Adult Kidney Cancer in Mauritania: Clinical and Therapeutic Aspects

Introduction: since its creation, our urology department has taken care of tumor pathologies in particular kidney cancer in adults;our goal is to study the clinical and therapeutic epidemiological profiles of adult kidney cancer in Mauritania. Materials and Methods: We carried out a retrospective study over a period of six years, from January 1, 2012 to December 31, 2017, including all cases of adult kidney cancer registered in the urology-andrology departments of the Cheikh Zayed Hospital and Pathological Anatomy of the National Hospital of Nouakchott (Mauritania). Results: we collected 50 cases of kidney cancer. The average annual incidence was 8.3 cases. The average age of the patients was 52.98 years with extremes of 18 and 84 years. There was a female predominance (52%) or 29 women for 21 men. Lumbar pain was the most frequent clinical expression, more than half of the patients had symptoms over a period of at least 12 months before the first consultation. The left kidney was the most frequently affected. The right localization was demonstrated in 23 patients, the extension assessment was made with thoraco-abdomino-pelvic CT in 40 patients. Twelve patients had a tumor localized in the kidney. The extension assessment had made it possible to objectify the existence of metastases in 17 of our patients (37%). The preferred locations of these metastases were pulmonary and hepatic. Surgical intervention was performed in 44 patients (88%), of whom 36 underwent radical nephrectomy (72%), and two patients underwent partial nephrectomy (4.5%). Surgical abstention was decided from the outset in 6 patients (13.6%). None of our patients had received treatment with anti-angiogenics. The histological type most observed in our patients was renal cell carcinoma, observed in 34 patients, or 77.72%. At the time of the study, more than a third of the patients had died. The mortality rate in our series had reached 24%. A specific survival rate could not be assessed due to lack of information in the files and significant numbers of patients lost to follow-up at the time of the study. Conclusion: adult kidney cancer in Mauritania is characterized by its low incidence, its occurrence in a relatively young population, its female predominance, its often late diagnosis at locally advanced and metastatic stages, and the treatment is the most often surgical.

Antitumor Activity of Recombinant Antimicrobial Peptid Penaeidin-2 against Kidney Cancer Cells

Penaeidin-2（Pen-2） is an important antimicrobial peptide derived from the Pacific white shrimp, Penaeus vannamei, and possesses both antibacterial and antifungal activities. Recent studies suggest that recombinant penaeidins show similar activities to the native Pen-2 protein. Previous researches have shown that some antimicrobial peptides（AMPs） exhibit cytotoxic activity against cancer cells. To date, there have been no studies on the antitumor effects of Pen-2. This study evaluated the potential of recombinant pen-2（rPen-2） in the selective killing of kidney cancer cell lines ACHN and A498, and its action mechanism. MTT assays found the maximal growth inhibition of HK-2, ACHN and A498 cells treated with 100 μg/mL rPen-2 at 48 h was 13.2%, 62.4%, and 70.4%, respectively. DNA-specific fluorescent dye staining showed a high percentage of apoptosis on cancer cells. Flow cytometry revealed that the apoptosis rate of HK-2, ACHN and A498 cells was 15.2%, 55.2%, and 61.5% at 48 h respectively, suggesting that rPen-2 induced higher apoptosis rate in cancer cells than in HK-2 cells. Laser confocal scanning microscopy demonstrated that the plasma membrane was the key site where rPen-2 interacted with and destroyed tumor cells. Scanning electron microscopy showed the morphologic changes of the cell membranes of kidney cancer cells treated with rPen-2. These results suggest that rPen-2 is a novel potential therapeutic agent that may be useful in treating kidney cancers.

New imaging technologies for robotic kidney cancer surgery

Objective:Kidney cancers account for approximately 2%of all newly diagnosed cancer in 2020.Among the primary treatment options for kidney cancer,urologist may choose between radical or partial nephrectomy,or ablative therapies.Nowadays,robotic-assisted partial nephrectomy(RAPN)for the management of renal cancers has gained popularity,up to being considered the gold standard.However,RAPN is a challenging procedure with a steep learning curve.Methods:In this narrative review,different imaging technologies used to guide and aid RAPN are discussed.Results:Three-dimensional visualization technology has been extensively discussed in RAPN,showing its value in enhancing robotic-surgery training,patient counseling,surgical planning,and intraoperative guidance.Intraoperative imaging technologies such as intracorporeal ultrasound,near-infrared fluorescent imaging,and intraoperative pathological examination can also be used to improve the outcomes following RAPN.Finally,artificial intelligence may play a role in the field of RAPN soon.Conclusion:RAPN is a complex surgery;however,many imaging technologies may play an important role in facilitating it.

