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Hum Pathol 2020 Jun 30. Epub 2020 Jun 30.

Departments of Pathology, Indiana University, Indianapolis, IN 46202, USA; Departments Urology, Indiana University, Indianapolis, IN 46202, USA. Electronic address:

Renal cell carcinoma, unclassified (RCC-U), is a heterogenous group of tumors that do not fit in any recognized histologic types. Immunohistochemical studies are frequently used to characterize these tumors. Herein, we sought to investigate the immunophenotypes of 300 cases of RCC-U. Read More

J Cancer Res Clin Oncol 2020 Jul 2. Epub 2020 Jul 2.

Fujian Provincial Key Laboratory of Ecology-Toxicological Effects and Control for Emerging Contaminants, Key Laboratory of Ecological Environment and Information Atlas (Putian University) Fujian Provincial University, Key Laboratory of Loquat Germplasm Innovation and Utilization (Putian University), Fujian Province University, College of Environmental and Biological Engineering, Putian University, Putian, 351100, Fujian, China.

Purpose: With the wide application of high-throughput sequencing and the development of multiomics analysis, somatic mutational profiling has demonstrated that there is heterogeneity across multiple malignancies. Meanwhile, tumor mutational burden (TMB) was proven to be effective predictors of immunotherapy response. However, the significance of TMB in predicting prognosis remains unclear. Read More

Mod Pathol 2020 Jul 2. Epub 2020 Jul 2.

Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.

Chromophobe renal cell carcinoma (chRCC) is a histologically and molecularly distinct class of rare renal tumor. TCGA studies revealed low mutational burden, with only TP53 and PTEN recurrently mutated, and discovered alterations in TERT promoter and in the electron transport chain Complex I genes. However, knowledge on drug targetable genes is limited and treatments at metastatic stage do not follow a molecular rationale. Read More

BMJ Case Rep 2020 Jul 2;13(7). Epub 2020 Jul 2.

Department of Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA

Checkpoint inhibitor immunotherapy has revolutionised cancer treatment since its inception. During an inflammatory response, activated cytotoxic T cells expressing programmed cell death protein 1 (PD-1) interact with programmed cell death-ligand 1 (PD-L1) on peripheral tissues to thwart an autoimmune reaction. Cancer cells upregulate PD-L1 expression to evade the immune system and are vulnerable to attack in the presence of PD-1 or PD-L1 checkpoint inhibitors. Read More

J Am Soc Cytopathol 2020 Jun 5. Epub 2020 Jun 5.

University of California Irvine School of Medicine, Orange, California. Electronic address:

Introduction: Core needle biopsy (CNB) of renal masses has not been commonly performed because of the perceived low sensitivity until recent years. Rapid onsite evaluation (ROSE) using touch preparations (TPs) has the potential to improve the yield of CNB, although it can be challenging because of the diverse morphology of various types of renal tumors and native cells.

Materials And Methods: We retrospectively reviewed percutaneous CNBs of renal masses with ROSE using TPs. Read More

BMC Urol 2020 Jul 2;20(1):84. Epub 2020 Jul 2.

Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), 300 East 66th Street, New York, NY, 10065, USA.

Background: Several phase 3 studies reported positive results for combinations of Immune-Oncology (IO) and Vascular Endothelial Growth Factor (VEGF) targeted therapies in patients with metastatic clear cell Renal Cell Carcinoma (ccRCC). However, there are limited data on outcomes to systemic therapy after IO-VEGF combinations.

Methods: A retrospective analysis was performed on patients with metastatic ccRCC treated at the Memorial Sloan Kettering Cancer Center and Cleveland Clinic who initiated systemic therapy post IO-VEGF including combinations with VEGF receptor (VEGFR) tyrosine kinase inhibitors (IO-TKI) and combinations with the anti-VEGF monoclonal antibody bevacizumab (IO-Bev). Read More

BMC Urol 2020 Jul 2;20(1):85. Epub 2020 Jul 2.

A.C. Camargo Cancer Center, Rua Antônio Prudente 211, Liberdade, São Paulo, 01509-010, Brazil.

