de Almeida E Paula Felipe, Bezerra Stephania Martins, da Cunha Isabela Werneck, Munhoz Guilherme Consentino, Abreu Diego, Lara Primo Nery, da Costa Walter Henriques, Zéqui Stênio de Cássio
Department of Pelvic Surgery, Division of Urology, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil; Department of Urology, Presidente Prudente Cancer Hospital, Presidente Prudente, São Paulo, Brazil.
Department of Anatomic Pathology, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil.
Urol Oncol. 2019 Dec;37(12):947-954. doi: 10.1016/j.urolonc.2019.07.012. Epub 2019 Aug 28.
To analyze the intratumoral immunohistochemical expression of renin and its value as a prognostic factor for recurrence in nonmetastatic clear cell renal cell carcinoma (ccRCC).
A total of 498 patients with nonmetastatic ccRCC from the Latin American Renal Cancer Group database who underwent partial or radical nephrectomy between 1990 and 2016 were selected. All cases were revised, and 2 distinct samples were obtained for tissue microarray construction. Ten years of follow-up was assessed, and disease-free survival rates (DFS) were analyzed. Renin expression was classified qualitatively as negative or positive. For the quantitative analysis, a cutoff was estimated using the maximum of the standardized log-rank statistic.
Nuclear renin was qualitatively positive in 360 cases (72%) and negative in 138 (28%), whereas quantitatively, an equal number of cases had ≤35% or >35% renin-positive nuclei. The absence of renin expression was associated with high-grade tumors (by ISUP and Fuhrman classification, both P < 0.001), greater microscopic venous invasion (P = 0.046), and renal vein invasion (P = 0.026). In the multivariate analyses, qualitatively negative renin expression was an unfavorable prognostic factor for DFS (RR = 2.923, P < 0.001). With regard to quantitative renin expression, a cutoff of ≤35 was associated with worse DFS (RR = 4.085, P < 0.001).
The intratumoral immunohistochemical expression of renin in patients with ccRCC provides valuable prognostic data regarding the likelihood of recurrence.
分析肾素在肿瘤内的免疫组化表达及其作为非转移性透明细胞肾细胞癌（ccRCC）复发预后因素的价值。
从拉丁美洲肾癌组数据库中选取1990年至2016年间接受部分或根治性肾切除术的498例非转移性ccRCC患者。对所有病例进行复查，并获取2个不同样本用于组织芯片构建。评估10年随访情况，并分析无病生存率（DFS）。肾素表达定性分为阴性或阳性。对于定量分析，使用标准化对数秩统计量的最大值估计临界值。
核肾素定性阳性360例（72%），阴性138例（28%）；定量分析时，肾素阳性核≤35%或>35%的病例数相等。肾素表达缺失与高级别肿瘤（根据ISUP和Fuhrman分类，均P<0.0
