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The Latinx Disparity in Surgery for Kidney Cancer: Data from The South Texas Region. 拉丁裔在肾癌手术中的差异:来自南德克萨斯地区的数据。
Pub Date : 2022-03-01 DOI: 10.52733/kcj20n1-a1
F. Dursun, Rahul Patel, D. Hui, Hanzhang Wang, A. Mansour, D. Pruthi, D. G. Alonso, L. Jayakumar, R. Rodriguez, R. Svatek, M. Liss, D. Kaushik
The South Texas region, with a predominantly Latinx population, has a very high incidence of renal cell carcinoma (RCC), including those with tumor extending into the major blood vessels called venous tumor thrombus (VTT). There is currently no data on outcomes of Latinx patients with VTT as most published studies are from predominantly Caucasian population. Therefore, we performed this study to fill an urgent, unmet need. We reviewed patients who underwent radical nephrectomy with removal of VTT (called tumor thrombectomy) between 2015 and 2020. We collected data on demographics, clinical, pathological characteristics and outcomes of patients. Univariate and multivariate Cox regression analyses were used to evaluate the associations between ethnicity and disease progression or survival. We identified 112 patients, of which 67 (62%) were Latinx, and 41 (38%) were non-Latinx. Approximately 60% of patients had Level II-IV VTT; Latinx presented with a higher level of tumor thrombus (p=0.046). Latinx patients had a higher rate of no insurance (11% vs. 27%, p=0.04) and were more likely to lost to follow-up after surgery (22.4% vs. 13.3%, p=0.23) compared to non-Latinx. Fewer Latinx received systemic therapy (28% vs. 42%; p=0.13). Ninety-day mortality for the entire cohort was 3.8%. The Latinx population in the South Texas region present late, with advanced thrombus level, and do not have access to systemic therapy. Given symptomatic disease, surgical treatment, if feasible, is their only option. Our results highlight disparate treatment patterns which require further investigation and health-care policy changes.
南德克萨斯地区以拉丁裔人口为主,肾细胞癌(RCC)的发病率非常高,包括肿瘤延伸到主要血管的静脉肿瘤血栓(VTT)。目前还没有关于拉丁裔VTT患者预后的数据,因为大多数已发表的研究主要来自高加索人群。因此,我们进行这项研究是为了填补一个迫切的、未被满足的需求。我们回顾了2015年至2020年间接受根治性肾切除术并移除VTT(称为肿瘤血栓切除术)的患者。我们收集了患者的人口统计学、临床、病理特征和预后数据。使用单因素和多因素Cox回归分析来评估种族与疾病进展或生存之间的关系。我们确定了112例患者,其中67例(62%)为拉丁裔,41例(38%)为非拉丁裔。大约60%的患者有II-IV级VTT;拉丁部肿瘤血栓水平较高(p=0.046)。与非拉丁裔患者相比,拉丁裔患者的无保险率更高(11%对27%,p=0.04),术后更容易失去随访(22.4%对13.3%,p=0.23)。接受全身治疗的拉丁裔患者较少(28% vs. 42%;p = 0.13)。整个队列的90天死亡率为3.8%。南德克萨斯地区的拉丁裔人群出现较晚,血栓水平较高,无法获得全身治疗。对于有症状的疾病,如果可行,手术治疗是他们唯一的选择。我们的结果强调了不同的治疗模式,这需要进一步的调查和医疗保健政策的改变。
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引用次数: 1
SETD2 regulates the methylation of translation elongation factor eEF1A1 in clear cell renal cell carcinoma. SETD2调控透明细胞肾细胞癌中翻译延伸因子eEF1A1的甲基化。
Robert Hapke, Lindsay Venton, Kristie Lindsay Rose, Quanhu Sheng, Anupama Reddy, Rebecca Prather, Angela Jones, W Kimryn Rathmell, Scott M Haake

Background: SET domain-containing protein 2 (SETD2) is commonly mutated in renal cell carcinoma. SETD2 methylates histone H3 as well as a growing list of non-histone proteins.

Objective: Initially, we sought to explore SETD2-dependent changes in lysine methylation of proteins in proximal renal tubule cells. Subsequently, we focused on changes in lysine methylation of the translation elongation factor eEF1A1.

