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Rakic I, Rakic N, Stephens A, Corsi N, Davis M, Tinsley S, Butaney M, Arora S, Sood A, Autorino R, Rogers C, Abdollah F. Assessing the impact of lymphovascular invasion on overall survival in surgically treated renal cell carcinoma patients: A nationwide cohort analysis. Urol Oncol 2023; 41:435.e1-435.e9. [PMID: 37625905 DOI: 10.1016/j.urolonc.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/07/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Lymph-vascular invasion (LVI) is recognized as an adverse pathological feature in patients with renal cell carcinoma (RCC). However, its impact on overall survival (OS) is not clear and scarcely addressed in the literature. We aimed to assess the prognostic ability of LVI as a predictor of OS in RCC patients using a large, North American cohort. METHODS We included 95,783 cM0 RCC patients, diagnosed between 2010 and 2015, who underwent partial or radical nephrectomy within the National Cancer Database. Kaplan-Meier curves and log-rank tests were used to depict and compare survival curves. Cox regression analysis tested the impact of LVI on OS, after adjusting for all available confounders. RESULTS Mean age (SD) was 59 (12), and most patients had pT1 stage (72.2%). Nodal status was pN0, pN1, and pNx, in 14.5%, 2.3%, and 83.3%, respectively. Overall, 9.0% of patients had LVI. The mean (SD) follow-up of the cohort was 39 months (24). At 5 years, OS was 65% in patients with LVI vs. 86% in patients without LVI (p<.0001). When patients were stratified based on nodal stage, these rates were 64% vs. 78% in pN0 patients, 31% vs. 41% in pN1 patients, and 69% vs. 87% in pNx patients (all P < 0.001). On multivariable analysis, and in comparison to patients without LVI, those with LVI had 1.37- (P < 0.001), 1.18- (P = 0.068), and 1.53-fold (P < 0.001) greater risk of death, when also harboring pN0, pN1, and pNx disease, respectively. CONCLUSIONS Our findings are the first, to our best knowledge, to illustrate the clear detrimental impact of LVI on OS in surgically treated RCC patients. These findings might be useful in postoperative patient counseling and need to be accounted for when designing future clinical trials.
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Affiliation(s)
- Ivan Rakic
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | - Nikola Rakic
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Alex Stephens
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | - Nicholas Corsi
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | - Matt Davis
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI
| | | | - Mohit Butaney
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Sohrab Arora
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Craig Rogers
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Firas Abdollah
- Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI.
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Li W, Wang B, Dong S, Xu C, Song Y, Qiao X, Xu X, Huang M, Yin C. A Novel Nomogram for Prediction and Evaluation of Lymphatic Metastasis in Patients With Renal Cell Carcinoma. Front Oncol 2022; 12:851552. [PMID: 35480102 PMCID: PMC9035798 DOI: 10.3389/fonc.2022.851552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Lymphatic metastasis is an important mechanism of renal cell carcinoma (RCC) dissemination and is an indicator of poor prognosis. Therefore, we aimed to identify predictors of lymphatic metastases (LMs) in RCC patients and to develop a new nomogram to assess the risk of LMs. Methods This study included patients with RCC from 2010 to 2018 in the Surveillance, Epidemiology, and Final Results (SEER) database into the training cohort and included the RCC patients diagnosed during the same period in the Second Affiliated Hospital of Dalian Medical University into the validation cohort. Univariate and multivariate logistic regression analysis were performed to identify risk factors for LM, constructing a nomogram. The receiver operating characteristic (ROC) curves were generated to assess the nomogram’s performance, and the concordance index (C-index), area under curve value (AUC), and calibration plots were used to evaluate the discrimination and calibration of the nomogram. The nomogram’s clinical performance was evaluated by decision curve analysis (DCA), probability density function (PDF) and clinical utility curve (CUC). Furthermore, Kaplan-Meier curves were performed in the training and the validation cohort to evaluate the survival risk of the patients with lymphatic metastasis or not. Additionally, on the basis of the constructed nomogram, we obtained a convenient and intuitive network calculator. Results A total of 41837 patients were included for analysis, including 41,018 in the training group and 819 in the validation group. Eleven risk factors were considered as predictor variables in the nomogram. The nomogram displayed excellent discrimination power, with AUC both reached 0.916 in the training group (95% confidence interval (CI) 0.913 to 0.918) and the validation group (95% CI 0.895 to 0.934). The calibration curves presented that the nomogram-based prediction had good consistency with practical application. Moreover, Kaplan-Meier curves analysis showed that RCC patients with LMs had worse survival outcomes compared with patients without LMs. Conclusions The nomogram and web calculator (https://liwenle0910.shinyapps.io/DynNomapp/) may be a useful tool to quantify the risk of LMs in patients with RCC, which may provide guidance for clinicians, such as identifying high-risk patients, performing surgery, and establishing personalized treatment as soon as possible.