Background: To evaluate demographic, clinical and pathological characteristics of small renal masses (SRM) (≤ 4 cm) in a Latin-American population provided by LARCG (Latin-American Renal Cancer Group) and analyze predictors of survival, recurrence and metastasis.

Methods: A multi-institutional retrospective cohort study of 1523 patients submitted to surgical treatment for non-metastatic SRM from 1979 to 2016. Comparisons between radical (RN) or partial nephrectomy (PN) and young or elderly patients were performed. Read More

BMC Cancer 2020 Jul 2;20(1):620. Epub 2020 Jul 2.

Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.

Absract: BACKGROUND: Several studies have investigated the associations between the podocalyxin-like protein (PODXL) expression quantity or locations and cancers survival, but the results were far from conclusive. Therefore, we proceeded a meta-analysis on PODXL in various human cancers to find its prognostic value and followed confirmation using the TCGA datasets.

Methods: We performed a systematic search, and 18 citations, including 5705 patients were pooled in meta-analysis. Read More

J Laparoendosc Adv Surg Tech A 2020 Jul 1. Epub 2020 Jul 1.

Department of Surgery, Mount Sinai Medical Center, Comprehensive Cancer Center, Miami Beach, Florida, USA.

Metastatic disease to the pancreas is a rare entity from all malignant pancreatic masses. Its diagnosis is very challenging, but with the introduction of endoscopic ultrasound (EUS)-fine needle aspiration (FNA), now there is a feasible way to make an accurate histopathological and definitive diagnosis. This is a retrospective review of 11 patients with metastasis to the pancreas diagnosed with EUS-FNA in a tertiary referral center over a period of 3 years. Read More

J Urol 2020 Jul 2:101097JU0000000000001230. Epub 2020 Jul 2.

Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada.

Purpose: The time between radiographic identification of a renal tumor and surgery can be concerning for patients and clinicians due to fears of tumor progression while awaiting treatment. This study aimed to evaluate the association between surgical wait time and oncologic outcomes for patients with renal cell carcinoma (RCC).

Materials And Methods: The Canadian Kidney Cancer information system (CKCis) is a multi-institutional prospective cohort initiated in January 2011. Read More

Biomark Med 2020 Jul 2. Epub 2020 Jul 2.

Department of Pharmaceutics, Medical College of Jiaxing University, Jiaxing, PR China.

The discrimination of renal cell carcinoma from renal angiomyolipoma (RAML) is crucial for the effective treatment of each. Serum samples were analyzed by nuclear magnetic resonance spectroscopy-based metabolomics and a number of metabolites were further quantified by HPLC-UV. clear-cell renal carcinoma (ccRCC) was characterized by drastic disruptions in energy, amino acids, creatinine and uric acid metabolic pathways. Read More

Eur J Histochem 2020 Jul 1;64(3). Epub 2020 Jul 1.

Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg.

A simple dark field microscopy technique was used for visualization of blood vessels in normal human renal tissues and carcinoma. Phase contrast condenser ring apt for high power objectives was combined with a 10x objective in order to create a dark field illumination of the specimens examined. The endothelial lining of the vessels had been stained by using CD31 monoclonal antibodies combined with conventional peroxidase immunohistochemistry. Read More

Surg Case Rep 2020 Jul 1;6(1):156. Epub 2020 Jul 1.

Department of General Thoracic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Background: Secondary pneumothorax after chemotherapy for a malignant pulmonary tumor is a complication from a large cavity causing refractory pneumothorax.

Case Presentation: A 61-year-old man was referred due to prolonged air leakage from a pulmonary cavity that developed after treatment for pulmonary metastases from renal cell carcinoma. As air leakage continued after thoracic drainage and endobronchial occlusion, we planned thoracoscopy-assisted surgery. Read More

J Mol Histol 2020 Jul 1. Epub 2020 Jul 1.

Department of Urology, Shenzhen Luohu People's Hospital, Shenzhen University, Shenzhen, 518000, China.

