Metastatic renal cell carcinoma to the pancreas and other sites—a multicenter retrospective study

Duarte, Cassandra; Hu, Junxiao; Beuselinck, Benoit; Panian, Justine; Weise, Nicole; Dizman, Nazli; Collier, Katharine A.; Rathi, Nityam; Li, Haoran; Elias, Roy; Martinez-Chanza, Nieves; Rose, Tracy L.; Harshman, Lauren C.; Gopalakrishnan, Dharmesh; Vaishampayan, Ulka; Zakharia, Yousef; Narayan, Vivek; Carneiro, Benedito A.; Mega, Anthony; Singla, Nirmish; Meguid, Cheryl; George, Saby; Brugarolas, James; Agarwal, Neeraj; Mortazavi, Amir; Pal, Sumanta; McKay, Rana R.; Lam, Elaine T.

doi:10.1016/j.eclinm.2023.102018

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…While lymph node metastases had significantly decreased expression compared to the kidney, FOLH1 expression in the bone, endocrine glands, skin, and gastrointestinal tract was numerically higher than that in the kidney. Given that the site of metastasis is a prognostic factor in RCC, with bone associated with worse outcomes and endocrine metastases associated with improved prognosis [34,35], these findings have implications for therapeutic strategies in the advanced setting based on the predominance of metastatic sites involved.…”

Section: Discussionmentioning

confidence: 99%

Characterization of FOLH1 Expression in Renal Cell Carcinoma

Ovruchesky,

Pan,

Guer

et al. 2024

Cancers

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Purpose: Given the emergence of PSMA-targeted diagnostic agents and therapeutics, we sought to investigate patterns of FOLH1 expression in RCC and their impacts on RCC outcomes. Methods: We conducted a pooled multi-institutional analysis of patients with RCC having undergone DNA and RNA next-generation sequencing. FOLH1-high/low expression was defined as the ≥75th/<25th percentile of RNA transcripts per million (TPM). Angiogenic, T-effector, and myeloid expression signatures were calculated using previously defined gene sets. Kaplan–Meier estimates were calculated from the time of tissue collection or therapy start. Results: We included 1,724 patients in the analysis. FOLH1 expression was significantly higher in clear cell (71%) compared to non-clear cell RCC tumors (19.0 versus 3.3 TPM, p < 0.001) and varied by specimen site (45% primary kidney/55% metastasis, 13.6 versus 9.9 TPM, p < 0.001). FOLH1 expression was correlated with angiogenic gene expression (Spearman = 0.76, p < 0.001) and endothelial cell abundance (Spearman = 0.76, p < 0.001). While OS was similar in patients with FOLH1-high versus -low ccRCC, patients with FOLH1-high clear cell tumors experienced a longer time on cabozantinib treatment (9.7 versus 4.6 months, respectively, HR 0.57, 95% CI 0.35–0.93, p < 0.05). Conclusions: We observed differential patterns of FOLH1 expression based on histology and tumor site in RCC. FOLH1 was correlated with angiogenic gene expression, increased OS, and a longer duration of cabozantinib treatment.

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Section: Discussionmentioning

confidence: 99%

Characterization of FOLH1 Expression in Renal Cell Carcinoma

Ovruchesky,

Pan,

Guer

et al. 2024

Cancers

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“…Surgical resection is still feasible as a treatment option for isolated pancreatic metastasis of renal cell carcinoma, although previous report suggests the effect of tyrosine kinase inhibitors to improve the overall survivals of renal cell carcinoma metastasized to pancreas [7][8][9][10]. Currently, we have multiple treatment options such as surgery, vascular endothelial growth factor receptor-targeted therapy, and immunotherapy [11]. Even if patients have extrapancreatic metastases, their five-year overall survival is approximately 50% after the surgical resection [8].…”

Section: Discussionmentioning

confidence: 99%

Isolated Pancreatic Metastasis From Renal Clear Cell Renal Cell Carcinoma 29 Years After Radical Nephrectomy

Fujiwara,

Koyamada,

Nishimura

et al. 2024

Cureus

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Isolated metastatic tumors of the pancreas from other origins are only 2-3% of pancreatic cancers, and renal cell carcinoma is the most common origin of metastasis. It is challenging to differentiate between pancreatic tumors and those with a history of renal cancer to optimize treatment and management of this tumor. Here, we present a case of isolated renal cell cancer metastasis to the pancreas, which occurred 29 years after the radical nephrectomy. Surgical resection and pancreatectomy is a feasible treatment because of the low rate of complication and favorable prognosis. However, isolated metastatic pancreatic cancer from renal cell cancer is rare and has relatively high risk of recurrence. Therefore, a larger sample size is necessary to evaluate long-term oncologic outcomes and to optimize diagnostic and therapeutic strategies.

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“…Hepatic metastatic lesions are more common than pancreatic metastases, with the liver being affected in 18% of cases [ 16 ], and pancreatic lesions with an estimated incidence of 3%-10% [ 17 ]. In our case, the single liver lesion and the multiple pancreatic nodular lesions necessitated an extensive evaluation to differentiate a neuroendocrine tumor and primary liver cancer from metastatic cancer.…”

Section: Discussionmentioning

confidence: 99%

Late Recurrence of Renal Cell Carcinoma in Unusual Sites 23 Years After Nephrectomy

Castillo,

Martinez

2023

Cureus

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Renal cell carcinoma (RCC) is a common malignancy in the elderly population and it is notorious for its mechanism of late metastasis to unusual anatomical sites. Late recurrences are common following curative treatment, such as radical nephrectomy. Pancreatic metastases and hepatic metastatic lesions make the diagnosis and classification of a primary tumor challenging. This necessitates a high index of suspicion and an extensive interrogation. We present the case of a 68-year-old Hispanic female with progressive pain in the right upper quadrant, weight loss, and decreased appetite. She has a history of renal cell carcinoma treated with radical nephrectomy and radiotherapy. A pancreatic biopsy was performed based on the ultrasound and computed tomography findings at a private clinic. Subsequently, the patient was referred to the Instituto Oncologico Nacional (ION) due to immunohistochemical features suggestive of a well-differentiated neuroendocrine tumor. At ION, a more comprehensive medical history was obtained, and the immunohistochemistry panel was extended, confirming the diagnosis of late recurrence of RCC. One possible explanation for the very late relapse of our patient is the presence of malignant cells that were spared or seeded during the surgical intervention and remained dormant or latent, subsequently spreading via hematogenous dissemination or via the lymphatic system. We highlight the importance of medical history, pathological examination, and immunohistochemical analysis in establishing a differential diagnosis, given the nature of RCC, which can often present asymptomatically and has a propensity for late recurrence. Further research should focus on developing standardized surveillance protocols for such cases.

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Metastatic renal cell carcinoma to the pancreas and other sites—a multicenter retrospective study

Cited by 8 publications

References 27 publications

Characterization of FOLH1 Expression in Renal Cell Carcinoma

Characterization of FOLH1 Expression in Renal Cell Carcinoma

Isolated Pancreatic Metastasis From Renal Clear Cell Renal Cell Carcinoma 29 Years After Radical Nephrectomy

Late Recurrence of Renal Cell Carcinoma in Unusual Sites 23 Years After Nephrectomy

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