Renal Cell Carcinoma: A Review

BUB1-deficiency suppresses kidney renal clear cell carcinoma progression via the PI3K/Akt pathway: A bioinformatics-oriented validating study

Although great advances have been reached in the diagnosis, treatment and prognosis of kidney renal clear cell carcinoma (KIRC), the advancement of therapeutic strategies for KIRC in clinical practices have been seriously limited due to its unknown molecular mechanisms. To resolve this issue, through analyzing the datasets from the online UCSC database, a novel BUB1 gene was found to be elevated in the cancerous tissues compared to their normal tissues of KIRC, and and KIRC patients with high-expressed BUB1 tended to have a worse prognosis. The subsequent experiments validated that BUB1 protein was located in both nucleus and cytoplasm of KIRC cells, and the expression levels of BUB1 gene were significantly elevated in KIRC tissues and cells, in contrast to their normal counterparts. Loss-of-function experiments verified that knockdown of BUB1 suppressed cell proliferation, mobility, epithelial-mesenchymal transition (EMT) and tumor growth, whereas induced apoptotic cell death in the KIRC cells in vitro and in vivo. In addition, bioinformatics analysis predicted that the differentially-expressed genes (DEGs) in the BUB1-deficient cohorts were enriched in the cell division-related PI3K/Akt signal pathway, and we evidenced that silencing of BUB1 was capable of inactivating the downstream PI3K/Akt signal pathway. Of note, deficiency of BUB1-induced suppressing effects on the malignant phenotypes in KIRC cells were all reversed by co-treating cells with PI3K/Akt pathway activator 740Y-P. Furthermore, it was found that the expression status of BUB1 gene were related with epigenetic modifications, immune infiltration and immunotherapy responses in KIRC. Collectively, silencing of BUB1 inhibited the progression of KIRC through inactivating the downstream PI3K/Akt signal pathway, and BUB1 gene could be potentially used as biomarkers for the diagnosis and treatment of KIRC in clinic.

A novel peptide TCL6148 induces ferroptosis via the GOT1/GPX4 pathway to enhance sunitinib sensitivity in renal cell carcinoma

Renal cell carcinoma (RCC) represents a deadly type of genitourinary cancer, noted for its strong tendency to metastasize and its unfavorable outlook for patients. Despite significant advancements in targeted therapies and immunotherapies, tumor heterogeneity and therapeutic resistance remain formidable challenges, underscoring the urgent need for novel treatment strategies. Long non-coding RNAs (lncRNAs), once thought to be non-translatable, have recently been discovered to encode functional peptides that are crucial in the progression of tumors. In this study, we employed peptidomics to screen RCC tissues for lncRNA-encoded peptides and identified a novel peptide, TCL6148, encoded by TCL6. Through detailed bioinformatics assessments, laboratory experiments, and studies conducted in living organisms, we established that TCL6148 exerts anti-tumor effects by triggering ferroptosis in RCC cells through the GOT1/GPX4 signaling pathway. Mechanistically, TCL6148 facilitated the accumulation of Fe2+, increased levels of reactive oxygen species (ROS), and boosted lipid peroxidation, thus rendering RCC cells more susceptible to ferroptosis. Importantly, TCL6148 significantly enhanced the therapeutic effectiveness of sunitinib, indicating a promising combined approach for addressing drug resistance. In vivo experiments further validated the safety and efficacy of TCL6148 in suppressing RCC tumor growth. Collectively, our findings identify TCL6148 as a promising candidate for RCC treatment and provide novel insights into peptide-based therapeutic approaches, offering a potential avenue for improving RCC management.

Inhibition of the PI3K/AKT signaling pathway contributes to the anti-renal cell carcinoma effects of deoxyelephantopin

Renal cell carcinoma (RCC) is the most common kidney cancer. Despite advances in treatment, current therapeutic strategies are often limited by side effects, drug resistance, and low response rates, necessitating alternatives for RCC treatment. Deoxyelephantopin (DEO), a sesquiterpene lactone from Elephantopi Herba, has demonstrated anticancer properties in multiple cancer models; however, its effects on RCC remain unknown. This study aimed to investigate the anti-RCC effects of DEO and its underlying molecular mechanisms. Human RCC cell lines (786-O, Caki-1, A498) and a murine RCC cell line (RENCA) were used for in vitro assays. Results revealed that DEO dose-dependently inhibited cell viability and colony formation in 786-O, Caki-1, A498, and RENCA cells, while also inducing apoptosis in 786-O and Caki-1 cells. A RENCA allograft mouse model was used for in vivo assays. DEO significantly suppressed tumor growth without causing notable changes in body weight, organ coefficients, or serum biochemical markers (ALT, AST, BUN, Cr). Network pharmacology analysis predicted the PI3K/AKT signaling pathway as a key mediator of DEO's anti-RCC effects. Western blotting showed that DEO downregulated the expression of EGFR, p-EGFR (Tyr1068), PI3K p110α, p-Akt (Ser473), mTOR, p-mTOR (Ser2448), p-p70S6K (Thr389), 4E-BP1, p-4E-BP1 (Thr37/46), HIF-1α, and Bcl-2. Overactivation of AKT attenuated DEO's inhibitory effects on cell viability in 786-O cells. In conclusion, this study is the first to demonstrate that DEO exerts anti-RCC effects in both cellular and animal models, primarily through inhibition of the PI3K/AKT pathway. These findings suggest that DEO holds promise as a lead compound for RCC management.

Proteomics and succinylation modification characterization in clear cell renal cell carcinoma

Clear cell renal cell carcinoma (ccRCC) represents the most lethal form of kidney cancer, with a significant number of patients experiencing tumor progression. Succinylation modification is a novel post-translational modification (PTM) that refers to modifying a protein with a succinyl group, which most frequently happens to lysine residues. Recent studies have revealed that abnormal succinylation, altered protein activity, dysfunctional roles in energy metabolism, and subsequent epigenetic modifications are linked to the onset and progression of conditions like inflammation, cancer, and other diseases. No studies have offered a comprehensive analysis of succinylation modification in ccRCC or clarified the mechanisms by which this modification operates within disease progression. In this study, we applied quantitative proteomics and succinylation modification omics to extensively examine the global proteome and succinylation modification changes in ccRCC tissues. Using high-throughput liquid chromatography-mass spectrometry, we identified 4801 lysine succinylation modification sites across 1274 proteins in ccRCC and adjacent non-cancerous tissues. Additionally, 434 succinylation sites within 328 proteins displayed significant differential modification in ccRCC (fold change (FC) > 1.5 or p < 0.05). Notably, the succinylated proteins were primarily associated with energy metabolism pathways, including fatty acid elongation, glyoxylate and dicarboxylate metabolism, the tricarboxylic acid cycle, and oxidative phosphorylation, and were predominantly located within the mitochondria. This study is the first to present a global proteomic profile and a detailed succinylation modification landscape in ccRCC. These findings introduce new potential approaches for treating ccRCC by reversing abnormal succinylation modifications.

