Novel Liquid Biomarkers and Innovative Imaging for Kidney Cancer Diagnosis: What Can Be Implemented in Our Practice Today? A Systematic Review of the Literature

Campi, Riccardo; Stewart, Grant D.; Staehler, Michael; Dabestani, Saeed; Kuczyk, Markus A.; Shuch, Brian; Finelli, Antonio; Bex, Axel; Ljungberg, Börje; Capitanio, Umberto

doi:10.1016/j.euo.2020.12.011

Cited by 34 publications

(18 citation statements)

References 99 publications

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“…Notably, in the context of LRMs, the paradigm of precision oncology has still not permeated into practice [3,6]. This concept is outlined by the current unmet clinical needs related to renal mass characterization (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, future research should integrate data on the genomic landscape of LRMs to provide a deeper understanding of the spectrum of disease aggressiveness, aiming to match disease biology to surveillance intensity. Lastly, while waiting for innovative diagnostic pathways for patients with LRMs [6] and more robust data on the long‐term oncological outcomes of AS, more evidence is needed on the impact of patient values and preferences on decision‐making in order to integrate them in to contemporary patient‐centred models of care.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, active treatment of incidental LRMs may be associated with non‐negligible adverse events and may impact patients’ quality of life. Unfortunately, to date, there are still no validated serum or urinary biomarkers, or innovative imaging methods, to refine the diagnosis and biology of RCC before management decisions are made [6], and the impact of renal tumour biopsy is still controversial [7]. As such, given the several and at times competing patient‐, tumour‐ and provider‐related factors at play, decision‐making in patients with LRMs is highly complex [8].…”

Section: Introductionmentioning

confidence: 99%

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Intermediate‐ and long‐term oncological outcomes of active surveillance for localized renal masses: a systematic review and quantitative analysis

et al. 2021

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To evaluate intermediate-and long-term oncological outcomes of active surveillance (AS) for localized renal masses (LRMs). MethodsThis systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered on PROSPERO (CRD42021230416). Studies on AS for LRMs with at least 3 years' follow-up were eligible. Two review authors independently screened the literature, extracted data, and assessed risk of bias. The primary outcomes were metastasis rate, renal cell carcinoma (RCC)-specific mortality (RCC-SM) and all-cause mortality (ACM). Pooled estimates were obtained from random-effects models. Subgroup analyses were performed for small renal masses (SRMs; ≤4 cm) and non-SRMs (>4 cm). ResultsWe analysed 18 unique cohorts comprising 2066 patients. The pooled initial maximum tumour size was 2.8 cm (95% confidence interval [CI] 2.7-3.0) and the percutaneous biopsy rate was 28%. The pooled mean annual growth rate was 2.8 mm (95% CI 2.1-3.4). Within a pooled mean follow-up of 53 months, 2.1% (95% CI 1.0-3.6) of patients developed metastatic disease, 1.0% (95% CI 0.3-2.1) died from RCC and 22.6% (95% CI 15.8-30.2) died from any cause. For patients with SRMs (nine studies, n = 987), the pooled metastasis rate was 1.8% (95% CI 0.5-3.7), RCC-SM was 0.6% (95% CI 0-2.1), and ACM was 28.5% (95% CI 17.4-41.4). Across five studies reporting on outcomes of 239 patients with non-SRMs, the pooled metastasis rate was 5.1% (95% CI 0-17.3), RCC-SM was 2.1% (95% CI 0-8.9) and ACM was 29.1% (95% CI 13.6-47.3). This review is limited by non-standardized inclusion criteria, definitions and follow-up, data heterogeneity, limited patient numbers in sub-analyses and absence of high-quality studies. ConclusionsActive surveillance is a safe intermediate-and long-term management option for well-selected patients with LRMs, especially those with SRMs. Limited data are available for non-SRMs, but current evidence would support further evaluation of this approach in selected patients. It is not possible to draw definitive conclusions until more high-quality data become available.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intermediate‐ and long‐term oncological outcomes of active surveillance for localized renal masses: a systematic review and quantitative analysis

et al. 2021

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“…Moreover, they might allow for circulating biomarkers assessment at various time points in a timely, cost-effective, specific and sensitive minimally invasive manner [ 8 , 10 , 14 ]. Thus, it is imperative to unveil and develop minimally invasive markers that may not only detect cancer, but also prognosticate and predict response to therapy [ 15 , 16 ].…”