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Affiliation(s)
- Wenle Li
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Bing Wang
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Shengtao Dong
- Department of Spine Surgery, Second Affifiliated Hospital of Dalian Medical University, Dalian, China
| | - Chan Xu
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Yang Song
- Department of Gastroenterology and Hepatology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Ximin Qiao
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
- Department of Urology, Xianyang Central Hospital, Xianyang, China
- *Correspondence: Chengliang Yin, ; Meijin Huang, ; Xiaofeng Xu, ; Ximin Qiao,
| | - Xiaofeng Xu
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
- Department of Urology, Xianyang Central Hospital, Xianyang, China
- *Correspondence: Chengliang Yin, ; Meijin Huang, ; Xiaofeng Xu, ; Ximin Qiao,
| | - Meijin Huang
- Department of Oncology, 920th Hospital of People's Liberation Army (PLA) Joint Logistics Support Force, Yunnan, China
- *Correspondence: Chengliang Yin, ; Meijin Huang, ; Xiaofeng Xu, ; Ximin Qiao,
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macau, Macau SAR, China
- *Correspondence: Chengliang Yin, ; Meijin Huang, ; Xiaofeng Xu, ; Ximin Qiao,
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Chiapponi C, Alakus H, Schmidt M, Faust M, Bruns CJ, Büttner R, Eich ML, Schultheis AM. Lymphatic Vessel Invasion in Routine Pathology Reports of Papillary Thyroid Cancer. Front Med (Lausanne) 2022; 9:841550. [PMID: 35265646 PMCID: PMC8899077 DOI: 10.3389/fmed.2022.841550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose It is not mandatory to report lymphatic vessel invasion in pathology reports of papillary thyroid cancer (PTC) according to the current Union for International Cancer Control (UICC) TNM (tumor, nodes, and metastases) classification. However, there is some evidence for its correlation with lymph node metastasis (LNM) and prognosis. The aim of this study was to explore the clinical implication of lymphatic vessel invasion documentation of PTC because pathology reports play a pivotal role in postsurgical clinical decision-making in endocrine tumor boards. Methods Patients undergoing postoperative radioiodine treatment for PTC at the University Hospital of Cologne, Germany between December 2015 and March 2020 were identified. Pathology reports were screened for documentation of lymphatic vessel invasion. Demographics and clinicopathologic data of patients documented, including lymphatic vessel invasion and lymph nodal involvement were analyzed. Results A total of 578 patients were identified and included. Lymphatic vessel invasion was reported in pathology reports of 366 (63.3%) and omitted in 112 (36.7%) patients. Positive lymphatic vessel invasion (L1) was diagnosed in 67 (18.3%) of 366 patients and was documented as absent (L0) in 299 (81.7%) patients. Lymph nodal (N) status was positive (N+) in 126 (45.6%) and negative (N0) in 150 (54.3%) of these patients. In 54 (80.6%) L1 cases N+ status and in 137 (65.6%) L0 cases N0 status was diagnosed. In 13 (19.4%) cases with L1 status, there were no LNMs (L1 N0). In total, 72 (34.4%) patients had LNM despite L0 status (L0 N+). The sensitivity and specificity of LVI reporting for LNM were 0.42 and 0.91, respectively. Conclusion In routine pathology reports of PTC used for indication to postoperative radioiodine treatment by a German endocrine tumor board, lymphatic vessel invasion was found to be reported inconsistently and mostly as L0. L1 diagnoses, however, reliably correlated with reported LNM and might, thus, be relevant for clinical decision-making. For this reason, we advocate for standardized pathologic reassessment of lymphatic vessel invasion, in particular for cases where lymph nodes are not included in the pathologic specimen and if L0 is documented.