Do patients with intermediate-risk renal carcinoma who receive adjuvant pembrolizumab really benefit in recurrence-free survival? Analysis of a cohort of nephrectomies over 10 years

PURPOSE

Pembrolizumab has shown benefits as adjuvant therapy in the Keynote-564 trial, improving disease-free survival (DFS) across broad patient subgroups. However, it remains unclear if all patients, including those potentially cured by surgery alone, derive real benefits or are unnecessarily exposed to adverse effects and costs. This study aimed to evaluate DFS in Keynote-564-like patients who underwent nephrectomy without adjuvant pembrolizumab.

METHODS

We included nephrectomy patients meeting Keynote-564 criteria. Clinical and pathological features were analyzed, and Cox regression was used to identify predictors. DFS and overall survival (OS) were assessed.

RESULTS

Forty-three patients met Keynote-564 criteria (100% intermediate risk). Among them, 12 patients (28%) experienced recurrence. Significant differences between recurrent (Re+) and non-recurrent (Re-) patients were observed in ECOG ≥ 1 frequency (25% vs. 0%; p < 0.05), tumour size (9.4 vs. 6.9 cm; p = 0.02), and renal pelvis invasion (50% vs. 19%; p = 0.04). Cox regression identified ECOG ≥ 1 as a predictor of recurrence (HR = 17.97, 95% CI 1.76-187.16; p = 0.016). After a median follow-up of 59.5 months, 2-year DFS and OS were 86% and 93%, respectively. Treating only relapsed patients with pembrolizumab would have saved €1,254,167.

CONCLUSION

Our recurrence rate was lower than Keynote-564, whereby no strong predictors of recurrence were identified. Although ECOG ≥ 1 was statistically significant, its clinical utility remains limited. Further research is needed to determine if adjuvant pembrolizumab provides a true benefit in intermediate-risk patients.

Role of Systemic Therapy in Localized Renal Cell Carcinoma: Where Do We Stand and Where Are We Heading?

The effectiveness of immunotherapy and targeted therapy has been well established in metastatic renal cell cancer (mRCC). These therapies demonstrated higher overall response rates and led to prolonged survival. In contrast, in localized RCC, conventional treatment is either partial or complete nephrectomy. While surgery is a curative option in early stages, high recurrence rates remain a concern, with survival rates ranging from 53% to 85%, depending on the initial stage at the time of diagnosis. Given favorable outcomes with systemic therapies in the metastatic setting, there has also been an increased interest in utilizing these therapies for the localized stage with the rationale to eradicate the micro-metastatic clone, thereby reducing the recurrence rates. Despite these encouraging developments, challenges regarding the optimal timing, duration, and combination of systemic therapies are still under investigation. Adding to that, balancing the benefits of systemic therapies with potential toxicities is also crucial, especially in patients who might otherwise benefit from surgery alone. This review describes the current landscape, ongoing clinical trials, and future directions of systemic therapy in the management of localized RCC.

Activity of lenvatinib-based therapy in previously treated patients with metastatic renal cell carcinoma: A European multicenter study (LENVA-LAT)

BACKGROUND AND OBJECTIVE

Lenvatinib's activity after immune checkpoint inhibitors (ICI) combination therapy in renal cell carcinoma (RCC) remains unknown. We aimed to describe the real-world outcomes of patients with metastatic RCC (mRCC) treated with lenvatinib after failure of the prior standard of care.

METHODS

Multicenter retrospective study including patients with mRCC treated with lenvatinib-based therapies beyond first-line therapy between 2020 and 2024. The primary endpoints were objective response rate (ORR) and time-to-treatment failure (TTF). Secondary endpoints included disease control rate (DCR), overall survival (OS), and safety.

RESULTS

We included 133 patients, with a median age of 61 years. Clear-cell was the main subtype (82.0 %). Before lenvatinib treatment, 15.8 %, 51.9 %, and 27.8 % of patients showed favorable, intermediate, and poor risk disease, respectively, according to the International Metastatic RCC Database Consortium (IMDC). Moreover, patients received a median of 3 previous lines of treatment, including ICIs (90.2 %) and cabozantinib (90.2 %). Lenvatinib was given alone (45.9 %) or in combination with everolimus (33.8 %), pembrolizumab (18.0 %) or investigational agents (2.3 %). The ORR and DCR were 29.1 % and 67.7 %, respectively, with no differences between regimens or lines of treatment. With a median follow-up time of 13.5 months, the median TTF and OS were 6.2 and 9.6 months. Toxicity was manageable with dose modifications required in 34.6 %. The discontinuation rate was 9.8 %, with one toxic death.

CONCLUSION

Lenvatinib-based regimens were active and safe for heavily pre-treated patients with mRCC. These findings provide evidence to support its use in daily practice.

Metastatic Oncocytic Renal Neoplasm Presenting as Gastrointestinal Bleeding

Renal cancer (RC) is known for its diverse clinical presentations and unpredictable behavior. While it often metastasizes to common sites such as the lymph nodes, lungs, bones, and liver, its potential to metastasize to the gastrointestinal tract (GIT) is relatively rare. We report an unusual case of an 87-year-old male patient with a history of metastatic oncocytic renal neoplasm who presented with intermittent rectal bleeding. Colonoscopy revealed a bleeding mass in the sigmoid colon. Biopsy confirmed metastatic renal neoplasm, consistent with prior pathology. Immunohistochemistry was positive for AE1/AE3, CAIX, and PAX-8, supporting renal origin. Recent CT imaging showed enlargement of the left renal mass with direct extension into the descending colon and associated lymphadenopathy. Metastasis of RC in the GIT, especially the colon, is rare and even more so in oncocytic subtypes. This case underscores the importance of considering RC in patients with GI bleeding and a history of renal neoplasm. Early recognition and individualized, multidisciplinary management are crucial for optimal outcomes.

Von Hippel-Lindau Disease : A Comprehensive Review of Diagnosis, Genetics, Clinical Challenges, and Surveillance

von Hippel-Lindau (VHL) disease is a genetic condition predisposing individuals to the development of benign and malignant tumors across various organs. This review explores the intricate genetic underpinnings of VHL disease, its clinical manifestations, and the associated malignancy risks. The latest diagnostic criteria, surveillance guidelines, and advancements in therapeutic strategies, including the Food and Drug Administration-approved hypoxia-inducible factor-2α inhibitor, belzutifan, are focused on. Through a multidisciplinary approach, tailored surveillance programs aim to improve patient outcomes while balancing intervention risks. Emerging technologies such as wholebody magnetic resonance imaging and liquid biopsies hold promises for enhancing non-invasive surveillance. This review underscores the significance of ongoing research and interdisciplinary care in managing this complex syndrome.

Systemic Treatment of Locally Advanced or Metastatic Non-Clear Cell Renal Cell Carcinoma

Non-clear cell renal cell carcinoma (nccRCC) represents a heterogenous group of malignancies with varying degrees of clinical aggressiveness and response to different systemic therapies. As the characterization of subtypes of nccRCC continues to evolve, it is important to understand the evidence around systemic treatments used in advanced or metastatic stages of specific subtypes. Here, we review the literature on systemic therapies in nccRCC, with a focus on prospective trials that included patients with papillary renal cell carcinoma (RCC), chromophobe RCC, RCC not further classified/unclassified RCC, translocation RCC, collecting duct RCC, and renal medullary carcinoma. We also review emerging treatments for other molecularly defined subtypes of this disease.

