Tissue-based research in kidney cancer: current challenges and future directions

Abstract

The past several years have seen unprecedented advances in the application of various therapeutic strategies for the treatment of patients with renal cancer. The availability of active immunotherapy, antiangiogenic therapy, and targeted therapy for this disease has brought front and center issues related to choosing the appropriate treatment for particular patient populations. It is increasingly evident that the most promising treatment selection strategies will incorporate identifying specific features of the tumor itself. To facilitate this move toward personalized medicine, it is critically important to establish some standard principles for renal cancer tissue collection, preparation, and analysis for translational research studies. In this article, we identify and discuss some critical issues related to tissue-based kidney cancer research. We focus on five major areas as follows: (a) surgical and image-guided techniques for tissue collection; (b) quality control of specimen collection, processing, storage, and review; (c) issues related to analysis of paraffin embedded tissues; (d) genomic studies; and (e) assessment of reproducibility of assays across institutions. In addition, some practical implementation strategies are proposed. Although many of the topics discussed are specific for renal cancer, several are also relevant to tissue based biomarker investigations in a broad array of malignancies.

Figure 1

Variables recorded in the NCI Tissue Procurement Form include clinical diagnosis, specimen site, type of anesthesia, induction/anesthesia start time, incision time, type of surgery (open versus laparoscopic), ischemia time, type of ischemia (warm versus cold), and resection time. Specific tumor characteristics such as size and macroscopic features are also included.

Figure 2

Schematic of the experimental design utilized by Dr. Bratslavsky to assess the impact of storage temperature and time on mRNA and protein expression in renal cancer tissue.