Активное наблюдение опухолей почки, накапливающих рентгеноконтрастное вещество

Introduction: Prompt surgical excision remains the standard of care for clinically localized enhancing renal tumors, for this reason the natural history of untreated renal cell carcinoma (RCC) has not been established. In order to increase our understanding of the natural history of RCC we reviewed our experience with the active surveillance of enhancing renal tumors.Methods: We reviewed our renal cancer database for enhancing renal masses that were radiographically observed for a period of at least 12 months. Variables examined included patient age, gender, lesion size on presentation, radiographic tumor characteristics, duration of active surveillance, linear tumor growth rate, incidence, type of surgical intervention, and surgical pathology.Results: 109 patients with 124 sporadic enhancing renal tumors were identified undergoing a period of active surveillance of at least 12 months. Mean patient age was 69.8 years (median 73, range 35—87). Mean duration of active surveillance was 33.4 months (median 26, range 12—156). Multifocal disease was present in 9% (10/109) patients on presentation. Tumor size on presentation was a mean of 2.61 cm (median 2.0, range 0.4—12.0). Overall mean tumor growth rate was 0.28 cm/yr (median 0.21, range -1.4—2.47). Observed linear growth rates were independent of patient age, gender, tumor size on presentation, and radiographic characteristics (solid versus cystic), p > 0.05. Of the patients initiating a period of active surveillance 36% (39/109) eventually underwent definitive therapy. Extirpative and ablative therapies were used in 72% (28/39) and 28% (11/39) of the patients undergoing surgical intervention, respectively. Malignant pathology was present in 90% (35/39) of the patients undergoing treatment. Of the malignant tumors evaluated, 68% were clear cell RCC.Conclusions: Our current series reveals that the majority of small enhancing renal tumors show a slow interval growth and they are malignant. The investigation and development of clinical and radiographic predictors of future tumor growth would be of great benefit in order to avoid unnecessary intervention in selected patients.

Endothelial CD276 (B7-H3) expression is increased in human malignancies and distinguishes between normal and tumour-derived circulating endothelial cells

Background:Mature circulating endothelial cells (CEC) are surrogate markers of endothelial damage. CEC measured in patients with advanced cancer are thought not only to derive from damaged normal vasculature (n-CEC), bu

Discrepancy between radiological and pathological size of renal masses

<p>Abstract</p> <p>Background</p> <p>Tumor size is a critical variable in staging for renal cell carcinoma. Clinicians rely on radiological estimates of pathological tumor size to guide patient counseling regarding prognosis, choice of treatment strategy and entry into clinical trials. If there is a discrepancy between radiological and pathological measurements of renal tumor size, this could have implications for clinical practice. Our study aimed to compare the radiological size of solid renal tumors on computed tomography (CT) to the pathological size in an Australian population.</p> <p>Methods</p> <p>We identified 157 patients in the Westmead Renal Tumor Database, for whom data was available for both radiological tumor size on CT and pathological tumor size. The paired Student's <it>t</it>-test was used to compare the mean radiological tumor size and the mean pathological tumor size. Statistical significance was defined as <it>P </it>< 0.05. We also identified all cases in which post-operative down-staging or up-staging occurred due to discrepancy between radiological and pathological tumor sizes. Additionally, we examined the relationship between Fuhrman grade and radiological tumor size and pathological T stage.</p> <p>Results</p> <p>Overall, the mean radiological tumor size on CT was 58.3 mm and the mean pathological size was 55.2 mm. On average, CT overestimated pathological size by 3.1 mm (<it>P </it>= 0.012). CT overestimated pathological tumor size in 92 (58.6%) patients, underestimated in 44 (28.0%) patients and equaled pathological size in 21 (31.4%) patients. Among the 122 patients with pT1 or pT2 tumors, there was a discrepancy between clinical and pathological staging in 35 (29%) patients. Of these, 21 (17%) patients were down-staged post-operatively and 14 (11.5%) were up-staged. Fuhrman grade correlated positively with radiological tumor size (<it>P </it>= 0.039) and pathological tumor stage (<it>P </it>= 0.003).</p> <p>Conclusions</p> <p>There was a statistically significant but small difference (3.1 mm) between mean radiological and mean pathological tumor size, but this is of uncertain clinical significance. For some patients, the difference leads to a discrepancy between clinical and pathological staging, which may have implications for pre-operative patient counseling regarding prognosis and management.</p