In the original article, we realized that an error occurred when we grouped the separate photos to generate the combined Figure 4 The same image was accidentally pasted twice in one figure, while we were not fully aware of the error at that time. We immediately reviewed the original data again and made sure that no changes need to be made in other parts of the paper. We are sure that the published manuscript was published without prior knowledge of the error and that it does not alter the conclusions of the study. Read More

Cardiovasc Intervent Radiol 2020 Jul 1. Epub 2020 Jul 1.

Department of Urology, Weill Cornell Medicine/New York Presbyterian, 525 E. 68th Street, Starr 946, New York, NY, 10065, USA.

Purpose: Thermal ablation of small renal tumors is safe and efficacious. Thermoablation of tumors greater than 3 cm has decreased efficacy and a greater risk of complications. Combined embolization and radiofrequency ablation has shown encouraging results. Read More

Radiol Case Rep 2020 Aug 24;15(8):1317-1322. Epub 2020 Jun 24.

Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri- Columbia, One Hospital Drive, Columbia, MO, 65212, USA.

Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominant disorder that predisposes patients to cutaneous tumors, pulmonary cysts with recurrent spontaneous pneumothoraces, and a variety of renal neoplasms including hybrid oncocytic and chromophobe renal cell carcinomas. There has been much debate regarding the genetic link with the occurrence of colorectal cancer and other colonic anomalies. Associations between BHD and intestinal adenomatous polyposis and sigmoid diverticulosis have been described in the literature, but there have been no prior reports of appendiceal diverticulosis in patients with BHD. Read More

Mod Pathol 2020 Jul 1. Epub 2020 Jul 1.

Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.

Uterine leiomyomas (ULs) constitute a considerable health burden in the general female population. The fumarate hydratase (FH) deficient subtype is found in up to 1.6% and can occur in hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome. Read More

Nature 2020 Jul 1. Epub 2020 Jul 1.

Telethon Institute of Genetics and Medicine (TIGEM), Naples, Italy.

The mechanistic target of rapamycin complex 1 (mTORC1) is a key metabolic hub that controls the cellular response to environmental cues by exerting its kinase activity on multiple substrates. However, whether mTORC1 responds to diverse stimuli by differentially phosphorylating specific substrates is poorly understood. Here we show that transcription factor EB (TFEB), a master regulator of lysosomal biogenesis and autophagy, is phosphorylated by mTORC1 via a substrate-specific mechanism that is mediated by Rag GTPases. Read More

Int J Mol Sci 2020 Jun 29;21(13). Epub 2020 Jun 29.

Molecular Oncology and Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Research Center- LAB2, E Bdg 1st floor, Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal.

The tumor microenvironment has gained a lot of attention from the scientific community since it has a proven impact in the development of tumor progression and metastasis. Extracellular vesicles (EVs) are now considered one of the key players of tumor microenvironment modulation. Clear cell renal cell carcinoma (ccRCC) is the most lethal urological neoplasia and presents a high metastatic potential, which reinforces the need for the development of more effective predictive biomarkers. Read More

Zhonghua Bing Li Xue Za Zhi 2020 Jul;49(7):693-698

Department of Pathology and Laboratory, KK Women's and Children's Hospital, Singapore 229899, Singapore.

To study clinical pathological characteristics, immunohistochemical, molecular genetical changes and prognosis in pediatric eosinophilic solid and cystic renal cell carcinoma (ESC RCC) with TSC2 gene mutations. The tissue samples were collected from two pediatric ESC RCC patients between 2017 and 2018. The tissues were subjected to histological examination and immunohistochemistry using EnVision system. Read More

Int Urol Nephrol 2020 Jun 30. Epub 2020 Jun 30.

Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Eğitim Mahallesi, Dr. Erkin Cd., Kadıköy, 34722, Istanbul, Turkey.

Purpose: To compare the effects of two border-age groups: young adults and octogenarians on survival of sporadic renal cell carcinoma (RCC).

Methods: We reviewed the records of 1619 patients that underwent radical or partial nephrectomy due to RCC between January 2004 and December 2018 in two high-volume centers. Patients were divided into two groups based on their age: ≤ 40 years old (group 1) and ≥ 80 years old (group 2). Read More

World J Clin Cases 2020 Jun;8(12):2502-2509

Department of Radiology, First Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100853, China.