Regulator of cullins-1 predicts a poor prognosis and regulates epithelial-mesenchymal transition process through GSK-3β/Wnt signaling in renal cell carcinoma

Background

Renal cell carcinoma (RCC) exhibits malignant biological characteristics of cell invasion and metastasis. The role of regulator of cullins-1 (ROC1) in RCC is unknown. The present work focused on exploring ROC1's biological effect on RCC as well as clarifying its related mechanism.

Methods

The messenger RNA (mRNA) expression of ROC1 in RCC tumor tissue and normal tissue was examined by reverse transcription-polymerase chain reaction (RT-PCR). We analyzed mRNA expression through RT-PCR, whereas protein level via western blot (WB) assay. We did some biological experiments in this study, including Cell Counting Kit-8 (CCK-8) assay, 5-ethynyl-2'-deoxyuridine (EdU) assay, Transwell invasion assay, and xenograft tumor assay.

Results

ROC1 expression markedly increased in the RCC samples relative to healthy samples. ROC1 was related to the dismal outcome of RCC patients. We also found that the overexpression of ROC1 (oeROC1) promoted cell proliferation, epithelial-mesenchymal transition (EMT), and invasion, whereas ROC1 interference had opposite effects. ROC1 regulated GSK-3β/Wnt pathway within RCC cells. By constructing the RCC metastasis model in nude mice, it was found that ROC1 knockdown inhibited tumor metastasis, while shGSK-3β could reverse the effect of ROC1 knockdown.

Conclusions

Collectively, our work preliminarily illuminated the tumor-promoting role of ROC1 in RCC and the potential molecular mechanism. Thus, our study may provide some evidence for the treatment of RCC.

The deubiquitinase YOD1 suppresses tumor progression by stabilizing ZNF24 in clear cell renal carcinoma

Metastasis remains a significant challenge in the management of clear cell renal cell carcinoma (ccRCC), and a continued focus on its underlying mechanisms is crucial for improving patient outcomes and optimizing clinical therapies. The ovarian-tumor related protease (OTU) is involved in regulating critical cell signaling pathways, but the functions of most OTUs have yet to be explored. In this study, an unbiased RNAi screening revealed that ovarian tumor domain-containing 2 (YOD1) knockdown significantly promoted cell metastasis. YOD1 downregulation promoted ccRCC growth and metastasis both in vitro and in vivo. Notably, YOD1 knockdown stimulated the growth of organoids derived from ccRCC patients. Further investigation revealed that YOD1 directly interacted with and stabilized Zinc finger protein 24 (ZNF24) expression by deubiquitination in a manner dependent on its catalytic activity. YOD1 inhibition attenuated ZNF24 transcriptional repression of vascular endothelial growth factor A (VEGFA), thereby promoting VEGFA gene expression. Furthermore, ZNF24 was identified as a key mediator of YOD1 function. The expression of YOD1 and ZNF24 was significantly downregulated in tumor tissues, with a strong correlation between them. Importantly, reduced YOD1 and ZNF24 levels were strongly associated with poor clinical outcomes in ccRCC patients. Our results reveal the mechanism by which YOD1 regulates VEGFA transcription and suppresses tumorigenesis by deubiquitinating ZNF24, providing a therapeutic target in ccRCC.

Paraneoplastic and symptomatic score (PRIMAL) for prediction of overall and cancer-specific survival after surgery in patients with renal cell carcinoma

PURPOSE

To develop the PRIMAL (Prognostic Risk stratification for Integrating Manifestations of symptoms and Abnormal Labs) score to predict prognosis in renal cell carcinoma (RCC) by integrating clinical presentation, paraneoplastic syndromes (PNS), and abnormal laboratory values at diagnosis.

MATERIALS AND METHODS

5256 T1-T4, N0/1, M0/1 RCC surgical patients from 4 institutions were analyzed retrospectively. Preoperative variables included hematuria, visceral pain, nausea/vomiting, thrombocytopenia (<100 × 109/L), hypoalbuminemia (<3.5 g/dL), anemia (<11.5 mg/dL for women, <12.5 mg/dL for men), elevated De Ritis Ratio (AST/ALT > 1.25), elevated neutrophil-to-lymphocyte-ratio (NLR > 2.27). Patients were stratified into 4 PRIMAL categories (Low = 0, Favorable-intermediate = 1-2, Unfavorable-intermediate = 1-2+anemia, High ≥ 3). Multivariable Cox regression and Kaplan-Meier analyses assessed association with overall survival (OS) and cancer-specific survival (CSS). C-indexes, Receiver operating characteristic curves and Area under curve assessed accuracy of the model towards OS and CSS individually and in combination with the Leibovich score.

RESULTS

2513 (48%) patients had low, 1532 (29%) favorable-intermediate, 909 (17%) unfavorable-intermediate, 302 (6%) high PRIMAL score. High score patients exhibited highest hazard ratios (HR) for all-cause mortality (ACM) (HR = 7.71, 95% CI = 5.98-9.93) and cancer-specific mortality (CSM) (HR = 8.54, 95% CI = 5.96-12.24). Five-year OS rates were 91%, 82%, 65% and 46%, while CSS rates were 95%, 90%, 76% and 60% for Low, Favorable-Intermediate, Unfavorable-Intermediate and High groups, respectively. PRIMAL achieved C-indexes of 0.70 for OS and 0.74 for CSS prediction. The combined CSS PRIMAL-Leibovich model yielded an AUC of 0.76 (P = 0.02), outperforming individual scores.

CONCLUSION

PRIMAL is a valuable tool for RCC prognostication, enabling assessment of disease aggressiveness at diagnosis. Including PRIMAL score during initial evaluations enhances stratification, identifying patients with a higher risk disease and aids clinical decision-making.

The pathogenesis and therapeutic implications of metabolic reprogramming in renal cell carcinoma

Renal cell carcinoma (RCC), a therapeutically recalcitrant genitourinary malignancy, exemplifies the profound interplay between oncogenic signaling and metabolic adaptation. Emerging evidence positions metabolic reprogramming as a central axis of RCC pathogenesis, characterized by dynamic shifts in nutrient utilization that transcend canonical Warburg physiology to encompass lipid anabolism, glutamine auxotrophy, and microenvironment-driven metabolic plasticity. This orchestrated rewiring of cellular energetics sustains tumor proliferation under hypoxia while fostering immunosuppression through metabolite-mediated T cell exhaustion and myeloid-derived suppressor cell activation. Crucially, RCC exhibits metabolic heterogeneity across histological subtypes and intratumoral regions-a feature increasingly recognized as a determinant of therapeutic resistance. Our review systematically deciphers the molecular architecture of RCC metabolism, elucidating how VHL/HIF axis mutations, mTOR pathway dysregulation, and epigenetic modifiers converge to reshape glucose flux, lipid droplet biogenesis, and amino acid catabolism. We present novel insights into spatial metabolic zonation within RCC tumors, where pseudohypoxic niches engage in lactate shuttling and cholesterol efflux to adjacent vasculature, creating pro-angiogenic and immunosuppressive microdomains. Therapeutically, we evaluate first-in-class inhibitors targeting rate-limiting enzymes in de novo lipogenesis and glutamine metabolism, while proposing biomarker-driven strategies to overcome compensatory pathway activation. We highlight the synergy between glutaminase inhibitors and PD-1 blockade in reinvigorating CD8+ T cell function, and the role of lipid-loaded cancer-associated fibroblasts in shielding tumors from ferroptosis. Finally, we outline a translational roadmap integrating multi-omics profiling, functional metabolomics, and spatial biology to match metabolic vulnerabilities with precision therapies.

