A prospective analysis of the association between macronutrient intake and renal cell carcinoma in the European Prospective Investigation into Cancer and Nutrition

Previous case‐control studies have suggested that a high intake of animal foods and its associated nutrients are associated with an increased risk of renal cell carcinoma, although data from prospective studies are limited. We report here on the relationship between macronutrient intake and renal cell carcinoma incidence among 435,293 participants enrolled in the European Prospective Investigation into Cancer and Nutrition. Cox proportional hazard models were used to examine the association of dietary intake of fat, protein, carbohydrate, fiber and cholesterol and risk of renal cell carcinoma adjusted for age, sex, center, height, body mass index, physical activity, education, smoking, menopausal status, alcohol and energy intake. During an average 8.8 years of follow‐up, 507 renal cell carcinoma cases occurred. Risk of renal cell carcinoma was not associated with macronutrient intake, including nutrients derived from animal sources. Our results indicate that macronutrient intake is not associated with risk of renal cell carcinoma in this cohort of European men and women. © 2009 UICC     

Alcohol consumption and renal cell cancer risk in two Italian case-control studies.

BACKGROUND: There is some evidence that alcohol consumption is inversely associated with renal cell cancer (RCC), but the issue is still unclear. PATIENTS AND METHODS: We investigated the relation using data from two Italian multicentric case-control studies conducted from 1985 to 2004, including a total of 1115 incident, histologically confirmed cases and 2582 controls hospitalised with acute, non-neoplastic conditions. RESULTS: Compared with non-drinkers, the multivariate odds ratios (ORs) of RCC were 0.87 [95% confidence interval (CI) 0.73-1.04] for 4 to 8 drinks per day of alcoholic beverages, with a significant inverse trend in risk (P value = 0.01). The ORs were 0.85 (95% CI 0.71-1.02) for wine, 0.84 (95% CI 0.68-1.03) for beer and 0.86 (95% CI 0.70-1.05) for spirits consumption, as compared with abstainers. No trend in risk of RCC emerged with duration (P value = 0.94) and age at starting alcohol consumption (P value = 0.81). Results were consistent in men and women, as well as in strata of age, smoking and body mass index. CONCLUSIONS: This pooled analysis found an inverse association between alcohol drinking and RCC. Risks continued to decrease even above eight drinks per day (i.e. >100 g/day) of alcohol intake, with no apparent levelling in risk.     

Alcoholic beverages and risk of renal cell cancer

Using a mailed questionnaire, we investigated the risk of renal cell cancer in relation to different types of alcoholic beverages, and to total ethanol in a large population-based case-control study among Swedish adults, including 855 cases and 1204 controls. Compared to non-drinkers, a total ethanol intake of >620 g month(-1) was significantly related to a decreased risk of renal cell cancer (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.4-0.9; P-value for trend=0.03). The risk decreased 30-40% with drinking more than two glasses per week of red wine (OR 0.6, 95% CI 0.4-0.9), white wine (OR 0.7, 95% CI 0.4-1.0), or strong beer (OR 0.6, 95% CI 0.4-1.0); there was a clear linear trend of decreasing risk with increasing consumption of these beverages (P-values for trends <0.05).     

Statin use and the risk of renal cell carcinoma in 2 prospective US cohorts

BACKGROUND:

Statins are widely used cholesterol‐lowering agents that may have potential antitumor effect. Epidemiological studies on statin use and renal cell carcinoma (RCC) risk have been inconsistent.

METHODS:

The authors investigated the association between statin use and RCC risk in the Nurses' Health Study and Health Professionals Follow‐Up Study. In total, 80,782 women and 37,869 men were followed for 14 years and 16 years, respectively. Regular statin use was assessed at baseline and was updated biennially during follow‐up. RCC diagnosis was confirmed by medical record review.

RESULTS:

Two hundred seventy‐seven incident RCC cases (164 women and 113 men) were identified. Compared with no current use, the multivariate relative risks of current statin use were 0.68 (95% confidence interval, 0.46‐1.00) in women and 1.17 (95% confidence interval, 0.75‐1.82) in men. The results for ever versus never users of statins were similar. No dose‐response relation with duration of statin use and RCC risk was observed. On subgroup analyses, statin use was associated with a reduced RCC risk among women who had no history of hypertension.

