Transarterial ethiodised oil marking before CT-guided renal cryoablation: evaluation of tumour visibility in various renal cell carcinoma subtypes

AIM

To evaluate ethiodised oil retention of transarterial embolisation using ethiodised oil (ethiodised oil marking) before computed tomography (CT)-guided percutaneous cryoablation (PCA) according to renal cell carcinoma (RCC) subtype.

MATERIALS AND METHODS

Ethiodised oil marking was performed 1-3 days before PCA in 99 patients with 99 RCCs from 2016 to 2020. Ethiodised oil retention on CT images was evaluated retrospectively and CT attenuation values in the tumour were measured. Regions of interest (ROI) were placed on the tumours to calculate: average (ROI-average), maximal (ROI-max), minimum (ROI-min), and standard deviation (ROI-SD). Qualitative scores comprising a five-point scale (5, excellent; 1, poor) were evaluated for the retention scores (RS) of ethiodised oil in the tumour (ethiodised oil-RS) and the visualisation scores (VS) of the boundary between the tumour and renal parenchyma (boundary-VS).

RESULTS

The histological subtypes comprised clear cell (ccRCC; n=85), papillary (pRCC; n=6), and chromophobe/oncocytoma renal cell carcinoma (chrRCC; n=8). The mean ROI-average, ROI-max, and ROI-SD were significantly higher in ccRCCs than in chrRCCs and pRCCs (p<0.05). The mean ethiodised oil-RS was significantly lower in pRCCs than in ccRCCs (p=0.039), and the mean boundary-VS was >4 in all subtypes. Even with poor intratumour ethiodised oil retention (n=6), sufficient boundary-VS was obtained due to "inverted marking." All PCA procedures were completed without additional intravenous contrast material injection at the time of PCA.

CONCLUSION

Regardless of the tumour subtypes, ethiodised oil marking aids in visualising the boundary between the tumour and parenchyma on non-contrast CT in PCA.

Safety and efficacy of PD-1/PD-L1 blockade in patients with preexisting antinuclear antibodies

PURPOSE

Immune checkpoint inhibitors (ICIs) show promising clinical activity in advanced cancers. However, the safety and efficacy of PD-1/PD-L1 blockade in patients with preexisting antinuclear antibodies (ANA) are unclear.

METHODS

191 patients treated with nivolumab, pembrolizumab, atezolizumab, or durvalumab for unresectable advanced cancers between September 2014 and December 2018 were identified retrospectively. Patients were divided into positive (ANA titers ≥ 1:160) and negative ANA groups (ANA titers < 1:160). Development of immune-related adverse events (irAEs), the overall response rate (ORR), and disease control rate (DCR) were monitored.

RESULTS

Positive ANA titers were seen in 9 out of 191 patients. Four patients in the positive ANA group and 69 patients in the negative group developed irAEs of any grade without a significant difference between the groups. The development of endocrine, pulmonary, and cutaneous irAEs was not significant, whereas positive ANA was significantly higher in patients who developed colitis (2/9) than in patients who did not (3/182, P = 0.0002). DCR in the positive and negative ANA group was 37.5% and 67.5%, respectively, and was not statistically significant, but had better efficacy in patients without ANA (P = 0.08). ANA-related autoimmune diseases such as SLE, Sjögren's syndrome, MCTD, scleroderma, dermatomyositis, and polymyositis was not induced in either group. However, one patient with preexisting dermatomyositis had a flare up after initiation of atezolizumab.

CONCLUSION

Further studies to identify predictive factors for the development of irAEs are required to provide relevant patient care and maximize the therapeutic benefits of ICIs.

Use of CDK1 and CDK2 activity to predict renal cell cancer recurrence

341

Background: We established original methods enabling simultaneous analysis of protein expressions and kinase activities of the CDK (cyclin-dependent kinase) molecules in lysate of tumor tissue in a clinical setting (C2P technology, Ishihara et al: Biochim Biophys Acta. 1741; 226-233, 2005). The clinical utility of the technology was first evaluated in breast cancer, and combination analysis of CDK1 and CDK2 activity was shown to be a significant prognostic indicator for relapse (Kim et al. Ann Oncol. 19;68-72,2009). The objective of our study is to evaluate the efficacy of CDK1 and CDK2 activity as a prognostic marker in human renal cell carcinoma (RCC).

Methods: Surgical specimens were obtained from 115 patients with RCC without metastasis. These patients were selected randomly for this study. Protein expression and kinase activity of CDKs and cyclins were analyzed using a newly developed assay system. The system to measure the CDK specific activity (SA) is named C2Ps (Sysmex, Kobe, Japan). We then examined the specific activities of CDK1 and CDK2 and calculated CDK2/CDK1 ratio in RCC. Also, risk score (RS) was examined as described in previous study (JGH van Nes et al: Br J Cancer. 100; 494-500, 2009). Cut off value was calculated by ROC analysis.

