Dietary and circulating vitamin D and risk of renal cell carcinoma: a meta-analysis of observational studies

ABSTRACT Objective: This meta-analysis is the first to evaluate the associations of circulating and dietary intake of vitamin D with risk of risk of renal cell carcinoma (RCC). Our findings showed that higher circulating vitamin D level and dietary vitamin D intake were associated with a reduced risk of RCC. The possible explanation might be attributed to the anti-inflammatory effect, inhibiting cell proliferation, inducing cell differentiation and apoptosis. Materials and Methods: We searched the MEDLINE, EMBASE, and Scopus databases from their inception points through December 2018 for observational studies. The pooled relative risks (RRs) with corresponding 95% CIs were calculated using random-effects or fixed-effects models. The Newcastle-Ottawa scale was employed to assess the quality of the included studies. Results: A total of 9 publications were included in this meta-analysis. An overall analysis of the highest versus lowest intake levels revealed that circulating vitamin D level was protectively associated with risk of RCC 0.76 (95% CI: 0.64-0.89, P=0.001), with no evidence of heterogeneity (I2=38.8%, P=0.162). In addition, dietary vitamin D intake was associated with a reduced risk of RCC (RR: 0.86; 95% CI: 75-0.99, P=0.030). Statistical heterogeneity was not identified (I2=28.8%, P=0.199). Subgroup analyses results showed the gender differences, and the associations were significant in results with women participants (RR: 0.70; 95% CI: 0.55-0.88) and case-control studies (RR: 0.80, 95% CI: 0.67-0.95). Conclusion: Higher circulating vitamin D level and higher dietary vitamin D intake both might be associated with a reduced risk of RCC. Further high-quality randomized controlled trials are required in the future to confirm our results.

Carcinomas renales recientemente reconocidos / Recently recognized renal carcinomas

The classification working group of the International Society of Urological Pathology consensus conference on renal neoplasia was in charge of making recommendations regarding additions and changes to the current World Health Organization Classification of Renal Tumors (2004). Members of the group performed an exhaustive literature review, assessed the results of the preconference survey and participated in the consensus conference discussion and polling activities. On the basis of the above inputs, there was consensus that 5 entities should be recognized as new distinct epithelial tumors within the classification system:tubulocystic renal cell carcinoma (RCC), acquired cystic disease–associated RCC, clear cell (tubulo)papillary RCC, the MiT family translocation RCCs (in particular t(6;11) RCC), and hereditary leiomyomatosis RCC syndrome–associated RCC.The new classification is to be referred to as the International Society of Urological Pathology Vancouver Classification of Renal Neoplasia.

Vigilancia activa en masas renales menores de 4 cm / Active surveillance for renal masses less than 4 cm

El carcinoma de células renales corresponde al 3.5 porcien de de todos los tumores malignos y tiene una mortalidad cercana al 40 por cien. La tasa de sobrevida relativa para tumores localizados en el riñón es del 90 por cien a los 5 años y de 82 por cien a los 10 años y la incidencia de aumenta a una tasa de 2 por cien a 2,5 por cien por año. Entre 60 por cien y 70 por cien de los nuevos casos de CCR diagnosticados son asintomáticos y de descubrimiento incidental. La observación de masas renales menores de 4 cm de diámetro es aceptada en pacientes como un proceso activo que requiere la focalización del recurso humano y administrativo, con una inversión económica importante, para dar a estos pacientes la mejor opción terapéutica según su condición. Por esta razón los pacientes con masas renales pequeñas (<4cm.) con características definidas, pueden beneficiarse en algún momento de la observación activa teniendo en cuenta que durante el seguimiento se pueden encontrar diferentes resultados y de acuerdo a estos cambiar la observación por otra opción terapeútica