CONCLUSIONS:

The current study indicated that statin use may be associated with a lower risk of RCC in women, although these results need to be investigated further. Cancer 2012;. © 2011 American Cancer Society.     

Chemotherapy for non-clear-cell renal cell carcinoma

Clear-cell carcinoma is the most common histopathologic subtype of kidney tumors. Consequently, clinical trials for advanced-stage kidney cancer have focused on patients with clear-cell carcinoma and not on the less common subtypes, including papillary, chromophobe, collectingduct carcinoma, and sarcomatoid-variant tumors. Whereas immunotherapy has constituted the standard treatment for patients with clear-cell renal cell carcinoma (RCC), it does not appear to have activity in the management of patients with other histologic subtypes. Novel therapies, including those targeting the vascular endothelial growth factor pathway, have recently demonstrated significant activity in clear-cell RCC. Historically, chemotherapy has shown limited activity in advanced-stage RCC; however, clinical trials to date have failed to individualize treatment based on histologic subtype. In this article, we will review the literature and present our experience with the use of chemotherapy in patients with non-clear-cell kidney cancer by histologic subtype.     

肾细胞癌的相关标志物

肾细胞癌是成年人肾脏最常见的恶性肿瘤,其自然过程极难预料,仅依靠分期和分级等尚不能提供足够的预后信息.寻找适合的肿瘤标志物有助于该病的诊断和监测,提供更有效的预后信息,确定发生复发和转移的风险,甚至可以作为肿瘤靶向治疗的标靶,并有助于深入了解肾细胞癌的疾病发展过程和揭示与之有关的分子生物学信息.本文回顾分析了近年来RCC相关性肿瘤标志物的最新研究进展情况.     

The incidence and mechanism of sunitinib-induced thyroid atrophy in patients with metastatic renal cell carcinoma

Background:

To elucidate the incidence and mechanisms of sunitinib-induced thyroid atrophy, we investigated serial volumetric and functional changes, and evaluated histological changes of the thyroid gland in metastatic renal cell carcinoma patients who received sunitinib.

Methods:

Thyroid volume (by computed tomography volumetry) and thyroid function were measured at baseline, during the treatment, and at post-treatment periods. Histological evaluation of the thyroid gland was performed in four autopsied patients.

Results:

The median reduction rate in thyroid volume at last evaluation during sunitinib treatment was 30% in all 17 patients. The incidence of hypothyroidism during sunitinib treatment was significantly higher in the high reduction rate group (n=8; more than 50% reduction in volume) than in the low reduction rate group (n=9; less than 50% reduction in volume). Half of the patients in the high reduction rate group exhibited a transient thyroid-stimulating hormone suppression, suggesting thyrotoxicosis during sunitinib treatment. Histological evaluation demonstrated atrophy of thyroid follicles and degeneration of follicular epithelial cells without critical diminution of vascular volume in the thyroid gland.

Conclusion:

Thyroid atrophy is frequently observed following sunitinib treatment and may be brought about by sunitinib-induced thyrotoxicosis or the direct effects of sunitinib that lead to degeneration of thyroid follicular cells.     

Etiologic heterogeneity of clear‐cell and papillary renal cell carcinoma in the Netherlands Cohort Study

At present, mostly case‐control and retrospective studies have investigated the association between etiologic risk factors and the development of histologic subtypes of renal cell carcinoma (RCC). Therefore, we assessed the heterogeneity between body mass index (BMI), cigarette smoking, alcohol consumption and hypertension across clear‐cell RCC (ccRCC) and papillary RCC (pRCC) risk in the prospective Netherlands Cohort Study on diet and cancer. In 1986, 120 852 participants aged 55 to 69 completed a self‐administered questionnaire on diet and other risk factors for cancer. Participants were followed up for cancer through record linkage. Tumor histology was assessed through centralized revision by two experienced uropathologists. After 20.3 years of follow‐up, 384 histologically verified RCC cases, including 315 ccRCC and 46 pRCC cases and 4144 subcohort members were eligible for case‐cohort analysis. Hazard ratios and 95% confidence intervals were estimated by multivariable‐adjusted proportional hazards models. Overall, BMI was associated positively with ccRCC risk, but inversely with pRCC risk. Cigarette smoking was associated with an increased ccRCC, but a decreased pRCC risk. Alcohol consumption was inversely associated with both ccRCC and pRCC risk. Hypertension was associated with an increased risk of both ccRCC and pRCC. Statistically significant etiologic heterogeneity was observed for BMI, BMI change since age 20, and smoking duration in current smokers across ccRCC and pRCC risk. In conclusion, we observed potential heterogeneity for BMI, BMI change and smoking duration across ccRCC and pRCC risk.     

