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Renal tumors: diagnostic and prognostic biomarkers.

肾脏肿瘤:诊断和预后相关的生物学标记

Tan PH,Cheng L,Rioux-Leclercq N,Merino MJ,Netto G,Reuter VE,Shen SS,Grignon DJ,Montironi R,Egevad L,Srigley JR,Delahunt B,Moch H,

Abstract

The International Society of Urological Pathology convened a consensus conference on renal cancer, preceded by an online survey, to address issues relating to the diagnosis and reporting of renal neoplasia. In this report, the role of biomarkers in the diagnosis and assessment of prognosis of renal tumors is addressed. In particular we focused upon the use of immunohistochemical markers and the approach to specific differential diagnostic scenarios. We enquired whether cytogenetic and molecular tools were applied in practice and asked for views on the perceived prognostic role of biomarkers. Both the survey and conference voting results demonstrated a high degree of consensus in participants' responses regarding prognostic/predictive markers and molecular techniques, whereas it was apparent that biomarkers for these purposes remained outside the diagnostic realm pending clinical validation. Although no individual antibody or panel of antibodies reached consensus for classifying renal tumors, or for confirming renal metastatic disease, it was noted from the online survey that 87% of respondents used immunohistochemistry to subtype renal tumors sometimes or occasionally, and a majority (87%) used immunohistochemical markers (Pax 2 or Pax 8, renal cell carcinoma [RCC] marker, panel of pan-CK, CK7, vimentin, and CD10) in confirming the diagnosis of metastatic RCC. There was consensus that immunohistochemistry should be used for histologic subtyping and applied before reaching a diagnosis of unclassified RCC. At the conference, there was consensus that TFE3 and TFEB analysis ought to be requested when RCC was diagnosed in a young patient or when histologic appearances were suggestive of the translocation subtype; whereas Pax 2 and/or Pax 8 were considered to be the most useful markers in the diagnosis of a renal primary.

摘要

国际泌尿病理学会经在线调查,就肾脏肿瘤问题达成了共识,强调了肾脏肿瘤相关的诊断和报告问题。在这篇报道中,主要强调了肾脏肿瘤诊断及预后评估相关的生物分子。尤其着眼于免疫组化标记的应用及其在鉴别诊断中的应用。我们调查了细胞遗传学及分子检测是否用于了常规工作中,并征求了生物学标记实际预后意义的意见。该调查及投票得出的共识结果表明,参与者对预后/预测的生物学标记及分子技术具有高度共识,但很明显的是该目的的生物标记尚未经临床研究验证,仍处于诊断领域之外。尽管尚未有单个或一组抗体能完全区分肾脏肿瘤、或确诊肾脏转移性疾病,但也注意到,在线调查中87%的参与者有时或者偶尔用免疫组化的方法来进行肾脏肿瘤的分类,大多数(87%)的参与者使用免疫组化标记(Pax2或者Pax8,肾细胞癌标记,一组广谱CK,CK7,vimentin和CD10)来确定转移性肾细胞癌的诊断。大家一致认为免疫组化应当用于形态学分类中,尤其是在诊断无法分类的肾细胞癌时。此次会议一致认为在年轻患者诊断为肾细胞癌或者形态学提示可能是有易位的亚型时应当进行TFE3和TFEV分析,Pax2和/或Pax8被认为是诊断肾脏原发肿瘤中最有用的标记。

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