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Affiliation(s)
- Costanza Chiapponi
- Department of General, Visceral, Cancer and Transplant Surgery, University Clinic of Cologne, Cologne, Germany
| | - Hakan Alakus
- Department of General, Visceral, Cancer and Transplant Surgery, University Clinic of Cologne, Cologne, Germany
| | - Matthias Schmidt
- Department for Nuclear Medicine, University Clinic of Cologne, Cologne, Germany
| | - Michael Faust
- Policlinic for Endocrinology, Diabetes and Prevention Medicine, University Clinic of Cologne, Cologne, Germany
| | - Christiane J Bruns
- Department of General, Visceral, Cancer and Transplant Surgery, University Clinic of Cologne, Cologne, Germany
| | - Reinhard Büttner
- Institute for Pathology, University Clinic of Cologne, Cologne, Germany
| | - Marie-Lisa Eich
- Institute for Pathology, University Clinic of Cologne, Cologne, Germany
| | - Anne M Schultheis
- Institute for Pathology, University Clinic of Cologne, Cologne, Germany
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Bhindi B, Wallis CJD, Boorjian SA, Thompson RH, Farrell A, Kim SP, Karam JA, Capitanio U, Golijanin D, Leibovich BC, Gershman B. The role of lymph node dissection in the management of renal cell carcinoma: a systematic review and meta-analysis. BJU Int 2018; 121:684-698. [PMID: 29319926 DOI: 10.1111/bju.14127] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Our objective was to evaluate the role of retroperitoneal lymph node dissection (LND) in non-metastatic (M0) and metastatic (M1) renal cell carcinoma (RCC). We searched Medline, EMBASE, Web of Science and Scopus from database inception to 29 August 2017 for studies of patients who underwent partial or radical nephrectomy for M0 or M1 RCC. Two investigators independently selected studies for inclusion. Risk of bias was assessed using the Newcastle-Ottawa scale, Cochrane Collaboration tool and National Heart, Lung and Blood Institute Quality Assessment Tool. Random effects meta-analysis was performed for all-cause-mortality. The GRADE approach was used to characterize quality of evidence. A total of 51 unique studies were included in the qualitative systematic review. Risk of bias was low in 41/51 (80%) studies. LND was not associated with all-cause mortality in either M0 (hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.92-1.12; I2 = 0%; four studies), M1 (HR 1.04, 95% CI 0.83-1.29; I2 = 0%; two studies), or pooled M0 and M1 settings (HR 1.00, 95% CI 0.92-1.09; I2 = 0%; seven studies), with no statistically significant differences according to M stage subgroups (P = 0.50). In the three studies that examined M0 subgroups with a high risk of nodal metastasis, LND was not associated with improved oncological outcomes. Studies on the association of extent of LND with survival reported inconsistent results. Meanwhile, a small proportion of patients with pN1M0 disease demonstrate durable long-term oncological control after surgery, with 10-year cancer-specific survival of 21-31%. Nodal involvement is independently associated with adverse prognosis in both M0 and M1 settings. GRADE quality of evidence was moderate or low for the outcomes examined. Although LND yields independent prognostic information, the existing literature does not support a therapeutic benefit to LND in either M0 or M1 RCC. High-risk M0 patient groups warrant further study, as a subset of patients with isolated nodal metastases experience long-term survival after surgical resection.