Background: Minimal-fat angiomyolipoma (mf-AML) is often misdiagnosed as renal cell carcinoma before surgery.

Aim: To analyze the magnetic resonance imaging (MRI) features of mf-AML and the causes of misdiagnosis by MRI before operation.

Methods: A retrospective analysis was performed on ten patients with mf-AML confirmed by surgical pathology, all of whom underwent preoperative MRI examination to analyze the morphological characteristics and MRI signals of the tumor. Read More

Cancer Manag Res 2020 23;12:4871-4881. Epub 2020 Jun 23.

Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Center Institute, Cleveland, OH, USA.

Immunotherapy has revolutionized the management of metastatic renal cell carcinoma with four checkpoint inhibitors (nivolumab, ipilimumab, avelumab, and pembrolizumab) approved either as monotherapy or as combination therapy. The use of ipilimumab and nivolumab for treatment-naïve, intermediate to poor risk, metastatic renal cell carcinoma was the first checkpoint inhibitor-based combination therapy and remains the only dual checkpoint inhibitor combination approved in mRCC. In this article, we review the trials that led to the approval of ipilimumab and nivolumab in this setting. Read More

Cancer Manag Res 2020 16;12:4585-4593. Epub 2020 Jun 16.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.

Purpose: Immune checkpoint inhibitors (ICIs) have been approved for various types of cancer; however, they cause a broad spectrum of immune-related adverse events (irAEs). The association between the development of irAEs and the clinical benefit remains uncertain. We aimed to evaluate the association of irAEs and the treatment efficacy in real-world practice. Read More

Cancer Manag Res 2020 11;12:4461-4473. Epub 2020 Jun 11.

Department of Urology, The First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China.

Objective: To develop and validate a nomogram for predicting the overall survival (OS) of renal cell carcinoma (RCC) patients after nephrectomy.

Materials And Methods: In total, 488 patients with RCC who underwent nephrectomy at the Urology Department of the First Hospital of Shanxi Medical University between January 2013 and December 2018 were randomly divided into a development cohort (n = 344) and a validation cohort (n = 144). The development cohort was used to build a prediction model, and the validation cohort was used for validation. Read More

Cancer Manag Res 2020 10;12:4309-4320. Epub 2020 Jun 10.

Department of Urology, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, People's Republic of China.

Objective: Renal cell carcinoma (RCC) displays an increasing incidence and mortality rate worldwide in recent years. More and more evidence demonstrated microRNAs function as positive or negative regulatory factors in many cancers, while the role of miR-301a in RCC is still unclear.

Material And Methods: The expression and clinical significance of miR-301a were assessed via bioinformatic software on open microarray datasets of the Cancer Genome Atlas (TCGA) and then confirmed by quantitative real-time PCR (qRT-PCR) in RCC cell lines. Read More

Onco Targets Ther 2020 19;13:5857-5868. Epub 2020 Jun 19.

Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.

Purpose: Clear cell renal cell carcinoma (ccRCC) is a common urological carcinoma in adults. Long non-coding RNA (lncRNA) taurine-upregulated gene 1 (TUG1) has been reported to be involved in the progression of diverse human cancers, including renal cell carcinoma (RCC). However, the biological mechanism of TUG1 was rarely reported in ccRCC. Read More

Onco Targets Ther 2020 12;13:5563-5574. Epub 2020 Jun 12.

Department of Hematology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, People's Republic of China.

Background: Small nucleolar RNA host gene 12 (SNHG12) expression is associated with multiple cancers, including renal cell carcinoma, prostate cancer, cervical cancer, nasopharyngeal carcinoma, colorectal cancer, and hepatocellular carcinoma. However, SNHG12 biological function is unclear in diffuse large B-cell lymphoma (DLBCL).

Methods: SNHG12 expression and associated clinicopathological characteristics were evaluated in DLBCL tissues. Read More

Medicina (Kaunas) 2020 Jun 26;56(6). Epub 2020 Jun 26.

Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, 06100 Perugia, Italy.