Methods: To accomplish these objectives, we initially performed a systems-wide analysis of protein lysine-methylation and expression in wild type (WT) and SETD2-knock out (KO) kidney cells and later focused our studies on eEF1A1 as well as the expression of lysine methyltransferases that regulate its lysine methylation.

Results: We observed decreased lysine methylation of the translation elongation factor eEF1A1. EEF1AKMT2 and EEF1AKMT3 are known to methylate eEF1A1, and we show here that their expression is dependent on SET-domain function of SETD2. Globally, we observe differential expression of hundreds of proteins in WT versus SETD2-KO cells, including increased expression of many involved in protein translation. Finally, we observe decreased progression free survival and loss of EEF1AKMT2 gene expression in SETD2-mutated tumors predicted to have loss of function of the SET domain.

Conclusion: Overall, these data suggest that SETD2-mutated ccRCC, via loss of enzymatic function of the SET domain, displays dysregulation of protein translation as a potentially important component of the transformed phenotype.

背景:SET结构域蛋白2 (SETD2)在肾细胞癌中通常发生突变。SETD2甲基化组蛋白H3以及越来越多的非组蛋白。目的:最初,我们试图探索setd2依赖的近端肾小管细胞赖氨酸甲基化蛋白的变化。随后,我们关注翻译延伸因子eEF1A1赖氨酸甲基化的变化。方法:为了实现这些目标,我们首先在野生型(WT)和setd2敲除(KO)肾细胞中对蛋白质赖氨酸甲基化和表达进行了系统范围的分析,然后将研究重点放在eEF1A1以及调节其赖氨酸甲基化的赖氨酸甲基转移酶的表达上。结果:我们观察到翻译延伸因子eEF1A1的赖氨酸甲基化降低。已知EEF1AKMT2和EEF1AKMT3会甲基化eEF1A1,我们在这里表明它们的表达依赖于SETD2的set结构域功能。在全球范围内,我们观察到WT与SETD2-KO细胞中数百种蛋白质的差异表达,包括许多参与蛋白质翻译的表达增加。最后,我们观察到,在setd2突变的肿瘤中,无进展生存期降低,EEF1AKMT2基因表达丧失,预计这些肿瘤具有SET结构域的功能丧失。结论:总的来说,这些数据表明,setd2突变的ccRCC,通过丧失SET结构域的酶功能,显示出蛋白质翻译的失调,这是转化表型的一个潜在的重要组成部分。
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引用次数: 0
A Tribute to Dr. Christopher G. Wood, MD 向医学博士克里斯托弗·g·伍德致敬
Nizar Tannir
Tributes to individuals who have passed away share one common purpose: to help us heal. We find comfort by sharing the legacies of the loved ones we’ve lost. Today we pay tribute to Dr. Christopher G. Wood, Professor of Urology.
向逝去的人致敬有一个共同的目的:帮助我们痊愈。我们通过分享我们失去的亲人的遗产来找到安慰。今天我们向克里斯托弗·g·伍德博士致敬,他是泌尿学教授。
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引用次数: 0
IKCS2021 Top Abstracts IKCS2021热门摘要
Pub Date : 2021-12-20 DOI: 10.52733/kcj19n4-abs
Robert Figlin
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引用次数: 0
Radiological Correlates of pT3a Kidney Cancer: Importance of Irregular Tumor Sinus Border pT3a肾癌的放射学相关性:不规则肿瘤窦边界的重要性
Pub Date : 2021-12-17 DOI: 10.52733/kcj19n4-a1
Y. Ye, D. Palacios, R. Campbell, Alain Rizk, Hajime Tanaka, Carlos Munoz-Lopez, Emily Abramczyk, G. Roversi, Jianbo Li, C. Weight, R. Abouassaly, E. Remer, S. Campbell
Purpose: Preoperative assessment of T3a renal-cell-carcinoma (RCC) in absence of main renal vein involvement or lymph node enlargement is challenging but has potential implications for counseling and prognosis. Materials and Methods: A retrospective review of 1129 cT1-T3aN0M0 RCC patients managed with partial/radical nephrectomy (PN/RN) in our institution (2012-2014) was performed. Exclusion criteria included radiological evidence of main renal vein involvement or substantial lymphadenopathy. Eleven radiological findings suggestive of