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Grabowska, B., Ulvskog, E., Carlsson, J., Fiorentino, M., Giunchi, F., Lindblad, P. & Sundqvist, P. (2018). Clinical outcome and time trends of surgically treated renal cell carcinoma between 1986 and 2010: results from a single centre in Sweden. Scandinavian journal of urology, 52(3), 206-212
Open this publication in new window or tab >>Clinical outcome and time trends of surgically treated renal cell carcinoma between 1986 and 2010: results from a single centre in Sweden
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2018 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, no 3, p. 206-212Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aims of this study were to create a cohort of retrospectively collected renal cell carcinoma (RCC) specimens to be used a basis for prognostic molecular studies, and to investigate the outcome and time trends in patients surgically treated for RCC in a single-centre cohort.

MATERIALS AND METHODS: Patients undergoing surgery for RCC between 1986 and 2010 were included in the study. Medical records were reviewed, and the diagnostic tissue was re-evaluated according to a modern classification. The change in patient and tumour characteristics over time was analysed.

RESULTS: The study included 345 patients. Smaller tumours, as indicated by primary tumour diameter, tumour (T) stage and American Joint Committee on Cancer (AJCC) stage, were found more frequently in later years compared to the early 1990s. No changes in the clinical outcome for the patients were seen among the time periods investigated. Increasing T stage, AJCC stage, primary tumour diameter and decreasing haemoglobin levels were associated with cancer-specific mortality in univariate analysis. A high calcium level was significantly associated with increased cancer-specific mortality (hazard ratio = 4.25, 95% confidence interval 1.36-13.28) in multivariate analysis.

CONCLUSIONS: This study on patients who underwent surgery for RCC from 1986 to 2010 at a single institution in Sweden indicates that there has been a change in tumour characteristics of patients diagnosed with RCC over time. It was also shown that calcium levels were an independent prognostic factor for cancer-specific mortality in this cohort. This cohort could provide a valuable basis for further molecular studies.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2018
Keywords
OKCC, RCC, histopathology, kidney cancer, molecular biomarkers, renal cancer, survival
National Category
Urology and Nephrology Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-68371 (URN)10.1080/21681805.2018.1430706 (DOI)000452052700008 ()29972347 (PubMedID)2-s2.0-85049554390 (Scopus ID)
Available from: 2018-08-07 Created: 2018-08-07 Last updated: 2019-01-07Bibliographically approved
Åström, M., Tajeddinn, W., Karlsson, M. G., Linder, O., Palmblad, J. & Lindblad, P. (2018). Cytokine Measurements for Diagnosing and Characterizing Leukemoid Reactions and Immunohistochemical Validation of a Granulocyte Colony-Stimulating Factor and CXCL8-Producing Renal Cell Carcinoma. Biomarker Insights, 13, Article ID UNSP 1177271918792246.
Open this publication in new window or tab >>Cytokine Measurements for Diagnosing and Characterizing Leukemoid Reactions and Immunohistochemical Validation of a Granulocyte Colony-Stimulating Factor and CXCL8-Producing Renal Cell Carcinoma
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2018 (English)In: Biomarker Insights, ISSN 1177-2719, E-ISSN 1177-2719, Vol. 13, article id UNSP 1177271918792246Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Various paraneoplastic syndromes are encountered in renal cell carcinomas. This case report illustrates that a paraneoplastic leukemoid reaction may precede the diagnosis of renal cell carcinoma and be explained by cytokine production from the cancer cells.

CASE PRESENTATIONS: A 64-year-old man was referred for hematology workup due to pronounced leukocytosis. While being evaluated for a possible hematologic malignancy as the cause, he was found to have a metastasized renal cell carcinoma, and hyperleukocytosis was classified as a leukemoid reaction. A multiplex panel for measurement of 25 serum cytokines/chemokines showed highly elevated levels of granulocyte colony-stimulating factor (G-CSF) and CXCL8 (C-X-C-motif chemokine ligand 8, previously known as interleukin [IL]-8). By immunohistochemistry it was shown that the renal carcinoma cells expressed both these cytokines. Two additional, consecutive patients with renal cell carcinoma with paraneoplastic leukocytosis also showed elevated serum levels of CXCL8, but not of G-CSF. Nonparametric statistical evaluation showed significantly higher serum concentrations of CXCL8, IL-6, IL-10, monocyte chemoattractant protein 1 (MCP-1), and tumor necrosis factor, but lower interferon gamma (IFN-gamma) and IL-1 alpha, for the 3 renal cell carcinoma cases compared with healthy blood donors.

