Growth Pattern of Clear Cell Renal Cell Carcinoma in Patients with Delayed Surgical Intervention: Fast Growth Rate Correlates with High Grade and May Result in Poor Prognosis

Objectives.Previous studies revealed an unclear correlation between the growth rate of renal cell carcinoma (RCC) and tumor grade and did not focus on certain histological subtype. This report investigated the correlation between the growth rate and tumor grade in clear cell RCC (ccRCC).Methods. We reviewed 60 patients with 61 ccRCC confirmed by delayed surgeries after at least 12 months of active surveillance. The linear growth rate (LGR), volumetric growth rate (VGR), and volume doubling time (VDT) were calculated, and their correlations with clinicopathologic characteristics were analyzed.Results. The mean LGR, VGR, and VDT were 0.86 (range 0–4.74) cm/year, 20.96 (range 0.31–211.93) cm3/year, and 667 (range 33–3321) days, respectively. ccRCCs with high grade had greater LGR (P<0.001) and VGR (P=0.001) and lower VDT (P=0.017) than ccRCCs with low grade. Grade (OR = 5.185,P=0.004) was the only independent risk factor of LGR >0.5 cm/year, and grade (OR = 3.006,P=0.046) and initial size (OR = 0.392,P=0.004) were independent risk factors of VDT <1 year. Five patients developed metastasis after surgery with LGR >0.5 cm/yr altogether; of them, four had cancer-related death by the last follow-up.Conclusions. Fast growth rate of ccRCC is significantly correlated with high tumor grade and may result in poor prognosis, especially for those with LGR >0.5 cm/yr.

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Assessment of intratumor heterogeneity using imaging texture features in clear cell renal cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.663 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 663-663

Author(s):

Durga Udayakumar ◽

Durgesh Dwivedi ◽

Ze Zhang ◽

Yin Xi ◽

Tao Wang ◽

...

Keyword(s):

Gene Expression ◽

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Clear Cell ◽

Texture Features ◽

Tumor Grade ◽

High Grade ◽

Metabolic Processes ◽

Cell Renal Cell Carcinoma

663 Background: Intratumoral heterogeneity (ITH) relates to aggressiveness in clear cell renal cell carcinoma (ccRCC), the most common and aggressive subtype of kidney cancer. Percutaneous biopsies have high diagnostic accuracy. However, ITH lowers their reliability in larger, heterogeneous tumors. Haralick texture features extracted from a gray level co-occurrence matrix (GLCM) is a robust method to assess intrinsic tumor imaging characteristics. Some of these features, including entropy as a measure of ITH, have recently been used in differentiating malignant from benign tumors in various organs. We aim to understand how tumor entropy extracted from magnetic resonance (MR) imaging correlate with tumor grade (aggressiveness) and gene expression heterogeneity in ccRCC. Methods: This IRB-approved, prospective study included T2-weighted (T2W) and arterial spin labeled (ASL) MR images of 62 patients with ccRCC. The GLCM was constructed for regions-of interest (ROI) within the tumor and 13 Haralick texture features were estimated. Correlations between texture features and tumor grade were evaluated by logistic regression and quantified by the area under the receiving operating characteristic (ROC) curve (AUC). RNA sequencing of 182 tumor samples in 49 resected tumors was performed. Entropy was correlated with standard deviation (SD) of normalized gene expression levels in multiple samples from the same tumor. Spearman correlation (rho) was computed for each gene. False discovery rate q values < 0.05 were considered statistically significant. Results: Entropy was higher in high-grade than low-grade tumors (11.28 ± 0.52 vs. 10.95 ± 0.65) on T2W (q = 0.028) and ASL (10.45 ± 1.15 vs. 9.65 ± 1.29) (q = 0.013). Entropy had an AUC of 0.70 (T2) for high-grade prediction and was weakly correlated with tumor size (R2 = 0.2). Higher T2 and ASL entropy correlated with higher SD of gene expression. Gene ontology analysis of top correlated genes revealed strong enrichment of genes in metabolic processes. Conclusions: Higher MRI entropy predicts high tumor grade and correlates with increased heterogeneity in gene expression of metabolic processes.

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Down-regulation of BCL2L13 renders poor prognosis in clear cell and papillary renal cell carcinoma

Cancer Cell International ◽

10.1186/s12935-021-02039-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fei Meng ◽

Luojin Zhang ◽

Mingjun Zhang ◽

Kaiqin Ye ◽

Wei Guo ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Kidney Cancer ◽

Renal Cell ◽

Poor Prognosis ◽

Clear Cell ◽

Papillary Renal Cell Carcinoma ◽

Functional Enrichment ◽

Cancer Tissue ◽

Down Regulation

Abstract Background BCL2L13 belongs to the BCL2 super family, with its protein product exhibits capacity of apoptosis-mediating in diversified cell lines. Previous studies have shown that BCL2L13 has functional consequence in several tumor types, including ALL and GBM, however, its function in kidney cancer remains as yet unclearly. Methods Multiple web-based portals were employed to analyze the effect of BCL2L13 in kidney cancer using the data from TCGA database. Functional enrichment analysis and hubs of BCL2L13 co-expressed genes in clear cell renal cell carcinoma (ccRCC) and papillary renal cell carcinoma (pRCC) were carried out on Cytoscape. Evaluation of BCL2L13 protein level was accomplished through immunohistochemistry on paraffin embedded renal cancer tissue sections. Western blotting and flow cytometry were implemented to further analyze the pro-apoptotic function of BCL2L13 in ccRCC cell line 786-0. Results BCL2L13 expression is significantly decreased in ccRCC and pRCC patients, however, mutations and copy number alterations are rarely observed. The poor prognosis of ccRCC that derived from down-regulated BCL2L13 is independent of patients’ gender or tumor grade. Furthermore, BCL2L13 only weakly correlates with the genes that mutated in kidney cancer or the genes that associated with inherited kidney cancer predisposing syndrome, while actively correlates with SLC25A4. As a downstream effector of BCL2L13 in its pro-apoptotic pathway, SLC25A4 is found as one of the hub genes that involved in the physiological function of BCL2L13 in kidney cancer tissues. Conclusions Down-regulation of BCL2L13 renders poor prognosis in ccRCC and pRCC. This disadvantageous factor is independent of any well-known kidney cancer related genes, so BCL2L13 can be used as an effective indicator for prognostic evaluation of renal cell carcinoma.

