Advanced and metastatic renal cell carcinoma – Ain Shams Clinical Oncology Department Experience

Background: Renal cell carcinoma is a rare tumor and till recently few treatment options were available. It is poorly understood why people develop RCC since only a few etiologic factors have been clinically identified as risk factors for RCC.Purpose: To analyze our experience at Ain Shams University Clinical Oncology department in Egypt with patients presenting with advanced renal cell carcinoma to provide a correlations between clinic-pathological factors, treatment and survival outcomes.Methodology: Retrospective review of the data of 54 patients who were diagnosed as RCC and presented to Ain Shams University Clinical Oncology department in Egypt from 1 May 2013 till 1 May 2015. Descriptive and clinic-pathological data were described using simple and relative frequencies. Survival outcome for the patients will be described using Kaplan Meier curves stratified according to morphology, age group and treatment received.Results: The sample included 54 patients (53.7% were males) of whom 14.3% were less than 40 years and 3.7% were elderly (≥ 70 years old). The median age was 55.5 years (SD ± 13.6 , range 19-71). Median PFS was 6.5 months (SD ± 12.3846 Range 43) while the median OS was 13 months (SD ± 12.161 Range 46). PFS in patients aged below 55.5 years was 9 months (95% CI=6.509-11.491) compared to 4 months (95% CI=2.704-5.296) in older patients (p = .004). PFS in patients who achieved PR after sunitinb was 17 months (95% CI=6.916-27.084) compared to 5 months (95% CI=3.699-6.301) in patients who didn’t achieved PR (p < .001). OS in patients aged below 55.5 years was 15 months (95% CI=9.131-20.869) compared to 11 months (95% CI=8.947-13.053) in older patients (p = .012). Favorable pathology status was associated with prolonged OS of 14 months (95% CI= 9.403-18.597) versus 11 months (95% CI=8.363-13.637) for unfavourable pathology status (p = .11). Low grades histopathogy was associated with prolonged OS of 44 months (95% CI= 38.456-49.544) versus 12 months (95% CI=10.077-13.923) for higher grades (p = < .001).Conclusion: Multivariate analyses supported a conclusion that younger age was an independent prognostic factor for survival along with other known risk factors such as tumor grade and pathology status.

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Kidney Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2006.0089 ◽

2006 ◽

Vol 4 (10) ◽

pp. 1072 ◽

Cited By ~ 2

Author(s):

_ _

Keyword(s):

United States ◽

Risk Factors ◽

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Kidney Cancer ◽

Renal Cell ◽

Tumor Grade ◽

The United States ◽

Nodal Metastases ◽

Recent Version

An estimated 38,890 Americans will be diagnosed with kidney cancer and 12,840 will die of this disease in the United States in 2006. Renal cell carcinoma (RCC) constitutes approximately 2% of all malignancies, with a median age at diagnosis of 65 years. Smoking and obesity are among the risk factors for RCC development, and tumor grade, local extent of the tumor, presence of regional nodal metastases, and evidence of metastatic disease at presentation are the most important prognostic determinants of 5-year survival. These guidelines discuss evaluation, staging, treatment, and management after treatment. For the most recent version of the guidelines, please visit NCCN.org

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Renal cell carcinoma in young compared to older patients: Comparison of clinicopathological risk factors and survival

Scandinavian Journal of Urology and Nephrology ◽

10.1080/00365590701571555 ◽

2008 ◽

Vol 42 (2) ◽

pp. 121-125 ◽

Cited By ~ 4

Author(s):

A. Thoroddsen ◽

G. V. Einarsson ◽

S. Hardarson ◽

V. Petursdottir ◽

J. Magnusson ◽

...

Keyword(s):

Risk Factors ◽

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Older Patients

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Faculty Opinions recommendation of Sorafenib for older patients with renal cell carcinoma: subset analysis from a randomized trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1127042.584173 ◽

2008 ◽

Author(s):

David M Nanus

Keyword(s):

Renal Cell Carcinoma ◽

Randomized Trial ◽

Cell Carcinoma ◽

Renal Cell ◽

Older Patients ◽

Subset Analysis

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Overall Survival Prediction in Renal Cell Carcinoma Patients Using Computed Tomography Radiomic and Clinical Information

Journal of Digital Imaging ◽

10.1007/s10278-021-00500-y ◽

2021 ◽

Author(s):

Zahra Khodabakhshi ◽

Mehdi Amini ◽

Shayan Mostafaei ◽

Atlas Haddadi Avval ◽

Mostafa Nazari ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Overall Survival ◽

Cell Carcinoma ◽

Clinical Features ◽

Renal Cell ◽

Radical Nephrectomy ◽

Clinical Information ◽

Tumor Grade ◽

Imaging Biomarkers ◽

Area Density

AbstractThe aim of this work is to investigate the applicability of radiomic features alone and in combination with clinical information for the prediction of renal cell carcinoma (RCC) patients’ overall survival after partial or radical nephrectomy. Clinical studies of 210 RCC patients from The Cancer Imaging Archive (TCIA) who underwent either partial or radical nephrectomy were included in this study. Regions of interest (ROIs) were manually defined on CT images. A total of 225 radiomic features were extracted and analyzed along with the 59 clinical features. An elastic net penalized Cox regression was used for feature selection. Accelerated failure time (AFT) with the shared frailty model was used to determine the effects of the selected features on the overall survival time. Eleven radiomic and twelve clinical features were selected based on their non-zero coefficients. Tumor grade, tumor malignancy, and pathology t-stage were the most significant predictors of overall survival (OS) among the clinical features (p < 0.002, < 0.02, and < 0.018, respectively). The most significant predictors of OS among the selected radiomic features were flatness, area density, and median (p < 0.02, < 0.02, and < 0.05, respectively). Along with important clinical features, such as tumor heterogeneity and tumor grade, imaging biomarkers such as tumor flatness, area density, and median are significantly correlated with OS of RCC patients.

