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Eur Urol. 2015 Jan;67(1):85-97. doi: 10.1016/j.eururo.2014.04.029. Epub 2014 May 21.

Understanding pathologic variants of renal cell carcinoma: distilling therapeutic opportunities from biologic complexity.

Author information

1
Department of Urology, Yale School of Medicine, New Haven, CT, USA. Electronic address: Brian.shuch@yale.edu.
2
Department of Pathology and Laboratory Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA.
3
Divisions of Urology and Medical Oncology, Departments of Medicine and Surgery, Duke School of Medicine, Durham, NC, USA.
4
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
5
Department of Oncologic, Surgical and Gastrointestinal Sciences, Urologic Unit, University of Padova, Padova, Italy.
6
Unit of Anatomical Pathology, Department of Surgery and Pathology, University of Cordoba, Faculty of Medicine, Cordoba, Spain.
7
Department of Pathology and Diagnostic, University of Verona and Pederzoli Hospital, Peschiera del Garda, Verona, Italy.
8
Department of Solid Tumor Oncology and Urology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
9
Division of Urologic Oncology, Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA.

Abstract

CONTEXT:

Once believed to represent a uniform malignant phenotype, renal cell carcinoma (RCC) is now viewed as a diverse group of cancers that arise from the nephron.

OBJECTIVE:

To review the pathologic characteristics, clinical behavior, molecular biology, and systemic therapy options of recognized RCC histologic subtypes.

EVIDENCE ACQUISITION:

A systematic review of English-language articles was performed using the Medline and Web of Science databases. Manuscripts were selected with consensus of the coauthors and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria.

EVIDENCE SYNTHESIS:

The major findings of the evaluated manuscripts are discussed with an emphasis on the description of the pathologic features, clinical behavior, prognosis, and therapeutic strategies.

CONCLUSIONS:

Classification schemes for kidney cancer have undergone dramatic changes over the past two decades. Improvements in these classification schemes are important, as pathologic variants differ not only in disease biology, but also in clinical behavior, prognosis, and response to systemic therapy. In the era of genomic medicine, further refinements in characterization of RCC subtypes will be critical to the progress of this burgeoning clinical space.

PATIENT SUMMARY:

Kidney cancer can be subdivided into related but different cancers that arise from the kidney's tubules. In this article we review current classifications for kidney cancer, discuss their characteristics, and provide an overview of each subtype's clinical behavior and treatment. We stress that each subtype harbors unique biology and thus responds differently to available treatment strategies.

KEYWORDS:

Kidney cancer; Molecular biology; Pathology; Subtype; Systemic therapy

PMID:
24857407
DOI:
10.1016/j.eururo.2014.04.029
[Indexed for MEDLINE]

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