Section: Liquid Biopsiesmentioning

confidence: 99%

Unveiling the World of Circulating and Exosomal microRNAs in Renal Cell Carcinoma

Sequeira

Constâncio

Lobo

et al. 2021

Cancers

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Renal cell carcinoma is the third most common urological cancer. Despite recent advances, late diagnosis and poor prognosis of advanced-stage disease remain a major problem, entailing the need for novel early diagnosis tools. Liquid biopsies represent a promising minimally invasive clinical tool, providing real-time feedback of tumor behavior and biological potential, addressing its clonal evolution and representing its heterogeneity. In particular, the study of circulating microRNAs and exosomal microRNAs in liquid biopsies experienced an exponential increase in recent years, considering the potential clinical utility and available technology that facilitates implementation. Herein, we provide a systematic review on the applicability of these biomarkers in the context of renal cell carcinoma. Issues such as additional benefit from extracting microRNAs transported in extracellular vesicles, use for subtyping and representation of different histological types, correlation with tumor burden, and prediction of patient outcome are also addressed. Despite the need for more conclusive research, available data indicate that exosomal microRNAs represent a robust minimally invasive biomarker for renal cell carcinoma. Thus, innovative research on microRNAs and novel detection techniques are likely to provide clinically relevant biomarkers, overcome current clinical challenges, and improve patient management.

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“…Yet, disentangling the ultimate role of sex from that of other factors (such as the access and pattern of imaging examinations) is complex in light of the currently available evidence. In fact, several studies on this topic may not provide a contemporary view on renal cancer diagnostic pathways [119] and did not take into account how different diagnostic patterns might have contributed to the observed rates of renal cancer diagnoses among males and females. For example, in the study by Beisland et al, the rate of females in the incidental detected tumor group was higher than in the symptomatic group, which may be explained by an earlier diagnosis with lower stage at diagnosis in female patients [120], raising concerns regarding the potential impact of women's increased health conscious attitude on the pattern of RCC presentation.…”

Section: Diagnosismentioning

confidence: 99%

Sex and Gender Differences in Kidney Cancer: Clinical and Experimental Evidence

Peired

Campi

Angelotti

et al. 2021

Cancers

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Sex and gender disparities have been reported for different types of non-reproductive cancers. Males are two times more likely to develop kidney cancer than females and have a higher death rate. These differences can be explained by looking at genetics and genomics, as well as other risk factors such as hypertension and obesity, lifestyle, and female sex hormones. Examination of the hormonal signaling pathways bring further insights into sex-related differences. Sex and gender-based disparities can be observed at the diagnostic, histological and treatment levels, leading to significant outcome difference. This review summarizes the current knowledge about sex and gender-related differences in the clinical presentation of patients with kidney cancer and the possible biological mechanisms that could explain these observations. Underlying sex-based differences may contribute to the development of sex-specific prognostic and diagnostic tools and the improvement of personalized therapies.

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Novel Liquid Biomarkers and Innovative Imaging for Kidney Cancer Diagnosis: What Can Be Implemented in Our Practice Today? A Systematic Review of the Literature

Cited by 34 publications

References 99 publications

Intermediate‐ and long‐term oncological outcomes of active surveillance for localized renal masses: a systematic review and quantitative analysis

Intermediate‐ and long‐term oncological outcomes of active surveillance for localized renal masses: a systematic review and quantitative analysis

Unveiling the World of Circulating and Exosomal microRNAs in Renal Cell Carcinoma

Sex and Gender Differences in Kidney Cancer: Clinical and Experimental Evidence

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