The relationship of sox9, e-cadherin and klf4 expressions with clinicopathological parameters in clear cell renal cell carcinomas and its prognostic significance

Introduction: Renal cell carcinoma is the most common malignant tumor of the kidney and is among the most common cancers in the world. Clear cell renal cell carcinoma accounts for 60-80% of renal cell carcinomas. The development of metastases in patients after nephrectomy has led to new prognostic factors and investigation of treatment modalities. In this study, it was aimed to investigate the relationship of immunohistochemical expressions of SOX9, E-cadherin and KLF4 with clinicopathological parameters in clear cell renal cell carcinoma. Material-Methods: In this study, partial and radical nephrectomy materials of 92 patients diagnosed with clear cell renal cell carcinoma in Bolu Abant Izzet Baysal University Faculty of Medicine, Department of Pathology between 2015 and 2022 were retrospectively analyzed. SOX9, E-cadherin and KLF4 immunohistochemical stains were applied to the appropriate paraffin blocks of the cases. Results: There were 92 cases in the study, and the mean age of these cases was 59.5 (±10.6). Of the cases, 69 (75%) were male and 23 (25%) were female. All of the cases were stained positive for SOX9. E-cadherin is positive in 88 cases (95.7%). KLF4 expression was lost in 71 cases (78.2%). A significant correlation was found between SOX9 overexpression and nuclear grade, sarcomatoid and rhabdoid differentiation, and distant metastasis. A significant correlation was found between low E-cadherin expression and nuclear grade, sarcomatoid and rhabdoid differentiation, and distant metastasis. There was a significant correlation between low KLF4 expression and nuclear grade, pathological stage and tumor diameter. Conclusion: SOX9, E-cadherin and KLF4 expressions were found to be associated with poor prognostic parameters in clear cell renal cell carcinoma. It is thought that these immunohistochemical stains can be used as a potential biomarker in clear cell renal cell carcinoma and may guide in determining the prognosis and response to treatment. The obtained data are promising for the development of new treatment modalities targeting cancer stem cells in clear cell renal cell carcinoma.