Prognostic significance of preoperative molecular serum analysis in renal cancer.
OBJECTIVE
We evaluated the postoperative clinical course of patients with renal cancer identified preoperatively by microsatellite analysis to examine the correlation between microsatellite alterations and risk of disease recurrence and patient mortality 2 years after nephrectomy.


METHODS
A panel of 28 microsatellite markers was used previously to assess loss of heterozygosity and microsatellite instability in urine, serum, and tumor DNA of 30 patients with clinically organ-confined renal masses who underwent partial or radical nephrectomy. The clinical reports and imaging data in the medical records of patients with a minimum follow-up of 2 years were retrospectively reviewed to determine their postoperative course.


RESULTS
Two-year follow-up was available for the 30 patients (100%) who entered the study. Mean age was 61.6 +/- 12.9 years (range, 21-77 years). Tumor stage was associated with patient mortality (P = 0.03). Tumor grade was associated with mortality (P = 0.03) and disease recurrence (P < 0.01). The frequency of microsatellite alterations (loss of heterozygosity) found in the preoperative serum of patients with renal masses served as a prognostic indicator for disease recurrence (P < 0.01).


CONCLUSIONS
Analysis of microsatellite alterations found in preoperative blood samples is a promising method for the detection of renal cancer. The presence of frequent molecular changes in preoperative serum was associated with disease recurrence. These findings suggest a role for microsatellite analysis in future studies attempting to stratify patients with clinically organ-confined renal cancer into low- and high-risk prognostic groups. Larger prospective randomized trials are needed to validate the clinical utility of this observation.
Gonzalgo
Mark L
ML
The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, 150 Marburg Building, 600 North Wolfe Street, Baltimore, MD 21287-2101, USA.
Eisenberger
Claus F
CF
Lee
Shing M
SM
Trock
Bruce J
BJ
Marshall
Fray F
FF
Hortopan
Steven
S
Sidransky
David
D
Schoenberg
Mark P
MP
D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D004247:DNA / Q000097:blood / Q000652:urine*; D004273:DNA, Neoplasm / Q000097:blood*; D018450:Disease Progression; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D019656:Loss of Heterozygosity; D018895:Microsatellite Repeats / Q000235:genetics*; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D016482:Urinalysis
D004273:DNA, Neoplasm; D004247:DNA