代谢综合征与肾透明细胞癌相关性研究

目的 代谢综合征(metabolic syndrome,MS)是一组临床症候群,MS及其相关组分与癌症发生发展及病理特征具有密切关系.本研究旨在分析MS及其相关组分与肾透明细胞癌(clear cell cenal cell carcinoma,CCRCC)分期、分级及肿瘤大小的相关性.方法 回顾性分析2013-01-01-2015-12-30于山西医科大学第一医院就诊且病理诊断为CCRCC的375例患者的临床资料,包括年龄、性别、身高、体质量、血压、空腹血糖、生化结果、病理分期分级和肿瘤大小等.计数资料采用x2检验,计量资料以(x)±s表示,组间比较采用t检验,多因素分析采用Logistic回归分析.结果 MS组56例患者,其中男性患者32例,女性患者24例;非MS组319例患者,其中男性患者206例,女性患者113例.男女患者比较,差异无统计学意义,P=0.287.MS组与非MS组相比,年龄、吸烟、饮酒等差异无统计学意义,P值分别为0.100、0.691和0.269;而BMI指数、收缩压、空腹血糖、TG、HDL-C等差异均有统计学意义,均P＜0.001.在病理特点方面,MS与非MS相比,CCRCC病理分期(P=0.018)、分级(P=0.026)及肿瘤大小(P=0.026),差异均有统计学意义.MS相关疾病与CCRCC分期分析,糖尿病(P＜0.001)、高血压(P=0.015)、血脂紊乱(P=0.006)与CCRCC的分期有关.结论 CCRCC合并MS者病理分期较高、分级较低、肿瘤更大,糖尿病、高血压和血脂紊乱都可增加CCRCC的病理分期.     

Sarcomatoid renal cell carcinoma with foci of chromophobe carcinoma

Both chromophobe carcinoma and sarcomatoid carcinoma of the kidney are rare. The former is characterized by a relatively good prognosis, while the latter is a highly aggressive tumor. Coexistence of the two components in one renal tumor, which has been reported only rarely, is therefore paradoxical. Both sarcomatoid and chromophobe renal carcinoma were diagnosed in a 52-year-old woman following nephrectomy and resection of metastases in the right lobe of the liver. She died of the disease two months after the first operation; only the sarcomatoid component of her tumor was seen in the liver metastasis and the recurrent carcinoma. Differences in phenotype, immunophenotype and DNA-ploidy patterns of the two components are reported. The intensive p53 staining observed only in the sarcomatoid area supports the role of the TP53 gene in the transformation of chromophobe renal carcinoma to sarcomatoid carcinoma.     

Measurement of progesterone receptor in human renal cell carcinoma and normal renal tissue

Progesterone receptor was measured in eight samples of renal cell carcinoma, nine samples of normal renal tissue, and one sample of melanoma tissue. Progesterone receptor was identified in all samples, with the exception of one renal cell carcinoma. Three patients, all with receptor-positive tumors, were treated with medroxyprogesterone acetate for metastatic disease. In one of these patients there was a partial objective response to treatment. Further research regarding progesterone receptor in renal cell carcinoma is indicated.     