CONCLUSIONS: In suspected paraneoplastic leukocytosis, multiplex serum cytokine analyses may facilitate diagnosis and provide an understanding of the mechanisms for the reaction. In the index patient, combined G-CSF and CXCL8 protein expression by renal carcinoma cells was uniquely documented. A rapidly fatal course was detected in all 3 cases, congruent with the concept that autocrine/paracrine growth signaling in renal carcinoma cells may induce an aggressive tumor phenotype. Immune profiling studies could improve our understanding for possible targets when choosing therapies for patients with metastatic renal cell carcinoma.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
chemokine, IL-6, IL-10, monocytosis, paraneoplastic leukocytosis, autocrine signaling, multiplex, inflammatory response, precision medicine, biomarker
National Category
Immunology in the medical area Medical Biotechnology (with a focus on Cell Biology (including Stem Cell Biology), Molecular Biology, Microbiology, Biochemistry or Biopharmacy)
Identifiers
urn:nbn:se:oru:diva-68648 (URN)10.1177/1177271918792246 (DOI)000441829800001 ()30147294 (PubMedID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-08-31Bibliographically approved
Thorstenson, A., Harmenberg, U., Lindblad, P., Ljungberg, B. & Lundstam, S. (2016). Impact of quality indicators on adherence to National and European guidelines for renal cell carcinoma. Scandinavian journal of urology, 50(1), 2-8
Open this publication in new window or tab >>Impact of quality indicators on adherence to National and European guidelines for renal cell carcinoma
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2016 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, no 1, p. 2-8Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this population-based study was to evaluate the impact of quality indicators on the adherence to guidelines for renal cell carcinoma (RCC).

Material and methods: Since 2005, virtually all patients with newly diagnosed RCC in Sweden have been registered in the National Swedish Kidney Cancer Register (NSKCR). The register contains information on histopathology, nuclear grade, clinical stage, preoperative work-up, treatment, recurrence and survival. In addition, a number of quality indicators have been measured in the register aiming to increase the quality of care. The quality indicators are: the coverage of the register, histology reports, preoperative chest computed tomography (CT), partial nephrectomy, laparoscopic surgery, centralization to high-volume hospitals and waiting times.

Results: A total of 8556 patients with diagnosed RCC were registered from 2005 to 2013 (99% coverage). In 2013, 99% of the histopathology reports were standardized. The number of patients with preoperatively chest CT increased from 59% in 2005 to 89% in 2013. The proportion of patients with RCC T1aN0M0 who underwent partial nephrectomy increased from 22% in 2005 to 56% in 2013. Similarly, laparoscopic radical nephrectomies increased from 6% in 2005 to 24% in 2013. The median tumour size at detection decreased from 60 mm in 2005 to 55 mm in 2013. The proportion of patients who were incidentally detected increased from 43% in 2005 to 55% in 2013.

Conclusions: The data show an improved adherence to the guidelines for RCC as measured by quality indicators and a steady process of earlier detection of patients with RCC.

Place, publisher, year, edition, pages
Taylor & Francis, 2016
Keywords
Population-based, quality indicators, renal cell carcinoma, surgery, Sweden, tumour size, tumour type
National Category
Cancer and Oncology Urology and Nephrology
Research subject
Surgery esp. Urology Specific; Oncology
Identifiers
urn:nbn:se:oru:diva-45369 (URN)10.3109/21681805.2015.1059882 (DOI)000367832000002 ()26202573 (PubMedID)2-s2.0-84954092344 (Scopus ID)
Note

Funding Agencies:

Umeå University

Lions Cancer Research Foundation, Umeå

Research Foundation at the Urology Department of Sahlgrenska University Hospital

Foundation of Anna-Lisa and Bror Björnsson

Stockholm Cancer Society

Capio St Görans Hospital

Available from: 2015-07-29 Created: 2015-07-29 Last updated: 2018-07-09Bibliographically approved
Dabestani, S., Thorstenson, A., Lindblad, P., Harmenberg, U., Ljungberg, B. & Lundstam, S. (2016). Renal cell carcinoma recurrences and metastases in primary non-metastatic patients: a population-based study. World journal of urology, 34(8), 1081-1086
Open this publication in new window or tab >>Renal cell carcinoma recurrences and metastases in primary non-metastatic patients: a population-based study
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2016 (English)In: World journal of urology, ISSN 0724-4983, E-ISSN 1433-8726, Vol. 34, no 8, p. 1081-1086Article in journal (Refereed) Published
Abstract [en]

Purpose: To present the occurrence of metastases and local recurrences in primary non-metastatic patients with renal cell carcinoma (RCC) in a contemporary Swedish population-based cohort.

