Best of AUA 2014: Kidney Cancer
Presented by Monish Aron, MD,
• A comparison of active surveillance and primary surgical intervention in patients with small renal tumors found no difference in overall or disease-specific survival over a 4-year follow-up. No patient progressed to metastatic disease, indicating that active surveillance is a viable option for T1a tumors.
• Several abstracts suggested that microRNAs may have a role as prognostic markers in renal cell carcinoma (RCC) and may open the door for novel targeted therapies. A microRNA expression profile has been used to potentially differentiate benign tumors from cancer on needle biopsy and may also differentiate among RCC subtypes.
• A dendritic cell-based vaccine was highly effective in eradicating both primary and metastatic cells in a mouse model of metastatic RCC, proving more effective than sunitinib (Sutent) monotherapy.
• Contrary to popular belief, kidney cancer mortality is decreasing as a result of early diagnosis and treatment, a population-based dataset found. Over 30 years, kidney cancer mortality has declined from 4.3 per 100,000 to 3.5 per 100,000.
• Lifestyle modification can help reduce mortality from kidney cancer. Physical activity leads to a 50% reduction in cancer-specific mortality, while obesity leads to a threefold increase in kidney cancer deaths and smoking leads to a twofold increase in kidney cancer deaths.
• Magnetic resonance spectroscopy was able to reliably differentiate between benign and malignant lesions in the kidney, suggesting this technology could potentially allow for better diagnosis of benign versus malignant tumors and thereby potentially decrease overtreatment of small renal masses.
• There is a difference in the DNA methylation signature between benign and malignant kidney biopsies, potentially paving the way for a panel of DNA methylation markers that may improve the reproducibility and predictability of renal mass biopsies for preoperative planning.
• Renal mass biopsies accurately predicted histology in only 72% of patients and accurately predicted grade in only 24%. The biopsy complication rate was 22%, with 6% being high grade.