Kidney cancer journal : official journal of the Kidney Cancer Association最新文献

C-reactive protein may be overexpressed in kidney cancer tissue. We determined if urine C-reactive protein concentration is greater in patients with high grade renal cell carcinoma or greater than healthy controls, and compared to other urologic cancers and non-cancerous urologic disease. This observational study obtained pre-nephrectomy urine and plasma from 87 patients with a small imaged renal mass (≤4cm) undergoing partial nephrectomy. Postoperative pathology established clear cell or papillary renal cell cancer, angiomyolipoma, chromophobe, or oncocytoma, and tumor Fuhrman grade. Follow-up urine was collected from 52 clear cell/papillary cancer patients. Urine and/or plasma were from bladder or prostate cancer patients and matched healthy controls. C-reactive protein was measured by enzyme-linked immunosorbent assay. Urine C-reactive protein in grade 1-2 (n=41) and grade 3-4 (n=24) renal cancer was 17- and 80-fold greater than controls, respectively. This decreased 85% post-nephrectomy, suggesting origin from tumors and not systemic filtration from blood. Urine C-reactive protein in angiomyolipoma, chromophobe, or oncocytoma, bladder or prostate cancer was less than grade 3-4 renal cancer. C-statistic to differentiate grade 1-2 from 3-4 clear cell/papillary renal cancer was 0.98 (95% CI 0.95-1.00); sensitivity 1.00 (95% CI, 0.87-1.00), specificity 0.95 (95% CI 0.84-0.99). Two patients with remarkably high pre-nephrectomy urine C-reactive protein, but no others, developed late metastases. Pre-nephrectomy urine C-reactive protein was increased in patients with high grade clear cell and papillary renal cancer, but not other renal or urologic disease. Urine C-reactive protein may be used pre-surgically to noninvasively grade small renal masses, and may predict future renal cell cancer metastasis.

Background: Microwave ablation (MWA) is an emerging treatment modality for clinical T1a (cT1a) small renal masses (SRM) with studies showing it has comparable oncological outcomes to partial nephrectomy (PN). However, more research is needed to the impact of each treatment on kidney function decline.

Objective: To compare the progression of kidney function decline in patients with cT1a SRM treated with MWA or PN.

Methods: This study included prospective data on patients treated between 2015-2021 with kidney function data collected from 2015-2024 from a single institutional database. Three outcomes for kidney function decline were examined: 30% decline in estimated glomerular filtration rate (eGFR) compared to pre-treatment, chronic kidney disease (CKD) upstaging compared to pre-treatment and eGFR <60 mL/min/1.73m², and the composite endpoint of the previous two events. Cox proportional hazards models were used to compare outcomes between the two treatments.

Results: Among 97 MWA and 49 PN included, MWA patients were older, had lower baseline eGFR, and higher rates of CKD prior to treatment. Univariate Cox proportional hazard model showed treatment modality was not significantly associated with reaching kidney decline endpoints. After adjusting for patient characteristics (age, race, baseline eGFR, Charlson Comorbidity Index), only baseline eGFR was associated with reaching kidney function endpoints.

Conclusion: There was no statistically significant difference in kidney function decline between PN and MWA treatments for cT1a SRM. After adjusting for patient factors, the higher hazard for MWA was attenuated.

Introduction: Performing surgery for renal cell carcinoma (RCC) in patients with horseshoe kidneys presents unique anatomic challenges. The complexities of clinical decision-making and technical challenges are further compounded by the presence of both IVC tumor thrombus extension and metastatic disease.

Case presentation: We encountered the unique case of a 66-year-old woman with a horseshoe kidney who presented with a 14cm mass in her right kidney with level II tumor thrombus extension into the IVC, retroperitoneal lymphadenopathy, and pulmonary nodules that were biopsy-proven to be consistent with metastatic clear cell RCC (cT3aN1M1). She was treated with combination immune checkpoint inhibition (ICI) and targeted therapy upfront. Given her durable response to systemic therapy, we elected to perform a consolidative cytoreductive nephrectomy for residual ypT3aN0 disease, and she has since remained disease-free radiographically. Using step-by-step illustrative photographs obtained intraoperatively, we detail our surgical approach and highlight technical pearls to manage similar cases of advanced RCC arising from horseshoe kidneys.

Conclusion: We present a complex case of metastatic RCC with IVC tumor thrombus arising from a horseshoe kidney. We share our clinical and technical approach to overcoming the medical and surgical challenges inherent to her case. The optimal role and timing of cytoreductive nephrectomy relative to ICI administration continue to evolve based on both tumor- and patient-related factors. Indeed, we favor a multidisciplinary approach to optimize patient outcomes.

The 2024 American Society of Clinical Oncology (GU ASCO 2024) Genitourinary Cancers Symposium brought together leading cancer specialists from around the world to discuss the latest breakthroughs in treating genitourinary cancers, especially kidney cancer. The focus was on immunotherapy and combination treatments, offering promising new options for patients with advanced and high-risk tumors. The symposium also highlighted advancements in patient care, including a new tool to assess quality of life in people with metastatic kidney cancer.