the risk of cancer. Screening to detect cancer at an early stage and appropriate treatment of diabetic patients with cancer are important to improve their prognosis. This paper summarizes the associations between diabetes and common cancers, interprets possible mechanisms involved, and addresses implications for medical practice.
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Lo CH, Huang WY, Chao HL, Lin KT, Jen YM. Novel application of stereotactic ablative radiotherapy using CyberKnife ® for early-stage renal cell carcinoma in patients with pre-existing chronic kidney disease: Initial clinical experiences. Oncol Lett 2014; 8:355-360. [PMID: 24959276 PMCID: PMC4063570 DOI: 10.3892/ol.2014.2129] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 04/24/2014] [Indexed: 12/25/2022] Open
Abstract
The treatment of renal cell carcinoma (RCC) in patients diagnosed with chronic kidney disease (CKD) requires particular care in order to preserve the remaining renal function. The present study aimed to investigate the potential of a novel nephron-sparing treatment, which is capable of targeting tumors embedded deep within tissues. The present study analyzed three patients, with pre-existing CKD and multiple comorbidities, who were successfully treated for stage I RCC using the CyberKnife® stereotactic ablative radiotherapy (SABR) system. The total prescribed dose was 40 Gy in five fractions administered over five consecutive days. Treatment efficiency was determined using computed tomography scans of the tumors and periodic measurements of the glomerular filtration rate over a period of 12–40 months. Local control, defined as a radiologically stable condition, was achieved in all patients. Lung metastasis was observed in one patient nine months after SABR; however, the side-effects were generally mild and self-limiting. One patient developed renal failure 26 months after SABR, while the severity of CKD was only marginally altered in the other two patients and renal failure did not occur. In conclusion, in the present study, SABR with CyberKnife® was observed to be well tolerated in the patients, with an acceptable acute toxicity effect. Therefore, it may represent a potential therapeutic option for patients with early-stage RCC who have previously been diagnosed with CKD, but for whom other nephron-sparing treatments are contraindicated.
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Affiliation(s)
- Cheng-Hsiang Lo
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Hsing-Lung Chao
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
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Bagrodia A, Kopp RP, Mehrazin R, Lee HJ, Liss MA, Jabaji R, Kane CJ, Wake RW, Patterson AL, Wan JY, Derweesh IH. Impact of renal surgery for cortical neoplasms on lipid metabolism. BJU Int 2014; 114:837-43. [PMID: 24656182 DOI: 10.1111/bju.12744] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the incidence of and risk factors for development of hyperlipidaemia in patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) for renal cortical neoplasms, as hyperlipidaemia is a major source of morbidity in chronic kidney disease (CKD). PATIENTS AND METHODS We conducted a two-centre retrospective analysis of 905 patients (mean age 57.5 years, mean follow-up 78 months), who underwent RN (n = 610) or PN (n = 295) between July 1987 and June 2007. Demographics, preoperative and postoperative hyperlipidaemia were recorded. De novo hyperlipidaemia was defined as that ocurring ≥6 months after surgery in cases where laboratory values met National Cholesterol Education Program Adult Treatment Panel III definitions. The Kaplan-Meier method was used to assess freedom from de novo hyperlipidaemia. Multivariable analysis was conducted to determine the risk factors for de novo hyperlipidaemia. RESULTS There were no significant differences with respect to demographics, preoperative glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) (P = 0.123) and hyperlipidaemia (P = 0.144). Tumour size (cm) was significantly larger in the RN group vs the PN group (7.0 vs 3.7; P < 0.001). Significantly greater postoperative GFR <60 mL/min/1.73 m(2) was noted in the RN group (45.7 vs 18%, P < 0.001). Significantly, more de novo hyperlipidaemia developed in the RN group than in the PN group (23 vs 6.4%; P < 0.001). The mean time to development of hyperlipidaemia was longer for PN than for RN (54 vs 44 months; P = 0.03). Five-year freedom from de novo hyperlipidaemia probability was 76% for RN vs 96% for PN (P < 0.001). Multivariable analysis showed that RN (odds ratio [OR] 2.93; P = 0.0107), preoperative GFR <60 mL/min/1.73 m(2) (OR 1.98; P = 0.037) and postoperative GFR <60 mL/min/1.73 m(2) (OR 7.89; P < 0.001) were factors associated with hyperlipidaemia development. CONCLUSION Patients who underwent RN had a significantly higher incidence of and shorter time to development of de novo hyperlipidaemia. RN and pre- and postoperative eGFR <60 mL/min/1.73 m(2) were associated with development of hyperlipidaemia. Further follow-up and prospective investigation are necessary to confirm these findings.