With the widespread use of imaging modalities performed for the staging of prostate cancer, the incidental detection of synchronous tumors is increasing in frequency. Robotic surgery represents a technical evolution in the treatment of solid tumors of the urinary tract, and it can be a valid option in the case of multi-organ involvement. We reported a case of synchronous prostate cancer and bifocal renal carcinoma in a 66-year-old male. Read More

Cancers (Basel) 2020 Jun 26;12(6). Epub 2020 Jun 26.

Department of Radiation Oncology, University of Freiburg-Medical Center, Robert-Koch-Str. 3, 79106 Freiburg, Germany.

The purpose of this study was to evaluate the value of routine blood markers regarding their predictive potential for treatment outcomes of elderly head-and-neck squamous cell carcinoma (HNSCC) patients. In total, 246 elderly HNSCC patients (≥65 years) undergoing (chemo)radiotherapy from 2010 to 2018 were analyzed for treatment outcomes, depending on their hemoglobin, glomerular filtration rate (GFR), C-reactive protein (CRP) and albumin values, representing anemia, kidney function, inflammation and nutrition status, respectively. Local/locoregional control, progression-free and overall survival (OS) were calculated using the Kaplan-Meier method. Read More

Am J Surg Pathol 2020 Jun 26. Epub 2020 Jun 26.

Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania.

Individuals with acquired cystic kidney disease (ACKD) in the setting of end-stage renal disease (ESRD) have a high risk of developing renal cell carcinoma (RCC). ACKD-RCC is considered a distinct renal neoplasm in the International Society of Urologic Pathologists (ISUP)-World Health Organization (WHO) classification of kidney tumors which may behave aggressively. Since its original description, there have been multiple case reports and series published; however, the pathogenesis of this neoplasm is uncertain and there is limited data on the genetic aberrations of this tumor. Read More

AJR Am J Roentgenol 2020 Jun 29. Epub 2020 Jun 29.

Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 298, Boston, MA 02114, U.S.A.

The purpose of this study was to assess the safety, technical results and clinical outcomes of CT-guided percutaneous microwave ablation of stage T1a renal cell carcinoma. This retrospective study investigated consecutive patients who underwent CT-guided microwave ablation for T1a renal cell carcinoma from October 2015 to May 2019. Patient demographics of tumor characteristics, comorbidities, technical details and clinical outcomes were evaluated. Read More

JAMA Netw Open 2020 Jun 1;3(6):e207199. Epub 2020 Jun 1.

Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York.

Importance: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, are commonly prescribed medications with anti-inflammatory and antiplatelet properties used long term to decrease the risk of cardiovascular events. A recent study showed that aspirin was associated with improved survival in patients with head and neck squamous cell carcinoma (HNSCC) who were treated with surgery.

Objective: To examine whether use of NSAIDs during definitive chemoradiation therapy (CRT) was associated with improved outcomes in patients with HNSCC. Read More

Mol Oncol 2020 Jun 30. Epub 2020 Jun 30.

Genetics and Cellular Engineering Group, Institute of Molecular Toxicology and Pharmacology, Helmholtz Zentrum Munich GmbH, German Research Center for Environmental Health, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.

Nonsense-mediated decay (NMD) proteins are responsible for the surveillance and degradation of aberrant RNAs. Suppressor with morphogenetic effect on genitalia 7 (SMG7) is an NMD complex protein and a regulator of tumor necrosis factor (TNF)-induced extrinsic apoptosis, however, this unique function has not been explored in detail. In this study, we show that loss of Smg7 leads to unrestricted expression of long non-coding RNAs (lncRNAs) in addition to NMD targets. Read More

Exp Oncol 2020 06;42(2):115-119

Institute of Molecular Biology and Genetics, National Academy of Science of Ukraine, Kyiv 03143, Ukraine.

Aim: To analyze the expression levels of hsa-miR-30c-5p and hsa-miR-138-1 in tumors of patients with renal cell carcinoma to determine whether they could be used as diagnostic markers.

Materials And Methods: The relative expression of hsa-miR-30c-5p and hsa-miR-138-1 was compared in the paired samples of kidney tumor tissue and conventionally normal tissue adjacent to the tumor.