Results: 115 cases were tested, though 32 cases were excluded of low sample quality (30 cases) and of assay failure (2 cases). 83 cases were analyzed. They included 63 male and 20 female patients, ranging in age from 19 to 83 years. At a median follow up of 33 months (1-109M), tumor with low CDK2/CDK1 ratio showed significantly better 5-year progression-free survival (PFS) than those with high CDK2/CDK1 ratio (91.2% vs. 51.6%, p=0.0016). Also, RS enabled the classification of RCCs into high-risk and low-risk groups, patients with tumors classified as low RS showed better PFS than patients with tumors with high RS (88.9% vs. 63.9%, p=0.0488).

Conclusions: CDK1 specific activity of tumors and the CDK2 specific activity are both associated with recurrence and prognosis. Analysis of cyclin-dependent kinase activity in the clinical setting could be a powerful approach for predicting cancer recurrence and prognosis in RCC after surgery and has potential for use as a routine laboratory test.

No significant financial relationships to disclose.

Significance of serum soluble Fas ligand in patients with bladder carcinoma

BACKGROUND

The interaction of Fas and Fas ligand (FasL) plays an important role in cytotoxic T-lymphocyte-mediated and natural killer cell-mediated apoptosis against tumor cells. Circulating soluble FasL (sFasL) has been suggested to provide protection from Fas-mediated apoptosis. The current study examined this possibility in patients with bladder carcinoma.

METHODS

The levels of sFasL in the serum of 163 patients with bladder carcinoma were determined using an enzyme-linked immunoadsorbent assay. Antiautologous tumor cytotoxic activity was assessed by the 12-hour chromium isotope ((51)Cr) release assay.

RESULTS

The mean serum level of sFasL in patients with bladder carcinoma was 2.5-fold higher than that in healthy donors. The level of serum sFasL in patients with muscle-invasive bladder carcinoma was 2.5-fold higher than that in patients with superficial bladder carcinoma. In addition, serum sFasL levels in patients with T1 and Tis bladder carcinoma was 2-fold and 2.7-fold higher, respectively, than levels in patients with Ta bladder carcinoma. The serum level of patients with sFasL in Grade 3 bladder carcinoma were 2.4-fold and 1.7-fold higher than that in patients with Grade 1 and Grade 2 bladder carcinoma, respectively. Patients with Ta bladder carcinoma with a low level of serum sFasL (less than the median value) had a longer postoperative tumor-free interval than patients with a high sFasL level (greater than the median value) in the 5-year follow-up. There was an apparent inverse correlation between the level of serum sFasL and antiautologous tumor cytotoxic activity.

CONCLUSIONS

The results of the current study demonstrated that the level of serum sFasL is correlated with both disease progression and increase in the tumor grade, and that an elevated serum sFasL level predicted early recurrence in patients with Ta bladder carcinoma. These findings suggest that elevated serum sFasL levels might be associated with a greater risk of disease progression and recurrence in patients with bladder carcinoma.

Isolation and characterizartion of alginic acid from commercially cultured Nemacystus decipiens (Itomozuku)

An alginate was isolated from commercially cultured Nemacystus decipiens which had been harvested in Yonashiro Town (Okinawa, Japan). The yield of the alginate was 1.6% (w/w of wet alga), and the uronic acid, ash and moisture contents of the alginate were 86.0%, 12.0%, and 2.3% (w/w), respectively. The molecular mass of the alginate was estimated to be about 1.5 x 10(5). The infrared spectrum and optical rotation of the alginate were in agreement with those of the standard alginate. D-Mannuronic acid and L-guluronic acid were identified by 1H- and 13C-NMR spectroscopy, the molar ratio of both sugar residues being estimated to be 0.72:1.00.

[Renal cell carcinoma with late skin metastasis: a case report]

An 81-year-old man complaining of appetite loss visited our clinic. Four subcutaneous nodules were visible. One was seen on the right chest, 1 on the left shoulder and 2 on the abdomen. They were soft, dome-like masses and 20 to 30 mm in diameter. Computed tomography revealed multiple metastatic lesions in the brain, lungs, abdomen and skin. The patient had undergone radical nephrectomy for renal cell carcinoma 15 years earlier. The histology of the biopsy specimens obtained at nephrectomy was grade 1 and that of the subcutaneous nodules was grade 2. The patient died 49 days after admission, in spite of interferon-alpha therapy. To our knowledge, this is the 63rd case of skin metastasis of renal cell carcinoma in Japanese literature.

[Intravesical instillation of Maalox for the treatment of bladder hemorrhage due to prostate cancer invasion: report of two cases]

Two cases treated by intravesical instillation of Maalox for bladder hemorrhage are reported. A 79-year-old man and an 81-year-old man were admitted because of macroscopic hematuria and bladder tamponade. In both cases, bladder hemorrhage caused by bladder invasion of prostate cancer had not improved after bladder lavage, intravenous drip infusion and medication of hemostatics. In the first case, bladder hemorrhage had decreased 4 days after the intravesical instillation of 50-100 ml Maalox for an hour per day. In the second case, irrigation of Maalox was performed because of the difficulty of intravesical instillation of Maalox due to irritable bladder. The bladder hemorrhage had not completely disappeared but improved 5 days after the bladder irrigation of 100 ml of Maalox with 100 ml of 0.9% NaCl for an hour per day. This method is easy and can be performed without complications. This method might be useful as first-line therapy in the case of severe bladder hemorrhage.

