RESUMEN
Tyrosine kinase inhibitors (TKIs) play a crucial role in the treatment of advanced renal cell carcinoma (RCC). However, there is a lack of useful biomarkers for assessing treatment efficacy. Through urinary metabolite analysis, we identified the metabolites and pathways involved in TKI resistance and elucidated the mechanism of TKI resistance. To verify the involvement of the identified metabolites obtained from urine metabolite analysis, we established sunitinib-resistant RCC cells and elucidated the antitumor effects of controlling the identified metabolic pathways in sunitinib-resistant RCC cells. Through the analysis of VEGFR signaling, we aimed to explore the mechanisms underlying the antitumor effects of metabolic control. Glutamine metabolism has emerged as a significant pathway in urinary metabolite analyses. In vitro and in vivo studies have revealed the antitumor effects of sunitinib-resistant RCC cells via knockdown of glutamine transporters. Furthermore, this antitumor effect is mediated by the control of VEGFR signaling via PTEN. Our findings highlight the involvement of glutamine metabolism in the prognosis and sunitinib resistance in patients with advanced RCC. Additionally, the regulating glutamine metabolism resulted in antitumor effects through sunitinib re-sensitivity in sunitinib-resistant RCC. Our results are expected to contribute to the more effective utilization of TKIs with further improvements in prognosis through current drug therapies.
RESUMEN
Introduction: In testicular cancer, late relapse of teratoma with somatic-type malignancy is rare and associated with a poor survival. A case of retroperitoneal lymph node metastasis of teratoma with somatic-type malignancy 18 years after initial treatment for testicular cancer is reported. Case presentation: A 46-year-old man had a 15-mm-sized mass in the para-aortic region 18 years after initial treatment for testicular cancer, without elevated serum alfa-fetoprotein or human chorionic gonadotropin levels. Laparoscopic retroperitoneal lymph node dissection was performed. The pathological findings showed teratoma with somatic-type malignancy, and the findings of primary testicular cancer reported a yolk sac tumor, not teratoma. Conclusion: Late relapse of teratoma with somatic-type malignancy was resected by laparoscopic retroperitoneal lymph node dissection. Therefore, long-term follow-up should be considered if patients with small retroperitoneal masses did not undergo retroperitoneal lymph node dissection, and early detection and surgical resection for relapse might be effective.
RESUMEN
Molecular-targeted therapy was recommended for the systemic therapy of renal cell cancer (RCC) in the RCC guidelines, but these guidelines do not address the order of administration of the multiple presently available agents. There are several aspects that remain unknown regarding the optimal administration order and combination of molecular-targeted drugs. Until the optimal treatment sequence is determined by clinical trials, treatment individualization is required for each patient based on patient and disease characteristics. We herein investigate 12 cases of RCC patients who received axitinib. Axitinib was used as the first-line drug in 4 cases, second-line in 5 cases, third-line in 1 case and as a fourth-line drug in 2 cases. Partial response (PR) was observed in 4 cases (30%) and stable disease in 4 cases (30%) during axitinib treatment, with an overall response rate of 60%. The duration of PR ranged from 6 to 19 months. Based on our cases, axitinib exhibited reasonable therapeutic efficacy as first- as well as second-line treatment. However, more cases are required to draw firm conclusions.
RESUMEN
(Objectives) To evaluate the outcomes of patients who were surgically treated for retroperitoneal liposarcoma in our hospital from February 2002 to August 2015. (Methods) Fifteen patients were surgically treated for retroperitoneal liposarcoma in our hospital during the study period. All patients were diagnosed with liposarcoma on pathological examination. The mean follow-up period was 46.7 months (range, 1-126 months). (Results) There was no difference in the sex distribution of the patients (7 men and 8 women). The median age was 67 years (range, 33-78 years). The median tumor diameter was 24 cm (range, 7.5-45 cm) and the median tumor weight was 1,959 g (range, 545-15,400 g). One patient's operation was unsuccessful, with incomplete tumor resection. The surgical margin was positive in two patients. The 5- and 10-year survival rates were 67% and 50%, respectively. There was a significant difference in the survival rate between complete resection and incomplete resection, including surgical margin-positive patients (p=0.0019). Moreover, there was a significant difference in the recurrence-free rate between complete resection and surgical margin-positive patients (p=0.013). There was no significant difference according to whether removal of the tumor with adjacent viscera or removal of the tumor only had been performed (p=0.09 and 0.90, respectively). (Conclusions) Surgery is the mainstay of treatment for retroperitoneal liposarcoma, and complete resection is necessary.
RESUMEN
The patient was a 47 year-old female who had autosomal dominant polycystic kidney disease (ADPKD) with bilateral small renal cell carcinoma (RCC). We performed bilateral partial nephrectomy and radiofrequency ablation to the residual tumor. Pathological diagnosis was clear cell carcinoma,Fuhrman grade 3. Sunitinib therapy was started nine months after the operation because multiple liver metastases occurred. Twenty-six months after the operation,she died from rapid progression of liver metastasis.