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Affiliation(s)
- Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Efficacy and toxicity of sunitinib in patients with metastatic renal cell carcinoma with renal insufficiency. Eur J Cancer 2014; 50:746-52. [PMID: 24332573 DOI: 10.1016/j.ejca.2013.11.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/22/2013] [Accepted: 11/25/2013] [Indexed: 11/20/2022]
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Breda A, Lucarelli G, Luccarelli G, Rodriguez-Faba O, Guirado L, Facundo C, Bettocchi C, Gesualdo L, Castellano G, Grandaliano G, Battaglia M, Palou J, Ditonno P, Villavicencio H. Clinical and pathological outcomes of renal cell carcinoma (RCC) in native kidneys of patients with end-stage renal disease: a long-term comparative retrospective study with RCC diagnosed in the general population. World J Urol 2014; 33:1-7. [PMID: 24504760 DOI: 10.1007/s00345-014-1248-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/21/2014] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Patients with end-stage renal disease (ESRD) have an increased risk of developing renal cell carcinoma (RCC). This retrospective study compared clinical and pathological outcomes of RCC occurring in native kidneys of patients with ESRD (whether they underwent kidney transplantation or not) with those of renal tumors diagnosed in the general population. METHODS The study included a total of 533 patients with RCC. The ESRD cohort included 92 patients with RCC in native kidneys. Of these, 58 and 34 cases were identified before (pre-Tx group) and after kidney transplantation (post-Tx group), respectively. The control group was composed of 441 RCCs diagnosed in the general population. Variables were compared by chi-square and Student's t tests. Cancer-specific survival was assessed by Kaplan-Meier and Cox methods. RESULTS The ESRD groups had smaller (P = 0.001), lower-grade, and lower-stage tumors than the non-ESRD group (P = 0.001). The papillary RCC rate was higher in the ESRD groups (P = 0.01). Ten-year cancer-specific survivals were 94.5, 87.9, and 74.6 % in pre-Tx, post-Tx, and non-ESRD patients, respectively (P = 0.003). Mean follow-up was 90.2 months. At multivariate analysis, tumor size (HR = 1.10), pathological stage (HR = 1.46), presence of nodal (HR = 2.22) and visceral metastases (HR = 3.49), and Fuhrman grade (HR = 1.48) were independent adverse prognostic factors for cancer-specific survival. CONCLUSIONS Native kidney RCCs arising in ESRD patients are lower stage and lower grade as compared to RCCs diagnosed in the general population, and these tumors exhibit favorable clinical and outcome features.
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Affiliation(s)
- Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autonòma de Barcelona, c/Cartagena 340-350, 08025, Barcelona, Spain,
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Abstract
The incidence of early stage renal cell carcinoma (RCC) is increasing and observational studies have shown equivalent oncological outcomes of partial versus radical nephrectomy for stage I tumours. Population studies suggest that compared with radical nephrectomy, partial nephrectomy is associated with decreased mortality and a lower rate of postoperative decline in kidney function. However, rates of chronic kidney disease (CKD) in patients who have undergone nephrectomy might be higher than in the general population. The risks of new-onset or accelerated CKD and worsened survival after nephrectomy might be linked, as kidney insufficiency is a risk factor for cardiovascular disease and mortality. Nephron-sparing approaches have, therefore, been proposed as the standard of care for patients with type 1a tumours and as a viable option for those with type 1b tumours. However, prospective data on the incidence of de novo and accelerated CKD after cancer nephrectomy is lacking, and the only randomized trial to date was closed prematurely. Intrinsic abnormalities in non-neoplastic kidney parenchyma and comorbid conditions (including diabetes mellitus and hypertension) might increase the risks of CKD and RCC. More research is needed to better understand the risk of CKD post-nephrectomy, to develop and validate predictive scores for risk-stratification, and to optimize patient management.
