Growth Rates of Genetically Defined Renal Tumors: Implications for Active Surveillance and Intervention

PURPOSE Published series of growth rates of renal tumors on active surveillance largely consist of tumors without pathologic or genetic data. Growth kinetics of genetically defined renal tumors are not well known. Here, we evaluate the growth of genetically defined renal tumors and their association with patient clinical and genetic characteristics. PATIENTS AND METHODS We evaluated patients with an inherited kidney cancer susceptibility syndrome as a result of a pathologic germline alteration of VHL, MET, FLCN, or BAP1 with at least 1 solid renal mass managed with active surveillance at our institution. Tumor growth rates (GR) were calculated and patients were stratified by genetic alteration and other clinical and genetic factors to analyze differences in growth rates using linear regression and comparative statistics. RESULTS A total of 292 patients with 435 genetically defined tumors were identified, including 286 VHL-deficient, 91 FLCN-deficient, 52 MET-activated, and 6 BAP1-deficient tumors. There were significant differences in GRs when stratified by genetic alteration. BAP1-deficient tumors had the fastest median GR (0.6 cm/y; interquartile range [IQR], 0.57-0.68 cm/y), followed by VHL-deficient tumors (GR, 0.37 cm/y; IQR, 0.25-0.57 cm/y), FLCN-deficient tumors (GR, 0.10 cm/y; IQR, 0.04-0.24 cm/y), and tumors with MET activation (GR, 0.15 cm/y; IQR, 0.053-0.32 cm/y; P < .001). Tumors from the same patient had similar GRs. Younger age was independently associated with higher GR ( P = .005). CONCLUSION In a cohort of genetically defined tumors, tumor growth rates varied in a clinically and statistically different manner according to genetic subtype. Rapid growth of BAP1-deficient tumors indicates that these patients should be managed with caution. The faster growth of tumors in younger patients may support more frequent imaging, whereas the slower growth of other tumors may support extended surveillance beyond annual imaging in some instances.

Distinguishing Renal Cell Carcinoma From Other Focal Renal Lesions on Multidetector Computed Tomography

Background: The increased use of imaging modalities has led to a greater incidence in depicting solid renal mass. These lesions comprise a wide spectrum of malignant such as renal cell carcinoma (RCC) and benign histologies. Objective: To determine the multidetector computed tomography (MDCT) features that discriminate RCC from other focal renal lesions. Methods: A retrospective review was performed on 148 patients who underwent renal CT scan followed by renal surgery or biopsy during January 2008 to July 2014. Specific predictive MDCT features of RCC were determined by logistic regression analysis. Interobserver agreement (kappa [K] values) was also calculated for each CT feature. Results: In 148 pathologic proved focal renal lesions, 91 (61.5%) were RCCs and 57 (38.5%) were non-RCCs. RCCs were more likely to be in male patients (OR, 5.39; 95% CI, 2.25 - 12.90), no internal fat component (OR, 46.50; 95% CI, 5.25 - 411.90), locate at peripheral (OR, 7.41; 95% CI, 1.63 - 33.73), and mixed central-peripheral locations (OR, 26.22; 95% CI, 4.23 - 162.58) of the kidney. There was moderate-to-excellent agreement among the readers over all these features (K = 0.43 - 0.91). Conclusions: Focal renal lesion with no internal fat component in MDCT is the most useful characteristic in differentiating RCCs from others.

Homoeopathic treatment leading to a unique response in a patient with renal cell carcinoma

A 45-year-old male patient presented with bilateral solid renal mass probably renal cell carcinoma (RCC). After initial treatment, the patient got symptomatic relief from pain in flanks, acute retention of urine and hematuria. The patient initially declined repeated investigations but agreed for an ultrasound after two years of treatment; the result showed reduction in size of the mass. The urea, creatinine and hemoglobin percentage were normal and reported a normal blood pressure. The quality of life was maintained without the conventional surgery, radiotherapy, chemotherapy, or immunotherapy. While this case provides evidence of positive outcomes for homeopathic therapy, more studies are required in a hospital setting to establish the real extent to which this therapy may be employed.