Von Hippel-Lindau tumor suppressor pathways&corresponding therapeutics in kidney cancer

The identification and application of the Von Hippel-Lindau(VHL)gene is a seminal breakthrough in kidney cancer research.VHL and its protein p VHL are the root cause of most kidney cancers,and the cascading pathway below them is crucial for understanding hypoxia,in addition to the aforementioned tumorigenesis routes and treatments.We reviewed the history and functions of VHL/pVHL and Hypoxia-inducible factor(HIF),their well-known activities under low-oxygen environments as an E3 ubiquitin ligase and as a transcription factor,respectively,as well as their non-canonical functions revealed recently.Additionally,we discussed how their dysregulation promotes tumorigenesis:beginning with chromosome 3 p-arm(3p)loss/epigenetic methylation,followed by two-allele knockout,before the loss of complimentary tumor suppressor genes leads cells down predictable oncological paths.These different pathways can ultimately determine the grade,outcome,and severity of the deadliest genitourinary cancer.We finished by investigating current and proposed schemes to therapeutically treat clear cell renal cell carcinoma(cc RCC)by manipulating the hypoxic pathway utilizing Vascular Endothelial Growth Factor(VEGF)inhibitors,mammalian target of rapamycin complex 1(mTORC1)inhibitors,small molecule HIF inhibitors,immune checkpoint blockade therapy,and synthetic lethality.

Global,regional,and national burden of kidney,bladder,and prostate cancers and their attributable risk factors,1990–2019

Background:The burden of kidney,bladder,and prostate cancers has changed in recent decades.This study aims to investigate the global and regional burden of,and attributable risk factors for genitourinary cancers during the past 30 years.Methods:We extracted data of kidney,bladder,and prostate cancers from the Global Burden of Disease 2019 database,including incidence,mortality,disability-adjusted life-years(DALYs),and attributable risk factors from 1990 to 2019.Estimated annual percentage changes(EAPC)were calculated to assess the changes in age-standardized incidence rate,age-standardized mortality rate(ASMR),and age-standardized DALYs rate(ASDR).The associations between cancers burden and socio-demographic index(SDI)were also analyzed.Results:Compared with 1990,the global incident cases in 2019 were higher by 154.78%,123.34%,and 169.11%for kidney,bladder,and prostate cancers,respectively.During the 30-year study period,there was a downward trend in ASMR and ASDR for bladder cancer(EAPC=–0.68 and–0.83,respectively)and prostate cancer(EAPC=–0.75 and–0.71,respectively),but an upward trend for kidney cancer(EAPC=0.35 and 0.12,respectively).Regions and countries with higher SDI had higher incidence,mortality,and DALYs for all three types of cancers.The burden of bladder and prostate cancers was mainly distributed among older men,whereas the burden of kidney cancer increased among middle-aged men.Smoking related mortality and DALYs decreased,but high body mass index(BMI)and high fasting plasma glucose(FPG)related mortality and DALYs increased among kidney,bladder,and prostate cancers during the study period.Conclusions:Kidney,bladder,and prostate cancers remain major global public health challenges,but with distinct trend for different disease entity across different regions and socioeconomic status.More proactive intervention strategies,at both the administrative and academic levels,based on the dynamic changes,are needed.