Identification of Molecular Subtypes of Clear-Cell Renal Cell Carcinoma in Patient-Derived Xenografts Using Multi-Omics

Background/Objectives: Clear-cell renal cell carcinoma (ccRCC) is a heterogenous disease that can be classified into multiple molecular subtypes with differential prognosis and sensitivities to treatments based on their genomic, transcriptomic, proteomic, and metabolic profiles. Patient-derived xenografts (PDXs) are high-fidelity cancer models because they maintain similar genotypes and immunohistologic phenotypes to the parental tumors and respond to standard-of-care therapies as expected. However, whether the molecular subtypes identified in ccRCC patient samples are preserved in PDX models is not clear. Our objective is to compare the transcriptional and proteomic profiles of our PDX models to those of ccRCC patients and identify both similarities and distinctions between molecular profiles of PDX subtypes and corresponding ccRCC patient subtypes, so that proper PDX subtypes can be used when investigating the corresponding ccRCC patient subtypes. Methods: To match PDXs to the human ccRCC molecular subtypes, we compared the transcriptomic and proteomic profiles of five ccRCC PDX models established in our lab to those of the human ccRCC molecular subtypes reported by our group, as well as other groups, using hierarchical analysis, Principal Component Analysis (PCA), and Permutation Correlation Analysis. The enrichment of key molecular pathways in PDXs and ccRCC subtypes was determined using Gene Set Enrichment Analysis. Results: We found that each PDX resembles one of the molecular subtypes closely at both transcript and protein levels. In addition, PDXs representing different molecular subtypes show unique metabolic characteristics. Moreover, molecular subtypes of PDXs correlated with ccRCC patient subtypes in key pathway activities implicated in ccRCC progression and therapy resistance. Conclusions: Our results suggest that PDX subtypes should be used when investigating the molecular mechanism of cancer progression and therapy resistance for corresponding ccRCC patient subtypes. This "matching" strategy will greatly facilitate the clinical translation of positive findings into the optimal management of ccRCC patients.

CD70-targeted cancer theranostics: Progress and challenges

CD70, a tumor-associated antigen, exhibits elevated expression in clear cell renal cell carcinoma (ccRCC), nasopharyngeal carcinoma, and lymphoma, among others, with minimal presence in healthy tissues. CD70 has emerged as a promising biomarker for molecular imaging, targeted therapies, and immunotherapies. ImmunoPET imaging with single-domain antibody-derived tracers, such as [18F]RCCB6 and [68Ga]Ga-NOTA-RCCB6, demonstrates exceptional diagnostic precision, identifying both common and rare metastases from ccRCC. This capability enhances staging accuracy and further enables early intervention. Beyond diagnostics, CD70-targeted imaging optimizes patient selection for emerging therapies, such as CAR-T cells and antibody-drug conjugates, by stratifying candidates based on their CD70 expression levels. It also supports real-time monitoring of therapeutic responses, enabling dynamic adjustments to treatment. The integration of these imaging tools into clinical workflows enhances personalized treatment efficacy for CD70-expressing cancers. Radiotheranostic strategies can further allow the simultaneous diagnosis and treatment of malignancies, opening new horizons for the precise management of CD70+ tumors.

Tumor-Educated Platelets in Urological Tumors: A Novel Biosource in Liquid Biopsy

Platelets, traditionally recognized for their role in hemostasis, have emerged as pivotal players in cancer biology. They actively contribute to tumor proliferation, angiogenesis, immune evasion, and metastasis and thus play a significant role in cancer progression. Tumor-educated platelets (TEPs) acquire protumorigenic phenotypes through RNA, protein, and receptor profile alterations driven by interactions with tumors and their microenvironment. These modifications enable TEPs to enhance tumor growth and dissemination and to play a critical role throughout the metastatic process. Moreover, TEPs are promising biomarkers that can easily be analyzed in liquid biopsies. Since they dynamically mirror tumor activity through transcriptomic and proteomic changes, their analysis offers a non-invasive method for determining cancer detection and diagnosis, patient prognosis, therapy monitoring, and personalization of treatment. Their demonstrated accuracy in identifying cancer types and predicting treatment responses underscores their ability to provide real-time insights into tumor biology, including in urological malignancies. Their diagnostic potential and their accessibility as blood-sourced biomarkers position TEPs as transformative tools in advancing personalized oncology. Here, we focus on the role of TEPs in urological tumors, exploring their applications in early cancer detection, disease monitoring, and the design of tailored therapeutic strategies.

Robot-assisted partial nephrectomy and robot-assisted radical prostatectomy using the Chinese surgical systems KangDuo-SR-2000 and EDGE MP1000 versus the Da Vinci Xi system: a prospective, single-center, non-randomized clinical trial

PURPOSE

This study aims to compare the safety and efficacy of robot-assisted partial nephrectomy (RAPN) and robot-assisted radical prostatectomy (RARP) using the Chinese surgical systems KangDuo-SR-2000 (KD-SR-2000) and EDGE MP1000 (MP1000) versus the Da Vinci Xi (DV-Xi) system, to explore viable alternative options to DV-Xi.

METHODS

This prospective, single-center, non-randomized clinical trial enrolled 261 patients who underwent RAPN or RARP from August 2023 to June 2024. All surgeries were performed by 3 surgeons. For RAPN, the primary outcome included surgical success, positive surgical margin (PSM), warm ischemia time (WIT) and conversion to open or laparoscopic surgery. The secondary outcome was estimated glomerular filtration rate (eGFR). For RARP, the primary outcome was surgical success without conversion to open or laparoscopic surgery, and the secondary outcomes included PSM and urinary continence recovery at 4 weeks post-catheter removal.

RESULTS

Baseline demographics were comparable across the KD-SR-2000 group (n = 88), EDGE MP1000 group (n = 59) and DV-Xi group (n = 114). No significant differences observed in primary and secondary outcomes. However, operation time and suture time per stitch were longer in Chinese surgical systems for both RAPN and RARP compared to DV-Xi, and estimated blood loss (EBL) is higher in RAPN. Subgroup analyses indicated that performance differences were primarily attributed to the KD-SR-2000, with no significant differences observed between the MP1000 and DV-Xi. No severe complications (Clavien-Dindo grade ≥ 3) reported in any group.