Results: We found a significant decrease in miR-30c-5p and miR-138-1 levels in tumor tissues even in the cases of early stage cancer. Read More

Drugs 2020 Jun 29. Epub 2020 Jun 29.

Department of Medical Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France.

Immune checkpoint inhibitors (ICIs) in combination with vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) have become a new standard of care in treatment-naïve patients with advanced renal cell carcinoma (RCC). The rationale for these combinations relies on the interplay between the immune and angiogenic systems. The angiogenic factors and their receptors can promote an immunosuppressive tumor microenvironment by a direct effect on the innate immune cells and adaptive immune cells, and by an indirect effect through their influence on endothelial cells. Read More

Clin Genitourin Cancer 2020 May 11. Epub 2020 May 11.

University of California San Diego, La Jolla, CA. Electronic address:

Background: The efficacy of partial nephrectomy (PN) in setting of pT3a pathologic-upstaged renal cell carcinoma (RCC) is controversial. We compared oncologic and functional outcomes of radical nephrectomy (RN) and PN in patients with upstaged pT3a RCC.

Patients And Methods: This was a multicenter retrospective analysis of patients with cT1-2N0M0 RCC upstaged to pT3a postoperatively. Read More

Urol Clin North Am 2020 Aug 10;47(3):xiii-xiv. Epub 2020 Jun 10.

Department of Urology, NYU Langone Health, 222 East 41st, 12th Floor, New York, NY 10017, USA. Electronic address:

Urol Clin North Am 2020 Aug 8;47(3):399-411. Epub 2020 Jun 8.

Department of Therapeutic Radiology, Yale School of Medicine, 35 Park Street, New Haven, CT 06519, USA. Electronic address:

Stereotactic radiosurgery and stereotactic body radiation therapy (SBRT) have led to a resurgence of the use of radiotherapy in the management of advanced renal cell carcinoma (RCC). These techniques provide excellent local control and palliation of metastatic sites of disease with minimal toxicity. Additionally, SBRT to the primary tumor may be efficacious and well tolerated in select patients that are not surgical candidates. Read More

Urol Clin North Am 2020 Aug 11;47(3):389-397. Epub 2020 Jun 11.

Department of Urology, NYU Langone Health, 222 East 41st, 12th Floor, New York, NY 10017, USA.

Despite advances in systemic therapy and immunotherapy, surgery continues to have a role in management of advanced renal cell carcinoma (aRCC). Minimally invasive surgery (MIS) is considered standard of care for smaller, localized tumors due to faster recovery without compromising oncologic outcomes. There are concerns about MIS for aRCC due to a potential risk of inferior oncologic outcomes and unusual patterns of disease recurrence. Read More

Urol Clin North Am 2020 Aug 10;47(3):379-388. Epub 2020 Jun 10.

Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA. Electronic address:

Surgical metastasectomy continues to be utilized for patients with solitary or low-volume metastatic renal cell carcinoma (mRCC). Although few high-quality data are available to evaluate outcomes, local treatment is recommended when feasible because it may allow a subset of patients to delay or avoid systemic treatments. With the development of improved mRCC therapies, utilization of metastasectomy has increased because most patients have incomplete responses to systemic treatment of their metastases. Read More

Urol Clin North Am 2020 Aug 7;47(3):371-377. Epub 2020 Jun 7.

Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. Electronic address:

The role of lymph node dissection (LND) in the management of renal cell carcinoma (RCC) is controversial. LND serves an indisputable staging role by providing pathologic nodal stage. However, while earlier observational studies had suggested a survival benefit to LND, more recent observational evidence and a randomized trial do not support a survival benefit. Read More

Urol Clin North Am 2020 Aug 11;47(3):359-370. Epub 2020 Jun 11.

James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, 600 N. Wolfe Street / Marburg 144, Baltimore, MD 21287, USA.

