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This review summarizes current knowledge on several novel and emerging renal entities, including eosinophilic solid and cystic renal cell carcinoma (RCC), RCC with fibromyomatous stroma, anaplastic lymphoma kinase-rearranged RCC, low-grade oncocytic renal tumor, eosinophilic vacuolated tumor, thyroidlike follicular RCC, and biphasic hyalinizing psammomatous RCC. Their clinical features, gross and microscopic morphology, immunohistochemistry, and molecular and genetic features are described. The diagnosis of most of them rests on recognizing their morphologic features using immunohistochemistry. Accurate diagnosis of these entitles will further reduce the category of "unclassifiable renal carcinomas/tumors" and will lead to better clinical management and improved patient prognostication.

MeSH
karcinom z renálních buněk * diagnóza genetika patologie MeSH
lidé MeSH
nádorové biomarkery genetika MeSH
nádory ledvin * diagnóza genetika patologie MeSH
Check Tag
lidé MeSH
Publikační typ
časopisecké články MeSH
přehledy MeSH

Článek

Typy a charakter renálních lézí - diagnostika, léčba a prognóza
[Types and characteristics of renal lesions - diagnosis, treatment and prognosis]

Onkologie (Olomouc, Print). 2023 ; 17 (2) : 119-122. [pub] 20230427

ISSN 1802-4475
Medvik
Zdroj

Charakter renálních lézí může predikovat další vývoj onemocnění, prognózu a stává se tak hned v úvodu součástí rozhodovacího procesu, jakou strategii léčby zvolit. Bohužel prostá TMN klasifikace stadia onemocnění nemusí být vždy dostatečná. V případě některých centrálně uložených nálezů renálního karcinomu (Renal Cell Carcinoma – RCC) můžeme zaznamenat přehodnocení primárního stadia cT1 na finální patologické stadium pT3a. Další specifickou skupinu v hodnocení RCC tvoří cystické renální léze, jejichž diagnostika a následný terapeutický management vychází z klasifikace dle Bosniaka na základě CT vyšetření. Zejména přístup k cystám kategorie IIF a III zůstává pro kliniky v některých případech problematický. Dle dostupných údajů je riziko malignity u kategorie IIF 3–10 % a naopak až 49 % případů stadia III může být benigních. Obecně pak mají cystické tumory lepší prognózu než solidní nádory.

Characteristics of renal lesions may predict further development of the disease, its prognosis and thus becomes part of the decision-making process, as to which treatment strategy to choose, right from the beginning. Unfortunately, a simple TMN classification of the disease stage may not always be sufficient. Some of the centrally localized renal cell carcinomas (RCC) may be re-evaluated from the primary stage cT1 to the final pathological stage pT3a. Cystic renal lesions represent another specific group in the evaluation of RCC. Their diagnostic work up and treatment strategy is guided by the Bosniak classification based on the CT. The clinical approach towards the cysts of IIF and III categories may be difficult at least in some cases. According to the available data up to 3-10% of the Bosniak category IIF complex renal cysts may be malignant, while up to 49% of the category III cysts may be benign. In general, the prognosis of cystic tumors is better than that of the solid tumors.

MeSH
klinické rozhodování MeSH
lidé MeSH
nádory ledvin * chirurgie diagnóza klasifikace terapie MeSH
nefrektomie MeSH
prognóza MeSH
stupeň závažnosti nemoci MeSH
urologické chirurgické výkony MeSH
Check Tag
lidé MeSH
Publikační typ
přehledy MeSH

Článek

Long non-coding RNAs enable precise diagnosis and prediction of early relapse after nephrectomy in patients with renal cell carcinoma

Journal of cancer research and clinical oncology. 2023 ; 149 (10) : 7587-7600. [pub] 20230329