Methods: Between 2005 and 2009, a total of 4527 patients were included in the prospective National Swedish Kidney Cancer Register accounting for nearly all RCC patients in Sweden. Among M0 patients, 472 (13 %) had no follow-up data registered within 5-year follow-up time and were excluded from the analysis.

Results: In total, 939 (21 %) had distant metastases at presentation with a decrease from 23 to 18 % during the inclusion period. Of 3107 patients with follow-up data and with M0 disease, 623 (20 %) were diagnosed with a tumor recurrence during 5-year follow-up. Mean time to recurrence was 24 months (SD ± 20 months). Among these, 570 patients (92 %) were at primary diagnosis treated with radical nephrectomy, 23 patients (3.7 %) with partial nephrectomy and 12 patients (1.9 %) with minimally invasive treatments. The most frequent sites of metastases were lung (54 %), lymph nodes (22 %) and bone (20 %). The treatment of recurrence was in 50 % systemic treatments, while metastasectomy was performed in 17 % of the patients, out of which 68 % were with a curative intention.

Conclusions: In this population-based study, 21 % of the patients had metastatic disease at presentation, with a decreasing trend over the study period. During 5-year follow-up, 20 % of the primary non-metastatic patients had recurrent disease. Of the patients with recurrence, half were given systemic oncological treatment and 17 % underwent metastasectomy.

Place, publisher, year, edition, pages
New York, USA: Springer, 2016
Keywords
Renal cell carcinoma, metastases, recurrent disease, local recurrence, surgery, nephrectomy, partial nephrectomy, minimal invasive therapy
National Category
Cancer and Oncology Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-48084 (URN)10.1007/s00345-016-1773-y (DOI)000381101100006 ()26847337 (PubMedID)2-s2.0-84957538219 (Scopus ID)
Note

Funding Agencies:

Umeå University

Lions Cancer Research Foundation in Umeå

Research Foundation at the Urology Department of Sahlgrenska University Hospital

Foundation of Anna-Lisa and Bror Björnsson

Available from: 2016-02-19 Created: 2016-02-07 Last updated: 2018-07-10Bibliographically approved
Lee, J. E., Kim, N., Adami, H.-O. & Lindblad, P. (2015). Body mass, smoking habit, and hypertension and renal cell cancer survival. Paper presented at 106th Annual Meeting of the American-Association-for-Cancer-Research (AACR), Philadelphia, PA, USA, April 18-22, 2015. Cancer Research, 75, Article ID 883.
Open this publication in new window or tab >>Body mass, smoking habit, and hypertension and renal cell cancer survival
2015 (English)In: Cancer Research, ISSN 0008-5472, E-ISSN 1538-7445, Vol. 75, article id 883Article in journal, Meeting abstract (Other academic) Published
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
urn:nbn:se:oru:diva-49620 (URN)10.1158/1538-7445.AM2015-883 (DOI)000371578501335 ()
Conference
106th Annual Meeting of the American-Association-for-Cancer-Research (AACR), Philadelphia, PA, USA, April 18-22, 2015
Available from: 2016-04-04 Created: 2016-04-04 Last updated: 2018-07-03Bibliographically approved
Thorstenson, A., Harmenberg, U., Lindblad, P., Holmström, B., Lundstam, S. & Ljungberg, B. (2015). Cancer Characteristics and Current Treatments of Patients with Renal Cell Carcinoma in Sweden. BioMed Research International, Article ID 456040.
Open this publication in new window or tab >>Cancer Characteristics and Current Treatments of Patients with Renal Cell Carcinoma in Sweden
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2015 (English)In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 456040Article in journal (Refereed) Published
Abstract [en]

Methodology: Since the start in 2005 virtually all patients with newly diagnosed renal cell carcinoma (RCC) in Sweden are reported to the National Swedish Kidney Cancer Register (NSKCR). The register contains information on histopathology, nuclear grade, clinical stage, preoperative work-up, treatment, recurrence, and survival.

Results: A total of 8556 patients with newly diagnosed RCC were registered in the NSKCR from 2005 to 2013 resulting in a coverage of 99% as compared to the Swedish Cancer Registry. The mean tumor size at detection decreased from 70 mm in 2005 to 64 mm in 2010. The proportion of patients who were incidentally detected increased. The proportion of patients with tumor stage T1a who underwent partial nephrectomy increased from 22% in 2005 to 56% in 2012. Similarly, the proportion of laparoscopically performed radical nephrectomies increased from 6% in 2005 to 17% in 2010. During the five years of follow-up 20% of the patients had a recurrence.