High Levels of PD-L1+ and Hyal2+ Myeloid-derived Suppressor Cells in Renal Cell Carcinoma

Renal cell carcinoma (RCC) patients frequently have increased number of immunosuppressive myeloid cells in circulation. High number of myeloid-derived suppressor cells (MDSCs) in the blood are associated with immune suppression as well as with cancer-related inflammation which drives the mobilization of myeloid cells to tumor tissue. Here, we show that peripheral blood from a previously untreated RCC patient has increased the number of monocytic CD33+CD11b+ MDSCs, which also co-expressed PD-L1 and membrane-bound enzyme hyaluronidase 2 (Hyal2). PD-L1 expression is associated with immune suppression, whereas expression of Hyal2 is associated with inflammation, because Hyal2+ myeloid cells can degrade the extracellular hyaluronan (HA), leading to the accumulation of pro-inflammatory HA fragments with low molecular weight. These findings implicate the potential involvement of monocytic MDSCs in both tumor-associated immune suppression and cancer-related inflammation. Analysis of organotypic tumor-tissue slice cultures prepared from cancer tissue of the same patient revealed the significant presence of PD-L1+ HLA-DR+ macrophage-like or dendritic cell-like antigen-presenting cells in tumor stroma. Interestingly, stroma-associated PD-L1+ cells frequently have intracellular hyaluronan. Collectively, data presented in this study suggest that the interplay between tumor-recruited myeloid cells and stromal HA may contribute to the inflammation and immune tolerance in kidney cancer

Active surveillance of enhancing renal tumors

Introduction: Prompt surgical excision remains the standard of care for clinically localized enhancing renal tumors, for this reason the natural history of untreated renal cell carcinoma (RCC) has not been established. In order to increase our understanding of the natural history of RCC we reviewed our experience with the active surveillance of enhancing renal tumors.Methods: We reviewed our renal cancer database for enhancing renal masses that were radiographically observed for a period of at least 12 months. Variables examined included patient age, gender, lesion size on presentation, radiographic tumor characteristics, duration of active surveillance, linear tumor growth rate, incidence, type of surgical intervention, and surgical pathology.Results: 109 patients with 124 sporadic enhancing renal tumors were identified undergoing a period of active surveillance of at least 12 months. Mean patient age was 69.8 years (median 73, range 35—87). Mean duration of active surveillance was 33.4 months (median 26, range 12—156). Multifocal disease was present in 9% (10/109) patients on presentation. Tumor size on presentation was a mean of 2.61 cm (median 2.0, range 0.4—12.0). Overall mean tumor growth rate was 0.28 cm/yr (median 0.21, range -1.4—2.47). Observed linear growth rates were independent of patient age, gender, tumor size on presentation, and radiographic characteristics (solid versus cystic), p &gt; 0.05. Of the patients initiating a period of active surveillance 36% (39/109) eventually underwent definitive therapy. Extirpative and ablative therapies were used in 72% (28/39) and 28% (11/39) of the patients undergoing surgical intervention, respectively. Malignant pathology was present in 90% (35/39) of the patients undergoing treatment. Of the malignant tumors evaluated, 68% were clear cell RCC.Conclusions: Our current series reveals that the majority of small enhancing renal tumors show a slow interval growth and they are malignant. The investigation and development of clinical and radiographic predictors of future tumor growth would be of great benefit in order to avoid unnecessary intervention in selected patients