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Marandino L, Mollica V, Campi R. Cytoreductive nephrectomy for oligometastatic clear cell renal cell carcinoma in the era of immuno-oncology. Curr Opin Urol 2025; 35:301-307. [PMID: 39995165 DOI: 10.1097/mou.0000000000001269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2025]
Abstract
PURPOSE OF REVIEW Advancements in immune-oncology treatments and metastasis-directed therapy (MDT) techniques have significantly transformed treatment paradigms for patients with oligometastatic clear cell renal cell carcinoma (ccRCC). Within this evolving therapeutic landscape, the role of cytoreductive nephrectomy remains a topic of debate. This review aims to synthesize recent literature regarding the role of cytoreductive nephrectomy for patients with oligometastatic ccRCC in the contemporary immune-oncology era. RECENT FINDINGS While no prospective data are available regarding the role of cytoreductive nephrectomy for patients with oligometastatic ccRCC in the new immune-oncology (IO) era, results from recent retrospective studies suggest that careful patient selection remains critical. Apart from patients with symptomatic primary tumors, cytoreductive nephrectomy may still play a role in the treatment of oligometastatic patients with favorable clinical features, such as no immediate need for systemic therapy, absence of adverse metastatic sites, or oligometastatic lesions amenable to MDT. Deferred cytoreductive nephrectomy may have a rationale in patients with a deep response to IO at oligometastatic sites. Prognostic biomarkers to assess the biological behavior of oligometastatic disease and identify patients most suitable for cytoreductive nephrectomy are currently lacking. Novel imaging remains under investigation, with its treatment implications in oligometastatic RCC yet to be established. SUMMARY Notwithstanding the lack of prospective evidence, cytoreductive nephrectomy may still play a role for selected patients with oligometastatic ccRCC. Future research efforts should aim to identify prognostic tools aiding tailored decision-making in this setting.
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Affiliation(s)
- Laura Marandino
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, The Netherlands
| | - Veronica Mollica
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, The Netherlands
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Campi
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, The Netherlands
- Department of Experimental and Clinical Medicine, Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
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Wang F, Wang P, Wang X, Lu H, Han Y, Wang L, Li Z. Development and validation of a prediction model for the prognosis of renal cell carcinoma with liver metastases: a population-based cohort study. Front Med (Lausanne) 2024; 11:1464589. [PMID: 39691372 PMCID: PMC11649420 DOI: 10.3389/fmed.2024.1464589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 11/20/2024] [Indexed: 12/19/2024] Open
Abstract
Background Current studies on the establishment of prognostic model for renal cell carcinoma (RCC) with liver metastases (LM) were scarce. This study aimed to develop nomograms to predict the prognosis of RCC with LM. Methods Patients diagnosed with RCC between 2010 and 2021 from the Surveillance, Epidemiology, and End Results (SEER) database were selected. The eXtreme Gradient Boosting (XGBoost) and Random Forest (RF) machine learning algorithms were used to screen for the most influential factors affecting prognosis, and the Venn diagram method was employed for further refinement. Subsequently, a nomogram related to brain metastases was constructed. The performance of the nomograms was evaluated through receiver operating characteristics (ROC) curves, calibration plots, C-index, time-dependent C-index, and decision curve analysis (DCA). Kaplan-Meier (K-M) survival curves were used to provide additional verification of the clinical efficacy of the nomogram. Results This research comprised 2,395 RCC patients with LM. The Venn diagram demonstrated that age, histological type, grade, AJCC T stage, AJCC N stage, surgery, chemotherapy, marital status, and lung metastasis were highly relevant variables to patients with LM. The AUC, C-index, calibration curves, and DCA curves showed excellent performance of the nomogram. Additionally, the prognostic nomogram accurately classified RCC with LM patients into low- and high-risk groups for mortality. Conclusion This study developed a novel nomogram to predict the prognostic factors of RCC with LM, providing a valuable reference for making accurate clinical decisions.
