Programmed death ligand 1 (PD-L1) is a protein which, when interacting with its receptor programmed death 1, acts as a negative regulator of the antitumor T-cell-mediated immune response. The prognostic value of PD-L1 expression in renal cell carcinoma (RCC) has been controversial. In this study, the prognostic value of PD-L1 expression in RCC was evaluated by analyzing PD-L1 immunoreactivity in tumor cells and tumor-infiltrating immune cells (TIICs) in 346 RCC patients with long-term follow-up. PD-L1 positivity in tumor cells was associated with higher World Health Organization nucleolar grade (P<0.001), recurrence (P=0.011), and death due to RCC (P=0.031). PD-L1 positivity in TIICs was associated with higher nucleolar grade (P<0.001), higher T-stage (P=0.031), higher N-stage (P=0.01), recurrence (P=0.007), and death due to RCC (P=0.001). A significant positive association of time to cancer-specific death with both PD-L1-positive tumor cells and TIICs were also found. The data indicate that RCC patients with PD-L1-positive tumor cells and TIICs are at significant risk for cancer progression and the expression may be used as a complementary prognostic factor in the management of RCC patients.

Objective: To test the hypothesis that a combination of 6 posterior and 6 anterior cores detects more cancer than 12 posterior cores at a repeat transrectal prostate biopsy in men who have had one previous benign systematic biopsy.

Patients and methods: Three hundred and forty men with persistently raised serum PSA were randomly allocated 1:1 to either a standard 12-core biopsy (12 cores from the lateral peripheral zone through a side-fire biopsy canal) or an experimental 12-core biopsy protocol with 6 anterior cores through an end-fire biopsy canal and 6 cores from the lateral peripheral zone through a side-fire biopsy canal. All biopsies were obtained transrectally with ultrasound guidance. The primary endpoint was cancer detection. Secondary endpoints were detection of ISUP Grade Groups/Gleason Grade Group ≥2 cancer, total biopsy cancer length and complications leading to medical intervention.

Results: Prostate cancer was detected in 42/168 men (25%) in the experimental biopsy group and in 36/172 (21%) in the standard biopsy group (p = 0.44). The corresponding proportions for Gleason score ≥7 were 12% and 7% (p = 0.14). Median total cancer length was 4 (inter quartile range [IQR] = 1.5 - 6) mm in the end-fire group and 3 (IQR = 1.3 - 7) mm in the side-fire group. Ten men in the end-fire group and three in the side-fire group had a medical intervention for biopsy-related complications (p = 0.05).

Conclusion: The biopsy protocol that included six end-fire anterior cores did not detect more cancer and was associated with more complications.

While overweight among adults has been linked with renal cell carcinoma (RCC) risk, little is known about the potential influence of overweight and obesity during adolescence. To ascertain if adolescent body mass index is associated with subsequent risk of RCC, we identified a cohort of 238,788 Swedish men who underwent mandatory military conscription assessment between 1969 and 1976 at a mean age of 18.5 years. At the time of conscription assessment, physical and psychological tests were performed including measurements of height and weight. Participants were followed through linkage to the Swedish Cancer Registry to identify incident diagnoses of RCC. The association between body mass index (BMI, kg/m(2)) at conscription assessment and subsequent RCC was evaluated using multivariable Cox regression. During a follow-up of up to 37 years, 266 men were diagnosed with RCC. We observed a trend for higher RCC risk with increasing BMI during adolescence, where one-unit increase in BMI conferred a 6% increased risk of RCC (95% CI 1.01-1.10). compared to normal weight men (BMI 18.5- < 25), men with overweight (BMI 25- < 30) or obesity (BMI >= 30) had hazard ratios for RCC of 1.76 (95% CI 1.16-2.67) and 2.87 (95% CI 1.26-6.25), respectively. The link between overweight/obesity and RCC appear to be already established during late adolescence. Prevention of unhealthy weight gain during childhood and adolescence may thus be a target in efforts to decrease the burden of RCC in the adult population.

Renal cell carcinoma (RCC) is the most commonly diagnosed renal tumor, consisting of ~3% of all malignancies worldwide. The prognosis of RCC can vary widely, and detecting patients at risk of recurrence at an early stage of disease may improve patient outcome. The factors presently used in a clinical setting cannot reliably predict the natural history of the disease. Therefore, there is a requirement to identify novel biomarkers that can aid in predicting patient outcome. Previous studies have indicated that microRNAs (miRNAs/miRs) are potential candidates as prognostic biomarkers for patients suffering from RCC. Consequently, the aims of the present study were to validate the potential of 3 of these miRNAs to predict the prognosis of patients with RCC, and to investigate the stability of endogenous control genes for miRNA studies in RCC tissues. The expression of 7 endogenous controls was measured using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) in formalin-fixed paraffin-embedded tumor and benign tissues from patients suffering from clear cell RCC (ccRCC). The analyses identified RNU48 and U47 as the most stable endogenous controls. The expression of miR-126, miR-21 and miR-10b was analyzed using RT-qPCR in renal tissues from 116 patients diagnosed with ccRCC. All three investigated miRNAs were differentially expressed between malignant and benign tissues. miR-126 and miR-10b were also differentially expressed between grades and stages of ccRCC. In a univariate, but not in a multivariate model, low expression of miR-126 was associated with shorter time to recurrence of the disease. The results of the present study indicate that of the 3 miRNAs investigated, the expression of miR-126 has the strongest potential as a prognostic biomarker for patients suffering from ccRCC.