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Affiliation(s)
- Bimal Bhindi
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Christopher J D Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Ann Farrell
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
| | - Simon P Kim
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jose A Karam
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Umberto Capitanio
- Unit of Urology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Dragan Golijanin
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA.,Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Boris Gershman
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA.,Warren Alpert Medical School of Brown University, Providence, RI, USA
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Dufies M, Giuliano S, Ambrosetti D, Claren A, Ndiaye PD, Mastri M, Moghrabi W, Cooley LS, Ettaiche M, Chamorey E, Parola J, Vial V, Lupu-Plesu M, Bernhard JC, Ravaud A, Borchiellini D, Ferrero JM, Bikfalvi A, Ebos JM, Khabar KS, Grépin R, Pagès G. Sunitinib Stimulates Expression of VEGFC by Tumor Cells and Promotes Lymphangiogenesis in Clear Cell Renal Cell Carcinomas. Cancer Res 2017; 77:1212-1226. [PMID: 28087600 DOI: 10.1158/0008-5472.can-16-3088] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 11/16/2022]
Abstract
Sunitinib is an antiangiogenic therapy given as a first-line treatment for renal cell carcinoma (RCC). While treatment improves progression-free survival, most patients relapse. We hypothesized that patient relapse can stem from the development of a lymphatic network driven by the production of the main growth factor for lymphatic endothelial cells, VEGFC. In this study, we found that sunitinib can stimulate vegfc gene transcription and increase VEGFC mRNA half-life. In addition, sunitinib activated p38 MAPK, which resulted in the upregulation/activity of HuR and inactivation of tristetraprolin, two AU-rich element-binding proteins. Sunitinib stimulated a VEGFC-dependent development of lymphatic vessels in experimental tumors. This may explain our findings of increased lymph node invasion and new metastatic sites in 30% of sunitinib-treated patients and increased lymphatic vessels found in 70% of neoadjuvant treated patients. In summary, a therapy dedicated to destroying tumor blood vessels induced the development of lymphatic vessels, which may have contributed to the treatment failure. Cancer Res; 77(5); 1212-26. ©2017 AACR.
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Affiliation(s)
- Maeva Dufies
- University of Nice Sophia Antipolis, Institute for Research on Cancer and Aging of Nice, CNRS UMR 7284, INSERM U1081, Centre Antoine Lacassagne, Nice, France
| | - Sandy Giuliano
- University of Nice Sophia Antipolis, Institute for Research on Cancer and Aging of Nice, CNRS UMR 7284, INSERM U1081, Centre Antoine Lacassagne, Nice, France
- Biomedical Department, Centre Scientifique de Monaco, Monaco, Principality of Monaco
| | - Damien Ambrosetti
- Central Laboratory of Pathology, Centre Hospitalier Universitaire (CHU) de Nice, Hôpital Pasteur, Nice, France
| | - Audrey Claren
- University of Nice Sophia Antipolis, Institute for Research on Cancer and Aging of Nice, CNRS UMR 7284, INSERM U1081, Centre Antoine Lacassagne, Nice, France
- Radiotherapy Department, Centre Antoine Lacassagne, Nice, France
| | - Papa Diogop Ndiaye
- University of Nice Sophia Antipolis, Institute for Research on Cancer and Aging of Nice, CNRS UMR 7284, INSERM U1081, Centre Antoine Lacassagne, Nice, France
| | - Michalis Mastri
- Center for Genetics and Pharmacology, Roswell Park Cancer Institute, Buffalo, New York
| | - Walid Moghrabi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - Marc Ettaiche
- Statistics Department, Centre Antoine Lacassagne, Nice, France
| | | | - Julien Parola
- University of Nice Sophia Antipolis, Institute for Research on Cancer and Aging of Nice, CNRS UMR 7284, INSERM U1081, Centre Antoine Lacassagne, Nice, France
| | - Valerie Vial
- Biomedical Department, Centre Scientifique de Monaco, Monaco, Principality of Monaco
| | - Marilena Lupu-Plesu
- University of Nice Sophia Antipolis, Institute for Research on Cancer and Aging of Nice, CNRS UMR 7284, INSERM U1081, Centre Antoine Lacassagne, Nice, France
| | | | - Alain Ravaud
- Service d'Oncologie Médicale, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | | | | | | | - John M Ebos
- Center for Genetics and Pharmacology, Roswell Park Cancer Institute, Buffalo, New York
| | - Khalid Saad Khabar
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Renaud Grépin
- Biomedical Department, Centre Scientifique de Monaco, Monaco, Principality of Monaco
| | - Gilles Pagès
- University of Nice Sophia Antipolis, Institute for Research on Cancer and Aging of Nice, CNRS UMR 7284, INSERM U1081, Centre Antoine Lacassagne, Nice, France.
