Analysis Of Related Factors Of Early Clear Cell Renal Cell

Objective To detect the clinicopathological features, the essentials of diagnosis and differential diagnosis of metastatic cc RCC. To identify aberrantly expressed EMT markers in early localized clear cell renal cell carcinomas(cc RCCs) and to evaluate their prognostic values for predicting postoperative metastasis.Methods Immunohistochemical staining was carried out on tissue microarray to detect the expression features of Snail, CD151, Slug, Twist, CMTM8 and PD-L1 in 58 instances of early localized cc RCC(p T1-2), including 22 instances developing metastasis during a follow-up period of 3 years, and 36 instances without metastatic disease within 3 years. The metastasis-free survival(MFS) was calculated to investigate the potential prognostic values of the established markers.Results 1.The cohort comprised of more males than females. Among the 42 cases metastatic cc RCC, 19 cases metastasized to the lung, 8 cases metastasized to the bone. The predominant histologic pattern of metastatic cc RCCs was characterized by the presence of small nest and interstitial capillaries clustered hyperplasia. Immunohistochemically, CD10, vimentin, CAⅨ, PAX8, RCC and EMA protein were expressed in the metastasis foci in different degrees with the expression rates of 39(92.9%), 40(95.2%), 38(90.5%), 38(90.5%), 31(73.8%) and 38(90.5%), respectively. 2.Tumor size, nucleolus grade and necrosis are associated with metastatic potential of early localized cc RCCs. The larger tumor, the higher nucleolus grade more necrosis, the higher metastatic potential(P<0.05). 3.The positive rates of Snail and CD151 in normal renal tissues were much lower than that in primary cc RCCs(Snail: 4.2% vs. 22.4%, CD151: 8.3%vs. 46.6%). The metastatic lesions were found to suffer much higher positive rates than the primary tumors(Snail: 69.0%vs. 22.4%, CD151: 96.6%vs. 46.6%)(P<0.05). As to Slug, Twist, CMTM8 and PD-L1, their expressions were showed no differences among the three groups(normal renal tissues, primary cc RCCs, metastatic cc RCCs)(P>0.05). 4.Primary cc RCCs developing metastasis in 3 years bear higher positive rates than their counterparts without metastasis(Snail, 40.9% vs. 11.1%; CD151, 72.7% vs. 30.6%)(P<0.05). 5.Further survival analysis demonstrated that high Snail and CD151 expressions were associated with postoperative MFS in patients with early localized cc RCCs. Nucleolus grade and tumor necrosis were two independent predictors for MFS of these patients.Conclusions Metastatic cc RCC presents unique clinicopathological features. Combing the clinical history and morphology characteristics, as well as immunohistochemical markers would facilitate the diagnosis and differential diagnosis of the metastatic cc RCC. Snail and CD151 are associated with metastatic potential of early localized cc RCCs; thus they may be regarded as potential prognostic biomarkers for early stage cc RCCs.