Background Kidney cancer is a growing public health concern. Using Global Burden of Disease (GBD) data, this study quantified its global burden from 1990 to 2021 and projected trends to guide prevention, diagnosis, and treatment. Methods The analysis of kidney cancer from 1990 to 2021 used GBD open data as a secondary dataset to examine global incidence, deaths, disability-adjusted life years (DALYs), and age-standardized rates. Spearman correlation analysis was used to assess the relationship between age-standardized rates and the Socio-demographic Index (SDI) globally and across 21 specific regions. A decomposition analysis was performed using data on aging, population dynamics, and epidemiological trends to identify factors contributing to changes in kidney-cancer DALYs and deaths from 1990 to 2021. Future projections for incidence, mortality, and DALYs were generated using the Bayesian Age-Period-Cohort model. Results The findings indicate a notable 16% increase in the age-standardized incidence rate (ASIR) for kidney cancer. Conversely, the age-standardized death rate (ASDR) decreased by approximately 4%. Additionally, there was an overall reduction of 11% in the age-standardized years of life lost (ASYR). Significant disparities in kidney cancer burden by sex and geographic location were identified. Increased body mass index and smoking were identified as the main contributors to kidney cancer. Population growth was found to play a role in the escalation of disease burden. The burden of kidney cancer is expected to diminish by 2036. Conclusions The ASIR of renal cancer increases while the ASDR and ASYR decrease. Promising indications suggest a future decrease in the burden associated with kidney cancer.
Therapeutic options for Renal Cell Carcinoma (RCC) are rapidly advancing. Systemic immune-oncology (IO) treatments, including immune checkpoint inhibitor (ICI) combination therapy and ICI with vascular endothelial growth factor tyrosine kinase inhibitors (VEGF TKIs), have shown substantial overall survival advantages. Data comparing first-line treatments for advanced RCC is limited, and second- and third-line therapies are frequently determined by approvals prior to current therapies. Pragmatic clinical trials (PCTs) are designed to inform a clinical decision by implementing evidence in a real-world setting. PCTs have increasing relevancy in oncology and offer advantages including generalizability, ease of trial execution, and can assist in evaluating whether therapies exhibit equivalent efficacy in clinical practice. Several PCTs have provided insight into metastatic RCC (mRCC) management. COMPARZ and PICSES trials compared pazopanib to sunitinib for mRCC patients and offered new insights into tolerability and patient preference. The MaRCC Registry yielded real-world data on treatment patterns and physician decision-making. The CARMENA trial demonstrated non-inferiority of sunitinib alone versus nephrectomy followed by sunitinib, while the STAR trial explored standard continuous versus intermittent VEGF-TKI therapy. Ongoing PCTs include the PROBE trial, ODYSSEY RCC, and CARE1 trials. Future opportunities for PCTs include comparing second-line treatment regimens for mRCC, examining differences in clinical responses by gender or age, the use of consolidative tumor-directed therapy in oligometastatic disease or for debulking metastases, and the impact of lifestyle variances on management. PCTs are needed to fill knowledge gaps and address patient-centered priorities that can inform our practices and improve quality care for patients with mRCC.
Background: While hereditary renal cell carcinoma (RCC) syndromes account for up to 16% of RCC cases and have screening guidelines; no screening recommendations exist for individuals with family history of RCC and negative genetic testing (familial RCC risk).Objective: This study aimed to assess current practices regarding screening recommendations for patients with familial RCC risk, evaluate the perceived need for formalized screening guidelines, and identify optimal clinician involvement for developing such guidelines.Methods: We surveyed healthcare providers who provide medical care for RCC patients, assessing current familial RCC screening practices, the need for and process of developing empiric risk guidelines, and case-based scenarios to understand current practice. This IRB-approved survey was distributed using listservs, professional connections, and snowball methods. Descriptive statistics and qualitative coding were used to analyze the data.Results: Seventy healthcare providers participated, primarily genetic counselors (n = 46; 66%) and medical oncologists (n = 11; 16%). Respondents indicated that: 1) screening guidelines are needed (n = 64; 91%) for familial RCC risk; 2) RCC patients inquired about the risk of RCC to family members after receiving negative genetic test results (n = 59; 84%, sometimes, often, or always); and 3) asked about screening recommendations for family members with similar frequency (n = 56, 80%). Respondents varied on the optimal screening mechanism and indications for screening unaffected relatives of RCC patients.Conclusions: Our findings show providers need screening guidelines to address patient inquiries, guide clinical management, and improve insurance coverage. Respondents agreed that there was a need for a multi-disciplinary team to develop standardized recommendations.
Mesenchymal neoplasms of the kidney encompass a wide range of tumor types with heterogeneous clinical, histologic, and molecular features. Given their rarity relative to renal epithelial neoplasms, diagnosis may be challenging. In this review, the clinicopathologic and molecular characteristics of selected mesenchymal neoplasms of the adult kidney are discussed, including benign entities with diverse lines of differentiation (such as juxtaglomerular cell tumor, angiomyolipoma, and anastomosing hemangioma), sarcomas (synovial sarcoma, leiomyosarcoma, Ewing sarcoma), and tumors with variable biologic potential (solitary fibrous tumor). Mesenchymal lesions that may arise in peri-nephric soft tissue (including well differentiated / dedifferentiated liposarcoma and perinephric myxoid pseudotumor of fat) are also highlighted, given their potential to present as a 'renal' mass.