Development of a Prognostic Index for Kidney Cancer Based on Hypoxia Landscape

Objective:Kidney cancer is a group of cancers occurred in the kidney.Hypoxia is a condition characterized by insuff-cient oxygen supply in the body or specifie organs.It has been proven to play an essential role in the pathogenesis and development of various cancer.However,the roles and mechanisms of hypoxia in kidney cancer have not been investigated clearly.In this study,we comprehensively analyzed the roles of hypoxia in kidney cancer.Methods:The RNA-Seq data of kidney cancer were downloaded from TCGA dataset.The survival of patients with diffentially expressed hypoxia-related genes was analyzed with the survival package.The prognostic value of hypoxia-related genes was evaluated with univariate Cox regression analysis.The correlation of hypoxia-related genes to immune ells infiltration and gene mutation in kidney cancer was assessed.We identifed 7 hypoxia-related genes of kidney cancer,with which we developed a hypoxia-related genes-based prognostic index using multivariate Cox regression analysis to establish the prog-nostic model.Results:The high-risk group showed lower survival compared with the low-risk group.HRGPI was an independent pre-dictor of kidney cancer,and it was associated with malignant stages.Hypoxia-related genes were correlated to activation of inflammatory pathways,infiltration of inflammatory ellls,and expression of inhibitory immune checkpoints,indicat ing that hypoxia was related to im-mune response in kidney cancer.Lastly,we found that hypoxia was related to missense mutation in kidney cancer.Conclusion:Hy-poxia is a risk factor of kidney cancer.It can be regarded as the prognostic indicator and therapeutic target for the treatment of kidney cancer in the future.

Machine learning-based prognostic and metastasis models of kidney cancer

Background:Kidney cancer originates from the urinary tubule epithelial system of the renal parenchyma,accounting for 20% of all urinary system tumors.Approximately 70% of cases are localized at diagnosis,and 30%are metastatic.Most localized kidney cancers can be cured by surgery,but most metastatic patients relapse after surgery and eventually die of kidney cancer.Therefore,accurately predicting patient survival and identifying high-risk metastatic patients will effectively guide interventions and improve prognosis.Methods:This study used the data of 12,394 kidney cancer patients from the surveillance,epidemiology,and end results database to construct a research cohort related to kidney cancer survival and metastasis.Eight machine learning models(including support vector machines,logistic regression,decision tree,random forest,XGBoost,AdaBoost,K-nearest neighbors,and multilayer perceptron)were developed to predict the survival and metastasis of kidney cancer and six evaluation indicators(accuracy,precision,sensitivity,specificity,F1 score,and area under the receiver operating characteristic[AUROC])were used to verify,evaluate,and optimize the models.Results:Among the eight machine learning models,Logistic Regression has the highest AUROC in both prediction scenarios.For 3-year survival prediction,the Logistic Regression model had an accuracy of 0.684,a sensitivity of 0.702,a specificity of 0.670,a precision of 0.686,an F1 score of 0.683,and an AUROC of 0.741.For tumor metastasis prediction,the Logistic Regression model had an accuracy of 0.800,a sensitivity of 0.540,a specificity of 0.830,a precision of 0.769,an F1 score of 0.772,and an AUROC of 0.804.Conclusion:In this study,we selected appropriate variables from both statistical and clinical significance and developed and compared eight machine learning models for predicting 3-year survival and metastasis of kidney cancer.The prediction results and evaluation results demonstrated that our model could provide decision support for early intervention for kidney cancer patients.

Synchronous multiple primary malignant neoplasms in breast,kidney,and bilateral thyroid:A case report

BACKGROUND Multiple primary malignant neoplasms(MPMNs)are rare,while synchronous MPMNs(SMPMNs)are even less common.Owing to the progression of medical technology and the extension of life expectancy,its incidence is gradually increasing.CASE SUMMARY Although reports of breast and thyroid dual cancers are common,cases of an additional diagnosis of kidney primary cancer within the same individual are rare.CONCLUSION We present a case of simultaneous MPMN of three endocrine organs,reviewing the relevant literature to enhance our understanding of SMPMNs while emphasizing the increasingly important need for accurate diagnosis and multidisciplinary management whenever this challenging situation arises.

Three-dimensional imaging reconstruction of the kidney’s anatomy for a tailored minimally invasive partial nephrectomy:A pilot study

