FIVE YEARS SURVIVAL AND QUALITY OF LIFE AFTER RADICAL NEPHRECTOMY: A DESCRIPTIVE SINGLE CENTER STUDY

Objective: This study aims to evaluate five years of survival rate, and quality of life of the patient after radical nephrectomy in our center. Material & Methods: This descriptive longitudinal study included thirty patients who were diagnosed as having renal mass in the Urology division H. Adam Malik General Hospital between January 2014 and December 2015. All patients were completely followed-up for 5 years or the patient died during the observation. We used a translated and validated Indonesian written European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Version 3.0 (EORTC QLQ-C30) questionnaire to assess the patient’s quality of life. Results: Overall 5-years survival of kidney tumor patients was 100%, 66.67%, 50%, 8.33%, respectively for stage 1 to 4. We found a sharp decrease in the cumulative survival rate of stage IV group in the first 24 months compared to the first 12 months, from 66.67% to 25%. This pattern of decrease was not found in the other group of stage. Overall, the quality of life of patients has increased in the first three years postoperatively and decreased in the two years afterward. These fluctuations consistently occur in all groups. All of the groups had reached the maximum quality of life at the third year postoperatively. Conclusion: Stage I renal cell carcinoma patient shown the best five-years survival rate and quality of life among others. The quality of life for all groups inclined for the first three years after surgery and decline consistently afterward. These findings are in accordance with many studies that have been published previously.

Laparoscopic single port radical nephrectomy challenges: a case presentation

Renal cell carcinoma accounts 2 % of global cancer diagnoses and death. In Malaysia, its occurrence is found in 1.9 in 100,000 patients and more predominantly in male with ratio male to female of 2.75:1 in 2006. Radical nephrectomy has been proven to give the best chance of cure and long term survival. Throughout the years, conventional open surgery has evolved to single port laparoscopic surgery. It has its own advantages, difficulties and cases selections criteria. We report a successful case of Laparoscopic single port surgery in a renal cell carcinoma patient with underlying prostate carcinoma.

PD-L1+ and Hyal2+ myeloid cells in renal cell carcinoma: a case report

RCC patients frequently have increased numbers of immunosuppressive myeloid cells in circulation. High numbers of myeloid derived suppressor cells (MDSCs) in the blood are associated with immune suppression as well as with cancer-related inflammation which drives the mobilization of myeloid cells to tumor tissue. Here we show that peripheral blood from a previously untreated renal cell carcinoma patient has increased numbers of monocytic CD33+CD11b+ MDSCs, which also co-expressed PD-L1 and membrane-bound enzyme hyaluronidase 2 (Hyal2). PD-L1 expression is associated with immune suppression, whereas expression of Hyal2 is associated with inflammation, because Hyal2+ myeloid cells can degrade the extracellular hyaluronan (HA), leading to the accumulation of pro-inflammatory HA fragments with low molecular weight. These findings implicate the potential involvement of monocytic MDSCs in both tumor-associated immune suppression and cancer-related inflammation. Analysis of organoid-like tumor-tissue slice cultures prepared from cancer tissue of the same patient revealed the significant presence of PD-L1+ HLA-DR+ macrophage-like or dendritic cell-like antigen-presenting cells in tumor stroma. Interestingly that stroma-associated PD-L1+ cells frequently have intracellular hyaluronan. Collectively, data presented in this study suggest that the interplay between tumor-recruited myeloid cells and stromal hyaluronan may contribute to the inflammation and immune tolerance in cancer.

Semaphorin 3A induces cytoskeletal paralysis in tumor-specific CD8+ T cells

ABSTRACTSemaphorin-3A (Sema3A) regulates tumor angiogenesis, but its role in modulating anti-tumor immunity is unclear. We demonstrate that Sema3A secreted within the tumor microenvironment (TME) suppresses tumor-specific CD8+ T cell function via Neuropilin-1 (NRP1), a receptor that is upregulated upon activation with T cells’ cognate antigen. Sema3A inhibits T cell migration, assembly of the immunological synapse, and tumor killing. It achieves these functional effects through hyper-activating the acto-myosin system in T cells leading to cellular paralysis. Finally, using a clear cell renal cell carcinoma patient cohort, we demonstrate that human tumor-specific CD8+ T cells express NRP1 and are trapped in Sema3A rich regions of tumors. Our study establishes Sema3A as a potent inhibitor of anti-tumor immunity.

Safe use of nivolumab in a patient with renal cell carcinoma and hepatitis B

Introduction Immunotherapy with checkpoint inhibitors gains a major role in bladder cancer. Because of the treatment’s immune modulatory effects, patients may develop hepatitis. Hepatitis B was an exclusion criterion in clinical trials that investigated nivolumab. Therefore, its effects and risk of hepatitis B reactivation in nivolumab are not clinically investigated in renal cell carcinoma patients with hepatitis B. Case report In this case report, we presented a metastatic renal cell carcinoma patient who was treated with anti-viral treatment for hepatitis reactivation caused by previous sunitinib therapy. After progression, nivolumab was commenced and the patient was closely monitored with hepatic function tests. Management and outcome Nivolumab was well tolerated and no treatment-related adverse effect occurred. Hepatitis or viral hepatitis reactivation was not detected. Discussion This case supports the safety of nivolumab in patients with renal cell carcinoma and viral hepatitis.