The role for cytoreductive nephrectomy (CN) in the treatment of metastatic renal cell carcinoma (mRCC) has evolved with advancements in systemic therapy. During the cytokine-based immunotherapy era, CN provided a clear survival benefit and was considered standard of care in management of mRCC. The development of targeted systemic therapy directed at the vascular endothelial growth factor pathway altered the treatment paradigm and accentuated the importance of risk stratification in treatment selection. Read More

Urol Clin North Am 2020 Aug;47(3):345-358

Kidney Cancer Program, Division of Urologic Oncology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. Electronic address:

This article reviews the use of adjuvant therapies for prevention of recurrence following resection of clinically localized renal cell carcinoma (RCC). Clinical trials evaluating adjuvant therapy for RCC have focused primarily on the use of tyrosine kinase inhibitors and mammalian target of rapamycin inhibitors, which had improved outcome in patients with metastatic disease. However, all but 1 trial found no difference in disease-free survival in the adjuvant setting and none improved overall survival. Read More

Urol Clin North Am 2020 Aug 11;47(3):329-343. Epub 2020 Jun 11.

Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1373, Houston, TX 77030, USA. Electronic address:

There has been strong interest in using neoadjuvant therapy to decrease recurrence rates and facilitate surgical resection in locally advanced renal cell carcinoma. To date, no evidence exists to support improvement in oncologic outcomes with neoadjuvant therapy. Likewise, although targeted therapies have shown efficacy in tumor downsizing, this does not often translate to downstaging. Read More

Urol Clin North Am 2020 Aug 7;47(3):319-327. Epub 2020 Jun 7.

Dana-Farber Cancer Institute, Lank Center for Genitourinary Oncology, 450 Brookline Avenue, Boston, MA 02215, USA. Electronic address:

Variant histology renal cell carcinoma (vRCC) encompasses rare non-clear cell subtypes that have long been associated with poor prognosis and minimal response to therapies targeting vascular endothelial growth factor and its receptor. Molecular advances have helped classify vRCC into distinct entities and identify putative targetable driver alterations, such as MET in papillary subtypes. More have since been identified in other vRCC subtypes, including alterations of tumor metabolism, chromatin remodeling genes, cell-cycle genes, and inactivation of tumor suppressors such as TP53 or NF2. Read More

Urol Clin North Am 2020 Aug 11;47(3):305-318. Epub 2020 Jun 11.

Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA. Electronic address:

In an era of several therapeutic options available, optimal treatment sequencing is crucial to providing patients the most effective therapy and promoting quality of life. In clear cell renal cell carcinoma, a combination approach with an immunotherapy backbone, such as nivolumab/ipilimumab or axitinib/pembrolizumab, has a key role in the first-line setting. Safety and activity data support the transition to single-agent targeted therapies in the second-line setting. Read More

Urol Clin North Am 2020 Aug 10;47(3):293-303. Epub 2020 Jun 10.

Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, 353 East 68th Street, 5th Floor, New York, NY 10065, USA. Electronic address:

In the preceding two decades, several milestones have been reached in the management of patients with metastatic renal cell carcinoma (mRCC), including the development of novel targeted agents paralleling an increased understanding of the molecular biology of this disease process. Recently, a renewed enthusiasm for immunotherapy in the form of immune checkpoint blockade has resulted in significant strides in the treatment of mRCC. Despite these advances, treatment remains challenging for clinicians, and only modest survival benefits are observed with current treatment paradigms. Read More

Urol Clin North Am 2020 Aug 11;47(3):281-291. Epub 2020 Jun 11.

Department of Radiology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Population Health NYU Langone Medical Center, New York, NY 10016, USA. Electronic address:

Patients with renal cell carcinoma may develop metastases after radical nephrectomy, and therefore monitoring with imaging for recurrent or metastatic disease is critical. Imaging varies with specific suspected site of disease. Computed tomography/MRI of the abdomen and pelvis are mainstay modalities. Read More

Urol Clin North Am 2020 Aug;47(3):271-280

Division of Urology, Department of Surgery, McMaster University, McMaster Institute of Urology, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Room G334, Hamilton, Ontario L8N 4A6, Canada.

Advanced renal cell carcinoma is not uncommon, but necessitates a multidisciplinary approach for optimal treatment. Targeted therapy has increased the likelihood of urologists managing patients in all disease stages. Neoadjuvant therapy is currently experimental. Read More