Prognostic Models and Algorithms in Renal Cell Carcinoma
Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH 44195, USA. Urologic Clinics of North America
(Impact Factor: 1.2).
12/2008; 35(4):613-25; vii. DOI: 10.1016/j.ucl.2008.07.003
Although surgical treatment is curative for localized renal cell carcinoma (RCC), 25% of patients present with locally advanced or disseminated disease, and disease will recur systemically in another 20% to 30% of those who have localized disease at presentation. Many clinical, histologic, and molecular factors have been identified that place patients who have localized RCC at greater risk for recurrence and those who have metastatic disease at risk for progression or death. This article reviews the major prognostic factors for RCC and the most commonly used algorithms developed for use before or after nephrectomy and before initiation of systemic therapy. These RCC nomograms allow more accurate counseling of patients regarding their likely clinical course and facilitate treatment planning.
Available from: Teiichiro Aoyagi
- "Renal cell carcinoma (RCC) is the most common type of kidney cancer and is classified into five histologic subtypes, clear cell (70–80%), papillary (10–15%), chromophobe (3– 5%), collecting duct (1%), and unclassified (1%) RCC . A quarter of patients with RCC will develop locally advanced or metastatic diseases and a third of patients with localized disease at presentation will have recurrence thereafter  . Since the malignant nature and therapeutic response to recent molecular targeting agents differ among the histological subtypes of RCC, it is critical to make a correct diagnosis of renal tumors. "
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ABSTRACT: New fluorescent Fluolid dyes have advantages over others such as stability against heat, dryness, and excess light. Here, we performed simultaneous immunostaining of renal tumors, clear cell renal cell carcinoma (RCC), papillary RCC, chromophobe RCC, acquired cystic disease-associated RCC (ACD-RCC), and renal angiomyolipoma (AML), with primary antibodies against Kank1, cytokeratin 7 (CK7), and CD10, which were detected with secondary antibodies labeled with Fluolid-Orange, Fluolid-Green, and Alexa Fluor 647, respectively. Kank1 was stained in normal renal tubules, papillary RCC, and ACD-RCC, and weakly or negatively in all other tumors. CK7 was positive in normal renal tubules, papillary RCC, and ACD-RCC. In contrast, CD10 was expressed in renal tubules and clear cell RCC, papillary RCC, AML, and AC-RCC, and weakly in chromophobe RCC. These results may contribute to differentiating renal tumors and subtypes of RCCs. We also examined the stability of fluorescence and found that fluorescent images of Fluolid dyes were identical between a tissue section and the same section after it was stored for almost three years at room temperature. This indicates that tissue sections can be stored at room temperature for a relatively long time after they are stained with multiple fluorescent markers, which could open a door for pathological diagnostics.
Available from: Seung Hyun Jeon
- "To date, several studies have been conducted to determine the differential characteristics of late recurrence of localized RCC after radical nephrectomy. However, on the basis of the current medical literature, no consensus has been reached about the parameters predicting late recurrence of localized RCC because of the small patient numbers [2-16]. According to the study by Adamy et al. , which was conducted with 44 patients with late recurrence (beyond 5 years after nephrectomy), patients with late recurrence tended to have fewer initial symptoms, smaller tumor size, and less aggressive disease (pT1) compared with patients with early recurrence. "
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ABSTRACT: The objective of this study was to determine the factors affecting the time to recurrence after radical nephrectomy for localized renal cell carcinoma.
We retrospectively evaluated 321 patients who received radical nephrectomies for localized renal cell carcinoma (pT1a-pT2b N0M0). Of 29 patients with disease recurrence, 9 had recurrence more than 5 years after radical nephrectomy. We evaluated the clinicopathological factors, with the use of a retrospective study design.
Tumor necrosis was statistically different between the late recurrence group and the recurrence free group (Fisher exact test, p=0.046). Hematuria at diagnosis (chi-square test, p=0.045) was statistically significant in early recurrence. In the univariate logistic regression analysis, tumor necrosis (odds ratio [OR], 4.629; 95% confidence interval [CI], 1.106 to 19.379; p=0.036) and pT stage>1 (OR, 7.232; 95% CI, 1.727 to 30.280; p=0.007) were risk factors of late recurrence. In the multivariable logistic regression analysis, pT stage>1 (OR, 7.143; 5% CI 1.706 to 29.912, p=0.007) was associated with late recurrence. Regarding early recurrence, initial symptoms at diagnosis and pathologic T stage>1 were statistically significant in both univariate and multivariable logistic regression analysis. In terms of recurrence site, patients with late recurrence tended to have unusual metastasis sites other than lung, liver or bone (chi-square test, p=0.012).
These data suggest that tumor necrosis may affect late disease recurrence. Patients with initial symptoms and hematuria at diagnosis are vulnerable to recurrence in a shorter period after nephrectomy. Patients with late recurrence showed a tendency to have unusual metastasis site other than lung, liver or bone.
Available from: Walter Martin Gregory
- "Many prognostic algorithms or models combine elements of the TNM staging system with tumour grade and combinations of pathological or clinical factors (Galfano et al, 2008; Lane and Kattan, 2008). However, estimates of risk may be relatively wide for individual patients, not applicable to all subtypes or stages of RCC and some models have not been independently validated. "
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ABSTRACT: Validated objective biomarkers are needed for patients with renal cell carcinoma (RCC) to guide patient management and define high-risk populations for follow-up or for therapeutic purposes.
Patients undergoing nephrectomy for RCC (n=286 all stages, 84% with conventional clear cell type) were included with a median duration follow-up of 5 years. The prognostic significance of pre-operative haematological and biochemical variables, including C-reactive protein (CRP) values were examined and whether they added additional information to a recently published pre-operative scoring system was determined.
C-reactive protein was the most significant predictor of overall survival (OS; χ(2)=50.9, P<0.001). Five-year OS for patients with CRP ≤ 15 mg l(-1) vs >15 mg l(-1) was 72% (95% CI 65-78%) and 33% (95% CI 23-44%), respectively. Similar results were seen for cancer-specific survival (CSS) and disease-free survival. On multivariate analysis, CRP remained highly significant for CSS (χ(2)=17.3, P<0.0001) and OS (χ(2)=9.8, P<0.002), in addition to other pre-operative variables including log of neutrophil/lymphocyte ratio, red blood cell count and white cell count. C-reactive protein was significant in addition to the pre-operative nomogram score (χ(2)=12.5, P=0.0004 for OS, χ(2)=16.2, P=0.0001 for CSS and χ(2)=8.6, P=0.003 for DFS) and was still significant when other pre-operative variables were included.
C-reactive protein and other haematological and biochemical variables have independent prognostic significance in RCC and may enhance pre-operative scoring systems.
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