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Derweesh IH. Editorial comment. J Urol 2013; 191:309. [PMID: 24161499 DOI: 10.1016/j.juro.2013.08.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Cozzi DA, Ceccanti S, Frediani S, Mele E, Cozzi F. Renal function adaptation up to the fifth decade after treatment of children with unilateral renal tumor: a cross-sectional and longitudinal study. Pediatr Blood Cancer 2013; 60:1534-8. [PMID: 23606234 DOI: 10.1002/pbc.24545] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/05/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mild-to-moderate renal function loss may be an independent risk factor for cardiovascular disease and overall mortality. As in adults with renal carcinoma nephrectomy is associated with an high risk for moderate renal function loss, we aimed to assess the renal function adaptation over a long period of time in children with unilateral renal tumor (URT). PROCEDURE Seventy-two children who underwent surgery for URT were enrolled in this study. Glomerular filtration rate was estimated (eGFR) with the Modification of Diet in Renal Study or the Schwartz equation, as appropriate for the age. RESULTS Twelve patients treated by nephron-sparing surgery (Group A) and 42 treated by nephrectomy (Group B) had an age between 2 and 30 years; 18 patients treated by nephrectomy had an age between 33 and 51 years (Group C). At cross-sectional follow-up 8% patients of Group A, 42% of Group B and 78% of Group C presented a mild-to-moderate renal function. The longitudinal data stratified by post-operative intervals showed that patients of Group C presented a significant progressive decrease in mean ± standard deviation eGFR (88.1 ± 22.6 during the third decade after surgery vs. 66.6 ± 15.6 ml/min/1.73 m(2) during the fifth decade after surgery; P = 0.02). The longitudinal data stratified by age showed that patients with an age between 45 and 54 years presented a mean eGFR significantly lower than that expected for the physiological renal function decline with aging (P = 0.001). CONCLUSION Aging is associated with a mild-to-moderate renal function loss in many adult patients following nephrectomy during childhood for URT.
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Affiliation(s)
- Denis A Cozzi
- Paediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, Italy.
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Lee CH, Hsieh SY, Lin JL, Liu MS, Yen TH. Hepatocellular carcinoma in patients with chronic kidney disease. World J Gastroenterol 2013; 19:2466-2472. [PMID: 23674847 PMCID: PMC3646136 DOI: 10.3748/wjg.v19.i16.2466] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/25/2012] [Accepted: 01/30/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate outcomes of hepatocellular carcinomas (HCCs) in patients with chronic kidney disease (CKD).
METHODS: Four hundred and forty patients referred between 2000 and 2002 for management of HCCs were categorized according to their CKD stage, i.e., estimated glomerular filtration rate (eGFR) > 90 (stage 1), 60-90 (stage 2), 30-60 (stage 3), 15-30 (stage 4), and < 15 (stage 5) mL/min per 1.73 m2, respectively. Demographic, clinical and laboratory data were collected and mortality rates and cause of mortality were analyzed. The mortality data were examined with Kaplan-meier method and the significance was tested using a log-rank test. An initial univariate Cox regression analysis was performed to compare the frequency of possible risk factors associated with mortality. To control for possible confounding factors, a multivariate Cox regression analysis (stepwise backward approach) was performed to analyze those factors that were significant in univariate models (P < 0.05) and met the assumptions of a proportional hazard model.
RESULTS: Most HCC patients with CKD were elderly, with mean age of diagnosis of 60.6 ± 11.9 years, and mostly male (74.8%). Hepatitis B, C and B and C co-infection virus were positive in 61.6%, 45.7% and 14.1% of the patients, respectively. It was found that patients with stages 4 and 5 CKD were not only older (P = 0.001), but also had higher hepatitis C virus carrier rate (P = 0.001), lower serum albumin level (P = 0.001), lower platelet count (P = 0.037), longer prothrombin time (P = 0.001) as well as higher proportions of advanced cirrhosis (P = 0.002) and HCCs (P = 0.001) than patients with stages 1 and 2 CKD. At the end of analysis, 162 (36.9%) patients had died. Kaplan-Meier analysis revealed that patients with stages 4 and 5 CKD suffered lower cumulative survival than stages 1 and 2 CKD (log-rank test, χ2 = 11.764, P = 0.003). In a multivariate Cox-regression model, it was confirmed that CKD stage [odds ratio (OR) = 1.988, 95%CI: 1.012-3.906, P = 0.046)], liver cirrhosis stage (OR = 3.571, 95%CI: 1.590-8.000, P = 0.002) and serum albumin level (OR = 0.657, 95%CI: 0.491-0.878, P = 0.005) were significant predictors for mortality in this population.