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Affiliation(s)
- Fei Wang
- Department of Reproductive Medicine, Central Hospital of Zhumadian, Henan, China
| | - Pan Wang
- Department of Urology and Male Reproductive Health, Maternal and Child Health Hospital, Luoyang, China
| | - Xihao Wang
- Department of Urology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Hengming Lu
- Department of Gastroenterology, Central Hospital of Zhumadian, Henan, China
| | - Yuchun Han
- Department of Urology, Women and Children's Hospital, Central Hospital of Zhumadian, Henan, China
| | - Lianqu Wang
- Department of Urology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Zhihui Li
- Department of Reproductive Medicine, Central Hospital of Zhumadian, Henan, China
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Bloise F, Manfredi F, Zatteri L, Dima G, Carli C, Di Vita R, Olivieri M, Sammarco E, Ferrari M, Salfi A, Bonato A, Serafin D, Coccia N, Doni L, Galli L, Sisani M, Roviello G, Catalano M, Paolieri F. First-Line Treatments and Management of Metastatic Renal Cell Carcinoma Patients: An Italian Interdisciplinary Uro-Oncologic Group Algorithm. Cells 2024; 13:961. [PMID: 38891093 PMCID: PMC11172287 DOI: 10.3390/cells13110961] [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: 04/29/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
The treatment landscape for metastatic renal cell carcinoma (mRCC) has undergone significant transformations in recent years. The introduction of novel combination therapies involving tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors has resulted in improved oncological outcomes compared to traditional TKI monotherapy. In this evolving paradigm, the pivotal role of the multidisciplinary tumor board is underscored, particularly in shaping the therapeutic trajectory for patients eligible for locoregional interventions like cytoreductive nephrectomy and metastasectomy. In cases where systemic treatment is deemed appropriate, the absence of direct comparisons among the various combination therapies complicates the selection of a first-line approach. The clinician is faced with the challenge of making decisions based on patient-specific factors such as performance status, risk classification according to the International Metastatic Renal Cell Carcinoma Database Consortium, comorbidities, and disease characteristics, including the number and location of metastases and tumor histology. Considering these concerns, we propose, as a member of a Tuscany Interdisciplinary Uro-Oncologic Group, an algorithm to streamline the decision-making process for mRCC patients, offering guidance to clinicians in their day-to-day clinical practice.
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Affiliation(s)
- Francesco Bloise
- Medical Oncology Unit, San Donato Hospital, Azienda Toscana Sud Est, 52100 Arezzo, Italy; (F.B.); (M.S.)
| | - Fiorella Manfredi
- Medical Oncology Unit, Sant’Andrea Hospital, Azienda Sanitaria Locale 5 Spezzino, 19124 La Spezia, Italy;
| | - Luca Zatteri
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Giovanni Dima
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Chiara Carli
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Rosanna Di Vita
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Maria Olivieri
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Enrico Sammarco
- Medical Oncology Unit, Livorno Hospital, Azienda Toscana Nord Ovest, 57124 Livorno, Italy;
| | - Marco Ferrari
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Alessia Salfi
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Adele Bonato
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Debora Serafin
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Natalia Coccia
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Laura Doni
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Luca Galli
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Michele Sisani
- Medical Oncology Unit, San Donato Hospital, Azienda Toscana Sud Est, 52100 Arezzo, Italy; (F.B.); (M.S.)
