Cathy D Vocke1, Christopher J Ricketts1, Adam R Metwalli1, Peter A Pinto1, Rabindra Gautam1, Mark Raffeld2, Maria J Merino2, Mark W Ball1, W Marston Linehan3. 1. Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD. 2. Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD. 3. Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD. Electronic address: WML@nih.gov.
Abstract
OBJECTIVE: To evaluate whether bilateral, multifocal clear cell renal cell carcinoma (ccRCC) patients can be differentiated by VHL mutation analysis into cases that represent either multiple independently arising primary tumors, or a single primary tumor which has spread ipsilaterally as well as to the contralateral kidney. The nature of kidney cancer multifocality outside of known hereditary syndromes is as yet poorly understood. MATERIALS AND METHODS: DNA from multiple tumors per patient were evaluated for somatic VHL gene mutation and hypermethylation. A subset of tumors with shared VHL mutations were analyzed with targeted, next-generation sequencing assays. RESULTS: This cohort contained 5 patients with multiple tumors that demonstrated a shared somatic VHL mutation consistent with metastatic spread including to the contralateral kidney. In several cases this was substantiated by additional shared somatic mutations in ccRCC-associated genes. In contrast, the remaining 14 patients with multiple tumors demonstrated unique, unshared VHL alterations in every analyzed tumor, consistent with independently arising kidney tumors. None of these latter patients showed any evidence of local spread or distant metastasis. CONCLUSION: The spectrum of VHL alterations within evaluated bilateral, multifocal ccRCC tumors from a single patient can distinguish between multiple independent tumor growth and metastasis. This can be performed using currently available clinical genetic tests and will improve the accuracy of patient diagnosis and prognosis, as well as informing appropriate management.
OBJECTIVE: To evaluate whether bilateral, multifocal clear cell renal cell carcinoma (ccRCC) patients can be differentiated by VHL mutation analysis into cases that represent either multiple independently arising primary tumors, or a single primary tumor which has spread ipsilaterally as well as to the contralateral kidney. The nature of kidney cancer multifocality outside of known hereditary syndromes is as yet poorly understood. MATERIALS AND METHODS: DNA from multiple tumors per patient were evaluated for somatic VHL gene mutation and hypermethylation. A subset of tumors with shared VHL mutations were analyzed with targeted, next-generation sequencing assays. RESULTS: This cohort contained 5 patients with multiple tumors that demonstrated a shared somatic VHL mutation consistent with metastatic spread including to the contralateral kidney. In several cases this was substantiated by additional shared somatic mutations in ccRCC-associated genes. In contrast, the remaining 14 patients with multiple tumors demonstrated unique, unshared VHL alterations in every analyzed tumor, consistent with independently arising kidney tumors. None of these latter patients showed any evidence of local spread or distant metastasis. CONCLUSION: The spectrum of VHL alterations within evaluated bilateral, multifocal ccRCC tumors from a single patient can distinguish between multiple independent tumor growth and metastasis. This can be performed using currently available clinical genetic tests and will improve the accuracy of patient diagnosis and prognosis, as well as informing appropriate management.
Authors: Tim H H Coorens; Taryn D Treger; Reem Al-Saadi; Luiza Moore; Maxine G B Tran; Thomas J Mitchell; Suzanne Tugnait; Christine Thevanesan; Matthew D Young; Thomas R W Oliver; Minou Oostveen; Grace Collord; Patrick S Tarpey; Alex Cagan; Yvette Hooks; Mark Brougham; Ben C Reynolds; Giuseppe Barone; John Anderson; Mette Jorgensen; G A Amos Burke; Johannes Visser; James C Nicholson; Naima Smeulders; Imran Mushtaq; Grant D Stewart; Peter J Campbell; David C Wedge; Iñigo Martincorena; Dyanne Rampling; Liz Hook; Anne Y Warren; Nicholas Coleman; Tanzina Chowdhury; Neil Sebire; Jarno Drost; Kourosh Saeb-Parsy; Michael R Stratton; Karin Straathof; Kathy Pritchard-Jones; Sam Behjati Journal: Science Date: 2019-12-06 Impact factor: 47.728