Sarcomatoid renal cell carcinoma is a highly malignant tumor with sarcomatoid dedifferentiation, which has rapid progression, high mortality rate and poor prognosis. Studies have shown that cytoreductive surgery, chemotherapy or targeted therapy are not effective to patients with advanced sarcomatoid renal cell carcinoma. With the further study of pathogenesis and molecular biological characteristics of sarcomatoid renal cell carcinoma, it is found that the expression levels of PD-1 and PD-L1 in it are higher than those of other subtypes, so the combination of immune checkpoint inhibitors and immunotherapy combined with targeted therapy have become the first-line therapy. This article mainly reviews the latest treatments for advanced sarcomatoid renal cell carcinoma, including surgery, chemotherapy, targeted drugs, immunotherapy and so on.

At present, systemic therapy is the main treatment option for metastatic renal cell carcinoma. However, active surveillance may be an alternative for patients with poor physical status or slow disease progression. Active surveillance can appropriately delay the timing of systematic treatment for some patients with metastatic renal cell carcinoma without affecting their prognosis. We have combined the latest researches to clarify the clinical significance, applicable population, disadvantages, scheme and prognosis of active surveillance in metastatic renal cell carcinoma in recent years in detail.

Renal cancer with multiple differentiation and multiple components is rare in clinic. It has the character of high malignancy, early metastasis, and poor prognosis. A patient with multiple differentiated renal cell carcinoma was diagnosed in our hospital mainly because of emaciation, fatigue and loss of appetite. CT scan showed the 6.5 cm×6.0 cm mass in the lower pole of right kidney with unequal enhancement and necrosis. The chest CT scan showed multiple enlarged lymph nodes in the mediastinum and right superior clavicle. The patient accepted the laparoscopic retroperitoneal right nephrectomy and right supraclavicular lymph node biopsy. Postoperative pathology showed multiple differentiated renal cell carcinoma with localized sarcomatoid leisions, including clear cell carcinoma, collecting duct-like carcinoma and medullary carcinoma combined with right supraclavicular lymph node metastasis. Targeted therapy was performed at 1 month after surgery. Liver and lung metastasis occured at 6 months and the patient died of multi-organ failure at 12 months after surgery.

Objective:To evaluate the effects of bosutinib on acute lung injury in mice with endotoxemia.Methods:Sixty clean-grade healthy male C57BL/6 mice, aged 8-12 weeks, weighing 20-25 g, were divided into 4 groups ( n=15 each) using a random number table method: control group (group C), bosutinib group (group B), endotoxemia group (group lipopolysaccharide [LPS]) and bosutinib plus endotoxemia group (group B+ LPS). Septic acute lung injury model was developed by intraperitoneal injection of LPS.Bosutinib 5 mg/kg was injected via the tail vein at 0.5 h before establishing the model in group B+ LPS and at the corresponding time point in group B. At 24 h after developing the model, the mice were sacrificed for microscopic examination of the pathological results of lung tissues which were scored for calculation of the lung coefficient (LI) and wet/dry lung weight (W/D) ratio, and for determination of the content of Evans blue in lung tissues (by Evans blue staining), expression of vascular endothelial cadherin (VE-cadherin), vascular cell adhesion molecule 1 (VCAM-1), phosphorylated nuclear transcription factor κB p65 (p-NF-κB p65), phosphorylated nuclear factor κB inhibitory protein α (pIκB-α) (by Western blot) and expression of interleukin-1beta (IL-1β), IL-6 and tumor necrosis factor-alpha (TNF-α) mRNA (using real-time polymerase chain reaction). Results:Compared with group C, the LI, W/D ratio, Evans blue content in lung tissues and lung injury score were significantly increased, and the expression of IL-1β mRNA, TNF-α mRNA, IL-6 mRNA, VCAM-1, p-NF-κB p65 and pIKB-α was up-regulated, and the expression of VE-cadherin was down-regulated in group LPS ( P<0.05), and no significant change was found in the parameters mentioned above in group B ( P>0.05). Compared with group B, the LI, W/D ratio, Evans blue content in lung tissues and lung injury score were significantly decreased, and the expression of IL-1β mRNA, TNF-α mRNA, IL-6 mRNA, VCAM-1, p-NF-κB p65 and pIKB-α was down-regulated, and the expression of VE-cadherin was up-regulated in group LPS ( P<0.05). Conclusions:Bosutinib can ameliorate the acute lung injury in mice with endotoxemia.

Nephron-sparing surgery (NSS) is the standard treatment method for T1 and some T2 stage renal cell carcinoma (RCC), but it is not recommended for T3 stage RCC. Due to the limited sensitivity and specificity of preoperative imaging, some cT1/2 upstaging to pT3a RCC patients also receive NSS. The efficacy of NSS versus radical nephrectomy for upstaging to T3a RCC remains highly controversial. This article summarizes the preoperative imaging diagnostic criteria of T3a RCC and risk factors of upstaging to pT3a, and compares the efficacy and prognosis between NSS and radical nephrectomy for upstaging to pT3a RCC.