Objective:The aim of the study was to evaluate three-dimensional virtual models(3DVMs)usefulness in the intraoperative assistance of minimally-invasive partial nephrectomy in highly complex renal tumors.Methods:At our institution cT1-2N0M0 all renal masses with Preoperative Aspects and Dimensions Used for an Anatomical classification score≥10 treated with minimally-invasive partial nephrectomy were considered for the present study.For inclusion a baseline contrast-enhanced computed tomography in order to obtain 3DVMs,the baseline and postoperative serum creatinine as well as estimated glomerular filtration rate values were needed.These patients,in which 3DVMs were used to assist the surgeon in the planning and intraoperative guidance,were then compared with a control group of patients who underwent minimally-invasive partial nephrectomy with the same renal function assessments,but without 3DVMs.Multivariable logistic regression models were used to predict the margin,ischemia,and complication score achievement.Results:Overall,79 patients met the inclusion criteria and were compared with 143 complex renal masses without 3DVM assistance.The 3DVM group showed better postoperative outcomes in terms of baseline-weighted differential estimated glomerular filtration rate(-17.7%vs.-22.2%,p=0.03),postoperative complications(16.5%vs.23.1%,p=0.03),and major complications(Clavien Dindo>III,2.5%vs.5.6%,p=0.03).At multivariable logistic regression 3DVM assistance independently predicted higher rates of successful partial nephrectomy(odds ratio:1.42,p=0.03).Conclusion:3DVMs represent a useful tool to plan a tailored surgical approach in case of surgically complex masses.They can be used in different ways,matching the surgeon's needs from the planning phase to the demolitive and reconstructive phase,leading towards maximum safety and efficacy outcomes.

Artificial intelligence for renal cancer:From imaging to histology and beyond

Artificial intelligence(AI)has made considerable progress within the last decade and is the subject of contemporary literature.This trend is driven by improved computational abilities and increasing amounts of complex data that allow for new approaches in analysis and interpretation.Renal cell carcinoma(RCC)has a rising incidence since most tumors are now detected at an earlier stage due to improved imaging.This creates considerable challenges as approximately 10%e17%of kidney tumors are designated as benign in histopathological evaluation;however,certain co-morbid populations(the obese and elderly)have an increased peri-interventional risk.AI offers an alternative solution by helping to optimize precision and guidance for diagnostic and therapeutic decisions.The narrative review introduced basic principles and provide a comprehensive overview of current AI techniques for RCC.Currently,AI applications can be found in any aspect of RCC management including diagnostics,perioperative care,pathology,and follow-up.Most commonly applied models include neural networks,random forest,support vector machines,and regression.However,for implementation in daily practice,health care providers need to develop a basic understanding and establish interdisciplinary collaborations in order to standardize datasets,define meaningful endpoints,and unify interpretation.

Powerful quantifiers for cancer transcriptomics

Every day,investigators find a new link between a form of cancer and a particular alteration in the sequence or/and expression level of a key gene,awarding this gene the title of“biomarker”.The clinician may choose from numerous available panels to assess the type of cancer based on the mutation or expression regulation(“transcriptomic signature”)of“driver”genes.However,cancer is not a“onegene show”and,together with the alleged biomarker,hundreds other genes are found as mutated or/and regulated in cancer samples.Regardless of the platform,a well-designed transcriptomic study produces three independent features for each gene:Average expression level,expression variability and coordination with expression of each other gene.While the average expression level is used in all studies to identify what genes were up-/down-regulated or turn on/off,the other two features are unfairly ignored.We use all three features to quantify the transcriptomic change during the progression of the disease and recovery in response to a treatment.Data from our published microarray experiments on cancer nodules and surrounding normal tissue from surgically removed tumors prove that the transcriptomic topologies are not only different in histopathologically distinct regions of a tumor but also dynamic and unique for each human being.We show also that the most influential genes in cancer nodules[the Gene Master Regulators(GMRs)]are significantly less influential in the normal tissue.As such,“smart”manipulation of the cancer GMRs expression may selectively kill cancer cells with little consequences on the normal ones.Therefore,we strongly recommend a really personalized approach of cancer medicine and present the experimental procedure and the mathematical algorithm to identify the most legitimate targets(GMRs)for gene therapy.

Study on Circulating Tumor Cells and Various Clinical Features and Blood-Related Indexes in Patients with Renal Cancer

