[New etiopathogenic findings in renal cell carcinoma: carcinogenesis and tumor development pathways]

Renal cancer is the third leading urological tumor after prostate and bladder cancers. Annual incidence of renal cancer in all stages has markedly increased in recent years. This represents a true increase in the number of actual cases that is not fully accounted for by widespread use of diagnostic imaging tests. This article is intended to provide an update on the carcinogenesis and tumor development pathways involved in the genesis of this tumor. Renal cell carcinoma (RCC) arises in renal epithelium and accounts for more than 90% of all malignant kidney tumors. Approximately 2% of RCCs are associated to hereditary syndromes, specific oncogenes, or changes in tumor suppressor genes. Changes in the VHL gene exist in all hereditary cases. This gene (located in the short arm of chromosome 3:3p25-26) is also involved in more than 60% of sporadic cases. This paper systematically addresses the latest findings on implications of the VHL gene in angiogenesis and its potential relationship to new molecules involved in management of RCC.

Predicting outcome to VEGF-targeted therapy in metastatic clear-cell renal cell carcinoma: data from recent studies

Attempts to predict outcome in patients with metastatic clear-cell renal cell carcinoma (RCC) have conventionally been based on pretherapy clinical factors such as performance status, disease-free interval, number of metastatic sites and several laboratory variables. These factors were developed before the era of VEGF-targeted therapy. Recent analysis from trials with anti-VEGF agents indicate that these factors continue to be of major importance in patient prognostication. Additionally, several serum and molecular markers, many of which relate to certain alterations of the von Hippel-Lindau pathway, are currently being investigated. Responses to VEGF-targeted agents appear to be related to a greater modulation of serum VEGF and soluble VEGF receptor levels. The impact of von Hippel-Lindau gene status on response to VEGF-targeted therapy was tested in a large study and was not found to predict a higher response rate to these agents. However, a subset of von Hippel-Lindau mutations that predict a 'loss of function' of the von Hippel-Lindau gene seem to have the best response to these agents. Future prognostic models will incorporate molecular markers with clinical variables to refine prognosis and prediction in metastatic clear-cell RCC patients treated with novel VEGF-targeted agents. These models, if externally and prospectively validated, will culminate in the rational selection of patients for specific VEGF-directed therapeutics.