CONCLUSION: HCC patients with stages 4 and 5 CKD had inferior survival than stages 1 and 2 CKD. This warrants further studies.
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Russo P, Szczech LA, Torres GS, Swartz MD. Patient and caregiver knowledge and utilization of partial versus radical nephrectomy: results of a national kidney foundation survey to assess educational needs of kidney cancer patients and caregivers. Am J Kidney Dis 2013; 61:939-46. [PMID: 23523238 DOI: 10.1053/j.ajkd.2013.01.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 01/29/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND In response to requests from patients, caregivers, and physicians for information on kidney cancer, the National Kidney Foundation (NKF) conducted a survey to assess the educational needs of the kidney cancer community. Key areas of assessment were patient and caregiver knowledge of risk factors for chronic kidney disease (CKD), including kidney cancer and nephrectomy, and of kidney-sparing surgical options. STUDY DESIGN Survey to assess educational needs of patients with kidney cancer and caregivers. SETTING & PARTICIPANTS Respondents were invited through physician referrals and online sources and included 365 adult patients with kidney cancer and 52 caregivers. PREDICTOR Age, geographic region, and cancer stages 1-2 versus 3-4. OUTCOMES & MEASUREMENTS Survey responses were descriptively analyzed, with data compared and weighted to the population age and geographic characteristics of the general kidney cancer population. RESULTS 83% of 181 early-stage patients, 92% of 123 late-stage patients, and 86% of 113 patients who did not know their stage received radical nephrectomy. Although 62% agreed that radical nephrectomy for cancer treatment is a risk factor for CKD, only 40% agreed that losing part or all of 1 kidney from injury or a disease other than cancer is a risk factor for CKD. 56% agreed that kidney cancer can be related to CKD. LIMITATIONS We did not have patient medical records to validate responses and we do not know the number of people who were invited to take the survey but declined. CONCLUSIONS There is a lack of patient awareness that kidney cancer and radical nephrectomy are risk factors for CKD. Only a minority of patients underwent partial nephrectomy or were given it as an option for their early-stage kidney cancer. This suggests a knowledge deficit among physicians, surgeons, patients, and caregivers alike that there is a bidirectional relationship between kidney cancer and CKD and that kidney-sparing surgery is preferable when feasible.
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Affiliation(s)
- Paul Russo
- Memorial Sloan Kettering Cancer Center, Weill School of Medicine, Cornell School of Medicine, New York, NY 10065, USA.
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Diabetes and risk of cancer. ISRN ONCOLOGY 2013; 2013:583786. [PMID: 23476808 PMCID: PMC3582053 DOI: 10.1155/2013/583786] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 01/09/2013] [Indexed: 12/19/2022]
Abstract
Diabetes and cancer represent two complex, diverse, chronic, and potentially fatal diseases. Cancer is the second leading cause of death, while diabetes is the seventh leading cause of death with the latter still likely underreported. There is a growing body of evidence published in recent years that suggest substantial increase in cancer incidence in diabetic patients. The worldwide prevalence of diabetes was estimated to rise from 171 million in 2000 to 366 million in 2030. About 26.9% of all people over 65 have diabetes and 60% have cancer. Overall, 8–18% of cancer patients have diabetes. In the context of epidemiology, the burden of both diseases, small association between diabetes and cancer will be clinically relevant and should translate into significant consequences for future health care solutions. This paper summarizes most of the epidemiological association studies between diabetes and cancer including studies relating to the general all-site increase of malignancies in diabetes and elevated organ-specific cancer rate in diabetes as comorbidity. Additionally, we have discussed the possible pathophysiological mechanisms that likely may be involved in promoting carcinogenesis in diabetes and the potential of different antidiabetic therapies to influence cancer incidence.
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