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      Surgical Insights for the Management of Variant Histology in Renal Cell Carcinoma

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          ABSTRACT

          Purpose:

          To review the current literature regarding variant (non-clear) histology of renal cell carcinoma (RCC) and the clinical management of these renal tumors.

          Material and Methods:

          A PubMed database search was performed in May 2020 focusing on variant RCC, its diagnosis and associated syndromes, tumor characteristics, and options for management.

          Results:

          A broad range of pathological, clinical and diagnostic characteristics amongst non-ccRCC variants were found to have an impact on the overall management of these tumors. The imaging modalities, frequency of surveillance, and timing for intervention were found to be dependent on the type of genetic alterations, type of histology, and tumor growth rates. The timing and type of surgery as well as the systemic therapy are tailored to the specific tumor type and patient.

          Conclusion:

          The findings of this review suggest that clinical management should be considered and adjusted for patients with non-ccRCC histological variants based on tumor subtype and genetic alterations.

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          Most cited references48

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          Cancer statistics, 2020

          Rebecca Siegel, Kimberly D Miller, Ahmedin Jemal (2020)
          Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statistics. In 2020, 1,806,590 new cancer cases and 606,520 cancer deaths are projected to occur in the United States. The cancer death rate rose until 1991, then fell continuously through 2017, resulting in an overall decline of 29% that translates into an estimated 2.9 million fewer cancer deaths than would have occurred if peak rates had persisted. This progress is driven by long-term declines in death rates for the 4 leading cancers (lung, colorectal, breast, prostate); however, over the past decade (2008-2017), reductions slowed for female breast and colorectal cancers, and halted for prostate cancer. In contrast, declines accelerated for lung cancer, from 3% annually during 2008 through 2013 to 5% during 2013 through 2017 in men and from 2% to almost 4% in women, spurring the largest ever single-year drop in overall cancer mortality of 2.2% from 2016 to 2017. Yet lung cancer still caused more deaths in 2017 than breast, prostate, colorectal, and brain cancers combined. Recent mortality declines were also dramatic for melanoma of the skin in the wake of US Food and Drug Administration approval of new therapies for metastatic disease, escalating to 7% annually during 2013 through 2017 from 1% during 2006 through 2010 in men and women aged 50 to 64 years and from 2% to 3% in those aged 20 to 49 years; annual declines of 5% to 6% in individuals aged 65 years and older are particularly striking because rates in this age group were increasing prior to 2013. It is also notable that long-term rapid increases in liver cancer mortality have attenuated in women and stabilized in men. In summary, slowing momentum for some cancers amenable to early detection is juxtaposed with notable gains for other common cancers.
          Article 0 comments Cited 8797 times – based on 0 reviews     Review now
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            Sunitinib Alone or after Nephrectomy in Metastatic Renal-Cell Carcinoma

            Arnaud Méjean, Alain Ravaud, Simon Thezenas … (2018)
            Cytoreductive nephrectomy has been the standard of care in metastatic renal-cell carcinoma for 20 years, supported by randomized trials and large, retrospective studies. However, the efficacy of targeted therapies has challenged this standard. We assessed the role of nephrectomy in patients with metastatic renal-cell carcinoma who were receiving targeted therapies.
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              Improved identification of von Hippel-Lindau gene alterations in clear cell renal tumors.

              Michael Nickerson, Erich Jaeger, Yangu Shi … (2008)
              To provide a comprehensive, thorough analysis of somatic mutation and promoter hypermethylation of the von Hippel-Lindau (VHL) gene in the cancer genome, unique to clear cell renal cancer (ccRCC). Identify relationships between the prevalence of VHL gene alterations and alteration subtypes with patient and tumor characteristics. As part of a large kidney cancer case-control study conducted in Central Europe, we analyzed VHL mutations and promoter methylation in 205 well-characterized, histologically confirmed patient tumor biopsies using a combination of sensitive, high-throughput methods (endonuclease scanning and Sanger sequencing) and analysis of 11 CpG sites in the VHL promoter. We identified mutations in 82.4% of cases, the highest VHL gene mutation prevalence reported to date. Analysis of 11 VHL promoter CpG sites revealed that 8.3% of tumors were hypermethylated and all were mutation negative. In total, 91% of ccRCCs exhibited alteration of the gene through genetic or epigenetic mechanisms. Analysis of patient and tumor characteristics revealed that certain mutation subtypes were significantly associated with Fuhrman nuclear grade, metastasis, node positivity, and self-reported family history of RCC. Detection of VHL gene alterations using these accurate, sensitive, and practical methods provides evidence that the vast majority of histologically confirmed ccRCC tumors possess genetic or epigenetic alteration of the VHL gene and support the hypothesis that VHL alteration is an early event in ccRCC carcinogenesis. These findings also indicate that VHL molecular subtypes can provide a sensitive marker of tumor heterogeneity among histologically similar ccRCC cases for etiologic, prognostic, and translational studies.
              Article 0 comments Cited 195 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int Braz J Urol
                Journal ID (iso-abbrev): Int Braz J Urol
                Journal ID (publisher-id): ibju
                Title: International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology
                Publisher: Sociedade Brasileira de Urologia
                ISSN (Print): 1677-5538
                ISSN (Electronic): 1677-6119
                Publication date (Electronic, pub): 10 January 2021
                Publication date (Electronic, collection): Sep-Oct 2021
                Volume: 47
                Issue: 5
                Pages: 935-942
                Affiliations
                [1 ] orgnameSUNY Upstate Medical University orgdiv1College of Medicine Syracuse NY United States originalCollege of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
                [2 ] orgnameSUNY Upstate Medical University orgdiv1Department of Urology Syracuse NY United States originalDepartment of Urology, SUNY Upstate Medical University, Syracuse, NY, United States
                Author notes
                Correspondence address: Mauro Antonio Dispagna, MD, SUNY Upstate Medical University, Urology 750 E Adams St Syracuse, New York, 13210-2306, United States. E-mail: maurodispagna@ 123456gmail.com

                CONFLICT OF INTEREST

                None declared.

                Author information
                https://orcid.org/0000-0001-9914-6023
                Article
                Publisher ID: S1677-5538.IBJU.2020.0778
                DOI: 10.1590/S1677-5538.IBJU.2020.0778
                PMC ID: 8321463
                PubMed ID: 33650834
                SO-VID: 4851e0ed-5146-46a1-84e1-0f013e97562b
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 03 September 2020
                Date accepted : 03 September 2020
                Page count
                Figures: 0, Tables: 1, Equations: 0, References: 44, Pages: 8
                Categories
                Subject: Review Article

                Keywords: carcinoma, renal cell,histology,surgical procedures, operative
                Data availability:
                Keywords: carcinoma, renal cell, histology, surgical procedures, operative

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