No abstract available.
Carcinoma, Renal Cell* ; Drug Therapy* ; Humans

The synchronous presentation of two separate neoplasms is extremely unusual. In 1921, Graves and Temleton first discovered synchronous two neoplasms in the same kidney. However, almost all reported synchronous tumors arising in a same kidney have been renal cell carcinoma and transitional cell carcinoma. We report a case report of a synchronous renal cell carcinoma and adult Wilms' tumor in a same kidney in a 41-year-old woman which was managed by radical nephrectomy and combination chemotherapy.
Adult* ; Carcinoma, Renal Cell* ; Carcinoma, Transitional Cell ; Drug Therapy, Combination ; Female ; Humans ; Kidney* ; Nephrectomy ; Wilms Tumor*

A retrospective analysis of our experience with six patients of renal cell carcinoma involving the renal vein and vena cava are reported. Since neither chemotherapy nor radiation has significantly altered the course of these advanced cases, radical nephrectomy with complete removal of the tumor tissue seems to be the only effective treatment. Knowledge of the accurate extent and nature of caval involvement is essential in planning the appropriate surgical procedure. Venacavography should be performed in large renal tumors and nonvisualization of the kidney containing tumor.
Carcinoma, Renal Cell* ; Drug Therapy ; Humans ; Kidney ; Nephrectomy ; Renal Veins* ; Retrospective Studies

Since 2006, tyrosine kinase inhibitors and anti-angiogenic drugs have revolutionized the treatment of metastatic renal cell carcinoma by improving progression-free survival and overall survival. The prognostic factors in metastatic renal cell carcinoma treated by targeted therapy include anatomical, histological, clinical, biological, and molecular parameters. The accuracy of these prognostic factors are not high when applied alone. A renal cancer prognostic system that combines all these prognostic factors can improve the risk assessment of renal cancer and prognosis prediction, and thus guide clinical decision-making.
Carcinoma, Renal Cell ; drug therapy ; secondary ; Humans ; Kidney Neoplasms ; drug therapy ; secondary ; Models, Theoretical ; Prognosis

Renal cell carcinoma is one of the most common malignant tumors of urinary system. The annual incidence rate is approximately 17.9/100 000 populations, and there is a continually rising trend in number of new diagnosis. Metastatic and high-risk renal cell cancer is associated with a poor prognosis and is resistant to traditional chemotherapy and/or radiotherapy. Although cytokine-based therapies (interferon and interleukin-2) have been widely used, their effectiveness remained unsatisfactory due to their low response rates and short survival. Drugs targeting anti-angiogenesis pathways have shown benefits in relapse-free survival. In this review, we introduce the recent advances in the treatment of renal cancer, especially the application of vasculogenic mimicry and mosaic vessels. Although targeted therapies with anti-angiogenic properties have proposed new treatment criteria for advanced renal cell carcinoma, new drugs or new combinations are needed to improve the clinical efficacy and minimize adverse effects.
Carcinoma, Renal Cell ; blood supply ; therapy ; Humans ; Kidney Neoplasms ; blood supply ; therapy