J Cancer Res Clin Oncol
ISSN 1432-1335
Medvik
Zdroj

PURPOSE: Renal cell carcinoma belongs among the deadliest malignancies despite great progress in therapy and accessibility of primary care. One of the main unmet medical needs remains the possibility of early diagnosis before the tumor dissemination and prediction of early relapse and disease progression after a successful nephrectomy. In our study, we aimed to identify novel diagnostic and prognostic biomarkers using next-generation sequencing on a novel cohort of RCC patients. METHODS: Global expression profiles have been obtained using next-generation sequencing of paired tumor and non-tumor tissue of 48 RCC patients. Twenty candidate lncRNA have been selected for further validation on an independent cohort of paired tumor and non-tumor tissue of 198 RCC patients. RESULTS: Sequencing data analysis showed significant dysregulation of more than 2800 lncRNAs. Out of 20 candidate lncRNAs selected for validation, we confirmed that 14 of them are statistically significantly dysregulated. In order to yield better discriminatory results, we combined several best performing lncRNAs into diagnostic and prognostic models. A diagnostic model consisting of AZGP1P1, CDKN2B-AS1, COL18A1, and RMST achieved AUC 0.9808, sensitivity 95.96%, and specificity 90.4%. The model for prediction of early relapse after nephrectomy consists of COLCA1, RMST, SNHG3, and ZNF667-AS1 and achieved AUC 0.9241 with sensitivity 93.75% and specificity 71.07%. Notably, no combination has outperformed COLCA1 alone. Lastly, a model for stage consists of ZNF667-AS1, PVT1, RMST, LINC00955, and TCL6 and achieves AUC 0.812, sensitivity 85.71%, and specificity 69.41%. CONCLUSION: In our work, we identified several lncRNAs as potential biomarkers and developed models for diagnosis and prognostication in relation to stage and early relapse after nephrectomy.

MeSH
karcinom z renálních buněk * diagnóza genetika chirurgie MeSH
lidé MeSH
lokální recidiva nádoru diagnóza genetika chirurgie MeSH
nádorové biomarkery genetika MeSH
nádory ledvin * diagnóza genetika chirurgie MeSH
nefrektomie MeSH
regulace genové exprese u nádorů MeSH
RNA dlouhá nekódující * genetika MeSH
Check Tag
lidé MeSH
Publikační typ
časopisecké články MeSH

Článek

European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2023 Update

European urology. 2023 ; 84 (1) : 49-64. [pub] 20230324

Eur Urol
ISSN 1873-7560
Medvik
Zdroj

CONTEXT: The European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial carcinoma (UTUC) has updated the guidelines to aid clinicians in evidence-based management of UTUC. OBJECTIVE: To provide an overview of the EAU guidelines on UTUC as an aid to clinicians. EVIDENCE ACQUISITION: The recommendations provided in these guidelines are based on a review of the literature via a systematic search of the PubMed, Ovid, EMBASE, and Cochrane databases. Data were searched using the following keywords: urinary tract cancer, urothelial carcinomas, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, (neo)adjuvant treatment, instillation, recurrence, risk factors, metastatic, immunotherapy, and survival. The results were assessed by a panel of experts. EVIDENCE SYNTHESIS: Even though data are accruing, for many areas there is still insufficient high-level evidence to provide strong recommendations. Patient stratification on the basis of histology and clinical examination (including imaging) and assessment of patients at risk of Lynch syndrome will aid management. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk UTUC and two functional kidneys. In particular, for patients with high-risk or metastatic UTUC, new treatment options have become available. In high-risk UTUC, platinum-based chemotherapy after radical nephroureterectomy, and adjuvant nivolumab for unfit or patients who decline chemotherapy, are options. For metastatic disease, gemcitabine/carboplatin chemotherapy is recommended as first-line treatment for cisplatin-ineligible patients. Patients with PD-1/PD-L1-positive tumours should be offered a checkpoint inhibitor (pembrolizumab or atezolizumab). CONCLUSIONS: These guidelines contain information on the management of individual patients according to the current best evidence. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen according to the risk stratification of these tumours. PATIENT SUMMARY: Cancer of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, timely and appropriate diagnosis is most important. A number of known risk factors exist.