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FACTORES PRONÓSTICOS DEL CARCINOMA DE CÉLULAS RENALES

FACTORES PRONÓSTICOS DEL CARCINOMA DE CÉLULAS RENALES. F. Algaba Unidad de Patología. Universitat Autònoma de Barcelona. CLASIFICACIÓN CÁNCER RENAL OMS 2016. DE CÉLULAS CLARAS 68.8% PAPILAR 20% CROMÓFOBO 7.3%

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FACTORES PRONÓSTICOS DEL CARCINOMA DE CÉLULAS RENALES

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  1. FACTORES PRONÓSTICOS DEL CARCINOMA DE CÉLULAS RENALES F. Algaba Unidad de Patología Universitat Autònoma de Barcelona

  2. CLASIFICACIÓN CÁNCER RENAL OMS 2016 • DE CÉLULAS CLARAS 68.8% • PAPILAR 20% • CROMÓFOBO 7.3% • DE DUCTOS COLECTORES (BELLINI) • MEDULAR • DE TRANSLOCACIÓN • MUCINOSO TUBULAR Y FUSOCELULAR • INCLASIFICABLE ACTUALIZACIÓN EN MARCADORESPRONÓSTICOS CLÁSICOS 5.9%

  3. Fuhrman grading

  4. 400x 1 2 3 4 Am J Surg Pathol 2011;35:1134–1139

  5. 400x 1 2 3 4 Am J Surg Pathol 2011;35:1134–1139

  6. ISUP (nucleolar) Novel Under study

  7. LOW GRADE HIGH GRADE Organ confined RCC shorter survival Grade III and IV versus Grade I and II (p = 0.018). Gelp et al. Am. J. Surg. Pathol.1993; 17: 275

  8. Different pT3a

  9. Sinus invasion

  10. J. Urol 2005; 174: 1218-1221 AJSP 2004; 28: 1594-1600

  11. Microvascular invasion Dall´Oglio BJI. 2007; 100: 552 10-year Cancer Specific Survival MVI (+) 85.1% MVI (-) 96.5% Shindo et al BJI. 2013; Jan 25.

  12. Mobile thrombus Different pT3a (wall invasion) Wall invasion No wall invasion

  13. Mobile thrombus Wall invasion Cases with complete removal 57% Hatcher et al J. Urol. 1991; 145: 20

  14. Solid thrombus Friable thrombus Bertini et al. Eur. Urol. 2011; 60: 358

  15. pT3b pT3c Cancer Specific Progression free Survival Survival Without peripheral or sinus fat invasion 47% 45% With peripheral & sinus fat invasion 25% 10% Roos et al BJI. 2009 ;104:461

  16. CLASIFICACIÓN CÁNCER RENAL OMS 2016 • DE CÉLULAS CLARAS 68.8% • PAPILAR 20% • CROMÓFOBO 7.3% • DE DUCTOS COLECTORES (BELLINI) • MEDULAR • DE TRANSLOCACIÓN • MUCINOSO TUBULAR Y FUSOCELULAR • INCLASIFICABLE POSIBLES NUEVOS MARCADORES PRONÓSTICOS 5.9%

  17. CAIX Ki67

  18. At median follow-up of 63 months (IQR 35.0– 91.8), on multivariate analysis cutoff points for CAIX 30% cutoff vimentin 50 % CAIX under-expression Vimentin over-expression were associated with worse survival (recurrence, specific and overall survival).

  19. CARCINOMA RENAL DE CÉLULAS CLARAS ENDOTHELIAL CELL VEGF VEGF CAIX Hypoxia inducible factor HIF-2α HIF-1α HIF-α HIF-2α VEGF VEGF HIF-α HIF-1α pVHL 19-30 HIF-2α HIF-α HIF-1α VEGF c-Myc HIF-1α HIF-1  HIF-2α VHL 3p HIF-1  Proliferation Apoptosis Perivascular cell

  20. HIF1α HIF2α pVHL normal HIF-1α HIF-2α negativos 12% • Nivel de • c-Myc similar pVHL deficiente HIF-1α HIF-2α positivos 61% pVHL deficiente Sólo HIF 2α positivo 27% • c-Myc Proliferación Gordan et al. Cancer Cell, 2008, 14: 435-446

  21. Después de Sunitinib 83 pacientes con metástasis 10 Hospitales

  22. Después de Sunitinib 83 pacientes con metástasis 10 Hospitales

  23. INMUN

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