Introduction: In 2017 a work panel under the European Association of Urology (EAU) pubslished the first comprehensive guideline specific to urology. The guideline offers practical evidence based guidance on use of tromboproprophylaxis (TP). Prior to this guideline publication, a previous questionaire (The NoRenCa-2 study) suggested a high degree of variation in TP practice in renal surgery across the nordic countries. We sought to examine the current practice at different urological departments accross the nordic region.

Materials and Method: A questionaire was distrubuted by e-mail to urological departments performing renal surgery. The questionnaire addressed familiarity with The American College of Chest Physicians (AACP), The National Institute for Health and Care Excellence (NICE), EAU, local and national guidelines and adressed TP practice specific for renal surgical procedures.

Results: Eighty-four sites were invited to complete the questionarie (reponse rate 45.9%). Participants expressed familiarity with the local (71.8%) guidelines followed by EAU (61.5%), National (41.0%) and AACP (7.7%) guidelines. Local (64.1%) guidelines was adhered to the most followed by EAU (43.6%) and National (23.1%) guidelines. For open nephrectomy, with no known risk factor for thrombosis, 94.9% offered Low Molecular Weight Heparin followed by early ambulation (69.2%), Graduated compression stockings (48.7%), Intermittent Pneumatic Compressionstockings (5.1%) and unfractionated Heparin (5.1%). A duration of 28 days (30.8%) was suggested by a majority while the remainder continued prophylaxis until discharge (20.5%), 10-14 days (5.1%), other duration (5.1%), 14-21 days (2.6%), 21-27 days (2.6%) and until ambulation(2.6%). Pharmacological TP was initiated postoperatively (56.4%) rather than preoperatively (37.2%)

Conclusion: TP is used widely across the nordic countries in a majority of renal procedures. Timing, duration and type of TP nevertheless varies greatly among sites

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.

Purpose: To examine the variation in venous thromboembolism prophylactic treatment (VTEP) among renal cancer patients undergoing surgery.

Materials and methods: An Internet-based questionnaire on renal tumor management before and after surgery was mailed to all Nordic departments of urology. The questions focused on the use of VTEP and were subdivided into different surgical modalities.

Results: Questionnaires were mailed to 91 institutions (response rate 53%). None of the centers used VTEP before surgery, unless the patient had a vena caval tumor thrombus. Overall, the VTEP utilized during hospitalization for patients undergoing renal surgery included early mobilization (45%), compression stockings (52%) and low-molecular-weight heparin (89%). In patients undergoing open radical Nx, 80% of institutions used VTEP during their hospitalization (23% compression stockings and 94% low-molecular-weight heparin). After leaving the hospital, the proportion and type of VTEP received varied considerably across institutions. The most common interval, used in 60% of the institutions, was for a period of 4 weeks. The restriction to the Nordic countries was a limitation and, therefore, may not reflect the practice patterns elsewhere. It is a survey study and, therefore, cannot measure the behaviors of those institutions that did not participate.

Conclusion: We found variation in the type and duration of VTEP use for each type of local intervention for renal cancer. These widely disparate variations in care strongly argue for the establishment of national and international guidelines regarding VTEP in renal surgery.

Introduction: The incidence of renal cell carcinoma (RCC), accounting for more than 90% of all renal malignances, has increased globally during recent decades. Obesity is a well-established risk factor for RCC, but earlier research has largely focused on adult exposure to risk. Little is known about the role of overweight and obesity during late adolescence.

Objectives: Our objective was to test whether body mass index (BMI) during late adolescence is associated with subsequent risk of RCC.

Methods: We used data from a cohort of 238 788 Swedish men who underwent mandatory military conscription assessment between 1969 and 1976 (at a mean age of 18.5 years). At the conscription assessment, physical and psychological tests were performed, including measurements of height and weight. Participants were followed for a diagnosis of RCC until 1 January 2010 through record linkage with the Swedish Cancer Registry. The association between BMI at conscription and subsequent RCC was evaluated using multivariate Cox regression analysis to estimate adjusted hazard ratios and corresponding 95% confidence intervals.

Results: During follow-up over a mean of 35.4 years, 266 diagnoses of RCC were identified. We observed a higher RCC risk with increasing BMI in adolescence, where a one unit increase in BMI was associated with a 5% increased risk in RCC (95% CI 1.00–1.10,p<0.049). Compared with normal weight men (BMI 18.5 to<25 kg/m2), men with overweight (BMI 25 to<30 kg/m2) and obesity (BMI  30 kg/m2) had a 1.69 (95% CI 1.12–2.57) and 2.74 (95% CI 1.26–5.96) time higher risk of RCC, respectively.

Conclusion: Data from this large population-based cohort study of men show an association between higher BMI in adolescence and a subsequently increased RCC risk, suggesting that overweight and obesity may already begin playing a role in RCC pathogenesis during adolescence. Prevention of childhood and adolescent obesity may thus be a target in efforts to decrease the burden of RCC in the adult population.