Objective: To investigate the value of CTC clinical features and blood-related test indicators in renal cancer patients by detecting the number of circulating tumor cells (CTC) in patients with renal cancer. Methods: To analyze 59 patients with renal cell carcinoma (RCC) admitted to the Department of Urology, Affiliated Hospital of Chengde Medical College from May 2018 to October 2019. According to the CTC count (5 pcs/3.5 ml), they were divided into CTC positive group and CTC negative group. The age, gender, tumor location, tumor size, hematuria, CEC (circulating endothelial cells), CTC Cluster (aggregate), gene mutation, platelet (PLT), albumin (ALB), hemoglobin (HB), alkaline phosphatase (AKP), lactate dehydrogenase (LDH) were compared between the two groups of patients and the correlation of the number of CTCs. Results: There were significant differences in tumor size, CEC, and gene mutations between the two groups (P < 0.05). The number of CTC in patients was correlated with the levels of HB, PLT and LDH (P < 0.05). Conclusion: The number of CTC in RCC patients is correlated with some clinical features (tumor size, CEC, gene mutation) and some related test indicators (HB, PLT, LDH), and can be combined with the above related indicators to predict the occurrence, metastasis and prognosis of renal cancer.

Source,migration,distribution,toxicological effects and remediation technologies of arsenic in groundwater in China

Groundwater with high arsenic(As) content seriously threatens human life and health. Drinking high-As groundwater for a long time will lead to various pathological changes such as skin cancer, liver cancer,and kidney cancer. High-As groundwater has become one of the most serious environmental geological problems in China and even internationally. This paper aims to systematically summarize the sources,migration, distribution, toxicological effects, and treatment techniques of As in natural groundwater in China based on a large number of literature surveys. High-As groundwater in China is mainly distributed in the inland basins in arid and semi-arid environments and the alluvial and lacustrine aquifers in river deltas in humid environments, which are in neutral to weakly alkaline and strongly reducing environments.The content of As in groundwater varies widely, and As(Ⅲ) is the main form. The main mechanism of the formation of high-As groundwater in China is the reduced dissolution of Fe and Mn oxides under the action of organic matter and primary microorganisms, alkaline environment, intense evaporation and concentration, long-term water-rock interaction, and slow groundwater velocity, which promote the continuous migration and enrichment of As in groundwater. There are obvious differences in the toxicity of different forms of As. The toxic of As(Ⅲ) is far more than As(V), which is considered to be more toxic than methyl arsenate(MMA) and dimethyl arsenate(DMA). Inorganic As entering the body is metabolized through a combination of methylation(detoxification) and reduction(activation) and catalyzed by a series of methyltransferases and reductases. At present, remediation methods for high-As groundwater mainly include ion exchange technology, membrane filtration technology, biological treatment technology, nanocomposite adsorption technology, electrochemical technology, and so on. All the above remediation methods still have certain limitations, and it is urgent to develop treatment materials and technical means with stronger As removal performance and sustainability. With the joint efforts of scientists and governments of various countries in the future, this worldwide problem of drinking-water As poisoning will be solved as soon as possible. This paper systematically summarizes and discusses the hot research results of natural high-As groundwater, which could provide a reference for the related research of high-As groundwater in China and even the world.

Comparison of the oncological,perioperative and functional outcomes of partial nephrectomy versus radical nephrectomy for clinical T1b renal cell carcinoma:A systematic review and metaanalysis of retrospective studies

Objective:To conduct a meta-analysis assessing the perioperative,functional and oncological outcomes of partial nephrectomy(PN)and radical nephrectomy(RN)for T1b tumours.The primary endpoints were the oncological outcomes.The secondary endpoints were the perioperative and functional outcomes.Methods:A systematic literature review was performed by searching multiple databases through February 2019 to identify eligible comparative studies according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement.Identified reports were assessed according to the Newcastle-Ottawa Scale for nonrandomized controlled trials.Results:Overall,13 retrospective cohort studies were included in the analysis.Patients undergoing PN were younger(weighted mean difference[WMD]3.49 years,95%confidence interval[CI]5.16 to1.82;p<0.0001)and had smaller masses(WMD0.45 cm,95%CI0.59 to0.31;p<0.0001).There were no differences in the oncological outcome,which was demonstrated by progression-free survival(hazard ratio[HR]0.70;pZ0.22),cancerspecific mortality(HR 0.91;pZ0.57)and all-cause mortality(HR 1.01;pZ0.96).The two procedures were similar in estimated blood loss(WMD16.47 mL;pZ0.53)and postoperative complications(risk ratio[RR]1.32;pZ0.10),and PN provided better renal function preservation and was related to a lower likelihood of chronic kidney disease onset(RR 0.38;pZ0.006).Conclusion:PN is an effective treatment for T1b tumours because it offers similar surgical morbidity,equivalent cancer control,and better renal preservation compared to RN.

