Relationship between the tumor necrosis factor related apoptosis inducing ligand (trail) and trail receptors with perirenal fat, renal sinus and renal vein invasion of renal cell carcinoma

Renal cell carcinoma (RCC) is the most common tumor of the kidney. Among the urologic malignancies mortality rate of RHK is the highest one. Despite the new agent targeted therapies, recurrent or metastatic RCC are highly resistant to chemotherapy. TRAIL only inhibits apoptosis in cancer cells so using for anti-cancer therapeutic continues in experimental trials. Renal sinus, contain within the lymphatic and vascular plexus, investigators thinks that renal sinus is the important area for the spread out of the kidney cell carcinoma and focuses on much lately. In this study, we investigated that TRAIL and its receptors expression among renal sinus, renal vein and perirenal fat involvement patients with RCC. In addition we evaluated the relationship between the renal vein, renal sinus, perirenal fat involvement and parameters such as, age, gender, tumor size, nuclear grade, histological subtype. We examined the data of 249 patients retrospectively who had RCC diagnosis. Renal sinus, renal vein and perirenal fat involvement were analyzed with age, gender, histological subtype, tumor size, nuclear grade. Results of statistical analysis only tumor diameter has a significant relationship between the renal sinus, renal vein and perirenal fat involvement. We examined 145 of the 249 patients that studied TRAIL and its receptors; analyzed the expression of TRAIL and its receptors between the renal sinus, renal vein and perirenal fat involvement. Nine patients were excluded for not enough paraffin blocks evaluated. Analyses results have shown that, there is a significant association between low TRAIL-R1 expression and of absence renal vein involvement (p=0,002); and significant association between the high TRAIL-R3 expression and renal ven involvement (p=0,005) TRAIL-R3 is decoy receptor. If TRAIL–R3 is high, connecting all of the TRAIL and there is no or a few TRAIL for the death receptors (TRAIL-R1 and TRAIL-R2). So apoptosis can not start and tumor acts aggressively. Even if TRAIL-R1 and TRAIL-R2 connects a few TRAIL, apoptosis can not realized; in this case we think that there is a problem in the intracellular signal pathways. We determined low TRAIL-R1 expression in the patients with the absence of renal vein involvement. Normally we expect high TRAIL-R1 expression in the tumor cells. The tumor is at the upper pole of the kidney and tumor diameter is bigger we think that tumor is so aggressive and low TRAIL-R1 expression happens without renal vein involvement. We must evaluate the low TRAIL-R1 expression with the absence of renal vein involvement with the another prognostic factors. Between the relationship; TRAIL and its receptors with renal sinus, renal vein and perirenal fat involvement must be investigated in larger series.