CONCLUSIONS

Chinese surgical systems provide a viable alternative, demonstrating non-inferiority compared to DV-Xi.

TRIAL REGISTRATION NUMBER

ChiCTR2300074914; Registration Date: 2023-08-21.

Unveiling the multifaceted roles of long non-coding RNA CTBP1-DT in human diseases: Special attention to its microprotein-encoding potential

C-terminal binding protein 1 divergent transcript (CTBP1-DT) is a novel long non-coding RNA (lncRNA) located on human chromosome 4p16.3. Numerous studies have shown that CTBP1-DT plays a critical regulatory role in various human malignancies and non-malignant diseases. In several cancers, the expression of CTBP1-DT is upregulated, closely associated with the risk of 12 types of cancer, and strongly correlated with the clinical pathological features and poor prognosis of 10 of these cancers. Mechanistically, CTBP1-DT is stimulated by the transcription factors ETV5 and Sp1, or methylated by YTHDC1. By competitively inhibiting 12 microRNAs, it activates 3 signaling pathways that influence malignant behaviors of tumor cells, including proliferation, apoptosis, cell cycle arrest, migration, invasion, immune evasion, and chemoresistance. Importantly, it also encodes the microprotein DNA damage up-regulated protein (DDUP), which mediates cisplatin resistance through sustained response to DNA damage signals. Furthermore, CTBP1-DT has been implicated in the progression of non-malignant diseases such as diabetes and related conditions, cardiovascular diseases, and osteoarthritis. This review summarizes the latest research on the RNA and protein functions of CTBP1-DT in human diseases, outlines various molecular regulatory networks centered around CTBP1-DT, and discusses the opportunities and challenges of its clinical applications.

Comparing the long-term prognosis and renal function changes of partial nephrectomy (PN) and radical nephrectomy (RN) in T1 stage renal cell carcinoma patients

Background

Radical nephrectomy (RN) and partial nephrectomy (PN) are common surgical treatments for T1 stage renal cell carcinoma (RCC). However, the long-term impact of these surgical approaches on prognosis and renal function remains an area of ongoing investigation. This study compared the effects of these procedures on prognosis and renal function.

Methods

The data of 1,030 T1 stage RCC patients treated at Peking University Cancer Hospital & Institute between January 2014 and August 2022 were analyzed. The primary endpoints of the study were overall survival (OS) and cancer-specific survival (CSS). The secondary endpoints included the annual mean estimated glomerular filtration rate (eGFR) and the average annual eGFR change rates.

Results

Based on a median follow-up time of 57 months, the OS and CSS rates were 96.6% and 98.5% in the overall cohort, respectively. The multivariate analysis identified age [hazard ratio (HR), 2.664; 95% confidence interval (CI): 1.147-6.192; P=0.02], tumor grade (HR, 2.247; 95% CI: 1.050-4.810; P=0.04), and surgical approach (HR, 2.585; 95% CI: 1.056-6.325; P=0.04) as adverse prognostic factors for OS, and age (HR, 4.603; 95% CI: 1.035-20.471; P=0.045) and tumor grade (HR, 4.972; 95% CI: 1.752-14.111; P=0.003) as adverse prognostic factors for CSS. Throughout the follow-up period, the eGFR of the RN patients showed a gradual increase, while that of the PN patients remained stable (P<0.001). Among the patients with preoperative diabetes, the eGFR of the RN patients decreased significantly compared to that of the PN patients (P=0.03).

Conclusions

T1 stage RCC has a favorable prognosis with surgery, and PN is an oncologically safe option. A persistent eGFR difference was observed between the PN and RN groups, with RN showing a gradual upward trend. However, patients with pre-existing diabetes experienced a greater decline in renal function after RN, which highlights the advantages of PN for such patients.

Prognostic factors and nomogram development for survival in renal cell carcinoma patients with multiple primary cancers: a retrospective study

Background

Patients with renal cell cancer have an increased risk of developing multiple primary cancers (MPCs) due to improved survival rates. The purpose of this study was to evaluate the clinicopathological features of MPCs and to generate a useful tool for predicting cancer-specific survival (CSS) in these patients.

Methods

A retrospective analysis was conducted on data from renal cell carcinoma (RCC) who were diagnosed with MPCs between 2001 and 2021 from the Surveillance, Epidemiology, and End Results (SEER) database. Patients with RCC meeting the criteria were selected for Kaplan-Meier (KM) survival analysis. The main outcome of this study was CSS, defined as the time from the initial diagnosis to either death due to cancer or the last follow-up. The Cox regression model was used to analyze the CSS factors of MPCs, the results of the multivariate analysis were displayed in a forest map, and the significant variables identified in the multivariate Cox analysis were used to construct the nomogram. Area under the curve (AUC) and calibration plots were used to evaluate the predictive performance of the nomogram.

Results

A total of 2,078 cases of renal cancer with MPCs diagnosed between 2001 and 2021 were included. Age and grade were determined through both univariate and multivariate analyses to be independent prognostic factors affecting CSS. Based on clinical practice, the final nomogram was constructed using the variables: sex, age, grade, summary stage, tumor-node-metastasis (TNM) stage and tumor size to predict CSS at 60, 120, and 180 months. The concordance index (C-index) for the CSS nomogram was 0.670 [95% confidence interval (CI): 0.642-0.698]. The model demonstrated a good predictive performance. To assess the consistency between observed and predicted values, a calibration curve was developed.

Conclusions

This study identified risk factors for CSS in patients with clear cell RCC (ccRCC) with MPCs and developed a nomogram to predict CSS in these patients. The model demonstrates strong clinical applicability and can serve as a valuable clinical decision-making tool for physicians and patients.

2-Undecanone induces ferroptosis via the STAT3/GPX4 pathway to enhance sensitivity of renal cell carcinoma to sunitinib

The development of resistance significantly reduces the efficacy of targeted therapies, such as sunitinib, in renal cell carcinoma (RCC) patients, emphasizing the need for novel therapeutic agents. Natural products, known for their diverse chemical structures and mechanisms of action, offer promising anti-tumor potential with favorable safety profiles and lower toxicity compared to synthetic drugs. 2-Undecanone, a natural compound extracted from Houttuynia cordata Thunb., has demonstrated anti-tumor effects, but its specific role in RCC treatment remains unclear. In this study, we integrated network pharmacology with in vitro experiments to explore the mechanisms underlying 2-Undecanone's effects on RCC. Our results reveal that 2-Undecanone effectively inhibits RCC cell viability, proliferation, and migration. Mechanistically, we discovered that 2-Undecanone induces ferroptosis in RCC cells by promoting reactive oxygen species (ROS) generation, intracellular Fe2+ accumulation, glutathione (GSH) production, lipid peroxidation, and modulation of the STAT3/GPX4 signaling pathway. Furthermore, 2-Undecanone lowers the IC50 value of sunitinib in RCC cells, enhancing their sensitivity to this targeted therapy. Additionally, 2-Undecanone potentiates sunitinib-induced ferroptosis. In summary, our research reveals that 2-Undecanone enhances the sensitivity of RCC cells to sunitinib through targeting the STAT3/GPX4 pathway, providing new insights into potential therapeutic strategies for RCC.