aggressive tumor biology or invasive phenotype based on prior literature were assessed for correlation with pT3a status. These included perinephric-findings (stranding, enhancing-nodule, collateral-vessels, or irregular-perinephric-tumor-contour), findings within the sinus (stranding, collecting-system invasion, branch-vein enlargement, or irregular-tumor-sinus-border [ITSB]), and tumor-necrosis, infiltrative-features, and tumor-size. Radiological assessment was blinded to final pathology. Sensitivity/specificity and logistic-regression analyses assessed the performance of each imaging-finding for detecting pT3a tumors. Results: Median tumor-size was 4.0cm and R.E.N.A.L. was 8. Median follow-up was 53 months (IQR:28-64). pT3a tumors were found in 281 patients (25%) and strongly correlated with local and systemic recurrence (p<0.02). ITSB was found in 350 patients (31%) and was the strongest predictor of pT3a status. Sensitivity/specificity/PPV/NPV/OR/C-Index for ITSB were 75%/84%/61%/91%/15.8(11.4-21.9)/0.80, for correlation with pT3a, respectively. The best predictive model included ITSB(yes/no) and tumor-size as a continuous variable (C-index=0.84). Addition of other imaging-findings did not improve the model (C-index=0.84). ITSB was the strongest contributor in all multivariable-models and also strongly correlated with recurrence-free-survival. Inter/intra-observer correlations for assessment of ITSB were 0.89/0.98, respectively. Conclusions: Our data suggest that ITSB and tumor-size associate with pT3a RCC, which could impact patient counseling.
目的:T3a肾细胞癌(RCC)在没有主肾静脉受损伤或淋巴结肿大的情况下的术前评估是具有挑战性的,但对咨询和预后有潜在的影响。材料与方法:回顾性分析我院(2012-2014年)1129例行部分/根治性肾切除术(PN/RN)的cT1-T3aN0M0肾细胞癌患者。排除标准包括主要肾静脉受累或实质淋巴结病变的影像学证据。根据先前的文献,评估了11个提示侵袭性肿瘤生物学或侵袭性表型的放射学结果与pT3a状态的相关性。这些包括肾周表现(搁浅、强化结节、侧支血管或不规则的肾周肿瘤轮廓)、窦内表现(搁浅、收集系统侵犯、支静脉扩大或不规则的肿瘤-窦边界[ITSB])、肿瘤坏死、浸润特征和肿瘤大小。放射学评估与最终病理不一致。敏感性/特异性和逻辑回归分析评估了每个成像发现检测pT3a肿瘤的性能。结果:肿瘤中位大小为4.0cm, r.e.n.a.l为8。中位随访53个月(IQR:28-64)。pT3a肿瘤281例(25%),与局部和全身复发密切相关(p<0.02)。在350例(31%)患者中发现ITSB,是pT3a状态的最强预测因子。ITSB与pT3a相关性的敏感性/特异性/PPV/NPV/OR/C-Index分别为75%/84%/61%/91%/15.8(11.4-21.9)/0.80。最佳预测模型包括ITSB(是/否)和肿瘤大小作为连续变量(C-index=0.84)。其他影像学结果的加入并未改善模型(C-index=0.84)。在所有多变量模型中,ITSB是最强的贡献者,并且与无复发生存密切相关。ITSB评估的观察者间/观察者内相关性分别为0.89/0.98。结论:我们的数据表明ITSB和肿瘤大小与pT3a RCC相关,这可能影响患者的咨询。
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引用次数: 1
How Can We Predict pT3a Kidney Cancer and What Does It Mean?: Commentary for the article "Radiological Correlates of pT3a Kidney Cancer: Importance of Irregular Tumor Sinus Border". 我们如何预测pT3a肾癌及其意义?:《pT3a肾癌的影像学相关因素:不规则肿瘤窦界的重要性》一文评论。
N. Singla
The ability to predict pathologically advanced renal cell carcinoma (RCC) within the primary tumor upfront can be helpful to guide prognostic counseling and hold implications for both surgical approach and multimodal therapeutic strategies. Herein, the investigators undertook a comprehensive assessment of radiographic features predictive of pT3a stage by querying 11 radiological findings across a robust retrospective cohort of patients with RCC. They found that an irregular tumor-sinus border (ITSB) correlated most strongly with pT3a stage and recurrence-free survival (RFS).