Conclusion: Over the last decade there has been a trend of earlier detection and less advanced tumors at detection in patients with RCC. An increasing proportion of the patients undergo laparoscopic and nephron-sparing procedures.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2015
National Category
Microbiology in the medical area Cancer and Oncology
Research subject
Biomedicine; Microbiology
Identifiers
urn:nbn:se:oru:diva-46509 (URN)10.1155/2015/456040 (DOI)000363574700001 ()26539495 (PubMedID)2-s2.0-84945951071 (Scopus ID)
Note

Funding Agencies:

Umeå University

Lions Cancer Research Foundation

Research Foundation at the Urology Department of Sahlgrenska University Hospital

Foundation of Anna-Lisa and Bror Björnsson

Stockholm Cancer Society

Capio S:t Görans Hospital

Available from: 2015-11-17 Created: 2015-11-16 Last updated: 2018-07-02Bibliographically approved
Cho, E., Adami, H.-O. & Lindblad, P. (2011). Epidemiology of renal cell cancer. Hematology/Oncology Clinics of North America, 25(4), 651-665
Open this publication in new window or tab >>Epidemiology of renal cell cancer
2011 (English)In: Hematology/Oncology Clinics of North America, ISSN 0889-8588, E-ISSN 1558-1977, Vol. 25, no 4, p. 651-665Article, review/survey (Refereed) Published
Abstract [en]

Renal cell cancer (RCC) is increasingly diagnosed at an early stage in many countries, which likely contributes to the recent leveling of RCC mortality in the United States and many European countries. However, over all stages nearly 50% of the patients die within 5 years after diagnosis. Smoking and obesity may account for approximately 40% of all incidental cases in high-risk countries. Besides obesity, rising prevalence of hypertension may play a growing role. Several other occupational and lifestyle factors may also affect the risk of RCC. Genetic variations may be an important factor in the differing incidence among populations.

Place, publisher, year, edition, pages
Maryland Heights, USA: Saunders Elsevier, 2011
Keywords
Epidemiology, Hypertension, Incidence, Mortality, Obesity, Renal cell cancer; Risk factors, Smoking
National Category
Medical and Health Sciences Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-40448 (URN)10.1016/j.hoc.2011.04.002 (DOI)000293661700002 ()21763961 (PubMedID)2-s2.0-79960343628 (Scopus ID)
Available from: 2015-01-08 Created: 2015-01-08 Last updated: 2018-05-06Bibliographically approved
Eunyoung, C., Lindblad, P. & Adami, H.-O. (2008). Kidney Cancer (2nd ed.ed.). In: Hans-Olov Adam, David J. Hunter, Dimitrios Trichopoulos (Ed.), Textbook of cancer epidemiology: . Oxford, United Kingdom: Oxford University Press
Open this publication in new window or tab >>Kidney Cancer
2008 (English)In: Textbook of cancer epidemiology / [ed] Hans-Olov Adam, David J. Hunter, Dimitrios Trichopoulos, Oxford, United Kingdom: Oxford University Press , 2008, 2nd ed.Chapter in book (Other academic)
Abstract [en]

Cigarette smoking and obesity may account for approximately 40% of cases in high-incidence countries. Continued research in kidney cancer is needed since nearly 50% of the patients die within five years after diagnosis. With the aim of prevention, the continued search for environmental causes should take into account the fact that kidney cancer consists of different types with specific genetic molecular characteristics. In some cases, these genetic alterations have been purportedly associated with specific exposures. Furthermore, genetic polymorphisms may have a modulating effect on metabolic activation and detoxification enzymes. Thus, better understanding of the genetic and molecular processes involved in kidney cancer may help with the analyzing exposure associations that are important in both its initiation and progression.

Place, publisher, year, edition, pages
Oxford, United Kingdom: Oxford University Press, 2008 Edition: 2nd ed.
Series
Monographs in epidemiology and biostatistics, ISSN 0740-0845
Keywords
Tobacco, obesity, genetic polymorphisms, hypertension, diet
National Category
Medical and Health Sciences Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-40573 (URN)10.1093/acprof:oso/9780195311174.003.0023 (DOI)9780195311174 (ISBN)
Available from: 2015-01-08 Created: 2015-01-08 Last updated: 2017-10-17Bibliographically approved
Greving, J. P., Lee, J. E., Wolk, A., Lukkien, C., Lindblad, P. & Bergström, A. (2007). Alcoholic beverages and risk of renal cell cancer. British Journal of Cancer, 97(3), 429-433
Open this publication in new window or tab >>Alcoholic beverages and risk of renal cell cancer
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2007 (English)In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 97, no 3, p. 429-433Article in journal (Refereed) Published
Abstract [en]

