Validation of the 2009 TNM Classification for Renal Cell Carcinoma: Comparison with the 2002 TNM Classification by Concordance Index

miR‑122 promotes proliferation and invasion of clear cell renal cell carcinoma by suppressing Forkhead box O3

MicroRNAs (miRNAs) serve an important role in renal cancer, but renal cancer miRNA expression data remains inconsistent. Therefore, there is a requirement for integrated analysis of these data. An increasing number of studies demonstrate that miR‑122 is dysregulated in numerous cancer types, including liver, lung and breast cancer, yet its role in clear cell renal cell carcinoma (ccRCC) remains unclear. In the present study, an integrated analysis of four ccRCC miRNAs expression datasets was performed and the expression of miR‑122 in the present cohort was validated. The effects of cell proliferation, colony formation, migration and invasion of ccRCC cells in vitro were assayed following transfection with miR‑122 mimics and inhibitor. The target gene of miR‑122 was confirmed using a luciferase reporter assay, and a xenograft mouse model was used to determine the effect of miR‑122 in ccRCC tumorigenicity in vivo. The present results demonstrated that patients with ccRCC with an increased miR‑122 level in tumor tissues had a shortened metastasis‑free survival time as indicated by The Cancer Genome Atlas‑Kidney Renal Clear Cell Carcinoma dataset and the present ccRCC cohort. Overexpression of miR‑122 in 786‑O cells improved cell proliferation, colony formation, migration and invasion, while knockdown of miR‑122 in SN12‑PM6 cells inhibited cell growth, colony formation, migration and invasion. Western blot analysis and luciferase reporter assays were used to identify FOXO3 as a direct target of miR‑122. The present results indicate that miR‑122 serves a tumor‑promoting role by direct targeting FOXO3 in ccRCC.

Updates in Pathologic Staging and Histologic Grading of Renal Cell Carcinoma

The most important prognostic parameter in renal cell carcinoma is tumor stage. Although pathologic primary tumor (pT) categories are influenced by tumor size (pT1-pT2), critical elements (≥pT3) are dictated by invasion of structures, including renal sinus, perinephric fat, and the renal vein or segmental branches. Because this invasion can be subtle, awareness of the unique characteristics of renal cell carcinoma is critical for the pathologist to aid in clinical decision making. This review addresses challenges in pathologic stage and grade reporting and updates to the World Health Organization and American Joint Commission on Cancer classification schemes.

Time trends in service provision and survival outcomes for patients with renal cancer treated by nephrectomy in England 2000-2010

OBJECTIVE

To describe the temporal trends in nephrectomy practice and outcomes for English patients with renal cell carcinoma (RCC).

PATIENTS AND METHODS

Adult RCC nephrectomy patients treated between 2000 and 2010 were identified in the National Cancer Data Repository and Hospital Episode Statistics, and followed-up until date of death or 31 December 2015 (n = 30 763). We estimated the annual frequency for each nephrectomy type, the hospital and surgeon numbers and their case volumes. We analysed short-term surgical outcomes, as well as 1- and 5-year relative survivals.

RESULTS

Annual RCC nephrectomy number increased by 66% during the study period. Hospital number decreased by 24%, whilst the median annual hospital volume increased from 10 to 23 (P < 0.01). Surgeon number increased by 27% (P < 0.01), doubling the median consultant number per hospital. The proportion of minimally invasive surgery (MIS) nephrectomies rose from 1% to 46%, whilst the proportion of nephron-sparing surgeries (NSS) increased from 5% to 16%, with 29% of all T1 disease treated with partial nephrectomy in 2010 (P < 0.01). The 30-day mortality rate halved from 2.4% to 1.1% and 90-day mortality decreased from 4.9% to 2.6% (P < 0.01). The 1-year relative survival rate increased from 86.9% to 93.4%, whilst the 5-year relative survival rate rose from 68.2% to 81.2% (P < 0.01). Improvements were most notable in patients aged ≥65 years and those with T3 and T4 disease.

CONCLUSIONS

Surgical RCC management has changed considerably with nephrectomy centralisation and increased NSS and MIS. In parallel, we observed significant improvements in short- and long-term survival particularly for elderly patients and those with locally advanced disease.

Multiple muscle metastases of the renal cell carcinoma after radical nephrectomy

Skeletal muscle is a very rare location for the metastasis of renal cell carcinoma. We report a 48-year-old man with multiple metastases in skeletal muscles 4 years after right radical nephrectomy was carried out for grade III renal cell carcinoma. The tumors located in the right psoas, paravertebral, and gluteus medius muscles. We performed magnetic resonance imaging for detection metastatic lesions in our patient. In this case report, we discuss the characteristics of these metastatic lesions on magnetic resonance imaging.