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Yang S, Gao Q, Jiang W. Relationship between tumour angiogenesis and expression of cyclo-oxygenase-2 and vascular endothelial growth factor-A in human renal cell carcinoma. J Int Med Res 2014; 43:110-7. [PMID: 25488950 DOI: 10.1177/0300060514545799] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE *These authors contributed equally to this work. To study the relationship between tumour angiogenesis and expression of cyclo-oxygenase (COX)-2 and vascular endothelial growth factor (VEGF)-A in human renal cell carcinoma. METHODS Archival samples of primary human renal cell carcinoma tissue and surrounding normal renal tissue (control samples) obtained from patients diagnosed with renal cell carcinoma were analysed for COX-2 and VEGF-A expression by immunohistochemistry using specific monoclonal antibodies. Tumour microvasculature was examined using factor VIII-related antigen antibody staining. RESULTS A total of 33 renal cell carcinoma and 12 control renal tissue specimens were included. COX-2 and VEGF-A genes were overexpressed in tumour specimens compared with normal epithelia. A significant correlation was found between COX-2 and VEGF-A expression. Microvessel density was found to be increased in tumour tissues that expressed COX-2 and VEGF-A. CONCLUSION Microvessel density was increased in tumour tissues that expressed COX-2 and VEGF-A, suggesting that COX-2 and VEGF-A are related to tumour angiogenesis in human renal cell carcinoma.
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Affiliation(s)
- Sheng Yang
- Department of Internal Medicine Oncology, The Union Hospital of Fujian Medical University, Fuzhou, China Fujian Provincial Key Laboratory of Tumour Translational Medicine, Fuzhou, China
| | - Qin Gao
- Teaching and Research Department of Thoracic Surgery, Union Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Wei Jiang
- Department of Urology, The Union Hospital of Fujian Medical University, Fuzhou, China
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Abstract
Lymphatic vessels (LVs) are involved in a number of physiological and pathophysiological processes such as fluid homoeostasis, immune surveillance, and resolution of inflammation and wound healing. Lymphangiogenesis, the outgrowth of existing LVs and the formation of new ones, has received increasing attention over the past decade on account of its prominence in organ physiology and pathology, which has been enabled by the development of specific tools to study lymph vessel functions. Several studies have been devoted to renal lymphatic vasculature and lymphangiogenesis in kidney diseases, such as chronic renal transplant dysfunction, primary renal fibrotic disorders, proteinuria, diabetic nephropathy and renal inflammation. This review describes the most recent findings on lymphangiogenesis, with a specific focus on renal lymphangiogenesis and its impact on renal diseases. We suggest renal lymphatics as a possible target for therapeutic interventions in renal medicine to dampen tubulointerstitial tissue remodelling and improve renal functioning.
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D2-40 immunoreactivity in penile squamous cell carcinoma: a marker of aggressiveness. Hum Pathol 2011; 42:1596-602. [DOI: 10.1016/j.humpath.2010.12.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 12/20/2010] [Accepted: 12/22/2010] [Indexed: 11/23/2022]
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Fohn LE, Rodriguez A, Kelley MC, Ye F, Shyr Y, Stricklin G, Robbins JB. D2-40 lymphatic marker for detecting lymphatic invasion in thin to intermediate thickness melanomas: Association with sentinel lymph node status and prognostic value—A retrospective case study. J Am Acad Dermatol 2011; 64:336-45. [DOI: 10.1016/j.jaad.2010.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 02/26/2010] [Accepted: 03/03/2010] [Indexed: 11/26/2022]
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The non-neoplastic kidney in tumor nephrectomy specimens: what can it show and what is important? Adv Anat Pathol 2010; 17:235-50. [PMID: 20574169 DOI: 10.1097/pap.0b013e3181e3c02d] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Surgical nephrectomy is a procedure that has been performed for nearly 100 years. In the presence of a normal contralateral kidney, such as in a renal transplant donor or child with Wilms tumor, it is a benign procedure without deleterious consequences on the remaining kidney. However, many adults and some children postnephrectomy will develop chronic kidney disease. The non-neoplastic kidney in tumor resections may harbor a large number of developmental and acquired diseases predictive of this outcome or that convey other medically significant information. Examination of the non-neoplastic kidney is a fertile opportunity to identify these unsuspected conditions that may ultimately dictate the subsequent clinical course and influence the medical care provided. This review discusses the consequences of unilateral and partial nephrectomy, and illustrates many conditions that may be encountered in the non-neoplastic cortex with a discussion of their clinical implications.