预测原发肿瘤内病理学晚期肾细胞癌(RCC)的能力有助于指导预后咨询,并对手术方法和多模式治疗策略具有启示意义。在此,研究人员对预测pT3a期的放射学特征进行了全面评估,方法是在一个强大的RCC患者回顾性队列中查询11个放射学结果。他们发现,不规则的肿瘤窦边界(ITSB)与pT3a分期和无复发生存期(RFS)的相关性最强。
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引用次数: 0
Tissue based biomarkers in non-clear cell RCC: Correlative analysis from the ASPEN clinical trial. 非透明细胞 RCC 中基于组织的生物标志物:来自 ASPEN 临床试验的相关分析。
Pub Date : 2021-10-01 DOI: 10.52733/kcj19n3-a1
Susan Halabi, Qian Yang, Andrea Carmack, Shiqi Zhang, Wen-Chi Foo, Tim Eisen, Walter M Stadler, Robert J Jones, Jorge A Garcia, Ulka N Vaishampayan, Joel Picus, Robert E Hawkins, John D Hainsworth, Christian K Kollmannsberger, Theodore F Logan, Igor Puzanov, Lisa M Pickering, Christopher W Ryan, Andrew Protheroe, Daniel J George, Andrew J Armstrong

Biomarkers are needed in patients with non-clear cell renal cell carcinomas (NC-RCC), particularly papillary renal cell carcinoma, in order to inform on initial treatment selection and identify potentially novel targets for therapy. We enrolled 108 patients in ASPEN, an international randomized open-label phase 2 trial of patients with metastatic papillary, chromophobe, or unclassified NC-RCC treated with the mTOR inhibitor everolimus (n=57) or the vascular endothelial growth factor (VEGF) receptor inhibitor sunitinib (n=51), stratified by MSKCC risk and histology. The primary endpoint was overall survival (OS) and secondary efficacy endpoints for this exploratory biomarker analysis were radiographic progression-free survival (rPFS) defined by intention-to-treat using the RECIST 1.1 criteria and radiographic response rates. Tissue biomarkers (n=78) of mTOR pathway activation (phospho-S6 and -Akt, c-kit) and VEGF pathway activation (HIF-1α, c-MET) were prospectively explored in tumor tissue by immunohistochemistry prior to treatment and associated with clinical outcomes. We found that S6 activation was more common in poor risk NC-RCC tumors and S6/Akt activation was associated with worse PFS and OS outcomes with both everolimus and sunitinib, while c-kit was commonly expressed in chromophobe tumors and associated with improved outcomes with both agents. C-MET was commonly expressed in papillary tumors and was associated with lower rates of radiographic response but did not predict PFS for either agent. In multivariable analysis, both pAkt and c-kit were statistically significant prognostic biomarkers of OS. No predictive biomarkers of treatment response were identified for clinical outcomes. Most biomarker subgroups had improved outcomes with sunitinib as compared to everolimus.

非透明细胞肾细胞癌(NC-RCC)患者,尤其是乳头状肾细胞癌患者需要生物标志物,以便为初始治疗选择提供信息,并确定潜在的新治疗靶点。我们招募了108名患者参加ASPEN,这是一项国际随机开放标签2期试验,对转移性乳头状、嗜色细胞或未分类的NC-RCC患者使用mTOR抑制剂依维莫司(57人)或血管内皮生长因子(VEGF)受体抑制剂舒尼替尼(51人)进行治疗,并根据MSKCC风险和组织学进行分层。该探索性生物标志物分析的主要终点是总生存期(OS),次要疗效终点是采用 RECIST 1.1 标准的意向治疗定义的放射学无进展生存期(rPFS)和放射学反应率。在治疗前,我们通过免疫组化方法对肿瘤组织中的 mTOR 通路激活(phospho-S6 和 -Akt、c-kit)和 VEGF 通路激活(HIF-1α、c-MET)的组织生物标志物(n=78)进行了前瞻性研究,并将其与临床结果进行了关联分析。我们发现,S6活化在低风险NC-RCC肿瘤中更为常见,S6/Akt活化与依维莫司和舒尼替尼的较差PFS和OS预后有关,而c-kit通常在嗜铬细胞瘤中表达,与两种药物的预后改善有关。C-MET 通常在乳头状肿瘤中表达,与较低的放射学反应率有关,但不能预测两种药物的 PFS。在多变量分析中,pAkt和c-kit都是具有统计学意义的OS预后生物标志物。在临床结果方面,没有发现可预测治疗反应的生物标志物。与依维莫司相比,大多数生物标志物亚组使用舒尼替尼的疗效都有所改善。