Textural differences in apparent diffusion coefficient between low- and high-stage clear cell renal cell carcinoma

OBJECTIVE

The purpose of this article is to evaluate differences in texture measures on apparent diffusion coefficient (ADC) maps between low- and high-stage clear cell renal cell carcinomas (RCCs).

MATERIALS AND METHODS

In this retrospective study, 61 patients with clear cell RCC at pathologic examination and who underwent preoperative MRI with diffusion-weighted imaging were included. Clear cell RCCs were clinically staged on review of preoperative MRI by a board-certified radiologist blinded to the pathologic findings. Whole lesions were segmented on ADC maps by two readers independently, from which first-order texture features (i.e., mean and skewness) and second-order texture features (i.e., cooccurrence matrix measures) were calculated. Texture metrics were compared between low- and high-stage clear cell RCC.

RESULTS

In 61 patients, there were 62 clear cell RCCs (33 low stage [stages I and II] and 29 high stage [stages III and IV]) at pathologic examination. Staging accuracy of qualitative interpretation was 100% for low-stage lesions and 37.9% (11/29) for high-stage lesions. There was no statistically significant difference in mean ADC between high- and low-stage clear cell RCCs (1.77×10(-3) vs 1.80×10(-3) mm2/s; p=0.7). However, high-stage clear cell RCCs were larger (6.96±2.93 vs 3.49±1.57 cm; p<0.0001) and had statistically significantly (p≤0.0001) higher ADC skewness (0.02±0.33 vs -0.52±0.65) and cooccurrence matrix correlation (0.64±0.11 vs 0.49±0.13). Multivariate logistic regression identified size, skewness, and cooccurrence matrix correlation as significant independent predictors of high stage (AUC=0.92). Interreader correlation in texture metrics ranged from 0.82 to 0.89.

CONCLUSION

First- and second-order ADC texture metrics differ between low- and high-stage clear cell RCCs. A model that includes size and ADC texture measures may help to stage clear cell RCCs noninvasively.

Predictive ability of the 2002 and 2010 versions of the Tumour-Node-Metastasis classification system regarding metastasis-free, cancer-specific and overall survival in a European renal cell carcinoma single-centre series

OBJECTIVE

To compare the predictive ability of the Tumour-Node-Metastasis (TNM) classification systems for renal cell carcinoma (RCC) using three different endpoints: metastasis-free (MFS); overall (OS); and cancer-specific survival (CSS).

PATIENTS AND METHODS

Data from 2739 consecutive patients with RCC, who underwent surgery at a single academic centre, were evaluated using multivariate Cox proportional models, Harrell's concordance (c)-index and by applying decision curve analysis (DCA) with regard to MFS, OS and CSS.

RESULTS

According to TNM 2010, significant differences for MFS were observed for pT1a vs pT1b, pT1b vs pT2a, pT3a vs pT3b and pT3b vs pT3c stages, respectively (all P < 0.05). With regard to OS, significant differences could be observed in pT1a vs pT1b and pT3a vs pT3b stages, respectively (all P < 0.05). The c-index for CSS, OS and MFS was slightly higher for the 2002 than for the 2010 version of the TNM classification system. Non-inferiority of the 2002 TNM system is supported by the results of the DCA.

CONCLUSION

According to our data, the predictive ability of the 2010 version of the TNM classification system regarding three different clinical endpoints is not superior to the 2002 version of this staging system.

Comparison of the 2002 and 2010 TNM classification systems regarding outcome prediction in clear cell and papillary renal cell carcinoma

AIMS

  A novel version of the tumour-node-metastasis (TNM) classification system for renal cell carcinoma (RCC) was introduced in 2010, although the prognostic significance with regard to different histological subtypes has not been explored. Therefore, the aim of our study was to compare the predictive ability of the 2002 and 2010 versions of the TNM classification system for clear cell and papillary RCC.

METHODS AND RESULTS

  Data from 2263 consecutive clear cell and 309 papillary RCC patients, operated at a single tertiary academic centre, were evaluated. According to TNM 2010, statistically significant differences for cancer-specific survival (CSS) were observed for pT1a versus pT1b (P < 0.001) and pT3a versus pT3b (P < 0.004) in clear cell RCC; and pT1b versus pT2a (P = 0.002) and pT3b versus pT3c (P = 0.046) in papillary RCC. The c-index for CSS in clear cell RCC was 0.74 and 0.73, and in papillary RCC 0.79 and 0.78, for the 2002 and 2010 versions of the TNM classification system, respectively.

CONCLUSIONS

  According to our data, the predictive ability of the 2010 version of the TNM classification system regarding CSS is not superior to the 2002 version, either in clear cell or in papillary RCC.