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Baldewijns MM, Roskams T, Ballet V, Van den Eynden GG, Van Laere SJ, Van der Auwera I, Lerut E, De Bruïne AP, Thijssen VL, Vermeulen PB, van Poppel H. A low frequency of lymph node metastasis in clear-cell renal cell carcinoma is related to low lymphangiogenic activity. BJU Int 2009; 103:1626-31. [DOI: 10.1111/j.1464-410x.2008.08272.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Despite the considerable progress made in our understanding of the pathogenesis, genetics, and pathology of renal cell carcinoma (RCC), difficulties remain relating to the prediction of clinical outcome for individual cases. Although there is evidence to show that high-grade tumors have a poorer prognosis when compared to those of low grade, debate remains regarding the predictive value of grading, especially for those tumors classified into the intermediate grades. Numerous composite morphologic and nuclear grading systems have been proposed for RCC and although that of the Fuhrman classification have achieved widespread usage, the validity of the grading criteria of this classification has been questioned. In addition, there are few studies that have attempted to validate the Fuhrman system for RCCs beyond that of the clear cell subtype. Recent studies have indicated that grading of papillary RCC should be based on nucleolar prominence alone and that the components of the Fuhrman grading classification do not provide prognostic information for chromophobe RCC. Independent of tumor grade, the prognostic importance of tumor stage for RCC is well recognized. The Union Internationale Contre le Cancer/American Joint Committee for Cancer Staging and End Results Reporting TNM staging system is now in its sixth edition (2002) and recent refinements have focused on defining size cut points that will identify apparently localized tumors that will develop recurrence and/or metastases despite attempted curative surgery. In parallel with these studies it has been shown that infiltration of the renal sinus is an important prognostic factor, being observed in almost all tumors >7 cm in diameter. Questions remain as to the appropriate stratification of regional extension of RCC, as defined in the T3 tumor-staging category. Recent modifications to this category have been suggested combining the level of infiltration of the venous outflow tract with the presence or absence of infiltration of the adrenal gland and/or perirenal fat. Similarly, the utility of classifying lymph node involvement by tumor is debated, although it is well recognized that lymph node infiltration is associated with a poor prognosis. Although the current TNM classification does provide useful prognostic information it would appear that further modifications are justified to enhance the predictive value of staging for RCC.
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Shimizu Y, Jin L, Yamaguchi H, Motosugi U, Sannohe S, Nagata K, Sakurai T, Murata S, Yasuda M, Shimizu M. Detection of lymphatic invasion in resected cases of primary pancreatic cancer based on immunohistochemistry of D2-40. Ann Diagn Pathol 2009; 13:168-72. [PMID: 19433295 DOI: 10.1016/j.anndiagpath.2009.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We investigated the presence of lymphatic invasion detected by D2-40 immunostaining compared to conventional hematoxylin-eosin (HE) staining in primary pancreatic cancer. We also compared the alkaline phosphatase-fast red detection method with the 3,3'-diaminobenzidine (DAB) detection method. We reviewed 25 cases of pancreatic cancer with lymph node (LN) metastases and 15 cases without LN metastases and evaluated the detection rate of lymphatic invasion by HE stain slide alone and D2-40 immunostains. Regarding the cases with positive LN metastasis, 4 (16%) of the 25 cases showed lymphatic invasion by HE slide alone, whereas 7 cases (28%) demonstrated positive lymphatic invasion by D2-40 immunostain. On the other hand, even in cases with negative LN metastasis, 3 of the 15 cases revealed lymphatic invasion by D2-40 immunostaining. Lymphatic invasion was easily detected by alkaline phosphatase-fast red technique, especially at the lower magnification. Regarding the location of lymphatic invasion, it was recognized not only at the peripheral portion but also in the central part of the tumors by D2-40 immunostains; this was difficult to identify by HE stain slide alone. Our study indicates that lymphatic invasion may be overlooked when only HE stain slides are used. In addition, the alkaline phosphatase-fast red detection method (vivid red color) is a distinctive advantage compared with the DAB detection method (brown color), especially in detecting lymphatic invasion at the lower magnification.
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Affiliation(s)
- Yoshihiko Shimizu
- Department of Pathology, Saitama Medical University, Saitama International Medical Center, Hidaka City, Saitama 350-1298, Japan
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