| | | | - Martina Catalano
- Department of Health Sciences, University of Florence, 50134 Florence, Italy;
| | - Federico Paolieri
- Department of Oncology, Hospital of Prato, Azienda USL Toscana Centro, 59100 Prato, Italy;
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Wang S, Gao P, Wang X, Duan L, He X, Qu J. Clinical utility of keratin 14 expression measurement in reflecting the tumor properties and prognosis in patients with renal cell carcinoma: a study with long-term follow-up. Int Urol Nephrol 2024; 56:2045-2053. [PMID: 38206525 DOI: 10.1007/s11255-023-03923-4] [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: 05/07/2023] [Accepted: 05/23/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Keratin 14 (KRT14) is hypothesized to be involved in the pathogenesis of renal cell carcinoma (RCC) based on its tumorigenic role in various cancers and its relationship with the prognosis of other urinary system malignancies. This study aimed to evaluate the correlation of KRT14 with tumor properties and prognosis in RCC patients. METHODS Data from 180 RCC patients who received tumor resection were retrospectively reviewed. The KRT14 was assessed by immunohistochemistry (IHC) staining in tumor tissues and non-tumor tissues. RESULTS KRT14 was insufficiently expressed in both tumor and non-tumor tissues, with median (interquartile range) IHC score of 2.0 (0.0-3.4) and 1.0 (0.0-2.0), respectively. While it was relatively higher in tumor versus non-tumor tissues (P < 0.001). Besides, tumor KRT14 was positively correlated with the pathological grade (P = 0.038), tumor size (P = 0.012), T stage (P = 0.006), and TNM stage (P = 0.018). Interestingly, tumor KRT14 high predicted shorter accumulating recurrence-free survival (RFS) (P = 0.003) and accumulating overall survival (OS) (P = 0.001), which was further verified by the multivariate Cox's regression analysis (both P < 0.05). Furthermore, tumor KRT14 high estimated shorter RFS and OS from the Gene Expression Profiling Interactive Analysis and Human Protein ATLAS databases (all P < 0.05). Subgroup analyses indicated that the correlation of tumor KRT14 with accumulating RFS and accumulating OS was more pronounced in RCC patients with better physical status (such as age < 65 years and better eastern cooperative oncology group performance status) and higher tumor stages (such as higher pathological grade). CONCLUSION High KRT14 in tumor tissue could reflect an advanced tumor features and unsatisfying survival in RCC patients.
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Affiliation(s)
- Shuangyu Wang
- Department of Nephrology, Handan Central Hospital, Handan, 056000, China
| | - Peng Gao
- Department of Traditional Chinese Medicine, Han Mine General Hospital of North China Medical Health Group, Handan, 056000, China
| | - Xiaozhi Wang
- Department of Emergency, Handan Central Hospital, No. 59 Congtai North Road, Handan, 056000, China
| | - Liping Duan
- Department of Nephrology, Handan Central Hospital, Handan, 056000, China
| | - Xinmei He
- Department of Nephrology, Handan Central Hospital, Handan, 056000, China
| | - Juanjuan Qu
- Department of Emergency, Handan Central Hospital, No. 59 Congtai North Road, Handan, 056000, China.
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Schütz V, Lin H, Kaczorowski A, Zschäbitz S, Jäger D, Stenzinger A, Duensing A, Debus J, Hohenfellner M, Duensing S. Long-Term Survival of Patients with Stage T1N0M1 Renal Cell Carcinoma. Cancers (Basel) 2023; 15:5715. [PMID: 38136261 PMCID: PMC10741977 DOI: 10.3390/cancers15245715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
Metastatic renal cell carcinoma (RCC) is among the most lethal urological malignancies. However, small, localized RCCs (≤7 cm, stage T1) have an excellent prognosis. There is a rare patient subgroup diagnosed with synchronous distant metastasis (T1N0M1), of which very little is known in terms of survival outcomes and underlying disease biology. Herein, we examined the long-term survival of 27 patients with clear cell RCC (ccRCC) stage T1N0M1 in comparison to 18 patients without metastases (T1N0M0). Tumor tissue was stained by immunohistochemistry for CD8+ tumor infiltrating lymphocytes (TILs). As expected, patients with stage T1N0M1 showed a significantly worse median cancer specific survival (CSS; 2.8 years) than patients with stage T1N0M0 (17.7 years; HR 0.077; 95% CI, 0.022-0.262). However, eight patients (29.6%) with ccRCC stage T1N0M1 survived over five years, and three of those patients (11.1%) survived over a decade. Some of these patients benefitted from an intensified, multimodal treatment including metastasis-directed therapy. The number of CD8+ TILs was substantially higher in stage T1N0M1 ccRCCs than in stage T1N0M0 ccRCCs, suggesting a more aggressive tumor biology. In conclusion, long-term survival is possible in patients with ccRCC stage T1N0M1, with some patients benefitting from an intensified, multimodal treatment approach.
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Affiliation(s)
- Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Huan Lin
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, 69120 Heidelberg, Germany
| | - Adam Kaczorowski
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, 69120 Heidelberg, Germany
| | - Stefanie Zschäbitz
- Department of Medical Oncology, National Center for Tumor Diseases Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Anette Duensing
- Precision Oncology of Urological Malignancies, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, 69120 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Stefan Duensing
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, 69120 Heidelberg, Germany
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