肾包膜侵犯状况对于肾癌临床症状及分期的意义

背景与目的：肾细胞癌是致死率最高的泌尿系统肿瘤,肾包膜侵犯状况可能与肾癌的临床病理特征及预后相关,但目前在这方面的研究很少。本研究探讨了肾包膜侵犯状况对于。肾癌临床症状及分期的意义。方法：根据肿瘤与。肾包膜之间的关系把肾包膜侵犯状况分为浸润而未穿透包膜和浸润且穿透包膜。回顾分析2006年在我科接受手术治疗的经病理确诊的101例连续肾癌病例的临床症状、术后病理显示的肾包膜侵犯状况以及TNM分期（AJCC 2002年版）,并比较3者之间的联系。结果：55例为体检发现,24例诉腰痛,18例有肉眼或镜下血尿,14例有恶液质等全身症状或者伴有转移症状。大体标本77例肿瘤直径≤7cm,50例44cm。病理T1期68例,T2期9例,〉T2期24例,其中N1-2或M1期的有19例。24例主诉腰痛的病例,肿瘤均未穿透肾包膜;而11例穿透肾包膜的,患者均无腰痛主诉。对于≤4cm的肾癌,腰痛与肾包膜穿透与否无明显相关：当肿瘤〉4cm时,29％（10／35）例无腰痛主诉的病例肿瘤已穿透肾包膜;当肿瘤〉7cm时,53％（8／15）例无腰痛主诉的病例中肿瘤穿透肾包膜;有转移症状或全身症状的病例,43％（6／14）肿瘤穿透肾包膜;无转移症状或全身症状的病例中,6％（5／87）肿瘤穿透肾包膜。40％（40／101）的病例出现肾包膜浸润,其中11例穿透肾包膜：在肿瘤〉7cm的病例中,71％（17／24）出现肾包膜浸润。当肾癌局部未穿透。肾包膜时,是否有包膜浸润对于肿瘤的淋巴结或内脏器官的转移无影响（4／29 vs 9／61,P〉0．05）;当肾癌浸润肾包膜时,如无进一步的肾包膜穿透,则肿瘤转移显著减少（6／11 vs 4／29,P〈0．01）。结论：就诊时腰痛主诉提示肾癌可能尚为局限性病变,对于较大的肾脏占位,如无腰痛主诉,则肿瘤可能已穿透。肾包膜肾包膜侵犯状况与肾癌的临床症状和病理分期有关联。肾包膜浸润在肾癌中比较常见,尤其对于较大的肿瘤,但穿透肾包膜的肿瘤很少。仅仅肾包膜浸润而不穿透不增加肾癌诊断时出现转移的概率,肾包膜的存在一定程度上减少了肿瘤的转移,在限制肿瘤扩散中有一定的保护性作用。     

RhoB在肾透明细胞癌中的表达及临床意义

目的:探讨RhoB在肾透明细胞癌中的表达及临床意义.方法:采用实时定量PCR、Western blot和免疫组化方法检测RhoB在肾透明细胞癌组织中的表达情况.选取60例肾透明细胞癌组织标本,详细收集病人临床病理资料,通过免疫组化方法检测RhoB在肾透明细胞癌组织中的蛋白表达水平,并分析RhoB的蛋白水平与临床病理资料的关系.结果:与对应瘤旁肾组织相比,RhoB的mRNA及蛋白表达水平在肾透明细胞癌组织标本中明显降低;RhoB的蛋白表达水平在不同年龄、性别组间差异无统计学意义(P>0.05),而在肿瘤直径大小、T分期、临床分期和组织分级间差异有显著统计学差异(P<0.05).结论:RhoB的表达降低可能在肾透明细胞癌的肿瘤发生中发挥作用,且其表达下降可能与肾透明细胞癌的恶性进展有关.     

肾细胞癌远处转移的分子生物学机制

研究表明,约25%的肾细胞癌患者获得诊断时已发生了不同程度的远处转移。肿瘤侵袭是转移的基础,血管生成为癌细胞转移提供了有利的途径,而能否最终形成远处转移视肿瘤细胞能否在血液中存活并与远处组织或器官粘附而种植于该处。本文综述肾细胞癌的侵袭,血管生成,免疫逃逸与远处粘附的分子生物学机制。     

肾细胞癌病理诊断中的形态计量学研究

为探讨细胞形态计量学方法在肾细胞癌病理诊断中的价值。方法　采用细胞形态计量学技术对 10 0例肾细胞癌 (RCC)及 10例正常肾组织标本进行测量分析。分析的参数包括 :核面积 ,核形态系数 ,核质比 ,核比轴 ,核短轴 ,轴率等。结果　本研究发现 :1.RCC具有明显的核异型性 ;2 .颗粒细胞癌核面积、核长轴、核短轴均大于透明细胞癌 ;3.核面积、核长轴与核短轴均与核Fuhrman分级呈高度正相关。结论 :细胞形态计量技术 ,完善了传统的单纯依靠经验进行病理诊断的方法 ,具有临床实用价值。     