[Rhabdomyolysis following radical prostatectomy: a case report]

A case of postoperative rhabdomyolysis following radical prostatectomy for prostate cancer is reported. A 60-year-old man was referred to our hospital because of an elevation of prostate specific antigen detected by the health checkup system. Sextant biopsy for the prostate revealed moderately differentiated adenocarcinoma. Radical prostatectomy was performed after hormonal therapy for 10 months. Two to three days after surgery, the patient complained of a feeling of listlessness. Serum levels of creatine phosphokinase were elevated to 6,584 IU/ml and creatinine slightly elevated to 1.6 mg/dl. Symptoms and laboratory findings improved after sufficient fluid infusion and injection of furosemide. To our knowledge, this is only the third case report in the world literature of postoperative rhabdomyolysis after urological surgery.

[Predictability of Gleason score and reduction time (tau) of prostatic volume after castration for the prognosis of prostatic cancer]

PURPOSE

The efficacy of the reduction time (tau) after castration as a prognostic factor was examined by comparing to Gleason score.

MATERIALS AND METHODS

The change of prostatic volume after castration was observed from the castration to 3 months after in 24 cases of prostatic cancer. Prostatic volume was examined by transrectal ultrasonography of the prostate. Survival curves was calculated by Kaplan-Meier method. Differences among survival curves were analyzed using Cox-Mantel test.

RESULTS

tau had a close relationship to the prognosis of each case (Wilcoxon test: p < 0.05, Cox-Mantel test: p < 0.05). Gleason score had a weak relationship to prognosis (Wilcoxon test: N. S., Cox-Mantel test: p < 0.05).

CONCLUSIONS

tau was efficient as prognostic factor compared to Gleason score.

[Two cases of functioning parathyroid cysts]

Two cases of functioning cysts are reported. The first patient was a 48-year-old man who underwent percutaneous cyst puncture for a palpable mass in the neck at another hospital. Hypercalcemic crisis brought the patient to Koga General Hospital. The second patient was a 69-year-old woman with the complaint of discomfort in the right neck of several years duration and with a palpable mass identified on physical examination at a local hospital. Both patients had high serum calcium and parathyroid hormone (PTH) levels and were diagnosed as having functioning parathyroid cysts by imaging studies including ultrasonography, computed tomographic scan, magnetic resonance imaging and scintigraphy. After parathyroidectomy, their serum calcium and PTH levels became normal, but calcium supplement was necessary in the first patient. To our knowledge, these are the 40th and 41st cases reported in the Japanese literature.

Osteopathy in broiler chicks fed toxic mimosine in Leucaena leucocephala

Further studies of mimosine toxicity in broiler chicks were done to clarify a possibility of osteopathy. The mineral content and density of femur and the strength, ductility, and toughness for the index of mechanical properties significantly decreased in the 1% mimosine group, compared with those in the control and restricted groups. The stiffness had a decreasing tendency in the 1% mimosine group. Consequently, it was concluded that chicks fed ad libitum a 1% mimosine diet for 12 days developed osteopathy. The bone mineral density and the strength of the restricted group were lower than those of the control group, and those of the 1% mimosine group were still lower than those of the restricted group. Contents of pyridinoline and deoxypyridinoline in the excrement were significantly higher in the restricted group than those in the control group, but the contents in the 1% mimosine group were significantly lowest among the groups. Osteopathy in chicks fed mimosine, therefore, seemed to be done by loss of appetite and changing to a low turnover of bone caused by mimosine.

[Studies on DNA ploidy of biopsy and surgical specimen for renal cell carcinoma]

BACKGROUND

The object of this study is to evaluate the efficacy of selective renal tumor biopsy in patients with renal cell carcinoma. The accuracy of histological diagnosis and DNA content of biopsies in predicting those of surgical specimens was assessed.

METHODS

From 1985 to 1994, 41 patients with renal cell carcinoma underwent selective renal tumor biopsy before partial or radical nephrectomy. DNA content of renal cell carcinoma in 41 patients in biopsy specimens and surgical specimens were examined in paraffin blocks with static cytofluorometry (SCM) and flow cytometry (FCM).

RESULTS

In 39 out of 41 cases, by SCM, as well as in 37 out of 41 cases by FCM, DNA content of biopsy could be analyzed. Findings of selective renal tumor biopsy for RCC coincided with those of surgical specimen in 27/39 (accuracy 69%, kappa 0.398) in cell types, 29/39 (accuracy 74%, kappa 0.432) in structural types, 26/39 (accuracy 67%, kappa 0.341) in gradings and 27/39 (accuracy 69%, kappa 0.532) in ploidy patterns.

CONCLUSION

It was assumed that DNA histograms might help the histological diagnosis by biopsy.