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High expression of P53-induced Ring-h2 protein is associated with poor prognosis in clear cell renal cell carcinoma

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2012.10.004 ◽

2013 ◽

Vol 39 (1) ◽

pp. 100-106 ◽

Cited By ~ 5

Author(s):

X.R. Wu ◽

J.J. Sha ◽

D.M. Liu ◽

Y.H. Chen ◽

G.L. Yang ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Poor Prognosis ◽

Clear Cell ◽

High Expression ◽

Cell Renal Cell Carcinoma

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Renal Cell Carcinoma Metastasis to the Maxillary Bone: A Case Report and Review of the Literature

10.21203/rs.3.rs-35855/v1 ◽

2020 ◽

Author(s):

Naoto Nishii ◽

Hiroaki Shimamoto ◽

Toshimitsu Ohsako ◽

Misaki Yokokawa ◽

Yuriko Sato ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Literature Review ◽

Oral Cavity ◽

Cell Carcinoma ◽

Pulmonary Metastasis ◽

Renal Cell ◽

Poor Prognosis ◽

Clear Cell ◽

Tumor Resection ◽

Maxillary Bone

Abstract Background: Metastasis of renal cell carcinoma (RCC) to the oral cavity is rare. Given the poor prognosis of metastatic RCC, treatment choice is difficult. Here, we report a case of RCC metastasis to the maxillary bone, and provide a detailed literature review regarding the patient characteristics, treatments and outcomes of RCC metastasis to the oral cavity.Case presentation: An 89-year-old Japanese man presented with an 8 × 8-mm granulomatous tumor with palpable pulsation in the left upper gingiva, which had been clinically suspected as an arteriovenous malformation. The patient had undergone left nephrectomy for clear cell carcinoma 7 years prior. Pulmonary metastasis had appeared 3 years later. The patient underwent tumor resection of the maxilla after intravascular embolization, and the tumor was histopathologically diagnosed as a metastasis of clear cell RCC to the maxillary bone. Seventeen months after surgery, he died because of pulmonary metastasis without evidence of recurrence in the oral cavity.Conclusion: Our literature review reveals that oral metastatic lesions of renal cancer often exhibit rapid enlargement and cause severe symptoms, such as dysphagia and bleeding. Although oral metastasis of RCC has a poor prognosis due to the presence of concurrent disseminated metastases, surgical therapy may be recommended because of its high local control rate and ability to maintain quality of life.

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Commentary: Increased CDC6 Expression Associates With Poor Prognosis in Patients With Clear Cell Renal Cell Carcinoma

Frontiers in Oncology ◽

10.3389/fonc.2021.730782 ◽

2021 ◽

Vol 11 ◽

Author(s):

Mustafa Zafer Temiz

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Poor Prognosis ◽

Clear Cell ◽

Cell Renal Cell Carcinoma

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CT-based radiomic model predicts high grade of clear cell renal cell carcinoma

European Journal of Radiology ◽

10.1016/j.ejrad.2018.04.013 ◽

2018 ◽

Vol 103 ◽

pp. 51-56 ◽

Cited By ~ 43

Author(s):

Jiule Ding ◽

Zhaoyu Xing ◽

Zhenxing Jiang ◽

Jie Chen ◽

Liang Pan ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Clear Cell ◽

High Grade ◽

Cell Renal Cell Carcinoma

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A case of high-grade mucinous tubular and spindle cell carcinoma

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa014 ◽

2020 ◽

Vol 2020 (2) ◽

Author(s):

Koujin Miura ◽

Yasushi Adachi ◽

Toshiaki Shirahase ◽

Yoji Nagashima ◽

Kazuki Suemune ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Poor Prognosis ◽

Spindle Cell ◽

Left Kidney ◽

Spindle Cell Carcinoma ◽

Low Grade ◽

High Grade ◽

Tomography Scan

Abstract Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare renal cell carcinoma that initially presents as low-grade renal cell carcinoma. However, cases of MTSCC with high-grade histology and poor prognosis have been reported. Here, we report a case of MTSCC with high-grade histological features and metastasis. A 77-year-old woman consulted a hospital following frequent and painful micturition. Computed tomography scan revealed a tumor of the left kidney. First, chemotherapy was performed, with no effects. Therefore, nephrectomy was subsequently performed. Histologically, the tumor showed the features of MTSCC with sarcomatoid component. Metastasis of the tumor into the lymph node was also observed. Although adjuvant chemotherapy was performed after nephrectomy, metastasis to the lungs and bone and local recurrence was observed. The patient is still alive 2 years after nephrectomy with metastasis and recurrence of the tumor. High-grade MTSCC shows a relatively poor prognosis, specifically MTSCC with metastasis upon nephrectomy.

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