Biomarkers in renal cell carcinoma:Are we there yet?

Management of kidney cancer has undergone a paradigm shift with the approval of new therapies over the last two decades.Although these drugs have improved clinical outcomes in patients with kidney cancer,there are still a large number of patients who do not show objective responses.A multitude of investigators,including those for The Cancer Genome Atlas have biologically characterized and sub-classified kidney cancer.However,we have not been able to identify molecular targets to effectively treat patients with kidney cancer.As we familiarize ourselves with newer drugs for patients with kidney cancer,it is important to understand that these drugs may not work in every patient and instead may expose patients to unnecessary toxic effects along with burdening society with the financial impact.As we head toward the era of“precision medicine”,validated biomarkers are being utilized to guide treatment choices and help identify pathways of resistance in other tumor types.The current review aims at evaluating the progress made so far in this realm for patients with kidney cancer.

Tumor cell death visualization of renal cell carcinoma under the combined effect of the Gratiola officinalis extract and cyclophosphamide using fluorescent staining methods

Objective of the study:We used fluorescence imaging methods of apoptosis and necrosis in human renal carcinoma A498 tumor cells in vitro to reveal the indicated forms of cell death under the combined effect of flavonoid-containing extract of Gratiola officinalis and cytostatic(cyclo-phosphamide).Materials and methods:The dyes were propidium iodide and acridine orange,which were used in the"alive and dead"test.This test helped us to identify the total number of dead cells in the forms of necrosis and apoptosis and the number of cells in which apoptosis had started,it was characterized by the appearance of apoptotic bodies or nucleus pyknosis.Results:We found the most pronounced cytotoxic activity at the ratio of extract of Gratiola officinalis and cyclophosphamide concentrations of 1∶1.The number of living cells decreased when exposed to the ratio of extract and cytostatic concentrations of 2∶1.When the ratio of concentration of the extract relative to the cytostatic increased to 3∶1,the cytostatic activity of the extract began to appear,the total number of tumor cells decreased.The number of cells with nucleus pyknosis and the number of cells with apoptosis signs significantly increased at a 3∶1 ratio of extract and cytostatic concentrations,which confirms the presence of pro-apoptotic activity of the studied combination.This trend indicates the dependence of a certain form of cell death(apoptosis,necrosis)on the ratio of extract and cytostatic doses,and it also demon-strates the cytostatic and cytotoxic effects of this combination.Conclusion:Fluorescence methods of investigation in the"alive and dead"test allowed us to visualize the forms of cell death of human kidney carcinoma A498 by combined exposure to the fiavonoid-containing extract of Gratiola officinalis and cytostatic(cyclophosphamide)24 h after exposure.We found that the combination with a concentration ratio of the extract and cyclophosphamide of 3:1 has the greatest effectiveness due to stimulation of the cytostatic effect and cytotoxic effect.

First-line pazopanib in patients with advanced non-clear cell renal carcinoma:An Italian case series

BACKGROUND Non-clear cell(ncc)metastatic renal-cell carcinoma(RCC)has dismal results with standard systemic therapies and a generally worse prognosis when compared to its clear-cell counterpart.New systemic combination therapies have emerged for metastatic RCC(mRCC),but the pivotal phase III trials excluded patients with nccRCC,which constitute about 30%of metastatic RCC cases.AIM To provide a piece of real-life evidence on the use of pazopanib in this patient subgroup.METHODS The present study is a multicenter retrospective observational analysis aiming to assess the activity,efficacy,and safety of pazopanib as first-line therapy for advanced nccRCC patients treated in a real-life setting.RESULTS Overall,48 patients were included.At the median follow-up of 40.6 mo,the objective response rate was 27.1%,the disease control rate was 83.3%,and the median progression-free survival and overall survival were 12.3(95%confidence interval[CI]:3.6-20.9)and 27.7(95%CI:18.2-37.1)mo,respectively.Grade 3 adverse events occurred in 20%of patients,and no grade 4 or 5 toxicities were found.CONCLUSION Pazopanib should be considered as a good first-line option for metastatic RCC with variant histology.