Association of 5α-reductase inhibitor prescription with immunotherapy efficacy in metastatic renal cell carcinoma: a multicenter retrospective analysis

BACKGROUND

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of metastatic renal cell carcinoma (mRCC), but response rates remain heterogeneous, and reliable predictive biomarkers are lacking. Recent studies suggest that androgen receptor (AR) signaling plays a role in regulating CD8+ T-cell function, implying that 5α-reductase inhibitors (5-ARIs), which lower androgen activity, could enhance antitumor immunity and improve clinical outcomes in patients receiving immunotherapy. This study retrospectively investigates the impact of a history of 5-ARI use (≥12 months) on the efficacy of ICIs in mRCC.

METHODS

We conducted a multicenter retrospective cohort study of 185 patients with mRCC who received ICIs. Patients were stratified based on their history of 5-ARI use. Baseline characteristics included age, body mass index, International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk group, programmed death-ligand 1 (PD-L1) expression levels, tumor stage, and metastasis sites. The primary endpoints were progression-free survival (PFS) and overall survival (OS), analyzed using Cox proportional hazards models. Secondary endpoints included objective response rate (ORR) and disease control rate (DCR). Key immunological insights were gained through single-cell RNA sequencing analysis of tumor samples.

RESULTS

Patients with a history of 5-ARI use demonstrated improved ORR (59.8% vs 39.8%, p=0.0075) and DCR (87.0% vs 78.7%, p=0.1747) compared with those without. The median PFS and OS were significantly longer in the 5-ARI group, with HRs of 0.64 (95% CI: 0.47 to 0.86, p=0.0085) for PFS and 0.65 (95% CI: 0.47 to 0.90, p=0.0271) for OS. Subgroup analysis further indicated enhanced ICI efficacy with 5-ARI use across age, IMDC risk scores, and PD-L1 expression levels. Single-cell RNA sequencing analysis revealed that 5-ARI treated patients exhibited a reduced presence of regulatory T cells and CD8 T-cell exhaustion (CD8 Tex), and lower programmed cell death protein-1 expression in CD8 Tex cells, suggesting an immunologically favorable modification of the tumor.

CONCLUSION

A history of 5-ARI use is associated with improved responses to ICI therapy in mRCC, potentially through AR-related modulation of CD8+ T-cell activity and favorable alterations in the immune microenvironment. These findings support further investigation into androgen-targeted approaches as adjunctive strategies in immunotherapy for RCC.

Targeting Heat Shock Transcription Factor 4 Enhances the Efficacy of Cabozantinib and Immune Checkpoint Inhibitors in Renal Cell Carcinoma

Recently, immune checkpoint inhibitors (ICIs) and cabozantinib, a tyrosine kinase inhibitor (TKI), have been used to treat renal cell carcinoma (RCC); the combination of these agents has become a standard treatment for RCC. TKIs generally target vascular endothelial growth factor. However, cabozantinib is characterized by its targeting of MET. Therefore, cabozantinib can be used as a late-line therapy for TKI-resistant RCC. According to data from The Cancer Genome Atlas (TCGA), heat shock transcription factor 4 (HSF4) expression is higher in RCC tissues than in normal renal tissues. HSF4 binds to the MET promoter in colorectal carcinoma to enhance MET expression and promote tumor progression. However, the functional role of HSF4 in RCC is unclear. We performed loss-of-function assays of HSF4, and our results showed that HSF4 knockdown in RCC cells significantly decreased cell functions. Moreover, MET expression was decreased in HSF4-knockdown cells but elevated in sunitinib-resistant RCC cells. The combination of cabozantinib and HSF4 knockdown reduced cell proliferation in sunitinib-resistant cells more than each monotherapy alone. Furthermore, HSF4 knockdown combined with an ICI showed synergistic suppression of tumor growth in vivo. Overall, our strategy involving HSF4 knockdown may enhance the efficacy of existing therapies, such as cabozantinib and ICIs.

What Is Renal Cell Carcinoma?

This JAMA Patient Page describes renal cell carcinoma and its risk factors, signs and symptoms, treatment, and prognosis.

CNPY2 in Solid Tumors: Mechanisms, Biomarker Potential, and Therapeutic Implications

Canopy FGF signaling regulator 2 (CNPY2) has emerged as a crucial player in cancer development by promoting cell proliferation, tissue repair, and angiogenesis. This review synthesizes the current understanding of CNPY2's role in solid tumors, particularly renal cell carcinoma, prostate cancer, hepatocellular carcinoma, and non-small-cell lung cancer. CNPY2 modulates key pathways such as p53, MYLIP, NF-κB, and AKT/GSK3β, thereby driving tumor growth and progression. In renal cell carcinoma, CNPY2 paradoxically promotes tumor growth through p53 upregulation, while in hepatocellular carcinoma, CNPY2 drives cell cycle progression via p53 destabilization. In prostate cancer, it enhances tumor progression by stabilizing androgen receptors through MYLIP interaction, and in non-small-cell lung cancer, it contributes to chemoresistance and metastasis through NF-κB and AKT/GSK3β signaling. Additionally, CNPY2 influences the tumor microenvironment, impacting immune function and metastatic potential. As a potential biomarker, CNPY2 shows promise for cancer detection and prognosis, particularly when used in combination with other markers. Early therapeutic strategies, including siRNA and miRNA approaches, are under exploration, though challenges remain due to CNPY2's expression in normal tissues and potential off-target effects. This review underscores the need for further research to fully elucidate CNPY2's oncogenic mechanisms and develop targeted therapies. Improved understanding of CNPY2's diverse roles may lead to novel diagnostic and therapeutic approaches in solid tumors.

Contribution and expression of renal drug transporters in renal cell carcinoma

Renal cell carcinoma (RCC) is a common substantive tumor. According to incomplete statistics, RCC incidence accounts for approximately 90% of renal malignant tumors, and is the second most prevalent major malignant tumor in the genitourinary system, following bladder cancer. Only 10%-15% of chemotherapy regimens for metastatic renal cell carcinoma (mRCC) are effective, and mRCC has a high mortality. Drug transporters are proteins located on the cell membrane that are responsible for the absorption, distribution, and excretion of drugs. Lots of drug transporters are expressed in the kidneys. Changes in carrier function weaken balance, cause disease, or modify the effectiveness of drug treatment. The changes in expression of these transporters during cancer pathology results in multi-drug resistance to cancer chemotherapy. In the treatment of RCC, the study of drug transporters helps to optimize treatment regimens, improve therapeutic effects, and reduce drug side effects. In this review, we summarize advances in the role of renal drug transporters in the genesis, progression, and treatment of RCC.