Objective: This study aimed to evaluate the efficacy and safety of programmed death-1 (PD-1) inhibitor combined tyrosine kinase inhibitor (TKI) therapy versus TKI monotherapy as the second-line regimen for patients with metastatic non-clear cell renal carcinoma (nccRCC) who failed first-line TKI therapy. Methods: The clinicopathological data of 67 patients with metastatic nccRCC who failed first-line TKI therapy between October 2011 and September 2020 were retrospectively analyzed, including 22 patients who received TKI monotherapy and 45 patients who received TKI plus PD-1 inhibitor as the second-line therapy. The efficacy was assessed according to Response Evaluation Criteria in Solid Tumors version 1.0/1.1 (RECIST 1.0/1.1), the Kaplan-Meier method was used to plot the survival curves, and the Log rank test was used to analyze the differences in the survival between the two groups. Treatment-related adverse events (AEs) after treatment were observed in both groups. Results: The overall objective response rate (ORR) and disease control rate (DCR) were 37.3% (25/67) and 56.7% (38/67), respectively. The overall second-line progression-free survival (PFS) was 7.7 months and Overall Survival (OS) was 25.2 months. The ORR and DCR of patients in the combination therapy group were 48.9% (22/45) and 71.1% (32/45), respectively, which were significantly improved compared with the TKI monotherapy group [13.6% (3/22) and 27.3% (6/22), respectively] (P=0.007 and P=0.001, respectively). The median PFS of 9.2 months for second-line treatment was longer in patients in the combination therapy group than in the TKI monotherapy group (5.2 months, P=0.001), but the median OS was not statistically different between the two groups (28.2 months vs 20.8 months, P=0.068). Common treatment-related AEs included hypertension, diarrhea, fatigue, stomatitis, hand-foot syndrome, and hypothyroidism. The incidence of hypothyroidism was higher in the combination therapy group [40.0% (18/45)] than in the TKI monotherapy group [22.7% (5/22), P=0.044]; the incidence of other treatment-related AEs between the two groups were not statistically significant (all P>0.05). Conclusion: Immune-targeted combination therapy was more effective than TKI monotherapy alone and was well tolerated in the treatment of metastatic nccRCC patients who failed first-line TKIs.
Humans ; Carcinoma, Renal Cell/drug therapy* ; Immunotherapy/adverse effects* ; Kidney Neoplasms/drug therapy* ; Retrospective Studies

Objective: This study aimed to evaluate the efficacy and safety of programmed death-1 (PD-1) inhibitor combined tyrosine kinase inhibitor (TKI) therapy versus TKI monotherapy as the second-line regimen for patients with metastatic non-clear cell renal carcinoma (nccRCC) who failed first-line TKI therapy. Methods: The clinicopathological data of 67 patients with metastatic nccRCC who failed first-line TKI therapy between October 2011 and September 2020 were retrospectively analyzed, including 22 patients who received TKI monotherapy and 45 patients who received TKI plus PD-1 inhibitor as the second-line therapy. The efficacy was assessed according to Response Evaluation Criteria in Solid Tumors version 1.0/1.1 (RECIST 1.0/1.1), the Kaplan-Meier method was used to plot the survival curves, and the Log rank test was used to analyze the differences in the survival between the two groups. Treatment-related adverse events (AEs) after treatment were observed in both groups. Results: The overall objective response rate (ORR) and disease control rate (DCR) were 37.3% (25/67) and 56.7% (38/67), respectively. The overall second-line progression-free survival (PFS) was 7.7 months and Overall Survival (OS) was 25.2 months. The ORR and DCR of patients in the combination therapy group were 48.9% (22/45) and 71.1% (32/45), respectively, which were significantly improved compared with the TKI monotherapy group [13.6% (3/22) and 27.3% (6/22), respectively] (P=0.007 and P=0.001, respectively). The median PFS of 9.2 months for second-line treatment was longer in patients in the combination therapy group than in the TKI monotherapy group (5.2 months, P=0.001), but the median OS was not statistically different between the two groups (28.2 months vs 20.8 months, P=0.068). Common treatment-related AEs included hypertension, diarrhea, fatigue, stomatitis, hand-foot syndrome, and hypothyroidism. The incidence of hypothyroidism was higher in the combination therapy group [40.0% (18/45)] than in the TKI monotherapy group [22.7% (5/22), P=0.044]; the incidence of other treatment-related AEs between the two groups were not statistically significant (all P>0.05). Conclusion: Immune-targeted combination therapy was more effective than TKI monotherapy alone and was well tolerated in the treatment of metastatic nccRCC patients who failed first-line TKIs.
Humans ; Carcinoma, Renal Cell/drug therapy* ; Immunotherapy/adverse effects* ; Kidney Neoplasms/drug therapy* ; Retrospective Studies