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引用次数: 0
Renal Cell Carcinoma Associated with Germline Mutations in the Krebs Cycle 肾细胞癌与克雷布斯循环中生殖系突变相关
Pub Date : 2021-06-27 DOI: 10.52733/kcj19n2-a2
Eric Lu, B. Shuch, A. Drakaki
Germline mutations in the fumarate hydratase (FH) and succinate dehydrogenase (SDH) genes lead to hereditary leiomyomatosis and RCC (HLRCC) and hereditary paraganglioma and pheochromocytoma, respectively. The renal cell carcinomas that arise in these conditions are characterized by dysregulated Krebs cycles, accumulation of oncometabolites, downstream changes in gene expression, and epigenetic modifications that carry unique therapeutic implications. In this review, we evaluate the current literature on these tumors, including the epidemiology, clinical course, screening guidelines, and management of localized and metastatic disease.
富马酸水合酶(FH)和琥珀酸脱氢酶(SDH)基因的种系突变分别导致遗传性平滑肌瘤病和RCC (HLRCC)以及遗传性副神经节瘤和嗜铬细胞瘤。在这些情况下发生的肾细胞癌的特征是克雷布斯循环失调、肿瘤代谢物积累、基因表达的下游变化以及具有独特治疗意义的表观遗传修饰。在这篇综述中,我们评估了目前关于这些肿瘤的文献,包括流行病学、临床病程、筛查指南以及局部和转移性疾病的处理。
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引用次数: 0
ASCO21 – Key Updates for Kidney Cancer Patients ASCO21 -肾癌患者的关键更新
Pub Date : 2021-06-27 DOI: 10.52733/kcj19n2-s1-a14
Neil J. Shah
Over the last decade, novel immunotherapies and targeted therapies have revolutionized the kidney cancer treatment landscape. ASCO Annual Meeting, 2021, was yet another success against this battle, and in this commentary, we will focus on a few critical abstracts presented at the meeting pertinent to kidney cancer.
在过去的十年中,新的免疫疗法和靶向治疗已经彻底改变了肾癌的治疗前景。2021年ASCO年会是抗击肾癌斗争的又一次成功,在本评论中,我们将重点介绍会议上提交的一些与肾癌相关的重要摘要。
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引用次数: 0
Changes, Challenges and Opportunities in Cancer Care During the COVID-19 Era and Beyond: Building on Lessons Learned From the Pandemic 2019冠状病毒病疫情期间及以后癌症护理的变化、挑战和机遇:以疫情教训为基础
Pub Date : 2021-06-27 DOI: 10.52733/kcj19n2-r1
Robert Motzer, E. Jonasch, B. McGregor, R. Figlin
In this roundtable discussion, nation's leading cancer experts from across the country share their perspectives on current changes, challenges and opportunities for delivering cancer care during the COVID-19 era. The roundtable panel examines long-term implications of the pandemic on the management and treatment of cancer especially focusing on significant issues in patient safety, toxicities associated with the use of immunotherapy, COVID-19 vaccination, and clinical trial designs. In this discussion, experts also brainstorm a range of recommendations focusing especially on how the cancer community can capitalize on lessons learned from the pandemic to develop creative approaches that can be taken forward.
在这次圆桌讨论中,来自全国各地的顶尖癌症专家分享了他们对2019冠状病毒病时代提供癌症治疗的当前变化、挑战和机遇的看法。圆桌小组审议了大流行对癌症管理和治疗的长期影响,特别侧重于患者安全、与使用免疫疗法相关的毒性、COVID-19疫苗接种和临床试验设计等重大问题。在这次讨论中,专家们还集思广益提出了一系列建议,特别侧重于癌症界如何利用从大流行中吸取的经验教训,制定可以向前推进的创造性方法。
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引用次数: 0
期刊
Kidney cancer journal : official journal of the Kidney Cancer Association
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