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Differential microRNA expression levels in patients with small renal masses: Predictors of progression to metastatic disease
Ariel Fredrick, MD, Travis Sullivan, MS, Kimberly Rieger-Christ, PhD.
Lahey Hospital and Medical Center, Burlington, MA, USA.

BACKGROUND:
The increase in use of cross-sectional imaging has resulted in an increased incidence of incidentally discovered small renal masses (SRM) <4 cm in size. Active surveillance for these lesions is becoming an accepted management strategy, but there is still a small risk of metastatic progression. Previous studies have shown microRNA (miRNA) profiles to differentiate between localized and metastatic clear cell renal cell carcinoma (ccRCC). Our objective was to identify a miRNA profile in SRMs predictive of metastases as a prognostic tool.
METHODS:
Total RNA was isolated from formalin fixed paraffin embedded partial or radical nephrectomy specimens from patients with pT1a ccRCC. 11 patients with eventual progression to metastatic disease and 14 patients with localized disease were analyzed. Expression levels of miRNA were determined by qRT-PCR.
RESULTS:
Expression levels of miRs 30b and 145 were significantly associated with time to recurrence comparing the localized and metastatic ccRCC groups. Levels of miRs 30b, 145, and 199 were significantly associated with cancer specific survival, and discriminated between localized and metastatic ccRCC (areas under the curve of 0.886, 0.860, and 0.851 respectively). Patient age and tumor size did not differ significantly between the two groups. MiRs 30b and 145 were downregulated in the metastatic group, while miR-199 was upregulated.
CONCLUSIONS:
Tissue samples from patients with pT1a ccRCC showed significant differences in miRNA expression levels. The miRNA identifiers in this study are consistent with previously published literature concerning progression to metastatic disease in ccRCC. Our goal will be to expand the sample size and compare expression levels in serum of patients on active surveillance as a potential decision-making tool for patients diagnosed with SRMs.


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