Robotic Surgery in the Management of Renal Tumors During Pregnancy: A Narrative Review

Renal masses are uncommon during pregnancy; they represent the most frequently encountered urological cancer in pregnant patients and require careful surgical planning. The introduction of robotic surgical systems aims to address these challenges by simplifying intra-corporeal suturing and reducing technical complexity. Robot-assisted laparoscopic renal surgery offers potential benefits over both open surgery and conventional laparoscopy, providing greater precision and reduced invasiveness, particularly in tumor excision and suturing. Although urological tumors during pregnancy are rare, early detection significantly improves outcomes by enabling intervention before the tumor advances and while the uterus remains relatively small. The decision regarding the timing and necessity of surgery in pregnant patients requires a careful assessment of maternal health, fetal development, and the progression of the disease. Risks for adverse pregnancy outcomes should be explained, and the patient's decision about pregnancy termination should be considered. Radical nephrectomy or nephron-sparing surgery are essential treatments for the management of renal tumors. Effective management demands close collaboration between a multidisciplinary team and the patient to ensure individualized care. The aim of this review was to evaluate the renal tumors during pregnancy in terms of epidemiology, risk factors, diagnosis and the safety of a robot-assisted laparoscopic approach in the management of these tumors.

Incidence and survival patterns of clear cell renal cell carcinoma from 2000 to 2017: A SEER Database Analysis

Background: Clear cell renal cell carcinoma (ccRCC) incidence and death have considerably changed in recent years. Our study aimed to investigate the incidence, survival, and tumor characteristics of ccRCC in the year of diagnosis. Methods: Our study participants were selected from the SEER database (2000-2017). Age-standardized incidence rates were calculated to compare incidence rates across time. In addition, we used Kaplan-Meier curves to calculate overall survival (OS) and Cox proportional hazards models to explore risk factors associated with mortality outcomes in patients with ccRCC. Results: In the SEER analysis from 2000 to 2017, the increasing trend in age-adjusted incidence of ccRCC has remained relatively stable over the years, increasing from 2.63 per 100,000 in 2000 to 8.79 per 100,000 in 2017. The increase in the incidence of patients at a localized stage plays a decisive role in the overall increase in the incidence of ccRCC. Conclusions: In the general population, patients diagnosed between 2009-2017 had a higher survival rate than those diagnosed between 2000-2008, which is consistent with all stages of the tumor. The incidence of ccRCC increases steadily with the year of diagnosis, while overall survival has significantly improved.

Pharmacovigilance imbalance analysis of VEGFR-TKI-related taste and smell disorders

Taste and smell disorders (TSDs) can induce diminished interest in food, inadequate nutrient intake, and emotional irregularities, particularly among cancer patients. Previous research found that the main culprits of TSD development in cancer patients are cytotoxic drugs such as taxol, fluorouracil, cyclophosphamide, and anthracycline-based drugs. The advent of targeted drugs such as vascular endothelial growth factor receptor-tyrosine kinase inhibitors (VEGFR-TKIs) has significantly extended the survival time of cancer patients, and thus widely used in clinical practice. However, the association between the use of VEGFR-TKIs and the development of TSDs havs not been studied.The adverse event(AE) reports related to VEGFR-TKIs were downloaded from the FDA Adverse Event Reporting System (FAERS) database. Disproportionality analysis was conducted to assess the correlation between VEGFR-TKIs and TSDs. The Standardized Medical Dictionary for Regulatory Activities (MedDRA) Queries (SMQs) were used to analyze the AEs of TSDs. The study found a statistically significant correlation between the occurrence of TSDs and the use of VEGF-TKIs (cabozantinib, axitinib, pazopanib, sunitinib, nintedanib, and lenvatinib).However, the instructions for Nintedanib, Sorafenib and Lenvatinib were not mentioned. Capbottinib demonstrated the highest number of reports(1790 cases), also with the strongest association (ROR 95%CI-low = 16.51; PRR = 16.18; IC025 = 3.96) when analyzing the narrow SMQ of TSDs. Dysgeusia, taste disorder, and ageusia were the most commonly reported preferred terms (PTs) in VEGFR-TKI-related TSDs, accounting for more than 90% of the reported cases. Cabozantinib showed the highest number of reports and strongest correlation with ageusia, taste disorder, parosmia, and anosmia. The study found significant association between the reports of TSDs and the use of VEGFR-TKIs, indicating the monitoring of TSD development and appropriate management in clinical is necessary.

Genetic Variations in MDM2 Gene Contribute to Renal Cell Carcinoma Susceptibility: A Genotype-Phenotype Correlation Study

BACKGROUND

This study aimed to investigate the polymorphic genotypes of MDM2 rs937282, rs937283, rs2279744, and rs769412, as well as the combined effects of MDM2 genotypes and environmental factors on RCC susceptibility.

METHODS

A total of 135 RCC patients and 590 controls were recruited for MDM2 genotyping using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Quantitative PCR was performed to assess MDM2 mRNA levels among 30 healthy individuals and 22 RCC patients.

RESULTS

MDM2 rs2279744, but not other polymorphisms, was significantly associated with an increased RCC risk (p = 0.0133). The MDM2 rs2279744 G allele was identified as a risk factor for RCC (odds ratio [OR] = 1.49, 95% confidence interval [CI] = 1.14-1.96, p = 0.0047). Among smokers (p = 0.0070), alcohol drinkers (p = 0.0233), individuals with hypertension (p = 0.0041), diabetes (p = 0.0225), and those with a family history of cancer (p = 0.0020), the MDM2 rs2279744 GT and GG genotypes exhibited increased RCC risks. However, this risk effect was not observed in non-smokers, non-drinkers, or individuals without hypertension, diabetes, or a family cancer history (all p > 0.05). Moreover, MDM2 mRNA levels were significantly higher in RCC patients compared to controls and varied among the rs2279744 genotypes, with GG genotype exhibiting the highest expression levels among both RCC patients and controls.

CONCLUSIONS

This study highlights the association between MDM2 rs2279744 genotypes and RCC risk, suggesting that genotype-associated MDM2 mRNA levels could contribute to early RCC detection. Further studies are warranted to elucidate the detailed mechanisms underlying the role of MDM2 in RCC development.

Centromere protein K enhances the activation of YAP1/TAZ signal cascade to drive the progression of clear cell renal cell carcinoma

Centromere protein K (CENPK) is a newly identified malignancy-related gene that exhibits differential expression in various cancers and plays a crucial role in carcinogenesis. However, it remains uncertain whether CENPK is involved in clear cell renal cell carcinoma (ccRCC). This work aimed to unveil the expression, clinical significance, biological functions, and regulatory mechanisms of CENPK in ccRCC. Through analysis of RNA-seq data obtained from TCGA, a high expression pattern of CENPK was identified in ccRCC, which was found to be associated with pathologic stage, histologic grade, and clinical outcome. The enrichment of CENPK in ccRCC was further verified through the analysis of clinical samples. By conducting cellular functional experiments, we showed an inhibitory effect of CENPK knockdown on the malignant behavior of ccRCC cells. GSEA revealed a close relationship between CENPK and the Hippo-YAP1/TAZ signal cascade. The following experiments demonstrated that the activation of YAP1/TAZ was strongly inhibited by CENPK knockdown, and this change was accompanied by a decrease in the levels of CTGF and CYR61. Blockade of the MST1/2-LATS1/2 axis reversed the suppressive impact of CENPK knockdown on YAP1/TAZ. The tumor-promoting impact observed upon CENPK overexpression was diminished in YAP1 knockout cells. Notably, ccRCC cells with reduced CENPK expression exhibited a diminished capability to form tumors in nude mice. This report highlights the importance of CENPK in ccRCC and sheds new light on the underlying mechanism of this cancer type. Therefore, CENPK has the potential to serve as a viable candidate target for treating ccRCC.