Decreased cross-sectional muscle area in male patients with clear cell renal cell carcinoma and peritumoral collateral vessels

BACKGROUND Sarcopenia is the loss of skeletal muscle mass(SMM)and is a sign of cancer cachexia.Patients with advanced renal cell carcinoma(RCC)may show cachexia.AIM To evaluate the amount of SMM in male clear cell RCC(ccRCC)patients with and without collateral vessels.METHODS In this study,we included a total of 124 male Caucasian patients divided into two groups:ccRCCa group without collateral vessels(n=54)and ccRCCp group with collateral vessels(n=70).Total abdominal muscle area(TAMA)was measured in both groups using a computed tomography imaging-based approach.TAMA measures were also corrected for age in order to rule out age-related effects.RESULTS There was a statistically significant difference between the two groups in terms of TAMA(P<0.05)driven by a reduction in patients with peritumoral collateral vessels.The result was confirmed by repeating the analysis with values corrected for age(P<0.05),indicating no age effect on our findings.CONCLUSION This study showed a decreased TAMA in ccRCC patients with peritumoral collateral vessels.The presence of peritumoral collateral vessels adjacent to ccRCC might be a fine diagnostic clue to sarcopenia.

Renal cell carcinoma and viral infections:A dangerous relationship?

Virus-related cancers in humans are widely recognized,but in the case of renal cancer,the link with the world of viruses is not clearly established in humans,despite being known in animal biology.In the present review,we aimed to explore the literature on renal cell carcinoma(RCC)for a possible role of viruses in human RCC tumorigenesis and immune homeostasis,hypothesizing the contribution of viruses to the immunogenicity of this tumor.A scientific literature search was conducted using the PubMed,Web of Science,and Google Scholar databases with the keywords“virus”or“viruses”or“viral infection”matched with(“AND”)“renal cell carcinoma”or“kidney cancer”or“renal cancer”or“renal carcinoma”or“renal tumor”or“RCC”.The retrieved findings evidenced two main aspects testifying to the relationship between RCC and viruses:The presence of viruses within the tumor,especially in non-clear cell RCC cases,and RCC occurrence in cases with pre-existing chronic viral infections.Some retrieved translational and clinical data suggest the possible contribution of viruses,particularly Epstein-Barr virus,to the marked immunogenicity of sarcomatoid RCC.In addition,it was revealed the possible role of endogenous retrovirus reactivation in RCC oncogenesis,introducing new fascinating hypotheses about this tumor’s immunogenicity and likeliness of response to immune checkpoint inhibitors.

Comparative Effectiveness of Median Sternotomy vs Minimal Access Cardiopulmonary Bypass and Circulatory Arrest for Resection of Renal Cell Carcinoma with Inferior Vena Caval Extension

Introduction: The use of cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA) is an adjunctive surgical technique that can be employed for the resection of renal cell carcinoma (RCC) with venous thrombus extension superior to the level of the hepatic veins. Median Sternotomy (MS) or Minimal Access (MA) incisions may be used to establish CPB during the resection of these extensive tumors. We review our experience with both incisional approaches and compareoperative details, perioperative complications, and recurrence free survival. Materials and Methods: From 1986 to 2012, 70 radical nephrectomies with concomitant inferior vena cava (IVC) thrombectomies were performed at our institution using MS (23 patients) and MA (47 patients) techniques. Preoperative patient characteristics, pathologic data, and organ specific postoperative complications and follow-up data were compared between groups. Estimates of overall and recurrence-free survival were constructed using Kaplan-Meier curves and compared using log-rank testing. Results: There were no significant differences with respect to patient demographics or preoperative comorbid conditions between the MA and MS groups. The MA group showed a significant reduction (p 0.05) in the duration of postoperative mechanical ventilation, length of stay, operative time, and number of blood transfusions compared to MS patients. Overall and organ-system specific complications demonstrated a decreased incidence of wound infection (37.9% v. 12.5%, p = 0.0135) and sepsis (14.3% v. 0%, p = 0.0137) in patients undergoing MA approach. Perioperative mortality was significantly reduced in the MA group (30.4% v. 8.5% p = 0.0179). Recurrence-free survival in the MS group was 0.59 years and 1.2 years in the MA group (p = 0.06). Conclusions: Minimal access surgical approaches for CPB and DHCA during the resection of RCC with extensive tumor thrombus provide similar oncologic control with decreased duration of mechanical ventilation, length of stay and infection related complications. Our findings suggest that MA techniques provide significant advantages over MS.