Using a mailed questionnaire, we investigated the risk of renal cell cancer in relation to different types of alcoholic beverages, and to total ethanol in a large population-based case-control study among Swedish adults, including 855 cases and 1204 controls. Compared to non-drinkers, a total ethanol intake of >620 g month(-1) was significantly related to a decreased risk of renal cell cancer (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.4-0.9; P-value for trend=0.03). The risk decreased 30-40% with drinking more than two glasses per week of red wine (OR 0.6, 95% CI 0.4-0.9), white wine (OR 0.7, 95% CI 0.4-1.0), or strong beer (OR 0.6, 95% CI 0.4-1.0); there was a clear linear trend of decreasing risk with increasing consumption of these beverages (P-values for trends <0.05).

Place, publisher, year, edition, pages
London, United Kingdom: Nature Publishing Group, 2007
Keywords
Adult, Aged, *Alcohol Drinking, *Beverages, Carcinoma, Renal Cell/*epidemiology, Case-Control Studies, Female, Humans, Kidney Neoplasms/*epidemiology, Male, Middle Aged, Risk Factors, Sweden/epidemiology
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-48981 (URN)10.1038/sj.bjc.6603890 (DOI)000248444900022 ()17653076 (PubMedID)2-s2.0-34547567399 (Scopus ID)0007-0920 (Print) 0007-0920 (Linking) (ISBN)
Available from: 2017-01-01 Created: 2016-03-06 Last updated: 2017-11-29Bibliographically approved
Ejerblad, E., Fored, C. M., Lindblad, P., Fryzek, J., McLaughlin, J. K. & Nyren, O. (2006). Obesity and risk for chronic renal failure. Journal of the American Society of Nephrology, 17(6), 1695-1702
Open this publication in new window or tab >>Obesity and risk for chronic renal failure
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2006 (English)In: Journal of the American Society of Nephrology, ISSN 1046-6673, E-ISSN 1533-3450, Vol. 17, no 6, p. 1695-1702Article in journal (Refereed) Published
Abstract [en]

Few large-scale epidemiologic studies have quantified the possible link between obesity and chronic renal failure (CRF). This study analyzed anthropometric data from a nationwide, population-based, case-control study of incident, moderately severe CRF. Eligible as cases were all native Swedes who were aged 18 to 74 yr and had CRF and whose serum creatinine for the first time and permanently exceeded 3.4 mg/dl (men) or 2.8 mg/dl (women) during the study period. A total of 926 case patients and 998 control subjects, randomly drawn from the study base, were enrolled. Face-to-face interviews, supplemented with self-administered questionnaires, provided information about anthropometric measures and other lifestyle factors. Logistic regression models with adjustments for several co-factors estimated the relative risk for CRF in relation to body mass index (BMI). Overweight (BMI>or=25 kg/m2) at age 20 was associated with a significant three-fold excess risk for CRF, relative to BMI<25. Obesity (BMI>or=30) among men and morbid obesity (BMI>or=35) among women anytime during lifetime was linked to three- to four-fold increases in risk. The strongest association was with diabetic nephropathy, but two- to three-fold risk elevations were observed for all major subtypes of CRF. Analyses that were confined to strata without hypertension or diabetes revealed a three-fold increased risk among patients who were overweight at age 20, whereas the two-fold observed risk elevation among those who had a highest lifetime BMI of >35 was statistically nonsignificant. Obesity seems to be an important-and potentially preventable-risk factor for CRF. Although hypertension and type 2 diabetes are important mediators, additional pathways also may exist.

Place, publisher, year, edition, pages
Philadelphia, USA: Lippincott Williams & Wilkins, 2006
Keywords
Adolescent, Adult, Aged, Body Mass Index, Case-Control Studies, Female, Humans, Kidney Failure, Chronic/*complications/*diagnosis/etiology, Male, Middle Aged, Obesity/*complications, Risk, Sweden
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-48977 (URN)10.1681/ASN.2005060638 (DOI)000237891100021 ()16641153 (PubMedID)2-s2.0-33646898442 (Scopus ID)1046-6673 (Print) 1046-6673 (Linking) (ISBN)
Available from: 2017-01-01 Created: 2016-03-06 Last updated: 2017-11-29Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1217-4289

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