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A convention-radiomics CT nomogram for differentiating fat-poor angiomyolipoma from clear cell renal cell carcinoma

Scientific Reports ◽

10.1038/s41598-021-84244-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yanqing Ma ◽

Weijun Ma ◽

Xiren Xu ◽

Zheng Guan ◽

Peipei Pang

Keyword(s):

Risk Factors ◽

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Logistic Model ◽

Clear Cell ◽

Cell Renal Cell Carcinoma ◽

Entire Cohort ◽

Conventional Ct ◽

Radiomics Signature

AbstractThis study aimed to construct convention-radiomics CT nomogram containing conventional CT characteristics and radiomics signature for distinguishing fat-poor angiomyolipoma (fp-AML) from clear-cell renal cell carcinoma (ccRCC). 29 fp-AML and 110 ccRCC patients were enrolled and underwent CT examinations in this study. The radiomics-only logistic model was constructed with selected radiomics features by the analysis of variance (ANOVA)/Mann–Whitney (MW), correlation analysis, and Least Absolute Shrinkage and Selection Operator (LASSO), and the radiomics score (rad-score) was computed. The convention-radiomics logistic model based on independent conventional CT risk factors and rad-score was constructed for differentiating. Then the relevant nomogram was developed. Receiver operation characteristic (ROC) curves were calculated to quantify the accuracy for distinguishing. The rad-score of ccRCC was smaller than that of fp-AML. The convention-radioimics logistic model was constructed containing variables of enhancement pattern, VUP, and rad-score. To the entire cohort, the area under the curve (AUC) of convention-radiomics model (0.968 [95% CI 0.923–0.990]) was higher than that of radiomics-only model (0.958 [95% CI 0.910–0.985]). Our study indicated that convention-radiomics CT nomogram including conventional CT risk factors and radiomics signature exhibited better performance in distinguishing fp-AML from ccRCC.

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191 Association of immune related adverse events with the efficacy of immune checkpoint inhibitors in metastatic renal cell carcinoma

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-sitc2020.0191 ◽

2020 ◽

Vol 8 (Suppl 3) ◽

pp. A205-A206

Author(s):

Vasilii Bushunow ◽

Leonard Appleman ◽

Roby Thomas

Keyword(s):

Renal Cell Carcinoma ◽

Adverse Events ◽

Cell Carcinoma ◽

Metastatic Renal Cell Carcinoma ◽

Renal Cell ◽

Checkpoint Inhibitors ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Kaplan Meier

BackgroundImmune checkpoint inhibitors (ICI) are first-line therapy for tumors including metastatic renal cell carcinoma (mRCC). Use of ICI is complicated by diverse immune-related adverse events (irAEs), which can add significant morbidity but are also associated with improved efficacy of therapy.1 2 Risk factors for development of irAE are still poorly understood. We hypothesized that patients with mRCC treated with ICI as first-line therapy have higher rates of developing irAE’s than patients previously treated with other therapies.MethodsWe conducted a single-institution, retrospective medical record review of patients with mRCC treated with immune-checkpoint inhibitors from March 2011 through April 15, 2020. We identified therapy duration, and presence, severity, and treatment of adverse events. We defined overall survival as time elapsed from date of diagnosis until death or until completion of study. We classified severity of adverse events according to CTCAE guidelines. Statistical methods included univariate Cox proportional hazards and logistic regression models, and Kaplan-Meier curves were plotted for subgroups.ResultsA total of 64 unique charts were reviewed. 18 patients (28%) of patients were treated with ICI as first-line therapy. 28 patients (44%) experienced immune-related adverse events with a total of 40 irAE’s identified. Most irAE were grade I-II (78%), with 7 (17%) grade III and 1 (2.4%) grade IV irAE’s. Most common sites were skin (29%), thyroid (20%) and gastrointestinal (15%). Patients with irAE had increased survival compared to those who did not have irAE (median survival not reached, vs 139 weeks, p=0.0004) (figure 1). This finding remained after excluding patients who had only experienced dermatologic irAE (median survival not reached in non-derm irAE subgroup, vs 144 weeks for dermatologic or no irAE, p=0.01) (figure 2). Patients treated with ICI as first line therapy had greater rates of developing irAE (72%) than those who had prior therapies (32%) (OR 5.4; p = 0.006). There was no association between histology type and rate of irAE.Abstract 191 Figure 1Kaplan-Meier survival plot of OS between patients with any irAE and those without any irAEAbstract 191 Figure 2Kaplan-Meier survival plot of OS between patients with non-dermatologic irAE and those without any irAE or only dermatologic irAEConclusionsThe development of irAE’s in patients with mRCC treated with ICI is associated with longer survival. This study joins the growing body of evidence showing that presence of irAE’s is associated with increased treatment efficacy. Use of ICI as first-line therapy is associated with higher risk of irAE. Given growing use of ICI as first-line therapy, further study to predict onset and severity of irAE’s is required.AcknowledgementsHong Wang, PhD, for statistical support.Ethics ApprovalThis study was approved by the University of Pittsburgh Institutional Review Board. Approval number STUDY19100386.ReferencesElias R, Yan N, Singla N, Levonyack N, Formella J, Christie A, et al. Immune-related adverse events are associated with improved outcomes in ICI-treated renal cell carcinoma patients. J Clin Oncol 2019;37(7):S645.Verzoni E, Cartenì G, Cortesi E, et al. Real-world efficacy and safety of nivolumab in previously-treated metastatic renal cell carcinoma, and association between immune-related adverse events and survival: the Italian expanded access program. J Immunother Cancer 2019;7(1):99.

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