红色胶状肾透明细胞癌的临床及病理特点——附2例报告

目的探讨大体标本为红色胶状肾透明细胞癌的临床特点。方法报告2例临床发现的特殊肾透明细胞癌的诊治情况,并回顾肾癌相关文献。结果临床2例肾透明细胞癌大体标本表现为均一红色,质软,胶状的特殊特点,其影像学及病理表现为典型肾透明细胞癌。结论在肾透明细胞癌大体标本可以表现为特殊的均一红色特点,其影像学为典型肾癌,大体标本与病理分期关系不明显。     

端粒酶活性与肾细胞癌发生发展的关系

目的：研究端粒酶与肾细胞癌发生发展的关系。方法：应用ＴＲＡＰ（ｔｅｌｏｍｅｒｉｃ ｒｅｐｅａｔ ａｍｐｌｉｆｉｃａｔｉｏｎ ｐｒｏｔｏｃｏｌ）方法,对２０例肾细胞癌病人术后标本中的肾病组织及癌旁正常肾组织进行研究。结果：２０例肾癌组织中有１４例癌组织（７０．０％）端粒酶表达阳性,２０例癌旁正常组织无一例组织端粒酶表达阳性。２０例肾癌样本中,９例Ｔ１期中有４例（４４．４％）端粒酶表达阳性;１１例Ｔ２     

Adjuvant therapy in renal cell carcinoma

Several drugs have demonstrated clinical activity in metastatic renal cell carcinoma (mRCC). The identification of key metabolic pathways has led to the development of novel targeted therapies which have drastically changed the treatment paradigm of mRCC. Moreover, immune-checkpoint inhibitors have recently shown significant activity in advanced disease. Despite these advancements, the role of adjuvant therapy in localized, non-metastatic RCC remains unclear. The utility of many of these agents in the adjuvant setting is currently being actively explored. In this review, we will summarize the main clinical trials investigating adjuvant therapy in renal cell carcinoma, focusing primarily on immunotherapy and targeted agents.     

肾嫌色细胞癌的诊断和治疗

目的：探讨肾嫌色细胞癌（renal chromophobe cell carcinoma,RCCC）的临床特征、病理学特点、诊断、治疗方法和预后。方法：回顾性分析2010年2月至2015年4月期间经病理检查证实的11例 RCCC 患者的临床资料,结合相关文献复习并进行讨论。结果：11例患者中7例男性,4例女性,年龄40～71岁,平均59岁。肿物直径3．5～14．5cm。病变位于右侧者6例,左侧5例。术前无症状者6例,单纯性腰背部疼痛不适5例。11例患者均经 CT 检查确诊,均行手术治疗。手术过程顺利,术后均有病理证实为肾嫌色细胞癌。出院后随访3～36个月,无肿瘤复发和转移。结论：RCCC 是一种低度恶性,少见的肾脏肿瘤。手术治疗是首选方法,预后较好。     

Fibre intake and renal cell carcinoma: a case-control study from Italy

Only 2 previous studies, conducted in Australia, United States and northern Europe, considered the role of dietary fibre intake on renal cell carcinoma (RCC) risk, and both showed a modest, inverse association. Therefore, we investigated in depth the topic of fibres and RCC, using data from a multicenter case-control study conducted in Italy from 1992 to 2004, including 767 cases with incident, histologically confirmed RCC and 1,534 controls admitted to the same network of hospitals as cases with acute nonmalignant conditions. Multivariate odds ratios (OR) and 95% confidence intervals (CI) were obtained after allowance for major identified confounding factors, including total energy intake. The continuous OR for an increase in intake equal to the difference between the 80th and the 20th percentile were 0.94 (95% CI: 0.82-1.08) for total dietary fibre, 0.98 (95% CI: 0.85-1.13) for soluble noncellulose polysaccharides, 0.92 (95% CI: 0.80-1.05) for total insoluble fibre, 0.90 (95% CI: 0.78-1.04) for cellulose, 0.95 (95% CI: 0.84-1.06) for insoluble noncellulose polysaccharides and 1.06 (95% CI: 0.93-1.21) for lignin. With reference to the sources of fibre, we found an inverse association with vegetable fibre (OR = 0.84, 95% CI: 0.73-0.97), but no association with fruit (OR = 0.98, 95% CI: 0.86-1.12) and grain fibre (OR = 1.05, 95% CI: 0.95-1.15). The inverse association with vegetable fibre may reflect a real favorable effect, or be an indicator of a beneficial role of a diet rich in vegetable on RCC risk.