OBJECTIVE: To establish a mutation prediction model for efficacy assessment, the genomic sequencing data of renal cancer patients from the MSKCC (Memorial Sloan Kettering Cancer Center) pan-cancer immunotherapy cohort was used. METHODS: The genomic sequencing data of 121 clear cell renal cell carcinoma patients treated with immune checkpoint inhibitors (ICI) in the MSKCC pan-cancer immunotherapy cohort were obtained from cBioPortal database (http://www.cbioportal.org/) and they were analyzed by univariate and multivariate Cox regression analysis to identify mutated genes associated with ICI treatment efficacy, and we constructed a comprehensive prediction model for drug efficacy of ICI based on mutated genes using nomogram. Survival analysis and time-dependent receiver operator characteristic curves were performed to assess the prognostic value of the model. Transcriptome and genomic sequencing data of 538 renal cell carcinoma patients were obtained from the TCGA database (https://portal.gdc.cancer.gov/). Gene set enrichment analysis was used to identify the potential functions of the mutated genes enrolled in the nomogram. RESULTS: We used multivariate Cox regression analysis and identified mutations in PBRM1 and ARID1A were associated with treatment outcomes in the patients with renal cancer in the MSKCC pan-cancer immunotherapy cohort. Based on this, we established an efficacy prediction model including age, gender, treatment type, tumor mutational burden (TMB), PBRM1 and ARID1A mutation status (HR=4.33, 95%CI: 1.42-13.23, P=0.01, 1-year survival AUC=0.700, 2-year survival AUC=0.825, 3-year survival AUC=0.776). The validation (HR=2.72, 95%CI: 1.12-6.64, P=0.027, 1-year survival AUC=0.694, 2-year survival AUC=0.709, 3-year survival AUC=0.609) and combination (HR=2.20, 95%CI: 1.14-4.26, P=0.019, 1-year survival AUC=0.613, 2-year survival AUC=0.687, 3-year survival AUC=0.526) sets confirmed these results. Gene set enrichment analysis indicated that PBRM1 was involved in positive regulation of epithelial cell differentiation, regulation of the T cell differentiation and regulation of humoral immune response. In addition, ARID1A was involved in regulation of the T cell activation, positive regulation of T cell mediated cyto-toxicity and positive regulation of immune effector process. CONCLUSION PBRM1 and ARID1A mutations can be used as potential biomarkers for the evaluation of renal cancer immunotherapy efficacy. The efficacy prediction model established based on the mutation status of the above two genes can be used to screen renal cancer patients who are more suitable for ICI immunotherapy.
Biomarkers, Tumor/genetics* ; Carcinoma, Renal Cell/therapy* ; Humans ; Immunotherapy/methods* ; Kidney Neoplasms/therapy* ; Mutation

Renal cell carcinoma (RCC) is a common lethal urological cancer,the distant metastasis of which is the leading cause of death.Although targeted agents have remarkably improved the overall prognosis of RCC patients,nearly all the patients eventually acquire therapeutic resistance.With the advent of immune checkpoint inhibitors,immunotherapy based on tumor microenvironment (TME) has shown a broad scope in clinical application.The deepening understanding of TME leads to the changes of therapeutic strategies for advanced RCC,and the combination of targeted therapy and immunotherapy is exhibiting a promising prospect.Herein,we reviewed the TME characteristics,candidate predictive biomarkers,and possible targets for future development of drugs against RCC.
Carcinoma, Renal Cell/therapy* ; Female ; Humans ; Immune Checkpoint Inhibitors ; Immunotherapy ; Kidney Neoplasms/therapy* ; Male ; Tumor Microenvironment

Fumarate hydratase-deficient renal cell carcinoma (FH-RCC) is an independent pathological subtype of renal cell carcinoma with a clear driver gene and a high degree of malignancy. Recent studies have found that patients with somatic FH mutations have similar clinico-biological behavior and poor prognosis to patients with germline FH mutations. FH-RCC has the characteristics of early age of onset, atypical imaging manifestations, variable pathological patterns, difficult clinical diagnosis and poor effect on traditional drug treatment, thus greatly endangering the life and health of patients. Under the organization of the Rare Kidney Cancer Collaborative Group, Genitourinary Cancer Committee, China Anti-Cancer Association, this guideline was developed based on basic research, clinical cohort and evidence-based medicine evidence, including imaging manifestations, pathological diagnosis, genetic testing, surgical and systemic treatment options, and provided recommendations and references for the diagnosis and treatment norms.
Humans ; Carcinoma, Renal Cell/therapy* ; Fumarate Hydratase/genetics* ; Consensus ; Kidney Neoplasms/therapy* ; Immunohistochemistry