Downregulation of fumarate hydratase is related to tumorigenesis in sporadic renal cell cancer

OBJECTIVE

Although germline mutations of fumarate hydratase (FH) are a useful molecular marker of hereditary leiomyomatosis and renal cell cancer (RCC) syndrome, their clinical significance in sporadic RCC has not been studied in detail. The aim of the present study was to investigate possible correlations between the expression of FH and the clinical implications of sporadic RCC.

MATERIALS AND METHODS

FH mRNA levels were evaluated in 140 tumor specimens from patients with primary RCC and in 62 specimens of corresponding normal-appearing kidney tissue using real-time quantitative polymerase chain reaction. Immunohistochemical staining was performed on 6 normal surrounding tissues and 71 RCC tissues.

RESULTS

FH mRNA levels were significantly lower in tumor tissues than in matched normal-appearing kidney tissues (p = 0.031). In all normal tissues, FH staining intensity was strong. However, the expression of FH showed no significant correlation with the pathological and clinical characteristics of patients with sporadic RCC.

CONCLUSIONS

Our results showed that FH mRNA expression decreased significantly in correlation with the transition from normal renal parenchyma to RCC. FH may be an indicator or tumorigenesis in sporadic RCC and could be a potential target for therapies against RCC in the future.

Prognostic significance of preoperative C-reactive protein elevation and thrombocytosis in patients with non-metastatic renal cell carcinoma

PURPOSE

The aim of this study was to investigate the association of preoperative C-reactive protein (CRP) elevation and thrombocytosis with the prognosis of patients with non-metastatic renal cell carcinoma (RCC).

MATERIALS AND METHODS

This was a retrospective review of the medical records of 177 patients (130 men and 47 women) with non-metastatic RCC who underwent a radical nephrectomy between March 2000 and May 2008 and for whom preoperative CRP and platelet data were available for analysis. Preoperative CRP elevation and thrombocytosis were compared with clinical and pathological variables.

RESULTS

There were 38 patients with CRP elevation and 11 patients with thrombocytosis. The mean follow-up time was 48.3 months (median, 48.0; range, 13-111 months). Twenty-three patients (13.0%) developed metastases and six patients died during the follow-up period. CRP elevation was significantly correlated with anemia (p=0.001), T stage (p=0.004), grade (p=0.025), and metastasis (p<0.001). Thrombocytosis was significantly correlated with anemia (p=0.003), T stage (p=0.002), and metastasis (p=0.001). The univariate analysis identified anemia, CRP elevation, thrombocytosis, tumor histology subtype, tumor size, T stage, and grade as significant prognostic factors associated with recurrence-free survival, whereas the multivariate analyses showed that CRP elevation (p=0.033) and tumor size (p=0.007) were independent prognostic factors.

CONCLUSIONS

Preoperative CRP elevation and thrombocytosis were associated with a poorer prognosis and a higher recurrence rate in patients with non-metastatic RCC. Moreover, preoperative CRP elevation appeared to be an independent predictor of tumor recurrence and prognosis. Preoperative thrombocytosis, however, was not an independent prognostic factor for tumor recurrence and prognosis.