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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% • DE DUCTOSACTUALIZACIÓN COLECTORES (BELLINI) • MEDULAR EN MARCADORES • DE TRANSLOCACIÓN PRONÓSTICOS CLÁSICOS 5.9% • MUCINOSO TUBULAR Y FUSOCELULAR • INCLASIFICABLE Fuhrman grading Grade 1 Nulear size 10 Nuclear form Regular Nucleoli absent Grade 2 15 Irregular 400X Grade 3 20 Irregular 100x Grade 4 ≥ 20 Bizarre Low mag. 400x 1 3 2 4 Am J Surg Pathol 2011;35:1134–1139 400x 1 3 2 4 Am J Surg Pathol 2011;35:1134–1139 ISUP (nucleolar) Novel Under study 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 Different pT3a Sinus invasion Site fat tissue invasion Perinephric Sinus. 5y survival LN Met Met 50.9% 7% 28% 25.9% 19% 30% J. Urol 2005; 174: 1218-1221 AJSP 2004; 28: 1594-1600 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. Mobile thrombus Different pT3a (wall invasion) Wall invasion No wall invasion Mobile thrombus Wall invasion 5y overal survival Mobile tumor thrombus Invading tumor thrombus 69% 26% Cases with complete removal 57% Hatcher et al J. Urol. 1991; 145: 20 Solid thrombus Solid thrombus Friable thrombus Friable thrombus Median OS Actuarial 5 ys OS 44 months 41% 8 months 15% Bertini et al. Eur. Urol. 2011; 60: 358 pT3b pT3c Cancer Specific Survival Without peripheral or sinus fat invasion With peripheral & sinus fat invasion 47% 25% Progression free Survival 45% 10% Roos et al BJI. 2009 ;104:461 CLASIFICACIÓN CÁNCER RENAL OMS 2016 • DE CÉLULAS CLARAS 68.8% • PAPILAR 20% • CROMÓFOBO 7.3% • DE DUCTOS COLECTORES POSIBLES (BELLINI) • MEDULAR NUEVOS • DE TRANSLOCACIÓN MARCADORES PRONÓSTICOS 5.9% • MUCINOSO TUBULAR Y FUSOCELULAR • INCLASIFICABLE CAIX Ki67 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). CARCINOMA RENAL DE CÉLULAS CLARAS Hypoxia inducible factor pVHL 19-30 HIF-2α HIF-1α HIF-α HIF-2α HIF-1α HIF-α HIF-2α HIF-1α HIF-α ENDOTHELIAL CELL VEGF CAIX VEGF VEGF VEGF c-Myc HIF-1α HIF-1 HIF-2α VHL 3p HIF-1 Proliferation Apoptosis Perivascular cell VEGF HIF1α HIF2α pVHL normal HIF-1α HIF-2α negativos 12% Nivel de c-Myc similar pVHL deficiente HIF-1α HIF-2α positivos pVHL deficiente Sólo HIF 2α positivo Gordan et al. Cancer Cell, 2008, 14: 435-446 61% 27% c-Myc Proliferación Después de Sunitinib 83 pacientes con metástasis 10 Hospitales Después de Sunitinib 83 pacientes con metástasis 10 Hospitales
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