Clinical value of contrast-enhanced ultrasound combined with quantitative analysis in Bosniak ≥ II cystic renal masses

OBJECTIVE

The 2019 Bosniak classification has improved the precise and detailed quantitative evaluation criteria, making the diagnosis of cystic renal masses (CRMs) more accurate and objective. This study addresses the clinical value of quantitative analysis and aims to investigate the feasibility of combining contrast-enhanced ultrasound (CEUS) with quantitative analysis for diagnosing Bosniak ≥ II CRMs.

METHODS

We retrospectively obtained 58 CRMs with confirmed pathology, which underwent CEUS and Contrast-enhanced computer tomography (CECT) evaluations according to Bosniak classification between January 2013 and August 2024. These lesions were divided into benign and malignant groups, followed by a quantitative analysis of the morphological details detected by CEUS. All morphological parameters were compared, and the diagnostic efficiencies were evaluated using receiver operating characteristics (ROC) curves, logistic regression (LR) analysis, and diagnostic curve analysis (DCA). Additionally, a cohort of 72 lesions was monitored for a period of ≥ 3 years, and changes in Bosniak classification were analyzed by categorizing them into stable, upgraded, and downgraded categories.

RESULTS

The analysis revealed no statistically significant difference between CEUS and CECT in our cohort's malignancy predictive rates across different Bosniak grades (p = 0.640). All morphological quantitative parameters showed statistically significant differences between the two groups (p < 0.001). ROC curve analysis revealed that the sum of enhanced wall thickness and enhanced septum thickness among quantitative parameters had the highest AUC value (AUC: 0.9226). Both LR models demonstrated superior clinical diagnostic performance with similar level of accuracy between qualitative and quantitative analysis, as evidenced by ROC (AUC: 0.9470, 0.9619, respectively) and DCA analyses. None of the lesions in the follow-up cohort were upgraded, suggesting that CRMs are relatively stable tumors with a low malignant potential.

CONCLUSION

This retrospective study demonstrated that CEUS combined with Bosniak classification and quantitative analysis could enhance diagnostic confidence in differentiating Bosniak ≥ II CRMs and could serve as a viable alternative to CECT in specific cases.

Gemcitabine-Loaded Microbeads for Transarterial Chemoembolization of Rabbit Renal Tumor Monitored by 18F-FDG Positron Emission Tomography/X-Ray Computed Tomography Imaging

BACKGROUND/OBJECTIVES

The purpose of this study was to develop the gemcitabine-loaded drug-eluting beads (G-DEBs) for transarterial chemoembolization (TACE) in rabbit renal tumors and to evaluate their antitumor effect using 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography/X-ray computed tomography (18F-FDG PET/CT).

METHODS

DEBs were prepared by polyvinyl alcohol-based macromer crosslinked with N-acryl tyrosine and N,N'-methylenebis(acrylamide). Gemcitabine was loaded through ion change to obtain G-DEBs. Their particle size and drug release profile were characterized. VX2 tumors were implanted in the right kidney of rabbits to establish the renal tumor model. The tumor-bearing rabbits received pre-scan by 18F-FDG PET/CT, followed by targeted transarterial injection of G-DEBs under digital subtraction angiography (DSA) guidance. The rabbits received another 18F-FDG PET/CT scan 10 or 14 days after the treatment. The therapeutic effect was further validated by histopathological analysis of the dissected tumors.

RESULTS

The average particle size of the microspheres was 58.06 ± 0.50 µm, and the polydisperse index was 0.26 ± 0.002. The maximum loading rate of G-DEBs was 18.09 ± 0.35%, with almost 100% encapsulation efficiency. Within 24 h, GEM was eluted from G-DEBs rapidly and completely, and more than 20% was released in different media. DSA illustrated that G-DEBs were delivered to rabbit renal tumors. Compared with the untreated control group with increased tumor volume and intense 18F -FDG uptake, the G-DEBs group showed significant reductions in tumor volume and maximum standard uptake value (SUVmax) 10 or 14 days after the treatment. Histopathological analysis confirmed that the proliferating area of tumor cells was significantly reduced in the G-DEBs group.

CONCLUSIONS

Our results demonstrated that G-DEBs are effective in TACE treatment of rabbit VX2 renal tumors, and 18F-FDG PET/CT provides a non-invasive imaging modality to monitor the antitumor effects of TACE in renal tumors.

Real-World Oncological Outcomes of Nivolumab Plus Ipilimumab in Advanced or Metastatic Renal Cell Carcinoma: A Multicenter, Retrospective Cohort Study in Japan

A combination of nivolumab and ipilimumab (NIVO + IPI) is the only approved combination of two immune checkpoint inhibitors for metastatic or advanced renal cell carcinoma (mRCC). Inadequate evidence of treatment with NIVO + IPI has been reported in Japanese cohorts. We evaluated the clinical efficacy of NIVO + IPI treatment. Patients with mRCC who received NIVO + IPI at nine Japanese facilities between August 2018 and March 2023 were enrolled in this study. The primary endpoint in this study was the assessment of oncological outcomes in patients with mRCC who received NIVO + IPI. Eighty-four patients with mRCC were enrolled. The median follow-up period was 18.3 months, and median progression-free and overall survival were 13.3 and 50.9 months, respectively. The objective response rate was 47.6%, and the disease control rate was 78.6%. To our knowledge, this is the largest study that evaluates Japanese patients with mRCC receiving NIVO + IPI treatment. In this study, the real-world oncological outcomes after NIVO + IPI treatment were comparable to those in the CheckMate 214 study.

Impact of Mannitol Administration on Postoperative Renal Function After Robot-Assisted Partial Nephrectomy

Background: This study investigated the effect of mannitol administration on postoperative renal function during robot-assisted partial nephrectomy (RAPN) in patients with renal cell carcinoma (RCC). Methods: Patients with RCC who underwent RAPN at eight Japanese facilities between March 2016 and November 2023 were enrolled. In this study, patients were categorized into two groups according to those who received mannitol during RAPN (Group I) and those who did not receive mannitol (Group II). Differences in covariates between the two groups were adjusted using propensity score matching (PSM). Results: The study included 1530 patients with RCC who underwent RAPN. PSM was performed on 531 participants in each group. No difference was observed in perioperative outcomes between the two groups in terms of length of hospital stay, surgical outcomes, achievement ratio of Trifecta, and estimated glomerular filtration rate at 28 days, 90 days, and 1 year postoperatively. Conclusions: Intraoperative mannitol administration during RAPN for improving renal function may be unnecessary.